Day #49 - Cryptococcus and HIV Redux

2 cases of cryptococcal meningitis admitted in 1 week. This is somewhat unusual.

We have previously discussed HIV+Cryptococcus here.

We talked again about the management including:

(a) effective anti-fungal therapy (amphotericin B 0.7mg/kg) induction (14d +/- flucytosine) followed by consolidation with fluconazole 400mg x 10 weeks followed by maintenance with fluconazole 200mg until CD4 >200 x 6 months and

(b) effective management of increased ICP.

If OP >320mmH20 -- they should have aggressive management of ICP (serial LP to <200) or VP shunt

If OP >180 and symptomatic -- they should also have aggressive management

The OP should also be measured at the end of the 14d induction therapy.

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FYI -- The US HIV guidelines are available here and here.

For the CC4s we will be discussing HIV again in seminar later this month.