Table 4. Responses to antifungal therapy in cryptococcal meningitis.
| Outcome, response | Criteria |
|---|---|
| Success | |
| Complete response | Survival and resolution of all attributable symptoms and signs of disease; plus |
| Documented clearance of pathogen from CSF; plus | |
| Documented clearance of pathogen from blood in cases of bloodstream disease; plus | |
| Documented clearance of pathogen from other sites of disease (if additional cultures are performed); plus | |
| Improvement or stabilization of radiological lesions if present (e.g., CNS cryptococcomaa) | |
| Partial response | Survival and improvement of attributable symptoms and signs of disease; plus |
| Documented clearance of pathogen from CSF; plus | |
| Documented clearance of pathogen from blood in cases of bloodstream disease; plus | |
| Documented clearance of pathogen from other sites of disease if additional cultures are performed; plus | |
| Improvement or stabilization in radiological lesions if present at baseline | |
| Failure | |
| Stable response | Survival and minor or no improvement in attributable symptoms and signs of disease; plus |
| Persistently positive results of cultures of CSF specimens or specimens of other infected sites | |
| Progression of disease | Worsening clinical symptoms or signs of disease plus |
| Persistently positive results of cultures of CSF specimens or specimens of other infected sites; or | |
| New sites of disease or worsening of preexisting lesions radiologically | |
| Death | Death during the prespecified period of evaluation, regardless of attribution |
NOTE. The minimum period of observation is 10 weeks after the time of initiation of study drug. The rationale for this minimum period of evaluation is that assessments of clinical and mycological responses may conflict at early time points.
a
Disappearance of cryptococcoma can take years beyond cure of cryptococcal disease. Therefore, a complete or partial response can be assessed despite persistence of these lesions.