| • | AKA European Blastomycoses |
| • | organism = cryptococcus neoformans |
| • | a yeast-like fungus with world wide distribution |
| • | inhalation of pigeon droppings (though pigeons not infected) |
| • | no animal-human nor human-human transmission |
| • | spreads from lungs to CNS, skin, and bone |
| • | primary cutaneous cryptococcal infection is rare or does not occur |
| • | in immunocompromised host, disseminates to almost all organs with a predilection to CNS |
| • | cutaneous findings in 10 to 15% of disseminated disease (may occur without CNS or pulmonary symptoms) |
cutaneous symptoms:
cryptococcus cellulitis:
| • | classic teaching = only presents as cellulitis when patients are immunocompromised secondary to glucocorticoids |
| • | e.g. lupus patient on prednisone and not responding to antibiotics: cryptococcus |
| • | other immunocompromised patients (e.g. AIDS, cancer) – diffuse or nodular cryptococcus |
| • | may mimic a bacterial cellulitis |
| • | or may appear as a cellulitis, evolve into a vesicular phase, and then become hemorrhagic and ulcerate |
| • | this sequence should suggest cryptococcus when occurring in an immunocompromised patient |
nodular cryptococcus:
| • | dome shaped red papules and nodules that develop slightly depressed centers (molluscum-like umbilicated lesions); progression to ulceration with extrusion of thick pus |
histology:
| • | granulomatous form --> good immunity |
| • | gelatinous form --> immunosuppressed |
latex agglutination test = sensitive and specific method for testing cryptococcus antigen in urine, serum, and CSF
treatment: responds to amphotericin, resistant to micafungin
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