Cryptococcosis is a subacute or chronic granulomatous infectious disease, primarily affecting the central nervous system, but it can also involve the lungs, skin, bones, and other internal organs or tissues. The fungus is commonly found in soil, on the surfaces of plants and animals, and on the skin and feces of healthy individuals. It is generally believed that the fungus can invade the human body through the respiratory tract or skin wounds and spread via the bloodstream.

bubble_chart Clinical Manifestations

1. The clinical manifestations of central nervous system cryptococcosis are similar to those of subcutaneous nodular meningitis. If the cryptococcal granuloma is confined to a specific area of the brain or spinal cord, it may resemble a brain tumor or brain abscess. The onset is slow, initially presenting as grade I paroxysmal headaches, often recurrent and accompanied by nausea, vomiting, or vertigo, with fever ranging from mild to severe. Over weeks to months, symptoms of increased intracranial pressure, meningeal irritation, and various ocular signs appear. Within 3–6 months, the condition tends to worsen, leading to hemiplegia, aphasia, ataxia, mental disturbances, and even seizures and unconsciousness, ultimately resulting in death due to respiratory failure. Occasionally, cases may persist with recurrent episodes for over 2 years without recovery.
2. Pulmonary cryptococcosis often occurs concurrently with central nervous system cryptococcosis. Symptoms include low-grade fever, cough, chest pain, etc. Some patients may be asymptomatic and only detected during X-ray examinations.

1. Cerebrospinal fluid: Increased pressure, slightly turbid appearance, white blood cell count 50–500×10⁶/L (predominantly lymphocytes), with cryptococci often mixed in. Protein levels are significantly elevated, while glucose and chloride levels are reduced. India ink staining may reveal round or oval cryptococci with thick capsules. Culture on Sabouraud agar produces milky-white, mucoid, shiny colonies.
2. Pulmonary cryptococcosis: Cryptococci may be identified in sputum samples.
3. X-ray examination: In pulmonary cryptococcosis, infiltrative shadows or single/multiple nodular shadows may be observed in the lungs.
4. Latex agglutination test: Can detect cryptococcal capsular polysaccharide antigens. Approximately 95% or more of patients with this condition may test positive in cerebrospinal fluid or serum.

bubble_chart Treatment Measures

Treatment of

(1) Amphotericin B Systemic administration is the same as for "candidiasis," but intrathecal injection must be added. Initially, use 0.011 mg each time, dissolved in 2–3 ml of cerebrospinal fluid or diluted with sterile water for injection and slowly injected. Gradually increase to 0.1–0.5 mg, with a total course of 20–30 times. Intrathecal injection can be alternated with intravenous injection to reduce toxicity and drug reactions. (2) Diamidine Administer at 5 mg/(kg·d) by intravenous drip in 10% glucose solution over 2–4 hours, with a treatment course of 1 month. Drug reactions are milder than with amphotericin B, but liver and kidney function must be monitored regularly during treatment. (3) 5-Fluorocytosine Often used clinically in combination with amphotericin B. The dose is 50–100 mg/(kg·d), divided into 4 doses, with a treatment course of 3–8 weeks. It may also cause gastrointestinal reactions, and occasionally rash, drug fever, leukopenia, or elevated transaminases. (4) Garlicin The dose and usage are the same as for "candidiasis."