《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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