Cryptococcosis

Definition

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 impaired 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 -- pinpoint red spots (petechiae)
• Sweating -- unusual, excessive at night
• Swollen glands
• Unintentional weight loss
• Weakness

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

Signs and tests

• Sputum culture and stain
• Lung biopsy
• Bronchoscopy
• Cerebrospinal Fluid culture and stain for Cryptococcus
• 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