Cryptococcus - Revision history

Aidan at 15:02, 30 March 2022

2022-03-30T15:02:16Z

← Older revision		Revision as of 15:02, 30 March 2022
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	* Infects CNS, lung, and bloodstream		* Infects CNS, lung, and bloodstream
	* Pulmonary infection more common with [[Cryptococcus gattii]] while CNS infection and fungemia were more common with [[Cryptococcus neoformans]]		* Pulmonary infection more common with [[Cryptococcus gattii]] while CNS infection and fungemia were more common with [[Cryptococcus neoformans]]

			== Investigations ==

			* Cryptococcal antigen (CRAG) from CSF or serum
			* CT chest for pulmonary infection
			** Most commonly shows clustered nodular pattern
			** May also show solitary pulmonary nodule/mass with or without cavitation, scattered nodules, or peribronchovascular consolidation

	== Management ==		== Management ==
	=== Patients with HIV ===		=== Patients with HIV ===
	==== CNS ~~disease~~ ====		==== CNS Disease ====
	* Induction (first 2+ weeks): [[Is treated by::liposomal amphotericin B]] (3-4 mg/kg IV daily) plus [[Is treated by::flucytosine]] (100 mg/kg per day orally in 4 divided doses)		* Induction (first 2+ weeks): [[Is treated by::liposomal amphotericin B]] (3-4 mg/kg IV daily) plus [[Is treated by::flucytosine]] (100 mg/kg per day orally in 4 divided doses)
	** IV formulations may be used in severe cases and in those without oral intake where the preparation is available) for at least 2 weeks		** IV formulations may be used in severe cases and in those without oral intake where the preparation is available) for at least 2 weeks
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	* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution		* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution

	=== Organ ~~transplant~~ ~~patients~~ ===		=== Organ Transplant Patients ===
	* Always consider decreasing immunosuppression if able to		* Always consider decreasing immunosuppression if able to

	==== CNS, ~~severe~~, or ~~disseminated~~ ~~disease~~ ====		==== CNS, Severe, or Disseminated Disease ====
	* Induction (first 2+ weeks): [[Is treated by::liposomal amphotericin B]] (3–4 mg/kg per day IV) plus [[Is treated by::flucytosine]] (100 mg/kg per day in 4 divided doses)		* Induction (first 2+ weeks): [[Is treated by::liposomal amphotericin B]] (3–4 mg/kg per day IV) plus [[Is treated by::flucytosine]] (100 mg/kg per day in 4 divided doses)
	** If not including [[flucytosine]], then extend induction to 4-6 weeks		** If not including [[flucytosine]], then extend induction to 4-6 weeks
	* Consolidation: [[Is treated by::fluconazole]] (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by [[fluconazole]] (200–400 mg per day orally) for 6–12 months (B-II)		* Consolidation: [[Is treated by::fluconazole]] (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by [[fluconazole]] (200–400 mg per day orally) for 6–12 months (B-II)

	==== Mild-to-~~moderate~~ ~~non~~-CNS ~~disease~~ ====		==== Mild-to-Moderate Non-CNS Disease ====
	* Includes mild-to-moderate pulmonary disease		* Includes mild-to-moderate pulmonary disease
	* [[Fluconazole]] (400 mg [6 mg/kg] per day) for 6–12 months		* [[Fluconazole]] (400 mg [6 mg/kg] per day) for 6–12 months

	=== Patients ~~without~~ HIV or ~~organ~~ ~~transplants~~ ===		=== Patients Without HIV or Organ Transplant ===
	* Induction (first 4+ weeks): [[Is treated by::amphotericin B deoxycholate]] (0.7–1.0 mg/kg per day IV) plus [[Is treated by::flucytosine]] (100 mg/kg per day orally in 4 divided doses)		* Induction (first 4+ weeks): [[Is treated by::amphotericin B deoxycholate]] (0.7–1.0 mg/kg per day IV) plus [[Is treated by::flucytosine]] (100 mg/kg per day orally in 4 divided doses)
	** If neurological complications or positive CSF cultures after 2 weeks of treatment, consider extending to 6 weeks total		** If neurological complications or positive CSF cultures after 2 weeks of treatment, consider extending to 6 weeks total
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	* Maintenance: [[Is treated by::fluconazole]] (200 mg [3 mg/kg] per day orally) for 6–12 months		* Maintenance: [[Is treated by::fluconazole]] (200 mg [3 mg/kg] per day orally) for 6–12 months

	=== Pregnant ~~patients~~ ===		=== Pregnant Patients ===
	* See review at [https://doi.org/10.1093/mmy/myz084]		* See review at [https://doi.org/10.1093/mmy/myz084]
	* In short, [[Is treated by::amphotericin B]] monotherapy is recommended, since [[fluconazole]] is teratogenic		* In short, [[Is treated by::amphotericin B]] monotherapy is recommended, since [[fluconazole]] is teratogenic

Aidan at 16:42, 25 January 2022

2022-01-25T16:42:48Z

← Older revision		Revision as of 16:42, 25 January 2022
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	* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010		* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010

	{{DISPLAYTITLE:''Cryptococcus'' ~~species~~}}		{{DISPLAYTITLE:''Cryptococcus''}}
	[[Category:Yeasts]]		[[Category:Yeasts]]

Aidan: Aidan moved page Cryptococcus species to Cryptococcus without leaving a redirect

2022-01-25T16:42:40Z

Aidan moved page Cryptococcus species to Cryptococcus without leaving a redirect

← Older revision		Revision as of 16:42, 25 January 2022
(No difference)

Aidan at 18:27, 15 October 2021

2021-10-15T18:27:25Z

← Older revision		Revision as of 18:27, 15 October 2021
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			== Clinical Manifestations ==

			* Infects CNS, lung, and bloodstream
			* Pulmonary infection more common with [[Cryptococcus gattii]] while CNS infection and fungemia were more common with [[Cryptococcus neoformans]]

	== Management ==		== Management ==
	=== Patients with HIV ===		=== Patients with HIV ===

Aidan: /* Management */ links

2019-11-21T11:25:56Z

Management: links

← Older revision		Revision as of 11:25, 21 November 2019
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	== Management ==		== Management ==

	=== Patients with HIV ===		=== Patients with HIV ===

	==== CNS disease ====		==== CNS disease ====
		⚫	* Induction (first 2+ weeks): [[Is treated by::liposomal amphotericin B]] (3-4 mg/kg IV daily) plus [[Is treated by::flucytosine]] (100 mg/kg per day orally in 4 divided doses)

⚫	* Induction (first 2+ weeks): ~~Liposomal~~ amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
	** IV formulations may be used in severe cases and in those without oral intake where the preparation is available) for at least 2 weeks		** IV formulations may be used in severe cases and in those without oral intake where the preparation is available) for at least 2 weeks
	* Consolidation: fluconazole (400 mg [6 mg/kg] per day orally) for a minimum of 8 weeks		* Consolidation: [[Is treated by::fluconazole]] (400 mg [6 mg/kg] per day orally) for a minimum of 8 weeks
	* Maintenance:		* Maintenance:
	** Fluconazole (200 mg per day orally) or ~~Itraconazole~~ (200 mg twice per day orally; drug-level monitoring strongly advised)		** [[Is treated by::Fluconazole]] (200 mg per day orally) or [[Is treated by::itraconazole]] (200 mg twice per day orally; drug-level monitoring strongly advised)
	** Start HAART 2–10 weeks after starting antifungals		** Start HAART 2–10 weeks after starting antifungals
	** Consider stopping antifungals once CD4 >= 100 for 3 months		** Consider stopping antifungals once CD4 >= 100 for 3 months

	==== Fungemia ====		==== Fungemia ====

	* First, rule out meningitis with an LP		* First, rule out meningitis with an LP
	* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution		* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution

	=== Organ transplant patients ===		=== Organ transplant patients ===

	* Always consider decreasing immunosuppression if able to		* Always consider decreasing immunosuppression if able to

	==== CNS, severe, or disseminated disease ====		==== CNS, severe, or disseminated disease ====
		⚫	* Induction (first 2+ weeks): [[Is treated by::liposomal amphotericin B]] (3–4 mg/kg per day IV) plus [[Is treated by::flucytosine]] (100 mg/kg per day in 4 divided doses)

		⚫	** If not including [[flucytosine]], then extend induction to 4-6 weeks
⚫	* Induction (first 2+ weeks): ~~Liposomal~~ ~~AmB~~ (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)
		⚫	* Consolidation: [[Is treated by::fluconazole]] (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by [[fluconazole]] (200–400 mg per day orally) for 6–12 months (B-II)
⚫	** If not including flucytosine, then extend induction to 4-6 weeks
⚫	* Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)

	==== Mild-to-moderate non-CNS disease ====		==== Mild-to-moderate non-CNS disease ====

	* Includes mild-to-moderate pulmonary disease		* Includes mild-to-moderate pulmonary disease
	* Fluconazole (400 mg [6 mg/kg] per day) for 6–12 months		* [[Fluconazole]] (400 mg [6 mg/kg] per day) for 6–12 months

	=== Patients without HIV or organ transplants ===		=== Patients without HIV or organ transplants ===
		⚫	* Induction (first 4+ weeks): [[Is treated by::amphotericin B deoxycholate]] (0.7–1.0 mg/kg per day IV) plus [[Is treated by::flucytosine]] (100 mg/kg per day orally in 4 divided doses)

⚫	* Induction (first 4+ weeks): ~~AmBd~~ (0.7–1.0 mg/kg per day IV) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
	** If neurological complications or positive CSF cultures after 2 weeks of treatment, consider extending to 6 weeks total		** If neurological complications or positive CSF cultures after 2 weeks of treatment, consider extending to 6 weeks total
	** If not including flucytosine, then extend induction by 2 weeks		** If not including flucytosine, then extend induction by 2 weeks
	** ~~For~~ ~~AmBd~~ ~~toxicity~~ ~~issues~~, ~~LFAmB~~ may be substituted in the second 2 weeks		** If there is [[amphotericin B deoxycholate]] toxicity, [[Is treated by::liposomal amphotericin B]] may be substituted in the second 2 weeks
	* Consolidation: fluconazole (400 mg per day) for 8 weeks		* Consolidation: [[Is treated by::fluconazole]] (400 mg per day) for 8 weeks
	* Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months		* Maintenance: [[Is treated by::fluconazole]] (200 mg [3 mg/kg] per day orally) for 6–12 months

	=== Pregnant patients ===		=== Pregnant patients ===

	* See review at [https://doi.org/10.1093/mmy/myz084]		* See review at [https://doi.org/10.1093/mmy/myz084]
	* In short, amphotericin monotherapy is recommended, since fluconazole is teratogenic		* In short, [[Is treated by::amphotericin B]] monotherapy is recommended, since [[fluconazole]] is teratogenic

	== Further Reading ==		== Further Reading ==

Aidan: /* Further Reading */

2019-08-16T01:29:02Z

Aidan: /* Management */ added pregnancy section

2019-08-16T01:26:14Z

Management: added pregnancy section

← Older revision		Revision as of 01:26, 16 August 2019
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	=== Patients with HIV ===		=== Patients with HIV ===

	=== CNS disease ===		==== CNS disease ====

	* Induction (first 2+ weeks): Liposomal amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)		* Induction (first 2+ weeks): Liposomal amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
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	** Consider stopping antifungals once CD4 >= 100 for 3 months		** Consider stopping antifungals once CD4 >= 100 for 3 months

	=== Fungemia ===		==== Fungemia ====

	* First, rule out meningitis with an LP		* First, rule out meningitis with an LP
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	* Always consider decreasing immunosuppression if able to		* Always consider decreasing immunosuppression if able to

	=== CNS, severe, or disseminated disease ===		==== CNS, severe, or disseminated disease ====

	* Induction (first 2+ weeks): Liposomal AmB (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)		* Induction (first 2+ weeks): Liposomal AmB (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)
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	* Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)		* Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)

	=== Mild-to-moderate non-CNS disease ===		==== Mild-to-moderate non-CNS disease ====

	* Includes mild-to-moderate pulmonary disease		* Includes mild-to-moderate pulmonary disease
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	* Consolidation: fluconazole (400 mg per day) for 8 weeks		* Consolidation: fluconazole (400 mg per day) for 8 weeks
	* Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months		* Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months

			=== Pregnant patients ===

			* See review at [https://doi.org/10.1093/mmy/myz084]
			* In short, amphotericin monotherapy is recommended, since fluconazole is teratogenic

	== Further Reading ==		== Further Reading ==

Aidan at 19:48, 15 August 2019

2019-08-15T19:48:45Z

Aidan at 11:48, 13 August 2019

2019-08-13T11:48:41Z

← Older revision		Revision as of 11:48, 13 August 2019
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			= Management =
	= ''Cryptococcus'' spp. =

	== ~~Management~~ ==		== Patients with HIV ==

	=== ~~Patients~~ ~~with~~ ~~HIV =~~==		== CNS disease ==

	==== CNS disease ====

	* Induction (first 2+ weeks): Liposomal amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)		* Induction (first 2+ weeks): Liposomal amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
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	** Consider stopping antifungals once CD4 >= 100 for 3 months		** Consider stopping antifungals once CD4 >= 100 for 3 months

	==== Fungemia ====		== Fungemia ==

	* First, rule out meningitis with an LP		* First, rule out meningitis with an LP
	* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution		* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution

	=== Organ transplant patients ===		== Organ transplant patients ==

	* Always consider decreasing immunosuppression if able to		* Always consider decreasing immunosuppression if able to

	==== CNS, severe, or disseminated disease ====		== CNS, severe, or disseminated disease ==

	* Induction (first 2+ weeks): Liposomal AmB (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)		* Induction (first 2+ weeks): Liposomal AmB (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)
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	* Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)		* Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)

	==== Mild-to-moderate non-CNS disease ====		== Mild-to-moderate non-CNS disease ==

	* Includes mild-to-moderate pulmonary disease		* Includes mild-to-moderate pulmonary disease
	* Fluconazole (400 mg [6 mg/kg] per day) for 6–12 months		* Fluconazole (400 mg [6 mg/kg] per day) for 6–12 months

	=== Patients without HIV or organ transplants ===		== Patients without HIV or organ transplants ==

	* Induction (first 4+ weeks): AmBd (0.7–1.0 mg/kg per day IV) plus flucytosine (100 mg/kg per day orally in 4 divided doses)		* Induction (first 4+ weeks): AmBd (0.7–1.0 mg/kg per day IV) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
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	* Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months		* Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months

	== Further Reading ==		= Further Reading =

	* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010		* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010

			[[Category:Yeasts]]

Aidan: Aidan moved page Cryptococcus to Cryptococcus species without leaving a redirect

2019-08-13T11:48:16Z

Aidan moved page Cryptococcus to Cryptococcus species without leaving a redirect

← Older revision		Revision as of 11:48, 13 August 2019
(No difference)

← Older revision		Revision as of 01:29, 16 August 2019
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	* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010		* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010

			{{DISPLAYTITLE:''Cryptococcus'' species}}
	[[Category:Yeasts]]		[[Category:Yeasts]]

← Older revision		Revision as of 19:48, 15 August 2019
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	= Management =		== Management ==

	== Patients with HIV ==		=== Patients with HIV ===

	== CNS disease ==		=== CNS disease ===

	* Induction (first 2+ weeks): Liposomal amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)		* Induction (first 2+ weeks): Liposomal amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
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	** Consider stopping antifungals once CD4 >= 100 for 3 months		** Consider stopping antifungals once CD4 >= 100 for 3 months

	== Fungemia ==		=== Fungemia ===

	* First, rule out meningitis with an LP		* First, rule out meningitis with an LP
	* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution		* If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution

	== Organ transplant patients ==		=== Organ transplant patients ===

	* Always consider decreasing immunosuppression if able to		* Always consider decreasing immunosuppression if able to

	== CNS, severe, or disseminated disease ==		=== CNS, severe, or disseminated disease ===

	* Induction (first 2+ weeks): Liposomal AmB (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)		* Induction (first 2+ weeks): Liposomal AmB (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)
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	* Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)		* Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)

	== Mild-to-moderate non-CNS disease ==		=== Mild-to-moderate non-CNS disease ===

	* Includes mild-to-moderate pulmonary disease		* Includes mild-to-moderate pulmonary disease
	* Fluconazole (400 mg [6 mg/kg] per day) for 6–12 months		* Fluconazole (400 mg [6 mg/kg] per day) for 6–12 months

	== Patients without HIV or organ transplants ==		=== Patients without HIV or organ transplants ===

	* Induction (first 4+ weeks): AmBd (0.7–1.0 mg/kg per day IV) plus flucytosine (100 mg/kg per day orally in 4 divided doses)		* Induction (first 4+ weeks): AmBd (0.7–1.0 mg/kg per day IV) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
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	* Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months		* Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months

	= Further Reading =		== Further Reading ==

	* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010		* [https://doi.org/10.1086/649858 IDSA Guidelines] 2010