Microbiology, cryptococcal polysaccharide antigen (CrAg), or histopathology are required to make the diagnosis for cryptococcosis.
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 consolidation therapy with fluconazole is recommended.
The lungs are generally the primary locus of infection, with extrapulmonary dissemination throughout the body with prominent symptomatic involvement of the brain and 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, regardless of immune status.
Screening for CrAg and pre-emptive treatment with high-dose fluconazole is effective in reducing mortality in adults who have HIV infection and CD4 count <100 cells/mm³.
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
Key diagnostic factors
- presence of risk factors
- constitutional symptoms
- productive cough
- dullness to percussion
- diminished breath sounds
- alteration of consciousness
- meningeal irritation
- skin lesions
Other diagnostic factors
- chest pain
- cranial neuropathy
- ocular manifestations
- HIV infection
- comorbidities and smoking
- exposure to Cryptococcus species
- male sex
- pregnancy and postnatal period
1st investigations to order
- serum cryptococcal polysaccharide antigen (CrAg)
- cerebrospinal fluid (CSF) cryptococcal polysaccharide antigen (CrAg)
- pleural fluid cryptococcal polysaccharide antigen (CrAg)
- HIV antibodies
- chest x-ray
- lumbar puncture
- cerebrospinal fluid (CSF) microscopy
- cerebrospinal fluid (CSF) white blood cell count (cells/mm³)
Investigations to consider
- CT chest
- MRI brain
- CT brain
- cryptococcus polymerase chain reaction (PCR)
- Primary or metastatic central nervous system (CNS) neoplasm
- Skin manifestations of systemic infections
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
- Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection
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