For a first episode, CSF cryptococcal culture is also recommended in parallel with cryptococcal antigen testing if this is feasible. Rapid cryptococcal antigen assays in CSF, serum, plasma or whole blood (depending on access to lumbar puncture) are preferred based on the much higher diagnostic accuracy of these rapid cryptococcal antigen assays versus the India ink test and the fact that these rapid assays depend less on the health-care provider’s skills. Advantages of the lateral-flow assay over the latex agglutination assay include its rapid (<10 minutes) turnaround time, cost–effectiveness, minimal training requirements and laboratory infrastructure, no need for refrigerated storage and higher clinical and analytical sensitivity. A serum, plasma or whole-blood cryptococcal antigen test is recommended as an initial diagnostic option in settings in which access to lumbar puncture is limited or contraindicated. The use of serum, plasma or whole blood cryptococcal antigen diagnosis does not replace the need for lumbar puncture with CSF examination when this is feasible, considering also the important survival benefit of facilitating control of intracranial pressure (128). In low- and middle-income countries, the use of rapid low-cost assays that rely on limited technical skills and laboratory infrastructure facilitates prompt diagnosis and the initiation of antifungal therapy. A low index of suspicion is needed for cryptococcal meningitis in regions with moderate to high HIV prevalence. Limited data from retrospective cohorts suggest that diagnostic performance among children is similar to that of adults (129, 130). The recommendations for adults have therefore been extended to children