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Reframing the clinical phenotype and management of cryptococcal meningitis
Maria Francisca Rocha1, Hamish D C Bain1, Neil Stone2
1National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK.
Abstract:
Cryptococcal meningitis is an important global health problem, resulting from infection with the yeast Cryptococcus, especially Cryptococcus neoformans and Cryptococcus gattii, which cause a spectrum of disease ranging from pulmonary and skin lesions to life-threatening central nervous system involvement. The diagnosis and management of cryptococcal meningitis have substantially changed in recent years. Cryptococcal meningitis often occurs in people living with advanced HIV infection, though in high-income countries with robust HIV detection and treatment programmes, it increasingly occurs in other groups, notably solid-organ transplant recipients, other immunosuppressed patients and even immunocompetent hosts. This review outlines the clinical presentation, management and prognosis of cryptococcal meningitis, including its salient differences in people living with HIV compared with HIV-negative patients. We discuss the importance of managing raised intracranial pressure and highlight the advantages of improved multidisciplinary team working involving neurologists, infectious disease specialists and neurosurgeons.
Insights
Cryptococcal meningitis, a serious global health issue caused by *Cryptococcus* yeast, requires updated diagnosis and management strategies. This review details clinical presentation, treatment, and prognosis, emphasizing differences in HIV-positive versus HIV-negative patients.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Cryptococcal meningitis is a significant global health concern caused by *Cryptococcus* yeast, particularly *Cryptococcus neoformans* and *Cryptococcus gattii*.
- It can lead to severe conditions, including life-threatening central nervous system infections.
- While historically linked to advanced HIV infection, it increasingly affects other immunocompromised individuals and even immunocompetent hosts.
Purpose of the Study:
- To review the current understanding of cryptococcal meningitis diagnosis and management.
- To outline the clinical presentation, management, and prognosis of the disease.
- To highlight differences in cryptococcal meningitis between HIV-positive and HIV-negative patients.
Main Methods:
- Literature review of recent advancements in cryptococcal meningitis diagnosis and management.
- Analysis of clinical presentation, treatment protocols, and patient outcomes.
- Comparison of disease characteristics in immunocompromised (including HIV-positive) and immunocompetent individuals.
Main Results:
- Diagnosis and management strategies for cryptococcal meningitis have evolved significantly.
- The condition affects a broader range of patients beyond those with advanced HIV, including transplant recipients and immunocompetent individuals.
- Effective management of raised intracranial pressure is crucial for improved outcomes.
Conclusions:
- Cryptococcal meningitis requires a multidisciplinary approach involving neurologists, infectious disease specialists, and neurosurgeons.
- Understanding the nuances between HIV-positive and HIV-negative patients is essential for optimal care.
- Recent changes in diagnosis and management offer improved prognosis for patients with cryptococcal meningitis.
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