, Volume 114, Issue 3, pp 153–157 | Cite as

Overview: Cryptococcosis in the patient with AIDS

  • Alan M. Sugar


Cryptococcosis is currently the most common life threatening mycoses found in patients with the acquired immunodeficiency syndrome (AIDS). Extrapulmonary involvement is most frequently seen, especially in the central nervous system and skin. Clinical findings are non-specific, even in patients with meningitis. Threshold for diagnosis of this infection should be low, with serum cryptococcal antigens, blood, urine and sputum cultures for Cryptococcus neoformans performed in febrile AIDS patients. Lumbar puncture should also be performed if unexplained headaches are included in a patient's complaints. There is currently no consensus for the most appropriate treatment strategy and the role of oral azoles versus amphotericin B or amphotericin B with flucytosine remains a serious question in need of further controlled studies. Patients eligible for multicentered trials should be encouraged to participate. Therapy for others should be individualized. This review will address some of these issues.


Meningitis Mycosis Amphotericin Multicentered Trial Azole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Zuger A, Louie E, Holzman RS, Simberkoff MS, Rahal JJ. Cryptococcal disease in patients with the aquired immunodeficiency syndrome. Ann Intern Med 1986; 104: 234–40.Google Scholar
  2. 2.
    Kovacs JA, Kovacs AA, Polis M, et al. Cryptococcosis in the aquired immunodeficiency syndrome. Ann Intern Med 1985; 103: 533–8.Google Scholar
  3. 3.
    Dismukes WE. Cryptococcal meningitis in patients with AIDS. J of Infect Dis 1988; 157: 624–8.Google Scholar
  4. 4.
    Anonymous. Cryptococcosis and AIDS. Lancet 1988; i: 1434–6.Google Scholar
  5. 5.
    Chuck SL, Sande MA. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. New Engl J Med 1989; 321: 794–9.Google Scholar
  6. 6.
    Clark RA, Greer D, Atkinson W, Valainis GT, Hyslop N. Spectrum of Cryptococcus neoformans infection in 68 patients infected with human immunodeficiency virus. Rev Infect Dis 1990; 12: 768–78.Google Scholar
  7. 7.
    Ellis DH, Pfeiffer TJ. Natural habitat of Cryptococcus neoformans var. gatti. J Clin Micro 1990; 28: 1642–4.Google Scholar
  8. 8.
    Clancy MN, Fleischmann J, Howard DH, Kwon-Chung KJ, Shimizu RY. Isolation of Cryptococcus neoformans gattii from a patient with AIDS in southern California (letter). J Infect Dis 1990; 161: 809.Google Scholar
  9. 9.
    Bottone EJ, Toma M, Johansson BE. Poorly encapsulated Cryptococcus neoformans from patients with AIDS: I. Preliminary observations. AIDS Res 1986; 2: 211–8.Google Scholar
  10. 10.
    Larsen RA, Bozzette S, McCutchan JA, et al. Persistent Cryptococcus neoformans infection of the prostate after successful treatment of meningitis. Ann Intern Med 1989; 111: 125–8.Google Scholar
  11. 11.
    Bennett JE, Dismukes WE, Duma RJ. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis. New Engl J Med 1979; 301: 126–31.Google Scholar
  12. 12.
    Sugar AM, Stern JJ, Dupont B. Overview: Treatment of cryptococcal meningitis. Rev Infect Dis 1990; 12: S338–48.Google Scholar
  13. 13.
    Dismukes WE, Cloud G, Gallis HA, et al. Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks. New Engl J Med 1987; 317: 334–41.Google Scholar
  14. 14.
    Galgiani JN. Fluconazole, a new antifungal agent. Ann Intern Med 1990; 113: 177–9.Google Scholar
  15. 15.
    Larsen RA, Leal MAE, Chan LS. Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS. A randomized trial. Ann Intern Med 1990; 113: 183–7.Google Scholar
  16. 16.
    Denning DW, Tucker RM, Hanson LH, Hamilton JR, Stevens DA. Itraconazole therapy for cryptococcal meningitis and Cryptococcosis. Arch Intern Med 1989; 149: 2301–8.Google Scholar
  17. 17.
    Bozzette SA, Larsen R, Chiu J, et al. A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. New Eng J Med 1991; 324: 580–4.Google Scholar
  18. 18.
    Sugar AM, Saunders C. Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with acquired immunodeficiency syndrome. Am J Med 1988; 85: 481–9.Google Scholar
  19. 19.
    Stern JJ, Hartman BJ, Sharkey P, et al. Oral fluconazole therapy for patients with acquired immunodeficiency syndrome and cryptcoccosis: experience with 22 patients. Am J Med 1988; 85: 477–80.Google Scholar
  20. 20.
    Powderly W, Saag M, Cloud G, et al. Fluconazole (FLU) versus amphotericin B (AMB) as maintenance therapy for prevention of relapse of AIDS-associated cryptococcal meningitis (CM). Abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy 1990: #1162.Google Scholar

Copyright information

© Kluwer Academic Publishers 1991

Authors and Affiliations

  • Alan M. Sugar
    • 1
    • 2
  1. 1.Evans Memorial Department of Clinical Research and the Department of MedicineThe University HospitalBostonUSA
  2. 2.The Thorndike Memorial Laboratory, Department of MedicineBoston City HospitalBostonUSA

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