By ULY CLINIC

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Cryptococcus meningitis

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Introduction

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It develops in patients who are immune compromised e.g. HIV-positive patients with low CD4 cell count.  

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Diagnostic criteria

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Headache, fever, intolerance to light and sound, neck stiffness, vomiting, seizures, deafness and blindness

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In advanced stages it may present with confusion, altered consciousness and coma. 

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Non-Pharmacological Treatment

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Refer to section on bacterial meningitis  

 

Pharmacological Treatment: 

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Treatment is in 3 phases: 

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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 

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• Fluconazole 400mg day for 8 weeks or until CSF is sterile.  

 

Phase 3: Suppressive phase 

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• Fluconazole 200mg per day until CD4 more than 350 

 

Note:   

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LP is done for diagnostic and therapeutic for cryptococal meningitis.

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Cryptococal antigen test should be done as there are cases of negative India ink results with cryptococal meningitis 

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Updated on, 27.10.2020

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References

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1. STG