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Disseminated disease may involve any organ, but central nervous system disease predominates Headache is usually the first symptom of meningitis Confusion and other mental status changes as well as cranial nerve abnormalities, nausea, and vomiting may be seen as the disease progresses Nuchal rigidity and meningeal signs occur about 50% of the time but are uncommon in HIV-infected patients Intracerebral mass lesions (cryptococcomas) are rarely seen Communicating hydrocephalus may complicate the course Primary C neoformans infection of the skin may mimic bacterial cellulitis, especially in immunocompromised persons

Maintenance antifungal therapy is important after treatment of an acute episode in HIV-related cases, since otherwise the rate of relapse is greater than 50% Fluconazole, 200 mg/d, is the maintenance therapy of choice, decreasing the relapse rate approximately tenfold compared with placebo and threefold compared with weekly amphotericin B in patients whose cerebrospinal fluid has been sterilized by the induction therapy After successful therapy of cryptococcal meningitis, it is possible to discontinue secondary prophylaxis with fluconazole in individuals with AIDS who have had a satisfactory response to antiretroviral therapy (eg, CD4 cell count > 100 200 cells/mcL for at least 6 months) Among practitioners treating patients without AIDS, there has been a trend in recent years to prescribe a brief course (eg, 3 months) of fluconazole as maintenance therapy following successful therapy for acute illness; recently published guidelines suggest this as an option

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With Project Builder, you can build all types of Mac OS X applications, including Carbon and Cocoa applications, bundles, frameworks, kernel extensions, Java applications and applets, plug-ins, and tools (don t worry if you do not know what some of these terms mean; they are all covered later in the chapter) Project Builder is in the tradition of an IDE in the sense that all development tools and commands are aggregated under a single program However, it does not include the main development tools (compiler, linker, assembler, version control, etc) as part of the program Instead, it uses UNIX development tools such as gcc, g++, and gdb In a sense, Project Builder is evolutionary: it continues the line of IDE-based development environments for the Macintosh, but breaks with tradition by using external UNIX-based build tools for implementing build and development tasks.

Factors that indicate a poor prognosis include the activity of the predisposing conditions, older age, organ failure, lack of spinal fluid pleocytosis, high initial antigen titer in either serum or cerebrospinal fluid, decreased mental status, increased intracranial pressure, and the presence of disease outside the nervous system

Chayakulkeeree M et al Cryptococcosis Infect Dis Clin North Am 2006 Sep;20(3):507 44 [PMID: 16984867]

namespace Example_8_3_ _ _ _Returning_multiple_values { class Doubler { public void DoubleInt(int firstNum, int secondNum) { firstNum = firstNum * 2; secondNum = secondNum * 2; } } class Tester { public void Run( ) { int first = 5; int second = 10; Console.WriteLine("Before doubling:"); Console.WriteLine("First number: {0}, Second number: {1}", first, second); Doubler d = new Doubler( ); d.DoubleInt(first, second); Console.WriteLine("After doubling:"); Console.WriteLine("First number: {0}, Second number: {1}", first, second); } static void Main(string[] args) { Tester t = new Tester( ); t.Run( ); } } }

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