The Evolution of Pulmonary Cryptococcosis

Abstract

Over 14 years 41 patients were diagnosed as having pulmonary cryptococcosis. Cryptococcus neoformans remained localized to the lung in 12 cases and disseminated in the remaining 29. Thirty-four patients were compromised hosts. Disseminated disease developed in 28 of these 34, and four of these 28 patients with disseminated disease presented with concomitant pulmonary and meningeal infections. In all the remaining 24 central nervous system involvement developed 2 to 20 weeks after the finding of an abnormal chest roentgenogram. Seven patients were normal hosts, and in six of these cases disease remained localized to the lung. Four important conclusions were drawn from this study: pulmonary cryptococcosis is rarely considered in the differential diagnosis of an abnormal chest roentgenogram, thereby leading to missed diagnoses and therapeutic errors; the natural history of untreated pulmonary cryptococcosis in compromised hosts is extrapulmonic dissemination; compromised hosts with pulmonary cryptococcosis should receive antifungal therapy because of a high propensity for dissemination; and normal hosts in whom dissemination has been excluded generally do not need antifungal therapy.

An antimicrobial evaluation of plants used for the treatment of respiratory infections in rural Maputaland, KwaZulu-Natal, South Africa

“…M. catarrhalis has recently emerged as a true pathogen and is now considered to be an important cause of upper respiratory tract infections in healthy children and elderly people, while it causes severe infections in immunocompromised hosts. S. aureus can cause diseases such as otitis media, and is also known to cause secondary infection in influenza patients-subsequently causing death (Kerkering et al, 1981;Aberg et al, 1999;Nester et al, 2001;Verduin et al, 2002). Many of the rural inhabitants are subjected to a poor socio-economic environment with crowded living conditions where a number of communicable diseases become prevalent.…”

Spectrum of Dermatological Lesions in Renal Allograft Recipients in a Tropical Environment

“…These patients showed an excel lent response to fluconazole. Kerkeringet al [17] reported cryptococcal lesions in the skin that antedated central ner vous system disease by weeks to months in 20% of their patients.…”

Bilateral Visual Loss Due to Cryptococcal Meningitis

“…If diagnosis of pulmonary cryptococcosis had been achieved, and antifungal therapy given, then cryptococcal meningitis could have been prevented and his vision could have been saved. In a study done by Kerkering et al, 14 CNS cryptococcosis developed two to 20 weeks after an abnormal chest roentgenogram. The conclusion of that study was that the natural history of untreated pulmonary cryptococcosis in a compromised host is extrapulmonic dissemination and these patients should receive antifungal therapy to prevent such an event.…”