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Cryptococcal meningitis in advanced HIV — RACP Adult Medicine MCQ

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HardInfectious diseasesCryptococcal meningitis in advanced HIVRACP Adult Medicine

A 36-year-old man with untreated HIV presents with headache and confusion. CD4 count is 32 cells/microlitre. CSF opening pressure is high, cryptococcal antigen is positive and India ink shows encapsulated yeasts. What is the most appropriate management?

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Correct answer: A — Induction amphotericin B plus flucytosine with management of raised intracranial pressure

Cryptococcal meningitis requires induction antifungal therapy, ideally amphotericin B plus flucytosine, and active control of raised intracranial pressure. Immediate ART alone risks deterioration and does not treat fungal meningitis. Low-dose fluconazole, antibacterial therapy alone or discharge is inadequate.

Reference: ASHM HIV guidance; Therapeutic Guidelines (eTG) Antibiotic