Cryptococcal pneumonia

Bacterial Infection 190 Mycobacterial Infection 191 Fungal Infections 191 Pneumocystis Jiroveci (Formerly Pneumocystis Carinii) 191 Aspergillosis 192 Mucormycosis 194 Cryptococcal Pneumonia 194 Histoplasmosis 195 Candidiasis 195 Viral Infection 195 Community Respiratory Viruses 195 Cytomegalovirus (CMV) 196... 

Cryptococcal meningitis is fatal if left untreated. Because pneumonia frequently precedes dissemination of disease and subsequent meningitis, all patients with culture-, histopathology-, or serology-proven disease should receive antifungal therapy. In patients with isolated pulmonary cryptococcosis, fluconazole is generally considered to be the therapy of choice (see Table 81-2).37 Alternatively, itraconazole or combination therapy (fluconazole plus flucytosine) has also been used with some success in patients. 

Cryptococcal meningitis is the most common form of fnngal CNS infection in the United States and is a major canse of morbidity and mortality in immnnosnppressed patients. In the United States, 85% of cases occur in HIV-infected patients. C. neoformans is a soil fungus acquired by inhalation of spores from the environment leading to a pneumonia, which is nsnaUy asymptomatic. Most patients present initially with disseminated disease, especially meningoencephalitis. The incubation period in AIDS patients may be very short, as opposed to a relatively normal host, in whom it may be very long. 

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