PHS Guidelines: Cryptococcosis

	Cryptococcosis UPHS/IDSA Guidelines
	Prevention of exposure Prevention of disease Prevention of recurrence Discontinuation of secondary phrophylaxis Children Pregnant women Prevention of Exposure 1. HIV-infected persons cannot completely avoid exposure to Cryptococcus neoformans. No evidence exists that exposure to pigeon droppings is associated with an increased risk for acquiring cryptococcosis. Prevention of Disease 2. Routine testing of asymptomatic persons for serum cryptococcal antigen is not recommended because of the low probability that the results will affect clinical decisions (DIII). 3. Prospective controlled trials indicate that fluconazole and itraconazole can reduce the frequency of cryptococcal disease among patients who have advanced HIV disease. However, most experts recommend that antifungal prophylaxis not be used routinely to prevent cryptococcosis because of the relative infrequency of cryptococcal disease, the lack of survival benefits associated with prophylaxis, the possibility of drug interactions, the potential development of antifungal drug resistance, and cost. The need for prophylaxis or suppressive therapy for other fungal infections (e.g., candidiasis, histoplasmosis, or coccidioidomycosis) should be considered in making decisions about prophylaxis for cryptococcosis. If used, fluconazole at doses of 100-200 mg daily is reasonable for patients whose CD4+ T-lymphocyte counts are less than 50 cells/無 (CI) (56-58). Prevention of Recurrence 4. Patients who complete initial therapy for cryptococcosis should be administered lifelong suppressive treatment (i.e., secondary prophylaxis or chronic maintenance therapy). Fluconazole is superior to itraconazole in preventing relapse of cryptococcal disease and is the preferred drug (AI). Discontinuation of Secondary Prophylaxis (Chronic Maintenance Therapy) 5. Although patients receiving secondary prophylaxis (chronic maintenance therapy) might be at low risk for recurrence of systemic mycosis when their CD4+ T-lymphocyte counts increase to greater than 100 cells/無 on HAART, the numbers of patients who have been evaluated are insufficient to warrant a recommendation to discontinue prophylaxis. Special Considerations Children 6. There are no data on which to base specific recommendations for children, but lifelong suppressive therapy with fluconazole after an episode of cryptococcosis is appropriate (AII). Pregnant Women 7. Prophylaxis with fluconazole or itraconazole should not be initiated during pregnancy because of the low incidence of cryptococcal disease, the lack of a recommendation for primary prophylaxis against cryptococcosis in nonpregnant adults, and the potential for adverse effects of these drugs during pregnancy (DIII). For patients who conceive while being administered primary prophylaxis, prophylaxis should be discontinued. However, because of the risk of the disease to maternal health, prophylaxis against recurrent cryptococcal disease with fluconazole during pregnancy is indicated (AIII). PHS index Network index
	The Network format © copyright 2000 The Network

HOME