The History of Cryptococcus and Cryptococcosis
This chapter considers over a century of clinical experience to examine the encapsulated yeast Cryptococcus, to identify the highlights of its maturation in identifying, understanding, diagnosing, and managing this major emerging fungal pathogen. In the areas of pathogenesis, diagnosis, and treatment of cryptococcosis, there are myriad events to report. A study conducted in 1998 demonstrated that cryptococcus could demonstrate morphological flexibility in that under certain environmental conditions the yeasts produce hyphae and spores without a mating reaction; in other words, some cryptococcal strains were found to have the ability to haploid fruit, and thus a new part of the life cycle of cryptococcus was identified. Another study introduced the rigorous methodology of comparative, randomized trials into antifungal therapy and particularly cryptococcosis. This study validated the efficacy of combination antifungal therapy for cryptococcosis, and represented a major starting point not just for cryptococcosis but also for other invasive fungal infections. This study initially provided much of the infrastructure for understanding the management of cryptococcal meningitis. The first large outbreak of cryptococcosis was associated with cows and mastitis in the 1950s, probably related to direct inoculation with contaminated fomites. The history of cryptococcosis has been dynamic and continues to evolve. From its humble beginnings as single case reports to its model system status in molecular studies for fungal pathogenesis, it has become a sophisticated complex organism for study and management.
