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Cryptococcal meningitis: a review for emergency clinicians.

Kathryn Marie Fisher1, Tim Montrief2, Mark Ramzy2

  • 1Department of Emergency Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.

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|January 9, 2021
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Summary

Cryptococcal meningitis (CM) requires prompt emergency department (ED) evaluation and management. Early diagnosis and empiric treatment are crucial for improving outcomes in patients with suspected CM.

Keywords:
Antifungal therapyAntiretroviral therapyCryptococcosisHIVImmunosuppressionMeningitis

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Area of Science:

  • Infectious Diseases
  • Neurology
  • Emergency Medicine

Background:

  • Cryptococcal meningitis (CM) is a high-risk condition often requiring emergency department (ED) intervention.
  • Patients may present with subacute symptoms, complicating early diagnosis.

Purpose of the Study:

  • To provide an evidence-based summary of current data for the emergency medicine evaluation and management of CM.
  • To guide clinicians in diagnosing and treating suspected CM in the ED.

Main Methods:

  • This narrative review synthesizes current literature on CM evaluation and management in the ED.
  • Focuses on diagnostic strategies, empiric treatment, and supportive care.

Main Results:

  • Newer Cryptococcal antigen tests offer high sensitivity and specificity in serum and CSF.
  • Empiric treatment should cover bacterial, fungal, and viral meningitis, including amphotericin B and flucytosine for presumed CM.
  • Management includes resuscitation, ICP control, and supportive care; ART initiation is contraindicated in the ED due to IRIS risk.

Conclusions:

  • CM, though rare, has significant morbidity and mortality.
  • Rapid diagnosis and evaluation for complications are essential.
  • Early infectious disease consultation and symptomatic care are imperative.