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==Overview== | ==Overview== | ||
[[Cryptococcosis]] may be classified based on the site of [[infection]]. The clinical [[syndrome]] can be classified as [[pulmonary]], [[CNS]], or [[Disseminated disease|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== | ==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]].<ref name="pmid10936151">{{cite journal| author=Núñez M, Peacock JE, Chin R| title=Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature. | journal=Chest | year= 2000 | volume= 118 | issue= 2 | pages= 527-34 | pmid=10936151 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10936151 }} </ref> | |||
:*Related to the mode of [[transmission]] via aerosolized [[basidiospore]]<nowiki/>s.<ref name="pmid19620339">{{cite journal| author=Velagapudi R, Hsueh YP, Geunes-Boyer S, Wright JR, Heitman J| title=Spores as infectious propagules of Cryptococcus neoformans. | journal=Infect Immun | year= 2009 | volume= 77 | issue= 10 | pages= 4345-55 | pmid=19620339 | doi=10.1128/IAI.00542-09 | pmc=PMC2747963 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19620339 }} </ref> | |||
:*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+ T cells|CD4 count]]<nowiki/>s (below 100).<ref name="pmid2671735">{{cite journal| author=Chuck SL, Sande MA| title=Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. | journal=N Engl J Med | year= 1989 | volume= 321 | issue= 12 | pages= 794-9 | pmid=2671735 | doi=10.1056/NEJM198909213211205 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2671735 }} </ref> | |||
:*Secondary to [[Disseminated disease|dissemination]] of inhaled [[spores]] in patients who are severely [[immunocompromised]]. | |||
:*[[Cryptococcosis]] is one of the leading causes of [[meningitis]] in adults worldwide.<ref name="cdcstat">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</ref> | |||
*'''Disseminated Cryptococcosis''' | |||
:*Most often involves the [[skin]], [[soft tissue]], and the [[Bone marrow|medulla of the bone]] in addition to the [[lungs]] and [[CNS]].<ref name="pmid18157678">{{cite journal |vauthors=Chuang YM, Ho YC, Chang HT, Yu CJ, Yang PC, Hsueh PR |title=Disseminated cryptococcosis in HIV-uninfected patients |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=27 |issue=4 |pages=307–10 |year=2008 |pmid=18157678 |doi=10.1007/s10096-007-0430-1 |url=}}</ref> | |||
:*Also associated with a severely [[immunocompromised]] status. | |||
*'''Cutaneous Cryptococcosis''' | |||
**[[Papules]], [[pustules]], [[nodules]], and [[ulcers]] are common [[skin]] [[lesions]].<ref name="pmid7671417">{{cite journal| author=Naka W, Masuda M, Konohana A, Shinoda T, Nishikawa T| title=Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D. | journal=Clin Exp Dermatol | year= 1995 | volume= 20 | issue= 3 | pages= 221-5 | pmid=7671417 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671417 }} </ref> | |||
===Causative Species=== | |||
'''''(a) Cryptococcus neoformans''''' | |||
:*The most common [[Cryptococcus neoformans|cryptococcal species]] associated with human [[disease]]. | |||
:*Variety includes: | |||
::*'''''Cryptococcus neoformans v. neoformans''''' (serotype D) | |||
:::*The major causative agent of [[cryptococcosis]] in Europe.<ref name="pmid24278784">{{cite journal |vauthors=Cogliati M |title=Global Molecular Epidemiology of Cryptococcus neoformans and Cryptococcus gattii: An Atlas of the Molecular Types |journal=Scientifica (Cairo) |volume=2013 |issue= |pages=675213 |year=2013 |pmid=24278784 |pmc=3820360 |doi=10.1155/2013/675213 |url=}}</ref> | |||
::*'''''Cryptococcus neoformans v. grubii''''' (serotype A) | |||
:::*The major causative agent of [[cryptococcosis]] in Asia and the U.S.<ref name="pmid24019866">{{cite journal |vauthors=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 |title=Geographically structured populations of Cryptococcus neoformans Variety grubii in Asia correlate with HIV status and show a clonal population structure |journal=PLoS ONE |volume=8 |issue=9 |pages=e72222 |year=2013 |pmid=24019866 |pmc=3760895 |doi=10.1371/journal.pone.0072222 |url=}}</ref> | |||
'''''(b) [[Cryptococcus gattii]]''''' | |||
:*Previously a variant of ''[[Cryptococcus neoformans|C. neoformans]]'', currently classified as a separate [[species]]. | |||
:*Emerging as a common [[fungal]] [[pathogen]] in the Pacific Northwest of the U.S.<ref name="pmid19757550">{{cite journal| author=Datta K, Bartlett KH, Baer R, Byrnes E, Galanis E, Heitman J et al.| title=Spread of Cryptococcus gattii into Pacific Northwest region of the United States. | journal=Emerg Infect Dis | year= 2009 | volume= 15 | issue= 8 | pages= 1185-91 | pmid=19757550 | doi=10.3201/eid1508.081384 | pmc=PMC2815957 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19757550 }} </ref> | |||
'''''(c) Cryptococcus uniguttulatus''''' | |||
:*Very rare | |||
:*Associated with [[ventriculitis]]<ref name="pmid11213945">{{cite journal| author=McCurdy LH, Morrow JD| title=Ventriculitis due to Cryptococcus uniguttulatus. | journal=South Med J | year= 2001 | volume= 94 | issue= 1 | pages= 65-6 | pmid=11213945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11213945 }} </ref> | |||
:*First isolated from a human [[Nail (anatomy)|nail]] | |||
'''''(d) Cryptococcus laurentii''''' | |||
:*Rare | |||
:*Associated with [[fungemia]], [[lung abscess|lung abscesses]], and [[meningitis]].<ref name="pmid16896431">{{cite journal |vauthors=Shankar EM, Kumarasamy N, Bella D, Renuka S, Kownhar H, Suniti S, Rajan R, Rao UA |title=Pneumonia and pleural effusion due to Cryptococcus laurentii in a clinically proven case of AIDS |journal=Can. Respir. J. |volume=13 |issue=5 |pages=275–8 |year=2006 |pmid=16896431 |pmc=2683308 |doi= |url=}}</ref> | |||
'''''(e) Cryptococcus albidus''''' | |||
:*Very rare | |||
:*Associated with [[ocular]] infections and [[meningitis]].<ref name="pmid9861831">{{cite journal| author=Johnson LB, Bradley SF, Kauffman CA| title=Fungaemia due to Cryptococcus laurentii and a review of non-neoformans cryptococcaemia. | journal=Mycoses | year= 1998 | volume= 41 | issue= 7-8 | pages= 277-80 | pmid=9861831 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9861831 }} </ref> | |||
*Although other species of ''[[Cryptococci]]'' exist, they are not known to be [[Infection|infectious]] to humans. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Fungal diseases]] | [[Category:Fungal diseases]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Pulmonology]] | |||
[[Category:Neurology]] | |||
[[Category:Dermatology]] | |||
Latest revision as of 21:10, 29 July 2020
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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.