Cryptococcosis

Microbiology, cryptococcal polysaccharide antigen (CrAg), or histopathology are required to make the diagnosis.

Therapy depends on the immunologic state and disease severity. For asymptomatic and mild-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.

Unrecognized and untreated cryptococcosis can be fatal, regardless of immune status.

Screening for CrAg and preemptive treatment with high-dose fluconazole is effective in reducing mortality in adults who have HIV infection and CD4 count <100 cells/microliter.

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 with Cryptococcus var. gattii.