Cryptococcosis classification: Difference between revisions
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==Overview== | ==Overview== | ||
Cryptococcosis may be classified based on the site of [[infection]] i.e. the clinical [[syndrome]] into [[pulmonary]], [[CNS]], or disseminated cryptococcosis. Another approach to the classification involves the [[species]] or variety of the cryptococcus causative organism and includes ''[[Cryptococcus neoformans]]'', ''[[Cryptococcus gattii]]'', and other rarer species. | [[Cryptococcosis]] may be classified based on the site of [[infection]] i.e. the clinical [[syndrome]] into [[pulmonary]], [[CNS]], or [[Disseminated disease|disseminated]] [[cryptococcosis]]. Another approach to the classification involves the [[species]] or variety of the [[cryptococcus]] causative organism and includes ''[[Cryptococcus neoformans]]'', ''[[Cryptococcus gattii]]'', and other rarer species. | ||
==Classification== | ==Classification== | ||
Cryptococcosis may be classified based on the site of [[infection]] i.e. the clinical [[syndrome]], or the species or variety of the [[cryptococcus]] causative organism. | [[Cryptococcosis]] may be classified based on the site of [[infection]] i.e. the clinical [[syndrome]], or the [[species]] or variety of the [[cryptococcus]] causative organism. | ||
===Site of Infection=== | ===Site of Infection=== | ||
*'''Pulmonary Cryptococcosis''' | *'''Pulmonary Cryptococcosis''' | ||
:*The most common clinical syndrome associated with [[Cryptococcus]], but may be [[asymptomatic]].<ref name="pmid10936151">{{cite journal| author=Núñez M, Peacock JE, Chin R| title=Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature. | journal=Chest | year= 2000 | volume= 118 | issue= 2 | pages= 527-34 | pmid=10936151 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10936151 }} </ref> | :*The most common clinical syndrome associated with [[Cryptococcus]], but may be [[asymptomatic]].<ref name="pmid10936151">{{cite journal| author=Núñez M, Peacock JE, Chin R| title=Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature. | journal=Chest | year= 2000 | volume= 118 | issue= 2 | pages= 527-34 | pmid=10936151 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10936151 }} </ref> | ||
:*Related to the mode of transmission via aerosolized [[basidiospore]]<nowiki/>s.<ref name="pmid19620339">{{cite journal| author=Velagapudi R, Hsueh YP, Geunes-Boyer S, Wright JR, Heitman J| title=Spores as infectious propagules of Cryptococcus neoformans. | journal=Infect Immun | year= 2009 | volume= 77 | issue= 10 | pages= 4345-55 | pmid=19620339 | doi=10.1128/IAI.00542-09 | pmc=PMC2747963 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19620339 }} </ref> | :*Related to the mode of [[transmission]] via aerosolized [[basidiospore]]<nowiki/>s.<ref name="pmid19620339">{{cite journal| author=Velagapudi R, Hsueh YP, Geunes-Boyer S, Wright JR, Heitman J| title=Spores as infectious propagules of Cryptococcus neoformans. | journal=Infect Immun | year= 2009 | volume= 77 | issue= 10 | pages= 4345-55 | pmid=19620339 | doi=10.1128/IAI.00542-09 | pmc=PMC2747963 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19620339 }} </ref> | ||
:*Extra-pulmonary infections are thought to be secondary to a primary pulmonary infection even in cases where the latter is not evident. | :*Extra-pulmonary [[infections]] are thought to be secondary to a primary [[pulmonary]] [[infection]] even in cases where the latter is not evident. | ||
*'''Central Nervous System (CNS) Cryptococcosis''' | *'''Central Nervous System (CNS) Cryptococcosis''' | ||
:*Classically seen in patients with [[AIDS]] and low [[CD4+ T cells|CD4 count]]<nowiki/>s (below 100).<ref name="pmid2671735">{{cite journal| author=Chuck SL, Sande MA| title=Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. | journal=N Engl J Med | year= 1989 | volume= 321 | issue= 12 | pages= 794-9 | pmid=2671735 | doi=10.1056/NEJM198909213211205 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2671735 }} </ref> | :*Classically seen in patients with [[AIDS]] and low [[CD4+ T cells|CD4 count]]<nowiki/>s (below 100).<ref name="pmid2671735">{{cite journal| author=Chuck SL, Sande MA| title=Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome. | journal=N Engl J Med | year= 1989 | volume= 321 | issue= 12 | pages= 794-9 | pmid=2671735 | doi=10.1056/NEJM198909213211205 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2671735 }} </ref> | ||
:*Secondary to dissemination of inhaled spores in patients who are severely [[immunocompromised]]. | :*Secondary to [[Disseminated disease|dissemination]] of inhaled [[spores]] in patients who are severely [[immunocompromised]]. | ||
:*[[Cryptococcosis]] is one of the leading causes of [[meningitis]] in adults worldwide.<ref name="cdcstat">C. neoformans Infection Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html. Accessed on December 31, 2015</ref> | :*[[Cryptococcosis]] is one of the leading causes of [[meningitis]] in adults worldwide.<ref name="cdcstat">C. neoformans Infection Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html. Accessed on December 31, 2015</ref> | ||
*'''Disseminated Cryptococcosis''' | *'''Disseminated Cryptococcosis''' | ||
| Line 21: | Line 21: | ||
:*Also associated with a severely [[immunocompromised]] status. | :*Also associated with a severely [[immunocompromised]] status. | ||
*'''Cutaneous Cryptococcosis'''<ref name="pmid7671417">{{cite journal| author=Naka W, Masuda M, Konohana A, Shinoda T, Nishikawa T| title=Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D. | journal=Clin Exp Dermatol | year= 1995 | volume= 20 | issue= 3 | pages= 221-5 | pmid=7671417 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671417 }} </ref> | *'''Cutaneous Cryptococcosis'''<ref name="pmid7671417">{{cite journal| author=Naka W, Masuda M, Konohana A, Shinoda T, Nishikawa T| title=Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D. | journal=Clin Exp Dermatol | year= 1995 | volume= 20 | issue= 3 | pages= 221-5 | pmid=7671417 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671417 }} </ref> | ||
**[[Papules]], [[pustules]], [[nodules]], [[ulcers]] are common skin lesions. | **[[Papules]], [[pustules]], [[nodules]], [[ulcers]] are common [[skin]] lesions. | ||
===Causative Species=== | ===Causative Species=== | ||
*'''''Cryptococcus neoformans''''' | *'''''Cryptococcus neoformans''''' | ||
:*The most common cryptococcal species associated with human disease. | :*The most common [[Cryptococcal infection|cryptococcal]] species associated with human disease. | ||
:*Variety includes: | :*Variety includes: | ||
::*'''''[[Cryptococcus neoformans]] v. neoformans''''' (serotype D) | ::*'''''[[Cryptococcus neoformans]] v. neoformans''''' (serotype D) | ||
| Line 32: | Line 32: | ||
:::*The major causative agent of cryptococcosis in Asia and the US. | :::*The major causative agent of cryptococcosis in Asia and the US. | ||
*'''''[[Cryptococcus gattii]]''''' | *'''''[[Cryptococcus gattii]]''''' | ||
:*Previously a variant of ''C. neoformans'', currently classified as a separate species. | :*Previously a variant of ''[[Cryptococcus neoformans|C. neoformans]]'', currently classified as a separate species. | ||
:*Emerging as a common fungal pathogen in the Pacific Northwest of the USA.<ref name="pmid19757550">{{cite journal| author=Datta K, Bartlett KH, Baer R, Byrnes E, Galanis E, Heitman J et al.| title=Spread of Cryptococcus gattii into Pacific Northwest region of the United States. | journal=Emerg Infect Dis | year= 2009 | volume= 15 | issue= 8 | pages= 1185-91 | pmid=19757550 | doi=10.3201/eid1508.081384 | pmc=PMC2815957 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19757550 }} </ref> | :*Emerging as a common [[fungal]] [[pathogen]] in the Pacific Northwest of the USA.<ref name="pmid19757550">{{cite journal| author=Datta K, Bartlett KH, Baer R, Byrnes E, Galanis E, Heitman J et al.| title=Spread of Cryptococcus gattii into Pacific Northwest region of the United States. | journal=Emerg Infect Dis | year= 2009 | volume= 15 | issue= 8 | pages= 1185-91 | pmid=19757550 | doi=10.3201/eid1508.081384 | pmc=PMC2815957 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19757550 }} </ref> | ||
*'''''Cryptococcus uniguttulatus''''' | *'''''Cryptococcus uniguttulatus''''' | ||
:*Very rare. Associated with [[ventriculitis]].<ref name="pmid11213945">{{cite journal| author=McCurdy LH, Morrow JD| title=Ventriculitis due to Cryptococcus uniguttulatus. | journal=South Med J | year= 2001 | volume= 94 | issue= 1 | pages= 65-6 | pmid=11213945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11213945 }} </ref> | :*Very rare. Associated with [[ventriculitis]].<ref name="pmid11213945">{{cite journal| author=McCurdy LH, Morrow JD| title=Ventriculitis due to Cryptococcus uniguttulatus. | journal=South Med J | year= 2001 | volume= 94 | issue= 1 | pages= 65-6 | pmid=11213945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11213945 }} </ref> | ||
:*First isolated from a human nail. | :*First isolated from a human [[Nail (anatomy)|nail]]. | ||
*'''''Cryptococcus laurentii''''' | *'''''Cryptococcus laurentii''''' | ||
:*Rare. Associated with [[fungemia]], [[lung abscess]]<nowiki/>es, and [[meningitis]]. | :*Rare. Associated with [[fungemia]], [[lung abscess]]<nowiki/>es, and [[meningitis]]. | ||
*'''''Cryptococcus albidus''''' | *'''''Cryptococcus albidus''''' | ||
:*Very rare. Associated with [[ocular]] infections, and [[meningitis]].<ref name="pmid9861831">{{cite journal| author=Johnson LB, Bradley SF, Kauffman CA| title=Fungaemia due to Cryptococcus laurentii and a review of non-neoformans cryptococcaemia. | journal=Mycoses | year= 1998 | volume= 41 | issue= 7-8 | pages= 277-80 | pmid=9861831 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9861831 }} </ref> | :*Very rare. Associated with [[ocular]] infections, and [[meningitis]].<ref name="pmid9861831">{{cite journal| author=Johnson LB, Bradley SF, Kauffman CA| title=Fungaemia due to Cryptococcus laurentii and a review of non-neoformans cryptococcaemia. | journal=Mycoses | year= 1998 | volume= 41 | issue= 7-8 | pages= 277-80 | pmid=9861831 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9861831 }} </ref> | ||
*Although other species of cryptococci exist, they are not known to be infectious to humans. | *Although other species of [[cryptococci]] exist, they are not known to be [[Infection|infectious]] to humans. | ||
==References== | ==References== | ||
Revision as of 16:02, 25 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Serge Korjian M.D.; Yazan Daaboul, M.D.
Overview
Cryptococcosis may be classified based on the site of infection i.e. the clinical syndrome into pulmonary, CNS, or disseminated cryptococcosis. Another approach to the classification involves the species or variety of the cryptococcus causative organism and includes Cryptococcus neoformans, Cryptococcus gattii, and other rarer species.
Classification
Cryptococcosis may be classified based on the site of infection i.e. the clinical syndrome, or the species or variety of the cryptococcus causative organism.
Site of Infection
- Pulmonary Cryptococcosis
- The most common clinical syndrome associated with Cryptococcus, but may be asymptomatic.[1]
- Related to the mode of transmission via aerosolized basidiospores.[2]
- Extra-pulmonary infections are thought to be secondary to a primary pulmonary infection even in cases where the latter is not evident.
- Central Nervous System (CNS) Cryptococcosis
- Classically seen in patients with AIDS and low CD4 counts (below 100).[3]
- Secondary to dissemination of inhaled spores in patients who are severely immunocompromised.
- Cryptococcosis is one of the leading causes of meningitis in adults worldwide.[4]
- Disseminated Cryptococcosis
- Most often involves the skin, soft tissue, and the medulla of the bone in addition to the lungs and CNS.
- Also associated with a severely immunocompromised status.
Causative Species
- Cryptococcus neoformans
- The most common cryptococcal species associated with human disease.
- Variety includes:
- Cryptococcus neoformans v. neoformans (serotype D)
- The major causative agent of cryptococcosis in Europe.
- Cryptococcus neoformans v. grubii (serotype A)
- The major causative agent of cryptococcosis in Asia and the US.
- Previously a variant of C. neoformans, currently classified as a separate species.
- Emerging as a common fungal pathogen in the Pacific Northwest of the USA.[6]
- Cryptococcus uniguttulatus
- Very rare. Associated with ventriculitis.[7]
- First isolated from a human nail.
- Cryptococcus laurentii
- Rare. Associated with fungemia, lung abscesses, and meningitis.
- Cryptococcus albidus
- Very rare. Associated with ocular infections, and meningitis.[8]
- Although other species of cryptococci exist, they are not known to be infectious to humans.
References
- ↑ Núñez M, Peacock JE, Chin R (2000). "Pulmonary cryptococcosis in the immunocompetent host. Therapy with oral fluconazole: a report of four cases and a review of the literature". Chest. 118 (2): 527–34. PMID 10936151.
- ↑ Velagapudi R, Hsueh YP, Geunes-Boyer S, Wright JR, Heitman J (2009). "Spores as infectious propagules of Cryptococcus neoformans". Infect Immun. 77 (10): 4345–55. doi:10.1128/IAI.00542-09. PMC 2747963. PMID 19620339.
- ↑ Chuck SL, Sande MA (1989). "Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome". N Engl J Med. 321 (12): 794–9. doi:10.1056/NEJM198909213211205. PMID 2671735.
- ↑ C. neoformans Infection Statistics. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/fungal/diseases/cryptococcosis-neoformans/statistics.html. Accessed on December 31, 2015
- ↑ Naka W, Masuda M, Konohana A, Shinoda T, Nishikawa T (1995). "Primary cutaneous cryptococcosis and Cryptococcus neoformans serotype D." Clin Exp Dermatol. 20 (3): 221–5. PMID 7671417.
- ↑ Datta K, Bartlett KH, Baer R, Byrnes E, Galanis E, Heitman J; et al. (2009). "Spread of Cryptococcus gattii into Pacific Northwest region of the United States". Emerg Infect Dis. 15 (8): 1185–91. doi:10.3201/eid1508.081384. PMC 2815957. PMID 19757550.
- ↑ McCurdy LH, Morrow JD (2001). "Ventriculitis due to Cryptococcus uniguttulatus". South Med J. 94 (1): 65–6. PMID 11213945.
- ↑ Johnson LB, Bradley SF, Kauffman CA (1998). "Fungaemia due to Cryptococcus laurentii and a review of non-neoformans cryptococcaemia". Mycoses. 41 (7–8): 277–80. PMID 9861831.