CNS INFECTIONS-CRYPTOCOCCAL MENINGITIS

SUMMARY

1. present(s) with progressive headache, cognitive impairment, and/or meningeal signs in patients with AIDS or on chronic corticosteroids.

2. CSF pressure is usually very elevated.

3. Standard CSF studies can be entirely normal, so always check the cryptococcal antigen titer in the blood and CSF.

4. Treat with amphotericin B deoxycholate or liposomal ampho B and flucytosine x 2 weeks, then change to oral
fluconazole x 8 more weeks (minimum).

5. Oral fluconazole for prophylaxis. Manage elevated ICP with daily taps to keep CSF pressure < 20 cm H₂O, or patients can lose their vision.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].