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Chapter 44 : Clinical Perspectives on and : Implications for Diagnosis and Management

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Abstract:

Human cryptococcosis is most commonly due to infection with and , with var. (serotype A) accounting for the great majority of infections worldwide. Cryptococcosis is uncommon in hematopoietic stem cell transplantation; in a large multicenter study in the United States, only 2 of 306 cases were associated with hematopoietic stem cell transplantation, and 54 with solid organ transplantation (SOT). Any condition associated with prolonged or high-dose corticosteroid exposure predisposes to cryptococcosis. Other than malignancy and organ transplantation, such conditions include connective tissue disorders (e.g., systemic lupus erythematosus and vasculitides), chronic obstructive pulmonary disease, and sarcoidosis. Visual loss is one of the most serious, debilitating sequelae (if not the most serious) of central nervous system (CNS) cryptococcosis. Rapid diagnosis and treatment is the key to achieving good outcomes. Molecular tests can distinguish between and but are seldom required for diagnosis of cryptococcosis due to either species. A decrease in susceptibility to azole drugs, especially fluconazole, was noted among isolates of var. from patients with AIDS, in parallel with widespread use of fluconazole prior to the advent of highly active antiretroviral therapy (HAART). The major determinants of outcome include neurological status, intracranial pressure (ICP), the presence of cerebral mass lesions, and cryptococcal load at presentation.

Citation: Sorrell T, Chen S, Phillips P, Marr K. 2011. Clinical Perspectives on and : Implications for Diagnosis and Management, p 595-606. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch44
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FIGURE 1

Chest radiograph of an immunocompetent 47-year-old male showing a right-upper lung zone mass lesion from which was isolated on percutaneous needle biopsy.

Citation: Sorrell T, Chen S, Phillips P, Marr K. 2011. Clinical Perspectives on and : Implications for Diagnosis and Management, p 595-606. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch44
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Image of FIGURE 2
FIGURE 2

Contrast CT head scan of an immunocompetent patient showing several ring-enhancing lesions in the cerebral hemispheres and in the regions of the basal ganglia due to .

Citation: Sorrell T, Chen S, Phillips P, Marr K. 2011. Clinical Perspectives on and : Implications for Diagnosis and Management, p 595-606. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch44
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References

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Tables

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TABLE 1

Patient risk groups and predisposing risk factors for development of cryptococcosis

Citation: Sorrell T, Chen S, Phillips P, Marr K. 2011. Clinical Perspectives on and : Implications for Diagnosis and Management, p 595-606. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch44
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TABLE 2

Comparison of and infection: sites of disease, symptoms, signs, spinal fluid, and head CT findings

Citation: Sorrell T, Chen S, Phillips P, Marr K. 2011. Clinical Perspectives on and : Implications for Diagnosis and Management, p 595-606. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch44
Generic image for table
TABLE 3

Clinical features and outcome of neurocryptococcosis in healthy hosts, based on cerebral CT scan

Citation: Sorrell T, Chen S, Phillips P, Marr K. 2011. Clinical Perspectives on and : Implications for Diagnosis and Management, p 595-606. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch44
Generic image for table
TABLE 4

Comparison of occurrence of lung and brain cryptococcomas due to and in immunocompetent persons

Citation: Sorrell T, Chen S, Phillips P, Marr K. 2011. Clinical Perspectives on and : Implications for Diagnosis and Management, p 595-606. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch44

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