主催: The Japanese Society for Medical Mycology
Cryptococcosis remains a worldwide invasive mycoses in immunocompromised hosts with significant morbidity and mortality. This presentation will focus on the recent IDSA guidelines as they are being adjusted. There will be discussions of management of cryptococcal meningoencephalitis in 3 groups:HIV-infected; transplant recipients; non-HIV, non-transplant hosts. There will be emphasis on management of complications such as increased intracranial pressure, IRIS and cryptococcomas. There will also be specific recommendations for unique populations such as children, pregnancy, and those in resource-limited environments. Recommendations for management will include other sites of infection such as the lungs and differences between C.neoformans and C. gattii infections. Important principles will be identified such as:(1) Induction therapy for meningitis using fungicidal regimens with amphotericin B plus flucytosine followed by consolidation and suppressive regimens using fluconazole. (2) Importance of early recognition and treatment of intracranial pressure and understanding/management of IRIS. (3)Use of lipid amphotericin B regimens in renally impaired patients. It is clear that cryptococcosis remains a challenging management issue with no new drugs or recent definitive studies. However, if diagnosis is made early, institution of guidelines and its principles considered and control of underlying disease available, cryptococcosis can be managed successfully in the vast majority of patients.
