Cryptococcal lung disease.
OBJECTIVE
Cryptococcosis is an important opportunistic fungal infection, especially in the immunocompromised patient. Meningitis is the most common manifestation of cryptococcosis; however, cryptococcal lung disease is probably underdiagnosed, and knowledge of epidemiology, diagnosis, and treatment is necessary.


RESULTS
Cryptococcal lung disease ranges from asymptomatic colonization or infection to severe pneumonia with respiratory failure. Clinical presentation of pulmonary cryptococcosis is highly variable and often is related to the immune status of the patient. There have been many important clinical trials outlining treatment of cryptococcal meningitis in patients with AIDS, but there is a lack of treatment data available for patients with cryptococcal lung disease. Treatment recommendations for cryptococcal lung disease are made on the basis of host immune status and severity of clinical illness. For less severe disease, fluconazole therapy is recommended. In immunocompromised patients, or those with severe disease, induction therapy with an amphotericin B preparation and flucytosine, followed by fluconazole as consolidation and maintenance therapy, is recommended.


CONCLUSIONS
Cryptococcal lung disease is an important and probably underdiagnosed infection. Knowledge of the epidemiology, diagnostic methodologies, and treatment is needed to ensure good patient outcomes.
Shirley
Rhett M
RM
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA.
Baddley
John W
JW
D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D015995:Prevalence
D000935:Antifungal Agents; D015725:Fluconazole