Cited by 2,660Fungal Infections and StudiesAntifungal resistance and susceptibilityInfectious Diseases and Tuberculosis

Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America

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Perfect, John R., Dismukes, William E., Dromer, Francoise, Goldman, David L., Graybill, John R., Hamill, Richard J., Harrison, Thomas S., Larsen, Robert A. +7 more·2010·Clinical Infectious Diseases

Abstract

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.”

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Research works printed but not linked: 3

  1. [34]Hamill R Sobel J El-Sadr W Randomized double-blind trial of ambisome and amphotericin B in acute cryptococcal meningitis in AIDS patients [abstract 1161] Program and abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy San Francisco Washington, DC American Society for Microbiology 1999
  2. [38]Pappas PG Fluconazole plus Amphotericin B vs. Amphotericin B alone for primary treatment of AIDS-associated cryptococcal meningitis: results of a phase II trial [abstract M626] Program and abstracts of the 48th Interscience Conference on Antimicrobial Agents and Chemotherapy Washington, DC American Society for Microbiology 2007
  3. [190]West SK Byrnes E Mustad S Emergence of Cryptococcus gattii in the Pacific Northwest United States [abstract M1849] Program and abstracts of the 48th Interscience Conference Antimicrobial Agents Chemotherapy Washington, DC Washington, DC American Society for Microbiology 2008

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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.
Venue
Clinical Infectious Diseases
Published
2010-02-01
Volume
50
Issue
3
Pages
291-322
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
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
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

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