Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America

Abstract

Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)–infected individuals, (2) organ transplant recipients, and (3) non–HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary crypto-coccosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and crypto-coccomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, 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.

Sudden cerebral depression detected by bispectral index monitoring in cryptococcal meningitis with elevated near‐fatal cerebrospinal fluid pressure

“…An increase in CSFP is associated with high mortality, so aggressive management for controlling CSFP is strongly recommended in the treatment guidelines of 2010 issued by the Infectious Diseases Society of America 1. In the current case, initial CSFP was very high, so that frequent lumbar punctures were required, and the signs of CSFP elevation developed suddenly.…”

“…In the current case, initial CSFP was very high, so that frequent lumbar punctures were required, and the signs of CSFP elevation developed suddenly. According to the guidelines,1 CSFP elevation should be managed with ventricular or continuous spinal drainage. Some reports have shown the efficacy and safety of continuous spinal drainage for severely raised CSFP3, 4 and this technique could be induced at the bedside, so we selected continuous drainage instead of ventricular.…”

“…Cerebrospinal fluid pressure (CSFP) elevation is common in cases of cryptococcal meningitis and is associated with high mortality 1. We describe a case of cryptococcal meningitis with CSFP of >50 cmH 2 O, who showed sudden depressions in cerebral function.…”

Perspectives on non-neoformanscryptococcal opportunistic infections

“…The exception to this would be areas with high prevalence of cryptococcal infections, increased antiretroviral drug resistance, and lack of access to antiretroviral therapy. In such scenarios, medication prophylaxis against Cryptococcus may be appropriate and should be considered on an individual basis [11]. …”

Infections After Orthotopic Liver Transplantation

“…Once diagnosed, cryptococcal meningitis is treated with a combination of liposomal amphotericin B or amphotericin B lipid complex and flucytosine (5-FC) for atleast 2 weeks for the induction regimen, followed by fluconazole for 8 weeks for consolidation therapy, and fluconazole for 6-12 months for maintenance treatment. 73 …”