Cryptococcosis

Definition

Cryptococcosis is a rare fungal infection caused by inhaling the fungus Cryptococcus neoformans.

Causes

Cryptococcus neoformans, the fungus that causes this disease, is ordinarily found in soil. Once inhaled, infection with cryptococcosis may heal on its own, remain localized in the lungs, or spread throughout the body (disseminate).

Most cases occur in people whose resistance to infection is lowered (such as by HIV infection, high doses of corticosteroid medications, cancer chemotherapy, or Hodgkin's disease).

In people with normal immune systems, the pulmonary (lung) form may have no symptoms. However, in people with impaired immune systems, the cryptococcus organism may spread to the brain.

The onset of neurological symptoms is gradual. The majority of people with this condition have meningoencephalitis (swelling and irritation of the brain and spinal cord) at the time of diagnosis.

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

Symptoms

• Abdominal fullness prematurely after meals
• Abdominal pain
• Abdomen, swollen
• Bleeding into the skin
• Blurred vision or double vision (diplopia)
• Bone pain or tenderness of the breastbone (sternum)
• Bruises (ecchymoses)
• Chest pain
• Confusion
• Cough -- dry
• Fatigue
• Fever
• Headache
• Loss of appetite
• Nausea
• Nerve pain or pain along the path of a specific nerve or nerve root
• Numbness and tingling
• Skin rash -- pinpoint red spots (petechiae)
• Sweating -- unusual, excessive at night
• Swollen glands
• Unintentional weight loss
• Weakness

Note: In individuals with normal immune systems there may be no symptoms

Exams and Tests

• Sputum culture and stain
• Lung biopsy
• Bronchoscopy
• CSF culture and stain
• Chest x-ray

Treatment

Some infections require no treatment. However, medical observation should continue for a year to detect any progression of the disease. If pulmonary lesions are present or the disease spreads, antifungal medications are prescribed, and treatment with these agents may be prolonged.

Medications include:

• Amphotericin B
• Flucytosine
• Fluconazole

Outlook (Prognosis)

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

Possible Complications

• Relapse of infection
• Meningitis
• Permanent brain or nerve damage
• Side effects of medications (such as Amphotericin B) can be severe

When to Contact a Medical Professional

Call your health care provider if symptoms develop that are suggestive of cryptococcosis, particularly if you have an impaired immune system.

Prevention

Minimize doses of corticosteroid medications. Safer sex practices reduce the risk of acquiring HIV and the subsequent opportunistic infections associated with a weakened immune system.

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