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
...g a Treatment Regimen...
...ngal Treatment Recommendations for Nonmen...
...d patients and immunocompetent patients...
...essed patientsa and immunocompetent patients...
...tients with Nonmeningeal, Nonpulmonary Cryptoco...
...tients with cryptococcemiaSame as CNS disease...
Patients for whom CNS disease has been ru...
...Antifungal Treatment Recommendations for Cryptoco...
...apyaLiposomal AmB (3-4 mg/kg per day)...
Alternatives for Induction...
...al AmB (6 mg/kg per day) or ABLC (5 mg/kg p...
AmBdb (0.7 mg/kg per day)for 4-6 weeks...
...ation therapy: Fluconazole (400-800 mg per day...
...therapy: Fluconazole (200-400 mg per day) for 6-12...
...e 3. Antifungal Treatment Recommenda...
...ction Therapy...
...1.0 mg/kg per day) plus flucytosine (100 m...
...mg/kg per day) for ≥ 6 weeksa,b (B, II)659...
...B (3-4 mg/kg per day) or ABLCd (5 mg/kg pe...
...g/kg per day) plus flucytosine (100 mg/kg pe...
...idation therapy: Fluconazole (400-800 mg per day)f...
...nance therapy: Fluconazole (200 mg...
...ngal Treatment Recommendations for Crypt...
...nduction Therapy...
...0.7-1.0 mg/kg per day) plus flucytosi...
...-4 mg/kg per day) or ABLCa (5 mg/kg per day,...
...0 mg/kg per day) or liposomal AmB (3...
...tives for Induction Therapyb
...plus fluconazole (B, I)...
...azole plus flucytosine (B, II)659...
...onazole (B, II)659...
...traconazole (C, II)659
...on therapy: Fluconazole (400 mg per...
...apy: Fluconazole (200 mg per day)a for...
...lternatives for Maintenance Thera...
Itraconazole (400 mg per day)d for ≥1 ye...
...mg/kg per week) for ≥1 yearc (C,...
...y active antiretroviral therapy (aHA...
.... Non-Meningeal Cryptococco...
...Cryptococcal Meningoencephalitis...
Complications
...lications...
...ent of Complications in Patients wit...
...sistence
...ck that adequate measures have been taken to imp...
...e induction phase of primary therapy for longer c...
...ial dosage of induction therapy was ≤0.7 mg/kg I...
...ent is polyene intolerant, consider...
...tient is flucytosine intolerant, consider A...
...intrathecal or intraventricular AmBd is gener...
...ally, persistent and relapse isola...
...le-exposed patients, increasing the dose of the...
...ological therapy with recombinant int...
...elapse
...induction phase therapy (see Persistence)....
Determine susceptibility of the relapse isolat...
...induction therapy and in vitro susce...
...compliance issues and a susceptible isolate...
...ated CSF Pressur...
...CSF pressure at baseline. A prompt basel...
...F pressure is ≥25 cm of CSF and the...
...is persistent pressure elevation ≥25 cm...
...ventriculoperitoneal (VP) shunts sho...
...ther Medications for Intracranial Pre...
...s no proven benefit and is not routinely r...
...zolamide and corticosteroids to control increas...
...nsider corticosteroids if signs of IRIS are pres...
...ce of Signs and Symptoms...
...of signs and symptoms, reinstitute drainage pr...
...ts with recurrence, measurement of opening pr...
...ong-term Elevated Intracranial Pr...
...F pressure remains elevated and if symptoms per...
...rebral Cyptococcomas...
...py with AmBd (0.7-1.0 mg/kg per day IV...
...onsolidation and maintenance therap...
...steroids for mass effect and surro...
...r large (≥3 cm), accessible lesions with...
...RIS...
...need to alter direct antifungal therapy....
...itive specific treatment recommendati...
...or complications, such as CNS inflammation w...
...oidal anti-inflammatory drugs and thalidomide h...
...Special Clinical Situation...
...egnant Women with Cryptococcosis...
...sseminated and CNS disease, use Am...
...onazole (pregnancy category C) after d...
...d stable pulmonary cryptococcosis, perform cl...
...RIS in the postpartum period.659
...dren with Cryptococcosis...
...on and consolidation therapy for CNS and dissemi...
...therapy is fluconazole (6 mg/kg per day orall...
...continuation of maintenance therapy in...
...r cryptococcal pneumonia, use fluconazole (6-12...
...coccosis in a Resource-Limited Healt...
...or disseminated disease where flucytosine is not...
...rapy is fluconazole (200-400 mg per day orally...
With CNS and/or disseminated disease where...
...or disseminated disease when polyene...