γ干扰素
倍增了巨噬细胞和中性粒细胞抗真菌能力,包括新型隐球菌。γ干扰素已被用于标准抗真菌治疗方案中,治疗AIDS相关的隐球菌性脑膜炎。其耐受性良好,可同时改善病原学及临床疗效。[54]Pappas PG, Bustamante B, Ticona E, et al. Recombinant interferon-gamma 1b as adjunctive therapy for AIDS-related acute cryptococcal meningitis. J Infect Dis. 2004;189:2185-2191.http://www.ncbi.nlm.nih.gov/pubmed/15181565?tool=bestpractice.com[55]Segal BH, Kwon-Chung J, Walsh TJ, et al. Immunotherapy for fungal infections. Clin Infect Dis. 2006;42:507-515.http://www.ncbi.nlm.nih.gov/pubmed/16421795?tool=bestpractice.com在HIV感染相关的隐球菌性脑膜炎中,在标准方案中加用短程的γ干扰素可以增加隐球菌感染的清除率。[56]Jarvis JN, Meintjes G, Rebe K, et al. Adjunctive interferon-γ immunotherapy for the treatment of HIV-associated cryptococcal meningitis: a randomized controlled trial. AIDS. 2012;26:1105-1113.http://www.ncbi.nlm.nih.gov/pubmed/22421244?tool=bestpractice.com
隐球菌葡萄糖醛酸木糖甘露聚糖蛋白共价结合疫苗
尽管已研究出针对新型隐球菌的疫苗,但仍需临床试验验证其疗效。[57]Oscarson S, Alpe M, Svahnberg P, et al. Synthesis and immunological studies of glycoconjugates of Cryptococcus neoformans capsular glucuronoxylomannan oligosaccharide structures. Vaccine. 2005;23:3961-3972.http://www.ncbi.nlm.nih.gov/pubmed/15917118?tool=bestpractice.com
高剂量两性霉素-B
与标准用量相比,高剂量两性霉素B被证明有更显著的杀真菌作用,但有待验证其药物毒性。[58]Bicanic T, Wood R, Meintjes G, et al. High-dose amphotericin B with flucytosine for the treatment of cryptococcal meningitis in HIV-infected patients: a randomized trial. Clin Infect Dis. 2008;47:123-130.http://cid.oxfordjournals.org/content/47/1/123.fullhttp://www.ncbi.nlm.nih.gov/pubmed/18505387?tool=bestpractice.com
其他唑类抗真菌药
伏立康唑和伯沙康唑具有抗隐球菌活性,可用于不能耐受标准方案或难治性的患者。[37]Limper AH, Knox KS, Sarosi GA, et al; American Thoracic Society. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011;183:96-128.http://www.thoracic.org/statements/resources/mtpi/treatment-of-fungal-infections-in-adult-pulmonary-critical-care-and-sleep-medicine.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/21193785?tool=bestpractice.com[59]Perfect JR, Marr KA, Walsh TJ, et al. Voriconazole treatment for less-common, emerging, or refractory fungal infections. Clin Infect Dis. 2003;36:1122-1131.http://www.ncbi.nlm.nih.gov/pubmed/12715306?tool=bestpractice.com[60]Raad II, Graybill JR, Bustamante AB, et al. Safety of long-term oral posaconazole use in the treatment of refractory invasive fungal infections. Clin Infect Dis. 2006;42:1726-1734.http://www.ncbi.nlm.nih.gov/pubmed/16705579?tool=bestpractice.com