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Cryptococcus gattii in the United States: clinical aspects of infection with an emerging pathogen

J R Harris1, S R Lockhart, E Debess

  • 1Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. ggt5@cdc.gov

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|October 22, 2011
PubMed
Abstract

Insights

Cryptococcus gattii (Cg) infections are increasing in the US Pacific Northwest. Outbreak strains (VGIIa, VGIIb, VGIIc) are linked to more underlying conditions and respiratory symptoms, while non-outbreak strains cause more CNS disease.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Epidemiology

Background:

  • Cryptococcus gattii (Cg) infections have risen in the US Pacific Northwest since 2004.
  • This study details the Cg outbreak and compares clinical features of infections in the US based on Cg genotype.

Purpose of the Study:

  • To describe the Cryptococcus gattii outbreak in the US Pacific Northwest.
  • To compare clinical characteristics of Cg infections in the US, differentiating between outbreak and non-outbreak strains.

Main Methods:

  • Passive surveillance (retrospective and prospective) of Cg infections by state health departments from 2005 to 2011.
  • Clinical isolates were genotyped by the CDC; patient interviews and chart reviews were conducted.
  • Analysis of symptom frequency, underlying conditions, and factors associated with mortality in US patients with Cg infection.

Main Results:

  • 96 Cg infections reported; 78 were outbreak strains (VGIIa, VGIIb, VGIIc) in patients in or traveling to the Pacific Northwest.
  • Outbreak strain infections were associated with more preexisting conditions (86%) and respiratory symptoms (75%) compared to non-outbreak strains (31% and 36%).
  • Outbreak strains were less likely to cause CNS symptoms (37%) than non-outbreak strains (90%). Mortality was 33% (19/57), with oral steroid use increasing death risk.

Conclusions:

  • Distinct clinical presentations may differentiate outbreak (VGIIa, VGIIb, VGIIc) and non-outbreak Cg infections in the US.
  • Clinicians should consider Cg testing, especially in patients with recent Pacific Northwest travel.

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