Cryptococcus

And that number understates it because it excludes tuberculous and HIV-associated cryptococcal meningitis.

Those get classified under their underlying diseases.

Cryptococcal meningitis alone kills about 147,000 people a year, mostly in sub-Saharan Africa, with 30-40% mortality even in the US and around 50% in low-resource settings.

So the real global toll is closer to 400,000? The order of magnitude, yes.

Meningitis isn't one disease.

So those were where I would walk into the cafeteria and I'd see Emma, the ID doc, across the room and I would run literally and say, Emma, can I quickly run this case by you? And she was very nice and she said, sure.

And then I'd give it, you know, give her a case and she'd say, oh, yeah, I'd be worried about Cryptococcus.

Immensely helpful, fun, collegial.

I'm not sure the specialists love doing that because, of course, they're providing a free service to me, but what the hell.

There's a study showing very interesting finding on travel-related fungal infection in immunocompromised.

What they found is that the majority of the cause is caused by dimorphic fungi and Cryptococcus.

What is very interesting is that infection can be acute or can be reactivated later, maybe years after exposure.

But most importantly, when we think about something uncommon, we have to make sure that we exclude the common things, for example, malaria.

And of note, when you see talaromycosis like this with the skin lesions, you have to do blood cultures.

And from blood cultures, when you do gram stain, it is actually not the type of one we expect to see, but it is going to be more of the septate or hyphae.

This is Cryptococcus and this is Histoplasma capsulatum.

Either nodules or ulcers can also be seen as previous case.