Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome

Kenneth Ssebambulidde; Seher H Anjum; Jessica C Hargarten; Prashant Chittiboina; Shmuel Shoham; Seyedmojtaba Seyedmousavi; Kieren A Marr; Dima A Hammoud; Bridgette Jeanne Billioux; Peter R Williamson

doi:10.3389/fneur.2022.994396

Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome

Front Neurol. 2022 Dec 1:13:994396. doi: 10.3389/fneur.2022.994396. eCollection 2022.

Affiliations

¹ Translational Mycology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States.
² Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.
³ Johns Hopkins School of Medicine, Baltimore, MD, United States.
⁴ Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
⁵ Center for Infectious Disease Imaging (CIDI), Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
⁶ Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.

Abstract

Cryptococcal meningoencephalitis (CM) continues to cause major morbidity and mortality in a range of patients such as those immunosuppressed from HIV and with biologic immunosuppressants, including treatments of autoimmunity, malignancies, and conditioning regimens for transplantation. It is currently the most common cause of non-viral meningitis in the United States. Infections in previously healthy patients also develop with autoantibodies to granulocyte-macrophage colony stimulating factor or with monogenetic defects. In all populations, mortality and significant long-term morbidity occur in 30-50% despite therapy, and immune reconstitution and post-infectious inflammatory response syndromes complicate management. To help with these difficult cases, we present here a practical tutorial of the care of a range of patients with CM in the absence of HIV/AIDS.

Keywords: Cryptococcus; cryptococcal; fungus; infectious diseases; neuroinflammation.

Publication types

Review