Cryptococcosis classification: Difference between revisions
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==Overview== | ==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 | 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 rarer species. | ||
==Classification== | ==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. | 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=== | ===Site of Infection=== | ||
*'''Pulmonary Cryptococcosis''' | *'''Pulmonary Cryptococcosis''' | ||
:*The most common clinical syndrome associated with Cryptococcus, but may be asymptomatic. | :*The most common clinical syndrome associated with Cryptococcus, but may be [[asymptomatic]]. | ||
:*Related to the mode of transmission via aerosolized | :*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. | :*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''' | *'''Central Nervous System (CNS) Cryptococcosis''' | ||
:*Classically seen in patients with AIDS and low CD4 | :*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 dissemination of inhaled spores in patients who are severely immunocompromised. | :*Secondary to 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> | :*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''' | *'''Disseminated Cryptococcosis''' | ||
:*Most often involves the skin, soft tissue, and the medulla of the bone in addition to the lungs and CNS. | :*Most often involves the [[skin]], [[soft tissue]], and the [[Bone marrow|medulla of the bone]] in addition to the [[lungs]] and [[CNS]]. | ||
:*Also associated with a severely immunocompromised status. | :*Also associated with a severely [[immunocompromised]] status. | ||
===Causative Species or Variety=== | ===Causative Species or Variety=== | ||
| Line 33: | Line 33: | ||
:*Emerging as a common fungal pathogen in the Pacific Northwest of the USA.<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> | :*Emerging as a common fungal pathogen in the Pacific Northwest of the USA.<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> | ||
*'''''Cryptococcus uniguttulatus''''' | *'''''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> | :*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. | :*First isolated from a human nail. | ||
*'''''Cryptococcus laurentii''''' | *'''''Cryptococcus laurentii''''' | ||
:*Rare. Associated with fungemia, lung | :*Rare. Associated with [[fungemia]], [[lung abscess]]<nowiki/>es, and [[meningitis]]. | ||
*'''''Cryptococcus albidus''''' | *'''''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> | :*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 infectious to humans. | *Although other species of cryptococci exist, they are not known to be infectious to humans. | ||
Revision as of 15:55, 11 January 2016
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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 rarer 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.[1]
- 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).[2]
- Secondary to dissemination of inhaled spores in patients who are severely immunocompromised.
- Cryptococcosis is one of the leading causes of meningitis in adults worldwide.[3]
- 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.[4]
- Cryptococcus uniguttulatus
- Very rare. Associated with ventriculitis.[5]
- 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.[6]
- Although other species of cryptococci exist, they are not known to be infectious to humans.
References
- ↑ 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
- ↑ 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.
- ↑ 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.