Lung Infection, Cryptococcus

• • 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