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Diagnosis and Management of Cryptococcal Meningitis

You answered:

D Perform a DNA or RNA PCR test on a dried bloodspot sample at 4-6 weeks of age. If the initial test is POSITIVE, have the infant return in 2 months for confirmatory HIV testing.

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. Fluconazole monotherapy 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.
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.

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