Cryptococcosis

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Cryptococcosis
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Cryptococcosis

• Cryptococcosis is a fungal disorder or an
  infection that is caused by the intake of fungus
  Cryptococcus neoformans, which is mostly found in
  soils enriched with pigeon droppings. In moist or
  desiccated pigeon dropping, Cryptococcus
  neoformans may remain viable for 2 years or
  longer.Two types of Cryptococcus neoformans are
  present which are known as neoformans and gattii.
  Cryptococcus neoformans var neoformans is the
  most common variety of this infection and it
  mainly affects immunosuppressed patients like
  those with HIV and AIDS.Cryptococcus neoformans
  var gattii is much less common type of infection
  but it mainly affects immunocompetent (normal
  immune function) individuals. This variety of
  infection is restricted to subtropical and
  tropical areas and the fungus found on eucalyptus
  trees and the surrounding air.

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What are the causes and risk factors for
cryptococcosis?

• The most common cryptococcosis infections affect
  people who are suffering with immunodeficiency,
  e.g. patients who are on high doses of
  corticosteroids, cancer chemotherapy patients,
  organ transplantation patients, and patients with
  acquired immune deficiency (AIDS) and human
  immunodeficiency virus infection (HIV).With the
  global emergence of acquired immune deficiency
  (AIDS), cryptococcosis is now one of the most
  common life-threatening fungal infections in
  these patients.Infection is basically through
  the intake of Cryptococcus spores released from
  soil and bird droppings. It occurs in both humans
  and animals, but animal-to-human and
  human-to-human transmission by respiratory
  droplets has not been documented.Transmission
  by organ transplantation has been reported when
  infected donor organs were used. Infection via
  cuts through the skin is not common but may
  occur.

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How is cryptococcosis diagnosed?

• The following laboratory and radiology tests are
  performed in the diagnosis of cryptococcal
  disease.
• Sputum culture and stain
• Lung biopsy
• Bronchoscopy
• CSF culture and stain
• Chest x-ray
• Skin biopsy shows characteristic histopathology

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What is the treatment for cryptococcosis?

• Treatment of cryptococcal disease relies on the
  patients immunological status and the site of
  infection. It is based on the following
  categories of infection.
• Pulmonary cryptococcosis in an immunocompetent
  patient
• Pulmonary cryptococcosis in an immunosuppressed
  patient
• CNS cryptococcosis
• Disseminated non-pulmonary, non-CNS
  cryptococcosis
• Usually immunocompetent patients with
  asymptomatic pulmonary disease do not require any
  treatment. If the disease does not resolve very
  early then the antifungal fluconazole can be
  given for 3-6 months.

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What is the treatment for cryptococcosis?
Continue

• Treatment goals for categories 2, 3 and 4 differ
  on whether the patient is suffering from HIV/AIDS
  or not. The goal in infected patients with
  HIV/AIDS is to first control the infection that
  is followed by life-long treatment to suppress
  Cryptococcus neoformans.For patients who are
  suffering with cryptococcal disease and not
  complicated by HIV/AIDS then the treatment goal
  is to eradicate the fungi and achieve a permanent
  cure.Several antifungal medications are used.
• Intravenous Amphotericin B is the drug of choice
  for the initial therapy of disseminated,
  pulmonary and CNS cryptococcosis.
• Flucytosine should be used in combination with
  amphotericin B.
• Oral fluconazole can be given in less major
  infections and is used for life-long treatment to
  prevent relapses.

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