Cryptococcose

Abstract

The capsulated yeast Cryptococcus neoformans is responsible for cryptococcosis. The main clinical feature is a disseminated meningo-encephalitis that occurs mostly in patients with cellular immune defects, especially those infected by the human immunodeficiency virus (HIV). The severity of the brain involvement determines the prognosis with an approximately 20 % mortality rate despite adequate antifungal treatment and highly active antiretroviral therapy. The diagnosis in based on microscopic examination showing encapsulated yeasts, on the detection of cryptococcal capsular polysaccharide in serum or cerebrospinal fluid, and especially on a positive culture. An extensive workup is mandatory in all cases. The classical regimen for cryptococcal meningitis and several extrameningeal cryptococcosis combines an induction and consolidation phases with amphotericin B + flucytosine, and fluconazole, respectively for a minimum of 8 weeks, followed by a maintenance phase with fluconazole which duration varies upon the immune status of the patient. The control of intracranial hypertension is a major factor influencing the prognosis of cryptococcal meningoencephalitis. The timing of the introduction of antiretroviral drugs should be discussed for patients for whom cryptococcosis reveals the HIV infection.