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
...ng a Treatment Regimen...
...ifungal Treatment Recommendations for Nonme...
...osuppressed patients and immunocompete...
...ppressed patientsa and immunocompetent patie...
...with Nonmeningeal, Nonpulmonary Crypto...
...nts with cryptococcemiaSame as CNS diseas...
...or whom CNS disease has been ruled out with no f...
...2. Antifungal Treatment Recommendations for Crypto...
...TherapyaLiposomal AmB (3-4 mg/kg per day) or Am...
Alternatives for Induction The...
...B (6 mg/kg per day) or ABLC (5 mg/kg per d...
...kg per day)for 4-6 weeks (B, III)659...
...idation therapy: Fluconazole (400-...
...therapy: Fluconazole (200-400 mg per...
...fungal Treatment Recommendations fo...
...duction Therapy
....0 mg/kg per day) plus flucytosine (100 mg/kg...
...c (0.7-1.0 mg/kg per day) for ≥ 6 weeksa,b (B,...
...omal AmB (3-4 mg/kg per day) or ABLCd (5...
...de (0.7 mg/kg per day) plus flucytosine (100...
...on therapy: Fluconazole (400-800 mg per day)f for...
...herapy: Fluconazole (200 mg per day)b...
Table 4. Antifungal Treatment Recommen...
Induction Therapy
...a (0.7-1.0 mg/kg per day) plus flucytosine (10...
...(3-4 mg/kg per day) or ABLCa (5 mg/kg p...
...0.7-1.0 mg/kg per day) or liposomal AmB (3-4 mg...
...ives for Induction Therapyb...
...Bd plus fluconazole (B, I)659...
Fluconazole plus flucytosine (B,...
Fluconazole (B, II)65...
...onazole (C, II)659...
...ation therapy: Fluconazole (400 mg per day)...
...therapy: Fluconazole (200 mg per day...
...lternatives for Maintenance Th...
...raconazole (400 mg per day)d for ≥...
...(1 mg/kg per week) for ≥1 yearc (C, I)6...
...active antiretroviral therapy (aHAART) 2-...
...igure 1. Non-Meningeal Cryptococcosi...
...tococcal Meningoencephalitis...
Complications
...omplicati...
...nt of Complications in Patients with Cryptoco...
...ersistence
...uate measures have been taken to improve immun...
...nstitute induction phase of primary...
...the initial dosage of induction therapy was...
...s polyene intolerant, consider flucona...
...patient is flucytosine intolerant, cons...
...se of intrathecal or intraventricular AmBd...
...y, persistent and relapse isolates...
...-exposed patients, increasing the do...
...munological therapy with recombinant interferon...
...lapse
...induction phase therapy (see Persistence...
...usceptibility of the relapse isolate (see Persi...
...n therapy and in vitro susceptibility testing, co...
...re are compliance issues and a susceptible...
...ted CSF Pressure...
...ssure at baseline. A prompt baseline lumbar punctu...
...essure is ≥25 cm of CSF and there are sympt...
...istent pressure elevation ≥25 cm of CSF and...
...entriculoperitoneal (VP) shunts should be placed o...
...Medications for Intracranial Pressur...
...has no proven benefit and is not routinely r...
...de and corticosteroids to control increa...
Consider corticosteroids if signs of IRI...
...nce of Signs and Symptoms
...rrence of signs and symptoms, rein...
...ients with recurrence, measurement...
...Elevated Intracranial Pressure
...ure remains elevated and if symptoms...
...erebral Cyptococc...
...n therapy with AmBd (0.7-1.0 mg/kg per da...
...onsolidation and maintenance therapy wi...
...eroids for mass effect and surroun...
...ge (≥3 cm), accessible lesions with...
IRI...
...need to alter direct antifungal thera...
...ecific treatment recommendation for minor IRIS man...
...major complications, such as CNS inflammation wit...
...al anti-inflammatory drugs and thalidomide hav...
...atment in Special Clinical Situa...
...nt Women with Cryptococcosis...
...sseminated and CNS disease, use AmBd o...
Start fluconazole (pregnancy category...
...or limited and stable pulmonary cryptoco...
...RIS in the postpartum period.659
...ren with Cryptococcos...
...nd consolidation therapy for CNS and disseminated...
...rapy is fluconazole (6 mg/kg per day or...
...ontinuation of maintenance therapy in childr...
...cryptococcal pneumonia, use fluconazole (6-12 mg/k...
...s in a Resource-Limited Health Care En...
...CNS and/or disseminated disease where flucytosin...
...therapy is fluconazole (200-400 mg pe...
...disseminated disease where polyene is not av...
...and/or disseminated disease when polyene is not...