[Cryptococcosis of the central nervous system. Clinical and diagnostic characteristics].
BACKGROUND
Evaluation of the clinical features and diagnostic methods in the cryptococcosis of central nervous system (CNS), so as to facilitate a rapid recognition which may result in earlier diagnosis in view of the rapid increase in frequency shown in that condition.


METHODS
A retrospective study of 13 patients with CNS cryptococcosis seen during the last 4 years. The isolation of C. neoformans in CSF, cerebral biopsy or other appropriate tissue was required for inclusion. The following were evaluated: 1) Age, sex, and underlying disease; 2) Clinical features; 3) Yield of biochemical, microbiological, pathological and imaging diagnostic procedures; 4) Treatment and evolution.


RESULTS
Age (X +/- SD): 37 +/- 20 years (range: 15-81). Sex: 77% males. Underlying disease was identified in 10 cases (77%): HIV infection in 7 (54%), diabetes mellitus in 2, alcohol abuse in 2, systemic erythematous lupus on corticoid and immunosuppressant therapy in 1 and chronic liver disease in 1. Clinical features on admission: abnormal behaviour in 10 (77%), headache in 10, low/high grade fever in 9 (69%), abnormal consciousness in 7, respiratory features in 5 (38%); motor deficit, cranial nerve involvement and visual abnormalities in 4 (31%) each; and meningeal signs in 3. Investigation of CSF was carried out in 12 cases. The biochemical studies were normal in 5 (42%). China ink stain was positive in 55% of cases, and latex agglutination in 80%. CSF culture was diagnostic in 92% of cases and the culture for C. neoformans was positive in 2 cerebral and one pulmonary biopsies and in two urine cultures. All patients were treated with amphotericin B and flucytosine was associated in 9. Two patients were subsequently treated with fluconazole. The outcome was good in 8 patients, and 4 had sequelae. One case relapsed.


CONCLUSIONS
1) HIV infection is the most common underlying disease. 2) There is a high rate of CNS cryptococcosis with normal CSF or with mild biochemical abnormalities. 3) The yield of the microbiological studies of CSF is high, with diagnostic confirmation in 92% of cases. 4) Differences in CNS cryptococcosis were not found between cases with HIV infection and those with other underlying diseases.
Jiménez-Mejías
M E
ME
Unidad de Enfermedades Infecciosas (Departamento de Medicina Interna), Hospital Universitario Virgen del Rocío, Sevilla.
Fernández
A
A
Alfaro
E
E
Regordan
C
C
Pachón Díaz
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002493:Central Nervous System Diseases / Q000382:microbiology*; D003453:Cryptococcosis / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Criptococosis del sistema nervioso central. Características clínicas y diagnóstico.