IDS Fungal Cryptococcosis Flashcards
Serotype A and D found in soil contaminated with avian excreta
C. neoformans
Serotype B and C inhabits arboreal species (eucalyptus tree)
C. gatti
T/F Cryptococcosis is common in immunocompetent
F; it’s opportunistic
Risk factors for Cryptococcosis
HAGS
Hematologic malignancies
Advanced HIV infection with CD4 <200/ul
Glucocorticoid treatment
Solid organ transplants with ongoing immunosuppressive therapy
Majority of cases are observed among patients with CD4 count of
<50cells/uL
usually present as
subacute meningitis
meningoencephalitis
skin lesions in cryptococcosis mimic
molluscum congtagiosum
pulmonary infection is manifested as
PCAD
Productive cough
Chest pain
Abnormal CXR
Dyspnea
CSF analysis in cryptococcosis serum protein - glucose - pleocytosis - Gram stain or india ink stain -
serum protein - mildly elevated
glucose - low to normal
pleocytosis - lymphocytes
Gram stain or india ink stain - numerous yeast
Opening pressure in cryptococcosis lumbar tap
> 20cmH20
Treatment for pulmonary Cryptococcosus in immunocompetent
fluconazole 200-400mg/d for 3-6 mos.
Treatment for Extrapulmonary cryptococcosis without CNS involvement immunocompetent
Fluconazole 200-400 mg/d for 3-6 months
or
AmB 0.5-1 mg/kg/d for 4-6 weeks
treatment for cryptococcosis in immunocompetent with CNS involvement
AmB 0.5-1 mg/kg/d + flucytosine 100mg/kg/day for 6-10 weeks
AmB 0.5-1 mg/kg/d + flucytosine100mg/kg/day for 2 weeks then fluconazole 400 mg/d for at least 10 weeks
Pulmonary and extrapulmonary cryptococcosis in person’s with AIDS treatment
Fluconazole 200-400mg/d + flucytosine 100mg/kg/d if severe for 10 weeks followed by LIFELONG Fluconazole
Cryptococcosis CNS involvement in AIDS
AmB 0.7-1 mkd + Flucytosine 100mkd for 2 wks then fluconazole 400mg/d for at least 10 wks then lifelong fluconazole 200mg/d
