Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts

Abstract

A case of primary cutaneous cryptococcal infection is presented and cases of primary cutaneous cryptococcosis in normal and immunocompromised hosts are reviewed. Cutaneous cryptococcosis can occur from local inoculation or dissemination from a distant site of infection. Risk factors associated with development of primary cutaneous cryptococcosis are those which affect cell-mediated immunity, such as corticosteroid usage, solid organ transplantation, sarcoidosis and immunosuppression. The cutaneous manifestations of cryptococcosis are protean and may mimic other cutaneous diseases. Patients with a diagnosis of cryptococcosis from a skin biopsy or culture should undergo evaluation to exclude disseminated disease and an evaluation of cell-mediated immunity. Although some patients do well without antifungal therapy, these patients cannot be discerned prospectively and therefore antifungal therapy appears warranted in all patients with localized disease. Choice of therapy depends on the extent of disease and immunocompetence of the host.

Primary Cryptococcal Tenosynovitis in a Patient with Rheumatoid Arthritis

“…This work-up should include serum cryptococcal antigen, blood, urine, and sputum cultures, a chest X-ray, and thorough dermatologic examination. If initial tests indicate dissemination or if symptoms suggest central nervous system involvement, then cerebrospinal fluid analysis should be performed [3].…”

“…Among these manifestations, cellulitis is more common in immunocompromised patients and rapidly progresses to deep structures [3][4][5][6].…”

“…As such, cryptococcal skin disease is commonly regarded as a marker of a disseminated disease state. Recently, it was found that primary cryptococcocal skin and soft [3,4].…”

Criptococose cutânea associada à severa infestação por Sarcoptes sp. e Demodex sp. em um cão

“…Já, a leucocitose por neutrofi lia é decorrente da infecção bacteriana secundária da pele. A forma cutânea primária de criptococose pode ocorrer indiferentemente do paciente ser imunocompetente ou imunocomprometido (CHRISTIANSON et al, 2003). As células T CD4+, no entanto, são críticas para o controle do fungo (KWON-CHUNG et al, 2000).…”

“…A escolha do antifúngico, no entanto, depende da extensão da doença e da imunocompetência do hospedeiro (CHRISTIANSON et al, 2003). Todavia, algumas cepas de Cryptococcus apresentam resistência a determinados fármacos, em especial ao fl uconazol (VORATHAVORN et al, 2013).…”