Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

426 Croup Cryptococcus Neoformans

Corticosteroids

Dexamethasone

Nebulized budesonide

Nebulized epinephrine requires caution and close cardiac monitoring.

follow-up

With primary care within 24 hours for moderate to severe cases

complications and prognosis

■Hypoxemia

■Cardiorespiratory failure rarely requires mechanical ventilation.

■Reactive airway disease later in life

Cryptococcus Neoformans.............................

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Worldwide distribution

■High concentration in pigeon feces; soil or decayed wood chips also

implicated

■Disease thought to occur after organism aerosolized and inhaled

■Exposure is common: many healthy subjects have positive skin tests

■New cases were rare before emergence of AIDS

■Immunologic defects in T-cell-mediated host defense are at

increased risk for progressive disease

■AIDS predisposing factor in 80–90% of cryptococcal infections, usu-

ally with CD4 count <100/mm^3

■Transplantation next most common risk factor, peak period 4–6 wks

or more post-tx

■Incidence increased in lymphoreticular malignancies (Hodgkin’s

disease) and sarcoidosis (even without steroids)

■2 varieties: var. neoformans true opportunistic pathogen; var.

gatti also causes disease in non-immunocompromised hosts, more

refractory to treatment

Signs & Symptoms

■Central Nervous System:

➣85% of cryptococcal infections involve brain or meninges

➣Acute or insidious (acute more common in AIDS/immuno-

suppressed)