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Cryptococcosis - Pulmonary
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Cryptococcosis - Pulmonary

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
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Synopsis

Cryptococcosis, also known as torulosis or European blastomycosis, is a fungal infection caused by Cryptococcus species. The pathogen is found worldwide in soil and avian excreta. This infection is typically seen in immunosuppressed patients, including patients with human immunodeficiency virus (HIV), but some patients may have no predisposing immunocompromising condition found.

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.

Codes

ICD10CM:
B45.9 – Cryptococcosis, unspecified

SNOMEDCT:
42386007 – Cryptococcosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

In patients who are immunocompromised with pulmonary nodules, there are many infectious and noninfectious etiologies that are possible (an infectious diseases consultation is recommended):

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: 04/13/2017
Last Updated: 06/05/2017
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Cryptococcosis - Pulmonary
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Cryptococcosis (CNS) : Fever, Headache, Nausea, Vomiting, Photophobia, Delirium, Nuchal rigidity
Clinical image of Cryptococcosis
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