Neurology: Case of the Month

Test Yourself — Patient 4

Cryptococcus Neoformans Meningitis

  1. The portal of entry for Cryptococcus neoformans is via
    • [ A ] inhalation
    • [ B ] blood stream
    • [ C ] ingestion of contaminated foods
    • [ D ] skin
  2. All of the following statements regarding cryptococcal meningitis are true EXCEPT:
    • [ A ] Cryptococcal antigen titers are elevated in the serum and CSF in 90% of cases.
    • [ B ] CSF cell differential shows mononuclear predominance, rarely eosinophilic.
    • [ C ] CSF protein is elevated, and CSF glucose is usually low, although both may be normal in early disease.
    • [ D ] The detection of CSF cryptococcal antigen titers is felt to be more sensitive than serum antigen titers.
  3. Initial features associated with high mortality in patients with cryptococcal meningitis include all of the following EXCEPT:
    • [ A ] Elevated opening CSF pressure.
    • [ B ] CSF glucose less than 30 mg/ml.
    • [ C ] Abnormal mental status at presentation.
    • [ D ] Seizures as an initial presentation.
  4. The treatment of cryptococcal meningitis usually includes all of the following EXCEPT:
    • [ A ] flucytosine
    • [ B ] amphotericin B
    • [ C ] erythromycin
    • [ D ] fluconazole
  5. The following statement is true about cryptococcal meningitis.
    • [ A ] Without treatment, cryptococcal meningitis is usually fatal.
    • [ B ] Treatment failure is predicted when CSF glucose remains low for longer than four weeks.
    • [ C ] Infection occurs when the yeast invades the tissue and forms a large mucoid capsule which protects the fungi from host defenses.
    • [ D ] All of the above are true.

 

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