Abstract
Cryptococcal infections burden the immunocompromised population with unacceptably high morbidity and mortality. This population includes HIV-infected individuals and those undergoing organ transplants, as well as seemingly immunocompetent patients (non-HIV, non-transplant). These groups are difficult to manage with the current therapeutic options and strategies, particularly in resource-limited settings. New trials aimed at providing the best treatment strategies for resource-limited countries that will reduce costs and adverse reactions have focused on decreasing the length of therapy and using more readily accessible antifungal agents such as fluconazole. Furthermore, the emergence of antifungal resistance poses another challenge for successful treatment and may require the development of new agents for improved management. This review will discuss the principles of management, current and future antifungal agents, as well as emerging techniques and future directions of care for this deadly infection.
Highlights
Cryptococcus spp. are encapsulated, polysaccharide-coated yeasts with two major species (C. neoformans and C. gattii) known to cause disease in humans
The increasing number of transplant recipients and patients receiving immunosuppressive medications such as corticosteroids, new biological drugs and new anti-neoplastic therapies has created an at-risk population with a high incidence of cryptococcal infection [2]. Antifungal drugs such as polyenes, flucytosine (5-FC), triazoles, and their combinations are the gold standard of care for cryptococcal meningitis [3]
Systemic corticosteroid use is a potentially life-saving intervention to be considered for the management of Immune Reconstitution Inflammatory Syndrome (IRIS) in cryptococcal meningitis, with a dose taper over 2–6 weeks [3]
Summary
Cryptococcus spp. are encapsulated, polysaccharide-coated yeasts with two major species (C. neoformans and C. gattii) known to cause disease in humans. These Cryptococcus spp. can invade the central nervous system (CNS) causing fungal meningoencephalitis. Mortality associated with cryptococcal meningitis is unacceptably high in both developed and developing countries. The increasing number of transplant recipients and patients receiving immunosuppressive medications such as corticosteroids, new biological drugs and new anti-neoplastic therapies has created an at-risk population with a high incidence of cryptococcal infection [2]. Antifungal drugs such as polyenes, flucytosine (5-FC), triazoles, and their combinations are the gold standard of care for cryptococcal meningitis [3]. This review will discuss the important drugs, their strategies for application, and future directions of care for this deadly infection
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