Cryptococcal meningoencephalitis: time for action

Cryptococcal meningoencephalitis was first described over a century ago. This fungal infection is preventable and treatable yet continues to be associated with excessive morbidity and mortality. The largest burden of disease resides in people living with HIV in low-income and middle-income countries. In this group, mortality with the best antifungal induction regimen (7 days of amphotericin B deoxycholate [1 center dot 0 mg/kg per day] and flucytosine [100 center dot 0 mg/kg per day]) in a clinical trial setting was 24% at 10 weeks. The world is now at an inflection point in terms of recognition, research, and action to address the burden of morbidity and mortality from cryptococcal meningoencephalitis. However, the scope of interventional programmes needs to increase, with particular attention to implementation science that is specific to individual countries. This Review summarises causes of excessive mortality, interventions with proven survival benefit, and gaps in knowledge and practice that contribute to the ongoing high death toll from cryptococcal meningoencephalitis.

Automated summary

Cryptococcal meningoencephalitis, a preventable and treatable fungal infection, has a high burden of disease in people living with HIV in low-income and middle-income countries. The world is now at a turning point in recognizing, researching, and taking action to address the morbidity and mortality from this disease, but there is a need to expand intervention programs with specific attention to implementation science in individual countries.