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Systemic Review of Published Reports on Primary Cutaneous Cryptococcosis in Immunocompetent Patients
1Department of Dermatology and Mycology Center, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
Abstract:
Primary cutaneous cryptococcosis (PCC) has been confirmed as a distinct clinical entity with secondary cutaneous cryptococcosis from systematic infection since 2003. Although it has been confirmed as a distinct clinical entity, little has progressed on PCC in immunocompetent hosts compared to their immunocompromised counterpart. We reviewed the literature on cases of PCC in immunocompetent patients from 2004 to 2014, and 21 cases from 16 reports were identified. Males are more likely to develop PCC infections, with a ratio of 17:4 male to female. These patients were found to be almost all senior population except for patients from Asia. Asymptomatic or moderate itching manifesting in a painful nodule is the most common presentation, although there is no typical clinical manifestation recorded. Upper limbs are the most common site of infection, accounting for 71.4 % of all patients. Of the 12 identified isolates, 6 strains are identified as C. neoformans, 5 as C. gattii, and 1 as C.laurentii. Fluconazole was used in 10 cases; however, only 80 % of the 10 cases could confirm that fluconazole was effective in clearing the infections. Interestingly although not approved as a treatment option, Itraconazole was effective in the seven cases it was used to treat cryptococcosis, with a dosage range of 100-400 mg/d and duration from 3 to 6 months. Even though the prognosis of these patients was generally good, more data are need to determine which antifungal azole is the better treatment option and whether primary skin infections could disseminate to systematic infection.
Insights
Primary cutaneous cryptococcosis (PCC) in immunocompetent individuals is often seen in older males, presenting as skin nodules. Itraconazole showed effectiveness, but more data is needed on optimal antifungal azole treatment for PCC.
Area of Science:
- Dermatology
- Mycology
- Infectious Diseases
Background:
- Primary cutaneous cryptococcosis (PCC) is a distinct clinical entity since 2003.
- Limited research exists on PCC in immunocompetent hosts compared to immunocompromised individuals.
- This review focuses on PCC cases in immunocompetent patients.
Purpose of the Study:
- To review and analyze cases of primary cutaneous cryptococcosis in immunocompetent patients.
- To identify demographic, clinical, and microbiological characteristics of PCC in this population.
- To evaluate treatment outcomes and identify potential therapeutic options.
Main Methods:
- Literature search for PCC cases in immunocompetent patients from 2004 to 2014.
- Inclusion of 21 cases from 16 published reports.
- Analysis of patient demographics, clinical presentation, causative fungal species, and treatment regimens.
Main Results:
- The majority of patients were older males (17:4 ratio).
- Upper limbs were the most common infection site (71.4%).
- Common presentations included asymptomatic to painful nodules; Cryptococcus neoformans and Cryptococcus gattii were identified isolates. Fluconazole was effective in 80% of cases, while itraconazole demonstrated efficacy in all seven treated cases.
Conclusions:
- Primary cutaneous cryptococcosis in immunocompetent hosts predominantly affects older males and often involves the upper limbs.
- While fluconazole shows some efficacy, itraconazole appears effective for treating PCC in immunocompetent individuals.
- Further research is required to establish optimal antifungal azole therapy and understand the potential for dissemination from primary skin infections.
