A 35-year-old man with HIV and CD4 count of 60 cells/μL presents with headache, fever, and meningismus. CSF opening pressure is 340 mmH₂O. India ink preparation of CSF shows encapsulated yeast. The diagnosis is cryptococcal meningitis. Induction therapy per WHO guidelines is:
- A Fluconazole 800 mg/day oral monotherapy
- B Amphotericin B deoxycholate (1 mg/kg/day) plus flucytosine for 2 weeks ✓
- C Voriconazole plus caspofungin for 6 weeks
- D Liposomal amphotericin B monotherapy for 4 weeks
Correct answer: B. Amphotericin B deoxycholate (1 mg/kg/day) plus flucytosine for 2 weeks
Explanation
WHO 2022 guidelines recommend amphotericin B deoxycholate (1 mg/kg/day) plus flucytosine (100 mg/kg/day) for 2 weeks as induction therapy for HIV-associated cryptococcal meningitis; this combination showed superior mycological clearance and improved survival in the ACTA and AMBITION-cm trials. The AMBITION-cm trial also demonstrated that a single high-dose liposomal amphotericin B (10 mg/kg) plus flucytosine/fluconazole is non-inferior, but standard induction remains AmB + 5-FC for 2 weeks.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.