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L2 - Cryptococcus Neoformans
L2 - Cryptococcus Neoformans
College of Medicine
2024
• Title: Cryptococcus neoformans
• Grade: 3
• Module: Infectious diseases
• Speaker: Lec. Dr. Basim M. Ibrahim
• Date: 21.03.2024
•
Objectives:
With the end of this lecture the students will be able to:
1. Define Cryptococcosis and Candidiasis.
2. Demonstrate some important characteristics of Cryptococcus spp.
and Candida spp.
3. State main clinical presentations of the two cases.
4. List laboratory diagnostic steps.
Cryptococcus spp.:
Classified into the Division: Basidiomycota.
Encapsulated yeast (surrounded by a large polysaccharide
capsule both in host and on some culture media).
First case of cryptococcal meningitis was reported in 1905.
Include 37 species, only Cryptococcus neoformans (C. neoformans)
is pathogenic to human.
Classified into 4 serotypes according to capsular lipopolysaccharide
antigens; A, B, C and D.
Capsule importance:
1. Resistance to phagocytosis.
2. Aids in identification.
3. Suppress T-cell function.
Difference between Yeast and Mold
CCC. Yeast Mold
Definition Microscopic fungus, consisting of Growth form of fungus, which grows in the
a single, oval cell form of multicellular filaments called hyphae
Appearance Oval in shape, and is colorless and Fuzzy appearance, and the colors can be
smooth green, orange, black, brown, purple and pink
Center for Food Security and Public Health, Iowa State University, 2012
2. Pulmonary cryptococcosis:
Either asymptomatic (majority) or symptomatic (self-limiting)
infection.
After initial infection, spreading to other organs may occur.
Symptoms include cough, fever, headache, weight loss, dyspnea,
malaise, chest pain and difficulty breathing.
Section of Rt. lung showing apical Distended alveoli filled with
cavity and multiple foci of Cryptococcus spp. (HE stain)
consolidation with a mucoid
appearance
3. Ocular lesions:
Optic neuritis, chorioretinitis and endophthalmitis.
Conjunictival Cryptococcosis
4. Skin lesions:
Formation of granulomatous reaction with giant cells.
Presentations: Papules, vesicles, ulcers, purpura, subcutaneous
tumor-like masses and abscesses.
Lesions can mimic: Acne, Lipomas and Basal cell carcinoma.
Annular, confluent,
erythematous plaques on
posterior Rt. calf 5 months
after onset of primary
cutaneous cryptococcosis
A. Initial presentation of erythematous and indurated skin.
B. Skin biopsy sample showing yeast forms with mucoid capsules.
C. Progressive ulceration of skin despite antifungal therapy.
D. Slow re-epithelization of skin after surgical debridement and 6 months of
antifungal therapy. Center for Food Security and Public Health, Iowa State University, 2012
5. Cellulitis:
Common in organ transplant recipients.
Bird
seed
agar
-ve / +ve
SDA medium
Note:
C. neoformans differs from Candida spp. by hydrolyzing urea and
not forming pseudohyphae.
4. Biochemical examination of CSF in addition
to numerous organisms:
5. Serology:
• Not useful in humans as Abs are often found in healthy people.
• Serological tests involve:
1. Latex agglutination test:
• Detect cryptococcal Ags.
• Sensitive and specific.
• In serum, CSF and broncho-alveolar lavage, false-ve results may
exist.
• Patient improves = ↓ titer ; No respond to therapy = ↑ titer.
2. Indirect fluorescent Ab test:
Identifies organism in culture/tissue section, by staining yeast cell wall.
3. Tube agglutination test.
4. ELISA.
Treatment:
Atrophic
Diffuse erythema affects mainly palate and
tongue and result in soreness, often denture-
induced.
Angular cheilitis
Signs of cracking and inflammation seen at
corners of mouth; painful, burning and
soreness.
Onychomycosis (nail infection):
Characterized by red swelling around nails, destruction of nail tissue
and loss of nail.
Difficult to treat, however, oral antifungal medications work best.
Ocular Candidiasis:
Characterized by cloudy vision and lesions within the eyes.
Caused by spreading of C. albicans via the bloodstream.
Treatment: Amphotericin B.
Other presentations:
1. Genital infections.
2. Bloodstream infections.
3. Cutaneous (skin, scalp and nails).
4. Diaper rash in newborn infants.
5. Deep (Invasive).
6. STD.
7. Sepsis.
Blood, swabs, vaginal discharge, urine, feces, nail
clippings, hair, skin scales, respiratory secretions or
material from cutaneous or muco-cutaneous lesions