Cryptococcal meningitis in India

Abstract

Cryptococcal meningitis caused by the environmental yeast Cryptococcus neoformans has emerged as a significant pathogen in immunocompromised and immunocompetent patient especially in human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). Recent advances in the diagnosis and management of cryptococcal meningitis are promising and have been improving long-term survival. Point-of-care testing has made diagnosing cryptococcal meningitis rapid, practical, and affordable. Cryptococcus neoformans var. neoformans is predominantly found in Cerebro Spinal Fluid sample. Although the diagnostic testing and the antifungal treatment of cryptococcal infections have become firmly established in clinical practice, new developments and the areas of ambiguity merit further consideration. Early diagnosis followed by the institution of specific therapy, where possible, has effectively reduced mortality. This review aims to present status of cryptococcosis in India. Fortunately, new approaches have been leading the way toward improving care for cryptococcal meningitis patients. New trials using different combinations of antifungal therapy are reviewed, and we summarize the efficacy of different regimens.

Keywords

• acquired immune deficiency syndrome
• antifungal therapy
• cryptococcal meningitis
• high active antiretroviral therapy
• human immunodeficiency virus
• immune reconstitution inflammatory syndrome