The definitive diagnosis of cryptococcal meningitis is made by culture from the CSF. Some patients can also present as a disseminated disease. Generally, headache, lethargy, personality changes, and memory loss can appear over 2 to 4 weeks. Some patients have symptoms for up to 2 to 8 months before diagnosis while others can present an acute illness in a few days. In patients with heavy infections, organ dysfunction may be accelerated, primarily due to tissue distortion caused by the growing fungal burden. There can be little or no necrosis or organ damage until later disease. This neurotropism is linked to several cryptococcal-specific factors which facilitate the permeability of the blood-brain barrier between them, metalloproteinases and ureases enzymes cause neuromodulation and mechanisms facilitate survival in the nutrient-deprived environment of the brain (autophagy and high-affinity sugar transporters). have a strong affinity for the central nervous system. While all organs can be involved, Cryptococcus spp. Possibly, the eradication of Cryptococci relies on natural killer cells and antibody-dependent cell-mediated killing.
The host response includes both cellular and humoral components. neoformans in this extracellular environment is glucosylceramide synthase. The essential factor in the survival of C. After being deposited into the pulmonary alveoli, the yeast spores must survive the normal to high pH and the physiological concentrations of carbon dioxide before they are phagocytized by alveolar macrophages, a more acidic environment, and disseminated after a latent period of containment in the lung lymph nodes.
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