Cryptococcal meningitis
Cryptococcal meningitis often presents as a subacute or chronic illness characterised by headache, fever and altered mental state. It may be associated with cerebral mass lesions (cryptococcomas), particularly in patients with Cryptococcus gattii infection.
Before starting treatment for cryptococcal meningitis, perform the investigations listed in Diagnosing and assessing cryptococcosis to exclude disseminated disease and identify risk factors contributing to diseaseChang 2021.
Patients with undiagnosed HIV infection may present initially with cryptococcal meningitis. Cryptococcal meningitis is an indicator condition for HIV testing1. If cryptococcal meningitis is identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection. In addition to HIV testing, if a patient without a history of immune compromise develops cryptococcal meningitis, undertake testing for other immune system disorders.
In patients with cryptococcal meningitis and newly diagnosed HIV, treatment for HIV is usually delayed until 4 to 6 weeks after starting treatment for cryptococcosis. The timing of antiretroviral therapy initiation is complex – seek expert advice. In patients with HIV infection taking antiretroviral therapy, check for drug interactions when prescribing antimicrobials.
Treatment of cryptococcal meningitis follows a 3-phase antifungal regimen; see Approach to managing cryptococcosis. Patients with cryptococcal meningitis also require monitoring and treatment for raised intracranial pressure; see Raised intracranial pressure in patients with cryptococcal meningitis for more information.