Cryptococcosis Flashcards
begins as
pulmo infection. remains localized to the lung in 90% of pxs.
remaining 10% disseminate hematogenously to other organs. cns and skin most common secondary sites.
most common cause of mycotic meningitis
cryptococcosis
incidence of skin inv
10-15% althoughit is lower in the HIV infected population.
cutaneous lesions may precede overt systemic disease by 2-8 months.
skin infection most freq on head and neck.
50% of HIV and dissmeniated cryptococcosis 28”” decelop molluscum contagiosum like lesions.
etio
c neoformans
subrtropical or tropical areas.
c gattii.
capsule easily identified in HE stain.
stains well with
fontana masson stain for melanin
epid
Worldwide. both humans and animasl.
pigeon droppings. soil. skin. dust.
males> females.
age 30-60 yo.
4th leading cause or opprtunistic infection and second most common fungal opportunist.
5-9 % manif as symptomatic disease.
dissemination in 50% or pxs w AIDS. skin involvement 6%
immunology
patex slide agglutination test- sensitive and specific.
false positive w Rheumatoid factor.
direct microspic exam and latex agglutination have been used w lesional skin scrapings to aid in rapid dx.
mycology
direct exam, a drop of serum or exudate is placed on aslide and a coverslip inserted.
shows yeast: 1 drop of 10% KOH can be added ro half the coverslip and 1 drop of india ink to other half ro demonstrate capsule.
skin biopsy sepcimen should be cultured.
dna prove detection assay allows rapid culture confirmation.
Tx
mild to mod ill non aids- fluconazole 400mg/ day for 8-24 weeks.
seriously ill non HIV/ amphotericin B IV ff by fluconazole orally is st tx.
non aids meningitis and all hiv positive- flucytosine is given agter initial amphotericin B tx.
HIV- Fluconazole given idnefinitely at a suppressive dose of 200mg/day.
primary inoculation- surgical tx alone or w fluconazole or itraconazole for 3-6 months.
