Clinical Features -  Initial pulmonary infection is usually asymptomatic. Most patients present with disseminated infection, especially meningoencephalitis. In the United States, 85% of cases occur in HIV-infected persons. 

Etiologic Agent  - Cryptococcus neoformans.

Reservoir - C. neoformans var. neoformans has been isolated from the soil worldwide, usually in association with bird droppings. Less common etiologic agent, C. neoformans var. gattii has been isolated from eucalyptus trees in tropical and sub-tropical regions.

Incidence - 0.4-1.3 cases per 100,000 in the general population. Among persons with AIDS, the annual incidence is 2-7 cases per 1,000.

Sequelae - Meningitis may lead to permanent neurologic damage. Mortality rate is about 12%. 

Transmission - Inhalation of airborne yeast cells and/or basidiospores. 

Risk Groups - Immunocompromised persons, especially those with HIV infection.

Surveillance - Active, population-based surveillance in selected U.S. sites. No national surveillance exists.

Challenges - Developing a cost-effective prevention strategy (although fluconazole is effective chemoprophylaxis for persons with AIDS, it does not affect survival and is not considered cost-effective).

Obtained with permission from the Centers for Disease Control.

December 2003