Cryptococcal meningoencephalitis

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Risk factor

Immunocompromised (HIV with <100 CD4)

Presentation

Headache, fever and malaise

Diagnosis

  • CSF: opening pressure, protein, glucose, WBCs < 50 with mononuclear predominance
  • India ink
  • Cryptococcal antigen
  • Culture on Sabouraud

Treatment

  • Initial: AmB + flucytosine (2wks)
  • Consolidation: Fluconazole (8 wks)
  • Maintenance: Fluconazole (>1 yr)
  • Serial LP to decrease pressure
  • Defer HAART for at least 2 weeks (immune reconstitution)