title: Cryptococcal meningitis: epidemiology and therapeutic options.
abstract: Cryptococcal meningitis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV) infection. Patients taking immunosuppressive drugs and some immunocompetent hosts are also at risk. Treatment of cryptococcal meningitis consists of three phases: induction, consolidation, and maintenance. Effective induction therapy requires potent fungicidal drugs (amphotericin B and flucytosine), which are often unavailable in low-resource, high-endemicity settings. As a consequence, mortality is unacceptably high. Wider access to effective treatment is urgently required to improve outcomes. For human immunodeficiency virus-infected patients, judicious management of asymptomatic cryptococcal antigenemia and appropriately timed introduction of antiretroviral therapy are important.
authors.affiliation: Tropical and infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Sloan
authors.affiliation: Tropical and infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Parris
keywords: HIV; antifungal therapy; antiretroviral therapy; cryptococcosis; immune reconstitution inflammatory syndrome; immunosuppression