Cryptococcosis Management

Publication Date: February 1, 2010

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

...ing a Treatment Regimen...

...ble 1. Antifungal Treatment Recommendations for...

...uppressed patients and immunocompetent pa...

...ppressed patientsa and immunocompetent...


...with Nonmeningeal, Nonpulmonary Cr...

...h cryptococcemiaSame as CNS disease...

...ents for whom CNS disease has been ruled out...


...ntifungal Treatment Recommendations for...

...duction TherapyaLiposomal AmB (3-4 mg/k...

...s for Induction Therapyb...

...somal AmB (6 mg/kg per day) or ABLC...

...kg per day)for 4-6 weeks (B, III)659...

...tion therapy: Fluconazole (400-800 mg pe...

...aintenance therapy: Fluconazole (200...


.... Antifungal Treatment Recommendat...

...uction Therapy...

...da,b (0.7-1.0 mg/kg per day) plus flucytosine (100...

....0 mg/kg per day) for ≥ 6 weeksa,b (B, II)...

...B (3-4 mg/kg per day) or ABLCd (5...

...(0.7 mg/kg per day) plus flucytosine (100 m...

...on therapy: Fluconazole (400-800 mg per day...

...nance therapy: Fluconazole (200 mg per day)b for...


...4. Antifungal Treatment Recommendations for...

...nduction Therapy...

...Bda (0.7-1.0 mg/kg per day) plus flucytosine (100...

...iposomal AmB (3-4 mg/kg per day) or ABLCa...

...Bd (0.7-1.0 mg/kg per day) or liposomal A...

...lternatives for Induction The...

...plus fluconazole (B, I)659...

...azole plus flucytosine (B,...

...conazole (B, II)659...

...azole (C, II)659...

...therapy: Fluconazole (400 mg per day)...

...ance therapy: Fluconazole (200 mg pe...

...ives for Maintenance Therapyc...

...conazole (400 mg per day)d for ≥...

...d (1 mg/kg per week) for ≥1 yearc (C, I)659...

Begin highly active antiretroviral the...


...e 1. Non-Meningeal Cryptococco...


...2. Cryptococcal Meningoencepha...


Complications

...mplications...

...Complications in Patients with Cryptoc...

...ersistence...

...equate measures have been taken to i...

...einstitute induction phase of primary therap...

...l dosage of induction therapy was ≤0.7 mg/k...

...the patient is polyene intolerant, consider fl...

...ucytosine intolerant, consider AmBd (0.7 mg/k...

...intrathecal or intraventricular AmBd is generally...

...tent and relapse isolates should be checked fo...

...ole-exposed patients, increasing the dose of the a...

...unological therapy with recombinant interferon (...

...lapse

...tion phase therapy (see Persistence). (B,...

...eptibility of the relapse isolate (se...

...ction therapy and in vitro susceptibility tes...

...e compliance issues and a susceptible isolate, p...

...ed CSF Pressure...

...CSF pressure at baseline. A prompt baseline...

...the CSF pressure is ≥25 cm of CSF and there ar...

...persistent pressure elevation ≥25 c...

...triculoperitoneal (VP) shunts should be placed...

...ations for Intracranial Pressure...

Mannitol has no proven benefit and...

...cetazolamide and corticosteroids to contro...

...ider corticosteroids if signs of IRI...

...e of Signs and Symptoms...

...ecurrence of signs and symptoms, r...

...ients with recurrence, measurement of openin...

...Elevated Intracranial Pressure...

...essure remains elevated and if sympt...

...bral Cyptococcomas...

...rapy with AmBd (0.7-1.0 mg/kg per day IV), lipos...

...dation and maintenance therapy with fluconazol...

...roids for mass effect and surrounding ede...

...large (≥3 cm), accessible lesions with...

IRI...

...d to alter direct antifungal therapy. (B, III)...

...tive specific treatment recommendation...

...major complications, such as CNS infl...

...dal anti-inflammatory drugs and thalido...

...eatment in Special Clinical Situa...

...omen with Cryptococcosis

...inated and CNS disease, use AmBd or LFAmB, w...

...le (pregnancy category C) after delivery...

...imited and stable pulmonary cryptococc...

...in the postpartum period.659...

Children with Cryptococ...

...n and consolidation therapy for CNS and disseminat...

...nce therapy is fluconazole (6 mg/kg per day o...

...uation of maintenance therapy in chi...

...occal pneumonia, use fluconazole (6-12...

...ptococcosis in a Resource-Limited Health Care...

...isseminated disease where flucytosine is no...

...nce therapy is fluconazole (200-400 mg per day...

...r disseminated disease where polyene is...

...S and/or disseminated disease when polyene is not...