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Pulmonary cryptococcosis

Key sources
The following summarized guidelines for the evaluation and management of pulmonary cryptococcosis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/CDC/NIH/HIVMA 2023), the American Thoracic Society (ATS 2011), and the Infectious Diseases Society of America (IDSA 2010).
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Guidelines

1.Diagnostic investigations

Evaluation for central nervous system involvement: as per ATS 2011 guidelines, perform a lumbar puncture with analysis of CSF for the presence of Cryptococcus species in patients with pulmonary cryptococcosis and any concern of dissemination, neurologic symptoms, or positive serum cryptococcal antigen titers.
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2.Medical management

General principles: as per NIH 2023 guidelines, treat patients with diffuse pulmonary disease similarly to CNS disease.
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More topics in this section

  • Antifungal therapy

  • Management of increased ICP

  • Management of immune reconstitution inflammatory syndrome

3.Surgical interventions

Indications for surgery: as per ATS 2011 guidelines, consider performing surgical resection in selected patients with pulmonary cryptococcosis and large mass lesions or areas refractory to medical therapy.
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4.Specific circumstances

Pediatric patients: initiate oral fluconazole 6-12 mg/kg/day for 6-12 months in pediatric patients with cryptococcal pneumonia.
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More topics in this section

  • Pregnant patients

  • Asymptomatic patients

  • Patients with Cryptococcus gattii infection