Infectious diseases: cryptococcal meningitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: cryptococcal meningitis

Sample item

A 35-year-old man with HIV and a CD4 count of 40 cells/mm3 has had headache and low-grade fever for 3 weeks, with neck stiffness. Non-contrast CT is normal. CSF opening pressure is raised, and cell count shows few lymphocytes. Which CSF test has the highest sensitivity for the likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Cryptococcal antigen by latex agglutination or lateral flow assay

Cryptococcal meningitis typically presents subacutely in advanced HIV, with few CSF inflammatory cells and a high opening pressure. CSF and serum cryptococcal antigen detection has a sensitivity of over 90%, higher than India ink microscopy which depends on the burden of organisms. Induction therapy is amphotericin B with flucytosine, and raised pressure is managed with repeated therapeutic lumbar punctures.

Option by option

  • A. CSF PCR for JC virus

    JC virus causes progressive multifocal leukoencephalopathy, a white matter disease with normal pressure.

  • B. India ink staining

    India ink is specific but misses cases with a low fungal load.

  • C. Cryptococcal antigen by latex agglutination or lateral flow assay (correct)

    Antigen assays are the most sensitive rapid test.

  • D. CSF adenosine deaminase

    Raised ADA supports tuberculous meningitis, which would show more cells and protein.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Cryptococcal antigen by latex agglutination or lateral flow assay. Cryptococcal meningitis typically presents subacutely in advanced HIV, with few CSF inflammatory cells and a high opening pressure.

Why is "CSF PCR for JC virus" not the answer?

JC virus causes progressive multifocal leukoencephalopathy, a white matter disease with normal pressure.

Why is "India ink staining" not the answer?

India ink is specific but misses cases with a low fungal load.

Why is "CSF adenosine deaminase" not the answer?

Raised ADA supports tuberculous meningitis, which would show more cells and protein.

What concept does this question test?

It tests Infectious diseases: cryptococcal meningitis in General Medicine. CSF and serum cryptococcal antigen detection has a sensitivity of over 90%, higher than India ink microscopy which depends on the burden of organisms. Induction therapy is amphotericin B with flucytosine, and raised pressure is managed with repeated therapeutic lumbar punctures.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: cryptococcal meningitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.