Last reviewed: 4 Jul 2021
Last updated: 30 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • constitutional symptoms
  • dyspnea
  • productive cough
  • dullness to percussion
  • diminished breath sounds
  • crackles
  • headache
  • alteration of consciousness
  • meningeal irritation
  • papilledema
  • skin lesions
  • coma

Other diagnostic factors

  • chest pain
  • cranial neuropathy
  • ocular manifestations

Risk factors

  • HIV infection
  • immunosuppression
  • comorbidities and smoking
  • exposure to Cryptococcus species
  • male sex
  • pregnancy and postpartum period

Diagnostic investigations

1st investigations to order

  • serum cryptococcal polysaccharide antigen (CrAg)
  • cerebrospinal fluid (CSF) cryptococcal polysaccharide antigen (CrAg)
  • pleural fluid cryptococcal polysaccharide antigen (CrAg)
  • cultures
  • HIV antibodies
  • chest x-ray
  • lumbar puncture
  • cerebrospinal fluid (CSF) microscopy
  • cerebrospinal fluid (CSF) white blood cell count (cells/microliter)

Investigations to consider

  • CT chest
  • MRI brain
  • CT brain
  • bronchoscopy
  • biopsy

Treatment algorithm

Contributors

Authors

Radha Rajasingham, MD

Assistant Professor of Medicine

Infectious Diseases and International Medicine

Department of Medicine

University of Minnesota

Minneapolis

MN

Disclosures

RR declares that she has no competing interests.

David R. Boulware, MD, MPH, CTropMed

Professor of Medicine

Infectious Diseases and International Medicine

Department of Medicine

University of Minnesota

Minneapolis

MN

Disclosures

DRB declares that he has received research support from Gilead.

Acknowledgements

Dr Radha Rajasingham and Dr David Boulware would like to gratefully acknowledge Dr Renata L. Riha and Dr Athanasia D. Pataka, previous contributors to this topic. RLR and ADP declare that they have no competing interests.

Peer reviewers

William Powderly, MD

Professor of Medicine

Washington University in St Louis

St Louis

MO

Disclosures

WP declares that he is a member of advisory boards for Gilead and Merck and his institution has received research grants from Merck; none of these are related to antifungal therapy. WP is a member of the Board of Directors (Past President) of the Infectious Diseases Society of America.

Ricardo Negroni, MD

Consultant

Muñiz Hospital

Honorary Professor

University of Buenos Aires

Buenos Aires

Argentina

Disclosures

RN declares that he has no competing interests.

Aimee Zaas, MD, MHS

Assistant Professor of Medicine

Division of Infectious Diseases and International Health

Duke University Medical Center

Durham

NC

Disclosures

AZ has received research funding from Enzon Pharmaceuticals and has been on the speaker's bureau for Astellas Pharma and Pfizer Inc.

Joseph Jarvis, BSc, MBBS, MRCP

Professor

Department of Clinical Research

Faculty of Infectious and Tropical Diseases

London School of Hygiene and Tropical Medicine

London

UK

Disclosures

JJ declares that he has no competing interests.

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