Cryptococcal Meningitis
Cryptococcal meningitis is infection of the meninges by Cryptococcus yeast, most often in people with advanced HIV or other major immune suppression.
Key takeaways
- Headache may build over days or weeks and can occur with fever, vomiting, visual change, confusion or few classic neck signs.
- Lumbar puncture establishes diagnosis and measures opening pressure, which is itself a major treatment target.
- Therapy has induction, consolidation and maintenance phases; a single oral antifungal course is not adequate for established meningitis.
The listings below are not for outpatient self-treatment; suspected cryptococcal meningitis requires urgent hospital and specialist care.
Diagnosis and pressure management
Cryptococcal antigen in blood or cerebrospinal fluid is highly informative, while culture confirms infection. Brain imaging may precede lumbar puncture when focal signs or mass effect are concerns. Raised intracranial pressure can damage vision and consciousness and may need repeated therapeutic lumbar punctures.
Antifungal phases
Induction commonly combines amphotericin-based therapy with flucytosine where feasible, followed by fluconazole-based consolidation and maintenance. Kidney function, electrolytes, blood counts and interactions require monitoring. In HIV, timing of antiretroviral initiation is coordinated to reduce inflammatory complications.
When to seek urgent care
Seek emergency care for severe or worsening headache with immune suppression, confusion, reduced consciousness, seizure, new weakness, visual loss, repeated vomiting or neck stiffness.