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
- 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. Ophthalmoscopic exam may indicate increased intracranial pressure[1]
Neck
- Neck stiffness is strongly suggestive of meningitis
Skin
Erythematous papules, pustules, and ulcers may be present on examination[2]
Heart
- Decreased heart rate indicates increased intracranial pressure[3]
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[4]
- Gait instability may be present
Special tests
Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:[5]
- Postive Kernig's sign indicates meningitis.
- 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:[6]
- Exacerbation of headache by moving head in horizontal direction two to three times indicates a 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). [7]](/images/f/f3/Cryptococcosis05.jpeg)
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). [7]
![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). [7]](/index.php/File:Cryptococcosis05.jpeg)
References
- ↑ Kestelyn P, Taelman H, Bogaerts J, Kagame A, Abdel Aziz M, Batungwanayo J, Stevens AM, Van de Perre P (1993). "Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome". Am. J. Ophthalmol. 116 (6): 721–7. PMID 8250075.
- ↑ Christianson JC, Engber W, Andes D (2003). "Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts". Med. Mycol. 41 (3): 177–88. PMID 12964709.
- ↑ Kalmar AF, Van Aken J, Caemaert J, Mortier EP, Struys MM (2005). "Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy". Br J Anaesth. 94 (6): 791–9. doi:10.1093/bja/aei121. PMID 15805143.
- ↑ Fassbinder W (1989). "[Responsibilities of the internist in kidney transplantation]". Verh Dtsch Ges Inn Med (in German). 95: 515–26. PMID 2690522.
- ↑ Thomas KE, Hasbun R, Jekel J, Quagliarello VJ (2002). "The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis". Clin Infect Dis. 35 (1): 46–52. doi:10.1086/340979. PMID 12060874.
- ↑ Uchihara T, Tsukagoshi H (1991). "Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis". Headache. 31 (3): 167–71. PMID 2071396.
- ↑ "Public Health Image Library (PHIL)".