Cryptococcosis Cryptococcus neoformans Cryptococcosis Cryptococcosis is a chronic

Cryptococcosis Cryptococcus neoformans.

Cryptococcosis • Cryptococcosis is a chronic, subacute to acute pulmonary, systemic or meningitis disease • Cryptococcus neoformans var. neoformans and Cryptococcus neoformans var. gattii – encapsulated yeast – The species has 4 serotypes (A, B, C, D) based on capsular polysaccharide antigen – C. neoformans var neoformans serotype A

Cryptococcosis • Epidermiology – distributed worldwide, pigeon feces, eucalyptus trees (var. gattii) • Transmission by inhalation of basidiospore or yeast cells • Cryptococcal infections in hosts who are immunosuppressed, including patients with AIDS

Transmission Inhalation respiratory infection dissiminated

Clinical features - sub acute meningitis - meningoencephalitis. CNS cryptococcosis – Most common clinical presentation of cryptococcosis: Cryptococcal meningitis – Prolong evolution of several months – headache, vomiting, neck stiffness, mental status

: 1/3 have evidence of pulmonary involvement - cough , dyspnea - abnormal CXR : Disseminated infection

Cryptococcosis • Pulmonary cryptococcosis – asymptomatic – x-ray Right upper lobe

This is Cryptococcus neoformans infection of the lung. There are numerous organisms that have a large mucoid capsule, giving the appearance of a clear zone around a faint round nucleus.

Cryptococcosis • Cutaneous & mucocutaneous cyptococcosis • Osseous cyrtococcosis : bone • Visceral crytococcosis : heart, kidneys, liver,

Cryptococcus antigen : highly sensitive and specific ( > 1: 8 ) : screening test for febrile patient

Laboratory diagnosis capsule India ink test Mucicarmine stain India ink test : detect the extensive capsule

This is an India ink preparation of cerebrospinal fluid in a patient with Cryptococcus neoformans meningitis. Note the clear zone of the capsule around the central nucleus of the organisms.

• Examination of CSF : - mildly elevation CSF protein - normal or slightly low glucose - a few lymphocytes. - numerous organism • Latex agglutination test : detect cryptococcal antigen • Patient improves : titer • No respond to therapy ; titer

Laboratory diagnosis • Culture: 370 C, 1 -2 days – SDA with out cyclohexamide: creamy, white and mucoid – Birdseed agar: brown to black colony – Urease positive Birdseed agar SDA - ve/+ve

Diagnosis and treatment of Cryptococcus meningitis HIV positive patient CD 4 lymphocyte count <200, 000/ml History suggestive of cryptococcal meningitis( CM ) ( and /or ) Headaches , fever , with/without mental status changes Positive serum cryptococcal antigen

Lumbar puncture No evidence of CM continue diagnostic evaluation Lumbar puncture Evidence of CM Positive culture for Cryptococcus neoformans, positive India ink stain No evidence of CM fluconazole 200 mg orally indefinitely Amphotericin 8 ( 0. 7 mg/kg/day ) iv plus flucytosine (25 mg/kg) q 6 h for 2 week , then fluconzole 400 mg po for 8 weeks, then fluconazole 200 mg po for life