Cryptococcosis

What is cryptococcosis?

Cryptococcosis is an illness caused by infection with Cryptococcus fungi in your brain or lungs. It can also spread to many areas of your body (disseminated cryptococcosis).

When you have a Cryptococcus infection in your brain, it’s called cryptococcal meningitis. It can cause fever, headaches and neck stiffness. In your lungs, it’s sometimes called cryptococcal pneumonia or pulmonary cryptococcosis. It can cause you to cough and feel like you can’t breathe deeply enough or catch your breath.

Different types of Cryptococcus fungi make different people sick. Cryptococcus neoformans usually only causes people with weakened immune systems to get sick. Cryptococcus gattii can make you sick even if you have a healthy immune system.

What are the symptoms of cryptococcosis?

Symptoms of cryptococcosis depend on where the fungus infects you. Lung infections can cause pneumonia-like symptoms, and central nervous system (brain and spinal cord) infections can cause meningitis-like symptoms. Disseminated cryptococcosis causes symptoms in many parts of your body.

Lung symptoms of cryptococcosis (cryptococcal pneumonia)

• Cough.
• Shortness of breath or feeling like you can’t catch your breath.
• Chest pain.
• Fever.

Central nervous system symptoms (cryptococcal meningitis)

• Fever.
• Headache.
• Neck pain or stiffness. You might not be able to touch your chin to your chest.
• Nausea.
• Vomiting.
• Sensitivity to light.

Disseminated cryptococcosis symptoms

If you have disseminated cryptococcosis, you might have lung or central nervous system symptoms as well as skin changes. You might notice:

• Thick or hard patches (plaques).
• Rashes.
• Sores.
• Bumps.
• Blisters.

What causes cryptococcosis?

The fungi Cryptococcus gattii (C. gattii) and Cryptococcus neoformans (C. neoformans) cause cryptococcosis. They live in the environment — in dirt (soil), on trees and in bird poop.

Where is Cryptococcus commonly found?

Both C. gattii and C. neoformans are found in many parts of the world. C. gattii is more commonly found in:

• Australia.
• British Columbia in Canada.
• The Pacific Northwest in the U.S.
• Southeast Asia.

How do you get cryptococcosis?

You get cryptococcosis from breathing in Cryptococcus fungi from the air. You can’t see it, and it’s hard to avoid it if you’re in an area where it’s common.

Most people breathe in the fungus without having symptoms. But in some people, the fungus grows in their lungs or travels through their body to their brain, making them sick. Sometimes you can have the fungus in your lungs for a long time, but it only grows and causes symptoms when something (like an illness or medications) weakens your immune system.

Is it contagious?

No, cryptococcosis isn’t contagious. You can’t get it from another person who’s infected.

Who’s more likely to get cryptococcosis?

C. neoformans is more likely to cause disease in people who have a weakened (compromised) immune system. This includes people who have:

• HIV/AIDS.
• Certain types of cancer, like lymphomas and leukemias.
• Received a stem cell, organ or bone marrow transplant.
• Conditions that require long-term use of high-dose corticosteroids (like certain chronic lung conditions and autoimmune disorders).

C. gattii can make both people with healthy immune systems and people with compromised immune systems sick.

What are the complications of cryptococcosis?

Cryptococcosis can cause serious complications, especially if you have an infection in your brain. Complications include:

• Increased pressure on your brain (intracranial pressure). This is excessive pressure caused by too much fluid that can cause brain damage if left untreated.
• Partial or complete blindness.
• Eye disease or inflammation.
• Weakness in the muscles that control your eyes (extraocular muscle paresis).
• Relapse. Cryptococcosis symptoms sometimes come back after treatment.
• Immune reconstitution inflammatory syndrome (IRIS). IRIS is a condition where your immune system overreacts after treatment and makes your symptoms worse. It’s more common in people with HIV, but sometimes people without HIV have experienced it, too.

How is cryptococcosis diagnosed?

Providers diagnose cryptococcosis by testing your tissues or body fluids for signs of Cryptococcus fungi. They may test your:

• Blood.
• Cerebrospinal fluid (CSF).
• Sputum (mucus coughed up from your lungs).

They’ll also use your symptoms, medical and travel history, and imaging to help diagnose cryptococcosis. Depending on your symptoms, you may get chest X-rays, a CT scan (computed tomography scan) or an MRI (magnetic resonance imaging) to look for changes in your lungs or brain.

How is cryptococcosis treated?

Providers use antifungals to treat cryptococcosis. Your specific treatment depends on where Cryptococcus is in your body and the health of your immune system. For instance, just one antifungal may be enough treatment for people with mild pulmonary cryptococcosis. But people who are severely ill or have cryptococcal meningitis might need more intense treatment, like multiple antifungal medications over a long period of time.

Specific medications and procedures used to treat cryptococcosis

Specific medications and procedures that can treat cryptococcosis include:

• Fluconazole.
• Amphotericin B (AmB).
• Flucytosine.
• Corticosteroids.
• Surgery to remove large masses of fungus (cryptococcomas).
• Therapeutic lumbar puncture or shunts (special tubes) to relieve pressure on your brain.

Can cryptococcosis be prevented?

It can be hard to avoid breathing in Cryptococcus if you’re in an area where it’s common. If you’re at a higher risk for getting sick from Cryptococcus, your provider may recommend:

• Targeted screening. Before beginning HIV treatment, a provider can test you for Cryptococcus antigens (recognizable parts of the fungus), even if you don’t have symptoms of cryptococcosis. If you test positive, they can treat you for cryptococcosis to prevent you from getting sick from the fungus already in your body.
• Prophylaxis. If you’re at high risk for cryptococcosis, your provider can treat you with antifungal medication. This can help prevent you from getting sick if you get exposed to Cryptococcus.

What can I expect if I have cryptococcosis?

Depending on where you’re infected and how severely sick you are, your provider may need to treat you with antifungal medications for weeks or months to get rid of cryptococcosis. If you have HIV, your provider may need to adjust your antiretroviral treatments. If you have another condition that weakens your immune system, treating the underlying condition may help you fight off cryptococcosis.

Can cryptococcosis be cured?

Antifungal treatments usually cure people with healthy immune systems. People with compromised immune systems can be harder to cure. Sometimes, your symptoms can come back after treatment.

What’s the mortality rate for cryptococcosis?

Mortality (death) rates for treated cryptococcosis in North America (including the U.S. and Canada) are estimated at 20%. But in parts of Africa, it’s estimated to be as high as 70%. What area of the world you live in greatly impacts the healthcare that’s available to you. That means people in economically disadvantaged parts of the world often have higher mortality rates for many diseases.

How do I take care of myself?

The best way to take care of yourself is to treat any conditions you have that might weaken your immune system. Keep up with scheduled appointments with your healthcare providers. Ask them about ways to identify signs or symptoms of infection. Talk to them about how to prevent infections and what you should do if you think you have one.

When should I see my healthcare provider?

If you have a condition that weakens your immune system, such as HIV, ask your provider how you can prevent illness. See a provider right away if you have a weakened immune system and you have symptoms of cryptococcosis or any other infection.

When should I go to the ER?

Go to the emergency room if you have symptoms of a severe illness, including:

• High fever (over 103 degrees Fahrenheit/40 degrees Celsius).
• Difficulty breathing.
• Vision changes.
• Chest pain.
• Bluish skin, lips or nails.
• Confusion.
• Seizures.

If you have a weakened immune system, ask your provider what symptoms should prompt you to go to the ER. You may need emergency care right away or with less severe symptoms than what’s listed here.

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• How serious is this infection?
• How do I take my medication?
• For how long do I need to be treated?
• What can I do to prevent an infection in the future?

A note from Cleveland Clinic

Cryptococcosis is a fungal infection that can be serious in people with compromised immune systems. But a provider can test you or give you preventive medications if you’re at a higher risk of getting sick. And thanks to advances in treatment, people living with HIV today have less risk of getting serious illnesses. Working together with your provider, you can make a plan to keep yourself as healthy as possible.