Clinical manifestations and management of cryptococcal infection

Cryptococcus neoformans is an important fungal pathogen causing invasive infection, especially of the central nervous system in this era of the HIV/AIDS epidemic. The choice of treatment depends on site(s) of infection and the patient's immune status. Use of appropriate antifungal agents decreases mortality significantly, but requires continued therapy and long-term maintenance to prevent relapses. The use of liposomal amphotericin B (L Amp B) has overcome some of the difficulties usually found in this setting. The major advantage of these liposomal formulations are faster clearance of C. neoformans [cerebrospinal fluid (CSF) negative] and a reduction in amphotericin toxicity. The majority of clinical efficacy data related to L Amp B are derived from compassionate use studies and case series. Use of liposomal amphotericin has also shown to be a cost effective approach.