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Cryptococcosis

The fungus Cryptococcus neoformans causes cryptococcosis, also called torulosis and European blastomycosis. Cryptococcosis usually begins as an asymptomatic pulmonary infection but disseminates to extrapulmonary sites, usually to the central nervous system (CNS) but also to the skin, bones, prostate gland, liver, or kidneys.

Cryptococcosis is most prevalent in men, usually those between ages 30 and 60, and is rare in children. It's especially likely to develop in immunocompromised patients, such as those with Hodgkin's disease, sarcoidosis, leukemia, or lymphoma and those who are receiving immunosuppressive agents. Currently, patients with acquired immunodeficiency syndrome (AIDS) are by far the most commonly affected group.

With appropriate treatment, the prognosis in pulmonary cryptococcosis is good. CNS infection, however, can be fatal, but treatment dramatically reduces mortality.

Causes

Signs and symptoms

Typically, pulmonary cryptococcosis is asymptomatic. Onset of CNS involvement is gradual (cryptococcal meningitis) and causes progressively severe frontal and temporal headache, diplopia, blurred vision, dizziness, ataxia, aphasia, vomiting, tinnitus, memory changes, inappropriate behavior, irritability, psychotic symptoms, seizures, and fever.

If untreated, symptoms progress to coma and death, usually a result of cerebral edema or hydrocephalus. Complications include optic atrophy, ataxia, hydrocephalus, deafness, paralysis, chronic brain syndrome, and personality changes.

Skin involvement produces red facial papules and other skin abscesses, with or without ulcerations; bone involvement produces painful osseous lesions of the long bones, skull, spine, and joints.

Diagnosis

The following laboratory and radiology tests are performed to assist in the diagnosis of cryptococcal disease.

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

Treatment

The patient with pulmonary cryptococcosis will require close medical observation for 1 year after diagnosis. Treatment is unnecessary unless extrapulmonary lesions develop or pulmonary lesions progress.

Treatment of disseminated infection calls for LV. amphotericin B or fluconazole. Patients with AIDS will also need long-term therapy, usually with oral fluconazole.

Prevention

The best way to prevent cryptococcosis is to stay free of HIV infection.

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.