Pulmonary cryptococcus (case series, Regional VIC, Australia)

Cryptococcus is a fungal pathogen, epidemiologically dominant in tropical and subtropical areas of Australia. With this clinical case report, we aim to acknowledge the incidence of pathogen in Victoria and solidify clinicians to in considering as a differential diagnosis with its different nature of presentations.

We identified five cases of pulmonary cryptococcus over a period of 10 months at Monash Medical Centre, Clayton, Victoria. Cases were retrospectively reviewed from onset of presentations through diagnosis and management. Identities and personal information of patients remained anonymous. Consents were obtained via electronic medical documentation.

In this case study, only one patient was immunosuppressed while others were immunocompetent. Number of cryptococcus gatti and neoformans was equally distributed in immunocompetent patients, while immunosuppressed patient had C.neoformans. Four out of five patients had respiratory symptoms and remaining patient (immunocompetent) had neurological complication despite absence of respiratory symptoms. As of radiological features, cavitating lesion was observed in immunosuppressed patient, while in immunocompetent ones, two had nodular feature, one had cavitating and other had endobronchial soft tissue density. Three patients achieved diagnosis confirmation by bronchial washings + BAL while two achieved by biopsy.