Cryptococcosis is an infection caused by the fungus Cryptococcus neoformans or Cryptococcus gattii.
The infection is usually caused by inhaling spores of the fungus.
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, blood, and fluid samples.
Antifungal medications are given by mouth or, if the infection is severe, intravenously.
(See also Overview of Fungal Infections.)
Cryptococcosis 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. Cryptococcosis may also spread to the skin and other tissues, such as the bones, joints, liver, spleen, kidneys, and prostate.
Cryptococcus neoformans occurs primarily in soil that is contaminated with bird droppings, particularly those of pigeons. Cryptococcus gattii usually is present in certain species of trees. Unlike Cryptococcus neoformans, Cryptococcus gattii is not associated with birds.
Cryptococcus neoformans is found all over the world. Outbreaks of Cryptococcus gattii have occurred in the Canadian province of British Columbia, the Pacific Northwest of the United States, Papua New Guinea, northern Australia, and in the Mediterranean region of Europe.
Cryptococcosis was relatively rare until the advanced HIV infection (also called AIDS) epidemic began. Serious infections that occur mainly in people with a weakened immune system are called opportunistic infections. Cryptococcosis is an opportunistic infection for people with advanced HIV infection.
The fungus tends to infect people who have a weakened immune system, including those with the following:
Hodgkin lymphoma or another lymphoma
Use of medications that suppress the immune system, such as those used to prevent rejection of an organ transplant and, when taken for a long time, steroids (also sometimes called glucocorticoids or cortico)
However, cryptococcosis caused by Cryptococcus gattii can also develop in people with a healthy immune system.
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, pneumonia and difficulty breathing
Meningitis: Headache, blurred vision, depression, agitation, and confusion
Skin infection: A rash, consisting of bumps (sometimes filled with pus) or open sores
Cryptococcosis may spread to the skin and cause a rash of bumps (sometimes filled with pus) or open sores.
Although lung infection is rarely severe, meningitis is life threatening.
Diagnosis of Cryptococcosis
Culture and examination of a sample of tissue or fluid
Blood and cerebrospinal fluid tests
To diagnose cryptococcosis, a doctor takes samples of tissue and body fluids, such as cerebrospinal fluid, sputum, urine, and blood, to be cultured and examined. A spinal tap (lumbar puncture) is done to obtain cerebrospinal fluid (the fluid that surrounds the brain and spinal cord).
Blood and cerebrospinal fluid may be tested for certain substances released by Cryptococcus called antigens.
Treatment of Cryptococcosis
Antifungal medications
Antifungal medications are usually used to treat cryptococcosis.
People without advanced HIV infection
If the infection affects only a small part of lung and does not cause any symptoms, treatment with antifungal medications may not be needed.
For people with symptoms, fluconazole is given by mouth for 6 to 12 months to shorten the duration of the illness and reduce the risk of the infection spreading.For people with symptoms, fluconazole is given by mouth for 6 to 12 months to shorten the duration of the illness and reduce the risk of the infection spreading.
For people with meningitis, treatment is amphotericin B, given intravenously for 2 to 4 weeks, followed by For people with meningitis, treatment is amphotericin B, given intravenously for 2 to 4 weeks, followed byfluconazole, given by mouth for many months.
For people without meningitis, treatment is typically with fluconazole for 6 to 12 months.
For people with an infection in the skin, bone, or other sites, treatment is usually with fluconazole given by mouth. If the infection is severe, people are given amphotericin B intravenously plus flucytosine and For people with an infection in the skin, bone, or other sites, treatment is usually with fluconazole given by mouth. If the infection is severe, people are given amphotericin B intravenously plus flucytosine andfluconazole, given by mouth.
People with advanced HIV infection
People with advanced HIV infection always require treatment.
Mild to moderate lung infection may be treated with fluconazole given by mouth for 6 to 12 months.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. Treatment may be needed for several months.Severe lung infection or meningitis may be treated with amphotericin B, given intravenously, plus flucytosine, followed by fluconazole, both given by mouth. Treatment may be needed for several months.
After cryptococcosis is treated, people with advanced HIV infection usually need to continue taking an antifungal medication (such as fluconazole) until their After cryptococcosis is treated, people with advanced HIV infection usually need to continue taking an antifungal medication (such as fluconazole) until theirCD4 count (the number of one type of white blood cell that decreases when advanced HIV infection is uncontrolled) is more than 100 cells per microliter of blood and they are also receiving antiretroviral therapy (ART).
In areas where resources are limited, people who have advanced HIV infection may be given amphotericin B and flucytosine for 1 week. In areas where resources are limited, people who have advanced HIV infection may be given amphotericin B and flucytosine for 1 week.
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