Cryptococcosis is a potentially fatal fungal infection of mainly the lungs, presenting as a pneumonia, and brain, where it appears as a meningitis.[4][9] Cough, difficulty breathing, chest pain and fever are seen when the lungs are infected.[5] When the brain is infected, symptoms include headache, fever, neck pain, nausea and vomiting, light sensitivity and confusion or changes in behaviour.[5] It can also affect other parts of the body including skin, where it may appear as several fluid-filled nodules with dead tissue.[6]

Other namesBusse-Buschke disease, cryptococcic meningitis, cryptococcosis lung, cryptococcosis skin, European Blastomycosis, torular meningitis, torulosis[1]
Micrograph of cryptococcosis showing the characteristically thick capsule of cryptococcus. Field stain.
SpecialtyInfectious disease[4]
CausesCryptococcus neoformans,[7] Cryptococcus gattii[8]
Risk factorsHIV/AIDS,[9] frequent feeding of Pigeons
Diagnostic methodBiopsy, culture[9]
TreatmentAntifungal medication

It is caused by the fungi Cryptococcus neoformans or less commonly Cryptococcus gattii, and is acquired by breathing in the spores from the air.[4] These fungi are found around the world in soil, decaying wood, pigeon droppings, and in the hollows of some species of trees.[9][11] Whereas C. neoformans infects generally people with HIV/AIDS and those on immunosuppressant drugs and does not usually affect fit and healthy people, C. gattii (found in some parts of Canada and the US) does.[9][11] Once breathed in, the dried yeast cells colonize the lungs, where they are either cleared by immune cells, lie dormant, or cause infection and spread.[12]

Diagnosis is by isolating Cryptococcus from a sample of affected tissue or direct observation of the fungus by using staining of body fluids.[9] It can be cultured from a cerebrospinal fluid, sputum, and skin biopsy.[9] Treatment is with fluconazole or amphotericin B.[9][10]

Data from 2009 estimated that of the almost one million cases of cryptococcal meningitis that occurred worldwide annually, 700,000 occurred in sub-Saharan Africa and 600,000 per year died.[13] Cryptococcosis was rare before the 1970s which saw an increase in at-risk groups such as people with organ transplant or on immunosuppressant medications.[9] The number of cases escalated in the mid-1980s with over 80% occurring in people with HIV/AIDS.[9]

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