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Updated guidance and implementable recommendations on the clinical approaches, screening, diagnosis, management, and follow-up care of patients with cryptococcosis.
A review published online in The Lancet Infectious Diseases presented updated guidelines for diagnosing and managing cryptococcosis. Christina C. Chang, PhD, and colleagues updated guidance and implementable recommendations on the clinical approaches, screening, diagnosis, management, and follow-up care of patients with cryptococcosis. The authors note that accurate delineation of cryptococcosis clinical syndrome is important because it guides the choice and duration of antifungal treatment. In high-income settings, the most optimal induction therapy option for cryptococcal meningitis, disseminated cryptococcosis, and severe isolated pulmonary cryptococcosis is liposomal amphotericin B 3 to 4 mg/kg daily and flucytosine 25 mg/kg four times a day. Patients with HIV-associated cryptococcal meningitis in low-income settings are best treated with liposomal amphotericin B 10 mg/kg as a single dose, with 14 days of flucytosine 25 mg/kg four times a day and fluconazole 1,200 mg daily as induction therapy. Physicians should expect clinical relapse and monitor and examine patients thoroughly for causality.
