Bibliographic Info
Recommendation
Recommended in favor
Strong
Certainty of evidence
Low
In settings without immediate access to lumbar puncture or when lumbar puncture is clinically contraindicated: If a cryptococcal antigen assay is not available and/or rapid access to results is not ensured: Prompt referral for further investigation and treatment as appropriate.
Notes and Remarks
Contraindications include significant coagulopathy or suspected space-occupying lesion based on focal nervous system signs (excluding cranial nerve VI palsy) or recurrent seizures and, where possible, confirmed by computed tomography. Raised intracranial pressure does not contraindicate lumbar puncture in (suspected) cryptococcal meningitis. Other contraindications include major spinal deformity and refusal by the patient after fully informed consent was sought.
Also Featured In
This recommendation also appears in the following guidelines:
Guidelines for the diagnosis, prevention, and management of cryptococcal disease in HIV-infected adults, adolescents and children, March 2018: supplement to the 2016 consolidated guidelines of the use of antiretroviral drugs for treating and preventing HIV infection
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach
Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV.