Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- sintomas constitucionais
- dispneia
- tosse produtiva
- macicez à percussão
- murmúrio vesicular diminuído
- estertores
- cefaleia
- alteração da consciência
- irritação meníngea
- papiledema
- lesões cutâneas
- coma
Other diagnostic factors
- dor torácica
- neuropatia craniana
- manifestações oculares
Risk factors
- Infecção pelo vírus da imunodeficiência humana (HIV)
- imunossupressão
- exposição a espécies de Cryptococcus
- sexo masculino
- gestação e período pós-parto
Diagnostic investigations
1st investigations to order
- antígeno polissacarídeo criptocócico (CrAg) sérico
- antígeno polissacarídeo criptocócico (CrAg) no líquido cefalorraquidiano (LCR)
- antígeno polissacarídeo criptocócico (CrAg) no líquido pleural
- culturas
- anticorpos antivírus da imunodeficiência humana (anti-HIV)
- radiografia torácica
- punção lombar
- microscopia do líquido cefalorraquidiano (LCR)
- contagem de leucócitos (células/microlitro) no líquido cefalorraquidiano (LCR)
Investigations to consider
- tomografia computadorizada (TC) do tórax
- ressonância nuclear magnética (RNM) cerebral
- TC cranioencefálica
- broncoscopia
- biópsia
Emerging tests
- reação em cadeia da polimerase para criptococos
Treatment algorithm
sem HIV
com vírus da imunodeficiência humana (HIV)
Contributors
Authors
Radha Rajasingham, MD
Associate Professor of Medicine
Infectious Diseases and International Medicine
Department of Medicine
University of Minnesota
Minneapolis
MN
Disclosures
RR receives grants from the US National Institutes of Health (NIH) for prevention of cryptococcal meningitis clinical trials. She is a consultant for the Pan American Health Organization for research in histoplasmosis screening. RR is an author of several references cited in this topic.
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. WP is an author of a reference cited in this topic.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Chayakulkeeree M, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2006 Sep;20(3):507-44. Abstract
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: cryptococcosis. Oct 2024 [internet publication].Full text
World Health Organization. Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV. Jun 2022 [internet publication].Full text
Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010 Feb 1;50(3):291-322.Full text Abstract
Boulware DR, Meya DB, Muzoora C, et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med. 2014 Jun 26;370(26):2487-98.Full text Abstract
Rolfes MA, Hullsiek KH, Rhein J, et al. The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis. Clin Infect Dis. 2014 Dec 1;59(11):1607-14.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Tuberculose
- Neoplasia primária ou metastática do sistema nervoso central (SNC)
- Manifestações cutâneas das infecções sistêmicas
More DifferentialsGuidelines
- Global guideline for the diagnosis and management of cryptococcosis
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: cryptococcosis
More GuidelinesVideos
Punção lombar diagnóstica em adultos: demonstração animada
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer