Cryptococcosis

Question 1

Is crypto an endemic fungi?

Answer 1

No (is present in soil everywhere)

Question 2

Which species of cryptococcus is associated with forest eucalyptus trees?

Answer 2

C.Gattii

Question 3

Transmission of cryptococcus?

Answer 3

Inhalation of fungi, viable organisms remain in lung/lymph nodes and reactive when immunocompromised -> proliferation and dissemination

Question 4

What conditions are associated with cryptococcus?

Answer 4

HIV
Myelodysplasitic disorders/myeloproliferative disorders
Sarcoid
Steroids
Organ Tx

No predisposition in 10-25%

Question 5

What is most common clinical manifestations of crypto?

Answer 5

Lung, CNS

Skin, bone etc can occur - points towards immunocompromised host

Question 6

What is the sensitivity of India ink stain for cryptococcus?

Answer 6

50%

Question 7

Classic LP findings in cryptococcus?

Answer 7

High WCC - lymphocytes
High protein, low glucose

Can have normal CSF cells/biochem

Question 8

Which strain of Cryptococcus is associated with cryptococcomas?

Answer 8

C.Gattii

Question 9

Can immunocompetent people get cryptococcosis? Differences?

Answer 9

Yes - 25% are in immunocompetent. Tend to have more significant complications.

Higher mortality, slower onset of symptoms, higher CSF WCC in meningitis

Question 10

Pulmonary manifestations of crypto?

Answer 10

Lobar or nodular changes with cavitation sometimes

Question 11

What Rx should be given If CRAG antigen blood positive with HIV?

Answer 11

3 months daily fluconazole 800mg