An HIV patient with CD4 < 50 cells/µL develops headache, meningism, and raised intracranial pressure. India ink preparation of CSF shows encapsulated yeast with a polysaccharide capsule. Cryptococcal antigen (CrAg) is positive. The drug regimen for induction therapy is:
- A Fluconazole 400 mg daily for 2 weeks
- B Voriconazole 6 mg/kg 12-hourly loading, then 4 mg/kg 12-hourly
- C Amphotericin B deoxycholate 0.7–1 mg/kg/day + flucytosine 100 mg/kg/day for 2 weeks ✓
- D Micafungin 150 mg IV once daily
Correct answer: C. Amphotericin B deoxycholate 0.7–1 mg/kg/day + flucytosine 100 mg/kg/day for 2 weeks
Explanation
WHO 2022 guidelines recommend two options for induction therapy of cryptococcal meningitis: (1) single-dose liposomal amphotericin B 10 mg/kg + flucytosine for 2 weeks, or (2) amphotericin B deoxycholate 0.7–1 mg/kg/day + flucytosine 100 mg/kg/day for 2 weeks. Flucytosine (5-FC) is essential in combination for CSF sterilization. Fluconazole monotherapy is inferior and now not recommended for induction. Voriconazole and echinocandins (micafungin) are ineffective against Cryptococcus. Serial lumbar punctures may be needed for raised ICP.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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