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Chapter 13 : Human Cryptococcosis
Category: Fungi and Fungal Pathogenesis
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In the first 100 years of clinical cases of Cryptococcus neoformans, the infection was described in most organs of the human and animal host. The clinical presentations of human cryptococcosis may be varied, and because of the variety of signs and symptoms, clinical diagnosis without laboratory studies can be difficult at times in both high- and low-risk patients. Clinical manifestations by organ system and demonstrates the breadth of clinical signs attributed to C. neoformans such as central nervous system (CNS), lung and skin. The relative differences in frequency of clinical symptoms and findings are compared in patients with or without human immunodeficiency virus (HIV) infection. A new factor in liver transplants has been the use of tacrolimus and its possible effect on cryptococcosis. It is known that all the immunophilins (cyclosporine, tacrolimus, and sirolimus) have anticryptococcal activity in vitro, but the effect of these medications on human cryptococcosis in this group remains uncertain. A review of pulmonary infections in immunocompromised patients prior to the AIDS epidemic described 34 of 41 patients with pulmonary cryptococcosis who had an underlying immunocompromised condition other than HIV. The most common radiographic findings (in order of frequency of occurrence) were alveolar or interstitial infiltrates, single or multiple-coin lesions, masses, cavitary lesions, and pleural effusions. A clinical principle emphasized in this study is that immunocompromised patients with pulmonary cryptococcosis frequently have disseminated infection and always require antifungal therapy. In animals, C. neoformans strains have been identified that appear to localize/produce infection directly in skin tissue.