Question:

I've recently taken a turn for the worse (headaches, fever, nausea) and am wondering if I may be developing a low-level crypto infection. I live in an apartment with a conure in a dirty birdcage (I stay away from it) AND very near to Golden Gate Park which is populated with many eucalyptus trees. I understand these are both the primary vectors for spreading this disease and wondered what the symptoms, diagnosis and treatment might be?

Thank You.

[To clarify, these diseases are opportunistic infections affecting people with HIV/AIDS.]

Answer provided by:

Daniel Lee, M. D.
Assistant Clinical Professor of Medicine
UCSD Medical Center
Owen Clinic

Cryptococcus neoformans is a fungal infection which can be seen in HIV-infected patients. We usually see cryptococcus infections in patients whose CD4 counts are below 200, but we can see infections in people whose counts are higher (~300). There are 2 varieties of Cryptococcus neoformans: Subtypes A, D, and A/D (known as Cryptococcus neoformans variety neoformans) and subtypes B, C (known as Cryptococcus neoformans variety gattii). C. neoformans var. neoformans is found throughout the world in association with excreta from certain birds including pigeons, canaries, and cockatoos. C. neoformans var. gattii is found primarily in tropical and subtropical regions and has been associated with several species of eucalyptus trees. The most common infections found with cryptococcus is meningitis or pneumonia. Cryptococcal meningitis can lead to fevers, headaches, neck stiffness, photophobia (light bothers your eyes), sometimes nausea and vomiting. Diagnosis of cryptococcal meningitis is made by a spinal tap or lumbar puncture looking for the presence of cryptococcus in the cerebrospinal fluid (by India Ink stain, cryptococcal antigen, or fungal culture). Often times, patients with cryptococcal meningitis likely have it in their blood first. Thus, a serum cryptococcal antigen may be helpful. If the serum (blood) test for cryptococcal antigen is negative, it is unlikely that you would have cryptococcus in the cerebrospinal fluid. If you are concerned, you should talk to your doctor or provider about these tests. In regards to treatment, one can use several antifungal agents, including amphotericin B (IV), flucytosine (oral), or fluconazole (IV or oral). Usually, initial treatment involves using a combination of IV amphotericin B + flucytosine for 2 weeks, followed by a switch to oral fluconazole 400 mg daily for 10 weeks minimum, followed by a maintenance dose of fluconazole 200 mg daily indefinitely. There are variations to this treatment, but talk to your provider regarding options.

Hope this information helps. Thanks again for your question.

If you are looking for more information, I would access the following reference: Cryptococcosis. - Infect Dis Clin North Am - 01-Dec-2002; 16(4): 837-74, v-vi.

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