Cryptococcal meningitis: epidemiology and therapeutic options

Abstract

Cryptococcal meningitis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV) infection. Patients taking immunosuppressive drugs and some immunocompetent hosts are also at risk. Treatment of cryptococcal meningitis consists of three phases: induction, consolidation, and maintenance. Effective induction therapy requires potent fungicidal drugs (amphotericin B and flucytosine), which are often unavailable in low-resource, high-endemicity settings. As a consequence, mortality is unacceptably high. Wider access to effective treatment is urgently required to improve outcomes. For human immunodeficiency virus-infected patients, judicious management of asymptomatic cryptococcal antigenemia and appropriately timed introduction of antiretroviral therapy are important.

Epidemiology and Clinical Characteristics of Cryptococcal Meningitis in China (1981-2013): A Review of the Literature

“…As for the treatment of HIVassociated cryptococcal meningitis, it consists of three phases: induction, consolidation, and maintenance [21]. Although later relapse is unlikely to occur during successful ART (antiretroviral therapy), lifelong fluconazole is still recommended after the presence of cryptococcal meningitis [22,23].…”

Cryptococcal meningitis initially presenting with eye symptoms in an immunocompetent patient: A case report

“…Such impaired patients include those with a malignancy, connective tissue disorder, HIV infection or those who have undergone organ transplantation (2,14). However, previous studies have shown that a number of patients infected with Cryptococcosis are immunocompetent (6,(15)(16)(17).…”

“…CM caused by the fungus Cryptococcus neoformans remains a leading cause of morbidity and mortality among immunocompromised patients, such as those with a malignancy, connective tissue disorder, immunodeficiency virus (HIV) infection or having undergone organ transplantation (2). However, immunocompetent patients are susceptible to CM and can present in the clinic with signs and symptoms typical of meningitis, such as fever, headache and neck stiffness (3).…”

“…However, immunocompetent patients are susceptible to CM and can present in the clinic with signs and symptoms typical of meningitis, such as fever, headache and neck stiffness (3). Treatment of CM consists of three phases: Induction, consolidation, and maintenance; effective induction therapy requires potent fungicidal drugs (2,4).…”

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“…Apart from primary infections these turned into opportunistic infections resulting into chronic, invasive and life-threatening fungal infections. Cryptococcus meningitis caused by Cryptococcus neofarmans and Cryptococcus gattii disseminates to brain resulting in fatal meningitis in the immune-compromised individuals accounting for upto 1 million cases 21 .…”