Diagnosis and Management of Cryptococcal Disease in Resource-Limited Settings
Cryptococcal meningitis is one of the most important fungal infections in the developing world, where deaths related to this disease are numerous. In resource-limited settings, mortality is high in large part because of difficulties in the diagnosis and management of this infection. This paper outlines many of the realities in many resource-limited settings, and describes priorities for public health action and research.
KeywordsCryptococcus Cryptococcosis Cryptococcal meningitis Diagnosis Management HIV/AIDS Resource-limited settings Amphotericin Fluconazole Lateral flow assay Cryptococcal antigen Latex agglutination
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- 3.•• Park BJ, Wannemuehler KA, et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23(4):525–30. This paper demonstrated the disparity in the burden of cryptococcal disease; it showed that the vast majority of cases were occurring in resource-limited settings. PubMedCrossRefGoogle Scholar
- 27.•• Meya DB, Manabe YC, et al. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count < or = 100 cells/microL who start HIV therapy in resource-limited settings. Clin Infect Dis. 2010;51(4):448–55. This paper is one of the first to demonstrate the effectiveness of early diagnosis and treatment of cryptococcal disease. PubMedCrossRefGoogle Scholar
- 29.•• Jarvis JN, Percival A, et al. Evaluation of a novel point-of-care cryptococcal antigen test on serum, plasma, and urine from patients with HIV-associated cryptococcal meningitis. Clin Infect Dis. 2011;53(10):1019–23. This paper demonstrates the utility of a point-of-care test, the lateral flow assay, in the diagnosis of cryptococcal disease. PubMedCrossRefGoogle Scholar
- 30.•• Lindsley MD, Mekha N, et al. Evaluation of a newly developed lateral flow immunoassay for the diagnosis of cryptococcosis. Clin Infect Dis. 2011;53(4):321–5. This paper demonstrates the utility of a point-of-care test, the lateral flow assay, in the diagnosis of cryptococcal disease. PubMedCrossRefGoogle Scholar