Cryptococcosis

Cryptococcosis (also known as torulosis and European blastomycosis) usually begins as a pulmonary infection that produces no signs or symptoms. It then disseminates to extrapulmonary sites, including the central nervous system (CNS), skin, bones, prostate gland, liver and kidneys.

With treatment, the prognosis in pulmonary cryptococcosis is good. Without treatment (particularly in immunocompromised patients), the disease can lead to CNS infection and death (invariably within 3 years). Treatment dramatically reduces mortality but not necessarily neurologic deficits, such as paralysis and hydrocephalus.

Cryptococcosis is especially likely to attack immunocompromised patients, particularly those with Hodgkin's disease, sarcoidosis, leukemia, or lymphomas and those taking immunosuppressant drugs. The incidence is increasing, especially in patients with acquired immunodeficiency syndrome (AIDS).

Causes

The airborne fungus Cryptococcus neoformans causes cryptococcosis. It's found in dust particles contaminated by pigeon stool.

Signs and symptoms

• Appetite, loss
• Abdominal fullness prematurely after meals
• Abdominal pain
• Chest pain
• Dry cough
• Headache
• Nausea
• Prolonged bleeding, bruising easily
• Skin rash may be present
  • Skin rash or lesion - pinpoint red spots ( petechiae )
  • Bleeding into the skin
  • Bruises ( ecchymoses )
• Unintentional weight loss

Diagnostic tests

The following laboratory and radiology tests are performed to assist in the diagnosis of cryptococcal disease.

• Sputum culture and stain
• Lung biopsy
• Bronchoscopy
• CSF culture and stain
• Chest x-ray
• Skin biopsy

Treatment

Cryptococcosis is best treated with a combination of amphotericin B and flucytosine, typically for 6 weeks. Because flucytosine may produce adverse reactions, amphotericin B alone may be used in selected cases. This therapy is continued indefinitely in the patient with AIDS. In the non-AIDS patient, weekly lumbar punctures should be performed until cultural conversion occurs.

Prevention

The best way to prevent cryptococcosis is to stay free of HIV infection. People with suppressed immune systems should try to stay away from areas contaminated with pigeon or other bird droppings, such as the attics of old buildings, barns, and areas under bridges where pigeons roost.