Treatment

Acute phase 3-6 weeks Maintenance up to CD4>

200
First line • Pirimetamin 200 mg p.o days 1, and The combination of the
continuously same with half dose in acute
Weight < 60 kg : 50 mg/days phase
Weight > 60 kg : 75 mg/days
• Sulfadiazin 4 – 6 gr/days p.o
• Falic acid 10 – 20 mg/days
Second line • Pirimetamin dose same as above Same as above
• Klindamisin 4 x 600 mg/hr p.o atau IV
• As. Folat dosis sda.
Third line Pirimetamin and folic acid with same dose,
with the addition of one drugs below :
• azithromycin 1 x 900 – 1200 mg.
• clarithromycin2 x 500 mg.
• Dapsone1 x 100 mg.
• minocycline2 x 150 – 200 mg.
• Atavaquone 2 x 1500 mg.
Prevention therapy ET advisable given to people
living with HIV with CD4 <100 uL, given
cotrimoxazole 2 tablets /days .cotrimoxazole 2
tablet/days
cryptococcal meningitis
 clinical symptoms
• Clinical symptoms are unclear
• Early symptoms include: fever, headache pain
and malaise.
• Fever may be the only symptom.
• The classic sign of a stiff neck is only 30%
 imaging

• Picture imaging is not typical.

• Overview imaging retrievable form:
hydrocephalus, diffuse edema, hornet of
meninges and choroid plexus.
 Diagnosis
• Identification fungi with india ink test
• Identification of fungi by culture.
• Antigen detection of C. Neoformans with
agglutination reactionutinasi.
 Penatalaksanaan
Acute phase Maintenance: until CD4> 200

First line The induction phase for 2 wk: One of these regimens:
• Amphotericin B 0.7 to 1 mg / kg / day IV, • Fluconazole 200 mg / day of
and P.O
• 5-fluorositosin 100 mg / kg / day, P.O • .Amphotericin B 1 mg / kg /
• Consolidation phase for 8 wk or CSS sterile: day, 1 or 2 x / wk IV
Fluconazole 400 mg / day P.O • .Itraconazole 200 mg 2x /
day P.O
Eond line The induction phase for 2 wk: Same as above
• Amphotericin B 0.7 to 1 mg / kg / day IV.
• Consolidation phase for 10 wk or CSS
sterile: Fluconazole 400 mg / day P.O
Third line Fluconazole 400-800 mg / day and 5- Same as above
fluorositosin P.O 100 mg / kg / day, P.O during
6-10 wk.
MK therapy for primary prophylaxis, up to now
not recommended.
cytomegalovirus encephalitis
 Clinical manifestation
• Onset Subacute-chronic.
• Progressive cognitive impairment
• Motor weakness and sensory deficit.
• Cranial nerve palsies.
• Ataxia.
 Diagnosis
• Clinical manifestations.
• CSS Analysis:
1. Increased mononuclear cells.
2. Increased protein.
3. Marker viruses: PCR-CMV.I
• imaging publishing: their pictures and videos.
Vetrikulitis which is considered as
pathognomonic