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.

Overview

Cryptococcosis is more common among immunocompromised patients who are at high risk for other fungal, bacterial, and viral infections. Cryptococcal meningitis can be indistinguishable from bacterial or viral meningitis. Cryptococcosis must be differentiated from diseases that cause symptoms of lower respiratory tract infection (fever, dyspnea, cough) and meningitis (fever, headache, neck stiffness, focal neurological deficits) such as coccidioidomycosis, histoplasmosis, tuberculosis, and community/hospital-acquired pneumonia. Cutaneous cryptococcosis in HIV/AIDS patients must be differentiated from molluscum contagiosum and Kaposi's sarcoma.

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.