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 i.e. the clinical syndrome into pulmonary, CNS, or disseminated cryptococcosis. Another approach to the classification involves the species or variety of the cryptococcus causative organism and includes Cryptococcus neoformans, Cryptococcus gattii, and other rares species.

Classification

Cryptococcosis may be classified based on the site of infection i.e. the clinical syndrome, or the species or variety of the cryptococcus causative organism.

Site of Infection

• Pulmonary Cryptococcosis

• The most common clinical syndrome associated with Cryptococcus, but may be asymptomatic.
• Related to the mode of transmission via aerosolized basidiospores.
• 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).
• Secondary to dissemination of inhaled spores in patients who are severely immunocompromised.
• Cryptococcosis is one of the leading causes of meningitis in adults worldwide.

• Disseminated Cryptococcosis

• Most often involves the skin, soft tissue, and the medulla of the bone in addition to the lungs and CNS.
• Also associated with a severely immunocompromised status.

Causative Species or Variety

• 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.

• Cryptococcus neoformans v. grubii (serotype A)

• The major causative agent of cryptococcosis in Asia and the US.

• Cryptococcus gattii

• Previously a variant of C. neoformans, currently classified as a separate species.
• Emerging as a common fungal pathogen in the Pacific Northwest of the USA.

• Cryptococcus uniguttulatus

• Very rare. Associated with ventriculitis.
• First isolated from a human nail.

• Cryptococcus laurentii

• Rare. Associated with fungemia, lung abscesses, and meningitis.

• Cryptococcus albidus

• Very rare. Associated with ocular infections, and meningitis.

• Although other species of cryptococci exist, they are not known to be infectious to humans.