Cryptococcosis physical examination

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.

• Patient may be in distress
• Altered mental status

Temperature

• A low grade fever is often present

• 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 stiffness is strongly suggestive of meningitis

Erythematous papules, pustules, and ulcers may be present on examination^[2]

• Decreased heart rate indicates increased intracranial pressure^[3]

• 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

Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:^[5]

• Kernig’s sign^[5]

• Postive Kernig’s sign indicates meningitis.

• Brudzinski’s sign^[5]

• 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

• 
  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]