Clinical Presentation

This fungus has a strong predilection for the central nervous system, causing meningitis and, occasionally, brain abscesses. Patients present subacutely with low-grade temperature, headache, and altered mental status. Signs of frank men-ingismus are usually absent. Alternate presentations include pulmonary disease with pneumonitis, nodules, and lung abscess; soft tissue, skin or joint infection; and fever of unknown origin.

The diagnosis of cryptococcosis is made by the detection of antigen in serum and CSF. Examination of the CSF is required in any transplant recipient who presents with cryptococcal infection from any site. With meningitis, the CSF analysis demonstrates lymphocytic pleocytosis, elevated protein, and low glucose; the opening pressure is elevated. Fungal cultures of CSF and blood should be performed.

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