Cryptococcosis
A cosmopolitan fungal infection due to Cryptococcus neoformans.
Epidemiology
Annual incidence has been estimated at between 1/5,000 and 1/50,000 depending on the geographic region. Immunodeficient patients are the main target.
Clinical description
Primary pulmonary cryptococcosis is usually asymptomatic, but disseminates throughout the organism, particularly to the central nervous system causing subacute meningoencephalitis. Mucocutaneous infection is frequent.
Etiology
C. neoformans is an encapsulated yeast that reproduces by budding. It is abundant in the ground, in fruit, milk, and pigeon droppings. Infection is acquired via the respiratory or digestive route, rarely through the skin, and disseminates in the organism by blood or the lymphatic system. Interhuman transmission does not occur.
Diagnostic methods
Diagnosis is made after detection of encapsulated yeast in cerebrospinal fluid or other affected organs, or in cultures.
Differential diagnosis
Differential diagnoses include the other species of Cryptococcus.
Management and treatment
Amphotericin B and newer antifungal drugs (triazoles) sterilize the lesions. The treatment should be continued for as long as the patient is immunodeficient.
Prognosis
The prognosis is usually good if treatment is well conducted.