| Element | Comment |
|---|---|
| At risk | Immunosuppression (organ transplant, lymphoma, steroid therapy, HIV/AIDS) |
| Suggestive clinical features | Insidious onset Neck stiffness absent or mild Papular or nodular skin lesions |
| CSF findings | Raised opening pressure High lymphocyte count (20–200/mm3) Protein and glucose levels usually only mildly abnormal Cryptococci may be seen on Gram stain India ink preparation positive in 60% CSF culture positive Cryptococcal antigen test positive (highly sensitive) |
| CT brain | Usually normal May show hydrocephalus May show mass lesions (∼10%) |
| Treatment | Amphotericin B plus flucytosine: seek expert advice |