RT Book, Section A1 Raffanti, Stephen P. A1 Person, Anna K. A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181057388 T1 Cryptococcal Infections T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessmedicine.mhmedical.com/content.aspx?aid=1181057388 RD 2024/03/28 AB Cryptococcus neoformans is the most common cause of meningitis in patients with HIV/AIDS. Cryptococcal meningoencephalitis typically manifests itself in patients whose CD4 cell counts are less than 50/mm3. The onset tends to be insidious with fairly nonspecific symptoms such as fever, nausea, and headache. Symptoms may be present for several weeks, and diagnostic delay is common. Seizures or focal neurologic presentations are rare, and neck stiffness and/or photophobia are usually absent. Diagnosis is usually made on examination of cerebrospinal fluid (CSF). Opening pressures may be quite elevated on LP, and CSF values usually reveal a normal CSF glucose concentration, a mildly elevated CSF protein concentration, and a CSF leukocyte count of less than 20/mL. India ink staining shows the organisms directly with an approximate sensitivity of 70%, whereas CSF cryptococcal latex antigen testing has a sensitivity approaching 90%. Fungal CSF cultures should also be sent. Cutaneous manifestations are seen in disseminated disease.