Resident Report 2/29 – Creepy Crypto

Teaching Points:

  • Standard HAART Therapy
    • 2NRTIs + either of the following:
      • protease inhibitor
      • NNRTI
      • Integrase inhibitor
      • TeachingTeadfsTeadsfsadfds
  • Etiologies of CNS involvement in a patient with HIV
    • Toxoplasmosis
    • CNS primary lymphoma
    • HSV infection
    • Cryptococcus
    • TB
    • Coccidiomycosis
  • CSF Fluid Analysis
    • Bacterial
      • WBC 800-20k
      • Protein 100-500
      • Glucose <40
    • Viral
      • WBC 5-500
      • Protein 30-150
      • Glucose 30-70
    • Fungal
      • WBC 20-2k
      • Protein 30-150
      • Glucose 30-70
    • TB
      • WBC 5-2000
      • Protein 750
    • Normal
      • WBC 0-5
      • Protein 15-50
      • Glucose 45-100
  • Cryptococcal infection can cause increase in opening pressure due to clogging of the arachnoid villi. This stresses importance of repeat LP until opening pressure goes back to normal.
  • Crypto infections can also cause mass-like and cavitary pulmonary lesions. May disseminate to prostate, bone, GU, and skin, causing a molluscum-like skin rash
  • Treatment
    • Amphoterecin + flucytosine x 2 weeks followed by fluconazole
    • Repeat LP until opening pressure normal.

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