Immunocompromised patient cryptococcosis

In immunocompromised patients pulmonary infection can lead to disseminated forms of the disease where the eyes, skin and bones become infected. Cryptococcal meningitis is particularly associated with AIDS patients, where it is a major cause of death. While cryptococcosis may be controlled by antifungal therapy, in AIDS patients there is a danger of relapse unless antifungal therapy is constantly maintained. 

Cryptococcosis is caused by Cryptococcus neoformans and occurs primarily in immunocompromised patients. Patients with acute meningitis are treated with amphotericin B with flucytosine. Patients infected with HIV require long-term suppressive therapy with fluconazole or itraconazole. 

Disease may remain localized in the lungs or may disseminate to other tissues, particularly the CNS, although the skin also can be affected. Hematogenous spread generally occurs in the immunocompromised host, although it also has been seen in individuals with intact immune systems. Cryptococcemia is the most common symptomatic extraneural infection associated with C. neoformans. Cryptococcemia can be documented in 5% to 22% of non-AIDS patients, and CNS involvement of C. neoformans can be fonnd in 18% to 50% of AIDS patients. Cryptococcal disease is present in 7.5% to 10% of AIDS patients. Therefore, patients with evidence of extranenral cryptococcosis should be evaluated for CNS disease. 

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