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Cryptococcal Meningitis — SCE Infectious Diseases MCQ

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HardFungal InfectionsCryptococcal MeningitisSCE Infectious Diseases

An immunosuppressed patient has subacute meningitis, raised opening pressure and strongly positive CSF cryptococcal antigen, but India ink is negative. How should the microscopy be interpreted?

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Correct answer: B — Negative India ink has insufficient sensitivity; CSF antigen and culture remain decisive

The best answer is “Negative India ink has insufficient sensitivity; CSF antigen and culture remain decisive”. India ink has limited sensitivity, particularly with lower organism burden; a compatible syndrome plus CSF antigen requires full cryptococcal management including pressure measurement and culture. Cryptococcal meningitis diagnosis relies on CSF cryptococcal antigen, culture and opening pressure; India ink has insufficient sensitivity to exclude disease.

Reference: BHIVA opportunistic-infection guidelines: https://bhiva.org/clinical-guideline/oi-guidelines/