The Poor Prognosis of Central Nervous System Cryptococcosis among Nonimmunosuppressed Patients: A Call for Better Disease Recognition and Evaluation of Adjuncts to Antifungal Therapy

We describe 9 nonimmunosuppressed patients with central nervous system cryptococcosis. Morbidity and mortality were high, especially among patients with cerebral infarcts. This was attributed to delayed diagnosis and apparent se-quelae of overwhelming host immune responses. We present clues suggesting the diagnosis. Increased recognition and timely diagnosis of this condition may improve outcomes. CNS cryptococcosis is a common fungal infection among im-munocompromised patients, especially among those with cell-mediated immune dysfunction, but it is rare among immu-nocompetent hosts. We recently encountered 9 cases of CNS cryptococcosis in nonimmunosuppressed hosts. The majority of the patients died, and the remaining experienced neurolog-ical sequelae. In this report, we review our experience at the University of Florida (Gainesville) from 1997 through January 2005. Results. Four of the patients had been previously healthy, and 3 only had hypertension. One patient had asymptomatic hepatitis C virus infection. The final patient had an indwelling ventriculoperitoneal shunt in place for 38 years (table 1). The median time from the onset of symptoms to diagnosis of CNS cryptococcosis was 44 days (range, 7 days to 1 year). Only 2 patients (patients 2 and 6) had the diagnosis of CN