Cryptococcosis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Serge Korjian M.D.; Yazan Daaboul, M.D.
Overview
Cryptococcosis may be classified based on the site of infection. The clinical syndrome can be classified as pulmonary, CNS, or disseminated cryptococcosis. Another approach to the classification is based upon the variety of species of the Cryptococcus causative organism, including Cryptococcus neoformans, Cryptococcus gattii, and other, rarer species.
Classification
Cryptococcosis may be classified based on the site of infection (the clinical syndrome), or the species of the Cryptococcus causative organism.
Site of Infection
- Pulmonary Cryptococcosis
- The most common clinical syndrome associated with Cryptococcus, but may be asymptomatic.[1]
- Related to the mode of transmission via aerosolized basidiospores.[2]
- Extra-pulmonary infections are thought to be secondary to a primary pulmonary infection, even in cases where the latter is not evident.
- Central Nervous System (CNS) Cryptococcosis
- Classically seen in patients with AIDS and low CD4 counts (below 100).[3]
- Secondary to dissemination of inhaled spores in patients who are severely immunocompromised.
- Cryptococcosis is one of the leading causes of meningitis in adults worldwide.[4]
- Disseminated Cryptococcosis
- Most often involves the skin, soft tissue, and the medulla of the bone in addition to the lungs and CNS.[5]
- Also associated with a severely immunocompromised status.
Causative Species
(a) Cryptococcus neoformans
- The most common cryptococcal species associated with human disease.
- Variety includes:
- Cryptococcus neoformans v. neoformans (serotype D)
- The major causative agent of cryptococcosis in Europe.[7]
- Cryptococcus neoformans v. grubii (serotype A)
- The major causative agent of cryptococcosis in Asia and the U.S.[8]
- Previously a variant of C. neoformans, currently classified as a separate species.
- Emerging as a common fungal pathogen in the Pacific Northwest of the U.S.[9]
(c) Cryptococcus uniguttulatus
- Very rare
- Associated with ventriculitis[10]
- First isolated from a human nail
(d) Cryptococcus laurentii
- Rare
- Associated with fungemia, lung abscesses, and meningitis.[11]
(e) Cryptococcus albidus
- Very rare
- Associated with ocular infections and meningitis.[12]
- Although other species of Cryptococci exist, they are not known to be infectious to humans.
References
- ↑ Núñez M, Peacock JE, Chin R (2000). "Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature". Chest. 118 (2): 527–34. PMID 10936151.
- ↑ Velagapudi R, Hsueh YP, Geunes-Boyer S, Wright JR, Heitman J (2009). "Spores as infectious propagules of Cryptococcus neoformans". Infect Immun. 77 (10): 4345–55. doi:10.1128/IAI.00542-09. PMC 2747963. PMID 19620339.
- ↑ Chuck SL, Sande MA (1989). "Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome". N Engl J Med. 321 (12): 794–9. doi:10.1056/NEJM198909213211205. PMID 2671735.
- ↑ C. neoformans Infection Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html. Accessed on December 31, 2015
- ↑ Chuang YM, Ho YC, Chang HT, Yu CJ, Yang PC, Hsueh PR (2008). "Disseminated cryptococcosis in HIV-uninfected patients". Eur. J. Clin. Microbiol. Infect. Dis. 27 (4): 307–10. doi:10.1007/s10096-007-0430-1. PMID 18157678.
- ↑ Naka W, Masuda M, Konohana A, Shinoda T, Nishikawa T (1995). "Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D." Clin Exp Dermatol. 20 (3): 221–5. PMID 7671417.
- ↑ Cogliati M (2013). "Global Molecular Epidemiology of Cryptococcus neoformans and Cryptococcus gattii: An Atlas of the Molecular Types". Scientifica (Cairo). 2013: 675213. doi:10.1155/2013/675213. PMC 3820360. PMID 24278784.
- ↑ Khayhan K, Hagen F, Pan W, Simwami S, Fisher MC, Wahyuningsih R, Chakrabarti A, Chowdhary A, Ikeda R, Taj-Aldeen SJ, Khan Z, Ip M, Imran D, Sjam R, Sriburee P, Liao W, Chaicumpar K, Vuddhakul V, Meyer W, Trilles L, van Iersel LJ, Meis JF, Klaassen CH, Boekhout T (2013). "Geographically structured populations of Cryptococcus neoformans Variety grubii in Asia correlate with HIV status and show a clonal population structure". PLoS ONE. 8 (9): e72222. doi:10.1371/journal.pone.0072222. PMC 3760895. PMID 24019866.
- ↑ Datta K, Bartlett KH, Baer R, Byrnes E, Galanis E, Heitman J; et al. (2009). "Spread of Cryptococcus gattii into Pacific Northwest region of the United States". Emerg Infect Dis. 15 (8): 1185–91. doi:10.3201/eid1508.081384. PMC 2815957. PMID 19757550.
- ↑ McCurdy LH, Morrow JD (2001). "Ventriculitis due to Cryptococcus uniguttulatus". South Med J. 94 (1): 65–6. PMID 11213945.
- ↑ Shankar EM, Kumarasamy N, Bella D, Renuka S, Kownhar H, Suniti S, Rajan R, Rao UA (2006). "Pneumonia and pleural effusion due to Cryptococcus laurentii in a clinically proven case of AIDS". Can. Respir. J. 13 (5): 275–8. PMC 2683308. PMID 16896431.
- ↑ Johnson LB, Bradley SF, Kauffman CA (1998). "Fungaemia due to Cryptococcus laurentii and a review of non-neoformans cryptococcaemia". Mycoses. 41 (7–8): 277–80. PMID 9861831.