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 Regimen...
...ungal Treatment Recommendations for Nonmeninge...
...unosuppressed patients and immunocompetent patient...
...ressed patientsa and immunocompetent patients...
...ients with Nonmeningeal, Nonpulmonary Cryp...
...ts with cryptococcemiaSame as CNS disease for 12 m...
...nts for whom CNS disease has been ruled ou...
...able 2. Antifungal Treatment Recommen...
...n TherapyaLiposomal AmB (3-4 mg/kg per day)...
...lternatives for Induction Th...
...osomal AmB (6 mg/kg per day) or ABLC...
...7 mg/kg per day)for 4-6 weeks (B, III...
...erapy: Fluconazole (400-800 mg per day) for 8 wee...
...aintenance therapy: Fluconazole (200-400 mg per da...
...ifungal Treatment Recommendations for Cryptococ...
...nduction Ther...
...a,b (0.7-1.0 mg/kg per day) plus flucytosine (10...
...mg/kg per day) for ≥ 6 weeksa,b (B, II)65...
...al AmB (3-4 mg/kg per day) or ABLCd (5 mg/...
...mBde (0.7 mg/kg per day) plus flucytosine (100...
Consolidation therapy: Fluconazole (400-800 mg p...
...nance therapy: Fluconazole (200 mg per da...
...ifungal Treatment Recommendations for Crypto...
...uction Thera...
...(0.7-1.0 mg/kg per day) plus flucytosine (...
...iposomal AmB (3-4 mg/kg per day) or ABL...
...mg/kg per day) or liposomal AmB (3-4 mg/...
...natives for Induction The...
...s fluconazole (B, I)65...
...conazole plus flucytosine (B, II...
...uconazole (B, II)65...
...azole (C, II)659...
...tion therapy: Fluconazole (400 mg per day) for...
Maintenance therapy: Fluconazole (200 mg per day...
...es for Maintenance Therapyc...
...(400 mg per day)d for ≥1 year (C, I)659...
...g per week) for ≥1 yearc (C, I)659...
...highly active antiretroviral therap...
...gure 1. Non-Meningeal Cryptoc...
.... Cryptococcal Meningoencephalitis
Complications
Complicatio...
...of Complications in Patients with...
...ersistenc...
...that adequate measures have been take...
...te induction phase of primary therapy f...
...l dosage of induction therapy was ≤0.7 mg/kg I...
If the patient is polyene intolerant, c...
...tient is flucytosine intolerant, consider AmBd...
...f intrathecal or intraventricular AmBd is...
...ly, persistent and relapse isolates sho...
...ole-exposed patients, increasing th...
...junctive immunological therapy with...
Relap...
...ion phase therapy (see Persistence). (B, II...
...e susceptibility of the relapse isol...
...fter induction therapy and in vitro suscepti...
...ompliance issues and a susceptible isol...
...evated CSF Pressure
Identify CSF pressure at baseline. A pr...
...CSF pressure is ≥25 cm of CSF and t...
...f there is persistent pressure ele...
...ntriculoperitoneal (VP) shunts should be plac...
...r Medications for Intracranial Pressu...
...itol has no proven benefit and is not r...
...lamide and corticosteroids to control increased...
...r corticosteroids if signs of IRIS are prese...
Recurrence of Signs and S...
...of signs and symptoms, reinstitut...
...ts with recurrence, measurement of op...
...erm Elevated Intracranial Pr...
...the CSF pressure remains elevated and if symptom...
...bral Cyptococcoma...
...y with AmBd (0.7-1.0 mg/kg per day I...
...onsolidation and maintenance therapy with f...
...for mass effect and surrounding edema. (B,...
...ry: for large (≥3 cm), accessible...
IRIS
...to alter direct antifungal therapy....
...specific treatment recommendation...
...jor complications, such as CNS inflammation wi...
...eroidal anti-inflammatory drugs and thalido...
...in Special Clinical Situation...
...ant Women with Cryptococcos...
...sseminated and CNS disease, use AmBd or LFAmB,...
...le (pregnancy category C) after delivery; avoid...
...limited and stable pulmonary cryptococcosis,...
...in the postpartum period.659...
...ren with Cryptococcosis...
...n and consolidation therapy for CNS and...
...rapy is fluconazole (6 mg/kg per d...
...uation of maintenance therapy in ch...
...ptococcal pneumonia, use fluconazol...
...coccosis in a Resource-Limited Hea...
...disseminated disease where flucytosine i...
...erapy is fluconazole (200-400 mg per day ora...
...CNS and/or disseminated disease wh...
...CNS and/or disseminated disease when polyene i...