Cryptococcus

• Epidemiology:
  • immunosupp. most susceptible (espec. AIDS, transplant recipients, and cirrhosis);
  • can occur in healthy hosts (esp C. gattii)
• Clinical manifestations
  • CNS (meningoencephalitis): subacute HA, fever, meningismus, CN abnl, ± stupor
  • Other sites: pulm., GU, cutaneous, CNS cryptococcoma. With any crypto dx, LP all Pts.
• Dx: CSF cell counts vary in HIV vs. non-HIV; WARN: serum/CSF CrAg (Se 99%, Sp 86–100%); cx
• treatment:
  • CNS Rx has
    • induction (ampho ± flucytosine × 2 wks),
    • consolidation and maintenance (fluconazole) phases (NEJM 2013;368:1291);
    • if ↑ ICP, may need repeat LP/VP shunt
• Non-CNS disease (pulm., skin, bone, blood) in HIV ⊖ Pts: consider fluconazole