Vestibular dysfunction due to cryptococcal meningitis

Cryptococcal Meningitis: Implications for the Otologist

“…Neck stiffness, meningism, neuropathy, visual disturbances, and a decrease in mental status are less common [1]. Because of its frequently mild and nonspecific presentation, the diagnosis is often delayed [4], averaging 31 days [5].…”

“…Cultures are highly reliable, being positive in 95% of the patients, although staining with Indian ink identified only 57%. Demonstration of cryptococcal antigen by the latex agglutination test has a sensitivity of up to 100% [1]. Without treatment, cryptococcal meningitis is almost inevitably fatal.…”

“…The nature of hearing loss can be fluctuating [1], the degree of loss varying from unilateral moderate to bilateral profound [1,4], and possibly reversible [7]. As illustrated in this case, the difficulty in arriving at an early diagnosis can result in the patient being treated for idiopathic sudden hearing loss with steroids which can potentially aggravate the unrecognized infection [4].…”

“…This opportunistic infection is favured by compromised cell-mediated immunity in the host, with 30-73% of all patients having underlying disease altering resistance to infection [1], especially patients with AIDS. Chronic respiratory disease, steroid therapy, malignancy, diabetes, and reticulosis are recognized associations of cryptococcosis [2].…”

“…Human beings are infected through inhalation of the organism which can then spread to extrapulmonary sites by the hematogenous route [3]. The organism has a high affinity for the central nervous system [1] which can result in meningitis. Cryptococcal meningitis can cause cochleovestibular damage with features distinctly different from those of bacterial meningitis.…”