It is possible that new highly active antiretroviral therapies change these recommendations for lifelong suppressive therapy, but studies of this idea are needed. CNS lesions may be managed by surgical excision. The tissue reaction is initially a myxoid degeneration with the area of inflammation assuming a gelatinous appearance. Large numbers of round yeast cells are found in the mucoid matrix. As the lesion progresses, a granulomatous reaction ensues.
Organisms decrease numerically and are usually found in giant cells and histiocytes.
In old healed granulomata, the yeasts are usually dead with disintegrated capsules. The yeasts are round, typically encapsulated, and 5-15 um in diameter. The blastoconidia are attached by a narrow neck. The capsules stain pink by the mucicarmine technique. A capsule may or may not be present.