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Cryptococcal meningitis

Lillian Tugume1, Kenneth Ssebambulidde2,3, John Kasibante2

  • 1Infectious Diseases Institute, Makerere University, Kampala, Uganda. ltugume@idi.co.ug.

Nature Reviews. Disease Primers
|November 9, 2023
PubMed

Insights

Cryptococcal meningitis, especially in people with HIV, remains a deadly threat. New treatments and diagnostics are improving outcomes, but long-term effects require further study.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Immunology

Background:

  • Cryptococcus neoformans and Cryptococcus gattii cause life-threatening meningoencephalitis, particularly in immunocompromised individuals, notably people living with HIV.
  • Despite a decline in HIV-associated cryptococcal meningitis (HIV-CM), it remains a leading cause of AIDS-related deaths globally, with high mortality rates (~50%) in resource-limited settings.
  • Advanced HIV disease contributes to the persistent burden of cryptococcosis.

Purpose of the Study:

  • To review the immunology, epidemiology, and current management strategies for cryptococcal meningitis, with a focus on HIV-associated cases.
  • To highlight advancements in diagnostics and therapeutics for cryptococcosis.
  • To discuss ongoing research into the long-term morbidity of cryptococcal meningitis survivors.

Main Methods:

  • Review of current literature on cryptococcal meningitis management.
  • Analysis of epidemiological trends in HIV-associated cryptococcosis.
  • Discussion of emerging treatment modalities and diagnostic tools.

Main Results:

  • Cryptococcal antigen screening and pre-emptive azole therapy are established interventions.
  • Enhanced pre-emptive combination treatments are under investigation to improve survival.
  • Short-course (≤7 days) amphotericin-based therapy with flucytosine is the current standard for induction therapy.

Conclusions:

  • While mortality from HIV-CM is decreasing, it remains a significant global health challenge.
  • New diagnostic and therapeutic strategies are expanding the options for managing cryptococcosis.
  • Further research is needed to understand and mitigate long-term neurological and psychological sequelae in survivors of cryptococcal meningitis.

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