UMEM Educational Pearls

Category: Neurology

Title: Cryptococcal Meningitis in Immunocompetent Patients

Keywords: Cryptococcus neoformans, cryptococcosis, meningoencephalitis (PubMed Search)

Posted: 10/23/2019 by WanTsu Wendy Chang, MD
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  • Cryptococcal meningitis is the most common fungal CNS infection that predominantly affects immunocompromised patients.
  • However, cases have been described in immunocompetent patients.
  • Clinical presentation may include headache, fever, neck pain, nausea, vomiting, light sensitivity, seizure, or altered mental status.
  • Neuroimaging is usually normal, though cryptococcomas, pseudocysts, and obstructing hydrocephalus can be seen.
  • Diagnosis with LP include elevated opening pressure, mononuclear predominance of cell count, low glucose, high protein, India ink microscopy, Cryptococcal antigen testing, and CSF culture.
  • Subacute symptoms contribute to delay in diagnosis which increases overall morbidity and mortality.

Bottom Line: Consider cryptococcal meningitis even in immunocompetent patients.