ABSTRACT
The findings shown here are those for a 52-year-old man 6 months after liver transplantation. Which statement is true about this infection?
a. It develops in patients with humoral immunodeficiencies b. It may be definitively diagnosed with serologic IgM assays c. It may be effectively treated with itraconazole d. It is transmitted by aerosolization e. It is characterized by broad-based buds
• Cryptococcus neoformans exists as a free living fungus in soil and avian excreta
• Inhalation of aerosolized organisms is the mode of transmission. Sweeping of bird cages or being in the presence of birds flapping their wings may easily predispose to this
• Cryptococcus neoformans is the only cryptococcal species that is pathogenic in humans
• Cryptococcosis is an opportunistic infection in patients with cell-mediated (T-cell) deficiency or dysfunction (such as patients receiving chemotherapy, with long-standing corticosteroid use, or with acquired immunodeficiency syndrome)
• Clinical manifestations include pneumonia, meningitis, and cranial nerve infiltration
• Definitive serologic test of choice is cryptococcal antigen test
• India ink stain may show yeastlike organisms with narrowbased buds
• Central nervous system (CNS) disease should be ruled out in patients with neurologic symptoms and in immunocompromised patients
• CNS disease is diagnosed with culture and cryptococcal antigen test of cerebrospinal fluid. If present, serial lumbar punctures to reduce intracerebral pressures may be needed
• Fluconazole may be used for non-CNS cryptococcosis. Amphotericin B with flucytosine is an accepted treatment for CNS disease
• Patients with acquired immunodeficiency syndrome require lifelong therapy with fluconazole after initial treatment to prevent relapses
