Clinical treatment of cryptococcal meningitis: an evidence-based review on the emerging clinical data

J Neurol. 2024 Jun;271(6):2960-2979. doi: 10.1007/s00415-024-12193-8. Epub 2024 Jan 30.

Abstract

Cryptococcal meningitis (CM) is a fatal fungal central nervous system (CNS) infection caused by Cryptococcus infecting the meninges and/or brain parenchyma, with fever, headache, neck stiffness, and visual disturbances as the primary clinical manifestations. Immunocompromised individuals with human immunodeficiency virus (HIV) infection or who have undergone organ transplantation, as well as immunocompetent people can both be susceptible to CM. Without treatment, patients with CM may have a mortality rate of up to 100% after hospital admission. Even after receiving therapy, CM patients may still suffer from problems such as difficulty to cure, poor prognosis, and high mortality. Therefore, timely and effective treatment is essential to improve the mortality and prognosis of CM patients. Currently, the clinical outcomes of CM are frequently unsatisfactory due to limited drug choices, severe adverse reactions, drug resistance, etc. Here, we review the research progress of CM treatment strategies and discuss the suitable options for managing CM, hoping to provide a reference for physicians to select the most appropriate treatment regimens for CM patients.

Keywords: Antifungal agents; Cryptococcal meningitis; Increased intracranial pressure; Treatment.

Publication types

  • Review

MeSH terms

  • Antifungal Agents* / therapeutic use
  • Evidence-Based Medicine
  • Humans
  • Meningitis, Cryptococcal* / drug therapy

Substances

  • Antifungal Agents