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
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
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.
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.
Respiratory Consultant
Royal Infirmary
Edinburgh
Scotland
UK
Disclosures
RLR declares that she has no competing interests.
Respiratory Physician
Royal Infirmary
Edinburgh
Scotland
UK
Disclosures
ADP declares that she has no competing interests.
Peer reviewers
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.
Consultant
Muñiz Hospital
Honorary Professor
University of Buenos Aires
Buenos Aires
Argentina
Disclosures
RN declares that he has no competing interests.
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.
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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