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British Medical Bulletin 2005 72(1):99-118; doi:10.1093/bmb/ldh043
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Published online 18 April 2005

© The Author 2005. Published by Oxford University Press on behalf of The British Council. All rights reserved. For permissions, please e-mail: journals.permissions@oupjournals.org

Cryptococcal meningitis

Tihana Bicanic and Thomas S. Harrison*

Division of Infectious Diseases, Department of Cellular and Molecular Medicine, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE.

* Correspondence to: Dr Thomas Harrison, Department of Infectious Diseases, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. E-mail: tharriso{at}sghms.ac.uk

Cryptococcal meningitis is a common opportunistic infection in AIDS patients, particularly in Southeast Asia and Africa. Cases also occur in patients with other forms of immunosupression and in apparently immunocompetent individuals. Mortality from HIV-associated cryptococcal meningitis remains high (10–30%), even in developed countries, because of the inadequacy of current antifungal drugs and the complication of raised intracranial pressure. In cohorts of HIV-infected patients from sub-Saharan Africa, cryptococcosis has accounted for 13–44% of all deaths. Optimal current therapy is with amphotericin B 0.7–1 mg/kg/day plus flucytosine 100 mg/kg/day for 2 weeks, followed by fluconazole 400 mg/day for 8 weeks and 200 mg/day thereafter. Saline loading reduces amphotericin B nephrotoxicity. If there is no contraindication on CT head scan, repeat lumbar puncture with drainage of cerebrospinal fluid (CSF) is recommended for patients with very raised CSF opening pressure. Expansion of antiretroviral programmes raises the prospect of transforming the long-term prognosis of these patients, provided that they survive the acute phase of the illness. Studies are needed to define more fungicidal drug regimens and to improve the treatment of raised intracranial pressure.


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J. Bromilow and T. Corcoran
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Br. J. Anaesth., October 1, 2007; 99(4): 528 - 531.
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