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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The treatment and medications depend on the patient's overall condition (for example, HIV/AIDS or not immunocompromised, having brain lesions or only pulmonary lesions) and the extent of the cryptococcal infection (single organ or multiple organ involvement). Most experts suggest that an infectious disease specialist should help guide the often long-term treatment with multiple antifungal medications. A few patients may require surgery to reduce or remove a fungal mass (cryptococcoma). The goal of treatment is to eliminate the fungi; however, for some patients, this is not possible, so these patients may require lifelong medication to suppress fungal growth or reactivation. Treatments for C. neoformans and C. gattii are similar.

Patients who are not immunocompromised usually are treated with amphotericin B alone (about six to 10 weeks) or combined with flucytosine (about two weeks). These treatments are then followed by fluconazole treatment for at least 10 additional weeks. This treatment is used for brain and severe lung infections. Antifungal therapy is usually extended until spinal fluid is negative in patients with brain infections, and lung lesions should show a size decrease in response to therapy. Mild infections in the lung may resolve without treatment but must be monitored to be sure reactivation or slow advancement of the infection does not occur.

Immunocompromised patients are treated as above but usually with only intravenously administered (IV) drugs at the start of treatment, and the length of treatment may range from about one to two years to a lifetime of suppressive therapy, usually with fluconazole, and medical checkups to determine if cryptococcosis is reactivated or lesions increase in size.

Consultation with an expert in infectious diseases is recommended to provide the individual with optimal treatment; in addition, these consultants are usually aware of any new treatment protocol changes that may develop with ongoing research that may benefit the patient.

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