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Pulmonary Cryptococcosis in Normal Hosts : Treat or Observe?

Judith A. Aberg
Author and Funding Information

Affiliations: St. Louis, MO
 ,  Dr. Aberg is Associate Professor of Medicine, Washington University School of Medicine. Dr. Aberg is a member of Speaker’s Bureau for Pfizer (makers of fluconazole), and a member of the Infectious Disease Society of America Practice Guidelines Committee, and investigator for the National Institute of Allergy and Infectious Disease, Bacteriology and Mycology Study Group, Grant N01-AI-15440.

Correspondence to: Judith A. Aberg, MD, Associate Professor of Medicine, Washington University School of Medicine, Department of Medicine, Division of Infectious Disease, AIDS Clinical Trials Unit, 4511 Forest Park Ave, Suite 304, St. Louis, MO 63108; e-mail: jaberg@im.wustl.edu



Chest. 2003;124(6):2049-2051. doi:10.1378/chest.124.6.2049
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Although it is accepted that the lung is the portal of entry for disseminated cryptococcosis, it remains unclear if disseminated disease results from reactivation of pulmonary disease since many patients have no evidence of pulmonary disease at time of diagnosis of disseminated disease. Treatment of cryptococcal pulmonary disease remains controversial. In fact, there is no consensus in the literature on what constitutes pulmonary infection vs colonization. The Infectious Disease Society of America (IDSA) guidelines for management of cryptococcal disease1 recommend that all symptomatic patients with positive respiratory culture findings be treated and have a lumbar puncture to exclude CNS infection; however, the management of patients without symptoms is less clear. The IDSA guidelines recommend that all asymptomatic patients with positive respiratory culture findings be considered for treatment, with the caveat that there are reports of immunocompetent patients with positive sputum culture findings who have done well clinically without treatment. The goal of treatment of isolated pulmonary cryptococcosis is to not only treat the infection but to prevent dissemination, particularly to the CNS.12

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