Cryptococcal meningitis – taking a closer look at treatment

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Burden

Cryptococcal meningitis – a fungal infection of the meninges caused by Cryptococcus neoformans or Cryptococcus gattii – affects hundreds of thousands of individuals across the globe each year. It is the most common cause of adult meningitis in many areas of the world suffering a high HIV burden.

This fungal disease disproportionately affects low- and middle-income countries, with it being most common in sub-Saharan Africa and South-East Asia [1]. Moreover, it is a particular burden in immunocompromised patients, a large proportion of whom are those suffering from HIV/AIDS – it has been estimated that this opportunistic infection is responsible for up to 15–20% of all AIDS-related deaths [1]. Despite an increasing availability of antiretroviral therapy, the incidence of cryptococcal meningitis in high-burden HIV areas such as sub-Saharan Africa has not decreased, possibly owing to issues surrounding regimen adherence and patient retention [2].

Outside of this group, the risk of cryptococcal infection is increased in other immunocompromised groups; for example, those taking immunosuppressive drugs, such as transplant recipients – a population that is reported to be increasing in number [3]. Finally, mortality rates among cryptoccoccal meningitis patients are high – ranging from 20–60% with treatment and rising to 100% if left untreated [1] – making prompt and effective treatment a necessity.

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