0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37
Cryptococcus Neoformans 427➣Mild/nonspecific symptoms or CNS-referable
➣Headache, nausea, dizziness, irritability, somnolence, clumsi-
ness, confusion, or obtundation all possible
➣Some HIV-positive pts may be asymptomatic
➣Seizures late finding
➣Physical findings non-specific: afebrile or mild temp to 39C, min-
imal to no nuchal rigidity
➣Papilledema 1/3, CN palsies 1/5
➣Mortality lower with var. gatti, but long-term neurologic sequelae
more common
■Pulmonary:
➣Asymptomatic or scant, blood-streaked sputum
➣HIV-positive pts: 5–25% with cryptococcus have cough and dys-
pnea
➣Rales or pleural friction rub uncommon, empyema extremely
rare
➣Nonimmunosuppressed: pulmonary cryptococcosis may pro-
gress/regress or remain stable for long periods
➣AIDS: cryptococcal pneumonia can be severe, rapidly progressive
(42% acute-phase mortality)
■Other sites:
➣Skin lesions 5–10% of patients, painless on face or scalp – often
ignored but frequently first signs of infection
➣In AIDS patients, skin lesions may resemble molloscum conta-
giosumtests
Laboratory
■No abnormalities in CBC, ESR
■CSF examination
■Always measure opening pressure
■Glucose usually low to very low
■Protein increased
■Leukocyte counts usually 20/mm^3 or higher with lymphocyte pre-
dominance
■In end-stage AIDS, low to absent CSF pleiocytosis possible, carries
grave prognosis
■Microbiology – culture
➣India ink examination of fluid NOT reliable, many HIV patients
have organisms that have hard to see or non-existent capsules
➣CSF, negative cultures do not rule out disease