Antifungal therapy and management of complications of cryptococcosis due to Cryptococcus gattii

Chen, Sharon C. -A., Korman, Tony M., Slavin, Monica A., Marriott, Deborah, Byth, Karen, Bak, Narin, Currie, Bart J., Hajkowicz, Krispin, Heath, Christopher H., Kidd, Sarah, McBride, William J. H., Meyer, Wieland, Murray, Ronan, Playford, E. Geoffrey and Sorrell, Tania C. (2013) Antifungal therapy and management of complications of cryptococcosis due to Cryptococcus gattii. Clinical Infectious Diseases, 57 4: 543-551. doi:10.1093/cid/cit341


Author Chen, Sharon C. -A.
Korman, Tony M.
Slavin, Monica A.
Marriott, Deborah
Byth, Karen
Bak, Narin
Currie, Bart J.
Hajkowicz, Krispin
Heath, Christopher H.
Kidd, Sarah
McBride, William J. H.
Meyer, Wieland
Murray, Ronan
Playford, E. Geoffrey
Sorrell, Tania C.
Title Antifungal therapy and management of complications of cryptococcosis due to Cryptococcus gattii
Formatted title
Antifungal therapy and management of complications of cryptococcosis due to Cryptococcus gattii
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2013-08-15
Year available 2013
Sub-type Article (original research)
DOI 10.1093/cid/cit341
Open Access Status Not yet assessed
Volume 57
Issue 4
Start page 543
End page 551
Total pages 9
Place of publication Cary, NC, United States
Publisher Oxford University Press
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
Abstract Background. We describe antifungal therapy and management of complications due to Cryptococcus gattii infection in 86 Australian patients followed for at least 12 months.
Formatted abstract
Background. We describe antifungal therapy and management of complications due to Cryptococcus gattii infection in 86 Australian patients followed for at least 12 months.

Methods. Patient data from culture-confirmed cases (2000–2007) were recorded at diagnosis, 6 weeks, 6 months, and 12 months. Clinical, laboratory, and treatment variables associated with raised intracranial pressure (ICP) and immune reconstitution inflammatory syndrome (IRIS) were determined.

Results
. Seven of 10 patients with lung infection received amphotericin B (AMB) induction therapy (6 with 5-flucytosine [5-FC] for a median of 2 weeks); median duration of therapy including azole eradication therapy was 41 weeks, with a complete/partial clinical response in 78%. For neurologic disease, 88% of patients received AMB, 78% with 5-FC, for a median of 6 weeks. The median total course was 18 months. Nine patients receiving fluconazole induction therapy were reinduced with AMB plus 5-FC for clinical failure. Raised ICP (31 patients) was associated with initial abnormal neurology, and neurologic sequelae and/or death at 12 months (both P = .02); cerebrospinal fluid drains/shunts were placed in 58% of patients and in 64% of 22 patients with hydrocephalus. IRIS developed 2–12 months after starting antifungals in 8 patients, who presented with new/enlarging brain lesions. Risk factors included female sex, brain involvement at presentation, and higher median CD4 counts (all P < .05); corticosteroids reduced cryptococcoma-associated edema.

Conclusions
. Induction AMB plus 5-FC is indicated for C. gattii neurologic cryptococcosis (6 weeks) and when localized to lung (2 weeks). Shunting was often required to control raised ICP. IRIS presents with cerebral manifestations.
Keyword Cryptococcus gattii
Antifungal therapy
Neurologic complications
IRIS
Reconstitution inflammatory syndrome
Neoformans variety gattii
Clinical-manifestations
Meningitis
Infection
HIV
Disease
Australia
Susceptibility
Determinants
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 38 times in Thomson Reuters Web of Science Article | Citations
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