Pulmonary Cryptococcosis

Abstract

Pulmonary cryptococcosis describes an invasive lung mycosis caused by Cryptococcus neoformans or Cryptococcus gattii complex. It is often a high-consequence disease in both immunocompromised and immunocompetent populations, and may be misdiagnosed as pulmonary malignancy, leading to a delay in therapy. Epidemiology follows that of cryptococcal meningoencephalitis, with C. gattii infection more common in certain geographic regions. Diagnostic tools include histopathology, microscopy and culture, and the detection of cryptococcal polysaccharide antigen or Cryptococcus-derived nucleic acids. All patients with lung cryptococcosis should have a lumbar puncture and cerebral imaging to exclude central nervous system disease. Radiology is key, both as an adjunct to laboratory testing and as the initial means of detection in asymptomatic patients or those with non-specific symptoms. Pulmonary cryptococcomas (single or multiple) may also be associated with disseminated disease and/or cryptococcal meningitis, requiring prolonged treatment regimens. Optimal management for severe disease requires extended induction (amphotericin B and flucytosine) and consolidation therapy (fluconazole) with close clinical monitoring. Susceptibility testing is of value for epidemiology and in regions where relatively high minimum inhibitory concentrations to azoles (particularly fluconazole) have been noted. Novel diagnostic tools and therapeutic agents promise to improve the detection and treatment of cryptococcosis, particularly in low-income settings where the disease burden is high.

Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort

“…There is no sound evidence base to inform the safe minimum treatment duration for different forms of C. gattii infection. C. gattii is recognized to be more complicated to treat than C. neoformans [1,3,27]. Australian guidelines from 2013 recommend 2 weeks induction therapy for isolated pulmonary diseases [1] whereas our regional guideline (NT) has to date recommended four weeks minimum induction treatment for all forms of C. gattii.…”

Chronic Submandibular Lymphadenopathy due to Cryptococcosis in Cat

“…Swollen submandibular lymph nodes and depletion of lymphoid tissues in this case have proven the dissemination of the infection. Severe disseminated cryptococcosis, diffuse pulmonary infiltrates, and/or dissemination to other sites including the CNS, requiring prolonged treatment regimens (Howard-Jones et al, 2022).…”

Pathogens of importance in lung disease—Implications of the WHO fungal priority pathogen list

“…In immunocompetent patients, isolated cryptococcomas are a frequent presentation and may be asymptomatic in 25%–55% of cases 11,12 . In contrast, for people living with HIV, fulminant disease with pulmonary infiltrates may occur, 13 and the presentation can be very hard to distinguish from other opportunistic lung infections, such as Pneumocystis jirovecii pneumonia (PJP) or tuberculosis, making clinical suspicion and appropriate diagnostic tests key to successful outcomes 14 Histoplasma spp.…”