Cryptococcal meningoencephalitis: time for action

Area of Science:

• Infectious Diseases
• Mycology
• Public Health

Background:

• Cryptococcal meningoencephalitis is a significant cause of mortality and morbidity globally.
• The highest burden of this fungal infection is observed in individuals living with HIV in low- and middle-income countries.
• Despite being preventable and treatable, high death rates persist.

Purpose of the Study:

• To review the causes of excessive mortality associated with cryptococcal meningoencephalitis.
• To summarize interventions demonstrating a survival benefit.
• To identify knowledge and practice gaps contributing to the ongoing high death toll.

Main Methods:

• This review synthesizes existing literature and clinical trial data on cryptococcal meningoencephalitis.
• It focuses on mortality causes, effective interventions, and implementation science challenges.
• Analysis includes data from clinical trials of antifungal induction regimens.

Main Results:

• Even with optimal antifungal induction (amphotericin B deoxycholate and flucytosine), 10-week mortality in a clinical trial setting was 24% for people with HIV.
• Significant gaps in knowledge and practice contribute to the persistent high mortality.
• The review highlights the need for increased scope of interventional programs.

Conclusions:

• Cryptococcal meningoencephalitis remains a critical global health challenge, particularly for immunocompromised populations.
• There is an urgent need for expanded interventional programs and country-specific implementation science.
• Addressing knowledge gaps and improving practices are essential to reduce the excessive mortality from this fungal infection.