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Cryptococcosis: An Emerging Airborne Mycosis of Global Concern

Mahendra Pal1 and Pratibha Dave

Cryptococcosis, an emerging highly infectious respiratory mycosis, is mainly caused by Cryptococcus neoformans and Cryptococcus gattii, which exist as saprobe in the environment. Currently, nine molecular types, five in C.neoformans and four in C. gattii are identified. The disease occurs in sporadic and epidemic form resulting into significant morbidity and mortality, especially in immunocompromised patients. Globally, cryptococcosis causes about 625,000 deaths annually. The clinical manifestation of pulmonary cryptococcosis includes cough, weight loss, sputum, chest pain, dysponea, fever, headache, and hemoptysis. The demonstration of pathogen both by direct microscopy in India ink and its isolation on Pal sunflower seed medium is still considered as gold standard to confirm an unequivocal diagnosis of cryptococcosis. The morphology of isolates can be easily studied in “Narayan” stain. The fluconazole, being a less toxic drug, is recommended for the management of pulmonary cryptococcosis. It is emphasized to undertake molecular characterization of Cryptococcus isolates to know the genotypes prevalent in different regions of the world. Since many laboratory in poor resource countries do not have facilities to undertake biochemical test, it is therefore, advised to use easily available, very sensitive, highly specific and low cost “Pal sunflower seed medium” to make an early diagnosis to save the life of patients from this enigmatic mycosis. Further research work on pathogenesis, epidemiology, and chemotherapy may be rewarding.