When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Cryptococcosis

Last reviewed: 6 Oct 2024
Last updated: 12 Jul 2024

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
Full details

Other diagnostic factors

  • chest pain
  • cranial neuropathy
  • ocular manifestations
Full details

Risk factors

  • HIV infection
  • immunosuppression
  • exposure to Cryptococcus species
  • male sex
  • pregnancy and postpartum period
Full details

Diagnostic tests

1st tests 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/mm³)
Full details

Tests to consider

  • CT chest
  • MRI brain
  • CT brain
  • bronchoscopy
  • biopsy
Full details

Emerging tests

  • cryptococcus polymerase chain reaction (PCR)

Treatment algorithm

ONGOING

HIV-negative

HIV-positive

Contributors

Authors

Radha Rajasingham, MD

Associate 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.

Acknowledgements

Dr Radha Rajasingham would like to gratefully acknowledge Dr David Boulware, Dr Renata L. Riha, and Dr Athanasia D. Pataka, previous contributors to this topic.

Disclosures

DRB has received research support from Gilead. 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.

  • Cryptococcosis images
  • Differentials

    • Tuberculosis
    • Primary or metastatic central nervous system (CNS) neoplasm
    • Skin manifestations of systemic infections
    More Differentials
  • Guidelines

    • Global guideline for the diagnosis and management of cryptococcosis
    • Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer