disseminated cryptococcosis in an immunocompetent patient a case report

Disseminated disease, especially noncutaneous cryptococcal abscess in immunocompetent hosts, is exceedingly rare. We report a case of disseminated cryptococcosis with soft tissue, pulmonary, and cerebral involvement in an otherwise healthy immunocompetent patient initially diagnosed by fine needle aspiration cytology (FNAC). 1. Introduction

Full Answer

Which CT findings are characteristic of disseminated cryptococcosis?

Cryptococcosis is an important opportunistic infection. A case of disseminated cryptococcosis in a healthy patient was reported. Chest CT revealed a left upper lobe nodule and enlarged mediastinal lymphadenopathy.

What is the pathophysiology of cryptococcal infection?

A key feature of cryptococcal pathogenesis involves the exit of this fungus from the lungs into blood, and entry into the central nervous system, and other organs in the body. In this patient, the lymph node involvement in the mediastinum was more advanced than anticipated for similar pulmonary involvement.

Is cryptococcosis an opportunistic fungal infection?

Cryptococcosis is an opportunistic fungal infection causes significant disease predominantly in immunocompromised patients. Here we present an excepcional case of disseminated cryptococcosis with pulmonary and cerebral involvement in an immunocompetent patient with no apparent predisposing factors at the time of hospital admission.

What is disseminated cryptococcosis?

Disseminated cryptococcosis is defined by either a (1) positive blood culture or (2) positive culture from at least two different sites.

How would a patient be infected with cryptococcosis?

Cryptococcosis is caused by a fungus known as Cryptococcosis neoformans. The infection may be spread to humans through contact with pigeon droppings or unwashed raw fruit. Contact with an infected individual may also spread the infection.

What are the complications of cryptococcal meningitis?

In immunocompromised patients, the overall mortality rate following treatment of cryptococcal meningitis is approximately 25%-30%. Of those who survive, 40% have significant neurological deficits, including loss of vision, decreased mental function, hydrocephalus, and cranial nerve palsies.

How would you screen patients for cryptococcal infection before symptoms appear?

There are three categories of methods that can be used to diagnose cryptococcal meningitis: India Ink microscopy, which can be used on cerebrospinal fluid (CSF); culture, which can be used on CSF or blood; and antigen detection.

What causes cryptococcal disease?

Cryptococcal disease is caused by the fungus Cryptococcus. The fungus is found worldwide in the environment in places such as decaying organic matter, trees, soil and bird droppings. The disease is mostly caused by two species of Cryptococcus: Cryptococcus neoformans and Cryptococcus gattii.

How is cryptococcal diagnosed?

The diagnosis can be made by microscopic examination and/or culture of tissue or body fluids such as blood, cerebrospinal fluid and sputum. The cryptococcal antigen test is a rapid test that can be performed on blood and/or on cerebrospinal fluid to make the diagnosis.

What are the signs and symptoms of cryptococcal meningitis?

The symptoms of cryptococcal meningitis include:Headache.Fever.Neck pain.Nausea and vomiting.Sensitivity to light.Confusion or changes in behavior.

How will you diagnose a case of cryptococcal meningitis?

The definitive diagnosis of cryptococcal meningitis is made by culture from the CSF. The opening pressure should be measured along with India ink evaluation, cryptococcal antigen testing, fungal culture, and routine spinal fluid studies.

What is the incubation period for cryptococcosis?

The incubation period is unknown, but studies have shown that symptoms develop between two and thirteen months following exposure with an average of six to seven months. Source: Cryptococcus has a worldwide distribution.

What is cryptococcal antigen test?

Cryptococcal Antigen Latex Agglutination System (CALAS®) is a qualitative and semi-quantitative test system for the detection of capsular polysaccharide antigens of Cryptococcus neoformans in serum and CSF.

How is cryptococcosis prevented?

The best way to prevent cryptococcosis is to not inhale the fungus. This is difficult to do if you live in areas where the fungus resides, although some researchers say that some masks (ones that filter particles that are as small as 3 micrometers) may help prevent inhalation.

What is the best drugs used in the treatment for CM cryptococcal meningitis?

The drug of choice (DOC) for initial therapy in disseminated or CNS cryptococcosis is amphotericin B. Amphotericin B may be used alone or in combination with flucytosine. Amphotericin B has a rapid onset of action and often leads to clinical improvement more rapidly than either intravenous or oral fluconazole.

What is cryptococcosis caused by?

Cryptococcosis is an invasive fungal disease caused by pathogenic encapsulated yeasts in the genus Cryptococcus. The main human pathogens are C. neoformans and C. gattii. They are often found in soil in areas frequented by birds, especially pigeons and chickens [ 1, 2 ]. They have a worldwide distribution, and account for most cases of cryptococcosis in humans. Most patients with cryptococcosis are immunocompromised. The reactivation of cryptococcal infection commonly presents as meningoencephalitis and/or pneumonia [ 3, 4 ]. In this study, we presented a case of disseminated cryptococcosis in an immunocompetent individual.

Is cryptococcosis a fungal infection?

Cryptococcosis is an important opportunistic infection. It is the third most common invasive fungal infection in solid organ transplant recipients. The primary organ affected is the lungs, but infection of the central nervous system and other organ systems are also seen. Here we reported a case of disseminated cryptococcosis in a healthy patient who presented with severe pneumonia, a left upper lobe nodule and enlarged mediastinal lymphadenopathy on a chest computed tomography scan.

What is disseminated cryptococcus?

Disseminated Cryptococcus infection is defined by a positive blood culture or a positive culture from at least two different sites. 7 Disseminated infection by cryptococcal species is commonly associated with HIV infection or several other immunocompromised conditions such as lymphoma or long-term immunosuppressive therapy. Very rarely, disseminated cryptococcal infection occurs in immunocompetent hosts. One case report described disseminated cryptococcal infection in a healthy individual, which involved bone marrow mimicking plasma cell dyscrasias. 8 The common forms of presentation of the infection include pulmonary cryptococcosis, cryptococcal meningitis and cutaneous cryptococcosis. The organism is widely prevalent in certain regions of the world; however, the most common forms of exposure include a history of exposure to soil or bird droppings. 9 In this case, the patient had a risk factor due to bird exposure at his home. The case emphasises the importance of being educated about the various presentations of disseminated cryptococcosis, including a bone or soft tissue involvement. Early diagnosis and management of this condition will significantly reduce morbidity and mortality.

What is cryptococcosis caused by?

Cryptococcosis is an infection caused by Cryptococcus, an encapsulated yeast organism which is prevalent in individuals who are immunocompromised or have risk factors associated with reduced immunity. It is extremely rare among people who are otherwise healthy and immunocompetent. On the basis of the population estimates from 2000, the incidence of cryptococcosis is 0.4–1.3 cases per 100 000 habitants and the case fatality ratio was 12%. 1 Cryptococcus neoformans and Cryptococcus gatti are the two species of the fungus which are responsible for almost all cases of cryptococcosis. C. neoformans is usually associated with infections in immunocompromised patients, whereas C. gatti is associated with infections in immunocompetent patients. 2 Several cases of cryptococcal infections in immunocompetent patients involving different organs and organ systems have been reported. 3–5 However, only a handful of cases involving disseminated cryptococcosis in immunocompetent patients have been reported in the literature. 2 6 We report a case of a 56-year-old immunocompetent man with disseminated cryptococcosis.

Is cryptococcosis a fungal infection?

Cryptococcosis is a fungal infection which is commonly associated with immune-compromised state. Disseminated infection in immunocompetent individuals is extremely rare. We present a case of a 56-year-old African American patient who presented with unilateral knee pain and swelling and was subsequently diagnosed with cryptococcal bone mass ...