Microscopic view of Cryptococcus neoformans fungi with a farmer's hand in the background.

Uncommon Infections: When a Simple Scratch Turns Serious

Author's portrait.
Rhea Morgan in Health & Wellness July 2025 • 4 min read.

"A farmer's story highlights the rare but real risk of cutaneous cryptococcosis in seemingly healthy individuals."


Fungal infections are more common than many people realize, and while some are superficial and easily treated, others can be more serious. Cryptococcosis is one such infection, caused by varieties of the Cryptococcus neoformans fungus. Typically, this infection is associated with individuals who have compromised immune systems, such as those with AIDS.

However, cryptococcosis can, in rare instances, occur in individuals with healthy immune systems. This is particularly true for infections caused by Cryptococcus neoformans var. gatti, whereas C. neoformans var. neoformans is more frequent in immunodepressed patients. Understanding how these infections manifest and are treated is crucial for early intervention and successful outcomes.

This article explores a case of primary cutaneous cryptococcosis—a skin infection—in an immunocompetent patient, shedding light on the risks, diagnosis, and treatment of this rare condition. We'll delve into how a seemingly minor injury can lead to a significant health issue and what steps can be taken to ensure a full recovery.

A Farmer's Unexpected Fungal Infection

Microscopic view of Cryptococcus neoformans fungi with a farmer's hand in the background.

A 67-year-old farmer from Blumenau, Brazil, experienced an unusual health issue following a minor injury. While cleaning his chicken coop, he was scratched by a hen on his right arm. Shortly after, he noticed erythematous spots—red, inflamed areas—around the scratch. These spots soon developed into itchy "small blisters" that spread across his forearm, eventually turning into open wounds.

Upon dermatological examination, the farmer was found to have nodular lesions with high borders and ulcerated, depressed centers. These lesions were surrounded by multiple excoriations (scratches) and ulcerations on the anterior surface of his right forearm, accompanied by exudation and suppuration (oozing and pus).

  • General Examination: The patient was alert and oriented, hypertensive, and had normal lung sounds.
  • Laboratory Tests: Glucose levels were at 89.0/ml, total cholesterol at 232, hemoglobin at 15.5, and eosinophils at 2.0. Platelet counts were normal, and electrolyte levels (sodium and potassium) were within normal ranges. Immunoglobulin levels (IgG, IgM, and IgA) were also normal. HIV tests (HIV1 and HIV2) were non-reactive.
  • Lung X-ray: Showed no abnormalities.
  • Mycological Examination: A direct examination with India ink revealed encapsulated and gemmulated forms typical of Cryptococcus sp. Culture showed milky colonies characteristic of Cryptococcus neoformans.
Based on these findings, the farmer was diagnosed with primary cutaneous cryptococcosis in an immunocompetent patient. The prescribed treatment was oral fluconazole at a dose of 450 mg per day for 40 days. This treatment led to complete healing, with total regression of the lesions. At a follow-up appointment 60 days later, the patient was healthy, with only residual scars.

Key Takeaways and Prevention

This case underscores that, although rare, cutaneous cryptococcosis can occur in individuals with intact immune systems. It highlights the importance of being vigilant about even minor injuries, especially when exposed to environments where fungal spores may be present, such as poultry farms.

While the farmer's case was successfully treated with fluconazole, early diagnosis is crucial. If you experience unusual skin lesions, especially after an injury, consult a healthcare professional promptly. Timely intervention can prevent the infection from spreading and ensure a positive outcome.

For those working in environments with potential exposure to Cryptococcus, such as farms or areas with pigeon droppings, taking preventative measures like wearing protective clothing and practicing good hygiene can reduce the risk of infection. Stay informed, stay vigilant, and prioritize your health to avoid uncommon infections.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

Is it possible to get a Cryptococcus infection even if my immune system is healthy?

Cryptococcosis, particularly when it manifests as primary cutaneous cryptococcosis, can indeed affect individuals with healthy immune systems, although it's more commonly seen in those with compromised immunity. The fungus Cryptococcus neoformans var. gatti is more often implicated in infections of immunocompetent individuals, while C. neoformans var. neoformans is more frequent in immunodepressed patients. Vigilance and awareness are important, especially if you're exposed to environments where these fungi might be present.

2

What were the specific symptoms experienced in the case of the farmer who contracted cutaneous cryptococcosis?

The farmer developed erythematous spots around the scratch, which then evolved into itchy blisters that spread and eventually turned into open wounds. Upon examination, nodular lesions with ulcerated centers were found. A mycological examination using India ink revealed encapsulated and gemmulated forms of Cryptococcus sp., and a culture confirmed Cryptococcus neoformans.

3

What exactly is primary cutaneous cryptococcosis, and how does it develop?

Primary cutaneous cryptococcosis is a skin infection caused by the Cryptococcus fungus. The infection begins when the fungus enters the skin through a wound, leading to lesions and other skin abnormalities. In the described case, a seemingly minor scratch led to a rare instance of primary cutaneous cryptococcosis.

4

What treatment options are available for cutaneous cryptococcosis, and how effective are they?

The farmer was successfully treated with oral fluconazole at a dose of 450 mg per day for 40 days. This treatment led to complete healing and regression of the lesions, with only residual scars remaining at a follow-up appointment 60 days later. Early diagnosis and appropriate antifungal treatment are essential for positive outcomes.

5

What are the broader implications of this cutaneous cryptococcosis case, and what can be done to prevent similar infections?

The farmer's diagnosis of cutaneous cryptococcosis underscores the importance of being cautious about even minor injuries, especially in environments where fungal spores may be present. This case highlights the need for heightened awareness among healthcare professionals and the general public about the possibility of rare fungal infections in immunocompetent individuals. While not specifically discussed, the environmental conditions that favor Cryptococcus growth and sporulation play a crucial role in transmission. Further research could focus on identifying these specific environmental factors to improve preventative measures.

Newsletter Subscribe

Subscribe to get the latest articles and insights directly in your inbox.