American Board of Internal Medicine (ABIM) Certification Practice Exam

For transplant recipients, what is the maintenance treatment duration for cryptococcal meningitis?

1. 2 weeks

2. 8 weeks

3. 6 months to 1 year

4. 1 year or more

The correct answer is: 6 months to 1 year

The recommended maintenance treatment duration for cryptococcal meningitis in transplant recipients is typically between 6 months to 1 year. This extended treatment period is crucial due to the immunocompromised state of transplant patients, who are at increased risk for opportunistic infections like cryptococcal meningitis. During the initial phase of treatment, intensive antifungal therapy is administered, usually lasting for 2 weeks, aimed at controlling the acute infection. Following this, the transition to a maintenance phase with lower doses of antifungal medication helps prevent recurrence of the infection. The 6-month to 1-year maintenance period is supported by guidelines that emphasize both the need for a sustained therapeutic effect and a careful monitoring strategy in this vulnerable population. In contrast, shorter durations such as 2 weeks or 8 weeks would not provide adequate protection against relapse in these patients, especially considering their ongoing immunosuppressive therapy. A duration of 1 year or more may be applied in certain high-risk cases but is not the standard for all transplant recipients, highlighting the tailored approach needed in managing cryptococcal infections.