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Cryptococcal Meningitis

Clinical Research Fellow, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Viet Nam; Email: jeremyday{at}hcm.vnn.vn

EXTRACT

INTRODUCTION

The HIV pandemic has raised the profile of Cryptococcus neoformans from an obscure yeast to the most important fungal cause of morbidity and death worldwide. Previously described as a rare cause of meningitis in the tropics, or in patients with some form of acquired immunodeficiency such as haematological malignancy or organ transplantation, cryptococcal meningitis is now a significant public health burden in developing countries. 20% of all AIDS deaths are due to cryptococcal meningitis, making it the second most common cause of death in HIV infection after tuberculosis (French et al. 2002). Moreover, despite the availability of highly active antiretroviral therapy (HAART), it continues to pose difficult management questions in the industrialized world. Questions remain for physicians regarding the optimal combination of antifungal agents, duration of treatment, accurate indicators of response to therapy, management of raised intracranial pressure, and the role of adjunctive therapies such as corticosteroids or other ...

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