Cryptococcus Infection

In general population: 0.4–1.3 cases per 100,000; AIDS pts: 2–7 cases per 1000.

Impact of cryptococcosis: Approximately 625,000 deaths each year worldwide.

Underlying immunocompromised conditions and risk factors: AIDS, systemic lupus erythematous, prolonged treatment with corticosteroids, organ transplantation, advanced malignancy, hematologic malignancy, diabetes, sarcoidosis, cirrhosis, idiopathic CD4 lymphocytopenia, or use of immune-modifying monoclonal antibodies (alemtuzumab, infliximab, etanercept, or adalimumab).

More and more pts with cryptococcosis are described as immunocompetent.

Respiratory insufficiency, severe ARDS

Elevated ICP

Underlying immunocompromised, genetic, or other conditions

Systemic mycosis and third most prevalent disease in HIV-positive individuals

Cryptococcus neoformans / C. gattii typically infect immunocompromised persons, essentially HIV and transplant-recipient pts, but also pts who do not have underlying HIV infection or are not transplant recipients. These pts tend to have a delayed diagnosis compared with the HIV and transplant groups and are remarkably currently the highest risk group for mortality in resource-available countries

Wide range of clinical presentations from asymptomatic respiratory colonization to dissemination of infection into any organ. In severely immunosuppressed pts, involvement of multiple body sites. Common sites for infection are the lungs and CNS

Pulmonary cryptococcosis/cryptococcal pneumonia: Mainly underestimated, not often recognized, multiple clinical presentations—asymptomatic solitary or multiple nodules, lobar infiltrates, interstitial infiltrates, cavities, endobronchial colonization or masses, mediastinal adenopathy, hilar adenopathy, miliary pattern, cavitary lesions, or pleural effusions/empyema, pneumothorax, and life-threatening pneumonia with ARDS

Cryptococcal meningitis/meningoencephalitis: Primary life-threatening infection, most frequent and most severe form. Mortality rate approximately 12%. Other CNS clinical manifestations: Cryptococcomas (abscesses) of brain, spinal cord granuloma, chronic dementia (from hydrocephalus)

Laryngeal cryptococcosis: hoarseness, cough, or acute airway obstruction