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Cryptococcosis ˌkrip-tə-(ˌ)kä-ˈkō-səs

(European Blastomycosis; Torulosis)

By Sanjay G. Revankar, MD, Professor of Medicine and Director, Infectious Disease Fellowship Program, Division of Infectious Diseases, Wayne State University School of Medicine
Jack D. Sobel, MD, Dean and Distinguished Professor of Medicine, Wayne State University School of Medicine

Cryptococcosis is infection caused by fungus Cryptococcus neoformans or Cryptococcus gattii.

  • 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 bird droppings, particularly those of pigeons. The fungus is present around the world, but infection was relatively rare until the AIDS epidemic began. Cryptococcosis is the most common potentially fatal fungal infection in people with AIDS. The fungus also infects other people who have a weakened immune system, including people who have Hodgkin lymphoma or sarcoidosis or who take drugs that suppress the immune system, such as those used to prevent rejection of an organ transplant and, when taken for a long time, corticosteroids. However, cryptococcosis, particularly when caused by Cryptococcus gattii, can also develop in people with a normal immune system.

Infection usually occurs when people inhale the spores of the fungus. Thus, cryptococcosis typically affects the lungs. It most commonly spreads to the brain and tissues covering the brain and spinal cord (meninges), resulting in meningitis. It may also spread to the skin and other tissues.

Symptoms of Cryptococcosis

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

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

  • Meningitis: Headache, blurred vision, and confusion

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

Lung infection is rarely dangerous. Meningitis is life threatening.

Diagnosis of Cryptococcosis

  • Culture and examination of a sample of tissue or fluid

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

Treatment of Cryptococcosis

  • Antifungal drugs

Antifungal drugs are usually used to treat cryptococcosis.

People with a normal immune system

If the infection affects only a small part of lung and does not cause any symptoms, usually no treatment is needed. However, some doctors prefer to always treat cryptococcosis. Fluconazole is given by mouth to shorten the duration of the illness and reduce the risk of the infection spreading.

If a lung infection causes symptoms, fluconazole is given by mouth for 6 to 12 months.

For meningitis, treatment is amphotericin B, given intravenously, plus flucytosine, given by mouth, followed by fluconazole, given by mouth, for many months.

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

People with a weakened immune system always require treatment. Mild to moderate lung infection may be treated with fluconazole given by mouth for 6 to 12 months. Severe lung infection or meningitis may be treated with amphotericin B, given intravenously, plus flucytosine, followed by fluconazole, both given by mouth.

After cryptococcosis is treated, people with AIDS usually need to continue taking an antifungal drug (such as fluconazole) until AIDS is controlled—that is, until their CD4 count (the number of one type of white blood cell) increases and stays high enough for at least 6 months.

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