Systemic cryptococcosis is a systemic mycosis acquired by the respiratory route, with the primary focus of infection in the lungs, and with occasional hematogenous dissemination, characteristically to the meninges, and on occasion to skin.
Causes of Disseminated Cryptococcosis
Associated with avian feces worldwide (parakeets, budgerigars, canaries, and especially pigeons). C. neoformans is inhaled in dust and causes a primary pulmonary focus of infection with subsequent hematogenous dissemination to meninges, kidneys, and skin. Between 10 and 15% of patients have skin lesions. Cellmediated immune deficiency is an important factor in pathogenesis in many patients.
Diagnosis
Confirmed by skin biopsy and fungal cultures.
Treatment
Primary prophylaxis In some centers, fluconazole is given to HIV-infected individuals with low CD41 cell counts; the incidence of disseminated infection is reduced, but there is no effect on the mortality rate.
Therapy of meningitis Amphotericin B65-flucytosine for 2 to 4 weeks in uncomplicated cases and for 6 weeks in complicated cases. Fluconazole (alternative).
Infection limited to skin Fluconazole, 400-600mg/d. Itraconazole (alternative), 400 mg/d.
Secondary prophylaxis In HIV disease (without immune reconstitution), lifelong secondary prophylaxis is given. Fluconazole, 200-400 mg/d; itraconazole (alternative), 200-400 mg/d.
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