Cryptococcosis

Cryptococcosis is a systemic infection caused by the fungus Cryptococcus neoformans. Other names for this infection include European blastomycosis and torulosis. It is a basidiomycetous encapsulated yeast, with two variations: neoformans and gattii. Neoformans can be found in soil worldwide that has been frequented by birds, especially pigeons and chickens. Infections are most associated with immunocompromised patients. Gattii is not associated with bird guano but has been grown from river red gum trees, forest red gum trees and in tropical and subtropical areas of Hawaii, Brazil, Australia, Southeast Asia, Central Africa. In contrast to Neoformans, gattii is mostly associated with the immunocompetent host (13).

Illness is caused by inhalation of the organism. The most common presentation for immunocompetent hosts is either an asymptomatic pulmonary infection or as cough, fever, sputum production, and pleuritic chest pain. The central nervous system has a high predilection for involvement, especially in immunocompromised patients and should be suspected whenever there is an infection detected at any organ site. Diagnosis is confirmed by isolation of the yeast form of the organism from the host or by twofold increase of the cryptococcal antigen (13,14).

Treatment depends on the immune status of the host and the anatomic site of the disease. Medications include amphotericin B, flucytosine, fluconazole and itraconazole. These agents are used alone or in combination depending on the clinical setting (12,14).

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