Dexamethasone in Cryptococcal Meningitis

Inclusion Criteria Concurrent Medication: Allowed: * Aerosolized pentamidine or systemic chemoprophylaxis for PCP. * Preventive therapy for steroid-associated ulcers and any other therapies required to manage steroid toxicity (e.g., insulin). Patients must have: * Documented initial episode or relapse of acute cryptococcal meningitis. (NOTE: Patients must be untreated for this episode except for administration of a test dose of 1 g or less amphotericin B.) * Acute cryptococcal meningitis with cerebrospinal fluid opening pressure \>= 250 mm H2O prior to receipt of antifungal therapy for this episode. * Documented HIV infection OR a diagnosis of AIDS based on a documented AIDS-defining opportunistic infection. * Ability to begin therapy within 8 hours after the pre-entry lumbar puncture. * Consent of parent or guardian if less than 18 years of age. NOTE: * Comatose patients eligible provided informed consent can be provided by guardian or next of kin. Exclusion Criteria Co-existing Condition: Patients with the following symptoms or conditions are excluded: * Concurrent CNS disease such as another infection or neoplasm that would interfere with assessment of response. * Prison incarceration. Concurrent Medication: Excluded: * Acetazolamide, mannitol, urea preparations, and other corticosteroids during the first 72 hours of the study. * Treatment or prophylaxis with other systemic antifungal agents at any time. * Antiretroviral therapy during the first 72 hours of t…