Microbiology, serum antigen levels, and histopathology are required to make the diagnosis.
Treatment depends on the immunological state and disease severity. For asymptomatic and mild to moderate disease with no central nervous system (CNS) involvement, oral fluconazole is the first-line treatment. For severe disease and CNS involvement, induction therapy with amphotericin-B plus flucytosine followed by a course of fluconazole is recommended.
The lungs are generally the primary locus of infection, with extrapulmonary dissemination affecting the meninges and, less commonly, the skin, bones, prostate, and other organs.
Meningoencephalitis is life-threatening, particularly in immunosuppressed patients.
Unrecognised and untreated cryptococcosis can be fatal, especially in immunocompromised patients.
Primary prophylaxis with either itraconazole or fluconazole is effective in reducing the incidence of cryptococcal disease in adults with HIV (CD4 <100 cells/microlitre), but there is no clear effect on overall mortality.
Cryptococcosis is an opportunistic fungal infection caused by Cryptococcus species. Cryptococcus neoformans var. grubii and Cryptococcus neoformans cause morbidity and mortality, especially in immunosuppressed populations, such as those with HIV. Occasionally, people with no apparent immune-system problems develop cryptococcosis, particularly Cryptococcus var. gattii.
History and exam
RLR declares that she has no competing interests.
ADP declares that she has no competing interests.
University of Buenos Aires
RN declares that he has no competing interests.
Assistant Professor of Medicine
Division of Infectious Diseases and International Health
Duke University Medical Center
AZ has received research funding from Enzon Pharmaceuticals and has been on the speaker's bureau for Astellas Pharma and Pfizer Inc.
Clinical Lecturer/Wellcome Trust Fellow
Centre for Infection
Division of Cellular and Molecular Medicine
St. George's University
JJ declares that he has no competing interests.
Distinguished Assistant Professor
Center for Infectious Diseases and Microbiology Translational Research
University of Minnesota
DRB declares that he has no competing interests.
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