MEDizzy - A 31-year-old man with AIDS was admitted to the emergency

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Antifungal Drugs

A 31-year-old man with AIDS was admitted to the emergency department with fever (102.4°F, 39.1°C), headache, confusion, muddled thinking, and vomiting. Physical examination revealed nuchal rigidity, diplopia, and loss of vision. An agglutination test of the spinal fluid for capsular polysaccharide antigen turned out to be positive. Which of the following treatments would be most appropriate for this patient?

ExplanationThe patient’s history, signs and symptoms, and lab results suggest the diagnosis of cryptococcal meningitis. After toxoplasmosis, cryptococcosis is the most common central nervous system infection associated with AIDS. Cryptococcus neoformans is a yeast that is characterized by a thick polysaccharide capsule. During infection, the capsular polysaccharide is dissolved in spinal fluid and can be detected by an agglutination test that is diagnostic of cryptococcosis. C. neoformans is sensitive to amphotericin B, flucytosine, and antifungal azoles. The current treatment recommended for acute cryptococcal meningitis is amphotericin B plus flucytosine. Synergism between the two drugs has been demonstrated in vitro and in vivo. It may be related to enhanced penetration of flucytosine through the amphotericin damaged fungal cell membrane.