Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- constitutional symptoms
- dyspnoea
- productive cough
- dullness to percussion
- diminished breath sounds
- crackles
- headache
- alteration of consciousness
- meningeal irritation
- papilloedema
- skin lesions
- coma
Risk factors
- HIV infection
- immunosuppression
- exposure to Cryptococcus species
- male sex
- pregnancy and postnatal period
Diagnostic investigations
1st investigations to order
- serum cryptococcal polysaccharide antigen (CrAg)
- cerebrospinal fluid (CSF) cryptococcal polysaccharide antigen (CrAg)
- pleural fluid cryptococcal polysaccharide antigen (CrAg)
- cultures
- HIV antibodies
- chest x-ray
- lumbar puncture
- cerebrospinal fluid (CSF) microscopy
- cerebrospinal fluid (CSF) white blood cell count (cells/microlitre)
Treatment algorithm
Contributors
Authors
Radha Rajasingham, MD
Associate Professor of Medicine
Infectious Diseases and International Medicine
Department of Medicine
University of Minnesota
Minneapolis
MN
Disclosures
RR receives grants from the US National Institutes of Health (NIH) for prevention of cryptococcal meningitis clinical trials. She is a consultant for the Pan American Health Organization for research in histoplasmosis screening. RR is an author of several references cited in this topic.
Acknowledgements
Dr Radha Rajasingham would like to gratefully acknowledge Dr David Boulware, Dr Renata L. Riha, and Dr Athanasia D. Pataka, previous contributors to this topic.
Disclosures
DRB has received research support from Gilead. RLR and ADP declare that they have no competing interests.
Peer reviewers
William Powderly, MD
Professor of Medicine
Washington University in St Louis
St Louis
MO
Disclosures
WP declares that he is a member of advisory boards for Gilead and Merck and his institution has received research grants from Merck; none of these are related to antifungal therapy. WP is a member of the Board of Directors (Past President) of the Infectious Diseases Society of America. WP is an author of a reference cited in this topic.
Ricardo Negroni, MD
Consultant
Muñiz Hospital
Honorary Professor
University of Buenos Aires
Buenos Aires
Argentina
Disclosures
RN declares that he has no competing interests.
Aimee Zaas, MD, MHS
Assistant Professor of Medicine
Division of Infectious Diseases and International Health
Duke University Medical Center
Durham
NC
Disclosures
AZ has received research funding from Enzon Pharmaceuticals and has been on the speaker's bureau for Astellas Pharma and Pfizer Inc.
Joseph Jarvis, BSc, MBBS, MRCP
Professor
Department of Clinical Research
Faculty of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
London
UK
Disclosures
JJ declares that he has no competing interests.
References
Key articles
Chayakulkeeree M, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2006 Sep;20(3):507-44. Abstract
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: cryptococcosis. Oct 2024 [internet publication].Full text
World Health Organization. Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV. Jun 2022 [internet publication].Full text
Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010 Feb 1;50(3):291-322.Full text Abstract
Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med. 2014 Jun 26;370(26):2487-98.Full text Abstract
Rolfes MA, Hullsiek KH, Rhein J, et al. The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis. Clin Infect Dis. 2014 Dec 1;59(11):1607-14.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available here.
Use of this content is subject to our disclaimer