44 CNS Infections

Cryptococcus

• thick capsule evade immune system

• meningitis

• Egyptian crypt for cryptococcus
• coffins: Yeast are round and heavily encapsulated
• repeating pattern on coffin: Cryptococcus capsule has a repeating polysaccharide capsular antigen. Main virulence factor for antiphagocytes
• NH3 spray bottle: Urease positive
• pigeons with droppings. Archaeologists coughing: Cryptococcus is inhaled from soil and/or pigeon droppings. Settles in lungs
• cane: Immunocompromised (HIV)

• different from bacterial (abrupt onset)
• important: raise ICP, risk of herniation

• archaeologists coughing: Pulmonary Crypto causes cough and dyspnea
• Neck brace: Can cause cryptococcosis, a fungal meningitis. Most common cause of fungal meningitis
• sweating: fever
• frogs, pinecone, with flute: flucytosine/amphoterecin B joint treatment with maintenaince fluconazole

• soap bubbles on lung: Diagnose with a microscopic exam of bronchopulmonary washing
• red and silver stripes: Diagnosis of pulmonary Crypto can be aided by mucicarmine or methenamine silver stain
• vase with bubbling tar: India Ink test can diagnose Crypto meningitis with lumbar puncture/CSF. Background dark, transparent organism
• latex gloves next to repeating patterns: Latex agglutination test detects polysaccharide capsular antigens and causes their agglutination

• soap bubbles on head: Causes "soap bubble" lesions in gray matter

PML