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Updated: Sep 27, 2026
Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Detection of Central Nervous System Pathogens
Published on: April 17, 2026
[Characterization of a group of patients with cryptococcosis of the central nervous system]
O Fernandez-Concepción1, C Fernández-Novales, M C Ariosa-Acuña
1Instituto de Neurologia y Neurocirugia, La Habana, Cuba. otmanfc@medscape.com
Insights
Central nervous system cryptococcosis cases increased, with most patients linked to pigeons but not HIV positive. Treatment with amphotericin B cured most, but severe cases and late diagnoses led to sequelae or death.
Area of Science:
- Infectious Diseases
- Neurology
- Epidemiology
Context:
- Central nervous system (CNS) cryptococcosis incidence has risen, particularly with the AIDS pandemic.
- The Instituto de Neurología y Neurocirugía in Havana has observed a significant increase in attended cases since 1998.
Purpose:
- To characterize the clinical and epidemiological profile of hospitalized CNS cryptococcosis patients between 1991 and 2000.
- To analyze patient demographics, clinical presentations, treatments, and outcomes.
Summary:
- A descriptive study of 16 adult patients revealed no epidemic outbreaks. 75% had contact with pigeons; none were HIV positive, but 50% had other immunosuppressive conditions.
- Clinical presentations included meningitis and meningoencephalitis, with headache as the most common initial symptom. Cerebrospinal fluid analysis often showed elevated protein and low cell count.
- Amphotericin B, sometimes with fluconazole, achieved an 87.5% cure rate. Severe forms and delayed diagnosis correlated with mortality and neurological sequelae.
Impact:
- Provides insights into the non-HIV associated cryptococcosis epidemiology and clinical spectrum in a specific region.
- Highlights the importance of early diagnosis and treatment for improving patient outcomes and reducing sequelae in CNS cryptococcosis.
- Informs clinical management strategies for cryptococcal meningitis and meningoencephalitis, particularly in immunocompromised individuals without HIV.
Introduction:
Incidence of cryptococcosis of the central nervous system has risen sharply since AIDS became pandemic; from early 1998, the Instituto de Neurología y Neurocirugía in Havana has beaten its own record in the number of cases attended.
Aim:
To describe the clinical epidemiological characteristics of patients with this disease who were hospitalised in this centre between 1991 and 2000.
Patients And Methods:
We present a descriptive study of 16 adult individuals who were admitted for this reason. Data on variables related with aspects concerning their epidemiology, clinical features, treatment and evolution were collected from a review of the clinical records and a survey conducted by post.
Results:
It was found that in no cases did the disease appear as an epidemic outbreak, in 75% of the patients there was some kind of link with pigeons, none of the patients were HIV positive, and 50% displayed other causes of immunosuppression. Clinical behaviour varied and forms of meningitis and meningoencephalitis were prevalent; 37.5% of the patients displayed mild forms of the disease and 62.5% had more serious forms. The initial symptom in most cases was headache. The most constant CSF pattern was a raised protein level in the cerebrospinal fluid with scarce cellularity. 87.5% of the patients were cured of the disease by treatment involving amphotericin B, in some cases associated with fluconazole. Death and the presence of post treatment sequelae were observed in patients with serious clinical forms and late diagnoses
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