Characterization of a group of patients with cryptococcosis of the central nervous system

INTRODUCTION: Incidence of cryptococcosis of the central nervous system has risen sharply since AIDS became pandemic; from early 1998, the Instituto de Neurologia y Neurocirugia in Havana has beaten its own record in the number of cases attended. AIM: To describe the clinical epidemiological characteristics of patients with this disease who were hospitalised in this centre between 1991 and 2000. PATIENTS AND METHODS: We present a descriptive study of 16 adult individuals who were admitted for this reason. Data on variables related with aspects concerning their epidemiology, clinical features, treatment and evolution were collected from a review of the clinical records and a survey conducted by post. RESULTS: It was found that in no cases did the disease appear as an epidemic outbreak, in 75% of the patients there was some kind of link with pigeons, none of the patients were HIV positive, and 50% displayed other causes of immunosuppression. Clinical behaviour varied and forms of meningitis and meningoencephalitis were prevalent; 37.5% of the patients displayed mild forms of the disease and 62.5% had more serious forms. The initial symptom in most cases was headache. The most constant CSF pattern was a raised protein level in the cerebrospinal fluid with scarce cellularity. 87.5% of the patients were cured of the disease by treatment involving amphotericin B, in some cases associated with fluconazole. Death and the presence of post treatment sequelae were observed in patients with serious clinical forms and late diagnoses