Systemic Review of Published Reports on Primary Cutaneous Cryptococcosis in Immunocompetent Patients

Abstract

Primary cutaneous cryptococcosis (PCC) has been confirmed as a distinct clinical entity with secondary cutaneous cryptococcosis from systematic infection since 2003. Although it has been confirmed as a distinct clinical entity, little has progressed on PCC in immunocompetent hosts compared to their immunocompromised counterpart. We reviewed the literature on cases of PCC in immunocompetent patients from 2004 to 2014, and 21 cases from 16 reports were identified. Males are more likely to develop PCC infections, with a ratio of 17:4 male to female. These patients were found to be almost all senior population except for patients from Asia. Asymptomatic or moderate itching manifesting in a painful nodule is the most common presentation, although there is no typical clinical manifestation recorded. Upper limbs are the most common site of infection, accounting for 71.4 % of all patients. Of the 12 identified isolates, 6 strains are identified as C. neoformans, 5 as C. gattii, and 1 as C.laurentii. Fluconazole was used in 10 cases; however, only 80 % of the 10 cases could confirm that fluconazole was effective in clearing the infections. Interestingly although not approved as a treatment option, Itraconazole was effective in the seven cases it was used to treat cryptococcosis, with a dosage range of 100-400 mg/d and duration from 3 to 6 months. Even though the prognosis of these patients was generally good, more data are need to determine which antifungal azole is the better treatment option and whether primary skin infections could disseminate to systematic infection.

Cryptococcus neoformans var. grubii Infection in HIV-Seronegative Patients from Northeast India: Report of Two Cases with Review of Literature

“…Out of the ten cases which used fluconazole earlier, eight cases responded well to this therapy. Itraconazole was also found to be a good therapeutic option in these cases [31]. In our case, we found fluconazole therapy was effective in eliminating the infection.…”

“…In this context, we are describing these two strains as separate entities in this report. Primary cutaneous cryptococcosis is recognized as a distinct clinical entity since 2003 [31]. Primary cutaneous cryptococcosis cases were reviewed by Du et al recently who found 21 reported cases.…”

Primary cutaneous cryptococcal infection with subsequent erythema nodosum in a 10-year-old immunocompetent girl

“…Primary cutaneous cryptococcal (PCC) infection has no pathognomonic presentation but presents most frequently as an asymptomatic or moderately itchy and painful nodule, cellulitis, or ulceration in exposed domains of the skin 4, 5. There were only 35 cases reported of PCC infection in immunocompetent individuals since 1966 4, 5.…”

Complete Remission of Primary Cutaneous Cryptococcosis in an Immunosuppressed Patient after Fluconazole Treatment

“…At the end of the treatment, a complete re-epithelialization was obtained, even if scarring caused a partial inability to completely extend the last three fingers of the left hand (Figure 3). [15]. They were almost all elderly subjects and upper limbs were the most common site of infection.…”

“…Interestingly, itraconazole was effective in other seven cases reported by literature. Despite the efficacy of medical treatment, some patients needed surgical debridement to remove infected tissues and repair skin damages [15,16]. observed in other patients affected by PCC, diagnosis was delayed because of the absence of risk factors and other systemic symptoms.…”