Cosmopolitan cryptococcal meningoencephalitis

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Abstract
Cryptococcosis is commonly perceived as a disease of the immunocompromised patient, yet cryptococcal meningoencephalitis is also a significant cause of serious illness in immunocompetent individuals, particularly in the tropics and sub tropics. The two biotypes of Cryptococcus neoformans, var. neoformans and var. gattii are recognised as causing most cryptococcal disease. The ecology and epidemiology of C. neoformans var. gattii is not yet fully resolved. The application of molecular typing may help to clarify these issues and be used to investigate the similarities between environmental and clinical isolates. The intriguing link of cryptococcosis with certain species of Eucalyptus tree warrants further investigation. Immunological research is gradually unravelling details of the host-Cryptococcus interaction and may eventually lead to new vaccines for immunisation of susceptible populations and novel modes of cytokine treatment. Clinical studies are raising new questions as to the virulence of the two biotypes of Cryptococcus neoformans as well as testing new agents and regimens for treatment.

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