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Cryptococcal meningitis: epidemiology and therapeutic options

Authors Sloan D, Parris V

Received 15 December 2013

Accepted for publication 7 February 2014

Published 13 May 2014 Volume 2014:6 Pages 169—182

DOI https://doi.org/10.2147/CLEP.S38850

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5


Derek J Sloan, Victoria Parris

Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK

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.

Keywords: cryptococcosis, HIV, immunosuppression, antifungal therapy, immune reconstitution inflammatory syndrome, antiretroviral therapy


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