Persistent Cryptococcus neoformans Infection of the Prostate after Successful Treatment of Meningitis

doi:10.1059/0003-4819-111-2-125

Persistent Cryptococcus neoformans Infection of the Prostate after Successful Treatment of Meningitis

Robert A. Larsen, MD;
Samuel Bozzette, MD;
J. Allen McCutchan, MD;
Joseph Chiu, MD;
Mary Ann Leal, MD;
Douglas D. Richman, MD; and
California Collaborative Treatment Group

Abstract

Study Objective: To assess the frequency of persistent Cryptococcus neoformans infection in patients with the acquired immunodeficiency syndrome (AIDS) after receiving apparently adequate treatment for meningitis.

Design: Blood, urine, and cerebrospinal fluid were cultured at the conclusion of primary therapy to assess the adequacy of treatment.

Setting: Outpatient clinics at three medical centers.

Patients: Patients had C. neoformans grown in culture from cerebrospinal fluid. Primary therapy consisted of either 2.0 g of amphotericin B alone; 6 weeks of combination therapy with flucytosine; or, if flucytosine was poorly tolerated, an adjusted minimum total amphotericin B dose. To meet criteria for adequate treatment of meningitis all patients had two sequential cerebrospinal fluid samples which were culture negative.

Measurements and Main Results: Nine of forty-one patients grew C. neoformans from urine after completion of primary treatment, but none had urinary symptoms. Fungi were visualized in expressed prostatic secretions in 4 of these patients. One patient refused further treatment and developed cryptococcemia within 5 weeks. Three patients received additional amphotericin B; all had persistent funguria without systemic relapse. Six patients received fluconazole; 4 became urine culture negative, and 2 had systemic relapse.

Conclusion: The persistence of urinary C. neoformans after adequate therapy for meningitis suggests that the urinary tract (probably the prostate) is a sequestered reservoir of infection from which systemic relapse may occur.

Article and Author Information

From the Los Angeles County-University of Southern California Medical Center, Los Angeles; the University of California, San Diego; and the University of California, Irvine, California. For current author addresses, see end of text.
Grant Support: Partial support by funds provided by the State of California and allocated on the recommendation of the University-Wide Task Force on AIDS.
Requests for Reprints: Robert A. Larsen, MD, Infectious Diseases, Pediatric Pavilion, Room 2E10, 1129 N. State Street, Los Angeles, California 90033.
Current Author Addresses: Drs. Larsen and Leal: Infectious Diseases, Pediatric Pavilion, Room 2E10, 1129 N. State Street, Los Angeles, CA 90033.

Dr. Bozzette: UCSD Treatment Center, 3821 4th Avenue, San Diego, CA 92103.

Dr. McCutchan: H811F University of California, San Diego Medical Center, 225 Dickenson Street, San Diego, CA 92103.

Dr. Chiu: University of California, Irvine Medical Center, Division of Infectious Diseases, Route 81, 101 City Drive South, Orange, CA 92668.

Dr. Richman: Infectious Disease, 111F, Veterans Administrative Medical Center, San Diego, CA 92161.