Diagnostic and therapeutic strategies in cryptococcosis: impact on outcome

Timothée Boyer Chammard (1, 2) , Elvis Temfack (3) , Olivier Lortholary (4, 5, 1, 2) , Alexandre Alanio (2, 6, 1)

1 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals
2 Mycologie moléculaire - Molecular Mycology
3 Douala General Hospital, Internal Medicine Department, Douala, Cameroun
4 UPD5 - Université Paris Descartes - Paris 5
5 Centre d'infectiologie Necker-Pasteur [CHU Necker]
6 Université Paris Diderot, Sorbonne Paris Cité, Paris, France

Cryptococcosis diagnosis has been recently improved by the use of rapid cryptococcal antigen testing with lateral flow assays, which have proved sensitive and specific. Using “test and treat” screening strategies for cryptococcal disease with these tests has been showed effective in reducing cryptococcal meningitis (CM) in HIV-infected patients. Recommended induction, consolidation, and maintenance therapeutic strategy for CM is widely unavailable and/or expensive in low and middle-income settings. New therapeutic strategies, mostly using reduced duration, have recently shown acceptable outcome or are currently tested. Diagnostic and therapeutic guidelines for cryptococcal disease in limited resources countries are undergoing a paradigmatic shift.

Keywords: Cryptococcus neoformans; cryptococcal meningo-encephalitis; cryptococcal antigen; HIV infection; advanced AIDS disease; screening

Domains: Mycology

Timothée Boyer Chammard, Elvis Temfack, Olivier Lortholary, Alexandre Alanio. Diagnostic and therapeutic strategies in cryptococcosis: impact on outcome. Memórias do Instituto Oswaldo Cruz, 2018, 113 (7), pp.e180050. ⟨10.1590/0074-02760180050⟩. ⟨pasteur-01855341⟩