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Semin Respir Crit Care Med 2008; 29(2): 141-150
DOI: 10.1055/s-2008-1063853
© Thieme Medical Publishers

Pulmonary Cryptococcosis

Joseph N. Jarvis1 , Thomas S. Harrison1
  • 1Centre for Infection, Department of Cellular and Molecular Medicine, St. George's University of London, London, United Kingdom
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Publication History

Publication Date:
26 March 2008 (online)

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ABSTRACT

Cryptococcosis is a common opportunistic infection in acquired immunodeficiency syndrome (AIDS) patients, also occurring in other immunosuppressed patients and occasionally those with no apparent immunocompromise. The majority of cases are caused by the ubiquitous encapsulated yeast, Cryptococcus neoformans, whereas Cryptococcus gattii accounts for a smaller proportion of cases, often in immunocompetent patients. Severe meningoencephalitis is the commonest presentation; however, pulmonary cryptococcosis in human immunodeficiency virus (HIV)-seropositive individuals is underdiagnosed and without appropriate treatment leads to severe disseminated disease. The natural history of pulmonary cryptococcal infection in other immunosuppressed patients is also of dissemination and progression in the majority of cases, whereas immunocompetent patients may present with more localized, self-limiting disease. The presentation is usually with nonspecific respiratory symptoms, although severe respiratory failure has been reported in both immunocompromised and immunocompetent patients. Radiological presentations are varied and nonspecific, influenced by the underlying immune status of the patient. Diagnosis is based on isolation of Cryptococcus from, or detection of cryptococcal antigen in, a pulmonary specimen, coupled with appropriate clinical, radiological, and histopathological findings. Antifungal treatment with amphotericin B + / - flucytosine is recommended for severe disease, whereas fluconazole is the treatment of choice for mild and localized infections.

KEYWORDS

Cryptococcus - cryptococcosis - pulmonary - pneumonia - HIV - epidemiology - clinical presentation - therapy

REFERENCES

  • 1 Jarvis J N, Harrison T S. HIV-associated cryptococcal meningitis.  AIDS. 2007;  21 , In press
    PubMedGoogle Scholar
  • 2 Aberg J A, Mundy L M, Powderly W G. Pulmonary cryptococcosis in patients without HIV infection.  Chest. 1999;  115 734-740
    CrossrefPubMedGoogle Scholar
  • 3 Chang W C, Tzao C, Hsu H H et al.. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients.  Chest. 2006;  129 333-340
    CrossrefPubMedGoogle Scholar
  • 4 Duperval R, Hermans P E, Brewer N S, Roberts G D. Cryptococcosis, with emphasis on the significance of isolation of Cryptococcus neoformans from the respiratory tract.  Chest. 1977;  72 13-19
    PubMedGoogle Scholar
  • 5 Hage C A, Wood K L, Winer-Muram H T, Wilson S J, Sarosi G, Knox K S. Pulmonary cryptococcosis after initiation of anti-tumor necrosis factor-alpha therapy.  Chest. 2003;  124 2395-2397
    CrossrefPubMedGoogle Scholar
  • 6 Kerkering T M, Duma R J, Shadomy S. The evolution of pulmonary cryptococcosis: clinical implications from a study of 41 patients with and without compromising host factors.  Ann Intern Med. 1981;  94 611-616
    PubMedGoogle Scholar
  • 7 Lui G, Lee N, Ip M et al.. Cryptococcosis in apparently immunocompetent patients.  QJM. 2006;  99 143-151
    CrossrefPubMedGoogle Scholar
  • 8 Pappas P G, Perfect J R, Cloud G A et al.. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy.  Clin Infect Dis. 2001;  33 690-699
    CrossrefPubMedGoogle Scholar
  • 9 Rozenbaum R, Goncalves A J. Clinical epidemiological study of 171 cases of cryptococcosis.  Clin Infect Dis. 1994;  18 369-380
    CrossrefPubMedGoogle Scholar
  • 10 Vilchez R A, Irish W, Lacomis J, Costello P, Fung J, Kusne S. The clinical epidemiology of pulmonary cryptococcosis in non-AIDS patients at a tertiary care medical center.  Medicine (Baltimore). 2001;  80 308-312
    CrossrefPubMedGoogle Scholar
  • 11 Nadrous H F, Antonios V S, Terrell C L, Ryu J H. Pulmonary cryptococcosis in nonimmunocompromised patients.  Chest. 2003;  124 2143-2147
    CrossrefPubMedGoogle Scholar
  • 12 Okongo M, Morgan D, Mayanja B, Ross A, Whitworth J. Causes of death in a rural, population-based human immunodeficiency virus type 1 (HIV-1) natural history cohort in Uganda.  Int J Epidemiol. 1998;  27 698-702
    CrossrefPubMedGoogle Scholar
  • 13 French N, Gray K, Watera C et al.. Cryptococcal infection in a cohort of HIV-1-infected Ugandan adults.  AIDS. 2002;  16 1031-1038
    CrossrefPubMedGoogle Scholar
  • 14 Corbett E L, Churchyard G J, Charalambos S et al.. Morbidity and mortality in South African gold miners: impact of untreated disease due to human immunodeficiency virus.  Clin Infect Dis. 2002;  34 1251-1258
    CrossrefPubMedGoogle Scholar
  • 15 Wasser L, Talavera W. Pulmonary cryptococcosis in AIDS.  Chest. 1987;  92 692-695
    PubMedGoogle Scholar
  • 16 Chayakulkeeree M, Perfect J R. Cryptococcosis.  Infect Dis Clin North Am. 2006;  20 507-544 v-vi
    CrossrefPubMedGoogle Scholar
  • 17 Speed B, Dunt D. Clinical and host differences between infections with the two varieties of Cryptococcus neoformans .  Clin Infect Dis. 1995;  21 28-34 discussion 35-26
    PubMedGoogle Scholar
  • 18 Krumholz R A. Pulmonary cryptococcosis: a case due to Cryptococcus albidus .  Am Rev Respir Dis. 1972;  105 421-424
    PubMedGoogle Scholar
  • 19 Burnik C, Altintas N D, Ozkaya G et al.. Acute respiratory distress syndrome due to Cryptococcus albidus pneumonia: case report and review of the literature.  Med Mycol. 2007;  45 469-473
    CrossrefPubMedGoogle Scholar
  • 20 Lynch III J P, Schaberg D R, Kissner D G, Kauffman C A. Cryptococcus laurentii lung abscess.  Am Rev Respir Dis. 1981;  123 135-138
    PubMedGoogle Scholar
  • 21 Casadevall A, Steenbergen J N, Nosanchuk J D. “Ready made” virulence and “dual use” virulence factors in pathogenic environmental fungi: the Cryptococcus neoformans paradigm.  Curr Opin Microbiol. 2003;  6 332-337
    CrossrefPubMedGoogle Scholar
  • 22 Lazera M S, Salmito Cavalcanti M A, Londero A T, Trilles L, Nishikawa M M, Wanke B. Possible primary ecological niche of Cryptococcus neoformans .  Med Mycol. 2000;  38 379-383
    CrossrefPubMedGoogle Scholar
  • 23 Randhawa H S, Kowshik T, Preeti Sinha K et al.. Distribution of Cryptococcus gattii and Cryptococcus neoformans in decayed trunk wood of Syzygium cumini trees in north-western India.  Med Mycol. 2006;  44 623-630
    CrossrefPubMedGoogle Scholar
  • 24 Kwon-Chung K J, Bennett J E. Epidemiologic differences between the two varieties of Cryptococcus neoformans .  Am J Epidemiol. 1984;  120 123-130
    PubMedGoogle Scholar
  • 25 Chen S, Sorrell T, Nimmo G et al.. Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Australasian Cryptococcal Study Group.  Clin Infect Dis. 2000;  31 499-508
    CrossrefPubMedGoogle Scholar
  • 26 Chen S C, Currie B J, Campbell H M et al.. Cryptococcus neoformans var. gattii infection in northern Australia: existence of an environmental source other than known host eucalypts.  Trans R Soc Trop Med Hyg. 1997;  91 547-550
    CrossrefPubMedGoogle Scholar
  • 27 Jenney A, Pandithage K, Fisher D A, Currie B J. Cryptococcus infection in tropical Australia.  J Clin Microbiol. 2004;  42 3865-3868
    CrossrefPubMedGoogle Scholar
  • 28 Ellis D H, Pfeiffer T J. Natural habitat of Cryptococcus neoformans var. gattii .  J Clin Microbiol. 1990;  28 1642-1644
    PubMedGoogle Scholar
  • 29 Pfeiffer T J, Ellis D H. Environmental isolation of Cryptococcus neoformans var. gattii from Eucalyptus tereticornis .  J Med Vet Mycol. 1992;  30 407-408
    CrossrefPubMedGoogle Scholar
  • 30 Lindberg J, Hagen F, Laursen A, Stenderup J, Boekhout T. Cryptococcus gattii risk for tourists visiting Vancouver Island, Canada.  Emerg Infect Dis. 2007;  13 178-179
    CrossrefPubMedGoogle Scholar
  • 31 Galanis E, MacDougall L, Li M, Kidd S, Lee M, Morshed M. Clinical and epidemiological aspects of locally acquired Cryptococcus gattii human infections, an emerging fungal pathogen in British Colombia, Canada. 17th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) Munich; Abstract O170 April 2007
    Google Scholar
  • 32 Goldman D L, Khine H, Abadi J et al.. Serologic evidence for Cryptococcus neoformans infection in early childhood.  Pediatrics. 2001;  107 E66-71
    CrossrefPubMedGoogle Scholar
  • 33 Wickes B L, Mayorga M E, Edman U, Edman J C. Dimorphism and haploid fruiting in Cryptococcus neoformans: association with the alpha-mating type.  Proc Natl Acad Sci U S A. 1996;  93 7327-7331
    CrossrefPubMedGoogle Scholar
  • 34 Hung J J, Ou L S, Lee W I, Huang J L. Central nervous system infections in patients with systemic lupus erythematosus.  J Rheumatol. 2005;  32 40-43
    PubMedGoogle Scholar
  • 35 Ross J J, Katz J D. Cryptococcal meningitis and sarcoidosis.  Scand J Infect Dis. 2002;  34 937-939
    CrossrefPubMedGoogle Scholar
  • 36 Chen G H, McDonald R A, Wells J C, Huffnagle G B, Lukacs N W, Toews G B. The gamma interferon receptor is required for the protective pulmonary inflammatory response to Cryptococcus neoformans .  Infect Immun. 2005;  73 1788-1796
    CrossrefPubMedGoogle Scholar
  • 37 Herring A C, Lee J, McDonald R A, Toews G B, Huffnagle G B. Induction of interleukin-12 and gamma interferon requires tumor necrosis factor alpha for protective T1-cell-mediated immunity to pulmonary Cryptococcus neoformans infection.  Infect Immun. 2002;  70 2959-2964
    CrossrefPubMedGoogle Scholar
  • 38 Goldman D L, Lee S C, Mednick A J, Montella L, Casadevall A. Persistent Cryptococcus neoformans pulmonary infection in the rat is associated with intracellular parasitism, decreased inducible nitric oxide synthase expression, and altered antibody responsiveness to cryptococcal polysaccharide.  Infect Immun. 2000;  68 832-838
    CrossrefPubMedGoogle Scholar
  • 39 Salyer W R, Salyer D C, Baker R D. Primary complex of Cryptococcus and pulmonary lymph nodes.  J Infect Dis. 1974;  130 74-77
    PubMedGoogle Scholar
  • 40 Baker R D. The primary pulmonary lymph node complex of cryptococcosis.  Am J Clin Pathol. 1976;  65 83-92
    PubMedGoogle Scholar
  • 41 Garcia-Hermoso D, Janbon G, Dromer F. Epidemiological evidence for dormant Cryptococcus neoformans infection.  J Clin Microbiol. 1999;  37 3204-3209
    PubMedGoogle Scholar
  • 42 Fessel W J. Cryptococcal meningitis after unusual exposures to birds.  N Engl J Med. 1993;  328 1354-1355
    CrossrefPubMedGoogle Scholar
  • 43 MacDougall L, Fyfe M. Emergence of Cryptococcus gattii in a novel environment provides clues to its incubation period.  J Clin Microbiol. 2006;  44 1851-1852
    CrossrefPubMedGoogle Scholar
  • 44 Feigin D S. Pulmonary cryptococcosis: radiologic-pathologic correlates of its three forms.  AJR Am J Roentgenol. 1983;  141 1262-1272
    PubMedGoogle Scholar
  • 45 Zinck S E, Leung A N, Frost M, Berry G J, Muller N L. Pulmonary cryptococcosis: CT and pathologic findings.  J Comput Assist Tomogr. 2002;  26 330-334
    CrossrefPubMedGoogle Scholar
  • 46 Chechani V, Kamholz S L. Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS.  Chest. 1990;  98 1060-1066
    CrossrefPubMedGoogle Scholar
  • 47 Chuck S L, Sande M A. Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome.  N Engl J Med. 1989;  321 794-799
    CrossrefPubMedGoogle Scholar
  • 48 Cameron M L, Bartlett J A, Gallis H A, Waskin H A. Manifestations of pulmonary cryptococcosis in patients with acquired immunodeficiency syndrome.  Rev Infect Dis. 1991;  13 64-67
    PubMedGoogle Scholar
  • 49 Meyohas M C, Roux P, Bollens D et al.. Pulmonary cryptococcosis: localized and disseminated infections in 27 patients with AIDS.  Clin Infect Dis. 1995;  21 628-633
    CrossrefPubMedGoogle Scholar
  • 50 Eng R H, Bishburg E, Smith S M, Kapila R. Cryptococcal infections in patients with acquired immune deficiency syndrome.  Am J Med. 1986;  81 19-23
    PubMedGoogle Scholar
  • 51 Zuger A, Louie E, Holzman R S, Simberkoff M S, Rahal J J. Cryptococcal disease in patients with the acquired immunodeficiency syndrome: diagnostic features and outcome of treatment.  Ann Intern Med. 1986;  104 234-240
    PubMedGoogle Scholar
  • 52 Dismukes W E. Cryptococcal meningitis in patients with AIDS.  J Infect Dis. 1988;  157 624-628
    CrossrefPubMedGoogle Scholar
  • 53 Clark R A, Greer D, Atkinson W, Valainis G T, Hyslop N. Spectrum of Cryptococcus neoformans infection in 68 patients infected with human immunodeficiency virus.  Rev Infect Dis. 1990;  12 768-777
    CrossrefPubMedGoogle Scholar
  • 54 Kovacs J A, Kovacs A A, Polis M et al.. Cryptococcosis in the acquired immunodeficiency syndrome.  Ann Intern Med. 1985;  103 533-538
    PubMedGoogle Scholar
  • 55 Driver J A, Saunders C A, Heinze-Lacey B, Sugar A M. Cryptococcal pneumonia in AIDS: is cryptococcal meningitis preceded by clinically recognizable pneumonia?.  J Acquir Immune Defic Syndr Hum Retrovirol. 1995;  9 168-171
    PubMedGoogle Scholar
  • 56 Murray J F. Pulmonary complications of HIV-1 infection among adults living in sub-Saharan Africa.  Int J Tuberc Lung Dis. 2005;  9 826-835
    PubMedGoogle Scholar
  • 57 Murray J, Sonnenberg P, Shearer S C, Godfrey-Faussett P. Human immunodeficiency virus and the outcome of treatment for new and recurrent pulmonary tuberculosis in African patients.  Am J Respir Crit Care Med. 1999;  159 733-740
    CrossrefPubMedGoogle Scholar
  • 58 Batungwanayo J, Taelman H, Bogaerts J et al.. Pulmonary cryptococcosis associated with HIV-1 infection in Rwanda: a retrospective study of 37 cases.  AIDS. 1994;  8 1271-1276
    PubMedGoogle Scholar
  • 59 Bernicker E H, Atmar R L, Schaffner D L, Greenberg S B. Unanticipated diagnoses found at autopsy in an urban public teaching hospital.  Am J Med Sci. 1996;  311 215-220
    PubMedGoogle Scholar
  • 60 Lucas S B, Hounnou A, Peacock C et al.. The mortality and pathology of HIV infection in a west African city.  AIDS. 1993;  7 1569-1579
    PubMedGoogle Scholar
  • 61 Lanjewar D N, Duggal R. Pulmonary pathology in patients with AIDS: an autopsy study from Mumbai.  HIV Med. 2001;  2 266-271
    CrossrefPubMedGoogle Scholar
  • 62 Wong M L, Back P, Candy G, Nelson G, Murray J. Cryptococcal pneumonia in African miners at autopsy.  Int J Tuberc Lung Dis. 2007;  11 528-533
    PubMedGoogle Scholar
  • 63 Grant A D, Djomand G, Smets P et al.. Profound immunosuppression across the spectrum of opportunistic disease among hospitalized HIV-infected adults in Abidjan, Cote d'Ivoire.  AIDS. 1997;  11 1357-1364
    CrossrefPubMedGoogle Scholar
  • 64 Grant A D, Sidibe K, Domoua K et al.. Spectrum of disease among HIV-infected adults hospitalised in a respiratory medicine unit in Abidjan, Cote d'Ivoire.  Int J Tuberc Lung Dis. 1998;  2 926-934
    PubMedGoogle Scholar
  • 65 Hajjeh R A, Conn L A, Stephens D S et al.. Cryptococcosis: population-based multistate active surveillance and risk factors in human immunodeficiency virus-infected persons. Cryptococcal Active Surveillance Group.  J Infect Dis. 1999;  179 449-454
    CrossrefPubMedGoogle Scholar
  • 66 Chen K Y, Ko S C, Hsueh P R, Luh K T, Yang P C. Pulmonary fungal infection: emphasis on microbiological spectra, patient outcome, and prognostic factors.  Chest. 2001;  120 177-184
    CrossrefPubMedGoogle Scholar
  • 67 Yang C J, Hwang J J, Wang T H et al.. Clinical and radiographic presentations of pulmonary cryptococcosis in immunocompetent patients.  Scand J Infect Dis. 2006;  38 788-793
    CrossrefPubMedGoogle Scholar
  • 68 Dromer F, Mathoulin S, Dupont B, Laporte A. Epidemiology of cryptococcosis in France: a 9-year survey (1985-1993). French Cryptococcosis Study Group.  Clin Infect Dis. 1996;  23 82-90
    CrossrefPubMedGoogle Scholar
  • 69 Brouwer A E, Siddiqui A A, Kester M I et al.. Immune dysfunction in HIV-seronegative, Cryptococcus gattii meningitis.  J Infect. 2007;  54 e165-e168
    CrossrefPubMedGoogle Scholar
  • 70 Lee K H, Chang U I, Kim H W et al.. Acute respiratory failure associated with cryptococcal pneumonia and disseminated cryptococcosis in an AIDS patient.  Korean J Intern Med. 2006;  21 39-42
    CrossrefPubMedGoogle Scholar
  • 71 Miller Jr W T, Edelman J M, Miller W T. Cryptococcal pulmonary infection in patients with AIDS: radiographic appearance.  Radiology. 1990;  175 725-728
    PubMedGoogle Scholar
  • 72 Clark R A, Greer D L, Valainis G T, Hyslop N E. Cryptococcus neoformans pulmonary infection in HIV-1-infected patients.  J Acquir Immune Defic Syndr. 1990;  3 480-484
    PubMedGoogle Scholar
  • 73 Visnegarwala F, Graviss E A, Lacke C E et al.. Acute respiratory failure associated with cryptococcosis in patients with AIDS: analysis of predictive factors.  Clin Infect Dis. 1998;  27 1231-1237
    CrossrefPubMedGoogle Scholar
  • 74 Wu T T, Wang H C, Yang P C, Kuo S H, Luh K T. Pulmonary cryptococcosis: manifestations in the era of acquired immunodeficiency syndrome.  J Formos Med Assoc. 1999;  98 621-626
    PubMedGoogle Scholar
  • 75 Gal A A, Koss M N, Hawkins J, Evans S, Einstein H. The pathology of pulmonary cryptococcal infections in the acquired immunodeficiency syndrome.  Arch Pathol Lab Med. 1986;  110 502-507
    PubMedGoogle Scholar
  • 76 Malabonga V M, Basti J, Kamholz S L. Utility of bronchoscopic sampling techniques for cryptococcal disease in AIDS.  Chest. 1991;  99 370-372
    CrossrefPubMedGoogle Scholar
  • 77 Similowski T, Datry A, Jais P, Katlama C, Rosenheim M, Gentilini M. AIDS-associated cryptococcosis causing adult respiratory distress syndrome.  Respir Med. 1989;  83 513-515
    CrossrefPubMedGoogle Scholar
  • 78 Murray R J, Becker P, Furth P, Criner G J. Recovery from cryptococcemia and the adult respiratory distress syndrome in the acquired immunodeficiency syndrome.  Chest. 1988;  93 1304-1306
    CrossrefPubMedGoogle Scholar
  • 79 Perla E N, Maayan S, Miller S N, Ramaswamy G, Eisenberg H. Disseminated cryptococcosis presenting as the adult respiratory distress syndrome.  N Y State J Med. 1985;  85 704-706
    PubMedGoogle Scholar
  • 80 Loerinc A M, Bottone E J, Finkel L J, Teirstein A S. Primary cryptococcal pneumonia mimicking Pneumocystis carinii pneumonia in a patient with AIDS.  Mt Sinai J Med. 1988;  55 181-186
    PubMedGoogle Scholar
  • 81 Shelburne III S A, Darcourt J, White Jr A C et al.. The role of immune reconstitution inflammatory syndrome in AIDS-related Cryptococcus neoformans disease in the era of highly active antiretroviral therapy.  Clin Infect Dis. 2005;  40 1049-1052
    CrossrefPubMedGoogle Scholar
  • 82 Lortholary O, Fontanet A, Memain N, Martin A, Sitbon K, Dromer F. Incidence and risk factors of immune reconstitution inflammatory syndrome complicating HIV-associated cryptococcosis in France.  AIDS. 2005;  19(10) 1043-1049
    CrossrefPubMedGoogle Scholar
  • 83 Trevenzoli M, Cattelan A M, Rea F et al.. Mediastinitis due to cryptococcal infection: a new clinical entity in the HAART era.  J Infect. 2002;  45 173-179
    CrossrefPubMedGoogle Scholar
  • 84 Jenny-Avital E R, Abadi M. Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy.  Clin Infect Dis. 2002;  35 e128-e133
    CrossrefPubMedGoogle Scholar
  • 85 Vilchez R A, Linden P, Lacomis J, Costello P, Fung J, Kusne S. Acute respiratory failure associated with pulmonary cryptococcosis in non-AIDS patients.  Chest. 2001;  119 1865-1869
    CrossrefPubMedGoogle Scholar
  • 86 Hammerman K J, Powell K E, Christianson C S et al.. Pulmonary cryptococcosis: clinical forms and treatment. A Center for Disease Control cooperative mycoses study.  Am Rev Respir Dis. 1973;  108 1116-1123
    PubMedGoogle Scholar
  • 87 Mitsuoka S, Kanazawa H. Images in thorax: an unique case of primary pulmonary cryptococcosis with extensive chest wall invasion.  Thorax. 2005;  60 86
    CrossrefPubMedGoogle Scholar
  • 88 Robinson II G R. Images in clinical medicine: severe cryptococcal pneumonia.  N Engl J Med. 1995;  332 1752
    CrossrefPubMedGoogle Scholar
  • 89 Emmons III W W, Luchsinger S, Miller L. Progressive pulmonary cryptococcosis in a patient who is immunocompetent.  South Med J. 1995;  88 657-660
    CrossrefPubMedGoogle Scholar
  • 90 Zhu L P, Shi Y Z, Weng X H, Muller F M. Case reports: pulmonary cryptococcosis associated with cryptococcal meningitis in non-AIDS patients.  Mycoses. 2002;  45 111-117
    CrossrefPubMedGoogle Scholar
  • 91 Reichman N, Elias M, Raz R, Flatau E. Cryptococcal meningitis following cryptococcal pneumonia in an immunocompetent.  Harefuah. 1999;  137 291-292, 350
    PubMedGoogle Scholar
  • 92 Lindell R M, Hartman T E, Nadrous H F, Ryu J H. Pulmonary cryptococcosis: CT findings in immunocompetent patients.  Radiology. 2005;  236 326-331
    CrossrefPubMedGoogle Scholar
  • 93 Khoury M B, Godwin J D, Ravin C E, Gallis H A, Halvorsen R A, Putman C E. Thoracic cryptococcosis: immunologic competence and radiologic appearance.  AJR Am J Roentgenol. 1984;  142 893-896
    CrossrefPubMedGoogle Scholar
  • 94 Gordonson J, Birnbaum W, Jacobson G, Sargent E N. Pulmonary cryptococcosis.  Radiology. 1974;  112 557-561
    PubMedGoogle Scholar
  • 95 Cheong W Y, Thomas A, Tan K P. Pulmonary cryptococcosis.  Singapore Med J. 1988;  29 223-231
    PubMedGoogle Scholar
  • 96 Patz Jr E F, Goodman P C. Pulmonary cryptococcosis.  J Thorac Imaging. 1992;  7 51-55
    PubMedGoogle Scholar
  • 97 Murayama S, Sakai S, Soeda H et al.. Pulmonary cryptococcosis in immunocompetent patients: HRCT characteristics.  Clin Imaging. 2004;  28 191-195
    CrossrefPubMedGoogle Scholar
  • 98 Roebuck D J, Fisher D A, Currie B J. Cryptococcosis in HIV negative patients: findings on chest radiography.  Thorax. 1998;  53 554-557
    CrossrefPubMedGoogle Scholar
  • 99 Lacomis J M, Costello P, Vilchez R, Kusne S. The radiology of pulmonary cryptococcosis in a tertiary medical center.  J Thorac Imaging. 2001;  16 139-148
    CrossrefPubMedGoogle Scholar
  • 100 Friedman E P, Miller R F, Severn A, Williams I G, Shaw P J. Cryptococcal pneumonia in patients with the acquired immunodeficiency syndrome.  Clin Radiol. 1995;  50 756-760
    CrossrefPubMedGoogle Scholar
  • 101 Sider L, Westcott M A. Pulmonary manifestations of cryptococcosis in patients with AIDS: CT features.  J Thorac Imaging. 1994;  9 78-84
    CrossrefPubMedGoogle Scholar
  • 102 Wallace J M, Hannah J B. Pulmonary disease at autopsy in patients with the acquired immunodeficiency syndrome.  West J Med. 1988;  149 167-171
    PubMedGoogle Scholar
  • 103 Baughman R P, Rhodes J C, Dohn M N, Henderson H, Frame P T. Detection of cryptococcal antigen in bronchoalveolar lavage fluid: a prospective study of diagnostic utility.  Am Rev Respir Dis. 1992;  145 1226-1229
    PubMedGoogle Scholar
  • 104 Saag M S, Graybill R J, Larsen R A et al.. Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America.  Clin Infect Dis. 2000;  30 710-718
    CrossrefPubMedGoogle Scholar
  • 105 Feldmesser M, Harris C, Reichberg S, Khan S, Casadevall A. Serum cryptococcal antigen in patients with AIDS.  Clin Infect Dis. 1996;  23 827-830
    PubMedGoogle Scholar
  • 106 Aberg J A. Pulmonary cryptococcosis in normal hosts: treat or observe?.  Chest. 2003;  124 2049-2051
    CrossrefPubMedGoogle Scholar
  • 107 Sarosi G A. Cryptococcal lung disease in patients without HIV infection.  Chest. 1999;  115 610-611
    CrossrefPubMedGoogle Scholar
  • 108 Meyohas M C, Meynard J L, Bollens D et al.. Treatment of non-meningeal cryptococcosis in patients with AIDS. Centre d'Informations et de Soins de l'Immunodeficience Humaine de l'Est Parisien.  J Infect. 1996;  33 7-10
    CrossrefPubMedGoogle Scholar
  • 109 Dromer F, Mathoulin S, Dupont B, Brugiere O, Letenneur L. Comparison of the efficacy of amphotericin B and fluconazole in the treatment of cryptococcosis in human immunodeficiency virus-negative patients: retrospective analysis of 83 cases. French Cryptococcosis Study Group.  Clin Infect Dis. 1996;  22(Suppl 2) S154-S160
    CrossrefPubMedGoogle Scholar
  • 110 Aberg J A, Price R W, Heeren D M, Bredt B. A pilot study of the discontinuation of antifungal therapy for disseminated cryptococcal disease in patients with acquired immunodeficiency syndrome, following immunologic response to antiretroviral therapy.  J Infect Dis. 2002;  185 1179-1182
    CrossrefPubMedGoogle Scholar
  • 111 Vibhagool A, Sungkanuparph S, Mootsikapun P et al.. Discontinuation of secondary prophylaxis for cryptococcal meningitis in human immunodeficiency virus-infected patients treated with highly active antiretroviral therapy: a prospective, multicenter, randomized study.  Clin Infect Dis. 2003;  36 1329-1331
    CrossrefPubMedGoogle Scholar
  • 112 Mussini C, Pezzotti P, Miro J M et al.. Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study.  Clin Infect Dis. 2004;  38 565-571
    CrossrefPubMedGoogle Scholar
  • 113 Larsen R A, Bozzette S A, Jones B E et al.. Fluconazole combined with flucytosine for treatment of cryptococcal meningitis in patients with AIDS.  Clin Infect Dis. 1994;  19 741-745
    PubMedGoogle Scholar
  • 114 Denning D W, Tucker R M, Hanson L H, Hamilton J R, Stevens D A. Itraconazole therapy for cryptococcal meningitis and cryptococcosis.  Arch Intern Med. 1989;  149 2301-2308
    CrossrefPubMedGoogle Scholar
  • 115 Perfect J R, Marr K A, Walsh T J et al.. Voriconazole treatment for less-common, emerging, or refractory fungal infections.  Clin Infect Dis. 2003;  36 1122-1131
    CrossrefPubMedGoogle Scholar
  • 116 Pitisuttithum P, Negroni R, Graybill J R et al.. Activity of posaconazole in the treatment of central nervous system fungal infections.  J Antimicrob Chemother. 2005;  56 745-755
    CrossrefPubMedGoogle Scholar
  • 117 Nunez M, Peacock Jr J E, Chin Jr R. Pulmonary cryptococcosis in the immunocompetent host: therapy with oral fluconazole: a report of four cases and a review of the literature.  Chest. 2000;  118 527-534
    CrossrefPubMedGoogle Scholar

Thomas S HarrisonM.D. 

Centre for Infection, Department of Cellular and Molecular Medicine

St. George's University of London, Cranmer Ter., London SW17 0RE, UK

Email: tharriso@sgul.ac.uk

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