Pulmonary cryptococcosis
Cryptococcus species can cause pulmonary disease in patients with immune compromise such as patients with HIV infection or malignancy as well as immunocompetent patients.
Signs of pulmonary cryptococcosis on chest imaging include single or multiple lung nodules, consolidation and interstitial changes. Cryptococcus species can be cultured from respiratory tract samples from patients with pulmonary cryptococcosis.
Before starting treatment for pulmonary cryptococcosis (including in patients who have had the nodule surgically removed), perform the investigations listed in Diagnosing and assessing cryptococcosis to exclude disseminated disease (especially cryptococcal meningitis) and identify risk factors contributing to diseaseChang 2021.
Pulmonary cryptococcosis is an indicator condition for HIV testing1. If pulmonary cryptococcosis is identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection. In addition to HIV testing, if a patient without a history of immune compromise develops pulmonary cryptococcosis, undertake testing for other immune system disorders. For advice on starting antiretroviral therapy for HIV infection, see Pulmonary cryptococcosis in adults with HIV infection.
Pulmonary cryptococcosis can be managed with either a 3-phase or a single-phase antifungal regimen; see Approach to managing cryptococcosis.