What is the prognosis of CNS cryptococcosis in HIV infection?

Updated: Jan 08, 2020
  • Author: Felicia J Gliksman, DO, MPH; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

CNS cryptococcosis is fatal unless treated. Several studies report acute mortality rates of 6-14%. A minority of patients die within the first 6 weeks after diagnosis, despite treatment. Those who survive usually live for longer than 18 months. In addition, the rate of relapse after treatment is high (30-50%).

Predictors of poor prognosis are controversial, but reportedly they have included the following:

  • High CSF cryptococcal antigen titer (>1:1024)

  • Minimal CSF pleocytosis

  • Altered mental status at presentation

  • Positive India Ink preparation

  • Hyponatremia

  • Positive cultures from extrameningeal sites


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