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
...ting a Treatment Regimen...
...ble 1. Antifungal Treatment Recomm...
...uppressed patients and immunocompetent patient...
...ssed patientsa and immunocompetent patients w...
...Nonmeningeal, Nonpulmonary Cryptococcosi...
...cryptococcemiaSame as CNS disease for 12 months...
...om CNS disease has been ruled out with n...
Table 2. Antifungal Treatment Recommendations for...
...erapyaLiposomal AmB (3-4 mg/kg per d...
...lternatives for Induction Thera...
...mB (6 mg/kg per day) or ABLC (5 mg/kg per day) fo...
AmBdb (0.7 mg/kg per day)for 4-6...
Consolidation therapy: Fluconazole...
...herapy: Fluconazole (200-400 mg per day...
...3. Antifungal Treatment Recommend...
...tion Therapy...
...,b (0.7-1.0 mg/kg per day) plus flucytosi...
...0.7-1.0 mg/kg per day) for ≥ 6 weeksa,b (B...
...l AmB (3-4 mg/kg per day) or ABLCd (5 mg/kg per d...
...7 mg/kg per day) plus flucytosine (100...
...ation therapy: Fluconazole (400-800...
...rapy: Fluconazole (200 mg per day)b for...
...able 4. Antifungal Treatment Recommendations for...
...tion Therapy...
...g/kg per day) plus flucytosine (100 mg/kg p...
...l AmB (3-4 mg/kg per day) or ABLCa (5 mg/kg...
...1.0 mg/kg per day) or liposomal AmB (3-...
...lternatives for Induction Therapy...
...s fluconazole (B, I)659...
...azole plus flucytosine (B,...
...nazole (B, II)659...
...traconazole (C,...
...onsolidation therapy: Fluconazole (400 mg per...
...enance therapy: Fluconazole (200 mg per day...
...ves for Maintenance Therapyc...
...(400 mg per day)d for ≥1 year (C, I)65...
...mg/kg per week) for ≥1 yearc (C, I)659...
...highly active antiretroviral therapy...
...gure 1. Non-Meningeal Cryptoco...
...ptococcal Meningoencephalitis...
Complications
Complicati...
...of Complications in Patients with Cryp...
...ersistence
Check that adequate measures have been taken t...
...institute induction phase of primary the...
...al dosage of induction therapy was ≤0.7 mg/...
...the patient is polyene intolerant, consider fl...
...ucytosine intolerant, consider AmBd (0.7 mg...
...ntrathecal or intraventricular AmBd is gen...
...ersistent and relapse isolates sho...
...le-exposed patients, increasing the...
...unological therapy with recombinant...
...lapse
...on phase therapy (see Persistence). (B, III)65...
...ermine susceptibility of the relapse...
After induction therapy and in vitr...
...compliance issues and a susceptible isolate...
...d CSF Pressure...
...pressure at baseline. A prompt baseli...
...CSF pressure is ≥25 cm of CSF and there are s...
...rsistent pressure elevation ≥25 c...
...ent ventriculoperitoneal (VP) shunts shoul...
...ions for Intracranial Pressure...
...no proven benefit and is not routi...
...de and corticosteroids to control incr...
...icosteroids if signs of IRIS are pr...
...rence of Signs and Sympto...
...currence of signs and symptoms, reinstitute dr...
...patients with recurrence, measurement of...
...rm Elevated Intracranial Pressure...
...f the CSF pressure remains elevated and if sympt...
...ral Cyptococcomas...
...therapy with AmBd (0.7-1.0 mg/kg per day I...
Consolidation and maintenance therapy...
...ids for mass effect and surrounding...
Surgery: for large (≥3 cm), accessible les...
IRI...
...need to alter direct antifungal therapy. (...
...ve specific treatment recommendation for minor IR...
...ications, such as CNS inflammation with incr...
...oidal anti-inflammatory drugs and...
...tment in Special Clinical Situation...
...Women with Cryptococcosis...
...and CNS disease, use AmBd or LFAmB, with or wi...
...e (pregnancy category C) after delivery; avoid fl...
...ed and stable pulmonary cryptococc...
...IRIS in the postpartum period.659...
...ildren with Cryptococcosi...
...consolidation therapy for CNS and di...
...erapy is fluconazole (6 mg/kg per day orally).659...
...ion of maintenance therapy in children re...
...tococcal pneumonia, use fluconazole (6-12 mg/kg...
...coccosis in a Resource-Limited Health Care Envi...
...disseminated disease where flucytosine i...
...ntenance therapy is fluconazole (200-40...
...ith CNS and/or disseminated disease wh...
...disseminated disease when polyene is n...