Cryptococcal meningoencephalitis: time for action. Issue 9 (September 2021)

• Record Type: Journal Article
• Authors: Stott, Katharine Elizabeth; Loyse, Angela; Jarvis, Joe N; Alufandika, Melanie; Harrison, Thomas Stephen; Mwandumba, Henry C; Day, Jeremy N; Lalloo, David G; Bicanic, Tihana; Perfect, John R; Hope, William
• Is Part Of: Lancet infectious diseases. Volume 21:Issue 9(2021)
• Page Start: e259
• Page End: e271
• Publication Date: 2021-09
• Subjects: Communicable diseases -- Periodicals; Infection -- Periodicals; Communicable Diseases -- Periodicals; Infection -- Periodicals; Maladies infectieuses -- Périodiques; Infection -- Périodiques; Communicable diseases; Infection; Periodicals; 616.905
• DOI: 10.1016/S1473-3099(20)30771-4
• Languages: English
• ISSNs: 1473-3099

Abstract

Summary: Cryptococcal meningoencephalitis was first described over a century ago. This fungal infection is preventable and treatable yet continues to be associated with excessive morbidity and mortality. The largest burden of disease resides in people living with HIV in low-income and middle-income countries. In this group, mortality with the best antifungal induction regimen (7 days of amphotericin B deoxycholate [1·0 mg/kg per day] and flucytosine [100·0 mg/kg per day]) in a clinical trial setting was 24% at 10 weeks. The world is now at an inflection point in terms of recognition, research, and action to address the burden of morbidity and mortality from cryptococcal meningoencephalitis. However, the scope of interventional programmes needs to increase, with particular attention to implementation science that is specific to individual countries. This Review summarises causes of excessive mortality, interventions with proven survival benefit, and gaps in knowledge and practice that contribute to the ongoing high death toll from cryptococcal meningoencephalitis. Translations: For the Vietnamese and Chichewa translations of the abstract see Supplementary Materials section.