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Cryptococcal Meningitis — SCE Infectious Diseases MCQ

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ModerateHIV MedicineCryptococcal MeningitisSCE Infectious Diseases

A 42-year-old man with HIV and a CD4 count of 30 cells/µL presents with headache, confusion, and fever. CSF shows: opening pressure 32 cmH2O, protein 0.8 g/L, glucose 2.1 mmol/L (serum 5.4), WCC 15 cells/µL (predominantly lymphocytes). India ink is positive. CSF cryptococcal antigen titre is 1:2048. What is the most appropriate initial treatment?

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Correct answer: B — Liposomal Amphotericin B 3–4 mg/kg/day IV plus Flucytosine 25 mg/kg QDS for 2 weeks

Cryptococcal meningitis induction therapy is Liposomal Amphotericin B (3–4 mg/kg/day) plus Flucytosine (25 mg/kg four times daily) for a minimum of 2 weeks (WHO 2022 and BHIVA guidelines). This combination has the most rapid CSF sterilisation. Fluconazole monotherapy has inferior outcomes. The raised opening pressure requires therapeutic lumbar punctures to manage. Consolidation is with Fluconazole 400 mg daily for 8 weeks, then maintenance Fluconazole 200 mg daily.

Reference: BHIVA 2022 – Guidelines on treatment of opportunistic infections in HIV; WHO 2022 – Guidelines for diagnosing and managing cryptococcal disease