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Cryptococcosis is a serious and potentially fatal fungal disease caused by members of the Cryptococcus neoformans species complex, comprising the two species Cryptococcus neoformans and Cryptococcus gattii with C. neoformans further divided into two varieties (var. neoformans and var grubii). It is believed to be acquired by inhalation of the infectious propagule from the environment. Although the exact nature of the infectious propagule is unknown, the leading hypothesis is the basidiospore created through sexual or asexual reproduction.
Cryptococcosis is a defining opportunistic infection for AIDS. Other conditions which pose an increased risk include certain lymphomas (e.g. Hodgkin’s lymphoma), sarcoidosis, and patients on long-term corticosteroid therapy.
Distribution is worldwide. The prevalence of cryptococcosis has been increasing over the past 20 years for many reasons, including the increase in incidence of AIDS and the expanded use of immunosuppressive drugs.
In humans, C. neoformans causes three types of infections:
Cryptococcal meningitis (infection of the brain) is believed to result from dissemination of the fungus from either an observed or unappreciated pulmonary infection. Cryptococcus gattii causes infections in immunocompetent people (those having a functioning immune system), but C. neoformans v. grubii, and v. neoformans usually only cause clinically evident infections in persons who have some form of defect in their immune systems (immunocompromised persons). People who have defects in their cell-mediated immunity, for example, people with AIDS, are especially susceptible to disseminated cryptococcosis. Cryptococcosis is often fatal, especially if untreated.
Symptoms include chest pain, dry cough, swelling of abdomen, headache, blurred vision and confusion. Symptoms may not be able to be detected.
Detection of cryptococcal antigen (capsular material) by culture of CSF, sputum and urine provides definitive diagnosis. Blood cultures may be positive in heavy infections.
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