What is Cryptococcosis?
Cryptococcosis (synonyms: torulosis, European blastomycosis; Kryptokokkose – German; cryptococcose – French; criptococcosis – Spanish) – subacute or chronic deep mycosis, characterized by a severe course with a primary lesion of the central nervous system, less often lung, skin and mucous membranes.
Causes of Cryptococcosis
The causative agent is Cryptococcus neoformans. In the pathological material it has the appearance of round-shaped yeast cells with a diameter of 3-10 microns surrounded by a transparent gelatinous capsule up to 50 microns wide. Mycelium does not form. Pathogenic for laboratory animals (white mice, rats). Stable in the external environment.
Cryptococcus is widespread in nature, it is found in the litter of pigeons, sparrows and other birds, while the birds themselves do not get sick. In the dried state, cryptococcus can persist for many months. Cryptococcus was found on the mucous membranes of healthy people as a saprophyte. Human infection occurs through air and dust.
Pathogenesis during Cryptococcosis
The gates of infection in most cases are the upper respiratory tract and lungs, less often there is primary cryptococcosis of the skin, possibly endogenous infection in healthy carriers with a decrease in their immune protection (HIV-infected, etc.). The disease is more common in people 40-60 years old, men suffer more often, often cryptococcosis has developed in patients with lymphogranulomatosis, which is also due to developing immunodeficiency.
Symptoms of Cryptococcosis
The duration of the incubation period has not been established. The most characteristic manifestation of cryptococcosis is meningoencephalitis. It was also described as torus meningitis. The disease is characterized by a gradual, hardly noticeable onset in the form of headache attacks, often in the frontal region, which gradually increase, become unbearable, move to the occipital region. Meningeal signs, ptosis, nystagmus, hemiplegia appear. Consciousness is disturbed, delirium. A characteristic feature of the disease in severe condition, body temperature remains subfebrile. The disease progresses slowly, leading to exhaustion, then a coma, death occurs from respiratory paralysis 4-6 months after the onset of the disease. In 30% of patients, in addition to damage to the central nervous system, lung cryptococcosis develops.
Cryptococcosis of the lungs occurs in the form of pneumonia, which is not only different from pneumonia of a different etiology, the body temperature is often subfebrile, sputum is poor, the process is more often bilateral. In the disseminated form of cryptococcosis, a variety of organs can be affected (liver, kidney, spleen, etc.). Lesions of the skin and mucous membranes occur relatively easily.
In HIV-infected people, cryptococcosis occurs almost exclusively as severe meningitis and meningoencephalitis.
With meningeal form and disseminated cryptococcosis, the prognosis is poor. With the defeat of the skin and mucous membranes favorable. Treatment with amphotericin B improves the prognosis.
Diagnosis of Cryptococcosis
It is clinically necessary to differentiate from tuberculous meningitis, neoplasms and brain abscess. The confirmation is the detection of cryptococcus.
Prevention of Cryptococcosis
Prevention is not developed.