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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 weakened 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, including pinpoint red spots (petechiae), ulcers, or other skin lesions
• Sweating -- unusual, excessive at night
• Swollen glands
• Unintentional weight loss

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

Signs and tests

Physical examination may reveal:

• Abnormal breath sounds
• Fast heart rate
• Fever
• Mental status changes
• Stiff neck

Tests that may be done include:

• Blood culture
• CT scan of the head
• Sputum culture and stain
• Lung biopsy
• Bronchoscopy
• Spinal tap to obtain a sample of cerebrospinal fluid (CSF)
• Cerebrospinal fluid (CSF) culture and other tests to check for signs of infection
• 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

Support Groups

Expectations (prognosis)

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

Complications

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

Calling your health care provider

Call your health care provider if you develop symptoms of cryptococcosis, especially if you have a weakened immune system.

Prevention

Take the lowest doses of corticosteroid medications possible. Practice safe sex to reduce the risk of getting HIV and the infections associated with a weakened immune system.

References

Kauffman CA. Cryptococcosis. In: Goldman L, Ausiello D, eds. . 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 357.