Cryptococcal meningitis

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By Joseph R Berger MD

Cryptococcal meningitis is also known as or subsumes Cryptococcoma and Cryptococcal meningoencephalitis. -ed.

Cryptococcal meningitis is the most common form of meningitis observed in AIDS, affecting 1% to 10% of HIV-infected persons. Other immunosuppressive conditions also predispose to its development, such as corticosteroid administration; however, it may also be seen in immunologically normal persons. Cryptococcal meningitis may be difficult to diagnose as its clinical features are often subtle. Headache is the most common of symptoms, but it is not universally present and papilledema occurs in less than one third of persons. On occasion, cryptococcal infection of the CNS presents as mass lesion in the brain (cyst, granuloma, or abscess) or as encephalitis. The toxicity of the antifungal drugs, particularly, amphotericin may render treatment difficult. In the AIDS population, long term prophylaxis may be required.

Key Points

  • Cryptococcal meningitis is the most common fungal meningitis and needs to be considered in the differential diagnosis of anyone with unexplained meningitis.
  • Although meningitis is the most common neurologic manifestation of cryptococcal infection, CNS mass lesions and vascular insults may also occur.
  • Cranial imaging studies either with CT scan or MRI in patients with cryptococcal meningitis may be unrevealing.
  • CSF cryptococcal antigen studies are typically, but not invariably, positive in cryptococcal meningitis.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited