Mycology: cryptococcal meningitis management: practice question

A Microbiology 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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Microbiology · Mycology: cryptococcal meningitis management

Sample item

A man with HIV and a CD4 count of 40 cells/mm3 has cryptococcal meningitis, with a positive CSF cryptococcal antigen and an opening pressure of 38 cm of CSF. Which management plan is most appropriate?

AAmphotericin B with flucytosine for two weeks, repeated therapeutic lumbar punctures, then fluconazole consolidationBItraconazole with dexamethasone to reduce oedemaCAmphotericin B alone, with acetazolamide to lower the pressureDFluconazole alone, with antiretroviral therapy started on the same day

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

The answer and the reasoning

A. Amphotericin B with flucytosine for two weeks, repeated therapeutic lumbar punctures, then fluconazole consolidation

Induction therapy is amphotericin B with flucytosine for about two weeks, followed by fluconazole consolidation and maintenance. Raised intracranial pressure is managed with serial therapeutic lumbar punctures. Early antiretroviral therapy increases mortality in cryptococcal meningitis, so it is deferred by several weeks.

Option by option

A. Amphotericin B with flucytosine for two weeks, repeated therapeutic lumbar punctures, then fluconazole consolidation (correct)
Correct. This follows the standard induction, pressure control and consolidation sequence.
B. Itraconazole with dexamethasone to reduce oedema
Itraconazole is inferior for meningitis, and adjunctive dexamethasone increased harm in a trial.
C. Amphotericin B alone, with acetazolamide to lower the pressure
Acetazolamide is not helpful for pressure in this setting and may cause harm.
D. Fluconazole alone, with antiretroviral therapy started on the same day
Fluconazole alone is weaker, and immediate antiretroviral therapy worsens outcomes through immune reconstitution.

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.

Questions about this Microbiology question

What is the answer to this Microbiology question?

The best answer is A, Amphotericin B with flucytosine for two weeks, repeated therapeutic lumbar punctures, then fluconazole consolidation. Induction therapy is amphotericin B with flucytosine for about two weeks, followed by fluconazole consolidation and maintenance.

Why is "Itraconazole with dexamethasone to reduce oedema" not the answer?

Itraconazole is inferior for meningitis, and adjunctive dexamethasone increased harm in a trial.

Why is "Amphotericin B alone, with acetazolamide to lower the pressure" not the answer?

Acetazolamide is not helpful for pressure in this setting and may cause harm.

Why is "Fluconazole alone, with antiretroviral therapy started on the same day" not the answer?

Fluconazole alone is weaker, and immediate antiretroviral therapy worsens outcomes through immune reconstitution.

What concept does this question test?

It tests Mycology: cryptococcal meningitis management in Microbiology. Raised intracranial pressure is managed with serial therapeutic lumbar punctures. Early antiretroviral therapy increases mortality in cryptococcal meningitis, so it is deferred by several weeks.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Mycology: cryptococcal meningitis management?

Make a one-line identity card for each organism: shape and stain, defining test, toxin, disease and drug. Then use the flashcards and the other Microbiology 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.