Cryptococcosis

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

Causes, incidence, and risk factors

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

     
  • Chest pain  
  • Dry cough  
  • Headache  
  • Nausea  
  • Confusion  
  • Blurred vision or double vision (diplopia)  
  • Fatigue  
  • Fever  
  • Unusual and excessive sweating at night  
  • Glands, swollen WITHOUT nearby areas appearing infected (e.g., red, painful, swollen)  
  • Prolonged bleeding, bruising easily  
  • Skin rash may be present       o Skin rash or lesion - pinpoint red spots (petechiae)       o Bleeding into the skin       o Bruises (ecchymoses)  
  • Unintentional weight loss  
  • Appetite, loss  
  • Abdominal fullness prematurely after meals  
  • Abdominal pain  
  • Abdomen, swollen  
  • Weakness  
  • Bone pain or tenderness of the breastbone (sternum)  
  • Numbness and tingling       o Nerve pain or pain along the path of a specific nerve       o Pain along a nerve root (major pathway from the spinal cord)

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

Signs 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

Expectations (prognosis)
Central nervous system involvement often has a fatal outcome, or leads to permanent damage.

Complications

     
  • Relapse of infection  
  • 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 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.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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