Cryptococcus neoformans

Question 1

CD4 Count

Answer 1

< 100 and AIDS
Cryptococcal meningitis

Question 2

Presentation

Answer 2

Subacute with symptoms for weeks to months

Neck stiffness and photophobia only present in 25-33% of patients

Question 3

Diagnosis

Answer 3

CSF analysis

Increased ICP
Elevated protein and low-to-normal glucose
Few WBC
Positive cryptococcal antigen titer
India ink stain positive for encapsulated yeast

Question 4

Treatment

Answer 4

If patient is not on ART–>delay for 2 weeks until induction and consolidation phase to avoid IRIS

Induction: Amphotericin B 3-4 mg/kg IV QD + Flucytosine 25 mg/kg QID x 2 weeks

Consolidation: Fluconazole 800 mg PO QD x ≥ 8 weeks; 400 mg if on ART

Maintenance: Fluconazole 200 mg PO QD x 12 months

Question 5

Prophylaxis

Answer 5

Primary prophylaxis NOT RECOMMENDED

Maintenance = secondary prophylaxis

D/C: Completed 1 year, Asymptomatic, CD4 count ≥ 100 cells/mm3 x 3 months on ART

Restart: CD4 count < 100 cells/mm3