POSTERPRESENTATI ON Open AccessDifficulties in the management of the meningitiswith C. neoformansElisabeta Otilia Benea1,2*,Doina Niculescu-Lupu1,erban Benea1,2,Daniela Camburu1,Manuela Podani1,Mihaela Ionica1,Cozmina Andrei1From The 7th Romanian National HIV/AIDS Congress and The 2nd Central European HIV ForumSibiu,Romania.29-31 May 2014ThemanagementofthemeningitiswithC. neoformansraisesmanyproblems: thechoosingoftheappropriateantifungaltherapy, the preventionand/orthecontrolofthecomplications, thecorrectmanagementoftheanti-retroviral therapy.WereporttwocaseswithHIVinfectionsameimmu-nologicalandclinicalstage, thefirstofthemwithrela-tively recent infection, the second with long-terminfection (>20years)and antiretroviraltherapy - experi-enced, butdiscontinuedfor4years, whodevelopedthesame opportunistic infection: cryptococcal meningitis.Althoughimmunological statuswassimilarinbothpatients, cerebrospinalfluidinflammatoryresponsewasstrongerinpatientinfectedlatest; bothhadincreasedcerebrospinalfluidpressure, requiringrepeatedlumbarpunctures.The antifungal treatment algorithmwas appliedaccordingtoguidelines, toavailabilityofmedicationsatthat time and antifungal susceptibility testing results.Although the combination of fluconazole plus flucyto-sine is knowed as being clinically inferior to amphotericinBbased therapy, faster rate of cerebrospinal fluid steriliza-tion was seen in patient with greater cerebrospinal fluidinflammatory response rather than in patient receivingantifungal therapy considered as gold standard.Toavoidingtheimmunereconstitutionsyndrome,antiretroviraltherapy was initiatedin both cases aftermore than 4 weeks of therapy of opportunistic infection(after 2 weeks of sterilizing cerebrospinal fluid cultures);however, the patient with long-term HIV infection devel-oped immune reconstitution syndrome after 21 days ofinitiating therapy.Choosingantiretroviraltherapywasachievedinbothcases according to guidelines, depending on the patientsmedical history(includingpreviousregimenstherapy)and drug interactions.Our cases illustrate that the same disease can have dif-ferent solutions because the patient makes the difference.Authors details1National Institute for Infectious DiseasesProf.Dr.Matei Bal,Bucharest,Romania.2Carol Davila University of Medicine and Pharmacy,Bucharest,Romania.Published:29 May 2014doi:10.1186/1471-2334-14-S4-P36Cite this article as: Benea et al.:Difficulties in the management of themeningitis with C. neoformans. BMC Infectious Diseases 2014 14(Suppl 4):P36.Submit your next manuscript to BioMed Centraland take full advantage of: Convenient online submission Thorough peer review No space constraints or color gure charges Immediate publication on acceptance Inclusion in PubMed, CAS, Scopus and Google Scholar Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submit1National Institute for Infectious DiseasesProf.Dr.Matei Bal,Bucharest,RomaniaFull list of author information is available at the end of the articleBenea et al. BMC Infectious Diseases 2014, 14(Suppl 4):P36http://www.biomedcentral.com/1471-2334/14/S4/P36 2014 Benea et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttributionLicense (http://creativecommons.org/licenses/by/4.0), whichpermitsunrestricted use,distribution, andreproductioninanymedium,provided theoriginal work is properly cited.TheCreative Commons Public DomainDedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies tothe data made available inthis article,unless otherwisestated.