Ketoconazole in the treatment of cryptococcosis of the central nervous system

Trevisol-Bittencourt, P. C.; Sander, J. W. A. S.; Silvado, C. S.; Wittig, E. O.

doi:10.1590/S0004-282X1991000200016

Abstracts

Two patients with cryptococcosis of the CNS were treated with ketoconazole (KTZ), an imidazole derivative with fungistatic properties; they had either failed standard therapy (Amphotericin-B + 5-Flurocytosine) or suffred intolerable side-effects to it. Both patients were administered KTZ 800 mg/day as monotherapy for six months without interruption and both responded. One month after KTZ therapy was withdrawn, however, a relapse of the infection was seen in one case. Side-effects were minimal during the trial of treatment. KTZ could be a useful drug in some cases of neurocryptococcosis.

Dois pacientes com neurocriptococose foram tratados com ketoconazole (KTZ), um derivado imidazólico de propriedades fungostáticas. Ambos foram tratados inicialmente com o esquema terapêutico tradicional (anfotericina-B + 5-flurocitosina) porém em um dos casos para-efeitos intoleráveis obrigaram a suspensão do tratamento e, no outro caso, não houve resposta ao esquema terapêutico. KTZ foi administrado regularmente por via oral em regime de monoterapia na dose de 800mg diárias durante 6 meses com ótimos resultados. Todavia, um mês após a suspensão do tratamento, houve recorrência da infecção em um paciente. Efeitos colaterais foram mínimos durante o curso do tratamento. KTZ pode ser útil no tratamento de alguns casos de neurocriptococose.

CONTENTS CONTEÚDO

P. C. Trevisol-Bittencourt^I; J. W. A. S. Sander^II; C. S. Silvado^III; E. O. Wittig^III

^INeurologist, Universidade Federal de Santa Catarina (UFSC) - Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, (UFPR) Curitiba

^IINeurologist, Institute of Neurology, Queen Square (London WC1N 3BG, UK) - Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, (UFPR) Curitiba

^IIINeurologist, Associate Professor, UFPR - Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, (UFPR) Curitiba

SUMMARY

Two patients with cryptococcosis of the CNS were treated with ketoconazole (KTZ), an imidazole derivative with fungistatic properties; they had either failed standard therapy (Amphotericin-B + 5-Flurocytosine) or suffred intolerable side-effects to it. Both patients were administered KTZ 800 mg/day as monotherapy for six months without interruption and both responded. One month after KTZ therapy was withdrawn, however, a relapse of the infection was seen in one case. Side-effects were minimal during the trial of treatment. KTZ could be a useful drug in some cases of neurocryptococcosis.

RESUMO

Dois pacientes com neurocriptococose foram tratados com ketoconazole (KTZ), um derivado imidazólico de propriedades fungostáticas. Ambos foram tratados inicialmente com o esquema terapêutico tradicional (anfotericina-B + 5-flurocitosina) porém em um dos casos para-efeitos intoleráveis obrigaram a suspensão do tratamento e, no outro caso, não houve resposta ao esquema terapêutico. KTZ foi administrado regularmente por via oral em regime de monoterapia na dose de 800mg diárias durante 6 meses com ótimos resultados. Todavia, um mês após a suspensão do tratamento, houve recorrência da infecção em um paciente. Efeitos colaterais foram mínimos durante o curso do tratamento. KTZ pode ser útil no tratamento de alguns casos de neurocriptococose.

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Dr. P. C. Trevisol-Bittencourt - Hospital Universitário, UFSC - Caixa Postal 173 - 88001 Florianópolis SC - Brasil

1. Craven. PC, Graybill JR, Jorgesen JH, Dismukes WE, Levine BE. High dose ketoconazole for treatment of fungal infections of the central nervous system. Ann Intern Med 1983:160-167.
2. Dismukes WE, Stamm AM, Graybill JR, Craven PC, Stevens DA, Stiller R, Sarosa JA, Medoff G, Gregg KR, Gallis HA, Fields BT, Kerkerian TA, Kaplowitz LG, Cloud G, Shadomy S. Treatment of systemic micoses with ketoconazole: emphasis on toxicity and clinical response in 52 patients, Ann Intern, Med 1983, 98:13-20.
3. Goldberg A. Oral ketoconazole and liver damage. London: HMSO - Comittee on Safety of Medicine, 1985, Adverse Reaction Series 19.
4. Graybill JR, Drutz DJ. Ketoconazole: a major innovation for treatment of fungal disease. Ann Intern Med 1980, 93:921-923.
5. Tija TL, Yeow YK, Tan CB. Cryptococcal meningitis. J Neurol Neurosurg Psychiat 1985, 48:853-858.
6. Trevisol-Bittencourt PC. Neurocriptococose: uma revisão. Arq. Cat Med 1984, 13:261-266.
7. White MC, Kendall-Taylor P. Adrenal hypofunction in patients taking ketoconazole. Lancet 1985, 1:44-45.

Ketoconazole in the treatment of cryptococcosis of the central nervous system

Ketoconazole no tratamento da neurocriptococose

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
June 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Craven. PC, Graybill JR, Jorgesen JH, Dismukes WE, Levine BE. High dose ketoconazole for treatment of fungal infections of the central nervous system. Ann Intern Med 1983:160-167.

[2] 2. Dismukes WE, Stamm AM, Graybill JR, Craven PC, Stevens DA, Stiller R, Sarosa JA, Medoff G, Gregg KR, Gallis HA, Fields BT, Kerkerian TA, Kaplowitz LG, Cloud G, Shadomy S. Treatment of systemic micoses with ketoconazole: emphasis on toxicity and clinical response in 52 patients, Ann Intern, Med 1983, 98:13-20.

[3] 3. Goldberg A. Oral ketoconazole and liver damage. London: HMSO - Comittee on Safety of Medicine, 1985, Adverse Reaction Series 19.

[4] 4. Graybill JR, Drutz DJ. Ketoconazole: a major innovation for treatment of fungal disease. Ann Intern Med 1980, 93:921-923.

[5] 5. Tija TL, Yeow YK, Tan CB. Cryptococcal meningitis. J Neurol Neurosurg Psychiat 1985, 48:853-858.

[6] 6. Trevisol-Bittencourt PC. Neurocriptococose: uma revisão. Arq. Cat Med 1984, 13:261-266.

[7] 7. White MC, Kendall-Taylor P. Adrenal hypofunction in patients taking ketoconazole. Lancet 1985, 1:44-45.