Pathogenesis and clinical presentation

C. neoformans is acquired primarily through inhalation of the desiccated yeast particles found in the environment. Inhaled cells reach distal alveolar spaces where they gradually rehydrate and form their characteristic polysaccharide capsules that enable resistance to phagocytosis. Defects in cellular immunity allow reconstitution of the protective capsule and multiplication ofyeast in the lungs. Although alveolar macrophages phagocytose the yeast, containment and killing requires a coordinated response between innate and adaptive humoral (complement and anticryptococcal antibodies) and T-cell-mediated host responses.5 Deficiencies in cell-mediated immunity allow the yeast to survive as a facultative intracellular pathogen in macrophages as they migrate from the lung to draining lymph nodes, leading to dissemination via the bloodstream to the meninges.

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