Pulmonary cryptococcosis and Cryptococcus gattii

Etiology:

The fungus Cryptococcus gattii, contracted through inhalation of spores.

Commonly grows in tropical and subtropical climes, yet has appeared in  British Columbia, Canada and the Pacific Northwest as the climate warms.

Manifestations:

  1. Pulmonary cryptococcosis
  2. basal meningitis,
  3. cerebral cryptococcomas
  4. skin, soft tissue, lymph node, bone, and joint infections

Symptoms:

  • Prolonged cough (lasting weeks or months)
  • Sputum production
  • Sharp chest pain
  • Shortness of breath
  • Sinusitis (cottony drainage, soreness, pressure)
  • Severe headache (meningitis, encephalitis, meningoencephalitis)
  • Stiff neck (prolonged and severe nuchal rigidity)
  • Muscle soreness (mild to severe, local or diffuse)
  • Photophobia (excessive sensitivity to light)
  • Blurred or double vision
  • Eye irritation ( soreness, redness)
  • Focal neurological deficits
  • Fever (delirium, hallucinations)
  • Confusion (abnormal behavior changes, inappropriate mood swings)
  • Seizures
  • Dizziness
  • night sweats
  • Weight loss
  • Nausea (with or without vomiting)
  • Skin lesions (rashes, scaling, plaques, papules, nodules, blisters, subcutaneous tumors or ulcers)
  • Lethargy
  • Apathy

Treatment:

antimicrobials:

  1. the anti-fungal drug Amphotericin B in conjunction with IV or oral Flucytosine
  2. followed by oral Fluconazole for 6 months
  3. surgical excision of walled off sporomas in the lungs (may be mistaken for lung cancer on X-ray).

A) Chest radiograph and B) computed tomography scan of the patient showing 3 nodular Cryptococcus gattii infiltrates near pleura.

Figure retrieved from: http://images.google.ca/imgres?imgurl=http://www.cdc.gov/ncidod/EID/13/1/images/06-0945_b.jpg&imgrefurl=http://www.cdc.gov/ncidod/EID/13/1/178-G.htm&usg=__zwXn6_afr3ZwCP3kQHKddxwDIbU=&h=285&w=600&sz=26&hl=en&start=16&um=1&itbs=1&tbnid=CK9QajTlLYpAqM:&tbnh=64&tbnw=135&prev=/images%3Fq%3Dcryptococcus%2Bgattii%26um%3D1%26hl%3Den%26sa%3DN%26tbs%3Disch:1

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