Cryptococcal meningoencephalitis: time for action

Cryptococcal meningoencephalitis was first described over a century ago.It is preventable and treatable yet continues to be associated with excessive morbidity and mortality.The largest burden of disease resides with people living with HIV (PLHIV) in low-and middleincome countries (LMICs).In this group, mortality with the best antifungal induction regimen (seven days of amphotericin B deoxycholate (1.0 mg/kg/day) and flucytosine (100 mg/kg/day)) in a clinical trial setting is 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 programs needs to increase, with particular attention to implementation science that is specific to individual countries.This review summarises causes of excessive mortality, interventions with demonstrated survival benefit, and gaps in knowledge and practice that contribute to the ongoing high death toll from cryptococcal meningoencephalitis.