Cryptococcosis: Everything You Need To Know

Cryptococcosis is caused by fungi found in soils that are contaminated with bird feces, especially pigeons.

Cryptococcosis is an infection caused by a fungus from the Cryptococcus family. In total, there are 30 types of cryptococci, but only two of these species have the ability to infect: Cryptococcus neoformans and Cryptococcus gatti .

Cryptococcosis is said to be an opportunistic infection, primarily targeting people with impaired immunity. Specifically, it attacks the lungs and the central nervous system.

These types of diseases were previously very rare, however, they began to gain importance when the number of AIDS patients increased. In fact, it is in them that it usually manifests itself most frequently.

General aspects of cryptococcosis

As the scientific evidence indicates, the fungi that cause cryptococcosis lodge in the ground, among the dust. They mainly appear on surfaces contaminated with bird feces. They are also found in the leaves and wood of eucalyptus trees, in tropical and subtropical regions.

The risk factors for contracting this disease are the following:

• Be male.
• Age between 20 and 50 years.
• Be positive for HIV.
• Have lymphomas or sarcoidosis.
• Present diabetes mellitus.
• Having undergone a transplant.
• Having cancer or having been treated with chemotherapy.
• Having had a prolonged treatment with corticosteroids.

The entry point for contaminating fungi is the lungs. The usual thing is that the person vacuums them from the ground. In some cases it is transmitted through the skin and, in very rare cases, it is acquired orally.

Symptoms and clinical manifestations

The symptoms of cryptococcosis are very varied. This depends on the area that is attacked by the infection. If the disease strikes a person with a normal immune system, they almost never have symptoms.

Cryptococcosis can have a subacute or chronic course. In the first case, the symptoms are moderate and of variable evolution. On the contrary, in the second case the disease has a long duration and slow progression. In both cases there are different clinical manifestations. Some of them are:

• Asymptomatic. In this case, the condition is mainly pulmonary, but does not require treatment, although it may leave some sequelae.
• Meningitis. It occurs in subacute and chronic cryptococcosis. It is the inflammation of the meninges and causes serious problems.
• Cryptococoma. It only occurs in 1% of cases and its symptoms are similar to that of a brain tumor.
• Meningoencephalitis. It is the simultaneous inflammation of the meninges and the brain. It is unusual for it to appear in its fulminant form.
• Pulmonary. It is generally transitory and mild. However, it also causes pneumonia and other lung diseases.
• Cutaneous. It occurs in 10-15% of cases. It manifests with papules, nodules, ulcers and sometimes with cellulite.
• Bone. It leads to osteomyelitis, arthritis, and injury.
• Genitourinary. It causes prostatitis, pyelonephritis, and papillitis.
• Disseminated. It affects several organs simultaneously.

Cryptococcosis diagnosis

There are four axes of diagnosis: clinical, microbiological, serological and imaging. Not all tests are always carried out, although it is advisable to practice them together. Let’s see each one:

• Clinical. It corresponds to the interrogation and the physical examination.
• Microbiological. Includes visualization of the germ in body fluids and culture to determine the presence of fungi.
• Serological. It corresponds to three tests: ELISA, indirect immunofluorescence for detection of antibodies and latex agglutination.
• Imaging. Includes chest X-ray, skull or lung CT, and nuclear magnetic resonance imaging of the skull.

Often the cultures are made from body fluids or cerebrospinal fluid, which is obtained by puncture. Sometimes lung biopsies or bronchoscopy and bronchoalveolar lavage are ordered to confirm the diagnosis.

Forecast

It has been established that in AIDS patients, cryptococcosis causes a mortality of around 20%. Among those who have had transplants, there is an increased risk of death from this disease in those who have had a liver transplant. If the disease attacks the central nervous system, it almost always causes death or leaves sequelae.

The prognosis of cryptococcosis depends on several factors. In general, it is more negative when any of the following variables is present:

• Immune Reconstitution Inflammatory Syndrome or IRIS.
• Absence of headache.
• Mental disorders
• Presence of HIV.
• Pregnancy.

The most advisable thing is to properly treat all the factors that predispose to suffering this disease. Likewise, the ideal is to maintain a rigorous environmental control in the places where birds are raised, especially pigeons.