Definition

Cryptococcosis is infection with Cryptococcus neoformans fungus.

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Causes, incidence, and risk factors

Cryptococcus neoformans is the fungus that causes this disease. It is usually found in soil. If you breathe it in, it infects your lungs. The infection may go away on its own, remain in the lungs only, or spread throughout the body (disseminate).

This infection is most often seen in people with a weakened immune system, such as those with HIV infection, taking high doses of corticosteroid medications, cancer chemotherapy, or who have Hodgkin's disease.

Cryptococcus is one of the most common life-threatening fungal infections in people with AIDS.

Symptoms

• Blurred vision or double vision
• Bone pain or tenderness of the breastbone
• Chest pain
• Confusion
• Cough -- dry
• Fatigue
• Fever
• Headache
• Nausea
• Skin rash, including pinpoint red spots (petechiae), ulcers, or other skin lesions
• Sweating -- unusual, excessive at night
• Swollen glands
• Unintentional weight loss

People with a normal immune system may have no symptoms at all.

The infection may spread to the brain in people who have a weakened immune system. Neurological (brain) symptoms start slowly. Most people with this infection have swelling and irritation of the brain and spinal cord when they are diagnosed.

Signs and tests

Physical examination may reveal:

• Abnormal breath sounds
• Fast heart rate
• Fever
• Mental status changes
• Stiff neck

Tests that may be done include:

• Blood culture
• CT scan of the head
• Sputum culture and stain
• Lung biopsy
• Bronchoscopy
• Spinal tap to obtain a sample of cerebrospinal fluid (CSF)
• Cerebrospinal fluid (CSF) culture and other tests to check for signs of infection
• Chest x-ray
• Cryptococcal antigen test (looks for a certain molecule that the Cryptococcus fungus can shed into the blood)

Treatment

Some infections require no treatment. Even so, there should be regular check-ups for a full year to make sure the infection has not spread. If there are lung lesions or the disease spreads, antifungal medications are prescribed. These drugs may need to be taken for a long time.

Medications include:

• Amphotericin B
• Flucytosine
• Fluconazole

Amphotericin B can have severe side effects.

Expectations (prognosis)

Central nervous system involvement often causes death or leads to permanent damage.

Calling your health care provider

Call your health care provider if you develop symptoms of cryptococcosis, especially if you have a weakened immune system.

Prevention

References

Kauffman CA. Cryptococcosis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 344.

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