Presentation
Comment Here Reference: Cryptococcus neoformans and gattii Board review style question #2 A 67 year old woman presented with a solitary lung nodule. Biopsy showed variably sized yeast with no discernible capsule. [pathologyoutlines.com]
Clinical presentations also depend on the characteristics of the immunological competency of the patients. In general, it is a systemic fungal infection with its origin as the inhalation of C. neoformans, initially affecting the lungs. [ncbi.nlm.nih.gov]
If phenoloxidase is present, it breaks down caffeic acid to melanin with resulting brown-black colour production.) [thunderhouse4-yuri.blogspot.com]
Meningeal cryptococcosis is the most frequent clinical presentation of this disseminated mycosis. The oral mucosa involvement is extremely unusual. Case report We present a case of cryptococcosis with an unusual clinical form. [elsevier.es]
Sign In A 36-year-old man presented to the emergency department with a 2 week-history of headache, photophobia, and fever. [nejm.org]
Entire Body System
- Asymptomatic
Many patients with cryptococcal pulmonary infection are asymptomatic. Those with pneumonia usually have cough and other nonspecific respiratory symptoms. [msdmanuals.com]
In immunocompetent individuals, the initial infection is usually controlled and asymptomatic and the organism remains dormant in a lymph node complex, much like tuberculosis. [broadinstitute.org]
In fact, one of the major challenges in treating cryptococcosis is that many patients with cryptococcal CNS disease are asymptomatic in terms of cryptococcal pneumonia, making it difficult for early detection. [norgenbiotek.com]
The earliest manifestation of reactivation is observed in individuals in whom asymptomatic cryptococcal antigenemia is detected (71–73). [jci.org]
- Fever
The symptoms are often similar to those of many other illnesses, and can include: Cough Shortness of breath Chest pain Fever In the brain (cryptococcal meningitis) Headache, fever, and neck pain are common symptoms of cryptococcal meningitis. [cdc.gov]
Report of a Case A 55-year-old white man was admitted to this hospital on Aug 7, 1965, with complaints of weight loss, fever, and hiccoughs. [jamanetwork.com]
• Present with Chronic meningitis, Meningo encephalitis• Manifest with – head ache low grade fever,• Visual abnormalities ,Coma – fatal• Treatment reduces the morbidity and cure in non immune suppressed expected. 13 DR.T.V.RAO MD 14. [slideshare.net]
Sign In A 36-year-old man presented to the emergency department with a 2 week-history of headache, photophobia, and fever. [nejm.org]
- Inflammation
Mediators Inflamm. 2020 Dec 3;2020:3412763. doi: 10.1155/2020/3412763. eCollection 2020. Mediators Inflamm. 2020. PMID: 33380899 Free PMC article. [pubmed.ncbi.nlm.nih.gov]
Closer view (3 of 4) Closer view of the vocal cords shows similar intense inflammation and rough surface. One year later (3 of 4) After a one-year course of fluconazole, an oral anti-fungal medication. Symptoms are gone. [laryngopedia.com]
Meningitis is an infection and inflammation of the meninges, which are the membranes that cover the brain and spinal cord. Meningitis can be caused by different germs, including bacteria, fungi, and viruses. [healthline.com]
Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome. J Infect Dis. 2010; 202 :962–70. [ PMC free article ] [ PubMed ] [ Google Scholar ] 9. [ncbi.nlm.nih.gov]
It is an opportunistic fungal pathogen notoriously known as the most common cause of fungal meningitis (infection and inflammation of the meninges) in immuno-compromised patients (such as people with AIDS). [microbeonline.com]
- Weakness
Cryptococcosis is most often seen in people with a weak immune system, such as those who: Are infected with HIV/AIDS Take high doses of corticosteroid medicines Cancer Are on chemotherapy medicines for cancer Have Hodgkin disease Have had an organ transplant [medlineplus.gov]
Moreover, 52 (69.9%) of the isolates could grow at 4ºC, including moderate grow 36 (49.3%), and weak grow 15 (20.6%). [brieflands.com]
[…] abscess, degenerative central nervous system Mycobacterial mimicked disease Fungal meningitis Patients with meningitis symptoms have complications of severe headaches, neck stiffness, and disorientation They may also have lesions in skin, lungs, bone weakness [microbenotes.com]
[…] night, swollen glands without the appearance of infection in nearby areas, skin rash, pinpoint red spots (petechiae), bleeding into the skin, bruises, unintentional weight loss, appetite loss, abdominal bloating, abdominal pain, abdominal swelling, weakness [rarediseases.org]
The capsule is also a weak activator of the host immune response if not intrinsically immunosuppressive. Shed capsular material will also act to bind host antibody and complement components, thereby protecting the organisms itself. [microbiollogy.blogspot.com]
- Pain
The symptoms are often similar to those of many other illnesses, and can include: Cough Shortness of breath Chest pain Fever In the brain (cryptococcal meningitis) Headache, fever, and neck pain are common symptoms of cryptococcal meningitis. [cdc.gov]
Lung symptoms may include: Difficulty in breathing Cough Chest pain Other symptoms may include: Bone pain or tenderness of the breastbone Fatigue Skin rash, including pinpoint red spots ( petechiae ), ulcers, or other skin lesions Sweating -- unusual, [medlineplus.gov]
[…] in nearby areas, skin rash, pinpoint red spots (petechiae), bleeding into the skin, bruises, unintentional weight loss, appetite loss, abdominal bloating, abdominal pain, abdominal swelling, weakness, bone pain, and numbness and/or tingling. [rarediseases.org]
Eighteen months prior to his admission, he noticed a lump on his scalp, with a gradual increase in swelling and local pain. He was submitted to an excisional biopsy of a bulging occipital-parietal lesion. [bjid.org.br]
Case report We admitted a 24 year old woman with hypaesthesia, painful dysaesthesia, gait disorder, and micturition disturbances. [jnnp.bmj.com]
Respiratoric
- Pneumonia
This organism causes a chronic pneumonia and can also cause meningitis. It is the only human pathogen fungus capable of producing a capsule. [atsu.edu]
Cryptococcus neoformans often produces a pneumonia, because infection is acquired via the respiratory tract. Here, C neoformans organisms have a clear capsule surrounding the pale blue nucleus with H and E staining. [webpath.med.utah.edu]
Those with pneumonia usually have cough and other nonspecific respiratory symptoms. [msdmanuals.com]
A C. neoformans infection in the lungs can cause a pneumonia-like illness. [cdc.gov]
In fact, one of the major challenges in treating cryptococcosis is that many patients with cryptococcal CNS disease are asymptomatic in terms of cryptococcal pneumonia, making it difficult for early detection. [norgenbiotek.com]
- Sputum
Cryptococcus neoformans infection is primarily acquired through inhalation and may invade; Respiratory system - (Sputum, Broncheal Wash, Lung Biopsy) Central Nervous System (CNS) - (Lumbar Puncture) Also implicated in; Skin infections Bone infections [thunderhouse4-yuri.blogspot.com]
Yeast forms would be visible by gram staining of the sputum and acid-fast staining would reveal acid-fast negative yeast cells. [atsu.edu]
CSF, sputum, and urine yield organisms most often, and blood cultures may be positive, particularly in patients with AIDS. [msdmanuals.com]
The physical exam may reveal: Abnormal breath sounds Fast heart rate Fever Mental status changes Stiff neck Tests that may be done include: Blood culture to differentiate between the two fungi CT scan of the head Sputum culture and stain Lung biopsy Bronchoscopy [medlineplus.gov]
- Dyspnea
[…] gattii infects immunocompetent individuals Major illness in patients with HIV / AIDS with an estimated 220,000 annual cases of cryptococcal meningitis worldwide (Lancet Infect Dis 2017;17:873) Pulmonary disease can be subacute and indolent Cough and dyspnea [pathologyoutlines.com]
However, AIDS-associated cryptococcal pulmonary infection may manifest as severe, progressive pneumonia with acute dyspnea and an x-ray pattern suggesting Pneumocystis infection. [msdmanuals.com]
- Respiratory Distress
The photos on this post were taken from speimens obtained from an 80 year old woman of Indian heritage who presented with respiratory distress. Unfortunately she succumbed to her infection. [thunderhouse4-yuri.blogspot.com]
- Hoarseness
Common characteristics of cryptococcus neoformans include longstanding hoarseness, sore throat, or edema of the vocal cords. Cryptococcus neoformans laryngitis is treated with oral anti-fungal medications such as fluconazole. [laryngopedia.com]
Cardiovascular
- Irregular Heart Rhythm
He gave a history of chorea in childhood and Bright's disease at age 21, and of a more recent episode of an irregular heart rhythm treated with digitalis. Physical examination of the moderately ill, perspiring, obese patient [jamanetwork.com]
Skin
- Night Sweats
Despite a good appetite, he lost approximately 6.8 kg (15 lb), and experienced night sweats and increasing fatigue. [jamanetwork.com]
There were no headaches, nausea, fever, weight loss, night sweat, skin alterations, or icterus. Except for a history of atopic eczematous dermatitis the patient had never experienced illness. [jnnp.bmj.com]
Neurologic
- Meningism
All untreated cases of cryptococcal meningitis are ultimately fatal. About 5-8% of patients with AIDS develop cryptococcal meningitis. [microbeonline.com]
An estimated 220,000 cases of cryptococcal meningitis occur among people with HIV/AIDS worldwide each year, resulting in nearly 181,000 deaths. 1 Most cryptococcal meningitis cases occur in sub-Saharan Africa (Figure 1). [cdc.gov]
Elevated CSF protein and a mononuclear cell pleocytosis are usual in cryptococcal meningitis. [msdmanuals.com]
Infection of the brain and meninges is the most common clinical manifestation. [broadinstitute.org]
- Confusion
Scientific classification … Wikipedia Cryptococcus — neoformans Systematik Abteilung: Basidienpilze (Basidio … Deutsch Wikipedia Cryptococcus gattii — Systematik Klasse: Ständerpilze (Basidiomycetes) Unterklasse … Deutsch Wikipedia Cryptococcus — Not to be confused [medicine.academic.ru]
The symptoms of cryptococcal meningitis include: Headache Fever Neck pain Nausea and vomiting Sensitivity to light Confusion or changes in behavior If you have symptoms that you think may be due to a C. neoformans infection, please contact your healthcare [cdc.gov]
Symptoms of brain infection may include: Fever and headache Neck stiffness Nausea and vomiting Blurred vision or double vision Confusion The infection can also affect the lungs and other organs. [medlineplus.gov]
Within a few days to a few weeks of contact, an infected person may develop the following symptoms: headache nausea vomiting mental changes, including confusion, hallucinations, and personality changes lethargy sensitivity to light In some cases, the [healthline.com]
Signs and symptoms of cryptococcal meningitis Headache Fever Change in mental status (ranging from confusion to lethargy to coma) Blurry vision (and other cranial nerve deficits) Neck stiffness Sensitivity to light Nausea and vomiting Seizures Papilledema [microbeonline.com]
- Papilledema
Papilledema. 2008. Review Article: Singh, N., Perfect, J. Immune Reconstitution Syndrome Associated with Opportunistic Mycoses. The LANCET Infectious Diseases 2007; Vol.7, Issue 6, 395-401. [antimicrobe.org]
Signs and symptoms of cryptococcal meningitis Headache Fever Change in mental status (ranging from confusion to lethargy to coma) Blurry vision (and other cranial nerve deficits) Neck stiffness Sensitivity to light Nausea and vomiting Seizures Papilledema [microbeonline.com]
- Chorea
He gave a history of chorea in childhood and Bright's disease at age 21, and of a more recent episode of an irregular heart rhythm treated with digitalis. Physical examination of the moderately ill, perspiring, obese patient [jamanetwork.com]
Treatment
Recommended treatment for cryptococcosis. [ Download PDF ] Vignettes R eview Article : Singh N, Treatment of opportunistic mycoses: how long is long enough ? Lancet Infect Dis 2003;3:703-08. Guideline: Perfect et al. [antimicrobe.org]
The type of treatment usually depends on the severity of the infection and the parts of the body that are affected. [cdc.gov]
Treatment with flucytosine does not result in a cure (full clearance of infection and immunity). [ppdictionary.com]
Individuals with compromised immune systems, or under immune suppressive therapy, should be given prolonged drug treatment to prevent relapses. [rarediseases.org]
Prognosis
(Sputum, Broncheal Wash, Lung Biopsy) Central Nervous System (CNS) - (Lumbar Puncture) Also implicated in; Skin infections Bone infections Other sites (disseminated) Treatment; (dependent on site of infection) Amphotericin B Flucytosine Fluconazole Prognosis [thunderhouse4-yuri.blogspot.com]
Mycological failure after 2 weeks of induction is recognized as a factor of bad prognosis, which requires continuation of the induction therapy (79). [jci.org]
High antigen securities generally correlate with disease severity and likewise a decrease corresponds to a good prognosis. [mycology.imedpub.com]
Etiology
@article{KwonChung2014CryptococcusNA, title={Cryptococcus neoformans and Cryptococcus gattii, the etiologic agents of cryptococcosis.}, author={Kyung J. Kwon-Chung and James A. [semanticscholar.org]
The results of the biopsy were unspecific and no etiological diagnosis was identified. After this procedure, the post-surgical wound never completely healed. [bjid.org.br]
Some years ago, it was considered that the etiologic agent of this disease was a single species, Cryptococcus neoformans, which had two varieties: C. neoformans var. neoformans, and C. neoformans var. gattii. [elsevier.es]
An analysis of 28 cases with emphasis on the clinical outcome and its etiologic agent. Rev Iberoam Micol. 2004;21:143-46. French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS. 2004;18:1615-27. Ruhnke M. [rarediseases.org]
Cryptococcus neoformans and Cryptococcus gattii, the etiologic agents of cryptococcosis. Cold Spring Harb Perspect Med. 2014; 4(7):a019760. [revistamvz.unicordoba.edu.co]
Epidemiology
Application of recent insights into the life cycle of C. neoformans and its different ways of engaging in sexual reproduction under laboratory conditions has just begun to affect research on the ecology and epidemiology of this human pathogenic fungus [pubmed.ncbi.nlm.nih.gov]
This volume provides a comprehensive review of the ecology, epidemiology, pathogenic mechanisms, host immunity, clinical features and diagnostic conditions, and principles of treatment and prevention of this important fungal pathogen. [asmscience.org]
C. neoformans is a form of yeast with biochemical, antigenic, and epidemiological differences. There are two known varieties. [ncbi.nlm.nih.gov]
Recent reports on outbreaks of cryptococcosis in goats due to C neoformans var gattii in Spain 19 will give new epidemiological insights. [jnnp.bmj.com]
Pathophysiology
(UpToDate: Cryptococcus neoformans infection outside the central nervous system [Accessed 05 August 2020]) Can resemble molluscum contagiosum Disseminated infection Immunocompetent host CNS infection / meningoencephalitis / uveitis Lung / pneumonia Pathophysiology [pathologyoutlines.com]
Prevention
This volume provides a comprehensive review of the ecology, epidemiology, pathogenic mechanisms, host immunity, clinical features and diagnostic conditions, and principles of treatment and prevention of this important fungal pathogen. [asmscience.org]
Taking this medication helps prevent relapses. [healthline.com]
Wearing masks may help to prevent the inhalation of Cryptococcus neoformans. [microbenotes.com]
Individuals with compromised immune systems, or under immune suppressive therapy, should be given prolonged drug treatment to prevent relapses. [rarediseases.org]