Question | Discussion | References

Diagnosis and Management of Cryptococcal Meningitis

You answered:

B Perform a lumbar puncture to measure and reduce the intracranial pressure as needed, then start amphotericin B while waiting for lab results.

This answer is incorrect. The lumbar puncture should be performed with measurement of CSF opening pressure and CSF cryptococcal antigen (CrAg) by either latex agglutination or lateral flow assay. Amphotericin monotherapy, however, is not the best initial therapy in this scenario.

Choose another answer:

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