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Cryptococcosis

C. neoformans var. neoformans infection; C. neoformans var. gatti infection; C. neoformans var. grubii infection

Cryptococcosis is infection with the fungi Cryptococcus neoformans or Cryptococcus gattii.

Causes

C neoformans and C gattii are the fungi that cause this disease. Infection with C neoformans is seen worldwide. Infection with C gattii has mainly been seen in the Pacific Northwest region of the United States, British Columbia in Canada, Southeast Asia, and Australia. In the United States, sporadic cases have been seen in many states including Washington, Oregon, California, Idaho, Hawaii, Georgia, Rhode Island, and Florida. Cryptococcus is the most common fungus that causes serious infection worldwide.

Both types of fungi are found in soil. If you breathe the fungus in, it infects your lungs. The infection may go away on its own, remain in the lungs only, or spread throughout the body (disseminate). C neoformans infection is most often seen in people with a weak immune system, such as those who:

  • Are infected with HIV/AIDS
  • Take corticosteroid medicines
  • Cancer
  • Are on chemotherapy medicines for cancer
  • Have Hodgkin disease
  • Have had an organ transplant

C gattii may affect people with normal immune system.

C neoformans is the most common life-threatening cause of fungal infection in people with HIV/AIDS.

People between 20 to 40 years of age are the most common age group that has this infection.

Symptoms

The infection may spread to the brain in people who have a weakened immune system. Neurological (brain) symptoms start slowly. Most people have swelling and irritation of the brain and spinal cord when they are diagnosed. Symptoms of brain infection may include:

  • Fever and headache
  • Neck stiffness
  • Nausea and vomiting
  • Blurred vision or double vision
  • Confusion

The infection can also affect the lungs and other organs. Lung symptoms may include:

Other symptoms may include:

People with a healthy immune system may have no symptoms at all.

Exams and Tests

The health care provider will perform a physical exam and ask about symptoms and travel history. The physical exam may reveal:

  • Abnormal breath sounds
  • Fast heart rate
  • Fever
  • Mental status changes
  • Stiff neck

Tests that may be done include:

  • Blood culture to differentiate between the two fungi
  • CT scan of the head
  • Sputum culture and stain
  • Lung biopsy
  • Bronchoscopy and bronchoalveolar lavage
  • Spinal tap to obtain a sample of cerebrospinal fluid (CSF)
  • Cerebrospinal fluid (CSF) culture and other tests to check for signs of infection
  • Chest x-ray
  • Cryptococcal antigen test (looks for a certain molecule that is shed from the cell wall of the Cryptococcus fungus into the bloodstream or CSF)

Treatment

Fungal medicines are prescribed for people infected with cryptococcus.

Medicines include:

  • Amphotericin B (can have severe side effects)
  • Flucytosine
  • Fluconazole

Outlook (Prognosis)

Central nervous system involvement often causes death or leads to permanent damage.

When to Contact a Medical Professional

Contact your provider if you develop symptoms of cryptococcosis, especially if you have a weakened immune system.

Open References

References

Kauffman CA, Chen SC-A. Cryptococcosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 317.

Perfect JR. Cryptococcosis (Cryptococcus neoformans and Cryptococcus gattii). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 262.

Robles WS, Ameen M. Cryptococcosis. In: Lebwohl MG, Heymann WR, Murrell DF, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 49.

  • Cryptococcus - cutaneous on the hand

    Cryptococcus - cutaneous on the hand - illustration

    These are cryptococcus skin lesions. Cryptococcus is a yeast (type of fungus) that seldom causes infection, but is considered opportunistic (it affects people with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections in people with AIDS.

    Cryptococcus - cutaneous on the hand

    illustration

  • Cryptococcosis on the forehead

    Cryptococcosis on the forehead - illustration

    This is an example of cryptococcus skin lesions on the forehead. Cryptococcus is a yeast (type of fungus) that seldom causes infection and is considered opportunistic (affecting individuals with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections in people with AIDS.

    Cryptococcosis on the forehead

    illustration

  • Fungus

    Fungus - illustration

    Fungal infections are caused by microscopic organisms (fungi) that can live on the skin. They can live on the dead tissues of the hair, nails, and outer skin layers.

    Fungus

    illustration

  • Cryptococcus - cutaneous on the hand

    Cryptococcus - cutaneous on the hand - illustration

    These are cryptococcus skin lesions. Cryptococcus is a yeast (type of fungus) that seldom causes infection, but is considered opportunistic (it affects people with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections in people with AIDS.

    Cryptococcus - cutaneous on the hand

    illustration

  • Cryptococcosis on the forehead

    Cryptococcosis on the forehead - illustration

    This is an example of cryptococcus skin lesions on the forehead. Cryptococcus is a yeast (type of fungus) that seldom causes infection and is considered opportunistic (affecting individuals with weakened immune systems). Cryptococcus is one of the more common life-threatening fungal infections in people with AIDS.

    Cryptococcosis on the forehead

    illustration

  • Fungus

    Fungus - illustration

    Fungal infections are caused by microscopic organisms (fungi) that can live on the skin. They can live on the dead tissues of the hair, nails, and outer skin layers.

    Fungus

    illustration

 

Review Date: 9/10/2022

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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