Cryptococcosis physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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 with ulcerations. Rales can be heard on auscultation in pulmonary cryptococcus infection.
Physical Examination
General appearance of patient
- Patient may look distressed
- 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 and may indicate increased intracranial pressure.
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:[1]
- Postive kernig's sign indicate 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:[2]
- 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). [3]](/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). [3]
![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). [3]](/index.php/File:Cryptococcosis05.jpeg)
References
- ↑ 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)".