1 / 17

Cryptococcosis

Cryptococcosis. Prattana Leenasirimakul Nakornping Hospital Chiang mai, Thailand. Cryptococcosis. Cryptococcus neoformans. Cryptococcosis. Cryptococcosis is a chronic, subacute to acute pulmonary, systemic or meningitis disease

polly
Download Presentation

Cryptococcosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cryptococcosis Prattana Leenasirimakul Nakornping Hospital Chiang mai, Thailand

  2. Cryptococcosis Cryptococcus neoformans.

  3. Cryptococcosis • Cryptococcosis is a chronic, subacute to acute pulmonary, systemic or meningitis disease • Cryptococcus neoformansvar. neoformansand Cryptococcus neoformans var. gattii • encapsulated yeast • The species has 4 serotypes (A,B,C,D) based on capsular polysaccharide antigen • C. neoformans var neoformans serotype A

  4. Cryptococcosis • Epidermiology • distributed worldwide, pigeon feces, eucalyptus trees (var. gattii) • Transmission by inhalation of basidiospore or yeast cells • Cryptococcal infections in hosts who are immunosuppressed, including patients with AIDS

  5. Transmission Inhalation respiratory infection dissiminated

  6. Clinical features - sub acute meningitis - meningoencephalitisCNS cryptococcosis • Most common clinical presentation of cryptococcosis: Cryptococcal meningitis • Prolong evolution of several months • headache, vomiting, neck stiffness, mental status

  7. : 1/3 have evidence of pulmonary involvement - cough , dyspnea - abnormal CXR : Disseminated infection

  8. Cryptococcosis • Pulmonary cryptococcosis • asymptomatic • x-ray Right upper lobe

  9. This is Cryptococcus neoformans infection of the lung. There are numerous organisms that have a large mucoid capsule, giving the appearance of a clear zone around a faint round nucleus.

  10. Cryptococcosis • Cutaneous & mucocutaneous cyptococcosis • Osseous cyrtococcosis : bone • Visceral crytococcosis : heart, kidneys, liver,

  11. Cryptococcus antigen : highly sensitive and specific ( > 1:8 ) : screening test for febrile patient

  12. Laboratory diagnosis capsule capsule India ink test Mucicarmine stain India ink test : detect the extensive capsule

  13. This is an India ink preparation of cerebrospinal fluid in a patient with Cryptococcus neoformans meningitis. Note the clear zone of the capsule around the central nucleus of the organisms.

  14. Examination of CSF : - mildly elevation CSF protein - normal or slightly low glucose - a few lymphocytes. - numerous organism • Latex agglutination test: detect cryptococcal antigen • Patient improves : titer • No respond to therapy ; titer

  15. Laboratory diagnosis • Culture: 370C, 1-2 days • SDA with out cyclohexamide: creamy, white and mucoid • Birdseed agar: brown to black colony • Urease positive SDA - ve/+ve Birdseed agar

  16. Diagnosis and treatment of Cryptococcus meningitis HIV positive patient CD4 lymphocyte count <200,000/ml History suggestive of cryptococcal meningitis( CM ) ( and /or ) Headaches , fever ,with/without mental status changes Positive serum cryptococcal antigen

  17. Lumbar puncture Lumbar puncture No evidence of CM continue diagnostic evaluation No evidence of CM fluconazole 200 mg orally indefinitely Evidence of CMPositive culture for Cryptococcus neoformans, positive India ink stain Amphotericin 8 ( 0.7 mg/kg/day ) iv plus flucytosine (25mg/kg) q6h for 2 week , then fluconzole 400 mg po for 8 weeks, then fluconazole 200mg po for life

More Related