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

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Clinical Perspectives on and : Implications for Diagnosis and Management, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816858/9781555815011_Chap44-1.gif /docserver/preview/fulltext/10.1128/9781555816858/9781555815011_Chap44-2.gif


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
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


Image of 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
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of 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
Permissions and Reprints Request Permissions
Download as Powerpoint


1. Aller,, A. I.,, R. Claro,, C. Castro,, C. Serrano,, M. F. Colom,, E. Martín-Mazuelos, and Grupo de Epidemiología de la Cryptococcosis. 2007. Susceptibility of Cryptococcus neoformans isolates in HIV-infected patients to fluconazole, itraconazole and voriconazole in Spain: 1994–1996 and 1997–2005. Chemotherapy 53: 300305.
2. Andreola,, C.,, M. P. Ribeiro,, C. R. de Carli,, A. L. Gouvea, and, A. L. Curi. 2006. Multifocal choroiditis in disseminated Cryptococcus neoformans infection. Am. J. Ophthalmol. 142: 346348.
3. BC Centre for Disease Control. 2007. BC Cryptococcus gattii surveillance summary, 1999–2006. http://www.bccdc.org/topic.php?item=109. [Online.] Accessed 28 April 2009.
4. Behrmann, R. E.,, J. R. Masci, and, P. Nicholas. 1990. Cryptococcal skeletal infections: case report and review. Rev. Infect. Dis. 12: 181190.
5. Bicanic, T.,, T. Harrison,, A. Niepieko,, N. Dyakopu, and, G. Meintjes. 2006. Symptomatic relapse of HIV-associated cryptococcal meningitis after initial fluconazole monotherapy: the role of fluconazole resistance and immune reconstitution. Clin. Infect. Dis. 43: 10691073.
6. Blackie, J. D.,, G. Danta,, T. Sorrell, and, P. Collignon. 1985. Ophthalmological complications of cryptococcal meningitis. Clin. Exp. Neurol. 21: 263270.
7. Bozzette,, S. A.,, R. A. Larsen,, J. Chiu,, M. A. Leal,, J. G. Tilles,, D. D. Richman,, J. M. Leedom, and, J. A. McCutchan. 1991. Fluconazole treatment of persistent Cryptococcus neoformans prostatic infection in AIDS. Ann. Intern. Med. 115: 285286.
8. Cameron,, M. L.,, J. A. Bartlett,, H. A. Gallis, and, H. A. Waskin. 1991. Manifestations of pulmonary cryptococcosis in patients with acquired immunodeficiency syndrome. Rev. Infect. Dis. 13: 6467.
9. Casadevall, A., and, J. R. Perfect. 1998. Cryptococcus neoformans. ASM Press, Washington, DC..
10. Chan, K. H.,, K. S. Mann, and, C. P. Yue. 1989. Neurosurgical aspects of cerebral cryptococcosis. Neurosurgery 25: 4448.
11. Charlier,, C.,, F. Dromer,, C. Leveque,, L. Chartier,, Y.-S. Cordoliani,, A. Fontanet,, O. Launay, and O. Lortholary. 2008. Cryptococcal neuroradiological lesions correlate with severity during cryptococcal meningoencephalitis in HIV-positive patients in the HAART era. PLoS ONE 3: E1950.
12. Chaturvedi, S.,, M. Dyavaiah,, R. A. Larsen, and, V. Chaturvedi. 2005. Cryptococcus gattii in AIDS patients, Southern California. Emerg. Infect. Dis. 11: 16861692.
13. Chechani, V., and, S. L. Kamholz. 1990. Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS. Chest 98: 10601066.
14. Chen J.,, A. Varma,, M. R. Diaz,, A, P. Litvintseva,, K. K. Wollenberg, and, K. J. Kwon-Chung. 2008. Cryptococcus neoformans strains and infection in apparently immunocompetent patients, China. Emerg. Infect. Dis. 14: 755762.
15. Chen,, S.,, T. Sorrell,, G. Nimmo,, B. Speed,, B. Currie,, D. Ellis,, D. Marriott,, T. Pfeiffer,, D. Parr,, K. Byth, and the Australasian Cryptococcal Study Group. 2000. Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Clin. Infect. Dis. 31: 499508.
16. Chen,, S. C.,, B. J. Currie,, H. M. Campbell,, D. A. Fisher,, T. J. Pfeiffer,, D. H. Ellis, and, T. C. Sorrell. 1997. Cryptococcus neoformans var. gattii infection in Northern Australia: existence of environmental source other than known host eucalypts. Trans. R. Soc. Trop. Med. Hyg. 91: 547550.
17. Chen,, Y. C.,, S. C. Chang,, C. C. Shih,, C. C. Hung,, K. T. Luhd,, Y. S. Pan, and, W. C. Hsieh. 2000. Clinical features and in vitro susceptibilities of two varieties of Cryptococcus neoformans in Taiwan. Diagn. Microbiol. Infect. Dis. 36: 175183.
18. Cohen, D. B., and, B. J. Glasgow. 1993. Bilateral optic nerve cryptococcosis in sudden blindness in patients with acquired immune deficiency syndrome. Ophthalmology 100: 16891694.
19. Colom,, M. F.,, S. Frases,, C. Ferrer,, A. Jover,, M. Andreu,, S. Reus,, M. Sanchez, and, J. M. Torres-Rodriguez. 2005. First case of human cryptococcosis due to Cryptococcus neoformans var. gattii in Spain. J. Clin. Microbiol. 43: 35483550.
20. Chuck, S. L., and, M. A. Sande. 1989. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. N. Engl. J. Med. 321: 794799.
21. Datta, K.,, K. H. Bartlett, and, K. A. Marr. 2009. cryptococcus gattii: emergence in western North America: exploitation of a novel ecological niche. Interdiscip. Perspect. Infect. Dis. 2009: 176532, p. 18.
22. Diamond, R. D., and, J. E. Bennett. 1974. Prognostic factors in cryptococcal meningitis. Ann. Intern. Med. 80: 176181.
23. Dromer,, F.,, S. Mathoulin,, B. Dupont,, L. Letenneur,, O. Ronin, and the French Cryptococcosis Study Group. 1996. Individual and environmental factors associated with infection due to Cryptococcus neoformans serotype D. Clin. Infect. Dis. 23: 9196.
24. Dromer, F.,, S. Mathoulin-Pelissier,, O. Launay,, O. Lortholary, and the French Cryptococcosis Study Group. 2007. Determinants of disease presentation and outcome during cryptococcosis: the Crypto A/D/study. PLoS. Med. 4: E21.
25. Dzendrowskyj,, T. E.,, B. Dolenko,, T. C. Sorrell,, R. L. Somorjai,, R. Malik,, C. E. Mountford, and U. Himmelreich. 2005. Identification of cerebral cryptococcoma using a computerized analysis of 1H NMR spectra in an animal model. Diagn. Microbiol. Infect. Dis. 52: 101105.
26. Einsiedel, L.,, D. L. Gordon, and, J. R. Dyer. 2004. Paradoxical inflammatory reaction during treatment of Cryptococcus noeformans var. gattii meningitis in an HIV-seronegative woman. Clin. Infect. Dis. 39: e7882.
27. Ellis, D., and, T. Pfeiffer. 1994. Cryptococcosis and the ecology of Cryptococcus neoformans. Jpn. J. Med. Mycol. 35: 111122.
28. Ellis, D.,, T. Sorrell, and, S. Chen. 2007. Impact of antifungal resistance in Australia. Microbiol. Aust. 28: 171175.
29. Ellis, D. H., and, T. J. Pfeiffer. 1990. Natural habitat of Cryptococcus neoformans var. gattii. J. Clin. Microbiol. 28: 16421644.
30. Ely,, E. W.,, J. E. Peacock,, Jr.,, E. F. Haponik, and, R. G. Washburn. 1998. Cryptococcal pneumonia complicating pregnancy. Medicine 77: 153167.
31. Fisher, D.,, J. Burrow,, D. Lo, and, B. Currie. 1993. cryptococcus neoformans in tropical northern Australia: predominantly variant gattii with good outcomes. Aust. NZ. J. Med. 23: 678682.
32. Franzot, S. P.,, I. F. Salkin, and, A. Casadevall. 1999. Cryptococcus neoformans var. grubii: separate varietal status for Cryptococcus neoformans serotype A isolates. J. Clin. Microbiol. 37: 838840.
33. Garcia-Hermoso, D.,, G. Janbon, and, F. Dromer. 1999. Epidemiological evidence for dormant Cryptococcus neoformans infection. J. Clin. Microbiol. 37: 32043209.
34. Graybill,, J. R.,, J. Sobel,, M. Saag,, C. van der Horst,, W. Powderly,, G. Cloud,, L. Riser,, R. Hamill,, W. Dismukes, and the NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups. 2000. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. Clin. Infect Dis. 30: 4754.
35. Hajjeh,, R. A.,, L. A. Conn,, D. S. Stephens,, W. Baughman,, R. Hamill,, E. Graviss,, P. G. Pappas,, C. Thomas,, A. Reingold,, G. Rothrock,, L. C. Hutwagner,, A. Schuchat,, M. E. Brandt,, R. W. Pinner, and the Cryptococcal Active Surveillance Group. 1999. Cryptococcosis: population-based multistate active surveillance and risk factors in human immunodeficiency virus-infected persons. Clin. Infect. Dis. 179: 449454.
36. Hedderwick., S. A.,, H. F. Bonilla,, S. F. Bradley, and, C. A. Kauffman. 1997. Opportunistic infections in patients with temporal arteritis treated with corticosteroids. J. Am. Geriatr. Soc. 45: 334337.
37. Himmelreich,, U.,, T. E. Dzendrowskyj,, C. Allen,, S. Dowd,, R. Malik,, B. P. Shehan,, P. Russell,, C. E. Mountford, and, T. C. Sorrell. 2001. Cryptococcomas distinguished from gliomas with MR spectroscopy: an experimental rat and cell culture study. Radiology. 220: 122128.
38. Himmelreich, U.,, C. Allen,, S. Dowd,, R. Malik,, B. P. Shehan,, C. M. Mountford and, T. C. Sorrell. 2003. Identification of metabolites of importance in the pathogenesis of pulmonary cryptococcomas in rat lung using magnetic resonance spectroscopy. Microbes Infect. 5: 285290.
39. Hospenthal, D. R., and, J. E. Bennett. 2000. Persistence of cryptococcomas on neuroimaging. Clin. Infect. Dis. 31: 13031306.
40. [Reference deleted.]
41. Jarvis, J. N.,, F. Dromer,, T. S. Harrison, and, P. Lortholary. 2008. Managing cryptococcosis in the immunocompromised host. Curr. Opin. Infect. Dis. 21: 596603.
42. Jenny, A.,, K. Pandithage,, D. A. Fisher, and, B. J. Currie. 2004. Cryptococcus infection in tropical Australia. J. Clin. Microbiol. 42: 38653868.
43. Johnston,, S. R. D.,, E. L. Corbett,, O. Foster,, S. Ash, and J. Cohen. 1992. Raised intracranial pressure and visual complications in AIDS patients with cryptococcal meningitis. J. Infect. 24: 185189.
44. Kaplan, M. H.,, P. P. Rosen, and, D. Armstrong. 1977. Cryptococcus in a cancer hospital. Cancer 39: 22652274.
45. Kaocharoen,, S.,, B. Wang,, K. M. Tsui,, L. Trilles,, F. Kong, and W. Meyer. 2008. Hyperbranched rolling circle amplification as a rapid and sensitive method for species identification within the Cryptococcus species complex. Electrophoresis 29: 31833191.
46. Katsu,, M,, S. Kidd,, A. Ando,, M. L. Moretti-Branchini,, Y. Mikami,, K. Nishimura, and W. Meyer. 2004. The internal transcribed spacers and 5.8S rRNA gene show extensive diversity among isolates of the Cryptococcus neoformans species complex. FEMS Yeast Res. 4: 377388.
47. Keah, K. C.,, S. Parameswari, and, Y. M. Cheong. 1994. Serotypes of clinical isolates of Cryptococcus neoformans in Malaysia. Trop. Biomed. 11: 205207.
48. Kerkering, T. M.,, R. J. Duma, and, S. Shadomy. 1981. The evolution of pulmonary cryptococcosis: clinical implications from a study of 41 patients with and without compromising host factors. Ann. Intern. Med. 94: 611616.
49. Kestelyn,, P.,, H. Taelman,, J. Bogaerts,, A. Kagame,, M. Abdel Aziz,, J. Batungwanayo,, A. M. Stevens, and P. Van de Perre. 1993. Optical manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome. Am. J. Ophthalmol. 116: 721727.
50. Khan, M. A., and, S. Sbar. 1975. Cryptococcal meningitis in steroid-treated systemic lupus erythematosus. Postgrad. Med. J. 5: 660662.
51. Kidd,, S. E,, F. Hagen,, R. L. Tscharke,, M. Huynh,, K. H. Bartlett,, M. Fyfe,, L. MacDougall,, T. Boekhout,, K. J. Kwon-Chung, and W. Meyer. 2004. A rare genotype of Cryptococcus gattii caused the cryptococcosis outbreak on Vancouver Island (British Columbia, Canada). Proc. Natl. Acad. Sci. USA 101: 1725817263.
52. Kontoyiannis,, D. P,, W. K. Peitsch,, B. T. Reddy,, E. E. Whimbey,, X. Y. Han,, G. P. Bodey, and K. L. Rolston. 2004. Cryptococcosis in patients with cancer. Clin. Infect. Dis. 32: e145150.
53. Kovacs,, J. A.,, A. A. Kovacs,, M. Polis,, W. C. Wright,, V. J. Gill,, C. U. Tuazon,, E. P. Gelmann,, H. C. Lane,, R. Longfield,, G. Overturf,, A. M. Macher,, A. S. Fauci,, J. E. Parrillo,, J. E. Bennett, and H. Masur. 1985. Cryptococcosis in the acquired immunodeficiency syndrome. Ann. Intern. Med. 103: 533538.
54. Kumlin, U.,, L. G. Elmquist,, M. Granlund,, B. Olsen, and, A. Tarnvik. 1997. CD4 lymphopenia in a patient with cryptococcal osteomyelitis. Scand. J. Infect. Dis. 29: 205206.
55. Kupfer, C., and, E. McCrane. 1974. A possible cause of decreased vision in cryptococcal meningitis. Invest. Ophthal. 13: 801804.
56. Kwon-Chung, K. J., and, J. E. Bennett. 1984. Epidemiologic differences between the two varieties of Cryptococcus neoformans. Am. J. Epidemiol. 120: 123130.
57. Kwon-Chung, K. J., and, J. E. Bennett. 1992. Medical Mycology. Lea & Febiger, Philadelphia, PA.
58. Kwon-Chung, K. J.,, T. Boekhout,, J. W. Fell, and, M. Diaz. 2002. Proposal to conserve the name Cryptococcus gattii against C. hondurianus and C. bacillisporus ( Basidiomycota, Hymenomycetes, Tremellomycetidae). Taxon 51: 804806.
59. Lalloo,, D.,, D. Fisher,, S. Naraqi,, I. Laurenson,, P. Temu,, A. Sinha,, A Sawerie, and, B. Mavo. 1994. Cryptococcal meningitis ( C. neoformans var. gattii) leading to blindness in previously healthy Melanesian adults in Papua New Guinea. Q. J. Med. 87: 343349.
60. Laurenson,, I. F.,, A. J. Trevett,, D. G. Lalloo,, N. Nwokolo,, S. Naraqi,, J. Black,, N. Tefurani,, A. Saweri,, B. Mavo,, J. Igo, and, D. A. Warrell. 1996. Meningitis caused by cryptococcus neoformans var. gattii and var. neoformans in Papua New Guinea. Trans. R. Soc. Trop. Med. Hyg. 90: 5760.
61. Levitz, S. M. 1991. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. Rev. Infect. Dis. 13: 11631169.
62. Lewis, J. L., and, S. Rabinovich. 1972. The wide spectrum of cryptococcal infections. Am. J. Med. 53: 315322.
63. Liliang,, P.-C.,, C.-L. Liang,, W.-N. Chang,, H.-J. Chen,, T.-M. Su,, K. Lu, and C.-H. Lu. 2003. Shunt surgery for hydrocephalus complicating cryptococcal meningitis in human immunodeficiency virus-negative patients. Clin. Infect. Dis. 37: 673678.
64. Lipson,, B. K.,, W. R. Freeman,, J. Beniz,, M. H. Goldbaum,, J. R. Hesslelink,, R. N. Weinreb, and, A. A. Sadun. 1989. Optic neuropathy associated cryptococcal arachnoiditis in AIDS patients. Am. J. Ophthalmol. 107: 523527.
65. Liss, H. P., and, D. Rimland. 1981. Asymptomatic cryptococcal meningitis. Am. Rev. Respir. Dis. 124: 8889.
66. Litvintseva, A. P.,, R. Thakur,, L. B. Reller, and, T. G. Mitchell. 2005. Prevalence of clinical isolates of Cryptococus gattii serotype C among patients with AIDS in sub-Saharan Africa. Eukaryot. Cell 192: 888892.
67. Lo, D. 1976. Cryptococcosis in the Northern Territory. Med. J. Aust. 2: 825828.
68. Lopez-Martinez,, R.,, J. L. Soto-Hernandez,, L. Ostrosky-Zeichner,, R. Castanon-Olivares,, V. Angeles-Morales, and J. Sotelo. 1996. Cryptococcus neoformans var. gattii among patients with cryptococcal meningitis in Mexico. First observations. Mycopathologia 134: 6164.
69. MacDougall, L., and, M. Fyfe. 2006. Emergence of Cryptococcus gattii in a novel environment provides clues to its incubation period. J. Clin. Microbiol. 44: 18511852.
70. MacDougall,, L.,, S. Kidd,, E. Galanis,, S. Mak,, M. J. Leslie,, P. R. Cieslak,, J. W. Kronstad,, M. G. Morshed, and, K. H. Bartlett. 2007. Spread of Cryptococcus gattii in British Columbia, Canada and its detection in the Pacific Northwest, USA. Emerg. Infect. Dis. 13: 4250.
71. Miller, K. D.,, J. M. Mican, and, R. T. Davey. 1996. Asymptomatic solitary pulmonary nodules due to Cryptococcus neoformans in patients infected with human immunodeficiency virus. Clin. Infect. Dis. 23: 810812.
72. Mitchell, D. H., and, T. C. Sorrell. 1991. Pancoast’s syndrome due to pulmonary infection with Cryptococcus neoformans variety gattii. Clin. Infect. Dis. 14: 11421144.
73. Mitchell,, D. H.,, T. C. Sorrell,, A. M. Allworth,, C. H. Heath,, A. R. McGregor,, K. Papanoum,, M. J. Richards, and T. Gottlieb. 1995. Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome. Clin. Infect. Dis. 20: 611616.
74. Mitchell, T. G, and, J. R. Perfect. 1995. Cryptococcosis in the era of AIDS: 100 years after the discovery of Cryptococcus neoformans. Clin. Microbiol. Rev. 8: 515548.
75. Montagna, M. T.,, M. A. Viviani, and, A. Pulito. 1997. Cryptococcus neoformans var. gattii in Italy. Environmental investigation related to an autochthonous clinical case in Apulia. J. Mycol. Med. 7: 9396.
76. Montejo,, M.,, K. Aguirrebengoa,, R. Preita, J. C. Ibañez de Maeztu,, J. Oñate, and P. Gonzalez de Zarate. 1995. Blindness in patients with cryptococcal meningitis and AIDS. Eur. Neurol. 35: 239240.
77. Montenegro, H., and, C. R. Paula. 2000. Environmental isolation of Cryptococcus neoformans var. gattii and Cryptococcus neoformans var. neoformans in the city of Sao Paulo, Brazil. Med. Mycol. 38: 385390.
78. Morgan,, J.,, K. M. McCarthy,, S. Gould,, K. Fan,, B. Athington-Skaggs,, N. Iqhal,, K. Stamey,, R. A. Hajjeh, and, M. E. Brandt, for the Gauteng Cryptococcal Surveillance Initiative Group. 2006. Cryptococcus gattii infection: characteristics and epidemiology in a South African province with high HIV seroprevalence, 2002–2004. Clin. Infect. Dis. 43: 10771080.
79. Nishikawa,, M.,, M. Lazera,, G. G. Barbosa,, L. Trilles,, B. R. Balassiano,, R. Macedo,, C. Bezerra,, M. A. Perez,, P. Cardarelli, and B. Wanke. 2003. Serotyping of 467 Cryptococcus neoformans isolates from clinical and environmental sources in Brazil: analysis of host and regional patterns. J. Clin. Microbiol. 41: 7377.
80. Okun, E., and, W. T. Butler. 1964. Ophthalmologic complications of cryptococcal meningitis. Arch. Ophthalm. 71: 5257.
81. Ostrow, T. D., and, P. A. Hudgins. 1994. Magnetic resonance imaging of intracranial fungal infections. Top. Magn. Reson. Imaging. 6: 2231.
82. Pappas,, P. G.,, J. R. Perfect,, G. A. Cloud,, R. A. Larsen,, G. A. Pankey,, D. J. Lancaster,, H. Henderson,, C. A. Kauffman,, D. W. Haas,, M. Saccente,, R. J. Hamill,, M. S. Holloway,, R. M. Warren, and, W. E. Dismukes. 2001. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin. Infect. Dis. 33: 690699.
83. Park,, B. J.,, K. A. Wannemuehler,, B. J. Marston,, N. Govender,, P. G Pappas, and, T. M. Chiller. 2009. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS 23: 525530.
84. Park, M. K.,, D. R. Hospenthal, and, J. E. Bennett. 1999. Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting. Clin. Infect. Dis. 28: 629633.
85. Perfect, J. R. 1989. Cryptococcosis. Infect. Dis. Clin. N. Am. 3: 77102.
86. Perfect,, J. R.,, W. E. Dismukes,, F. Dromer,, D. L. Goldman,, J. R. Graybill,, R. J. Hamill,, T. S. Harrison,, R. A. Larsen,, O. Lortholary,, M. H. Nguyen,, P. G. Pappas,, W. G. Powderly,, N. Singh,, J. D. Sobel, and, T. C. Sorrell. 2010. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin. Infect. Dis. 50: 291322.
87. Pfaller,, M. A.,, S. A. Messer,, L. Boyken,, C. Rice,, S. Tendolkar,, R. J. Hollis,, G. V. Doern, and, D. J. Diekma. 2005. Global trends in the antifungal susceptibility of Cryptococcus neoformans (1990 to 2004). J. Clin. Microbiol. 43: 21632167.
88. Rex,, J. H.,, R. A. Larsen,, W. E. Dismukes,, G. A. Cloud, and, J. E. Bennett. 1993. Catastrophic visual loss due to Cryptococcus neoformans meningitis. Medicine 72: 209224.
89. Richardson, P. M.,, A. Mohandas, and, N. Arumugasamy. 1976. Cerebral cryptococcosis in Malaysia. J. Neurol. Neurosurg. Psychiatry 39: 330337.
90. Rozenbaum,, R.,, A. R. Goncalves,, B. Wanke,, M. J. Caiuby,, H. Clemente,, M. D. Lazera,, P. C. Monteiro, and, A. T. Lonfero. 1992. Cryptococcus neoformans varieties as agents of cryptococcosis in Brazil. Mycopathologia 119: 133136.
91. Rozenbaum, R., and, A. R. Goncalves. 1994. Clinical epidemiological study of 171 cases of cryptococcosis. Clin. Infect. Dis. 18: 369380.
92. Saag, M.,, R. J. Graybill,, R. A. Larsen,, P. G. Pappas,, J. R. Perfect,, W. G. Powderly,, J. D. Sobel,, W. E. Dismukes, for the Mycoses Study Group Cryptococcal Subproject. 2000. Practice guidelines for the management of cryptococcal disease. Clin. Infect. Dis. 30: 710718.
93. Seaton,, R. A.,, A. J. Hamilton,, R. J. Hay, and, D. A. Warrell. 1996. Exposure to Cryptococcus neoformans var. gattii: a seroepidemiological study. Trans. R. Soc. Trop. Med. Hyg. 90: 508512.
94. Seaton,, R. A.,, N. Verma,, S. Naraqi,, J. P. Wembri, and, D. A. Warrell. 1997. Visual loss in immunocompetent patients with Cryptococcus neoformans var. gattii meningitis. Trans. R. Soc. Trop. Med. Hyg. 91: 4149.
95. Singh, N.,, F. Dromer,, J. R. Perfect, and, O. Lortholary. 2008. Cryptococcosis in solid organ transplant recipients: current state of the science. Clin. Infect. Dis. 47: 13211327.
96. Smith, A. B.,, J. G. Smirniotopoulos, and, E. J. Rushing. 2008. Central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics 28: 20332058.
97. Sorrell, T. C. 2008. East meets west. Cryptococcosis in Australia, abstr. SY-01–08, p. 42. Program and Abstracts of the 7th International Cryptococcus and Cryptococcosis Conference, 11 to 14 September, Nagasaki, Japan.
98. Sorrell,, T. C.,, S. C. A. Chen,, P. Ruma,, W. Meyer,, T. J. Pfeiffer,, D. H. Ellis, and, A. G. Brownlee. 1996. Concordance of clinical and environmental isolates of Cryptococcus neoformans var. gattii by random amplification of polymorphic DNA analysis and PCR fingerprinting. J. Clin. Microbiol. 34: 12521260.
99. Sorrell, T. C. 2001. Cryptococcus neoformans variety gattii. Med. Mycol. 39: 155168.
100. Sorrell, T. C., and, U. Himmelreich. 2008. NMR in Mycology. Curr. Fungal Inf. Rep. 2: 149156.
101. Speed, B., and, D. Dunt. 1995. Clinical and host differences between infections with the two varieties of cryptococcus neoformans. Clin. Infect. Dis. 21: 2834.
102. Stephen, C.,, S. Lester,, W. Black,, M. Fyfe, and, S. Raverty. 2002. Multispecies outbreak of cryptococcosis on southern Vancouver Island, British Columbia. Can. Vet. J. 43: 792794.
103. Tan, C. T. 1988. Intracranial hypertension causing visual failure in cryptococcal meningitis. J. Neurol. Neurosurg. Psychiatry 15: 944946.
104. Tay,, S. T.,, H. T. Tanty,, K. P. Ng,, M. Y. Rohani, and H. Hamimah. 2006. In vitro susceptibilities of Malaysian clinical isolates of Cryptococcus neoformans var. grubii and Cryptococcus gattii to five antifungal drugs. Mycoses 49: 324330.
105. Thompson,, G. R.,, III, N. P. Wiederhold,, A. W. Fothergill,, A. C. Vallor,, B. L. Wickes, and, T. F. Patterson. 2009. Antifungal susceptibilities among different serotypes of Cryptococcus gattii and Cryptococcus neoformans. Antimicrob. Agents Chemother. 53: 309311.
106. Torres,, O. H.,, E. Negredo,, J. Ris,, P. Domingo, and, A. M. Catafau. 1999. Visual loss due to cryptococcal meningitis in AIDS patients. AIDS 13: 530534.
107. Torres-Rodriguez, J. M.,, E. Alvarado-Ramirez,, F. Murciano, and, M. Sellart. 2008. MICs and minimum fungicidal concentrations of posaconazole, voriconazole and fluconazole for Cryptococcus neoformans and Cryptococcus gattii. J. Antimicrob. Chemother. 62: 205210.
108. Trilles, L.,, B. Fernandez-Torres,, M. dos Santos Lazera,, B. Wanke, and, J. Guarro. 2004. In vitro antifungal susceptibility of Cryptococcus gattii. J. Clin. Microbiol. 42: 48154817.
109. Van Dam, M. G.,, R. A. Seaton, and, A. J. Hamilton. 1998. Analysis of HLA association in susceptibility to infection with Cryptococcus neoformans var. gattii in a Papua New Guinea population. Med. Mycol. 36: 185188.
110. Velagraki,, A.,, V. G. Kiosses,, H. Pitsouni,, D. Youkas,, V. D. Danilidis, and, N. J. Legakis. 2001. First report of Cryptococcus neoformans var. gattii serotype B from Greece. Med. Mycol. 39: 419422.
111. West,, S.,, E. Brynes,, S. Mostad,, R. Thompson,, R. Barnes,, C. Beiser,, J. Heitman, and K. Marr. 2008. Emergence of Cryptococcus gattii in the Pacific Northwest United States, abstr. M1849, p. 658. 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, DC.
112. White, M.,, C. Cirricione,, A. Blevins, and, D. Armstrong. 1992. Cryptococcal meningitis with AIDS and patients with neoplastic disease. J. Infect. Dis. 165: 960966.
113. Widmer,, F.,, L. C. Wright,, D. Obando,, R. Handke,, R. Ganendren,, D. H. Ellis, and, T. C. Sorrell. 2006. Hexadecylphosphocholine (miltefosine) has broad-spectrum fungicidal activity and is efficacious in a mouse model of cryptococcosis. Antimicrob. Agents Chemother. 50: 414421.
114. Yu,, Y. L.,, Y. N. Lau,, E. Woo,, K. L. Wong, and B. Tse. 1988. Cryptococcal infection of the nervous system. Q. J. Med. 66: 8796.
115. Zonios,, D. I.,, J. Falloon,, C. Y. Huang,, D. Chaitt, and, J. E. Bennett. 2007. Cryptococcosis and idiopathic CD4 lymphocytopenia. Medicine 86: 7892.
116. Zuger,, A.,, E. Louie,, R. S. Holzman,, M. S. Simberkoff, and, J. J. Rahal. 1986. Cryptococcal disease in patients with acquired immunodeficiency syndrome. Diagnostic features and outcome of treatment. Ann. Intern. Med. 104: 234240.


Generic image for table

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
Generic image for table

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

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

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

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error