Cryptococcosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

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Overview

Physical examination findings in patients with cryptococcal meningitis include fever, nystagmus, papilledema and cranial nerve deficits. Cutaneous Cryptococcal infection will demonstrate erythematous papules, pustules, nodules, and ulcers. Rales can be heard on auscultation in pulmonary cryptococcus infection.

Physical Examination

General appearance of patient

• Patient may be in distress
• 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.

Neck

• Neck stiffness is strongly suggestive of meningitis.

Skin

Erythematous papules, pustules and ulcers may be present on examination.

Heart

• Decreased heart rate indicates increased intracranial pressure

Neuromuscular

• 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 instability may be present

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).