Cryptococcosis

Microbiology, serum antigen levels, and histopathology are required to make the diagnosis.

Therapy depends on the immunologic state and disease severity. For asymptomatic and mild-moderate disease with no CNS involvement, oral fluconazole is the first-line treatment. For severe disease and CNS involvement, induction therapy with amphotericin-B plus flucytosine followed by a course of fluconazole is recommended.

The lungs are generally the primary locus of infection, with extrapulmonary dissemination affecting the 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, especially in immunocompromised patients.

Primary prophylaxis with either itraconazole or fluconazole is effective in reducing the incidence of cryptococcal disease in adults with HIV (CD4 <100 cells/microliter) but there is no clear effect on overall mortality.

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.