In patients with AIDS, what is a common manifestation of cryptococcal infection?

In patients with AIDS, cryptococcal infection most commonly presents as meningoencephalitis. This occurs because the fungus Cryptococcus neoformans has a strong affinity for the central nervous system, especially in immunocompromised hosts such as those with HIV/AIDS. The infection typically manifests with symptoms such as headache, fever, nausea, and signs of meningeal irritation due to the inflammation of the meninges.

The pathogenesis involves the inhalation of aerosolized yeast cells, which can disseminate hematogenously to the CNS. Once in the brain, cryptococci can lead to an inflammatory response that results in elevated intracranial pressure and a potentially life-threatening condition if not treated promptly.

Other manifestations of cryptococcal infections, while they may occur, are less frequent in patients with advanced immunosuppression. For example, pneumonia may occur but is rarer compared to the central nervous system involvement. Skin lesions and bone pain can also happen but are not classic presentations for cryptococcal infection in the context of AIDS. The hallmark and most critical manifestation that clinicians monitor for in such patients is meningoencephalitis, making it the most recognized and significant concern.