A patient with AIDS (CD4 count 45 cells/µL) presents with fever, headache, and meningism. CSF India ink preparation reveals encapsulated budding yeasts. Serum cryptococcal antigen (CrAg) is 1:1024. First-line induction treatment in this resource-limited setting is:

• A Fluconazole 800 mg daily for 2 weeks
• B Liposomal amphotericin B 3 mg/kg plus flucytosine 25 mg/kg 6-hourly for 1 week (short-course) ✓
• C Voriconazole 400 mg twice daily for 2 weeks
• D Itraconazole 200 mg twice daily for 2 weeks

Explanation

WHO 2022 guidelines recommend a 1-week induction regimen with liposomal amphotericin B (or amphotericin B deoxycholate) plus flucytosine as the preferred treatment for HIV-associated cryptococcal meningitis. This short-course regimen achieves superior CSF sterilisation and reduces mortality compared to fluconazole monotherapy. Fluconazole monotherapy (option A) is inferior but used only when amphotericin is unavailable. Voriconazole and itraconazole lack adequate evidence for cryptococcal meningitis induction. Flucytosine targets DNA synthesis and acts synergistically.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.