Pulmonary cryptococcosis
Updates to Article Attributes
Pulmonary cryptococcosis is a fungal infection caused by Cryptococcus neoformans (var gattii or var and Cneoformans). The respiratory tract is the principal route of entry for infection byvia inhalation of fungal spores. It mostly causes several lung nodules or masses with or without cavitation mostly in immunocompromised patients; besides, consolidation, mediastinal lymphadenopathy, and pleural effusion may also be present. Although it is mainly seen in immunocompromised patients, it is also not uncommon in immunocompetent people, in particular, those who are exposed to pigeon and avian droppings
Epidemiology
Cryptococcosis predominantly occurs in immunocompromised patients but can also be seen in the normal hostimmunocompetent hosts, particularly, those exposed to avian (e.g. pigeon) droppings. 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:
- most often, causes several lung nodules or masses with or without cavitation, chiefly in immunocompromised patients
- additionally, consolidation, mediastinal lymphadenopathy, and pleural effusion may also be present.
In anthe immunocompetent host the pulmonary infections normally are asymptomatic, different fromin contradistinction to the immunocompromised patient, in whichwhom cryptococcal infectionsinfection is most often cause symptomatic infection, often disseminateand commonly disseminates to the central nervous system, skin, and bones 1:.
Overall, approximately one
-thirdthird of patients are asymptomatic-
symptoms.Symptoms
range from a mild cough and low-grade fever to acute presentation with high fever and severe shortness of breath
Serum cryptococcal antigen (sCRAG) islevels are helpful in diagnosis and follow-up.
Pathology
The method of entry is usually by inhalation of cryptococcal particles into the lungs, causing pulmonary infection. Spores are found worldwide in soil in which contaminated by avian droppings.
Radiographic features
CT
In general, there are several CT patterns that can be seen:
- clustered nodular pattern: most prevalent 4
- solitary pulmonary nodule or mass with or without cavitation
- scattered nodules
- peribronchovascular consolidation
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-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. Occasionally, unusual presentation such as large cavities may be seen 13.
Nuclear medicine
FDG PET-CT may play a complementary role to CT 6 and ~60% of patients can show higher FDG uptake than the mediastinal blood pool 4.
Treatment and prognosis
- antifungals such as oral fluconazole or intravenous amphotericin B
-<p><strong>Pulmonary cryptococcosis</strong> is a fungal infection caused by <em>Cryptococcus neoformans </em>(var <em>gattii</em> or var <em>neoformans</em>). The respiratory tract is the principal route of entry for infection by inhalation of fungal spores. It mostly causes several <a title="Lung nodules" href="/articles/pulmonary-nodule-1">lung nodules</a> or masses with or without cavitation mostly in immunocompromised patients; besides, <a title="Lung consolidation" href="/articles/air-space-opacification-1">consolidation</a>, mediastinal <a title="Lymphadenopathy" href="/articles/lymph-node-enlargement">lymphadenopathy</a>, and <a title="Pleural effusion" href="/articles/pleural-effusion">pleural effusion</a> may also be present. Although it is mainly seen in immunocompromised patients, it is also not uncommon in immunocompetent people, in particular, those who are exposed to pigeon and avian droppings.</p><h4>Epidemiology</h4><p><a href="/articles/cryptococcosis">Cryptococcosis</a> 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/acute-respiratory-distress-syndrome-1"> acute respiratory distress syndrome</a> (ARDS) <sup>3</sup>.</p><p>In an immunocompetent host the pulmonary infections normally are asymptomatic, different from the immunocompromised patient, in which cryptococcal infections often cause symptomatic infection, 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 a mild cough and low-grade fever to acute presentation with high fever and severe shortness of breath</li>-</ul><p>Serum cryptococcal antigen (sCRAG) is helpful in diagnosis and follow-up.</p><h4>Pathology</h4><p>The method of entry is usually by inhalation of cryptococcal particles into the lungs causing pulmonary infection. Spores are found worldwide in soil in which contaminated by avian droppings.</p><h4>Radiographic features</h4><h5>CT</h5><p>In general, there are several CT patterns that can be seen:</p><ul>- +<p><strong>Pulmonary cryptococcosis</strong> is a fungal infection caused by <em>Cryptococcus </em><em>gattii</em> and <em>C</em> <em>neoformans</em>. The respiratory tract is the principal route of entry for infection via inhalation of fungal spores.</p><h4>Epidemiology</h4><p><a href="/articles/cryptococcosis">Cryptococcosis</a> predominantly occurs in immunocompromised patients but can also be seen in immunocompetent hosts, particularly, those exposed to avian (e.g. pigeon) droppings. 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/acute-respiratory-distress-syndrome-1"> acute respiratory distress syndrome</a> (ARDS) <sup>3</sup>:</p><ul>
- +<li>most often, causes several <a href="/articles/pulmonary-nodule-1">lung nodules</a> or masses with or without cavitation, chiefly in immunocompromised patients</li>
- +<li>additionally, <a href="/articles/air-space-opacification-1">consolidation</a>, <a href="/articles/mediastinal-lymph-node-enlargement">mediastinal </a><a href="/articles/lymph-node-enlargement">lymphadenopathy</a>, and <a href="/articles/pleural-effusion">pleural effusion</a> may also be present.</li>
- +</ul><p>In the immunocompetent host the pulmonary infections normally are asymptomatic, in contradistinction to the immunocompromised patient, in whom cryptococcal infection is most often symptomatic, and commonly disseminates to the central nervous system, skin, and bones <sup>1</sup>.</p><p>Overall, approximately one third of patients are asymptomatic.</p><p>Symptoms range from a mild cough and low-grade fever to acute presentation with high fever and severe shortness of breath.</p><p>Serum cryptococcal antigen (sCRAG) levels are helpful in diagnosis and follow-up.</p><h4>Pathology</h4><p>The method of entry is usually by inhalation of cryptococcal particles into the lungs, causing pulmonary infection. Spores are found worldwide in soil contaminated by avian droppings.</p><h4>Radiographic features</h4><h5>CT</h5><p>In general, there are several CT patterns that can be seen:</p><ul>
-</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>. Occasionally unusual presentation such as large cavities may be seen <sup>13</sup>.</p><h5>Nuclear medicine</h5><p>FDG PET-CT may play a complementary role to CT <sup>6</sup> and ~60% of patients can show higher FDG uptake than the mediastinal blood pool <sup>4</sup>.</p><h4>Treatment and prognosis</h4><ul><li>antifungals such as oral fluconazole or intravenous amphotericin B</li></ul>- +</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>. Occasionally, unusual presentation such as large cavities may be seen <sup>13</sup>.</p><h5>Nuclear medicine</h5><p>FDG PET-CT may play a complementary role to CT <sup>6</sup> and ~60% of patients show higher FDG uptake than the mediastinal blood pool <sup>4</sup>.</p><h4>Treatment and prognosis</h4><ul><li>antifungals such as oral fluconazole or intravenous amphotericin B</li></ul>
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