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Cryptococcal meningitis

Meningitis cryptococcica · Kryptokoková meningitida

What it is

A yeast inhaled from soil and bird droppings that invades the brain's lining when immunity fails, above all in advanced HIV; it still causes about a fifth of AIDS deaths.

Symptoms & signs

  • Headache worsening over days to weeks
  • fever
  • vomiting
  • blurred or double vision
  • confusion
  • seizures and coma

🚩 Get help if…

  • call 112 / 911 now Confusion, fits or drowsiness
  • call 112 / 911 now Sudden loss of vision or double vision
  • see a doctor soon Headache for days with fever in someone with HIV or a transplant
  • see a doctor soon Headache worse lying down, with vomiting

Where it strikes

Medical treatment

  • Cryptococcal antigen test; lumbar puncture with opening pressure
  • Single high dose of liposomal amphotericin B with 14 days of flucytosine and fluconazole — as good as a week of standard amphotericin, with fewer side effects (AMBITION trial, 2022) trials support
  • repeated lumbar punctures to relieve pressure
  • fluconazole maintenance
  • HIV treatment delayed 4–6 weeks — starting early raised deaths (COAT trial)
  • Screening blood for antigen in advanced HIV and pre-emptive fluconazole trials support
  • Dexamethasone — more disability and slower clearance (CryptoDex trial) not confirmed in trials

Natural & lifestyle

  • Early HIV testing and treatment

Emerging & experimental

  • Oral encochleated amphotericin
  • new antifungals (fosmanogepix)

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Tamoxifen — repurposed as an antifungal; a Vietnamese trial did not speed clearance not confirmed in trials
  • Garlic — antifungal in the laboratory; no role in meningitis anecdotal / traditional

ICD codes