Cryptococcosis
Disease caused by Cryptococcus neoformans
Treatment
- Cryptococcal meningitis is the most frequent manifestation of cryptococcosis. Cryptococcal infection can also cause a pneumonitis which may be difficult to distinguish from Pneumocystis pneumonia. Infection may also involve other organs or may be disseminated
- Primary prophylaxis: One large RCT in Africa showed that an enhanced infection prophylaxis in severely immunosuppressed persons (CD4 < 50 cells/ μL) including TMP-SMX 160/800 mg for 12 weeks, isoniazid 300 mg/day for 12 weeks, fluconazole 100 mg/day for 12 weeks, azithromycin 500 mg/day for 5 days and albendazole 400 mg single dose may decrease overall opportunistic infections (including cryptococcal meningitis) and mortality. Due to the different epidemiology of opportunistic infections in Africa and in Europe these results may not be extrapolated to European countries
- Diagnosis: Positive microscopy, OR detection of antigen in serum or CSF OR culture from CSF, blood or urine. Serum cryptococcal antigen should be performed in all newly diagnosed PLWH with CD4 counts < 100 cells/μL. See Pre-emptive therapy below
- Treatment (Cryptococcal meningitis and disseminated cryptococcosis): 14 days induction therapy, then 8 weeks consolidation therapy, then secondary prophylaxis for at least 12 months. Stop, if CD4 count > 100 cells/μL and HIV-VL undetectable over 3 months
Drug / Dose | Comments | |
---|---|---|
Pre-emptive therapy | fluconazole 800 mg qd po for 2 weeks followed by 400 mg qd po for 8 weeks |
In case of:
|
Induction therapy |
liposomal amphotericin B + flucytosine 25 mg/kg qid po |
14 days
|
OR amphotericin B deoxycholate + flucytosine |
||
Consolidation therapy | fluconazole 400 mg qd po (single loading dose of 800 mg on 1st day) |
8 weeks See Drug-drug interactions between ARVs and Non-ARVs |
Secondary Prophylaxis/ Maintenance Therapy
- At least 12 months
- Consider to stop: if CD4 count >100 cells/μL and HIV-VL undetectable over 3 months
Drug / Dose | Comments |
---|---|
fluconazole 200 mg qd po |
See Drug-drug interactions between ARVs and Non-ARVs |