Cryptococcal meningitis: epidemiology and therapeutic options

Derek J. Sloan, Victoria Parris

Research output: Contribution to journalReview articlepeer-review

146 Citations (Scopus)

Abstract

Cryptococcal meningitis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV infection. Patients taking immunosuppressive drugs and some immunocompetent hosts are also at risk. Treatment of cryptococcal meningitis consists of three phases: Induction, consolidation, and maintenance. Effective induction therapy requires potent fungicidal drugs (amphotericin B and flucytosine, which are often unavailable in low-resource, high-endemicity settings. As a consequence, mortality is unacceptably high. Wider access to effective treatment is urgently required to improve outcomes. For human immunodeficiency virus-infected patients, judicious management of asymptomatic cryptococcal antigenemia and appropriately timed introduction of antiretroviral therapy are important.

Original languageEnglish
Pages (from-to)169-182
Number of pages14
JournalJournal of Clinical Epidemiology
Volume6
DOIs
Publication statusPublished - 13 May 2014

Keywords

  • Antifungal therapy
  • Antiretroviral therapy
  • Cryptococcosis
  • HIV
  • Immune reconstitution inflammatory syndrome
  • Immunosuppression

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