Cryptococcosis - Pulmonary
Infection is usually acquired by the respiratory route, and the lungs are 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, with hematogenous dissemination to the central nervous system (CNS) and occasionally the skin (cutaneous findings occur in 15%-20% of disseminated cases). Untreated disseminated disease is fatal. Mortality in AIDS patients is 10%-25%.
Initial pulmonary infection is usually asymptomatic. Most patients present with disseminated infection, especially meningoencephalitis. Headache, nausea, confusion, blurred vision, and abnormal gait may be seen as well as chest pain and cough. Papilledema, cranial nerve palsies, mild fever, and mild meningismus may be present in some patients.
The disease has a 2:1 male predilection, even prior to AIDS.
Pediatric Patient Considerations:
Cryptococcus has been described in children without any immunodeficiency or antecedent conditions, although it most commonly occurs in children with primary immunodeficiencies such as HIV, status-post organ transplant, severe combined immunodeficiency syndrome, or hyperimmunoglobulin M syndrome.
B45.9 – Cryptococcosis, unspecified
42386007 – Cryptococcosis
- Pneumocystis jirovecii infection – less likely to present with nodular lung disease
- Endemic fungal infections (histoplasmosis and coccidioidomycosis)
- Infections due to Nocardia species
- Infection due to Legionella species
- Viral infection (eg, adenovirus)
- Septic emboli – especially in patients who have indwelling central venous catheters
- Malignancy (including lymphoma)
Last Updated: 06/05/2017