Cryptococcosis differential diagnosis

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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.

Differentiating Cryptococcosis from other Diseases

• Blastomyces dermatitidis
  • CNS involvement is much less common with blastomyces.
  • Not ubiquitous, more common is endemic areas in North America.
• Coccidioides immitis
  • Usually disease course is more protracted, except with severe immunocompromise.
  • Not ubiquitous, more common is endemic areas in the Southwest United States.
• Histoplasma capsulatum
  • Also related to contaminated with bird or bat droppings.
  • Not ubiquitous. Common in the Central and Eastern United States.
• Paracoccidioides brasiliensis
  • Pulmonary involvement and skin lesions are common in the chronic form (very protracted course).
  • Acute paracoccidioidomycosis mainly affects the reticuloendothelial system, and is not usual of cryptococcosis.
  • Endemic to South and Central America.
• Tuberculosis
  • May present similarly given that immunocompromised status may prevent granuloma formation.
• Molluscum contagiosum
  • Is very similar in appearance to disseminated cryptococcosis manifesting on the skin (umbilicated lesions).
  • Patients are usually less sick, as molluscum is restricted to the skin.
• Bacterial/Viral Meningitis
  • May be indistinguishable before lab testing and CSF stain and culture.
  • Usually bacterial coverage is recommended for all meningitides, even if cryptococcal meningitis is highly suspected.
• Bacterial/Viral Pneumonia
  • May be indistinguishable before antigen testing.
  • May be equally as common as cryptococcal pneumonia in immunocompromised patients, more common in immunocompetent patients.