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
...Selecting a Tr...
...Table 1. Antifungal...
...osuppressed patients and immunocompetent patients...
...osuppressed patientsa and immunocompet...
...Patients with Nonmeninge...
...tients with cryptococcemiaSame as CNS disease fo...
...or whom CNS disease has been ruled o...
...uction TherapyaLiposomal AmB (3-4 mg/kg per day)...
...atives for Induction Therapyb
...iposomal AmB (6 mg/kg per day) or ABLC...
...7 mg/kg per day)for 4-6 weeks (B, III)659...
...n therapy: Fluconazole (400-800 mg per day)...
...therapy: Fluconazole (200-400 mg p...
...T...
...uction Therapy...
...(0.7-1.0 mg/kg per day) plus flucyto...
...mg/kg per day) for ≥ 6 weeksa,b (B, II)659...
...posomal AmB (3-4 mg/kg per day) or ABLC...
....7 mg/kg per day) plus flucytosine (...
...therapy: Fluconazole (400-800 mg per day)f fo...
...therapy: Fluconazole (200 mg per d...
...Table 4. Antifun...
...uction Therapy
AmBda (0.7-1.0 mg/kg per day) plus flucytosine...
...(3-4 mg/kg per day) or ABLCa (5 mg/kg pe...
....7-1.0 mg/kg per day) or liposomal AmB (3-4 mg/k...
...natives for Induction Therapyb...
...us fluconazole (B, I)659...
...zole plus flucytosine (B, II)659...
...azole (B, II)659...
...aconazole (C, II)...
...tion therapy: Fluconazole (400 mg per day) f...
...intenance therapy: Fluconazole (200 mg...
...natives for Maintenance Therap...
...le (400 mg per day)d for ≥1 year (C, I)659...
...Bdd (1 mg/kg per week) for ≥1 yearc (C, I)6...
...tive antiretroviral therapy (aHAART)...
...1. Non-Meningeal Cryptococc...
...ryptococcal Meningoencephalitis
Complications
...Complications...
...Managemen...
...Persistence...
...uate measures have been taken to improve immune st...
...duction phase of primary therapy for longer co...
...l dosage of induction therapy was ≤0....
...he patient is polyene intolerant, consider flucona...
...nt is flucytosine intolerant, consider...
...trathecal or intraventricular AmBd is ge...
...persistent and relapse isolates should be che...
In azole-exposed patients, increasing the...
...immunological therapy with recombinant interf...
...Relapse...
...t induction phase therapy (see Persist...
...susceptibility of the relapse isolate...
...uction therapy and in vitro susceptibility tes...
...re compliance issues and a suscept...
...Elevated...
...ify CSF pressure at baseline. A pr...
...CSF pressure is ≥25 cm of CSF and t...
...there is persistent pressure elevation ≥25 cm o...
...iculoperitoneal (VP) shunts should be placed only...
...Other Medications for...
...ol has no proven benefit and is not routi...
...de and corticosteroids to control...
...der corticosteroids if signs of IRI...
...Recur...
...recurrence of signs and symptoms, reinstitute dra...
...nts with recurrence, measurement of opening...
...Long-te...
...essure remains elevated and if symptoms persist f...
...Cerebr...
...duction therapy with AmBd (0.7-1.0 mg/k...
...onsolidation and maintenance therapy with...
...rticosteroids for mass effect and surr...
...arge (≥3 cm), accessible lesions with mass ef...
I...
...alter direct antifungal therapy. (B, III)659...
...definitive specific treatment recommendation for...
...jor complications, such as CNS inflammatio...
...steroidal anti-inflammatory drugs and thalidomide...
...Treatment in Special C...
...Pregn...
...or disseminated and CNS disease, use AmBd or...
...e (pregnancy category C) after delivery; avoid...
...and stable pulmonary cryptococcosis, perf...
...for IRIS in the postpartum period.659...
...Child...
...nd consolidation therapy for CNS and dissemin...
...enance therapy is fluconazole (6 mg/kg per day or...
...scontinuation of maintenance therapy in children r...
...coccal pneumonia, use fluconazole (6-12...
...Cryptococco...
...r disseminated disease where flucytosine is no...
...nce therapy is fluconazole (200-400 mg per day...
...S and/or disseminated disease where polyene i...
...th CNS and/or disseminated disease when...