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Cryptococcosis

Not to be confused with Cryptosporidiosis.
Cryptococcosis
Other namesBusse-Buschke disease, cryptococcic meningitis, cryptococcosis lung, cryptococcosis skin, European Blastomycosis, torular meningitis, torulosis[1]
Micrograph of cryptococcosis showing the characteristically thick capsule of cryptococcus. Field stain.
Pronunciation
SpecialtyInfectious disease[4]
Symptoms
CausesCryptococcus neoformans,[7] Cryptococcus gattii[8]
Risk factorsHIV/AIDS,[9] Aviculture
Diagnostic methodBiopsy, culture[9]
TreatmentAntifungal medication
Medication

Cryptococcosis is a potentially fatal fungal infection of mainly the lungs, presenting as a pneumonia, and brain, where it appears as a meningitis.[4][9] Cough, difficulty breathing, chest pain and fever are seen when the lungs are infected.[5] When the brain is infected, symptoms include headache, fever, neck pain, nausea and vomiting, light sensitivity and confusion or changes in behavior.[5] It can also affect other parts of the body including skin, where it may appear as several fluid-filled nodules with dead tissue.[6]

It is caused by the fungi Cryptococcus neoformans or less commonly Cryptococcus gattii, and is acquired by breathing in the spores from the air.[4] These fungi are found around the world in soil, decaying wood, pigeon droppings, and in the hollows of some species of trees.[9][11] Whereas C. neoformans generally infects people with HIV/AIDS and those on immunosuppressant drugs and does not usually affect fit and healthy people, C. gattii (found in some parts of Canada and the US) does.[9][11] Once breathed in, the dried yeast cells colonize the lungs, where they are either cleared by immune cells, lie dormant, or cause infection and spread.[12]

Diagnosis is by isolating Cryptococcus from a sample of affected tissue or direct observation of the fungus by using staining of body fluids.[9] It can be cultured from a cerebrospinal fluid, sputum, and skin biopsy.[9] Treatment is with fluconazole or amphotericin B.[9][10]

Data from 2009 estimated that of the almost one million cases of cryptococcal meningitis that occurred worldwide annually, 700,000 occurred in sub-Saharan Africa and 600,000 per year died.[13] Cryptococcosis was rare before the 1970s which saw an increase in at-risk groups such as people with organ transplant or on immunosuppressant medications.[9] The number of cases escalated in the mid-1980s with over 80% occurring in people with HIV/AIDS.[9] Pigeon breeders (or otherwise people who spend significant time with pigeons) are known to have a high incidence of cryptococcal infections including PCC due to Cryptococcus' association with pigeon droppings.[14][15]

  1. ^ "Cryptococcosis". NORD (National Organization for Rare Disorders). Retrieved 5 June 2021.
  2. ^ "Cryptococcosis". Lexico UK English Dictionary. Oxford University Press. Archived from the original on 2021-05-07.
  3. ^ "Cryptococcosis". Merriam-Webster.com Dictionary. Retrieved 2016-01-21.
  4. ^ a b c "ICD-11 — ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 5 June 2021.
  5. ^ a b c d "Symptoms of C. neoformans Infection". Fungal Diseases. Centers for Disease Control and Prevention. 14 January 2021. Retrieved 6 June 2021.
  6. ^ a b Johnstone, Ronald B. (2017). "25. Mycoses and Algal infections". Weedon's Skin Pathology Essentials (2nd ed.). Elsevier. p. 446. ISBN 978-0-7020-6830-0.
  7. ^ "C. neoformans Infection". Fungal Diseases. Centers for Disease Control and Prevention. 29 December 2020. Retrieved 5 June 2021.
  8. ^ "Where C. gattii Infection Comes From". Fungal Disease. Centers for Disease Control and Prevention. 29 January 2021. Retrieved 5 June 2021.
  9. ^ a b c d e f g h i j k Maziarz, Eileen K.; Perfect, John R. (2016). "Cryptococcosis". Infectious Disease Clinics of North America. 30 (1): 179–206. doi:10.1016/j.idc.2015.10.006. PMC 5808417. PMID 26897067.
  10. ^ a b "Treatment for C. neoformans Infection". Fungal Diseases. Centers for Disease Control and Prevention. 14 January 2021. Retrieved 6 June 2021.
  11. ^ a b "Where C. neoformans Infection Comes From". Fungal Diseases. Centers for Disease Control and Prevention. 2 February 2021. Retrieved 5 June 2021.
  12. ^ Sabiiti, Wilber; May, Robin C. (November 2012). "Mechanisms of infection by the human fungal pathogen Cryptococcus neoformans". Future Microbiology. 7 (11): 1297–1313. doi:10.2217/fmb.12.102. PMID 23075448.
  13. ^ Vallabhaneni, Snigdha; Mody, Rajal K.; Walker, Tiffany; Chiller, Tom (2016). "1. The global burden of fungal disease". In Sobel, Jack; Ostrosky-Zeichner, Luis (eds.). Fungal Infections, An Issue of Infectious Disease Clinics of North America. Philadelphia: Elsevier. pp. 3–4. ISBN 978-0-323-41649-8.
  14. ^ Walter JE, Atchison RW (July 1966). "Epidemiological and immunological studies of Cryptococcus neoformans". J Bacteriol. 92 (1): 82–7. doi:10.1128/jb.92.1.82-87.1966. PMC 276199. PMID 5328755.
  15. ^ Beatson M, Harwood M, Reese V, Robinson-Bostom L (May 2019). "Primary cutaneous cryptococcosis in an elderly pigeon breeder". JAAD Case Rep. 5 (5): 433–5. doi:10.1016/j.jdcr.2019.03.006. PMC 6510938. PMID 31192987.
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