Cryptococcus neoformans

Ashish Chandra Shrestha

Cryptococcosis
Chronic, subacute to acute pulmonary, systemic or meningitic disease.

Initiated

by

the

inhalation

of

basidiospores and/or desiccated yeast cells of Cryptococcus neoformans.

1-Morphology
Spherical/round budding cell 5 10 m
Surrounded by polysaccharide capsule.

2-Antigenic structure
Capsular polysaccharide Solubilised in serum, urine and spinal fluid and detected by ELISA, agglutination. Basis for four types (A,B,C,D)
Serotype A: Cryptococcus neoformans var grubii
Serotpes B and C: Cryptococcus neoformans var gatii Serotype D: Cryptococcus neoformans var neoformans

3-Reservoirs
Ubiquitous saprophyte , found in bird droppings (pigeon, chicken) and soil. Birds are not infected due to high body temperature.

4-Pathogenesis

5-Pathogenesis
Inhalation of yeast cells Primary Pulmonary infection may be asymptomatic or mimic flu like In immunocompromised, yeasts may multiply and disseminate to central nervous system

Other sites include skin, adrenals, bone, eye and prostrate gland.

6-Virulence factors
Capsule: resistance to phagocytosis. Melanin: possesses phenoloxidase that produces melanin. Melanin serves as an antioxidant that protects from phagocytosis. Laccase: catalyses formation of melanin-like pigment. Urease, phospholipase, superoxide dismutase secretions.

C. neoformans affects immunocompromised

hosts predominantly and is the commonest

cause of fungal meningitis; worldwide, 710% of patients with AIDS are affected.

7-Clinical features
1. Pulmonary Cryptococcosis: asymptomatic, cough, low-grade fever and pleuritic pain 2. Central Nervous System: dissemination to the brain and meninges cause meningitis, meningoencephalitis 3. Cutaneous Cryptococcosis: ulcerated lesions or cellulitis

4. Cryptococcosis of Bone: pain, arthritis 5. Ocular Cryptococcosis: papilledema and optic atrophy 6. Others: pyelonephritis or prostatitis, adrenal cortical lesions, endocarditis, hepatitis, sinusitis, and localized oesophageal lesions

MRI scan showing multiple cryptococcomas [white masses] in the brain

Nodular skin lesion caused by C. neoformans.

X-ray showing pulmonary cryptococcal infection [right upper lobe].

8-Laboratory diagnosis
1. Clinical material: Cerebrospinal fluid (CSF), biopsy tissue, sputum, bronchial washings, pus, blood and urine. Microscopy: (a) For exudates and body fluids : India ink to demonstrate encapsulated yeast cells. (b) For tissue sections use PAS digest, GMS Ovoid budding yeast- 3.0-7.0 x 3.3- 7.9 m.

Positive - Distinct, wide gelatinous capsules are present.

8-Laboratory diagnosis
Culture: Colonies (on Saboraud Dextrose agar) creamcoloured smooth, mucoid colonies. Incubated at 25 and 37 deg C for four weeks. Urea hydrolysis

8-Laboratory diagnosis
Immunodiagnosis/Serology: detection of cryptococcal capsular polysaccharide antigen in spinal fluid Latex agglutination. ELISA Molecular: RFLP, PCR.

8-Treatment
Immune competent Fluconazole,Itraconazole Immune Deficient Amphotericin B Flu cytosine AIDS patients are not totally cured , Relapses are frequent with fatal outcome.

 Morphology
Antigenic structure Reservoirs Pathogenesis Virulence factor Clinical features Laboratory diagnosis