Primary Complex of Cryptococcus and Pulmonary Lymph Nodes

Immediately subpleural nodules of Cryptococcus neotormans were found in lungs of eight patients at autopsy. Cryptococci also were present in the hilar lymph nodes of three patients. These observations and previous human and experimental studies suggest that the pathogenesis of primary pulmonary cryptococcal infection may be similar to that of primary pulmonary tuberculosis. The subpleural nodule represents the initial focus of infection, and spread to the hilar lymph nodes follows. It is probable that this primary pulmonary, lymph nodal complex is well contained in most patients, and that disseminated disease is unusual. In addition, the pathogenesis of some cases of cryptococcosis may be like that of secondary tuberculosis. This may explain the frequent absence of demonstrable pulmonary lesions and is consistent with experimental observations.