Key Points
ÎCryptococcosis is a global invasive mycosis associated with significant morbidity and mortality.
ÎCryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies.
ÎIf the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
Selecting a Treatment Regimen
Strength of Recommendation and Evidence Quality Strength A
Definition
B C
Quality I
II III
Good evidence for or against a recommendation Moderate evidence for or against a recommendation Poor evidence to support a recommendation Definition
Evidence from ≥ 1 randomized, controlled trial
Evidence from ≥ 1 clinical trial, without randomization, from cohort or case-controlled analytic studies (preferably from > 1 center), from multiple time-series, or dramatic results from uncontrolled experiments
Opinions of respected authorities, based on experience, descriptive studies, or reports of expert committees
Table 1. Antifungal Treatment Recommendations for Nonmeningeal Cryptococcosis
Patient Group
Immunosuppressed patients and immunocompetent patients with mild-to- moderate cryptococcosis
Immunosuppressed patientsa and immunocompetent patients with severe pulmonary cryptococcosis
Initial Antifungal Regimen
Fluconazole (400 mg per day)
Same as central nervous system (CNS) disease
Same as CNS disease Fluconazole (400 mg per day) Duration 6-12 months Evidence B-III
12 months
Patients with Nonmeningeal, Nonpulmonary Cryptococcosis Patients with cryptococcemia
Patients for whom CNS disease has been ruled out with no fungemia, with a single site of infection, and with no immunosuppressive risk factors
a Directly rule out CNS disease with lumbar puncture.
B-III
12 months 6-12 months
B-III B-III
