Any disease that man acquires from an animal, can be called zoonosis. Although we don’t realize it, we are exposed to contagious conditions like these 24 hours a day.
This is the case of cryptococcosis, an infection transmitted by pigeons, which, in some cases, can develop into meningitis .
Do you want to know more about this condition, its causes and treatments? Check out the article below
Contents
What is cryptococcosis?
Cryptococcosis is a pulmonary or disseminated infection, caused by the fungus Cryptococcus, which reaches the body through the inhalation of its particles.
This condition has several clinical forms, which can affect everyone. However, it is more common to happen to those who have low immunity.
Also known as systemic mycosis , cryptococcosis can be contracted in environments with the presence of organic matter, that is, in the soil, in trees, dried fruits and animal feces, mainly pigeons and birds.
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We can find this condition in the ICD-10 through the following codes:
- B450 – Pulmonary cryptococcosis;
- B451 – Brain cryptococcus;
- B452 – Cutaneous cryptococcosis;
- B453 – Bone cryptococcosis;
- B457 – Disseminated cryptococcosis;
- B458 – Other forms of cryptococcosis;
- B459 – Cryptococcosis, unspecified.
Epidemiology
Systemic mycoses, such as cryptococcosis, are not part of the national list of diseases that need epidemiological surveillance.
However, according to Data from the Hospitalization System of the Unified Health System (SIH-SUS), cryptococcosis had the highest number of hospitalizations in the period from 2000 to 2007.
In a global aspect, cryptococcosis affects people who are immunocompromised and who are within the sex and age group of the risk group.
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Origin of the infection
Cryptococcosis has two different causative agents, Cryptococcus Neoformans and Cryptococcus Gattii. These will determine what type of disease the patient will develop, which may be opportunistic or primary, which we will explain below:
Opportunist
This type can be found more frequently in urban centers and is associated with low immunity.
It is caused predominantly by the fungus type Cryptococcus Neoformans, being considered the main cause of meningoencephalitis (inflammation in the membrane that lines the brain), which we will explain further below.
Primary
Often found in tropical and / or subtropical regions, this type affects people considered healthy, also called immunocompetent. Primary cryptococcosis is associated with Cryptococcus Gattii.
Types: which part can be affected?
Cryptococcosis can affect some regions of the body, being divided into cutaneous, cerebral and pulmonary:
Cutaneous
This type is the most difficult to develop, so its diagnosis is more complicated. Thus, the ideal is to do a laboratory test that facilitates the diagnosis.
It occurs more frequently in people with blood type A, and can be noticed through skin lesions, known as ulcerations.
Cerebral
We can say that cryptococcosis is a condition that has an affinity with the central nervous system. Thus, when in contact with the organism, cryptococcosis can affect the brain and present lesions such as cysts, in addition to causing an expansion of the spaces in the brain.
In addition, cerebral cryptococcosis can develop into meningitis, with the presence of hydrocephalus (accumulation of fluid that can cause brain enlargement and headaches).
Pulmonary cryptococcosis
The lung is known to be the main gateway for cryptococcosis fungi.
This is because, when inhaling fungi, it is possible for them to settle in the lung, causing several clinical presentations, such as specific nodules in one location or severe pneumonia .
The patient may experience fever , cough , weight loss and chest pain .
Cryptococcosis and meningitis
Infections caused by the Cryptococcus Neoformans type often affect people with weakened immune systems. This is because, when entering the organism through the nasal passages, the agent settles in the lungs and, in some cases, can cause lesions characteristic of meningitis.
To better understand, it is necessary to know that meningitis is an inflammation of the membranes that line the brain and spinal cord, due to an infection, in this case, cryptococcosis.
When the fungus is allocated in the lung, it can spread through the body, moving through the body through the bloodstream, reaching the Central Nervous System. There, it is possible to develop meningitis.
In some cases, meningitis evolves to an acute degree, and may even progress to meningoencephalitis, in which there is also an impairment of the brain.
Read more: Meningitis can affect the immune system even after treatment
Causes
Cryptococcosis is caused by a fungus called Cryptococcus spp , which has 5 gene derivations, that is, 5 types.
This substance can be found in pigeon droppings and / or in eucalyptus trees, usually in tropical and subtropical regions.
Cryptococcosis infection occurs through the respiratory tract, when inhaling fungal spores.
Right after the first contact with the nasal cavity, the agent can spread through the body, reaching the bloodstream or the lymphatic system, however, the location most likely to be affected is the lung region.
How does transmission occur?
Cryptococcosis is a condition that has no direct transmission, that is, from person to person.
It is also known that interhuman transmission does not occur when other animals transmit the disease. However, it is necessary to pay attention to the inhalation of fungi, considered the cause of the condition.
That’s because, when excreting their faeces, pigeons leave behind an infinite amount of bacteria and fungi together.
When we do not properly clean the affected area, these feces will dry out and, consequently, evaporate, causing us to inhale the spores of these microorganisms, leading to cryptococcosis.
Risk factors
Because it is a widespread condition among people with low immunity, cryptococcosis may have its chances increased if the patient has any of the following conditions:
- AIDS;
- Tuberculosis;
- Diabetes;
- Alcoholism;
- Lung injury.
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What are the symptoms?
Cryptococcosis has different clinical presentations that, in general, are mild symptoms and difficult to identify.
Microorganisms infect the respiratory tract, making identification difficult through conventional tests, such as radiography. So stay tuned if you experience any of the symptoms below:
Skin changes
It is possible to have ulcerations on the skin, in addition to rashes and purulent lesions (with pus), in up to 15% of cases of cryptococcosis.
Breathing problems
Cryptococcosis can cause respiratory problems such as lung infection, respiratory dyspnea (difficulty breathing), runny nose and pneumonia.
These symptoms are often associated with patients with the Cryptococcus Neoformans type . It is also common to reach immunodepressive people, causing lung lesions, which can develop into meningitis.
Neurological syndromes
The headache is one of the most common symptoms of cryptococcosis. In addition, it is possible to experience blurred vision, confusion, agitation and other behavioral changes.
This symptom frequently affects patients with Cryptococcus Gattii type , in which it is necessary to resort to long antifungal therapies and in some cases, surgery.
Other symptoms
There are some other characteristic symptoms of cryptococcosis and who are just as important as those mentioned earlier. Are they:
- Sickness;
- Fever;
- Sweating;
- Weakness.
How is the diagnosis made?
The diagnosis of cryptococcosis can be made by an infectologist , using a computed tomography, in order to identify the presence of nodules, which can be single or multiple.
In addition, it is very important that the patient gives a brief report on his medical history in order to raise or confirm suspicions about the condition and his individual immune capacity.
Laboratory examination
Another way to diagnose cryptococcosis is through laboratory tests, serology and CSF cryptococcal antigen. For this, nankin ink is used, which helps to identify the presence of fungi, which are visible in the blood sample.
Urine sample
In some cases, the doctor may resort to collecting body fluids. For this, it is necessary to isolate the cryptococcus in the urine, with the confirmation or not of the presence of the microorganism.
Computed tomography
This exam is considered complementary, and aims to locate possible nodules in the lung, in addition to the presence of masses in the pulmonary pleura (membrane that covers the organ).
Is there a cure?
-Yeah . However, it is necessary to devote extra attention to the care of immunity. This is because the cases of opportunistic cryptococcosis occur just when the organism is weakened.
What is the treatment?
Treatment for cryptococcosis is available through the Unified Health System, where antifungal drugs are released.
In addition, all monitoring and treatment can be done free of charge by the system.
It is necessary to reinforce that the treatment must be indicated according to each case.
That is, people with immunodeficiency can be directed to a type of antifungal, while people with a favorable immune system can receive another type of medication, as we will explain below.
Medicines
Drug prescription ends up being very similar between immunodeficient patients and those without other conditions that affect health, the main difference between them being the duration and after treatment.
People without immune compromise
If the infection reaches only a small part of the lung, the risk of complications is reduced. The use of fluconazole is recommended in order to reduce the chances of spread.
If the responsible doctor notices the development of meningitis, the medication can be changed to the following composition of substances:
- Amphotericin B + Fluconazole for 6 to 12 months, depending on each case.
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Immunodeficient people
In the same way that people considered healthy should undergo treatment with Amphotericin B and Fluconazole, people with weakened immune systems also use the medication, but the difference is found in the post treatment.
That’s because people with a favorable immune system can simply stop taking the drug as soon as the infection is cured.
People with immunodeficiency, on the other hand, need to continue taking antifungals until the white blood cells return to the ideal amount and remain so for at least 6 months.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Prognosis
People with immune deficiency have a negative prognosis, with about 45% to 70% lethality from cryptococcosis. This may be due to the following factors:
- High load of fungi in the body;
- Sensory changes at the onset of symptoms, which makes diagnosis difficult;
- Absence of an inflammatory response to treatment;
- Presence of cryptococcosis in other places outside the central nervous system (lung, skin, liver, blood);
- Advanced immunosuppression (decreased immune response).
Already patients without immunological changes and who are undergoing treatment correctly, there are great chances of rapid improvement.
Complications
Complications are rare in cases of isolated pulmonary infection. However, people with weakened immune systems may experience fungal meningitis.
Fungal meningitis
Fungal meningitis is an inflammation of the meninges resulting from the installation of fungi. The condition most often affects people with low immunity and, in these cases, is rarely curable.
It can be classified as non-cryptococcal or, what we are talking about specifically here, caused by the fungus Cryptococcus (cryptococcal).
Patients with pulmonary cryptococcosis should always be tested for fungal meningitis by means of puncture.
This is because, some fragile patients may have these fungi introduced into the body through the bloodstream and taken to the Central Nervous System, where they will cause meningitis.
How to prevent cryptococcosis?
Currently, there are no measures to prevent cryptococcosis. However, some actions can be taken in order to prevent and control the proliferation of pigeons, which are considered the main channel of transmission of the disease.
For this, it is important not to offer food, water or shelter for these animals.
In addition, it is important to sanitize possible places that contain feces from these animals, since they contain large amounts of fungus present.
Cryptococcosis in cats
Cats are the animals most affected by cryptococcosis. As in humans, felines can contract the condition by inhaling the spores present in the pigeon droppings.
Despite not being identified in all cases, a common symptom is the so-called “clown nose”, in which the cat’s muzzle becomes swollen and reddened.
In addition, they may have nasal discharge, sneezing, in addition to swollen lymph nodes and behavioral changes.
We are exposed to viruses, bacteria and fungi at all times, without even realizing it. Therefore, some personal attitudes can improve the collective.
Avoid feeding pigeons or sheltering them, as this can lead to infections for other people.
If you know someone who has the lowest immunity or who is most vulnerable to this condition, share this article to let them know more about cryptococcosis!
