Cryptococcosis of the central nervous system. A report of five cases

INTRODUCTION: Since the 1980s, in relation to the spread of AIDS, there has been an enormous increase in cryptococcosis, a mycotic disorder which usually affects the central nervous system (CNS). This disease is caused by Cryptococcus neoformans, a microorganism acquired by inhalation of bird excrement. This germ produces a capsule which protects it from phagocytosis, can synthesize melanin which acts as an antioxidant of the cytotoxic lymphocytes and can reproduce at body temperature. Clinically it may show as chronic or subacute meningitis and/or encephalitis, as endocranial hypertension or as an intracranial space occupying lesion (crytococcoma). To establish the diagnosis, Chinese ink, culture and the latex agglutination test are useful. Treatment is with amphotericin B associated or not with fluocytokine and fluconazole, the protocol used depending on the clinical form. OBJECTIVE: To review the most up-to-date literature on cryptococcosis of the CNS to study the condition in relation to five cases. CLINICAL CASES: We report five patients with cryptococcosis of the CNS diagnosed and treated in the Instituto Nacional de Neurologia y Neurocirugia de la Habana, Cuba, showing an increase in the frequency of the occurrence of cases not related to HIV infection, great variety of clinico-humoral presentation and the characteristics of the treatment given. CONCLUSION: Cryptococcosis can be cured completely when the condition is diagnosed early; without treatment it is invariably fatal.