Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Cryptococcosis differential diagnosis
Introduction
Overview
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
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 diseases which all may cause neurological dysfuntion in an immunocompromised patient:
| Disease | Differentiating signs and symptoms | Differentiating tests |
|---|---|---|
| CNS lymphoma[1] |
|
|
| Disseminated tuberculosis[2] |
|
|
| Aspergillosis[3] |
|
|
| Cryptococcosis |
|
|
| Chagas disease[4] |
|
|
| CMV infection[5] |
|
|
| HSV infection[6] |
|
|
| Varicella Zoster infection[7] |
|
|
| Brain abscess[8][9] |
|
|
| Progressive multifocal leukoencephalopathy[10] |
|
Cutaneous Cryptococcosis must be differentiated from the following diseases:
- Molluscum contagiosum[11]
- 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[12][13]
- Cutaneous cryptococcosis may also present with violaceous papules.
- It can only be differentiated by biopsy.
- Blastomycosis[14]
- CNS involvement is much less common with blastomyces.
- Cutaneous manifestations may resemble cutaneous cryptococcosis.
- Not ubiquitous, more common in 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:[15][16][17][18][19]
| Cerebrospinal fluid level | Normal level | Bacterial meningitis[18] | Viral meningitis[18] | Cryptococcal meningitis | Tuberculous meningitis[20] | Malignant meningitis[15] |
|---|---|---|---|---|---|---|
| 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)[16] | > 0.5 | < 0.3 | > 0.6 | <0.3 | < 0.5 | <0.5 |
| Lactate (mmols/l)[17] | < 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
References
- ↑ Gerstner ER, Batchelor TT (2010). “Primary central nervous system lymphoma”. Arch. Neurol. 67 (3): 291–7. doi:10.1001/archneurol.2010.3. PMID 20212226.
- ↑ von Reyn CF, Kimambo S, Mtei L, Arbeit RD, Maro I, Bakari M, Matee M, Lahey T, Adams LV, Black W, Mackenzie T, Lyimo J, Tvaroha S, Waddell R, Kreiswirth B, Horsburgh CR, Pallangyo K (2011). “Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality”. Int. J. Tuberc. Lung Dis. 15 (8): 1087–92. doi:10.5588/ijtld.10.0517. PMID 21740673.
- ↑ Latgé JP (1999). “Aspergillus fumigatus and aspergillosis”. Clin. Microbiol. Rev. 12 (2): 310–50. PMC 88920. PMID 10194462.
- ↑ Rassi A, Rassi A, Marin-Neto JA (2010). “Chagas disease”. Lancet. 375 (9723): 1388–402. doi:10.1016/S0140-6736(10)60061-X. PMID 20399979.
- ↑ Emery VC (2001). “Investigation of CMV disease in immunocompromised patients”. J. Clin. Pathol. 54 (2): 84–8. PMC 1731357. PMID 11215290.
- ↑ Bustamante CI, Wade JC (1991). “Herpes simplex virus infection in the immunocompromised cancer patient”. J. Clin. Oncol. 9 (10): 1903–15. doi:10.1200/JCO.1991.9.10.1903. PMID 1919640.
- ↑ Hambleton S (2005). “Chickenpox”. Curr. Opin. Infect. Dis. 18 (3): 235–40. PMID 15864101.
- ↑ Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR (2013). “Brain abscess: Current management”. J Neurosci Rural Pract. 4 (Suppl 1): S67–81. doi:10.4103/0976-3147.116472. PMC 3808066. PMID 24174804.
- ↑ Patel K, Clifford DB (2014). “Bacterial brain abscess”. Neurohospitalist. 4 (4): 196–204. doi:10.1177/1941874414540684. PMC 4212419. PMID 25360205.
- ↑ Tan CS, Koralnik IJ (2010). “Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis”. Lancet Neurol. 9 (4): 425–37. doi:10.1016/S1474-4422(10)70040-5. PMC 2880524. PMID 20298966.
- ↑ 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.
- ↑ 15.0 15.1 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.
- ↑ 16.0 16.1 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.
- ↑ 17.0 17.1 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.
- ↑ 18.0 18.1 18.2 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.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Serge Korjian M.D.; Yazan Daaboul, M.D.