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Cryptococcosis in Adult
See also in: Pulmonary
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Cryptococcosis in Adult

See also in: Pulmonary
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Contributors: Saami Khalifian MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Cryptococcosis is a chronic fungal infection caused by Cryptococcus neoformans. The geographic distribution is worldwide, but there are 2 variants: C. neoformans var. gattii, seen more commonly in tropical locations and in immunocompetent patients; and C. neoformans var. neoformans, seen more commonly in immunosuppressed populations. The pathogen is found in soil and avian excreta. Human immunodeficiency virus (HIV)-infected patients account for 80%-90% of all patients with cryptococcosis.

Primary inoculation cutaneous cryptococcosis may occur in normal and immunocompromised hosts, but infection is usually acquired by the respiratory route, with the lungs as the primary focus of the infection. In the presence of a normal immune system, the infection is usually contained and remains latent in the lung and/or hilar nodes. If there is subsequent immunosuppression, organisms may proliferate and cause symptomatic, active infection. In this situation, secondary hematogenous dissemination to the central nervous system (CNS) and occasionally the skin occurs.

Pulmonary cryptococcosis may be heralded by chest pain and cough. In HIV-positive patients, it is usually more severe, especially with low CD4 counts. Headache, nausea, confusion, blurred vision, and abnormal gait may be presenting symptoms. Papilledema, cranial nerve palsies, mild fever, and mild meningismus may be present in some patients.

Cutaneous findings occur in 15%-20% of disseminated cases. The presentation is variable. Cellulitis, abscesses, papules, plaques, ulcers, sinus tracts, or purpura may all be seen. In HIV patients, molluscum-like umbilicated papules are described.

Other possible sites of infection include the skeletal system, eyes, lymph nodes, liver, and genitourinary tract.

However, the presence of cryptococcal infection does not imply abnormal immune status; perhaps a quarter of patients have no predisposing condition. The disease has a 2:1 male predilection (even prior to AIDS).

Untreated disseminated disease is fatal. Mortality in AIDS patients is 10%-25%.

Pediatric Patient Considerations:
Cryptococcus has been described in children without any immunodeficiency or antecedent conditions, although it most commonly occurs in children with immunodeficiencies such as HIV, status-post organ transplant, severe combined immunodeficiency syndrome, or hyperimmunoglobulin M syndrome.

Codes

ICD10CM:
B45.9 – Cryptococcosis, unspecified

SNOMEDCT:
42386007 – Cryptococcosis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Pulmonary disease:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 03/20/2017
Last Updated: 03/20/2017
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Cryptococcosis in Adult
See also in: Pulmonary
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Cryptococcosis (CNS) : Fever, Headache, Nausea, Vomiting, Photophobia, Delirium, Nuchal rigidity
Clinical image of Cryptococcosis
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