Cryptococcosis

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Cryptococcosis
Prattana Leenasirimakul Nakornping
Hospital Chiang mai, Thailand
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Cryptococcosis

• Cryptococcus neoformans.

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Cryptococcosis

• Cryptococcosis is a chronic, subacute to acute
  pulmonary, systemic or meningitis disease
• Cryptococcus neoformans var. neoformans and
  Cryptococcus neoformans var. gattii
• encapsulated yeast
• The species has 4 serotypes (A,B,C,D) based on
  capsular polysaccharide antigen
• C. neoformans var neoformans serotype A

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Cryptococcosis

• Epidermiology
• distributed worldwide, pigeon feces,
  eucalyptus trees (var. gattii)
• Transmission by inhalation of basidiospore or
  yeast cells
• Cryptococcal infections in hosts who are
  immunosuppressed, including patients with AIDS

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Transmission

• Inhalation respiratory infection
  dissiminated

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Clinical features

• - sub acute meningitis
• - meningoencephalitisCNS cryptococcosis
• Most common clinical presentation of
  cryptococcosis Cryptococcal meningitis
• Prolong evolution of several months
• headache, vomiting, neck stiffness, mental status

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• 1/3 have evidence of pulmonary
  involvement
• - cough , dyspnea
• - abnormal CXR
• Disseminated infection

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Cryptococcosis

• Pulmonary cryptococcosis
• asymptomatic
• x-ray

Right upper lobe
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This is Cryptococcus neoformans infection of the
lung. There are numerous organisms that have a
large mucoid capsule, giving the appearance of a
clear zone around a faint round nucleus.
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Cryptococcosis

• Cutaneous mucocutaneous cyptococcosis
• Osseous cyrtococcosis bone
• Visceral crytococcosis heart, kidneys, liver,

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Cryptococcus antigen

• highly sensitive and specific ( gt 18 )
• screening test for febrile patient

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Laboratory diagnosis
capsule
capsule
India ink test
Mucicarmine stain
India ink test detect the extensive capsule
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This is an India ink preparation of cerebrospinal
fluid in a patient with Cryptococcus neoformans
meningitis. Note the clear zone of the capsule
around the central nucleus of the organisms.
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• Examination of CSF
• - mildly elevation CSF protein
• - normal or slightly low glucose
• - a few lymphocytes.
• - numerous organism
• Latex agglutination test detect cryptococcal
  antigen
• Patient improves titer
• No respond to therapy titer

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Laboratory diagnosis

• Culture 370C, 1-2 days
• SDA with out cyclohexamide creamy, white and
  mucoid
• Birdseed agar brown to black colony
• Urease positive

SDA
- ve/ve
Birdseed agar
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Diagnosis and treatment of Cryptococcus
meningitis
HIV positive patient CD4 lymphocyte count
lt200,000/ml
History suggestive of cryptococcal meningitis(
CM )
( and /or )
Headaches , fever ,with/without mental status
changes
Positive serum cryptococcal antigen
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Lumbar puncture
Lumbar puncture
No evidence of CM continue diagnostic
evaluation
No evidence of CM fluconazole 200 mg orally
indefinitely
Evidence of CM Positive culture for
Cryptococcus neoformans, positive India ink stain
Amphotericin 8 ( 0.7 mg/kg/day ) iv plus
flucytosine (25mg/kg) q6h for 2 week , then
fluconzole 400 mg po for 8 weeks, then
fluconazole 200mg po for life