Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- 172 Candidiasis
- 173 Aspergillosis
- 174 Mucormycosis (and entomophthoramycosis)
- 175 Sporotrichum
- 176 Cryptococcus
- 177 Histoplasmosis
- 178 Blastomycosis
- 179 Coccidioidomycosis
- 180 Pneumocystis jirovecii (carinii)
- 181 Miscellaneous fungi and algae
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
176 - Cryptococcus
from Part XXII - Specific organisms: fungi
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- 172 Candidiasis
- 173 Aspergillosis
- 174 Mucormycosis (and entomophthoramycosis)
- 175 Sporotrichum
- 176 Cryptococcus
- 177 Histoplasmosis
- 178 Blastomycosis
- 179 Coccidioidomycosis
- 180 Pneumocystis jirovecii (carinii)
- 181 Miscellaneous fungi and algae
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
Summary
Cryptococcus neoformans, which is found worldwide as a soil organism and thought to be transmitted by inhalation, most often causes disease in patients with abnormal cell-mediated immunity, notably patients with human immunodeficiency virus (HIV) infection and solid organ transplant recipients, but the infection also occurs rarely in apparently immunocompetent persons. It is the most common systemic fungal infection in patients infected with HIV. It is estimated that over 1 million cases of invasive cryptococcal infection occur annually in patients with acquired immunodeficiency syndrome (AIDS) worldwide with more than 600 000 deaths each year. Most of these cases occur in resource-poor settings, especially in sub-Saharan Africa. With the advent of effective antiretroviral therapy (ART), cryptococcal infections have become much less common in the United States.
Two varieties of C. neoformans exist, distinguishable by serology: C. neoformans var. neoformans (serotypes A and D) and C. neoformans var. gattii (serotypes B and C). Virtually all HIV-associated infection is caused by C. neoformans var. neoformans. C. neoformans var. gattii is endemic in Australia and recent outbreaks of C. neoformans var. gattii infection have occurred in the Pacific northwestern parts of North America.
PRESENTATION AND DIAGNOSIS
The most common manifestation of cryptococcal infection is meningitis. Most patients develop insidious features of a subacute meningitis or meningoencephalitis, with fever, malaise, and headache, and are generally symptomatic for at least 2 to 4 weeks before presentation. In patients with a more subacute or chronic course, mental status changes such as forgetfulness and coma can also be seen. Classic meningeal symptoms and signs such as stiff neck and photophobia occur in only about one-quarter to one-third of all patients and generally are less likely to occur in HIV-positive patients. The typical pattern in the cerebrospinal fluid (CSF) is chronic meningitis with a lymphocytic pleocytosis.
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- Clinical Infectious Disease , pp. 1128 - 1133Publisher: Cambridge University PressPrint publication year: 2015