Cryptococcus

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Epidemiology
  • HIV patients
  • High dose steroids
  • Pigeons droppings
 
Etiology
  • Cryptococcus neoformans
  • Heavily encapsulated
  • Repeating polysacharide antigen is the main virulence factor
  • Primary skin inoculation is very rare
  • 10% of patients have dissemination from the lungs
 
Clinical presentation
  • Skin: Polymorphic
    • Ulcerated nodules
    • Acneiform
    • Mimecking molluscum contagiosum
  • Systemic
    • Meningitis
    • Lungs
    • Fever
 
Diagnosis
  • Lumbar puncture with CSF → India Ink stain - wide encapsulated halos
  • Latex agglutination test detects polysacharide antigen and causes agglutination
 
Treatment
  • Fluconazol, posaconazol, ravuconazol
  • Amphotericin B + flucytosine