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Cryptococcosis

C. neoformans var. neoformans infection; C. neoformans var. gatti infection; C. neoformans var. grubii infection

 

Cryptococcosis is infection with the fungi Cryptococcus neoformans and Cryptococcus gattii.

Causes

 

C. neoformans and C. gattii are the fungi that cause this disease. Infection with C. neoformans is seen worldwide. Infection with C. gattii is mainly seen in the U.S. Pacific Northwest, British Columbia in Canada, Southeast Asia, and Australia. It is the more common fungus that causes the infection.

Both types of fungi are found in soil. If you breathe the fungus in, it infects your lungs. The infection may go away on its own, remain in the lungs only, or spread throughout the body (disseminate). Cryptococcosis is most often seen in people with a weak immune system, such as those who:

  • Are infected with HIV/AIDS
  • Take high doses of corticosteroid medicines
  • Cancer
  • Are on chemotherapy medicines for cancer
  • Have Hodgkin disease
  • Have had an organ transplant

C. gattii may affect people with normal immune system.

C. neoformans is the most common life-threatening cause of fungal infection in people with HIV/AIDS.

People between 20 to 40 years of age have this infection.

 

Symptoms

 

The infection may spread to the brain in people who have a weakened immune system. Neurological (brain) symptoms start slowly. Most people have swelling and irritation of the brain and spinal cord when they are diagnosed. Symptoms of brain infection may include:

  • Fever and headache
  • Neck stiffness
  • Nausea and vomiting
  • Blurred vision or double vision
  • Confusion

The infection can also affect the lungs and other organs. Lung symptoms may include:

  • Difficulty in breathing
  • Cough
  • Chest pain

Other symptoms may include:

  • Bone pain or tenderness of the breastbone
  • Fatigue
  • Skin rash, including pinpoint red spots (petechiae), ulcers, or other skin lesions
  • Sweating -- unusual, excessive at night
  • Swollen glands
  • Unintentional weight loss

People with a healthy immune system may have no symptoms at all.

 

Exams and Tests

 

The health care provider will perform a physical exam and ask about symptoms and travel history. The physical exam may reveal:

  • Abnormal breath sounds
  • Fast heart rate
  • Fever
  • Mental status changes
  • Stiff neck

Tests that may be done include:

  • Blood culture to differentiate between the two fungi
  • CT scan of the head
  • Sputum culture and stain
  • Lung biopsy
  • Bronchoscopy and bronchoalveolar lavage
  • Spinal tap to obtain a sample of cerebrospinal fluid (CSF)
  • Cerebrospinal fluid (CSF) culture and other tests to check for signs of infection
  • Chest x-ray
  • Cryptococcal antigen test (looks for a certain molecule that is shed from the cell wall of the Cryptococcus neoformans fungus into the bloodstream)

 

Treatment

 

Some infections require no treatment. Even so, there should be regular checkups for a full year to make sure the infection has not spread. If there are lung lesions or the disease spreads, your provider will prescribe you antifungal medicines. These medicines may need to be taken for a long time.

Medicines include:

  • Amphotericin B (can have severe side effects)
  • Flucytosine
  • Fluconazole

 

Outlook (Prognosis)

 

Central nervous system involvement often causes death or leads to permanent damage.

 

When to Contact a Medical Professional

 

Call your provider if you develop symptoms of cryptococcosis, especially if you have a weakened immune system.

 

 

References

Chan PA. Cryptococcosis. In: Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier; 2017: 333-333.e1.

Kauffman CA. Cryptococcosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 336.

Perfect JR. Cryptococcosis (Cryptococcus neoformans and Cryptococcus gattii). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 264.

Robles WS, Ameen M. Cryptococcosis. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 47.

 
  • Cryptococcus, cutaneous on the hand

    Cryptococcus, cutaneous on the hand - illustration

    These are cryptococcus skin lesions. Cryptococcus is a yeast (type of fungus) that seldom causes infection, but is considered opportunistic (it affects people with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections people with AIDS. .

    Cryptococcus, cutaneous on the hand

    illustration

  • Cryptococcosis on the forehead

    Cryptococcosis on the forehead - illustration

    This is an example of cryptococcus skin lesions on the forehead. Cryptococcus is a yeast (type of fungus) that seldom causes infection and is considered opportunistic (affecting individuals with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections in people with AIDS.

    Cryptococcosis on the forehead

    illustration

    • Cryptococcus, cutaneous on the hand

      Cryptococcus, cutaneous on the hand - illustration

      These are cryptococcus skin lesions. Cryptococcus is a yeast (type of fungus) that seldom causes infection, but is considered opportunistic (it affects people with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections people with AIDS. .

      Cryptococcus, cutaneous on the hand

      illustration

    • Cryptococcosis on the forehead

      Cryptococcosis on the forehead - illustration

      This is an example of cryptococcus skin lesions on the forehead. Cryptococcus is a yeast (type of fungus) that seldom causes infection and is considered opportunistic (affecting individuals with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections in people with AIDS.

      Cryptococcosis on the forehead

      illustration

    Tests for Cryptococcosis

     

       

      Review Date: 7/31/2016

      Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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