Interpretation of <i>Global Guideline for the Diagnosis and Management of Cryptococcosis: an Initiative of the ECMM and ISHAM in Cooperation with the ASM</i>, 2024_West China Medical Journal

Authors：

LI Yongming ,  YE Feng

State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, Guangdong 510120, P. R. China;

Corresponding author：

YE Feng, Email: Tu276025@gird.cn

Keywords：

Cryptococcosis; guideline; interpretation

DOI：

10.7507/1002-0179.202504141

Video：

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In 2024, the European Confederation of Medical Mycology, the International Society for Human and Animal Mycology, and the American Society for Microbiology jointly published the first global clinical guideline for cryptococcosis in The Lancet Infectious Diseases, which systematically established differentiated diagnostic and treatment strategies tailored to distinct host types and infection sites. This article provides an in-depth interpretation of the guideline, focusing on critical clinical aspects including diagnosis and screening of cryptococcal infection, management of central nervous system (CNS) infections, pulmonary infections, non-CNS/non-pulmonary infections, intervention strategies for complications such as immune reconstitution syndrome, and individualized treatment recommendations for special populations (pregnant women and children). The article aims to deliver standardized and actionable clinical guidance for healthcare providers, facilitating optimized comprehensive management of cryptococcosis across multi-tier healthcare institutions.

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3.	Meya DB, Williamson PR. Cryptococcal disease in diverse hosts. N Engl J Med, 2024, 390(17): 1597-1610.
4.	Kassaza K, Wasswa F, Nielsen K, et al. Cryptococcus neoformans genotypic diversity and disease outcome among HIV patients in Africa. J Fungi (Basel), 2022, 8(7): 734.
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9.	Jiang YK, Zhou LH, Cheng JH, et al. Anti-GM-CSF autoantibodies predict outcome of cryptococcal meningitis in patients not infected with HIV: a cohort study. Clin Microbiol Infect, 2024, 30(5): 660-665.
10.	Qu J, Zhang X, Lu Y, et al. Clinical analysis in immunocompetent and immunocompromised patients with pulmonary cryptococcosis in western China. Sci Rep, 2020, 10(1): 9387.
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12.	Moosa MS, Lessells RJ. Toward simpler, safer treatment of cryptococcal meningitis. N Engl J Med, 2022, 386(12): 1179-1181.
13.	Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(3): 291-322.
14.	Takazono T, Hidaka Y, Morimoto S, et al. Comparison of liposomal amphotericin B alone and in combination with flucytosine in the treatment of non-HIV cryptococcal meningitis: a nationwide observational study. Mycoses, 2022, 65(9): 897-902.
15.	Naicker SD, Mpembe RS, Maphanga TG, et al. Decreasing fluconazole susceptibility of clinical South African Cryptococcus neoformans isolates over a decade. PLoS Negl Trop Dis, 2020, 14(3): e0008137.
16.	Bongomin F, Oladele RO, Gago S, et al. A systematic review of fluconazole resistance in clinical isolates of Cryptococcus species. Mycoses, 2018, 61(5): 290-297.
17.	Stone NR, Rhodes J, Fisher MC, et al. Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis. J Clin Invest, 2019, 129(3): 999-1014.
18.	Clinical and Laboratory Standards Institute. Epidemiological cutoff values for antifungal susceptibility testing: CLSI supplement M57S. 4th ed. Berwyn, PA: Clinical and Laboratory Standards Institute, 2022.
19.	Pastick KA, Nalintya E, Tugume L, et al. Cryptococcosis in pregnancy and the postpartum period: case series and systematic review with recommendations for management. Med Mycol, 2020, 58(3): 282-292.
20.	Bright PD, Lupiya D, van Oosterhout JJ, et al. The treatment of a pregnant HIV positive patient with cryptococcal meningitis in Malawi. Case report and review of treatment options. Med Mycol Case Rep, 2017, 19: 9-12.
21.	Mølgaard-Nielsen D, Svanström H, Melbye M, et al. Association between use of oral fluconazole during pregnancy and risk of spontaneous abortion and stillbirth. JAMA, 2016, 315(1): 58-67.
22.	Mølgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med, 2013, 369(9): 830-839.

1. World Health Organization. WHO fungal priority pathogens list to guide research, development and public health action: CC BY-NC-SA 3.0 IGO. Geneva: World Health Organization, 2022.
2. Zhao Y, Lin J, Fan Y, et al. Life cycle of Cryptococcus neoformans. Annu Rev Microbiol, 2019, 73: 17-42.
3. Meya DB, Williamson PR. Cryptococcal disease in diverse hosts. N Engl J Med, 2024, 390(17): 1597-1610.
4. Kassaza K, Wasswa F, Nielsen K, et al. Cryptococcus neoformans genotypic diversity and disease outcome among HIV patients in Africa. J Fungi (Basel), 2022, 8(7): 734.
5. Denning DW. Global incidence and mortality of severe fungal disease. Lancet Infect Dis, 2024, 24(7): e428-e438.
6. Chang CC, Harrison TS, Bicanic TA, et al. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. Lancet Infect Dis, 2024, 24(8): e495-e512.
7. Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis, 2020, 71(6): 1367-1376.
8. Li Z, Li Y, Chen Y, et al. Trends of pulmonary fungal infections from 2013 to 2019: an AI-based real-world observational study in Guangzhou, China. Emerg Microbes Infect, 2021, 10(1): 450-460.
9. Jiang YK, Zhou LH, Cheng JH, et al. Anti-GM-CSF autoantibodies predict outcome of cryptococcal meningitis in patients not infected with HIV: a cohort study. Clin Microbiol Infect, 2024, 30(5): 660-665.
10. Qu J, Zhang X, Lu Y, et al. Clinical analysis in immunocompetent and immunocompromised patients with pulmonary cryptococcosis in western China. Sci Rep, 2020, 10(1): 9387.
11. La Hoz RM, Pappas PG. Cryptococcal infections: changing epidemiology and implications for therapy. Drugs, 2013, 73(6): 495-504.
12. Moosa MS, Lessells RJ. Toward simpler, safer treatment of cryptococcal meningitis. N Engl J Med, 2022, 386(12): 1179-1181.
13. Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(3): 291-322.
14. Takazono T, Hidaka Y, Morimoto S, et al. Comparison of liposomal amphotericin B alone and in combination with flucytosine in the treatment of non-HIV cryptococcal meningitis: a nationwide observational study. Mycoses, 2022, 65(9): 897-902.
15. Naicker SD, Mpembe RS, Maphanga TG, et al. Decreasing fluconazole susceptibility of clinical South African Cryptococcus neoformans isolates over a decade. PLoS Negl Trop Dis, 2020, 14(3): e0008137.
16. Bongomin F, Oladele RO, Gago S, et al. A systematic review of fluconazole resistance in clinical isolates of Cryptococcus species. Mycoses, 2018, 61(5): 290-297.
17. Stone NR, Rhodes J, Fisher MC, et al. Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis. J Clin Invest, 2019, 129(3): 999-1014.
18. Clinical and Laboratory Standards Institute. Epidemiological cutoff values for antifungal susceptibility testing: CLSI supplement M57S. 4th ed. Berwyn, PA: Clinical and Laboratory Standards Institute, 2022.
19. Pastick KA, Nalintya E, Tugume L, et al. Cryptococcosis in pregnancy and the postpartum period: case series and systematic review with recommendations for management. Med Mycol, 2020, 58(3): 282-292.
20. Bright PD, Lupiya D, van Oosterhout JJ, et al. The treatment of a pregnant HIV positive patient with cryptococcal meningitis in Malawi. Case report and review of treatment options. Med Mycol Case Rep, 2017, 19: 9-12.
21. Mølgaard-Nielsen D, Svanström H, Melbye M, et al. Association between use of oral fluconazole during pregnancy and risk of spontaneous abortion and stillbirth. JAMA, 2016, 315(1): 58-67.
22. Mølgaard-Nielsen D, Pasternak B, Hviid A. Use of oral fluconazole during pregnancy and the risk of birth defects. N Engl J Med, 2013, 369(9): 830-839.

West China Medical Journal

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