Question | Discussion | References

Diagnosis and Management of Cryptococcal Meningitis

You answered:

A Start amphotericin B immediately, while waiting for lab results. Do not perform a lumbar puncture because the intracranial pressure may be high.

This answer is incorrect. Patients with suspected cryptococcal meningitis MUST have a lumbar puncture, provided it can be performed safely and there are no contraindications. At a minimum, the procedure should include measurement of CSF opening pressure and CSF cryptococcal antigen (CrAg) by either latex agglutination or lateral flow assay. If CSF CrAg testing is not available, smear microscopy with India Ink staining may be substituted.

Choose another answer:

B Perform a lumbar puncture to measure and reduce the intracranial pressure as needed, then start amphotericin B while waiting for lab results.
C Perform a lumbar puncture to measure and reduce the intracranial pressure as needed, then start amphotericin B plus fluconazole while waiting for lab results.
D Perform a lumbar puncture to measure and reduce the intracranial pressure as needed, then start high-dose fluconazole (800 mg daily) while waiting for lab results.

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