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Cryptococcal Meningitis Takes Toll on HIV Patients
Clin Infect Dis; 2017 Oct 4; Pasquier, et al
Cryptococcal meningitis has emerged as a significant threat to patients with HIV infection, as well as those who are HIV seronegative, according to a recent review of the medical literature.
- 1-year mortality for Cryptococcal meningitis caused by either Cryptococcus neoformans or C. gattii was 13% among non-HIV C. gattii infected patients in Australia.
- 1-year mortality for the same infection in Malawian HIV-infected patients who had been treated with fluconazole monotherapy was 78%.
- Impairment among infected patients also varied widely: 18% in an Australian cohort, compared to more than 70% in Taiwanese patients from non-HIV and HIV-infected groups.
Pasquier E, Kunda J, De Beaudrap P, et al. Long-term mortality and disability in Cryptococcal Meningitis: a systematic literature review. Clin Infect Dis. 2017;cix870. doi:10.1093/cid/cix870.
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Cerebral Venous Thrombosis & Steroids in Meningitis, Open Forum Infect Dis; 2017 Oct; Gallegos, et al
Early Onset GBS Meningitis Drops, Late Onset Jumps, Clin Infect Dis; 2017 Oct 16; Romain, et al
Better Diagnostic Tests for Histoplasma Meningitis, Clin Infect Dis; 2017 Aug 20; Block, et al
Understanding Meningococcal Disease, Asian Pac J Trop Med; 2017 Nov; Batista, et al
Cryptococcal Meningitis Takes Toll on HIV Patients, Clin Infect Dis; 2017 Oct 4; Pasquier, et al
Cryptococcal meningitis is an important cause of mortality and morbidity, but early diagnosis and management remains a challenge in many parts of the world, in part due to the need for lumbar puncture. Cryptococcal antigen titer in blood has been used as a screening approach for early diagnosis and initiation of preemptive therapy with fluconazole in HIV-infected patients, but optimal therapeutic regimen remains unclear. A major contributing factor to this topic is our incomplete knowledge on the pathogenesis of Cryptococcal meningitis, and elucidation of pathogenesis will help in developing optimal therapy of Cryptococcal meningitis. Continued surveillance of mortality and morbidity is needed in patients with Cryptococcal meningitis.
—Kwang Sik Kim, MD
Director, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
Professor of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD