29th July 2023

Pulmonary cryptococcosis

Lung disease can be seen in both immunocompetent and immunosuppressed people but is more likely to cause serious disease in the latter.

The lungs are the initial site of any Cryptococcus infection, as the yeast enters the body through inhalation. Infection presents as a pneumonia-like illness, with cough, dyspnoea, chest pain, and fever the predominant symptoms. In patients with an intact immune system, this may be asymptomatic. Though the disease can become dormant, and for individuals carrying Cryptococcus, there is a risk of reactivation if they undergo an immunosuppressive insult.

Diagnosis can be made through chest x-ray or CT scan to demonstrate pneumonia, and then cultures confirming the presence of Cryptococcus, using the Indian ink stain. Serum assays include the ELISA technique. Blood cultures are used to assess for the presence of disseminated disease.

First line treatment is with fluconazole for an extended treatment course of 6-12 months. Severe or untreated pulmonary cryptococcosis can cause ARDS, which may be life-threatening.