Cryptococcosis differential diagnosis: Difference between revisions
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{{CMG}} {{AE}} {{SSK}}; {{YD}} | {{CMG}} {{AE}} {{SSK}}; {{YD}} | ||
==Overview== | ==Overview== | ||
[[Cryptococcosis]] is more common among [[Immunocompromised|immunocompromised patients]] who are at high risk for other [[fungal]], [[bacterial]], and [[viral infections]]. Cryptococcal [[meningitis]] can be indistinguishable from [[Bacterial meningitis|bacterial]] or [[viral meningitis]]. Cryptococcosis must be differentiated from diseases that cause symptoms of [[lower respiratory tract infection]] ([[fever]], [[dyspnea]], [[cough]]) and [[meningitis]] ([[fever]], [[headache]], [[neck stiffness]], [[Focal neurologic signs|focal neurological deficits]]) such as [[coccidioidomycosis]], [[histoplasmosis]], [[tuberculosis]], and [[Community-acquired pneumonia|community]]/[[hospital-acquired pneumonia]]. Cutaneous [[cryptococcosis]] in [[HIV AIDS|HIV/AIDS patients]] must be differentiated from [[molluscum contagiosum]] and [[Kaposi's sarcoma]]. | [[Cryptococcosis]] is more common among [[Immunocompromised|immunocompromised patients]] who are at high risk for other [[fungal]], [[bacterial]], and [[viral infections]]. Cryptococcal [[meningitis]] can be indistinguishable from [[Bacterial meningitis|bacterial]] or [[viral meningitis]]. [[Cryptococcosis]] must be differentiated from diseases that cause symptoms of [[lower respiratory tract infection]] ([[fever]], [[dyspnea]], [[cough]]) and [[meningitis]] ([[fever]], [[headache]], [[neck stiffness]], [[Focal neurologic signs|focal neurological deficits]]) such as [[coccidioidomycosis]], [[histoplasmosis]], [[tuberculosis]], and [[Community-acquired pneumonia|community]]/[[hospital-acquired pneumonia]]. [[Cutaneous]] [[cryptococcosis]] in [[HIV AIDS|HIV/AIDS patients]] must be differentiated from [[molluscum contagiosum]] and [[Kaposi's sarcoma]]. | ||
==Differentiating Cryptococcosis from other Diseases== | ==Differentiating Cryptococcosis from other Diseases== | ||
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*Single solitary ring enhacning lesion on CT or MRI | *Single solitary ring enhacning lesion on CT or MRI | ||
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|Disseminated | |[[Disseminated tuberculosis]] | ||
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* Prior history of residence in an endemic area. | * Prior history of residence in an [[Endemic (epidemiology)|endemic]] area. | ||
* Chronic [[cough]], [[weight loss]], [[hemoptysis]] | * Chronic [[cough]], [[weight loss]], [[hemoptysis]] | ||
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* [[PCR]] of [[CSF]] for [[tuberculosis]] | * [[PCR]] of [[CSF]] for [[tuberculosis]] | ||
* Mycobacterial culture of CSF | * Mycobacterial culture of [[CSF]] | ||
* Brain biopsy for [[acid-fast bacilli]] staining | * [[Brain]] biopsy for [[acid-fast bacilli]] staining | ||
* Culture and acid stain positive for [[acid-fast bacilli]] | * Culture and acid stain positive for [[acid-fast bacilli]] | ||
* CXR shows cavitations. | * CXR shows [[Cavitation|cavitations]]. | ||
|- | |- | ||
|[[Aspergillosis]] | |[[Aspergillosis]] | ||
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* Pulmonary lesions in addition to CNS lesions. | * [[Pulmonary]] lesions in addition to [[CNS]] lesions. | ||
* Symptoms may include [[cough]], [[chest pain]], and [[hemoptysis]]. | * Symptoms may include [[cough]], [[chest pain]], and [[hemoptysis]]. | ||
| | | | ||
*CSF fungal culture, galactomannan. | *[[CSF]] fungal culture, [[galactomannan]]. | ||
|- | |- | ||
|[[Cryptococcosis]] | |[[Cryptococcosis]] | ||
| Line 43: | Line 43: | ||
*Symptoms include [[cough]], [[chest pain]], and [[hemoptysis]] | *Symptoms include [[cough]], [[chest pain]], and [[hemoptysis]] | ||
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*[[Cryptococcal antigen]] from [[CSF]] and serum | *[[Cryptococcal infection|Cryptococcal]] [[antigen]] from [[CSF]] and [[serum]] | ||
*CSF fungal culture | *[[CSF]] fungal culture | ||
|- | |- | ||
|[[Chagas disease]] | |[[Chagas disease]] | ||
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*History of residence in Central and South America | *History of residence in Central and South America | ||
*Acute infection is rarely symptomatic | *Acute infection is rarely symptomatic | ||
*[[Encephalitis]] or focal brain lesions | *[[Encephalitis]] or focal [[brain]] lesions | ||
*[[Myocarditis]] | *[[Myocarditis]] | ||
*Chronic infections in [[immunocompromised]] patients develops into [[encephalitis]] with necrotic brain lesions causing mass effect. | *Chronic infections in [[immunocompromised]] patients develops into [[encephalitis]] with [[necrotic]] [[brain]] lesions causing mass effect. | ||
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*Trypanosoma cruzi in blood, tissue or CSF | *[[Trypanosoma cruzi]] in [[blood]], [[Tissue (biology)|tissue]] or [[CSF]]; [[PCR]] of [[Tissue (biology)|tissue]] or [[body fluids]], [[Serological testing|serologic tests]]. | ||
|- | |- | ||
|[[Cytomegalovirus infection|CMV infection]] | |[[Cytomegalovirus infection|CMV infection]] | ||
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*Most common CNS opportunistic infection in AIDS patients | *Most common [[CNS]] [[opportunistic infection]] in [[AIDS]] patients | ||
*Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]] or [[polyradiculitis]]. | *Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]] or [[polyradiculitis]]. | ||
*In disseminated disease, it involves both [[liver]] and [[renal | *In [[disseminated disease]], it involves both [[liver]] and [[renal]] organs. | ||
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*Brain CT/MRI/biopsy: location of lesions are usually near the [[brain stem]] or | *[[Brain]] CT/MRI/biopsy: location of lesions are usually near the [[brain stem]] or periventricular areas. | ||
*[[PCR]] of CSF with detectable virus is diagnostic. | *[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic. | ||
*Brain biopsy with + staining for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed, because of the location of brain lesions. | *[[Brain biopsy]] with + [[staining]] for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed, because of the location of [[brain]] lesions. | ||
|- | |- | ||
|[[HSV|HSV infection]] | |[[HSV|HSV infection]] | ||
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*[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in disseminated disease, which usually affects only [[immunocompromised]] or acute infections | *[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in [[disseminated disease]], which usually affects only [[immunocompromised]] or acute infections | ||
*In pregnant women it may be associated with concurrent genital/oral lesions; can be spread to the neonate during acute infection in the mother, or via viral shedding in the birth canal. | *In [[pregnant]] women it may be associated with concurrent [[genital]]/[[oral]] lesions; can be spread to the [[neonate]] during acute infection in the mother, or via [[viral shedding]] in the [[birth canal]]. | ||
*Neonatal HSV can range from localized skin infections to encephalitis, pneumonitis, and disseminated disease. | *[[Neonatal]] [[Herpes simplex virus|HSV]] can range from localized [[Skin and soft-tissue infections|skin infections]] to [[encephalitis]], [[pneumonitis]], and [[disseminated disease]]. | ||
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*Brain CT/MRI/biopsy: location of lesions is usually the medial [[temporal lobe]] or the orbital surface of the [[frontal lobe]]. | *[[Brain]] CT/MRI/biopsy: location of lesions is usually the [[medial]] [[temporal lobe]] or the [[Orbital cavity|orbital]] surface of the [[frontal lobe]]. | ||
*[[PCR]] of [[CSF]] with detectable virus is diagnostic. | *[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic. | ||
|- | |- | ||
|Varicella Zoster infection | |[[Chickenpox|Varicella Zoster infection]] | ||
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*Multifocal involvement has subacute course, usually only in immunosuppressed, with headache, fever, focal deficits | *Multifocal involvement has subacute course, usually only in [[immunosuppressed]], with [[headache]], [[fever]], focal deficits and [[seizures]]. | ||
*Unifocal involvement is more typically seen in immunocompetent hosts, occurring after contralateral cranial nerve herpes zoster, with mental status changes, TIAs | *Unifocal involvement is more typically seen in [[immunocompetent]] hosts, occurring after [[contralateral]] [[cranial nerve]] [[herpes zoster]], with [[Altered mental status|mental status changes]], [[TIA|TIAs]] and [[stroke]]. | ||
*Disseminated [[varicella zoster virus]] can occur in adults during primary infection, presenting with [[pneumonitis]] and/or [[hepatitis]]. | *[[Disseminated disease|Disseminated]] [[varicella zoster virus]] can occur in adults during primary [[infection]], presenting with [[pneumonitis]] and/or [[hepatitis]]. | ||
*Disease is a [[vasculopathy]], with [[hemorrhage]] and [[stroke]]. | *Disease is a [[Vasculitis|vasculopathy]], with [[hemorrhage]] and [[stroke]]. | ||
| | | | ||
*[[PCR]] of [[CSF]] with detectable virus is diagnostic. | *[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic. | ||
|- | |- | ||
|[[Brain abscess]] | |[[Brain abscess]] | ||
| | | | ||
*Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]]. | *Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]]. | ||
*Signs and symptoms includes [[fever]] and necrotizing brain lesions with mass effect | *Signs and symptoms includes [[fever]] and [[necrotizing]] [[brain]] lesions with mass effect. | ||
| | | | ||
*CSF culture or culture of brain abscess. | *[[CSF]] culture or culture of [[brain abscess]]. | ||
|- | |- | ||
|[[Progressive multifocal leukoencephalopathy]] | |[[Progressive multifocal leukoencephalopathy]] | ||
| | | | ||
*Symptoms are often more insidious in onset and progress over months. Symptoms include progressive weakness, poor coordination, with gradual slowing of mental function. Only seen in the immunosuppressed. Rarely associated with fever or other systemic symptoms. | *Symptoms are often more insidious in onset and progress over months. Symptoms include progressive [[weakness]], poor [[coordination]], with gradual slowing of [[mental]] function. Only seen in the [[immunosuppressed]]. Rarely associated with [[fever]] or other systemic symptoms. | ||
| | | | ||
*PCR of CSF for JC virus. | *[[Polymerase chain reaction|PCR]] of [[CSF]] for [[JC virus]]. | ||
*Biopsy reveals white matter lesions and not well-circumscribed lesions. | *[[Biopsy]] reveals [[white matter]] lesions and not well-circumscribed lesions. | ||
|} | |} | ||
'''Cutaneous Cryptococcosis must be differentiated from the following diseases:''' | '''Cutaneous Cryptococcosis must be differentiated from the following diseases:''' | ||
*'''[[Molluscum contagiosum]]'''<ref name="pmid3001157">{{cite journal| author=Penneys NS, Hicks B| title=Unusual cutaneous lesions associated with acquired immunodeficiency syndrome. | journal=J Am Acad Dermatol | year= 1985 | volume= 13 | issue= 5 Pt 1 | pages= 845-52 | pmid=3001157 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3001157 }} </ref> | *'''[[Molluscum contagiosum]]'''<ref name="pmid3001157">{{cite journal| author=Penneys NS, Hicks B| title=Unusual cutaneous lesions associated with acquired immunodeficiency syndrome. | journal=J Am Acad Dermatol | year= 1985 | volume= 13 | issue= 5 Pt 1 | pages= 845-52 | pmid=3001157 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3001157 }} </ref> | ||
** Is very similar in appearance to disseminated cryptococcosis manifesting on the skin ([[umbilicated lesions]]). | ** Is very similar in appearance to [[Disseminated disease|disseminated]] [[cryptococcosis]] manifesting on the [[skin]] ([[umbilicated lesions]]). | ||
** Patients are usually less sick, as [[Molluscum contagiosum|molluscum]] is restricted to the skin. | ** Patients are usually less sick, as [[Molluscum contagiosum|molluscum]] is restricted to the [[skin]]. | ||
*'''[[Kaposi's Sarcoma]]'''<ref name="pmid2311432">{{cite journal| author=Jones C, Orengo I, Rosen T, Ellner K| title=Cutaneous cryptococcosis simulating Kaposi's sarcoma in the acquired immunodeficiency syndrome. | journal=Cutis | year= 1990 | volume= 45 | issue= 3 | pages= 163-7 | pmid=2311432 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2311432 }} </ref><ref name="pmid1634295">{{cite journal| author=Blauvelt A, Kerdel FA| title=Cutaneous cryptococcosis mimicking Kaposi's sarcoma as the initial manifestation of disseminated disease. | journal=Int J Dermatol | year= 1992 | volume= 31 | issue= 4 | pages= 279-80 | pmid=1634295 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1634295 }} </ref> | *'''[[Kaposi's Sarcoma]]'''<ref name="pmid2311432">{{cite journal| author=Jones C, Orengo I, Rosen T, Ellner K| title=Cutaneous cryptococcosis simulating Kaposi's sarcoma in the acquired immunodeficiency syndrome. | journal=Cutis | year= 1990 | volume= 45 | issue= 3 | pages= 163-7 | pmid=2311432 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2311432 }} </ref><ref name="pmid1634295">{{cite journal| author=Blauvelt A, Kerdel FA| title=Cutaneous cryptococcosis mimicking Kaposi's sarcoma as the initial manifestation of disseminated disease. | journal=Int J Dermatol | year= 1992 | volume= 31 | issue= 4 | pages= 279-80 | pmid=1634295 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1634295 }} </ref> | ||
**Cutaneous cryptococcosis may also present with violaceous [[papules]]. | **[[Cutaneous]] [[cryptococcosis]] may also present with violaceous [[papules]]. | ||
**It can only be differentiated by [[Skin biopsy|biopsy]]. | **It can only be differentiated by [[Skin biopsy|biopsy]]. | ||
*'''[[Blastomycosis]]'''<ref name="pmid1404541">Boyars MC, Zwischenberger JB, Cox Jr CS. Clinical manifestations of pulmonary fungal infections. Journal of thoracic imaging. 1992 Sep 1;7(4):12-22.</ref> | *'''[[Blastomycosis]]'''<ref name="pmid1404541">Boyars MC, Zwischenberger JB, Cox Jr CS. Clinical manifestations of pulmonary fungal infections. Journal of thoracic imaging. 1992 Sep 1;7(4):12-22.</ref> | ||
**CNS involvement is much less common with [[blastomyces]]. | **[[CNS]] involvement is much less common with [[blastomyces]]. | ||
**Cutaneous manifestations may resemble cutaneous cryptococcosis | **[[Cutaneous]] manifestations may resemble [[cutaneous]] [[cryptococcosis]] | ||
**Not ubiquitous, more common is [[endemic]] areas in North America. | **Not ubiquitous, more common is [[endemic]] areas in North America. | ||
===Differentiating cryptococcal meningitis from other causes of meningitis=== | ===Differentiating cryptococcal meningitis from other causes of meningitis=== | ||
Cryptococcal meningitis may be differentiated from other causes of [[meningitis]] by [[cerebrospinal fluid]] examination as shown below:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref> | [[Cryptococcal Meningitis|Cryptococcal meningitis]] may be differentiated from other causes of [[meningitis]] by [[cerebrospinal fluid]] examination as shown below:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref> | ||
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! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}} | ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}} | ||
Revision as of 17:35, 25 July 2017
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Cryptococcosis differential diagnosis On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Serge Korjian M.D.; Yazan Daaboul, M.D.
Overview
Cryptococcosis is more common among immunocompromised patients who are at high risk for other fungal, bacterial, and viral infections. Cryptococcal meningitis can be indistinguishable from bacterial or viral meningitis. Cryptococcosis must be differentiated from diseases that cause symptoms of lower respiratory tract infection (fever, dyspnea, cough) and meningitis (fever, headache, neck stiffness, focal neurological deficits) such as coccidioidomycosis, histoplasmosis, tuberculosis, and community/hospital-acquired pneumonia. Cutaneous cryptococcosis in HIV/AIDS patients must be differentiated from molluscum contagiosum and Kaposi's sarcoma.
Differentiating Cryptococcosis from other Diseases
Cryptococcosis is more common among immunocompromised patients who are at high risk for other fungal, bacterial, and viral infections. It should be differentiated from the following disease:
| Disease | Differentiating signs and symptoms | Differentiating tests |
|---|---|---|
| CNS lymphoma |
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| Disseminated tuberculosis |
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| Aspergillosis |
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| Cryptococcosis |
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| Chagas disease |
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| CMV infection |
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| HSV infection |
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| Varicella Zoster infection |
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| Brain abscess |
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| Progressive multifocal leukoencephalopathy |
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Cutaneous Cryptococcosis must be differentiated from the following diseases:
- Molluscum contagiosum[1]
- Is very similar in appearance to disseminated cryptococcosis manifesting on the skin (umbilicated lesions).
- Patients are usually less sick, as molluscum is restricted to the skin.
- Kaposi's Sarcoma[2][3]
- Cutaneous cryptococcosis may also present with violaceous papules.
- It can only be differentiated by biopsy.
- Blastomycosis[4]
- CNS involvement is much less common with blastomyces.
- Cutaneous manifestations may resemble cutaneous cryptococcosis
- Not ubiquitous, more common is endemic areas in North America.
Differentiating cryptococcal meningitis from other causes of meningitis
Cryptococcal meningitis may be differentiated from other causes of meningitis by cerebrospinal fluid examination as shown below:[5][6][7][8][9]
| Cerebrospinal fluid level | Normal level | Bacterial meningitis[8] | Viral meningitis[8] | Cryptococcal meningitis | Tuberculous meningitis[10] | Malignant meningitis[5] |
|---|---|---|---|---|---|---|
| Cells/ul | < 5 | >300 | 10-1000 | 10-500 | 50-500 | >4 |
| Cells | Lymphocyte:Monocyte 7:3 | Granulocyte > Lymphocyte | Lymphocyte > Granulocyte | Lympho.>Granulocyte | Lymphocytes | Lymphocytes |
| Total protein (mg/dl) | 45-60 | Typically 100-500 | Normal or slightly high | High | Typically 100-200 | >50 |
| Glucose ratio (CSF/plasma)[6] | > 0.5 | < 0.3 | > 0.6 | <0.3 | < 0.5 | <0.5 |
| Lactate (mmols/l)[7] | < 2.1 | > 2.1 | < 2.1 | >3.2 | > 2.1 | >2.1 |
| Others | ICP:6-12 (cm H2O) | CSF gram stain, CSF culture, CSF bacterial antigen | PCR of HSV-DNA, VZV | CSF gram stain, CSF india ink | PCR of TBC-DNA | CSF tumor markers such as alpha fetoproteins, CEA |
References
- ↑ Penneys NS, Hicks B (1985). "Unusual cutaneous lesions associated with acquired immunodeficiency syndrome". J Am Acad Dermatol. 13 (5 Pt 1): 845–52. PMID 3001157.
- ↑ Jones C, Orengo I, Rosen T, Ellner K (1990). "Cutaneous cryptococcosis simulating Kaposi's sarcoma in the acquired immunodeficiency syndrome". Cutis. 45 (3): 163–7. PMID 2311432.
- ↑ Blauvelt A, Kerdel FA (1992). "Cutaneous cryptococcosis mimicking Kaposi's sarcoma as the initial manifestation of disseminated disease". Int J Dermatol. 31 (4): 279–80. PMID 1634295.
- ↑ Boyars MC, Zwischenberger JB, Cox Jr CS. Clinical manifestations of pulmonary fungal infections. Journal of thoracic imaging. 1992 Sep 1;7(4):12-22.
- ↑ 5.0 5.1 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
- ↑ 6.0 6.1 Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
- ↑ 7.0 7.1 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
- ↑ 8.0 8.1 8.2 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
- ↑ Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
- ↑ Caudie C, Tholance Y, Quadrio I, Peysson S (2010). "[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]". Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.