Disseminated cryptococcosis is considered to be the most severe form of infection caused by two fungal species - Cryptococcus neoformans and less commonly Cryptococcus gattii. The majority of patients who develop this ailment suffer from immunodeficiency, primarily caused by human immunodeficiency virus (HIV) infection. Virtually every organ can be affected, but the lungs, the central nervous system (CNS), and the skin are main sites where disseminated cryptococcosis exerts symptoms. Clinical suspicion is confirmed by microbiological studies.
Cryptococcus neoformans, a ubiquitously distributed (found in soil and bird feces) fungal pathogen, and Cryptococcus gattii (an increasingly prevalent microorganism) are the two species that may cause an infection of virtually every organ termed cryptococcosis  . C. neoformans is associated with the incidence of disease in immunocompromised hosts, such as those suffering from HIV infection, organ transplant recipients, and in individuals who are receiving immunosuppressants or cytotoxic drugs; thus it is often described as an opportunistic pathogen  . In fact, cryptococcosis is the leading cause of acquired immunodeficiency syndrome (AIDS)-related death from fungi . However, an increasing number of reports show cryptococcosis in immunocompetent individuals, particularly with C. gattii as the underlying cause   . The pathogenesis stems from inhalation of spores that should be normally broken down by the macrophages residing in the respiratory epithelium, but impaired immune function can lead to involvement of any organ, such as the skin, the liver, spleen, kidneys, but most importantly, the lungs and the CNS . Disseminated cryptococcosis (DC), however, is a systemic and most severe form of disorder caused by these fungi, primarily because mortality rates rise rapidly in the absence of early recognition and proper therapy  . Some authors consider that the cutaneous signs appear first and precede the onset of DC by a few weeks . Lesions range from centrally-ulcerated small papules or macules to marked inflammatory changes (cellulitis or abscess formation), which may often be misdiagnosed as bacterial infections of the skin  . In addition to cervical lymphadenitis, manifestations of DC include fever, CNS symptoms such as headaches, cranial nerve palsies, and altered consciousness (hallmarks of cryptococcal meningitis), as well as severe cavitations and effusions of the lungs  .
The diagnosis of disseminated cryptococcosis needs to be made as soon as possible. The physician must first obtain a detailed patient history, during which the assessment of risk factors and previous illnesses could be crucial, particularly if HIV is identified. After an extensive physical examination, microbiological studies should be employed immediately. Several methods have been described in the literature when it comes to detecting cryptococcal species   . Identification of cryptococcal antigen through serological methods - latex agglutination and enzyme immunoassays (EIAs) is most frequently utilized due to their very high sensitivity and specificity rates, together with a very short turnaround time  . The cerebrospinal fluid (CSF) is usually the sample tested by these methods  . Cultivation of cryptococcus from CSF, sputum (specifically the bronchioalveolar lavage), urine, or scrapings from the skin, however, serves as a definite diagnostic measure, with positive results issued within 2-5 days   . Some authors advocate the need for a fine-needle aspiration cytology (FNAC) as the optimal technique for obtaining a viable sample of the lymph node aspirate for cultivation . Most recent studies promote the use of newly synthesized lateral flow assay (LFA), a non-invasive, cost-effective, and simple method that can yield positive results on the same day, with the benefit of detecting C. gattii infections that are otherwise unrecognized by standard serology tests .