What are the symptoms of Cryptococcosis (Cryptococcal disease)?

From the Guidelines

Cryptococcosis symptoms vary depending on the infection site, but commonly include fever, headache, neck stiffness, confusion, and sensitivity to light when the fungus affects the brain and spinal cord (cryptococcal meningitis), as well as cough, chest pain, and difficulty breathing with pulmonary involvement, as noted in the guidelines by the Infectious Diseases Society of America 1. The severity of symptoms depends on the patient's immune status, with immunocompromised individuals (especially those with HIV/AIDS, organ transplants, or on immunosuppressive medications) experiencing more severe presentations. Key symptoms to look out for include:

• Fever
• Headache
• Neck stiffness
• Confusion
• Sensitivity to light
• Cough
• Chest pain
• Difficulty breathing Early symptoms can be subtle and progress gradually, making diagnosis challenging. The causative organism, Cryptococcus (typically C. neoformans or C. gattii), is found in soil contaminated with bird droppings and certain trees, as discussed in the clinical practice guidelines for the management of cryptococcal disease 1. Diagnosis requires laboratory testing of blood, cerebrospinal fluid, or tissue samples. If you suspect cryptococcosis, especially with unexplained neurological symptoms and compromised immunity, seek immediate medical attention as untreated cryptococcal meningitis can be fatal, as emphasized in the guidelines 1. It is essential to consider the patient's immune status and the severity of symptoms when diagnosing and treating cryptococcosis, as highlighted in the evidence summary 1 and the clinical practice guidelines 1.

From the Research

Symptoms of Cryptococcosis

The symptoms of Cryptococcosis (Cryptococcal disease) can vary depending on the organ affected and the immune status of the patient.

• In cases of meningitis, symptoms may include:
  • Headaches
  • Fevers
  • Mental status changes
• Symptoms of pulmonary disease are nonspecific and may include:
  • Fever
  • Chills
  • Cough
  • Malaise
  • Night sweats
  • Dyspnea
  • Weight loss
  • Hemoptysis
• Primary pulmonary presentations may also include:
  • Cough
  • Chest pain
  • Low-grade fever
• In immunocompromised patients, symptoms may also include:
  • Persistent low-grade fever
  • Headache
  • Weight loss
  • Fatigue
  • Severe headache and neck stiffness

Diagnosis and Treatment

Diagnosis of Cryptococcosis is typically made by antigen testing of serum or cerebrospinal fluid, or by culture or histopathology of infected tissues 2, 3, 4, 5, 6.

• Treatment of Cryptococcosis is based on the anatomical site of disease, severity of disease, and underlying immune status of the patient.
• Amphotericin B preparations plus 5-flucytosine is used as initial treatment of meningitis, disseminated infection, or moderate-to-severe pulmonary infection, followed by fluconazole as a consolidation therapy 2, 3, 4, 5, 6.
• Fluconazole is effective for mild-to-moderate pulmonary infection 2, 5, 6.

Complications

Important complications of Cryptococcosis include:

• Elevated intracranial pressure
• Immune reconstitution syndrome, which may resemble active disease 2
• Visual impairment or blindness, mainly attributed to intracranial hypertension with residual deficits determined by the measures taken to lower intracranial pressures 3