PROGNOSIS AND TREATMENT 307 



Lesions of the Central Nervous System. The lesions consist of 

 areas of destroyed or dissolved tissue containing an abundance of 

 mucoid material and showing practically no inflammatory reaction. 

 The complete absence of leucocytes is very striking, though giant 

 cells may be formed. 



The parasite appears in the tissues as round, budding cells, sur- 

 rounded by a thick capsule of the mucoid material which is very 

 evidently secreted by the yeast and not formed by the tissues. These 

 yeast cells may be present in large numbers. In some cases they have 

 been demonstrated in the spinal fluid before death. The capsules 

 may be very clearly demonstrated by suspending some of the sedi- 

 ment from the centrifuged spinal fluid in a drop of India ink and 

 examining the fluid under the cover glass. The yeast cells may show 

 a marked variation in size. 



There appears to be an association between cryptococcosis and 

 Hodgkin's disease. The number of cases in which a concurrence of 

 the two diseases has been reported far exceeds what might be expected 

 on the basis of chance distribution. An adequate explanation for 

 this association has not yet been made unless it is that certain aspects 

 of cryptococcosis have been misdiagnosed as Hodgkin's disease. A 

 thorough search for Cnjptococcus neoformans in cases with the latter 

 diagnosis is indicated. 



Diagnosis. The differential diagnosis is made by the laboratory 

 demonstration of Cryptococcus neoformans in the lesions. In ulcers 

 the fungus is 2 to 15 microns in diameter. In spinal fluid the cells 

 are usually smaller and in many cases are difficult to demonstrate, 

 either because they are few and small or because they are mistaken 

 for normal host cells. Attempts to isolate C. neoformans in culture 

 from spinal fluid occasionally fail. This may be because of the 

 periodic disappearance of the fungus from the spinal fluid, since it 

 grows readily on acid dextrose (Sabouraud) agar and other usual 

 culture media, and if present and viable should grow readily. 



Prognosis and Treatment. The prognosis in cryptococcosis is very 

 grave. There are few reported cases of arrest or recovery but, as 

 with the other fatal mycoses, there is a probability that a mild un- 

 recognized form of the disease exists and that only the terminal 

 phases of the disease are known. 



Iodides and other chemotherapeutic agents effective in other my- 

 coses have not been useful. Symptomatic treatment, relief of pres- 

 sure by spinal taps, and supportive therapy have occasionally been 

 of benefit. There is some evidence that sulfadiazine is of value but 



