Pulmonary cryptococcosis

Pulmonary cryptococcosis is the consequence of the inhalation of Cryptococcus neoformans, an encapsulated yeast, from various environmental sources. It is commonly accepted that the acquisition of the disease occurs early in life and that the disease is mostly related to a reactivation from a pulmonary site in immunocompromised hosts such as patients infected with human immunodeficiency virus. Clinical and radiological presentations of the disease are nonspecific and are more severe in immunocompromised hosts with acquired immunodeficiency syndrome (AIDS). However, fulminant forms have also been reported in apparently immunocompetent hosts. C. neoformans has rarely been responsible for colonization of the respiratory tract; this usually occurs in immunocompetent hosts with preexisting pulmonary disease. Diagnosis of pneumonia is obtained by either analysis of bronchoalveolar lavage in AIDS patients or by the histology/mycological analysis of a pulmonary nodule. In any case, a careful work-up for diagnosing dissemination should always be performed. Antifungal treatment has to be given in most of the immunocompetent hosts and always in those with any kind of immunodeficiency with isolated pulmonary cryptococcosis.