Concerns About Cryptococcus and Pneumonia: Expert Insights

Questions related to cryptococcosis and pneumonia?

Dear Dr.
Huang Yi-Wen,
Last May, while I was organizing my mother's rental place, I found a drying rack covered with white substances and powdery material.
Without thinking much, I wiped it down with a wet tissue, but some residue remained.
I then placed the drying rack in my temporarily unoccupied studio apartment (which is airtight) until early April of this year.
Last week, I started staying in the studio again and used the drying rack to hang clothes near the bed while running a dehumidifier all day (with the airflow directed at the drying rack).
It wasn't until the next morning, when I collected the clothes, that I discovered the white substance on the drying rack was actually bird droppings.

I would like to ask the following questions:
1.
I kept the drying rack, which was contaminated with bird droppings, in the studio for nearly a year (during which I only occasionally opened the windows for ventilation and noticed bird droppings on the balcony as well).
Is it possible that the room is filled with Cryptococcus?
2.
In the situation where the drying rack has residual bird droppings and the dehumidifier is continuously blowing air on it, could Cryptococcus attach to the clothes? Does the airflow from the dehumidifier increase the spread of Cryptococcus in the room?
3.
I had an MRI check-up two years ago that revealed a 1.3 cm subpleural pulmonary infiltrate in the right lower lobe, with the report suggesting possible chronic inflammation.
Does having chronic inflammation in the lungs make one more susceptible to Cryptococcus infection?
4.
Since I have only been living here for a few days, do the furniture and items in the room need to be disinfected?
5.
If there is a suspicion of infection, what methods can be used for testing?
I apologize for the lengthy message, and I appreciate your help.
Thank you.

Yuan Yuan, 30~39 year old female. Ask Date: 2019/04/08

Dr. Huang Yiwen reply Pulmonology

Dear Yuan Yuan,
Cryptococcus neoformans is typically an opportunistic infection.
In immunocompetent individuals, inhalation of environmental cryptococci usually results in asymptomatic or self-limiting pulmonary disease.
However, in immunocompromised individuals, it can lead to disseminated disease with a very poor prognosis.
The initial symptoms are mild and nonspecific, making early diagnosis extremely challenging.
Common symptoms include fever, headache, cognitive dysfunction, altered consciousness, nausea, chest pain, and mild persistent cough.
Clinical symptoms primarily depend on the invasion of different tissues and organs, with the central nervous system being commonly affected due to the organism crossing the blood-brain barrier, leading to cryptococcal meningitis and resulting in permanent neurological damage.
Pulmonary symptoms are relatively rare, resembling bronchitis, with pulmonary lesions gradually forming fibrosis or consolidation.
Rarely, skin nodules or ulcers may develop.
Diagnostic methods include:
1.
Staining and microscopy: Specimens (cerebrospinal fluid, sputum, urine, and serum) are directly stained with India ink to observe the thick polysaccharide capsule.
2.
Culture.
3.
Biochemical reactions: Utilizing the unique biochemical properties of Cryptococcus neoformans, such as the production of (1) urease, (2) laccase, (3) phenoloxidase, and (4) catecholamines.
4.
Cryptococcal antigen testing: Methods like latex agglutination test are used to detect cryptococcal antigens in blood or cerebrospinal fluid, with an antigen titer greater than 1:8 considered indicative of infection.
Antigen titer testing can also serve as a basis for monitoring disease progression and treatment response.
5.
Molecular testing: Nucleic acid detection methods such as PCR and real-time PCR.
It is essential to maintain a well-ventilated living environment, and regular environmental disinfection using bleach at 500 ppm is also necessary.

Reply Date: 2019/04/08

More Info

Concerns about Cryptococcus and potential pneumonia are valid, especially given your recent exposure to bird droppings, which can harbor the fungus Cryptococcus neoformans. Let's address your questions one by one.

1. Presence of Cryptococcus in Your Apartment: If bird droppings were present in your apartment for an extended period, there is a possibility that Cryptococcus spores could be present in the environment. However, the actual concentration of spores would depend on various factors, including the amount of droppings, ventilation, and how long they were left undisturbed. Cryptococcus is primarily spread through inhalation of airborne spores, which can be released when dried droppings are disturbed. Since you mentioned that the apartment was mostly sealed, the risk of airborne spores accumulating might be lower, but it is still a concern.

2. Cryptococcus on Clothing: If the clothing was hung on a rack that had bird droppings, there is a possibility that spores could have transferred to the fabric, especially if the droppings were wet when you cleaned them. The dehumidifier blowing air over the rack may not necessarily increase the spread of Cryptococcus spores, but it could help dry out any moisture, which might facilitate the release of spores into the air. It’s advisable to wash any clothing that may have come into contact with the droppings thoroughly.

3. Chronic Lung Inflammation and Infection Risk: Having a history of chronic lung inflammation, such as the subpleural infiltrate you mentioned, can indeed increase your susceptibility to infections, including those caused by Cryptococcus. Individuals with compromised immune systems or pre-existing lung conditions are at a higher risk for developing infections from environmental pathogens. It is crucial to monitor any respiratory symptoms you may experience.

4. Disinfection of Furniture and Belongings: Given your exposure to bird droppings, it would be prudent to clean and disinfect any surfaces that may have come into contact with the droppings. Use a solution that can effectively kill fungi, such as a mixture of bleach and water (1:10 ratio), or a commercial disinfectant that specifies efficacy against fungi. Ensure proper ventilation during the cleaning process and wear protective gear, such as gloves and a mask, to avoid inhaling any spores.

5. Testing for Infection: If you suspect that you may have been infected with Cryptococcus, it is important to consult a healthcare professional. Diagnosis typically involves a combination of clinical evaluation and laboratory tests. Tests may include a chest X-ray or CT scan to assess lung involvement, blood tests to check for cryptococcal antigen, and possibly a lumbar puncture if there are neurological symptoms. Early diagnosis and treatment are crucial, especially for individuals with underlying health conditions.

In summary, while the risk of infection from your exposure is not guaranteed, it is essential to take precautions and monitor your health closely. If you experience any respiratory symptoms, such as cough, fever, or difficulty breathing, seek medical attention promptly. Additionally, maintaining a clean living environment and being aware of potential sources of infection can help mitigate risks associated with Cryptococcus and other pathogens.

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