HIV-infected patients with cryptococcal meningitis complain of fever, headache, nausea and vomiting, and cognitive dysfunction. CMV-induced disease represents reactivation of latent infection. CMV encephalitis presents with acute or subacute confusion, disorientation, and memory loss, and tends to have a more rapid progression than HIV dementia. A major advance in the early diagnosis of CMV encephalitis and radiculomyelitis is the detection of CMV DNA in cerebrospinal fluid. The development of PCR evaluation of the CSF for CMV has facilitated early and more definitive diagnosis.
Treatment is with ganciclovir or forscarnet, and in severe cases double therapy.