Cryptococcal meningitis: Diagnosis and treatment

In the last decade, largely due to the increasing number of immunocompromised patients, particularly those with AIDS, there has been a dramatic increase in the incidence of cryptococcosis. The majority of human cryptoccoccal infections are caused by C. neoformans. Pulmonary cryptococcosis is the commonest form of infection and meningitis is the most severe, being fatal in most cases. Diagnosis is usually by culture and/or serology. Combined therapy with amphotericin B and flucytosine remains the initial treatment of choice, although a short course of amphotericin B alone followed by high dose fluconazole or itraconazole and the combination of flucytosine with fluconazole or with itraconazole may be effective alternatives. Both azoles, given as single agent maintenance therapy, have been shown to be beneficial as they are more effective and less toxic than the weekly infusion of amphotericin B. Primary prophylaxis with fluconazole has been advocated but problems of resistance are a concern. To date, itraconazole has not been associated with problems of resistance.