CRYPTOCOCCALINFECTIONS-PerelmanSchoolofMedicineatthe.pptVIP

* * * * * * * * * * * * * CRYPTOCOCCAL INFECTIONS IN PATIENTS WITH AIDS Stephen J. Gluckman, M.D. Botswana-UPENN Partnership Microbiology Encapsulated yeast 4 serotypes A (C. neoformans v grubii) B and C ( C. gatti) D (C. neoformans v neoformans) All types can cause human disease Life cycle Asexual: yeast that reproduce by budding Human infections Sexual: only seen in the laboratory Ecology and Epidemiology World wide C. neoformans associated with bird droppings C. gatti not associated with birds, associated with eucalyptus trees Generally an infection of immunocompromised but can cause clinical disease in healthy persons Decreased Cell-mediated immunity AIDS – CD 4 usually 100 Prolonged corticosteroids Organ transplant Ecology and Epidemiology 15-30% of AIDS patients in Sub-Saharan Africa* Much less common in children No person to person transmission *Powderly, WG Clin Infect Dis 1993 Clinical Presentations Pulmonary Asymptomatic nodule Symptomatic: not distinguishable from other causes History, PE, routine laboratory testing does not produce features peculiarly suggestive of cryptococcal infection Diagnosis Staining of biopsy specimen Culture of sputum and/or blood Serum cryptococcal antigen (CRAG) All patients with pulmonary disease need a CSF examination to r/o sub clinical meningitis Silver Stain Clinical Presentations Cutaneous Disseminated disease Looks similar to molluscum contageosum Diagnosis: Unroofing a lesion and making a smear and culture Serum CRAG All patients with cutaneous disease need a CSF examination to r/o sub clinical meningitis Clinical Presentations Cryptococcal Meningitis Typical Subacute onset of fever and headache Photophobia and/or meningeal signs in only 25% Less typical Seizures Confusion Progressive dementia Visual or hearing impairment FUO Diagnosis CSF Serum CRAG: 99% sensitive in AIDS patients Cryptococcal Meningitis In 2003 there were 193 (+) CSF cultures for cryptococcus from PMH * Leucocytes No leucocytes in 31% Only 1-