Cryptococcosis is a systemic fungus infection that may involve any organ of the body, e.g., lungs, skin, the brain and the meninges.

The infection is caused by Cryptococcus (C) neoformans and is acquired by inhalation of soil contaminated with the causative organism. The infection is likely to occur in persons with acquired immunodeficiency syndrome (AIDS). However, it may also occur in persons with Hodgkin's disease or other lymphomas, or sarcoidosis, or individuals receiving long-term corticosteroid therapy.

Most cryptococcosis infections are self-limiting, subacute, or chronic. Signs and symptoms of cryptococcosis infections in persons with AIDS may include severe, progressive pneumonia with acute dyspnea. Pneumocystis infection may be present on x-ray. Single or multiple abscesses may develop in the organs. Primary lesions of the lungs may be asymptomatic and self-limited. There may be a low-grade temperature, skin lesions, and focal lesions in the bones, abdominal viscera or other tissues with little or no symptoms. The signs and symptoms associated with cerebral involvement may include headaches, dizziness, vertigo, stiffness of neck muscles, and signs and symptoms of cerebral meningitis. In the final stages, coma and renal failure occur. There may be self-limited pulmonary infection, or the infection may disseminate to the meninges, skin, bones, viscera, or other sites. In individuals who are not obviously immunocompromised, chronic meningitis is common when pulmonary lesions may not be clinically evident.

Cultures and through examination of cerebrospinal fluid (CSF), sputum, and urine are used to confirm the presence of C. neoformans.

Drug therapy with amphotericin B, followed by fluconazole maintenance in human immunodeficiency virus (HIV) positive patients, is the treatment of choice. Lesions may heal spontaneously without disseminating to other parts of the body.

Amphotericin B is highly toxic. Renal functional impairment is the main toxic risk. Creatinine and BUN levels should be monitored during treatment. The infection may be present in the urine after successful clearance of the organisms from the central nervous system (CNS). The prognosis for the condition is poor, and the cerebral and meningeal forms are usually fatal.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Review special provisions regarding the evaluation of specific respiratory conditions under 38 CFR 4.96(a) - Rating co-existing respiratory conditions.