Cryptococcosis in a patient with HIV infection

Abstract

Background Cryptococcus neoformans is encapsulated yeast with worldwide distribution, which may cause a self-limited pulmonary infection or disseminate (especially to the meninges, but sometimes to the skin, bones, viscera, or other sites). The infection is acquired by inhalation of contaminated soil. Cryptococcosis is a defining opportunistic infection for AIDS; also at increased risk for infection are patients with Hodgkin’s or other lymphomas, sarcoidosis, or those receiving long-term corticosteroid therapy. Progressive disseminated cryptococcosis also sometimes affects men over 40 years that aren’t obviously immunocompromised. Most cryptococcal infections have a self-limited, subacute or chronic course; in AIDS patients cryptococcal infection may present with acute, severe pneumonia. The brain is the most common organ infected by the hematogenous route; cryptococcal meningitis is an important complication of AIDS. Disseminated cutaneous involvement occurs also by hematogenous dissemination; it causes pustular, papular, nodular, or ulcerated lesions, sometimes resembling acne, molluscum contagiosum, or basal cell carcinoma. The initial treatment is based on amphotericin B and flucytosine; oral fluconazole is needed for chronic suppressive therapy, especially in AIDS patients.