A 35-year-old HIV-positive patient (CD4 count 52 cells/µL, not on ART) develops headache, fever, and mild neck stiffness over 3 weeks. CSF India ink preparation shows encapsulated yeast. CSF cryptococcal antigen is positive at 1:1024. What is the induction regimen of choice?
- A Liposomal amphotericin B + flucytosine for 2 weeks, then fluconazole consolidation ✓
- B Fluconazole 400 mg/day for 2 weeks
- C Voriconazole for 4 weeks
- D Amphotericin B deoxycholate monotherapy for 6 weeks
Correct answer: A. Liposomal amphotericin B + flucytosine for 2 weeks, then fluconazole consolidation
Explanation
Cryptococcal meningitis in HIV requires induction therapy with liposomal amphotericin B (AmBisome) plus flucytosine (5-FC) for 2 weeks, followed by fluconazole 400 mg/day for 8 weeks consolidation, then 200 mg/day maintenance (secondary prophylaxis) per WHO 2022 guidelines. Flucytosine addition significantly reduces mortality compared to amphotericin B alone. Fluconazole monotherapy (fungistatic) is inadequate for induction in severe meningitis with high antigen titer. Liposomal amphotericin B is preferred over deoxycholate due to less nephrotoxicity.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.