Pulmonary cryptococcosis
Updates to Article Attributes
Pulmonary cryptococcosis refers to lung involvement from cryptococcosis, a fungal infection caused by Cryptococcus neoformans (var gattii or var neoformans). Spores are commonly found in soil, especially that containing pigeon and avian droppings1. The respiratory tract is the principal route of entry for infection by inhalation of fungal spores3.
Epidemiology
Cryptococcosis predominantly occurs in immunocompromised patients but can also be seen in the normal host. The spectrum of pulmonary cryptococcosis depends on the host's defenses.
Clinical presentation
The presentation of pulmonary cryptococcosis can range from asymptomatic nodular disease to severe acute respiratory distress syndrome (ARDS) 3.
In the immunocompetent host the pulmonary infections normally are asymptomatic, different from the immunocompromised patient, in which cryptococcal infections often cause symptomatic infections, often disseminate to the central nervous system, skin, and bones1.
- approximately one third of patients are asymptomatic.
- symptoms range from mild cough and low-grade fever to acute presentation with high fever and severe shortness of breath1.
Radiographic features
CT
In general there are several CT patterns that can be seen
- clustered nodular pattern - most prevalent 4
- solitary pulmonary nodular
- scattered nodular
- bronchopneumonic
- single mass - rare
The most common CT findings in immunocompetent patients with pulmonary cryptococcosis are pulmonary nodules. The nodules are most often multiple, smaller than 10 mm in diameter, and well defined with smooth margins. The nodules usually involve less than 10% of the parenchyma and tend to be distributed peripherally in the middle and upper zones. Where there are multiple nodules, they are usually bilateral 2. Associated cavitation may be seen in up to 40% of cases 8.
FDG-PET
PET may play a complimentray role to CT 6 and approximately ~ 60% of patients can show higher FDG uptake than the mediastinal blood pool 4.
-<p><strong>Pulmonary cryptococcosis</strong> refers to lung involvement from <a title="Cryptococcosis" href="/articles/cryptococcosis">cryptococcosis</a>, a fungal infection caused by <em>Cryptococcus neoformans (</em>var <em style="font-size: 12px; color: rgb(102, 102, 102); line-height: 17px;">gattii</em> or var <em style="font-size: 12px; color: rgb(102, 102, 102); line-height: 17px;">neoformans)</em>. Spores are commonly found in soil, especially that containing pigeon and avian droppings<sup>1</sup>. The respiratory tract is the principal route of entry for infection by inhalation of fungal spores<sup>3</sup>.</p><h4>Epidemiology</h4><p>Cryptococcosis predominantly occurs in immunocompromised patients but can also be seen in the normal host. The spectrum of pulmonary cryptococcosis depends on the host's defenses.</p><h4>Clinical presentation</h4><p>The presentation of pulmonary cryptococcosis can range from asymptomatic nodular disease to severe<a title="Adult respiratory distress syndrome" href="/articles/adult-respiratory-distress-syndrome"> acute respiratory distress syndrome</a> (ARDS) <sup>3</sup>.</p><p>In the immunocompetent host the pulmonary infections normally are asymptomatic, different from the immunocompromised patient, in which cryptococcal infections often cause symptomatic infections, often disseminate to the central nervous system, skin, and bones<sup>1</sup>.</p><ul>-<li>approximately one third of patients are asymptomatic. </li>-<li>symptoms range from mild cough and low-grade fever to acute presentation with high fever and severe shortness of breath<sup>1</sup>.</li>- +<p><strong>Pulmonary cryptococcosis</strong> refers to lung involvement from <a href="/articles/cryptococcosis">cryptococcosis</a>, a fungal infection caused by <em>Cryptococcus neoformans (</em>var <em>gattii</em> or var <em>neoformans)</em>. Spores are commonly found in soil, especially that containing pigeon and avian droppings<sup>1</sup>. The respiratory tract is the principal route of entry for infection by inhalation of fungal spores<sup>3</sup>.</p><h4>Epidemiology</h4><p>Cryptococcosis predominantly occurs in immunocompromised patients but can also be seen in the normal host. The spectrum of pulmonary cryptococcosis depends on the host's defenses.</p><h4>Clinical presentation</h4><p>The presentation of pulmonary cryptococcosis can range from asymptomatic nodular disease to severe<a href="/articles/adult-respiratory-distress-syndrome"> acute respiratory distress syndrome</a> (ARDS) <sup>3</sup>.</p><p>In the immunocompetent host the pulmonary infections normally are asymptomatic, different from the immunocompromised patient, in which cryptococcal infections often cause symptomatic infections, often disseminate to the central nervous system, skin, and bones<sup>1</sup>.</p><ul>
- +<li>approximately one third of patients are asymptomatic. </li>
- +<li>symptoms range from mild cough and low-grade fever to acute presentation with high fever and severe shortness of breath<sup>1</sup>.</li>
-</li>-<li>solitary pulmonary nodular </li>-<li>scattered nodular </li>-<li>bronchopneumonic </li>-<li>single mass - rare</li>-</ul><p>The most common CT findings in immunocompetent patients with pulmonary cryptococcosis are <a title="Pulmonary nodules" href="/articles/pulmonary-nodule-1">pulmonary nodules</a>. The nodules are most often multiple, smaller than 10 mm in diameter, and well defined with smooth margins. The nodules usually involve less than 10% of the parenchyma and tend to be distributed peripherally in the middle and upper zones. Where there are multiple nodules, they are usually bilateral <sup>2</sup>. Associated cavitation may be seen in up to 40% of cases <sup>8</sup>.</p><h5>FDG-PET</h5><p>PET may play a complimentray role to CT <sup>6</sup> and approximately ~ 60% of patients can show higher FDG uptake than the mediastinal blood pool <sup>4</sup>. </p>- +</li>
- +<li>solitary pulmonary nodular</li>
- +<li>scattered nodular</li>
- +<li>bronchopneumonic</li>
- +<li>single mass - rare</li>
- +</ul><p>The most common CT findings in immunocompetent patients with pulmonary cryptococcosis are <a href="/articles/pulmonary-nodule-1">pulmonary nodules</a>. The nodules are most often multiple, smaller than 10 mm in diameter, and well defined with smooth margins. The nodules usually involve less than 10% of the parenchyma and tend to be distributed peripherally in the middle and upper zones. Where there are multiple nodules, they are usually bilateral <sup>2</sup>. Associated cavitation may be seen in up to 40% of cases <sup>8</sup>.</p><h5>FDG-PET</h5><p>PET may play a complimentray role to CT <sup>6</sup> and approximately ~ 60% of patients can show higher FDG uptake than the mediastinal blood pool <sup>4</sup>.</p>
Image ( create )
Image 2 CT (lung window) ( update )
Image 4 X-ray (Frontal) ( update )
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