Many of the symptoms of cryptococcal meningitis are similar to those seen in other diseases. These include: fever, fatigue, stiff neck, body aches, headaches (often severe), nausea/vomiting, and skin lesions. Other important symptoms include confusion, muddled thinking, vision problems, and possibly seizures.
People diagnosed with cryptococcal meningitis often have symptoms of infection outside the brain. This includes coughing and shortness of breath, from infection in the lungs, and skin lesions that can look like another infection called molluscum contagiosum. It is always advisable for HIV-positive people to report any symptoms, now matter how mild, to their health-care provider.
There are two ways to diagnose cryptococcal meningitis. The first involves looking for the fungus in the bloodstream. This is nothing more than a simple blood test. The second, most common way to diagnose cryptococcal meningitis involves the liquid—the cerebrospinal fluid (CSF)—that surrounds the brain and the spine. To collect this fluid, a doctor or a technician must perform a lumbar puncture, also called a spinal tap. Once a small amount of CSF has been removed from the spine, a laboratory can look for Cryptococcus neoformans in the fluid. A spinal tap is also done to check the amount of pressure in the brain. Because cryptococcal meningitis can cause the brain to swell, the pressure of the CSF can increase. Knowing the CSF pressure can help determine how severe the disease is. If the pressure is extremely high, additional CSF might be drained to ease symptoms and prevent damage to the brain.
This is what is involved in a spinal tap:
1) Your lower spine, just above your hips, will be punctured with a hollow needle. Your lower back will be cleaned and a local anesthetic (e.g., Novocain) will be injected near the site of the puncture.
2) You will lie on your side with your back to the person performing the test. You will be asked to bring your knees up to your abdomen and to bend your forehead toward your knees. Alternatively, you will be asked to sit up, with your knees tucked under your chin and your head dropped into your chest.
3) The needle is inserted through your lower back into the spinal column. You may feel a "pop" but, generally speaking, it is not painful. It is very important that you take deep breaths to keep yourself relaxed and that you remain perfectly still.
4) It takes approximately five minutes to remove enough CSF for analysis.
5) To check the pressure of the CSF, the person conducting the spinal tap will attach a machine called a manometer to the needle.
6) If you experience discomfort, you should communicate this to the person performing the test—without moving—so that he or she can reposition the needle.
7) After the spinal tap is completed, you will be asked to lie on your back for 15 to 30 minutes. Less than 1% of people experience a severe headache due to the movement of the CSF during a spinal tap.
Some doctors also request brain scans using magnetic resonance imagining (MRI). This is usually done before a spinal tap to check for other diseases than can cause symptoms similar to cryptococcal meningitis.