Cryptococcal meningitis is a sub-acute meningitis causes by inhalation of cryptococcal spores. It is more common in immunosuppression states such as HIV/AIDS with CD4 count of less than 100, malignancy such as lymphoma and leukemia, patients on chemotherapy and immunosuppressant [1]. The most common species are cryptococcal neoformans neoformans, cryptococcal neoformans grubii and cryptococcal gattii [1]. Recently cryptococcal gattii has been implicated in some epidemic cases in immunocompetent patients but there are also some sporadic cases reported in literature [2].

Human gets infected by inhaling the basidiospore which is small desiccated yeast with small polysaccharide capsule which makes it easy to be deposited in the alveoli and terminal bronchioles [3].

In immunocompetent individuals the yeast is engulfed by macrophages forming a small granuloma/hilar lymphadenopathy, in most of the cases the infection is cleared [4]. Some patient develops symptomatic focal pneumonitis presenting with a cough, sputum production, hemoptysis, dyspnea, chest pain, fever, malaise, night sweats, and weight loss [5]. Less commonly the patients may have a rash and gastrointestinal symptoms and very rarely superior vena cava obstruction and Pancoast syndrome due to a granulomatous extension to the apex of the chest wall [6].

In Immunocompromised individuals such as stem cell and solid organ transplantation, HIV infection, malignancies, cirrhosis, renal failure, chronic lung,  Cushing's syndrome, sarcoidosis, and treatment with glucocorticoids or tumor necrosis factor-alpha antagonists  reactivation of latent infection may occur and result in disseminated extra pulmonary infection to the skin and central nervous system [7,8].

Cutaneous manifestations are seen in 15% of patients with disseminated infection; which present as papules, plaques, purpura, ulcers, cellulitis, superficial plaques, abscesses, and sinus tracts [9].

Dissemination to the central nervous system will cause inflammation of the meninges, brain matter and granuloma formation in the brain parenchyma resulting in acute and subacute meningoencephalitis symptoms like fever, headache, vomiting, altered mentation and convulsions [7].

In Sub Saharan Africa majority of cryptococcal meningitis cases are HIV/AIDS associated due to burden of disease in this regions. Due to very low CD4+ T cells in HIV the individuals the immune system makes memory T- cells without exaggerated immune response. When the patients are initiated on ARV CD4+ cell increase and are activated through the memory cell to produce cytokines mostly interleukin-6(IL6), Interferon gamma (IFNγ) and TNF causing cryptococcal immune reconstitution syndrome (cIRIS) [10].

But because there is a direct synapse of Activated T-cells and macrophages in HIV positive individuals this results in a better antigen clearance compared to HIV negative individuals. In contrast, the HIV negative individuals with the cryptococcal infection present with a similar inflammatory response just after acquiring the infection termed as Cryptococcal post-infectious immune response syndrome (cPIIRS) [10].

The objective of this review is to describe the proportion of cryptococcal meningitis in immunocompetent patients, compare clinical presentation between immucompetent cases and immunocompromised cases and prognosis of infection. The knowledge of the difference in presentations between the two groups may guide management of cryptococcal meningitis.