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Cryptococcus neoformans:


Keywords (immunodeficiency): HIV, antiretroviral therapy, oropharyngeal thrush, hepatosplenomegaly, central umbilication, central necrosis, hemorrhagic crust.
*Cryptococcus neoformans is an encapsulated yeast
*Occurs in patients with advanced HIV (CD4<100/mm3)
*The most common manifestation is meningoencephalitis
*Pulmonary and/or disseminated disease may occur
*Cutaneous cryptococcosis considered as a marker of disseminated disease
*Rapid onset (2 weeks) of multiple widespread papular lesions with central umbilication
*Diagnostic clue is the presence of a small area of central hemorrhage or necrosis
*Resembles molluscum contagiosum
*Most common areas affected are head and neck
*Disseminated infections can affect liver, lymph nodes, peritoneum, adrenal gland, and eyes
*Diagnosis
**Biopsy of the lesion
**Histopathological examination after staining (periodic acid-Schiff, Gomori methenamine silver nitrate)
**Hyperplasia of the overlying dermis with underlying granulomas surrounding encapsulated yeasts
**Fungal blood culture is often positive in severe disseminated cryptococcal disease but a biopsy is more sensitive and specific than blood culture (because untreated HIV patients have multiple ongoing opportunistic infections)
**Serum antigen testing can be useful for the diagnosis
**The most common wrong answer is skin scrapings with a microscopic evaluation which is used for the diagnosis of fungal infections as tinea or candidiasis.
*Treatment:
**>/= 2 weeks of IV amphotericin B plus oral flucytosine
**Followed by a year of oral fluconazole (higher dose for 8 weeks, then maintenance)
DD:
*Kaposi Sarcoma:
**Primarily presents in homosexual men(men with HIV who are sexually active with other men)
**Red or purple papules with no necrosis
*Disseminated Mycobacterium avium complex:
**Common opportunistic infection
**Affects patients with advanced AIDS
**Presents as fever, night sweats, abdominal pain, diarrhea, weight loss
**Cutaneous lesions are uncommon and are usually nodular and ulcerating
*Pyoderma gangrenosum:
**Rare neutrophilic dermatitis
**Associated with inflammatory bowel disease and inflammatory arthritides
**Presents as a tender papule that degrades into a bluish, violaceous ulcer
*Basal cell carcinoma
**Single, pink, flesh-colored papules
**Arise slowly

Latest revision as of 16:27, 15 October 2019