Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America
Open accessAbstract
Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)–infected individuals, (2) organ transplant recipients, and (3) non–HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if 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.
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Interactions between Cryptococcus spp. and host immune responses dictate disease progression.
“It has become increasingly evident that interactions between Cryptococcus spp. and host immune responses dictate disease progression4, demanding a greater understanding of pathogen–host immune interactions.”
From Treatment strategies for cryptococcal infection: challenges, advances and future outlook (2021) · cites this paper as [4]
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- Authors
- Perfect, J. R., Dismukes, W. E., Dromer, F., Goldman, D. L., Graybill, J. R., Hamill, R. J., Harrison, T. S., Larsen, R. A., Lortholary, O., Nguyen, M.-H., Pappas, P. G., Powderly, W. G., Singh, N., Sobel, J. D., & Sorrell, T. C.
- Affiliations
- Duke Medical Center (US)
- University of Alabama at Birmingham (US)
- Institut Pasteur, Centre National de Référence Mycologie et Antifongiques, Unité de Mycologie Moleculaire, Paris, France
- Albert Einstein College of Medicine (US)
- Audie L. Murphy Memorial VA Hospital (US)
- United States Department of Veterans Affairs (US)
- St George's, University of London (GB)
- University of Southern California (US)
- Hôpital Necker-Enfants Malades (FR)
- University of Pittsburgh (US)
- University College Dublin (IE)
- Wayne State University (US)
- The University of Sydney (AU)
- Corresponding author
- Perfect, John R.
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-02-01
- Volume
- 50
- Issue
- 3
- Pages
- 291-322
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC5826644
- OpenAlex
- W2144543496
- Cited by
- 2,660
- References
- 198
- Citations by year
- 2026: 108 · 2025: 115 · 2024: 153 · 2023: 179 · 2022: 203 · 2021: 181 · 2020: 209 · 2019: 191 · 2018: 173 · 2017: 179 · 2016: 185 · 2015: 155 · 2014: 169 · 2013: 141 · 2012: 131
- FWCI
- 105.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
- Funders
- Pfizer
- Gilead Sciences
- Astellas Pharma
- National Institute of Allergy and Infectious Diseases (AI 73896, R01AI073896)
- Topics
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- cryptococcosis, cryptococcal meningoencephalitis, Cryptococcus gattii, pulmonary cryptococcosis, HIV infection, organ transplant recipients, intracranial hypertension, immune reconstitution inflammatory syndrome, cryptococcoma, amphotericin B lipid formulations, 5-fluorocytosine, antifungal resistance, resource-limited settings, pregnancy
- MeSH terms
- Antifungal Agents, Child, Child, Preschool, Cryptococcosis, Female, Humans, Pregnancy, United States, Case Management, Intracranial Hypertension
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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