🦠Pulmonary cryptococcus in patients w/ severe COVID-19🦠: A thread!
The CDC doesn't recognize cryptococcus as a common fungal disease complicating COVID-19: How common is it? We don't know! ~10 cases have been reported re: cryptococcus infection in non-HIV/Txplant patients w/ severe Covid 
Among these cases, 3/10 had isolated pulmonary🫁disease, 7/10 w/ CNS🧠disease. ALL pts had several RFs incl. 🫁 prolonged mechanical ventilation, 💉immunomodulatory therapies including steroids, toci, and 🦠immune dysregulation 2/2 direct SarsCOV2 viremia and critical illness
At least 1 of the cases occurred in patient who was d/c on prolonged steroids for organizing PNA, came back w/ recrudescent hypoxemic RF --> BAL fungal cx grew crypto, +serum crypto ag 😐
Who needs an LP?
🧠Headache/AMS (duh)
🧠Signs of systemic infx (fever, weight loss)
🧠Cirrhotics
🧠On high dose steroids
🧠Elevated serum CrAG
🧠Malignancy or known immunocompromised state
🧠Headache/AMS (duh)
🧠Signs of systemic infx (fever, weight loss)
🧠Cirrhotics
🧠On high dose steroids
🧠Elevated serum CrAG
🧠Malignancy or known immunocompromised state
OK and last but not least, crypto is everywhere! But especially in pigeon poop 💩. So keep a high index of suspicion of your patient is "frequently trapping wild pigeons in an abandoned building"... and never trust a Chicago pigeon💀
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