====== Cryptococcosis ======
Cryptococcosis is a [[fungal infection]] caused by Cryptococcus spp. that enters the body via inhalation, which mainly invades the [[lung]]s and [[central nervous system]]. 

It is particularly important in the era of the [[HIV]]/[[AIDS]] epidemy. The encapsulated yeast-like fungus was first isolated from fruit juice by San Felice in 1894 and was shown to be present in natural sources such as milk. Various types of soil contaminated with pigeon excretia provide an environmental source of this widely prevalent organism 
((Kuroki M, Phichaichumpon C, Yasuoka A, Chiranairadul P, Chosa T, Sirinirund P,
Miyazaki T, Kakeya H, Higashiyama Y, Miyazaki Y, Ishida Y, Kohno S. Environmental
isolation of Cryptococcus neoformans from an endemic region of HIV-associated
cryptococcosis in Thailand. Yeast. 2004 Jul 30;21(10):809-12. PubMed PMID:
15300677.
)).

Infection occurs through inhalation of a small diameter (<10 μm) yeast-like organism, which enters the respiratory passage but then remains dormant depending on the host reaction
((Neilson JB, Fromtling RA, Bulmer GS. Cryptococcus neoformans: size range of
infectious particles from aerosolized soil. Infect Immun. 1977 Sep;17(3):634-8.
PubMed PMID: 332630; PubMed Central PMCID: PMC421174.
)).

The mode of spread to the CNS is through haematogeneous dissemination from the lungs. Subsequently, the fungus spreads to the CSF to cause meningitis, encephalitis and ependymitis; it is this leptomeningeal spread that is responsible for the clinical manifestations, rather than choroid plexitis alone, which is often asymptomatic
((Kovoor JM, Mahadevan A, Narayan JP, Govindappa SS, Satishchandra P, Taly AV,
Shankar SK. Cryptococcal choroid plexitis as a mass lesion: MR imaging and
histopathologic correlation. AJNR Am J Neuroradiol. 2002 Feb;23(2):273-6. PubMed 
PMID: 11847053.
)).

The CNS is the preferred site for crpytococcal infection, as the soluble anticryptococcal factors present in serum are absent from CSF. In addition, the inflammatory response evoked is minimal, as the polysaccharide capsule of the fungus hinders phagocytosis and impairs leukocyte migration
((Igel HJ, Bolande RP. Humoral defense mechanisms in cryptococcosis: substances 
in normal human serum, saliva, and cerebrospinal fluid affecting the growth of
Cryptococcus neoformans. J Infect Dis. 1966 Feb;116(1):75-83. PubMed PMID:
5908853.
)).

see [[Cryptococcus gattii]].

see also [[Cryptococcal choroid plexitis]].


===== Diagnosis =====

[[Cryptococcosis Diagnosis]].

====Treatment====
The choice of antifungal treatment depends on the site of infection and the immune status of the patient; options include polyene-[[amphotericin B]] (Amp B), azoles (fluconazole, itraconazole) and flucytocine. Serially preformed lumbar punctures may serve to reduce headache in a patient with raised intracranial pressure. The surgical option is reserved for patients with hydrocephalus and [[intracranial hypertension]]
((Subramanian S, Mathai D. Clinical manifestations and management of cryptococcal infection. J Postgrad Med 2005;51:521–6)).