Cryptococcosis Management
Key Points
Key Points
- Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality.
- Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies.
- If the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
Selecting a Treatment Regimen
...ecting a Treatment Regim...
...ble 1. Antifungal Treatment Recommendations...
...patients and immunocompetent patients with mi...
...suppressed patientsa and immunocompete...
...ients with Nonmeningeal, Nonpulmonary Cr...
...yptococcemiaSame as CNS disease for 12 months (...
...ts for whom CNS disease has been ruled out with...
...gal Treatment Recommendations for Cryptococc...
...nduction TherapyaLiposomal AmB (3-4 mg/kg pe...
...ves for Induction Therapyb...
...l AmB (6 mg/kg per day) or ABLC (5...
...(0.7 mg/kg per day)for 4-6 weeks...
...solidation therapy: Fluconazole (400-800 mg p...
...therapy: Fluconazole (200-400 mg per d...
...le 3. Antifungal Treatment Recommendations fo...
Induction Therap...
....7-1.0 mg/kg per day) plus flucytosine (100 mg/kg...
...1.0 mg/kg per day) for ≥ 6 weeksa,b (B,...
...iposomal AmB (3-4 mg/kg per day) or ABL...
...g/kg per day) plus flucytosine (100...
...idation therapy: Fluconazole (400-800 mg per day...
...enance therapy: Fluconazole (200 mg per...
...fungal Treatment Recommendations f...
...duction Therapy...
...0 mg/kg per day) plus flucytosine (100 mg/kg per...
...somal AmB (3-4 mg/kg per day) or ABLCa (5 mg/kg...
...mg/kg per day) or liposomal AmB (3-4 mg/kg per d...
...ernatives for Induction...
...us fluconazole (B, I)659...
...lus flucytosine (B, II)659...
Fluconazole (B, II)...
...nazole (C, II)65...
Consolidation therapy: Fluconazole (400...
...therapy: Fluconazole (200 mg per day)a for ≥1 y...
...ves for Maintenance Therapyc
...0 mg per day)d for ≥1 year (C, I)659...
...mBdd (1 mg/kg per week) for ≥1 yearc (C, I)65...
...ly active antiretroviral therapy (aH...
...Non-Meningeal Cryptococcosis...
...yptococcal Meningoencephalitis...
Complications
...plications...
Management of Complications in Patients...
...ersistence
...heck that adequate measures have been take...
...tute induction phase of primary therapy for...
...ial dosage of induction therapy wa...
...patient is polyene intolerant, consid...
...lucytosine intolerant, consider AmBd (0.7...
...of intrathecal or intraventricular AmBd is general...
...persistent and relapse isolates sho...
...exposed patients, increasing the dose of the...
...nological therapy with recombinant inter...
...elaps...
...induction phase therapy (see Persistence)...
...termine susceptibility of the relaps...
...tion therapy and in vitro susceptibility...
...compliance issues and a susceptible isolate, pri...
...ted CSF Pressure...
...ify CSF pressure at baseline. A prompt baseline lu...
...essure is ≥25 cm of CSF and there a...
...is persistent pressure elevation ≥2...
...ermanent ventriculoperitoneal (VP)...
...tions for Intracranial Pressure...
...has no proven benefit and is not routinely r...
...azolamide and corticosteroids to c...
...corticosteroids if signs of IRIS are present (See...
...currence of Signs and...
...ecurrence of signs and symptoms, rei...
...with recurrence, measurement of opening pre...
...erm Elevated Intracranial Pressure...
...SF pressure remains elevated and if symptoms per...
...ral Cyptococcomas...
...uction therapy with AmBd (0.7-1.0 mg/...
...solidation and maintenance therapy with flucon...
...ticosteroids for mass effect and surround...
...y: for large (≥3 cm), accessible lesions with...
...RIS...
...to alter direct antifungal therapy...
...nitive specific treatment recommenda...
...omplications, such as CNS inflammation with increa...
...anti-inflammatory drugs and thalidomide have been...
...tment in Special Clinical Situatio...
...omen with Cryptococcosis...
...seminated and CNS disease, use AmBd...
...conazole (pregnancy category C) after delivery; a...
...mited and stable pulmonary cryptococcosis,...
...in the postpartum period.659...
...with Cryptococcosis...
Induction and consolidation therap...
...ance therapy is fluconazole (6 mg/kg per day orall...
...on of maintenance therapy in children receiv...
...cal pneumonia, use fluconazole (6-12 mg/kg per...
...tococcosis in a Resource-Limited Health Care Env...
...disseminated disease where flucytosine is...
...nance therapy is fluconazole (200-400 mg per d...
.../or disseminated disease where polyene is not...
...and/or disseminated disease when polye...