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Diagnosis and Management of Cryptococcal Relapse | OMICS International | Abstract
ISSN 2155-6113

Journal of AIDS & Clinical Research
Open Access

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Case Report

Diagnosis and Management of Cryptococcal Relapse

Abdu K Musubire1, David R Boulware2, David B Meya1,2 and Joshua Rhein2*

1Infectious Disease Institute, Makerere University, Kampala, Uganda

2University of Minnesota, Minneapolis, MN, USA

*Corresponding Author:
Joshua Rhein
University of Minnesota, A-620 Mayo
MMC 250, 420 Delaware Street SE
Minneapolis, MN, USA
Tel: 612-626-9943
E-mail: [email protected]

Received Date: March 04, 2013; Accepted Date: April 24, 2013; Published Date: April 29, 2013

Citation: Musubire AK, Boulware DR, Meya DB, Rhein J (2013) Diagnosis and Management of Cryptococcal Relapse. J AIDS Clinic Res S3:003. doi:10.4172/2155-6113.S3-003

Copyright: © 2013 Musubire AK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Despite improvements in the antifungal regimens and the roll out of antiretroviral therapy (ART) in sub- Saharan Africa, mortality due to cryptococcal meningitis remains high. Relapse of an initially successfully treated infection contributes to this mortality and is often a clinical dilemma in differentiating between paradoxical immune reconstitution inflammatory syndrome (IRIS) and culture-positive relapse or treatment failure. Herein, we present a clinical case scenario and review the case definitions, differential diagnosis, and management of relapse with an emphasis on the current diagnostic and management strategies. We also highlight the challenges of resistance testing and management of refractory relapse cases. The risk of relapse is influenced by: 1) the choice of induction therapy, with higher mortality risk with fluconazole monotherapy which can select for resistance; 2) non-adherence to or lack of secondary prophylaxis; 3) failure of linkage-to-care or retention-in-care of HIV ART programs