《美国感染性疾病协会隐球菌治疗指南》内容预览：

Cryptococcus neoformans and Cryptococcus gattii have now

been divided into separate species, although most clinical lab-

oratories will not routinely identify cryptococcus to the species

level [4]. C. gattii has recently been responsible for an ongoing

outbreak of cryptococcosis in apparently immunocompetent

humans and animals on Vancouver Island and surrounding

areas within Canada and the northwest United States, and the

management of C. gattii infection in immunocompetent hosts

needs to be specifically addressed [5]. Similarly, the human

immunodeficiency virus （HIV） pandemic continues, and cryp-

tococcosis is a major opportunistic pathogen worldwide, but

its management strongly depends on the medical resources

available to clinicians in specific regions. In the era of highly

active antiretroviral therapy （HAART）， the management of

cryptococcosis has become a blend of established antifungal

regimens together with aggressive treatment of the underlying

disease.

Although the widespread use of HAART has lowered the

incidence of cryptococcosis in medically developed countries

[6-9], the incidence and mortality of this infection are still

extremely high in areas where uncontrolled HIV disease persists

and limited access to HAART and/or health care occurs [10].

It is estimated that the global burden of HIV-associated cryp-

tococcosis approximates 1 million cases annually worldwide

[11]. In medically developed countries, the modest burden of

patients with cryptococcal disease persists, largely consisting of

patients with newly diagnosed HIV infection; a growing and

heterogeneous group of patients receiving high-dose cortico-

steroids, monoclonal antibodies such as alemtuzumab and in-

fliximab, and/or other immunosuppressive agents [12, 13]; and

otherwise “normal” patients. It is sobering that, despite access

to advanced medical care and the availability of HAART, the

3-month mortality rate during management of acute crypto-

coccal meningoencephalitis approximates 20% [14, 15]. Fur-

thermore, without specific antifungal treatment for cryptococ-

cal meningoencephalitis in certain HIV-infected populations,

mortality rates of 100% have been reported within 2 weeks

after clinical presentation to health care facilities [16]. It is

apparent that insightful management of cryptococcal disease is

critical to a successful outcome for those with disease caused

by this organism.

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