Cryptococcal Meningitis

  • Ahmed Al Hammadi
  • Luis Ostrosky-ZeichnerEmail author


Cryptococcal meningitis (CM) is the most common cause of adult meningitis in human immunodeficiency virus (HIV) patients with CD4+ cell count <100 cells/μL and is frequently seen in many immunocompromised patients. The respiratory tract is usually the primary site of infection, and the central nervous system is a major site of dissemination due to Cryptococcus neurotropism. Patients with CM present with subacute fever, headache, altered mental status, and even coma. Immune reconstitution inflammatory syndrome (IRIS) in patients with HIV and CM occurs in two forms: paradoxical and unmasking. Identification of risk factors causing IRIS and timely treatment after ruling out residual CM infection are important. Also, increased intracranial pressure plays a major rule in the pathophysiology of CM and needs to be managed promptly to avoid complications. Obtaining lumbar punctures is critical to make the diagnosis and relieve increased intracranial pressure. Cerebrospinal fluid (CSF) should be sent for analysis, fungal cultures, India ink staining, and cryptococcal antigen (CrAg) testing. The use of point-of-care tests for the detection of serum CrAg has a preemptive role in resource-limited settings in ART-naïve, high-risk HIV patients. The use of Amphotericin B formulations in combination with flucytosine is the mainstay of treatment for the induction step of the course, while fluconazole is used in consolidation and maintenance of therapy. Optimizing immunity in immunocompromised patients helps to treat CM. Alternative agents can be used to manage CM or its complications including adalimumab, sertraline, interferon-γ, and new antifungal agents such as Viamet.


Cryptococcus Cryptococcal Meningitis Fungal IRIS Immunocompromised HIV CSF 



Flucytosine, 5-fluorocytosine


Amphotericin B lipid complex


Acquired immune deficiency syndrome


Amphotericin B


Antiretroviral therapy


Cryptococcal meningitis




Central nervous system


Cryptococcal antigen


Cerebrospinal fluid


Computed tomography


Cytochrome P51


Enzyme-linked immunosorbent assay


Granulocyte macrophage colony-stimulating factor


Human immunodeficiency virus


Heat shock protein 90


Infectious Disease Society of America






Immune reconstitution inflammatory syndrome


Latex agglutination


Lateral flow assay


Lipid formulations of AmB


Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry


Minimal inhibitory concentrations


Magnetic resonance imaging


Post-infectious inflammatory response syndrome


Solid organ transplantation


T-helper type 1 response


Tumor necrosis factor-α




White cell count


World Health Organization


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.UT Health-McGovern Medical SchoolHoustonUSA

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