1. Prattana Leenasirimakul
Cryptococcosis
Prattana Leenasirimakul
Nakornping Hospital
Chiang mai, Thailand

2. Cryptococcosis
Cryptococcus neoformans.

3. Cryptococcosis
Cryptococcosis is a chronic, subacute to acute pulmonary, systemic or meningitis disease
Cryptococcus neoformans var. neoformans and Cryptococcus neoformans var. gattii
encapsulated yeast
The species has 4 serotypes (A,B,C,D) based on capsular polysaccharide antigen
C. neoformans var neoformans serotype A

4. Cryptococcosis Epidermiology
distributed worldwide, pigeon feces, eucalyptus trees (var. gattii)
Transmission by inhalation of basidiospore or yeast cells
Cryptococcal infections in hosts who are immunosuppressed, including patients with AIDS

5. Transmission
Inhalation respiratory infection dissiminated

6. Clinical features - sub acute meningitis
- meningoencephalitisCNS cryptococcosis
Most common clinical presentation of cryptococcosis: Cryptococcal meningitis
Prolong evolution of several months
headache, vomiting, neck stiffness, mental status

7. : 1/3 have evidence of pulmonary involvement
- cough , dyspnea
- abnormal CXR
: Disseminated infection

8. Cryptococcosis Pulmonary cryptococcosis asymptomatic x-ray
Right upper lobe

9. This is Cryptococcus neoformans infection of the lung
This is Cryptococcus neoformans infection of the lung. There are numerous organisms that have a large mucoid capsule, giving the appearance of a clear zone around a faint round nucleus.

10. Cryptococcosis Cutaneous & mucocutaneous cyptococcosis
Osseous cyrtococcosis : bone
Visceral crytococcosis : heart, kidneys, liver,

11. Cryptococcus antigen : highly sensitive and specific ( > 1:8 )
: screening test for febrile patient

12. Laboratory diagnosis India ink test : detect the extensive capsule
Mucicarmine stain
India ink test : detect the extensive capsule

13. This is an India ink preparation of cerebrospinal fluid in a patient with Cryptococcus neoformans meningitis. Note the clear zone of the capsule around the central nucleus of the organisms.

14. - normal or slightly low glucose - a few lymphocytes.
Examination of CSF :
- mildly elevation CSF protein
- normal or slightly low glucose
- a few lymphocytes.
- numerous organism
Latex agglutination test : detect cryptococcal antigen
Patient improves : titer
No respond to therapy ; titer

15. Laboratory diagnosis Culture: 370C, 1-2 days
SDA with out cyclohexamide: creamy, white and mucoid
Birdseed agar: brown to black colony
Urease positive
SDA
- ve/+ve
Birdseed agar

16. Diagnosis and treatment of Cryptococcus meningitis
HIV positive patient CD4
lymphocyte count <200,000/ml
History suggestive of cryptococcal meningitis( CM )
( and /or )
Headaches , fever ,with/without mental status changes
Positive serum cryptococcal antigen

17. Lumbar puncture Lumbar puncture
No evidence of CM continue diagnostic evaluation
No evidence of CM fluconazole 200 mg orally indefinitely
Evidence of CM Positive culture for Cryptococcus neoformans, positive India ink stain
Amphotericin 8 ( 0.7 mg/kg/day ) iv plus flucytosine (25mg/kg) q6h for 2 week , then fluconzole 400 mg po for 8 weeks, then fluconazole 200mg po for life