Cryptococcosis

Cryptococcus Infections
New strain of Cryptococcus Gattii fungus found in Oregon.

Cryptococcosis is a fungal infection usually caused by one of two main species of Cryptococcus fungi: Cryptococcus neoformans and Cryptococcus gattii.

Both humans and animals are susceptible to infections from these fungi, which can occur in perfectly healthy individuals as well as immunodeficient persons.

Before the Pacific Northwest cryptococcosis outbreaks in 2005, C. neoformans was the main species affecting humans, but a new strain of a different species emerged in the U.S., C. gattii, which turned out to be untreatable and fatal. After six Oregonians died from the airborne fungus by 2010, a healthy, native Florida man was found with the same infection in 2011.

As the fungus is native to Australia and parts of South America, scientists wondered how it made its way to and throughout North America, though the first out-of-place discovery of C. gattii (an older strain) was in British Columbia, Canada in 1999. The new strain was found to be much more deadly than the strain discovered in Canada, taking a fatal course in 25 percent of all reported human cases. Cryptococcus neoformans can also lead to severe symptoms and spread quickly, especially in those with weak immune systems. In sub-Saharan Africa, cryptococcal meningitis is a major cause of death for those who have HIV/AIDS.

Both species of fungus are airborne, and make their way through the body via the respiratory system from soil and natural environments. Cryptococcus gattii typically dwells near specific kind of trees or soil surrounding trees, while Cryptococcus neoformans spores are usually found in bird (mostly piegon) droppings, or soil where birds have left their mark. Upon breathing in the dried fungal spores, symptoms may appear gradually. The rapidly spreading fungi can cause unsightly physical damage, painful symptoms, and lead to swelling of the meninges and the brain.

Cryptococcosis Symptoms

Several symptoms overlap between the two main sources of cryptococcosis. They each can lead to respiratory and central nervous system problems, with changes in mental status and a potential risk of meningoencephalitis. Not all symptoms are alike between the two fungal infections, however.

 

C. Neoformans Cryptococcosis Symptoms

Those infected with C. neoformans may experience symptoms similar to pneumonia, including shortness of breath, fever, and cough. It can also lead to chest pain and weight loss in the acute stages. The fungus can cross the blood-brain barrier and result in an infection of the central nervous system, leading to meningoencephalitis. If the illness has advanced to this stage, it may cause headache, fever, alteration in mental status, and lethargy.

People who have very weak immune systems are at risk of the infection spreading to the eyes, bones, joints, and skin. In these persons, the infection can cause blurred vision, skin rash, sweating, swollen glands, bone tenderness, and nausea. Once the infection becomes meningitis, it can cause lifelong brain damage and possibly death. Additionally, people who have healthy immune systems may not experience any symptoms at all.

 

C. Gattii Cryptococcosis Symptoms

While it is a newer strain, the symptoms and effects of infection from C. gatti fungus are obvious. The majority of people with an acute infection feel fatigued, have a fever, headache, cough, and are short of breath. Like the other species, it can infect the brain and meninges, causing them to swell. If you experience serious mental changes, the infection may have spread into the brain. C gattii can also multiply and spread to the skin, lungs, and other organs if disseminated through the blood.

Symptoms appear to start slowly over time, ranging from 2 to 14 months following the time of initial infection. Depending on how the infection develops, it may lead to neurological damage and death.


Cryptococcosis Treatment

Regardless of the cryptococcus strain causing your infection, the treatment is the same. Six months or more taking a prescription antifungal medication will help lessen symptoms and rid your body of the infection. Less severe infections are usually treated with fluconazole or itraconazole. If the infection has progressed to the central nervous system, more medications are prescribed, such as amphotericin B, usually paired with flucytosine.

Certain infections do not require any treatment, though. If the illness goes away on its own, the infected person should still receive regular check ups to ensure it has not spread. Medications may need to be taken over a long period of time, especially depending on the patient. Those who have normal immune systems usually have six to ten weeks of treatment with amphotericin B alone, or two weeks when combined with flucytosine.

 

How Your Health Plan Can Help

From proper diagnosis to ten weeks of medication, having medical insurance is the best way to ensure quick recovery from cryptococcosis. In order to determine whether you have the disease or not, you should tell your doctor if you have been in the Pacific Northwest, tropical areas, or logging sites. To further investigate, the provider may also perform numerous tests, which can include exams and/or cultures of tissue, blood, mucus, and/or cerebrospinal fluid. Another test, the cryptococcal antigen test, may also be performed on the blood and/or cerebrospinal fluid. Having coverage for the litany of tests that may ensue is practical if you don’t intend to find yourself in debt with this illness.

Unfortunately for those with C. gattii infections, most lab tests cannot distinguish the species from C. neoformans, which may require special testing at a state health department or federal facility. The same medications will still be prescribed and likely help you beat the infection, however. As soon as you think you may have symptoms or be at risk for cryptococcosis, see a doctor. Your health plan will connect you with an array of nearby physicians and specialists, who can help you get the care you need – and for a much lower fee than going without coverage. If you have yet to get a health plan, or are about to run out, browse available plans near you.

 

 

References

 

1. March 2013. Centers for Disease Control and Prevention. Emerging Infectious Disease Journal. Cryptococcus gattii, Florida, USA, 2011.

2.2 May 2010. Christine Dell’Amore. National Geographic News. New, Deadly Cryptococcus Gattii Fungus Found in U.S.

3. Centers for Disease Control and Prevention. C. gattii cryptococcosis.

4. Centers for Disease Control and Prevention. C. neoformans cryptococcosis.

5. Charles Patrick Davis, MD, PhD. EMedicineHealth.com. Cryptococcosis Diagnosis.

 

Images: io9.com, CDC.

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