Cryptococcal Infection of the Central Nervous System

Cryptococcal Meningitis: Report of a Case

“…Generally, the CSF findings in non-AIDS patients are similar to those in AIDS patients. 2 However, low CSF WBC (<20x10 9 /L) is strikingly more noted in AIDS than in non-AIDS patients (69% vs 30%) with cryptococcal meningitis. 4,10 In addition, culture-proven cryptococcal meningitis could occur in the presence of normal initial CSF findings in immunocompromised patients.…”

“…2,8 Differences in the incidence of some signs and symptoms were noted between non-AIDS and AIDS patients: headache (87% vs 81%), fever (60% vs 88%), mental status changes (52% vs 19%), meningeal signs (50% vs 31%), photophobia (33% vs 19%), and seizures (15% vs 8%). Since 10% of non-AIDS or AIDS patients were asymptomatic, it is recommended that the CSF be examined in any patient with extraneural cryptococcosis.…”

“…9 However, the cephalic CT is recommended in suspected cases with cryptococcal meningitis to ascertain the presence of mass lesions, granulomas, edema or hydrocephalus, especially since the CNS involvement can present in various ways: subacute or chronic meningitis, encephalitis, focal brain or spinal cord lesions. 2,9 The routine examination of CSF usually suggests a chronic lymphocytic meningitis. Generally, the CSF findings in non-AIDS patients are similar to those in AIDS patients.…”

“…These include india ink smear, culture and antigen detection that show positivity in 60%, 75%, and 95% respectively in initial CSF examination. 2,12,13 Mortality in untreated cryptococcal meningitis reaches 86% as compared to 20% to 25% in patients treated with antifungal agents. 8 A six-week course of amphotericin-B has been the regimen of choice since 1951.…”

Opportunistic Infections in HIV‐Infected Patients

“…In a frequently cited study conducted in the pre-AJDS era, the combination of amphotericin B plus flucytosine was more effective than amphotericin B alone (69). This study has been criticized, however, because of the low dosage of amphotericin B chosen in both arms, and because the efficacy of the amphotericin B monotherapy arm was lower than historic controls (70). A similar trial has not been conducted in AIDS patients.…”