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Cryptococcosis - All Information

Definition of Cryptococcosis:

Cryptococcosis is infection with Cryptococcus neoformans fungus.

Causes, incidence, and risk factors:

Cryptococcus neoformans, the fungus that causes this disease, is ordinarily found in soil. It enters and infects the body through the lungs. Once inhaled, infection with cryptococcosis may go away on its own, remain in the lungs only, or spread throughout the body (disseminate).

Most cases are in people with a weakened immune system, such as those with HIV infection, taking high doses of corticosteroid medications, cancer chemotherapy, or who have Hodgkin's disease.

In people with a normal immune system, the lung (pulmonary) form of the infection may have no symptoms. In people with weakened immune systems, the cryptococcus organism may spread to the brain.

Neurological (brain) symptoms begin gradually. Most people with this infection have meningoencephalitis (swelling and irritation of the brain and spinal cord) when they are diagnosed.

Cryptococcus is one of the most common life-threatening fungal infections in people with AIDS.

Symptoms:

Blurred vision or double vision (diplopia)
Bone pain or tenderness of the breastbone (sternum)
Chest pain
Confusion
Cough -- dry
Fatigue
Fever
Headache
Nausea
Skin rash, including pinpoint red spots (petechiae), ulcers, or other skin lesions
Sweating -- unusual, excessive at night
Swollen glands
Unintentional weight loss

Note: People with a normal immune system may have no symptoms at all.

Signs and tests:

Physical examination may reveal:

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

Tests that may be done include:

Blood culture
CT scan of the head
Sputum culture and stain
Lung biopsy
Bronchoscopy
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 the Cryptococcus fungus can shed into the blood)

Treatment:

Some infections require no treatment. Even so, there should be regular check-ups for a full year to make sure the infection has not spread. If there are lung lesions or the disease spreads, antifungal medications are prescribed. These drugs may need to be taken for a long time.

Medications include:

Amphotericin B
Flucytosine
Fluconazole

Expectations (prognosis):

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

Complications:

Infection comes back
Meningitis
Permanent brain or nerve damage
Side effects of medications (such as Amphotericin B) can be severe

Calling your health care provider:

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

Prevention:

Take the lowest doses of corticosteroid medications possible. Practice safe sex to reduce the risk of getting HIV and the infections associated with a weakened immune system.

Cryptococcus, cutaneous on the hand

Cryptococcosis on the forehead

Reviewed last on: 9/15/2010
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Kauffman CA. Cryptococcosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 357.

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