Cryptococcus Meningitis, in the Patients with Human immunodeficiency Virus Infection

AIDS have given more importance to cryptococcosis,which was discovered a century ago.Cryptococcus neoformans is the most frequent cause of meningitis in HIV infected patients. Cryptococcus can infect any organ in the human body, the frequent sites are lung,CNS,skin,eye and prostrate The impact of capsular polysaccharide,melanin and ability to grow at higher temperature, in host immunity can be profound at pathophysiologic levels.Cryptococcal meningitis presentation in AIDS patients may be very subtle, with headache,fever,and lethargy. Meningeal signs occurs in some patients, photophobia and cranial nerve palsies are often absent, most patients have CD4 T-cell lower than 50 cells/l.African patients have higher rate of neurologic compromise. Strong cellular immune response producing granulomatous inflammation is essential for containment of infection. Pathophysiology of cryptococcosis is similar to reactivation of tuberculosis, and histoplasmosis.Diagnostic methods include, direct microscopic examination by India ink mixing of biologic fluids, detection of polysaccharide antigen and a positive blood culture. Treatment of choice in AIDS patients with cryptococcal meningitis with amphotericin B with flucocytosine or fluconazole for 4 to 6 weeks Monotherapy cannot be recommended for the treatment of this infection.