Update on the epidemiology and management of cryptococcal meningitis

Figures & data

Figure 1. Burden of cryptococcal meningitis in North America compared to Sub-Saharan Africa [1]

Figure 2. Cryptococcus species classification

Table 1. IDSA management guidelines [21].

	Induction therapy	Consolidation therapy	Maintenance therapy
HIV infection	Amphotericin B deoxycholate 0.7 – 1 mg/kg/day i.v + flucytosine 100 mg/kg/day p.o., for 2 weeks or Amphotericin B lipid complex, 5 mg/kg i.v. daily + flucytosine 100 mg/kg p.o. daily, for 2 weeks	Fluconazole 400 mg/day p.o., for 8 weeks	Fluconazole 200 mg/day p.o.
Organ transplantation	Liposomal amphotericin B 3 – 4 mg/kg/day i.v., for 2 weeks orAmphotericin B lipid complex 5 mg/kg/day i.v. + flucytosine 100 mg/kg/day p.o., for 2 weeks	Fluconazole 400 – 800 mg/day p.o. for 8 weeks	Fluconazole 200 – 400 mg/day p.o, for 6 – 12 months
Non-HIV/nontransplant	Amphotericin B deoxycholate 0.7 – 1 mg/kg/day i.v. + flucytosine 100 mg/kg/day p.o., for 4 weeks	Fluconazole 400 – 800 mg/day p.o, for 8 weeks	Fluconazole 200 mg/day p.o., for 6 – 12 months

HIV: Human immunodeficiency virus; IDSA: Infectious diseases Society of America; i.v.: Intravenously; p.o.: Per os.

Table 2. Commonly used antifungal compounds and examples of important adverse effects.

Antifungal compound	Type of therapy	Adverse effects
Amphotericin B deoxycholate	Induction	Fever, chills, nausea, nephrotoxicity, headache, anemia, diarrhea, vomiting, anorexia, hypertension, hypotension, flushing, delirium, ventricular fibrillation and cardiac arrest
Lipid formulations of amphotericin B:  Liposomal amphotericin B  Amphotericin B lipid complex  Amphotericin B colloidal dispersion	Induction	Similar to amphotericin B deoxycholate but less severe and frequent; safer to use in patients with impaired renal function
Flucytosine	Induction	Nausea, vomiting, diarrhea, headache, confusion, sedation, vertigo, skin rashes, bone marrow toxicity (leucopenia, thrombocytopenia)
Fluconazole	Induction (in underserved areas), consolidation, maintenance	Headache, dizziness, nausea, vomiting, abdominal pain, leucopenia, thrombocytopenia, alopecia, hypokalemia, hyperlipidemia and elevated liver enzymes

Park BJ, Wannemuehler KA, Marston BJ, Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 2009;23:525-30

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