CRYPTOCOCCAL DISEASE OF THE CNS IN IMMUNOCOMPETENT HOSTS - INFLUENCE OF CRYPTOCOCCAL VARIETY ON CLINICAL MANIFESTATIONS AND OUTCOME

We performed a retrospective review of cases of cerebral cryptococcosi s among patients admitted to 12 Australian teaching hospitals between 1985 and 1992. Of 118 cases identified, 35 occurred in immunocompetent hosts. When cases due to Cryptococcus neoformans variety neoformans w ere compared with those due to Cryptococcus neoformans variety gattii, we found that the latter tended to occur in healthy hosts whose resid ence or job was located in a rural area, and cerebral mass lesions and /or hydrocephalus and pulmonary mass lesions were more common. For a s ubgroup of patients with infection due to C. neoformans variety gattii , multiple enhancing lesions were observed on cerebral computed tomogr ams, and papilledema, high CSF and serum cryptococcal antigen titers, and a worse prognosis (despite prolonged amphotericin B therapy and in traventricular shunt insertion) were also noted. No significant differ ence in clinical course or outcome in terms of variety of C. neoforman s was noted for patients with cryptococcal meningitis whose computed t omographic scans appeared normal on presentation.