CNS Cryptococcus in Patients without HIV

Cryptococcus is frequently seen in patients with AIDS, but can also be seen in patients without HIV/AIDS, and in fact is not even rare.  The most common patients without HIV who are at risk for Cryptococcus are patients on immunosuppressive drugs, patients with diabetes, patients with cancer, and patients with lupus.  Some common presentations of CNS Cryptococcus can be very vague, such as headache, altered mental status, lethargy, and nausea and vomiting.

These patients with Cryptococcal meningitis often do not have a fever or elevated white blood cell count and may not have meningismus.  Headache is the most common symptom at presentation.  Sometimes the patients have no symptoms at all.  But, once a patient has onset of symptoms, death can occur in as little as 2 weeks if not diagnosed and treated with amphotericin B followed by fluconazole. If a blood culture comes back positive for Cryptococcus neoformans, the patient likely has extensive disease.

This disease can be so indolent that one must have a high degree of suspicion to test for the disease.  However, doing so can save lives.