Cryptococcosis is an opportunistic, fungal infection caused by the Cryptococcus species. The principal pathogens in humans are C. neoformans (primary) and C. gattii. Cryptococcus neoformans is typically found in pigeon droppings and acquired by inhaling dust from contaminated soil. The majority of affected patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship are immunocompromised immunocompromised A human or animal whose immunologic mechanism is deficient because of an immunodeficiency disorder or other disease or as the result of the administration of immunosuppressive drugs or radiation. Gastroenteritis. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with AIDS AIDS Chronic HIV infection and depletion of CD4 cells eventually results in acquired immunodeficiency syndrome (AIDS), which can be diagnosed by the presence of certain opportunistic diseases called AIDS-defining conditions. These conditions include a wide spectrum of bacterial, viral, fungal, and parasitic infections as well as several malignancies and generalized conditions. HIV Infection and AIDS, chronic steroid use, and organ transplant are particularly affected. The primary virulence Virulence The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. The pathogenic capacity of an organism is determined by its virulence factors. Proteus factor is an antiphagocytic capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides, consisting of repeating capsular polysaccharide antigens. The infection typically affects the lungs Lungs Lungs are the main organs of the respiratory system. Lungs are paired viscera located in the thoracic cavity and are composed of spongy tissue. The primary function of the lungs is to oxygenate blood and eliminate CO2. Lungs: Anatomy and presents as a primary lesion or pneumonia Pneumonia Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy. Pneumonia. Dissemination can occur to involve the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification and meninges Meninges The brain and the spinal cord are enveloped by 3 overlapping layers of connective tissue called the meninges. The layers are, from the most external layer to the most internal layer, the dura mater, arachnoid mater, and pia mater. Between these layers are 3 potential spaces called the epidural, subdural, and subarachnoid spaces. Meninges: Anatomy, skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions, bones, and visceral organs. Treatment for cryptococcal meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis is usually amphotericin B Amphotericin B Macrolide antifungal antibiotic produced by streptomyces nodosus obtained from soil of the orinoco river region of venezuela. Polyenes and flucytosine Flucytosine Flucytosine is a pyrimidine analog that disrupts fungal DNA and RNA synthesis. Flucytosine is always used in combination with other antifungal agents and is primarily used to treat cryptococcal meningitis. Flucytosine, Griseofulvin, and Terbinafine, followed by fluconazole Fluconazole Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in aids. Azoles. Cryptococcosis is an AIDS-defining illness and typically associated with CD4 count < 100 cells/μL.
Last updated: 17 Jun, 2021
The most significant risk factor for infection is an immunocompromised immunocompromised A human or animal whose immunologic mechanism is deficient because of an immunodeficiency disorder or other disease or as the result of the administration of immunosuppressive drugs or radiation. Gastroenteritis state. In decreasing frequency, the following conditions are most frequently associated with infection:
Clinical presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor varies depending on the affected area and immune status of the host:
Cutaneous cryptococcosis: Papulonodular lesions (some showing crusts and umbilicated center) are on the face and upper dorsum. Cryptococcus infection is confirmed in the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions lesions.
Image: “Disseminated cryptococcosis with cutaneous involvement Cutaneous involvement Coccidioides/Coccidioidomycosis in an immunocompetent patient” by Gabriely Lessa Sacht et al AL Amyloidosis. License: CC BY 4.0Photomicrograph of Cryptococcus neoformans processed using the mucicarmine stain:
The polysaccharide in the C. neoformans capsule created a prominent red stain.
Histological image showing Cryptococcus neoformans stained with India ink: The appearance of a halo surrounding each yeast cell represents the observable capsule.
Image: “Cryptococcus neoformans” by CDC/ Dr. Leanor Haley. License: Public Domain
Photomicrograph of a methenamine-stained lung tissue specimen harvested from a patient with acquired
immunodeficiency
Immunodeficiency
Chédiak-Higashi Syndrome syndrome (
AIDS
AIDS
Chronic HIV infection and depletion of CD4 cells eventually results in acquired immunodeficiency syndrome (AIDS), which can be diagnosed by the presence of certain opportunistic diseases called AIDS-defining conditions. These conditions include a wide spectrum of bacterial, viral, fungal, and parasitic infections as well as several malignancies and generalized conditions.
HIV Infection and AIDS) infected with Cryptococcus:
Histopathology reveals numerous extracellular C. neoformans yeast-form organisms within the alveolar space. Some of the
yeast
Yeast
A general term for single-celled rounded fungi that reproduce by budding. Brewers’ and bakers’ yeasts are saccharomyces cerevisiae; therapeutic dried yeast is yeast, dried.
Mycology organisms show narrow-base
budding
Budding
Mycology and characteristic variation in size.
Pulmonary cryptococcosis:
A 49-year-old man presenting to the hospital with
lymphadenopathy
Lymphadenopathy
Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease.
Lymphadenopathy for 3 months,
fever
Fever
Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin.
Fever for 1 month, and
HIV
HIV
Anti-HIV Drugs infection with a CD4 count of 108 cells/ÎĽL. Serum cryptococcal
antigen
Antigen
Substances that are recognized by the immune system and induce an immune reaction.
Vaccination titer was 1:40. Serum galactomannan assay was negative.
A: chest CT scan demonstrating multiple
pulmonary nodules
Pulmonary nodules
A number of small lung lesions characterized by small round masses of 2- to 3-mm in diameter. They are usually detected by chest ct scans. Such nodules can be associated with metastases of malignancies inside or outside the lung, benign granulomas, or other lesions.
Granulomatosis with Polyangiitis (arrow)
B: lung
biopsy
Biopsy
Removal and pathologic examination of specimens from the living body.
Ewing Sarcoma showing
encapsulated
Encapsulated
Klebsiella, yeast-like fungal cells consistent with cryptococcal infection (arrow) in alcian blue stain
Magnetic resonance imaging (MRI) of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification showing T2-weighted images T2-Weighted Images Imaging of the Head and Brain (left) and fluid attenuated inversion recovery ( FLAIR FLAIR Magnetic Resonance Imaging (MRI)) (right): bilateral, multiple nodular lesions in the basal ganglia Basal Ganglia Basal ganglia are a group of subcortical nuclear agglomerations involved in movement, and are located deep to the cerebral hemispheres. Basal ganglia include the striatum (caudate nucleus and putamen), globus pallidus, substantia nigra, and subthalamic nucleus. Basal Ganglia: Anatomy and thalamus Thalamus The thalamus is a large, ovoid structure in the dorsal part of the diencephalon that is located between the cerebral cortex and midbrain. It consists of several interconnected nuclei of grey matter separated by the laminae of white matter. The thalamus is the main conductor of information that passes between the cerebral cortex and the periphery, spinal cord, or brain stem. Thalamus: Anatomy (white arrows), and ill-defined area of signal intensity change in the left temporoparietal region (black arrows)
Image: “Cryptococcal meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis presenting with bilateral complete ophthalmoplegia Ophthalmoplegia Paralysis of one or more of the ocular muscles due to disorders of the eye muscles, neuromuscular junction, supporting soft tissue, tendons, or innervation to the muscles. Orbital and Preseptal Cellulitis: a case report” by Liyanage DS et al AL Amyloidosis. License: CC BY 2.0Condition | Treatment |
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CNS infection | Amphotericin B Amphotericin B Macrolide antifungal antibiotic produced by streptomyces nodosus obtained from soil of the orinoco river region of venezuela. Polyenes + flucytosine Flucytosine Flucytosine is a pyrimidine analog that disrupts fungal DNA and RNA synthesis. Flucytosine is always used in combination with other antifungal agents and is primarily used to treat cryptococcal meningitis. Flucytosine, Griseofulvin, and Terbinafine, followed by consolidation Consolidation Pulmonary Function Tests and maintenance therapy |
Immunocompetent and immunosuppressed with mild pulmonary infection (focal) | Fluconazole Fluconazole Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in aids. Azoles |
Immunocompetent and immunosuppressed with severe pulmonary infection | CNS infection treatment |
Immunocompetent and immunosuppressed with extrapulmonary, non-CNS infection (≥ 2 noncontiguous sites) | CNS infection treatment |