Division of Foodborne, Bacterial and Mycotic Diseases (DFBMD)
Clinical Features
Initial pulmonary infection with Cryptococcus neoformans may be asymptomatic. Most patients present with disseminated infection, especially meningoencephalitis. In the United States, most cases occur in HIV-infected persons.
Etiologic Agent
Cryptococcus neoformans, Cryptococcus gattii; rarely Cryptococcus laurentii, Cryptococcus albidus
Resovoir
C. neoformans has been isolated from the soil worldwide, usually in association with bird droppings. Less common etiologic agent, C. gattii, has been isolated from eucalyptus trees in tropical and sub-tropical regions, and also from areas in the Pacific Northwest.
Incidence
For C. neoformans infections, 0.4-1.3 cases per 100,000 in the general population. Among persons with AIDS, the annual incidence is 2-7 cases per 1,000.
Sequelae
Meningitis may lead to permanent neurologic damage. Mortality rate is about 12%.
Transmission
Inhalation of airborne yeast cells and/or basidiospores.
Risk Groups
Immunocompromised persons, especially those with HIV infection. C. gattii infection tends to occur in immunocompetent persons.
Surveillance
Active, population-based surveillance in selected U.S. and international sites. No national surveillance exists.
Challenges
Determining burden of disease in developing countries. Developing a cost-effective prevention strategy (although fluconazole is effective chemoprophylaxis for persons with AIDS, it does not affect survival and is not considered cost-effective).