Rarely, pyelonephritis occurs with renal papillary necrosis development. Besides skin lesions, focal lesions in bone, abdominal viscera, or other tissues usually cause little or no symptoms. Most symptoms of cryptococcal meningitis are attributable to brain swelling and are usually nonspecific, including headache, blurred vision, confusion, depression, agitation, or other behavioral changes. Except for ocular or facial palsies, focal signs are rare until relatively late in the course of infections. Blindness may develop due to brain swelling or direct involvement of the optic tracts.
Fever is usually low-grade and frequently absent.
AIDS patients may have minimal or no symptoms and completely normal CSF parameters except for the presence of many yeasts. However, elevated CSF protein and a mononuclear cell pleocytosis are usual, although neutrophilia occasionally predominates. Glucose is frequently low, and encapsulated yeasts forming narrow-based buds can be seen on India ink smears in most cases. Diagnosis Culture is definitive. The diagnosis is strongly suggested by identification of encapsulated budding yeasts by experienced observers in smears of body fluids, secretions, exudates, or other specimens.