Cryptococcal disease Flashcards
What is the causative agent of cryptococcal disease?
- Cryptococcus neoformans
How is cryptococcal infection acquired?
Via inhalation
Below what CD4 count do most cases of cryptococcal meningitis occur?
CD4 <100
What are the clinical presentations of cryptococcal disease?
- Pneumonia
- Cryptococcal meningitis
- Disseminated disease
What is the clinical presentation of cryptococcal meningitis?
- Subacute or chronic meningitis with headache, fever and altered mental status
- Cranial nerve palsies (CN VI)
- Papilledema
- May be indistinguishable from TB meningitis
What do the WHO guidelines suggest related to commencing ART in a newly diagnosed individual with HIV who has signs of meningitis?
If clinical symptoms suggest meningitis (TB or cryptococcal) at ANY CD4 count
- Delay ART initiation for 4-6 weeks
When should cryptococcal antigen screening occur for people with HIV?
Adults and adolescents
* Recommended for <100 cells/mm3 and considered for <200 cells/mm3
What is the recommended treatment for people with cryptococcal meningitis?
- Amphotericin B and flucytosine for 2 weeks
- Followed by fluconazole for 8 weeks
- Repeated lumbar punctures to reduce ICP
What is the CSF picture for cryptococcal meningitis?
- Raised opening pressure
- Raised protein and white cells with predominant lymphocytosis
When is fluconazole pre-emptive therapy for cryptococcal disease recommended by the WHO for people with HIV?
Fluconazole pre-emptive therapy
* For cryptococcal antigen–positive people without evidence of meningitis
* CD4 <100 cells/mm^3
How is cryptococcal disease diagnosed in low-resource settings
Early detection and treatment is required for those with advanced HIV
* Rapid diagnostic cryptococcal antigen (CrAg) assays (preferably lateral flow assays)
* Use in CSF, serum, plasma or whole blood
