What are the signs and symptoms 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

Signs and symptoms at onset may be nonspecific and include the following:

  • Headache (73-81%)

  • Fever (62-88%)

  • Malaise (38-76%)

  • Nausea and vomiting (8-42%)

  • Stiff neck (22-44%)

  • Visual disturbances (30%)

  • Altered mental status with somnolence (18-28%)

  • Photophobia (19%)

  • Papilledema (10%)

  • Cranial neuropathies, including nystagmus and amblyopia (6%)

Occasionally, patients may experience focal neurologic symptoms or seizures. Focal signs may indicate that the infectious meningeal process has reached superficial layers of the cortex and cerebellum, or they may point to cryptococcomas (ie, cryptococcal abscesses), most commonly in the basal ganglia and cerebellum (see the images below).

Magnetic resonance imaging showing a cryptococcoma Magnetic resonance imaging showing a cryptococcoma in the medulla.
Coronal section of brain showing a cryptococcoma i Coronal section of brain showing a cryptococcoma in the basal ganglia.

Mental status changes include confusion, psychomotor retardation, irritability, agitation, personality changes, and psychosis. Nuchal rigidity may be absent because of minimal inflammation.

Hydrocephalus must be suspected with new-onset impaired consciousness, motor signs, nausea, vomiting, or visual impairment. This usually occurs late in the course of cryptococcosis.

Bilateral visual loss also can result from arachnoiditis at the level of the optic nerves or cryptococcal invasion of the optic nerve. Occasionally, symptoms and signs of a radiculomyelopathy predominate because of spinal cord involvement. Patients may have radicular pain, stiffness or spasticity, limb weakness, sphincter disturbances, loss of sensation, and weakness.


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