Abstract
Cryptococcosis has become an important infection in both immunocompromised and immunocompetent
hosts. Although Cryptococcus is mainly recognized by its ability to cause meningoencephalitis, it can infect almost
any organ of the human body, with pulmonary infection being the second most common
disease manifestation. In cases of meningitis, symptom onset may be insidious, but
headaches, fevers, or mental status changes should warrant diagnostic testing. Symptoms
of pulmonary disease are nonspecific and may include fever, chills, cough, malaise,
night sweats, dyspnea, weight loss, and hemoptysis. Due to protean manifestations
of infection, diagnosis may be delayed or misdiagnosis may occur. Diagnosis typically
is made by antigen testing of serum or cerebrospinal fluid or by culture or histopathology
of infected tissues. A lumbar puncture with the measurement of opening pressure is
recommended for patients with suspected or proven cryptococcosis. Treatment of cryptococcosis
is based on the anatomical site of disease, severity of disease, and underlying immune
status of the patient. Amphotericin B preparations plus 5-flucytosine is used as initial
treatment of meningitis, disseminated infection, or moderate-to-severe pulmonary infection
followed by fluconazole as a consolidation therapy. Fluconazole is effective for mild-to-moderate
pulmonary infection. Important complications include elevated intracranial pressure
and immune reconstitution syndrome, which may resemble active disease.
Keywords
Cryptococcus
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Cryptococcus neoformans
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Cryptococcus gattii
- cryptococcosis - pneumonia - fluconazole - amphotericin B - flucytosine
