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Cryptococcosis +krip-tu-(+)k@-!kO-sus

by Alan M. Sugar, MD

Cryptococcosis is infection caused by the fungus Cryptococcus neoformans.

  • People may have no symptoms or may have headache and confusion, a cough and an achy chest, or a rash, depending on where the infection is.

  • The diagnosis is based on culture and examination of tissue and fluid samples.

  • Antifungal drugs are given by mouth or, if the infection is severe, intravenously.

Cryptococcus occurs primarily in soil that is contaminated with pigeon droppings. The fungus is present around the world, but infection was relatively rare until the AIDS epidemic began. The fungus sometimes infects people with Hodgkin lymphoma or sarcoidosis and those who are receiving long-term corticosteroid treatment. However, cryptococcosis can also develop in people with a normal immune system.

Cryptococcosis occurs mainly in the following:

  • Tissues covering the brain and spinal cord (meninges), resulting in meningitis

  • Lungs

  • Skin

Other organs are sometimes involved.

Symptoms and Diagnosis

Cryptococcosis usually causes mild and vague symptoms. Other symptoms occur depending on where the infection is:

  • Meningitis: Headache and confusion

  • Lung infection: No symptoms in some people, a cough or an aching chest in others, and, if the infection is severe, difficulty breathing

  • Skin infection: A rash, consisting of bumps (sometimes filled with pus) or open sores

To diagnose the infection, a doctor takes samples of tissue and body fluids to be cultured and examined. Blood and spinal fluid may be tested for certain substances released by Cryptococcus.

Treatment

People with a functioning immune system who have Cryptococcus in only a small part of their lungs usually do not require any treatment. However, people with a lung infection are often treated with fluconazole, given by mouth, to shorten the duration of their illness. For meningitis, amphotericin B and flucytosine are given intravenously, followed by fluconazole given by mouth. For a skin infection, people are usually given fluconazole by mouth or, if the infection is severe, amphotericin B intravenously.

People with a weakened immune system may be given fluconazole, amphotericin B, sometimes flucytosine, or a combination. If people with AIDS develop cryptococcosis, they usually need to take an antifungal drug, usually fluconazole, for the rest of their life. However, they may be able to stop the antifungal drug if their CD4 count (the number of one type of white blood cell) increases and stays high enough for at least 6 months.

Drugs Mentioned In This Article

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  • ANCOBON
  • DIFLUCAN