key: cord-0037587-d4bdj037
authors: Forrestel, Amy K.
title: Cryptococcosis
date: 2018-05-10
journal: Inpatient Dermatology
DOI: 10.1007/978-3-319-18449-4_43
sha: 9e7435c544d55f7fdbbad441be6af9d1378ab3cf
doc_id: 37587
cord_uid: d4bdj037

Infection with encapsulated yeast Cryptococcus neoformans or gattii. C. neoformans is found in bird and bat droppings and contaminated soil/dust; C. gattii colonizes trees/wood debris.

Amy K. Forrestel Overview • Infection with encapsulated yeast Cryptococcus neoformans or gattii -C. neoformans is found in bird and bat droppings and contaminated soil/dust; C. gattii colonizes trees/wood debris • Infection typically occurs following inhalation leading to variable pulmonary manifestations (ranging from asymptomatic mild pneumonitis to acute respiratory distress syndrome (ARDS)) -The majority of cases will remain contained within the lungs -Reactivation can occur when immunosuppression prevents continued proper containment of a latent infection • Cutaneous lesions almost always result from embolic hematogenous spread in disseminated disease -Approximately 10% of cryptococcal infections will become disseminated, typically occurring in immunocompromised patients (HIV/AIDS, chemotherapy, organ transplant, chronic steroid use); dissemination rates may reach up to 50% in AIDS patients, often occurring when CD4 counts are below 50-100/μL -In patients with disseminated disease, hematogenous spread leads to CNS (70-90%) and skin (10-15%) involvement most commonly • Primary cutaneous cryptococcosis is very rare following direct innoculation; skin involvement should lead one to suspect and evaluate for systemic disease in all cases

• Severe mengingo-encephalitis in immunocompromised patients is the most common clinical presentation of disseminated disease; most mycotic meningitis cases are secondary to cryptococcosis -Patients commonly experience fever, headache, and meningeal signs -Fatal if untreated; so a high index of suspicion is necessary • Symptomatology is based on the distribution of disseminated disease and can include lymph nodes, skin, eye, kidney, bones, etc.

• In disseminated disease cutaneous lesions are most commonly found on the head and neck and may present as umbilicated or crateriform nodules, indurated or soft plaques, ulcers, blisters, tumor-like masses, or draining sinuses -Molluscum-like papules with central umbilication, acneiform pustules, and Kaposi sarcoma-like lesions can be seen in AIDS patients. • Cyrptococcal cellulitis is seen in severely immunocompromised hosts and has an abrupt onset of red-brown erythema with rapid progression • In primary cryptococcosis lesions may be ulcers, nodules, abscesses, or plaques favoring exposed areas at the site of prior skin trauma with local adenopathy ( 

Clinical practice guidelines for the management of cryptoccal disease: 2010 update by the Infectious Diseases Society of America

AIDS Programme Rapid Advice. Diagnosis, prevention, and management of cryptococcal disease in HIV-infected adults, adolescents, and children