Cryptococcal Meningitis: Diagnosis and Management Update.

TitleCryptococcal Meningitis: Diagnosis and Management Update.
Publication TypeJournal Article
Year of Publication2015
AuthorsAbassi, M, Boulware, DR, Rhein, J
JournalCurr Trop Med Rep
Volume2
Issue2
Pagination90-99
Date Published2015 Jun 1
ISSN2196-3045
Abstract

Recent advances in the diagnosis and management of cryptococcal meningitis are promising and have been improving long-term survival. Point of care testing has made diagnosing cryptococcal meningitis rapid, practical, and affordable. Targeted screening and treatment programs for cryptococcal antigenemia are a cost effective method for reducing early mortality on antiretroviral therapy (ART). Optimal initial management with amphotericin and flucytosine improves survival against alternative therapies, although amphotericin is difficult to administer and flucytosine is not available in middle or low income countries, where cryptococcal meningitis is most prevalent. Controlling increased intracranial pressure with serial therapeutic lumbar punctures has a proven survival benefit. Delaying ART initiation for 4 weeks after the diagnosis of cryptococcal meningitis is associated with improved survival. Fortunately, new approaches have been leading the way toward improving care for cryptococcal meningitis patients. New trials utilizing different combinations of antifungal therapy are reviewed, and we summarize the efficacy of different regimens.

DOI10.1007/s40475-015-0046-y
Alternate JournalCurr Trop Med Rep
PubMed ID26279970
PubMed Central IDPMC4535722
Grant ListT32 AI055433 / AI / NIAID NIH HHS / United States
U01 AI089244 / AI / NIAID NIH HHS / United States