Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Most common sites of infection are lungs and CNS• Predilection for lower lobes of lungs +++ Epidemiology + • Pulmonary fungal infections are rising due to widespread use of broad-spectrum antibiotics, immunosuppressive drugs, and HIV infection• Occur anywhere in world, some with characteristic endemic areas• Cryptococcus neoformans: Found in pigeon excreta, grasses, trees, plants, fruits, insects, birds, dairy products-Exists also on skin and in nasopharynx, GI tract, and vagina +++ Symptoms and Signs +++ Pulmonary Infection + • Many asymptomatic• If symptoms, cough, pleuritic chest pain, fever +++ CNS Infection + • Usually follows asymptomatic pulmonary infection• Symptoms vary since many patients are immunocompromised• Many do not manifest usual signs of meningitis or cerebritis +++ Laboratory Findings + • Elevated serum antigen (via complement fixation tests) +++ Imaging Findings + • Chest film: Can appear as 3-10 cm pleural-based mass without smooth borders, areas of consolidation, or as disseminated miliary nodular infiltrate + • Elevated serum antigen (via complement fixation tests)• Histology: India ink stain• Culture is extremely time consuming• No skin test exists + • Chest x-ray• Chest CT scan• Sputum microscopy and culture + • Medical therapy warranted in most cases of pulmonary infection even if asymptomatic• Surgical resection rarely necessary• Open lung biopsy if diagnosis is equivocal +++ Surgery +++ Indications + • To exclude malignancy• Determine etiology of undiagnosed diffuse pulmonary infiltrate +++ Medications + • Amphotericin B is treatment of choice combined with flucytosine• Fluconazole and itraconazole are useful for long-term maintenance therapy +++ References ++Piarrouz R et al: Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients. Crit Care Med 2004;32:2443. ++Walsh TJ et al: Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. NEJM 2002;346:225. [PubMed: 11807146] Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth