Cryptococcal meningitis

Question 1

Goals of Management of CM

Answer 1

• To eradicate the infection and cure it
• To control the infection to reduce morbidity and mortality
• To prevent complications of CM
• To prevent/detect adverse effects associated with medicines used

Question 2

Clinical presentation of cryptococcal meningitis

Answer 2

Initial nonspecific signs and symptoms may be:
• Headache
• Fever
• Malaise
• Stiff neck
• Visual disturbances
• Nausea and vomiting
• Altered mental status with somnolence
• Photophobia
• Papilledema
• Cranial neuropathies including nystagmus and amblyopia

Question 3

Treatment of CM

Answer 3

•Amphotericin B
• Flucytosine
• Fluconazole

Question 4

Treatment Phases of CM

Answer 4

• Induction phase
• Consolidation phase
•Maintenance therapy phase

Question 5

General Mechanism of action of antifungal agents

Answer 5

• Depends on agent
• Involves an alteration of RNA or DNA
• Allows for an intracellular

Question 6

Additional Treatment of Patients with CM

Answer 6

Cytomegalovirus (CMV) meningitis may be present if severe immunosuppression, Consider management with:
• Combination therapy: Ganciclovir and Foscarnet
• Maintenance therapy: Valganciclovir 900 mg/day
• To be followed by maintenance therapy until evidence that ART-related immune reconstitution is sustained

Question 7

Cryptococcal meningitis spreads from the lungs to the rest of the body through what?

Answer 7

Bloodstream

Question 8

Areas commonly affected by cryptococcosis

Answer 8

CNS infection (cryptococcal meningitis)

Lungs (pulmonary cryptococcosis)

Other organs and systems with common disseminated cryptococcosis

Skin (cutaneous manifestations)

Prostate

Question 9

State the Diagnosis of cryptococcal meningitis (CM)

Answer 9

CSF and serum cryptococcal antigen (CrAg) tests with a sensitivity of > 90%, a negative test should not be used as a rationale to discontinue treatment

Question 10

Differential diagnosis of meningitis in patients with HIV

Answer 10

•Chronic paroxysmal hemicrania

Bacterial/meningococcal meningitis

Migraine headache

Neurosyphilis

Cytomegalovirus (CMV) ventriculoencephalitis

Consider immune reconstitution inflammatory syndrome (IRIS) if severe immunosuppression

Question 11

What is Cryptococcus neoformans

Answer 11

An encapsulated yeast that colonizes the airway and can cause meningitis or disseminated disease in other parts of the body

Question 12

Diagnosis of CM

Answer 12

• CSF Analysis
• Increased intracranial pressure
• CSF fluid appearance: clear or turbid
• Increased protein levels
•Glucose levels = normal (but ratio of CSF glucose: serum glucose can be < 60%) (hypoglycorrhachia)
• Increased lymphocytes (WBC may be low, normal, or high)

Question 13

Diagnosis of cryptococcal meningitis

Answer 13

1. Blood specimen
2. Fungal culture and susceptibility test
3. Cryptococcal serology
4. Cryptococcal antigen testing
5. Cerebrospinal fluid specimen: India ink smear, Fungal culture and susceptibility test, Cryptococcal antigen testing