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General: Cryptococcosis usually starts with a pulmonary infection (in the lungs), which usually spreads to the central nervous system (CNS). If left untreated, the infection can continue to spread to other organs in the body, including the skin, prostate and medullary cavity (bone marrow) of the bones. Pulmonary: Symptoms of cryptococcal pulmonary (lung) disease vary. Some patients are asymptomatic (experience no symptoms) while others, especially immunocompromised patients (like HIV/AIDS patients and organ transplant recipients), suffer from acute respiratory distress syndrome. Sometimes pulmonary disease manifests as a progressive mass that compresses important body tissues in the chest such as the vena cava (main veins to the heart). Common symptoms include fever, general feeling of discomfort, dry cough, pleuritic pain (pain in the membrane surrounding the lungs), and rarely, blood in the sputum. Less common symptoms include rales (crackling sound that occur when air moves through fluid–filled lungs), pleural effusions (fluid between the lining of the lung and the lining of the inside wall of the chest), cavitation (formation of cavities in a body tissue or an organ) and enlarged lymph nodes. Central nervous system (CNS): Meningitis and meningoencephalitis are the most common manifestations of an infection that has spread to the CNS. This form of infection is fatal without treatment after two weeks to several years of the onset of symptoms. Symptoms vary depending on the individual's overall health prior to infection. Some patients who are HIV–positive may have minimal or nonspecific symptoms when they are diagnosed with the condition. Common symptoms include headache, altered mental status (such as personality changes), confusion, lethargy, reduced consciousness, coma, nausea and vomiting. Other, less common, symptoms include fever, stiff neck, hearing defects and seizures. Dementia may indicate a condition called hydrocephalus (accumulation of cerebrospinal fluid in the brain) as a late complication. Blurred vision, photophobia and double vision, may occur secondary to arachnoiditis (inflammation and scarring of the membranes covering the spinal cord), inflammation of the optic nerve and chorioretinitis (inflammation behind the retina). Disseminated: If the infection continues to spread after lung and CNS infection, the skin, prostate and medullary cavity of the bones are the most likely organs to be affected next. Cutaneous (skin) manifestations occur in 10–15% of cases and usually take the form of papules, pustules, nodules, ulcers or draining sinuses. Cellulitis (inflamed connective tissue) with necrotizing vasculitis (inflamed blood vessels) is reported in patients who undergo organ transplantation. Bone lesions develop in 5–10% of the patients. Bone lesions usually cause the breakdown of the bone, and they may be confused with tuberculosis or neoplasm (tumor growth). Other less common forms of cryptococcosis include myocarditis (inflamed heart), chorioretinitis (inflamed choroid layer behind the retina in the eye), inflamed liver, peritonitis (inflamed lining of the abdominal cavity), kidney infection, enlarged prostate, myositis (inflamed muscle tissue) or adrenal involvement.
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