Clinical Syndromes: Cryptococcosis
Human cryptococcosis is caused by two species complexes, C. neoformans and C. gattii. As HIV/AIDS is the main risk factor of cryptococcosis, this opportunistic infection also occurs in solid organ transplant recipients and subjects with primary or acquired impaired cell-mediated immunity. However, there is increasing number of cases in otherwise healthy individuals particularly in relation to C. gattii infection. Lung and central nervous system are commonly affected. Meningoencephalitis is always fatal without treatment, and mortality approaches 20% in developed countries. Diagnosis is easy regarding performances of new point-of-care diagnostic assay such as lateral flow assay in serum and cerebrospinal fluid (CSF). A complete work-up for dissemination should be done in case of positive sample for Cryptococcus spp. Most severe patients should be treated with combination of liposomal amphotericin B (or amphotericin B deoxycholate if the former is not available) and flucytosine for at least 2 weeks followed by consolidation therapy with fluconazole for 8–10 weeks and finally with maintenance therapy with low doses of fluconazole. Elevated intracranial pressure should be promptly evaluated as its control has a significant benefit on mortality.
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