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Cryptococcus neoformans infection outside the central nervous system

Authors
Gary M Cox, MD
John R Perfect, MD
Section Editors
Carol A Kauffman, MD
Sheldon L Kaplan, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Cryptococcus neoformans pneumonia and infection outside the central nervous system in immunocompetent and immunocompromised patients will be reviewed here.

The microbiology and epidemiology of C. neoformans infection are presented separately. C. neoformans meningoencephalitis and Cryptococcus gattii infection are also discussed elsewhere. (See "Microbiology and epidemiology of Cryptococcus neoformans infection" and "Epidemiology, clinical manifestations, and diagnosis of Cryptococcus neoformans meningoencephalitis in HIV-infected patients" and "Clinical manifestations and diagnosis of Cryptococcus neoformans meningoencephalitis in HIV-seronegative patients" and "Treatment of Cryptococcus neoformans meningoencephalitis in HIV-infected patients" and "Treatment of Cryptococcus neoformans meningoencephalitis and disseminated infection in HIV seronegative patients" and "Cryptococcus gattii infection: Microbiology, epidemiology, and pathogenesis" and "Cryptococcus gattii infection: Clinical features and diagnosis" and "Cryptococcus gattii infection: Treatment".)

PULMONARY INFECTION IN IMMUNOCOMPETENT ADULTS

Clinical manifestations — Humans likely become infected with C. neoformans by inhaling the basidiospore form of the fungus or small, poorly encapsulated yeasts. Basidiospores are smaller than the yeast forms obtained from clinical samples and have much smaller polysaccharide capsules, facilitating deposition in the alveoli and terminal bronchioles after inhalation [1]. Following inhalation, C. neoformans likely cause a focal pneumonitis that may or may not be symptomatic. The immune status is the most important determinant of the subsequent course of the infection (eg, whether the pneumonitis resolves or progresses to symptomatic dissemination) [2,3].

A large segment of the population has been exposed to C. neoformans [4]. Subclinical primary infections are common and most are asymptomatic. Postmortem studies on immunocompetent persons without antecedent respiratory complaints have demonstrated small areas of granulomatous inflammation in the lung parenchyma and/or hilar lymph nodes due to C. neoformans [5,6]. The foci are generally smaller than those seen in tuberculosis and do not appear to calcify as frequently as seen with histoplasmosis. Infection can persist in a latent state; if the host immune system becomes compromised, organisms may be liberated from the granulomatous complexes and cause active infection.

There are also descriptions of pulmonary cryptococcosis in apparently immunocompetent patients [7,8]. In a review of approximately 90 immunocompetent hosts with pulmonary cryptococcosis, 32 percent of the patients were asymptomatic, and pulmonary infection was discovered as an incidental finding [7]. Asymptomatic patients with chest radiograph findings suspicious for malignancy who undergo biopsy are occasionally found to have cryptococcosis.

                          

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Literature review current through: Nov 2016. | This topic last updated: Thu May 28 00:00:00 GMT 2015.
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