Cryptococcosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Physical Examination

General appearance of patient

• Patient may look distressed
• Altered mental status

Vitals

Temperature

• A low grade fever is often present

HEENT

• Nystagmus may be present.
• Extra-ocular movements may be abnormal
• Ophthalmoscopic exam may be abnormal with signs consistent with papilledema and may indicate increased intracranial pressure.
• Inflamed sinuses with facial tenderness in some cases.
• Signs of infection indicating sinusitis, mastoiditis, and otitis media may help identify the source of infection and give a clue about diagnosis.

Neck

• Neck stiffness is strongly suggestive of meningitis.

Heart

• Decreased heart rate indicates increased intracranial pressure

Neuromuscular

• The mental status is usually intact
• Muscular strength is usually intact, but focal deficits might be present
• Sensation is usually intact, but focal deficits might be present
• Hyperactive reflexes may be present
• Deficits in cranial nerves might be present: decreased vision acuity, facial muscle weakness, decreased hearing (CN VIII), and diplopia
• Gait might be altered

Special tests

Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:

• Kernig's sign

• Postive kernig's sign indicate meningitis.

• Brudzinski's sign

• Positive brudzinski's sign may suggest meningitis

• It should be noted that Kernig's sign and brudzinski's sign are not typically present in fungal meningitis.
• Jolt accentuation:

• Exacerbation of headache by moving head in horizontal direction two to three times indicate positive test.

Gallery

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  Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus, Cryptococcus. From Public Health Image Library (PHIL).