《美國(guó)感染性疾病協(xié)會(huì)隱球菌治療指南》內(nèi)容預(yù)覽:
Cryptococcus neoformans and Cryptococcus gattii have now
been divided into separate species, although most clinical lab-
oratories will not routinely identify cryptococcus to the species
level [4]. C. gattii has recently been responsible for an ongoing
outbreak of cryptococcosis in apparently immunocompetent
humans and animals on Vancouver Island and surrounding
areas within Canada and the northwest United States, and the
management of C. gattii infection in immunocompetent hosts
needs to be specifically addressed [5]. Similarly, the human
immunodeficiency virus (HIV) pandemic continues, and cryp-
tococcosis is a major opportunistic pathogen worldwide, but
its management strongly depends on the medical resources
available to clinicians in specific regions. In the era of highly
active antiretroviral therapy (HAART), the management of
cryptococcosis has become a blend of established antifungal
regimens together with aggressive treatment of the underlying
disease.
Although the widespread use of HAART has lowered the
incidence of cryptococcosis in medically developed countries
[6-9], the incidence and mortality of this infection are still
extremely high in areas where uncontrolled HIV disease persists
and limited access to HAART and/or health care occurs [10].
It is estimated that the global burden of HIV-associated cryp-
tococcosis approximates 1 million cases annually worldwide
[11]. In medically developed countries, the modest burden of
patients with cryptococcal disease persists, largely consisting of
patients with newly diagnosed HIV infection; a growing and
heterogeneous group of patients receiving high-dose cortico-
steroids, monoclonal antibodies such as alemtuzumab and in-
fliximab, and/or other immunosuppressive agents [12, 13]; and
otherwise “normal” patients. It is sobering that, despite access
to advanced medical care and the availability of HAART, the
3-month mortality rate during management of acute crypto-
coccal meningoencephalitis approximates 20% [14, 15]. Fur-
thermore, without specific antifungal treatment for cryptococ-
cal meningoencephalitis in certain HIV-infected populations,
mortality rates of 100% have been reported within 2 weeks
after clinical presentation to health care facilities [16]. It is
apparent that insightful management of cryptococcal disease is
critical to a successful outcome for those with disease caused
by this organism.
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