By ULY CLINIC
Cryptococcus meningitis
Introduction
It develops in patients who are immune compromised e.g. HIV-positive patients with low CD4 cell count.
Diagnostic criteria
Headache, fever, intolerance to light and sound, neck stiffness, vomiting, seizures, deafness and blindness
In advanced stages it may present with confusion, altered consciousness and coma.
Non-Pharmacological Treatment
Refer to section on bacterial meningitis
Pharmacological Treatment:
Treatment is in 3 phases:
Phase 1: Induction phase
-
Amphotericin B 0.7mg/kg/day IV
AND
-
Flucytosine 100mg/kg/day administered orally for 14 days
OR
-
Fluconazole 1200mg IV/(PO) once daily for 14 days
Phase 2: Consolidation phase
-
Fluconazole 400mg day for 8 weeks or until CSF is sterile.
Phase 3: Suppressive phase
-
Fluconazole 200mg per day until CD4 more than 350
Note:
LP is done for diagnostic and therapeutic for cryptococal meningitis.
Cryptococal antigen test should be done as there are cases of negative India ink results with cryptococal meningitis
Updated on, 27.10.2020
References
1. STG