An HIV-positive patient with CD4 count 30 cells/µL presents with headache and neck stiffness. CSF shows India ink preparation with encapsulated budding yeast cells. Cryptococcal antigen latex agglutination test (CRAG) of CSF is positive at 1:512. What is the treatment protocol?
- A Fluconazole 400 mg/day alone for 10–12 weeks
- B Voriconazole IV for 4 weeks followed by oral itraconazole
- C Echinocandin (caspofungin) plus fluconazole for 4 weeks
- D Induction: IV amphotericin B + flucytosine for 2 weeks; consolidation: oral fluconazole for 8 weeks; maintenance: fluconazole 200 mg/day ✓
Explanation
WHO-recommended treatment for HIV-associated cryptococcal meningitis follows a three-phase approach: induction with IV amphotericin B deoxycholate (0.7–1 mg/kg/day) plus oral flucytosine (100 mg/kg/day) for 2 weeks — this combination is fungicidal and has superior mortality outcomes; consolidation with oral fluconazole 400 mg/day for 8 weeks; then maintenance/secondary prophylaxis with fluconazole 200 mg/day until CD4 >200 cells/µL on ART. Fluconazole monotherapy (induction) is inferior in mortality outcomes. Echinocandins have NO activity against Cryptococcus as the organism lacks 1,3-beta-glucan synthesis targets.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.