Epidemiology and management of cryptococcal meningitis: developments and challenges

Abstract

The significance of cryptococcal infection as a cause of human disease has dramatically evolved in recent years. The objective of this study was to outline the worldwide significance of cryptococcosis and review developments in the management of cryptococcal meningitis. Cryptococcus neoformans var. grubii remains an important cause of disease, particularly in hosts with acquired immunosuppression. Cryptococcus gattii, on the other hand, infects hosts with seemingly normal immune systems and a recent dramatic outbreak in a new ecologic environment highlights the emerging clinical significance of this fungal pathogen. The introduction of new antifungal agents and the adoption of strategies for controlling elevated intracranial pressure in cryptococcal meningitis have added to our therapeutic options. However, the mortality from this infection remains unacceptably high and we are faced with the specific challenges in the management of this disease.

Keywords::

• amphotericin B
• Cryptococcus gattii
• Cryptococcus neoformans
• fluconazole
• fungal infection
• HIV infection
• posaconazole
• voriconazole

Acknowledgments

We are grateful to J Andrew Alspaugh, MD and John R Perfect, MD for their comments on the manuscript. We also thank Miriam Post, MD for photographing the pathology specimens. Financial support was provided by a K08 award AI63084 from NIH and a New Scholar Award in Global Infectious Diseases of the Ellison Medical Foundation, to E Mylonakis.

Conflict of interest

E Mylonakis has served as a consultant for Biogen Idec. and received research support from Astellas Pharma, Inc.