Olfactory pathways in three patients with cryptococcal meningitis and acquired immune deficiency syndrome

The olfactory mucosa, bulbs and tracts were examined for the presence of Cryptococcus neoformans in 3 patients with the acquired immune deficiency syndrome (AIDS) and cryptococcal meningitis. Two of them had antibodies against HIV-1 and one had positive serology for HIV-2. Cryptococci were seen in the subarachnoid space around olfactory tracts and bulbs and in the submucosal olfactory nerve fascicles. In one case, olfactory nerve fascicles from the lamina propria were also affected. Olfactory epithelium and respiratory mucosa were not involved. We suggest that Cryptococcus reached the olfactory nerve fascicles through the olfactory pathways for cerebrospinal fluid drainage which might serve as a source of latent cryptococcal infection.