Pre-Emptive Fluconazole CrAg Positive — SCE Infectious Diseases MCQ

Correct answer: D — Perform lumbar puncture with opening pressure and CSF testing to exclude cryptococcal meningitis after review

The best answer is “Perform lumbar puncture with opening pressure and CSF testing to exclude cryptococcal meningitis after review”. Symptoms and a high titre raise the probability of CNS disease; CSF evaluation and opening pressure determine whether meningitis induction therapy is required. “Begin antiretroviral therapy immediately and repeat serum antigen after 1 week” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Treat with oral nystatin because serum antigen reflects mucosal colonisation” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Observe without antifungal therapy if fundoscopy is normal” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement. “Use chest CT alone to exclude disseminated cryptococcosis” is less appropriate because it does not satisfy the scenario's decisive clinical or jurisdictional requirement.

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