Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 19, Number 10—October 2013
CME ACTIVITY - Research

Cryptococcus gattii Infections in Multiple States Outside the US Pacific Northwest

Julie R. HarrisComments to Author , Shawn R. Lockhart, Gail Sondermeyer, Duc J. Vugia, Matthew B. Crist, Melissa Tobin D’Angelo, Brenda Sellers, Carlos Franco-Paredes, Monear Makvandi, Chad Smelser, John Greene, Danielle Stanek, Kimberly Signs, Randall J. Nett, Tom Chiller, and Benjamin J. Park
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.R. Harris, S.R. Lockhart, R.J. Nett, T. Chiller, B.J. Park); California Department of Public Health, Richmond, California, USA (G. Sondemeyer, D.J. Vugia); Georgia Department of Public Health, Atlanta (M.B. Crist, M.T. D’Angelo); Phoebe Putney Memorial Hospital, Albany, Georgia, USA (B. Sellers, C. Franco-Paredes); Hospital Infantil Federico Gomez, Mexico City, Mexico (C. Franco-Paredes); New Mexico Department of Health, Santa Fe, New Mexico, USA (M. Mkvandi, C. Smelser); Moffitt Cancer Center, Tampa, Florida, USA (J. Greene); Florida Department of Health, Tallahassee, Florida, USA (D. Stanek); Michigan Department of Community Health, Lansing, Michigan, USA (K. Signs); Montana Department of Public Health and Human Services, Helena, Montana, USA (R.J. Nett)

Main Article

Table 2

Characteristics of patients who died of Cryptococcus gattii infections acquired outside the Pacific Northwest, US, 2010–2012*

Age, y/sex State Onset to diagnosis, d Diagnosis to death, d/cause of death Underlying conditions Initial presentation/ clinical evaluation Leukocyte count CD4, cells/mm3 Sites yielding evidence of infection Cg type Shunt to manage elevated intracranial pressure? Imaging results Initial antifungal treatment
18/F
GA
10
4/cryptococcal infection (herniated brain stem)
None
HA, BV, WL, fever, photophobia, loss of appetite, fatigue, hearing loss
ND
ND
CNS only
VGIII
Yes
No head imaging results; pneumonia
Ambisome, 5-flucytosine
36/M
CA
7
0/cryptococcal infection
Unspecified immunocompromising condition
HA, NS, cough, dyspnea, fatigue, AMS
ND
ND
CNS and blood
VGIII
NA
Pneumonia (thought to be bacterial); no head imaging
None
39/M
GA
2
263/shunt blockage
None
HA, BV, chills, papilledema
15,500
217
CNS only
VGI
Yes
Head imaging showed multiple Virchow-Robin spaces, basal ganglia cortex cryptococcoma; pneumonia
Ambisome, 5-flucytosine; corticosteroid at initial discharge
56/M
NM
113
Died before diagnosis/cryptococcal infection
None
HA, NS, BV, WL, fatigue, muscle pain, AMS, confusion
12,600
560
CNS, lung, blood
VGIII
NA
Normal head imaging; pleural effusion
None
68/F
CA
41
Died before diagnosis/cryptococcal infection
Liver transplant, dialysis-dependent ESRD, diabetes. Multiple recent hospitalizations for VRE of leg, recurrent pleural effusion.
Nausea, fatigue, confusion
20,700
ND
Blood only
VGIIb
NA
Abnormal chest imaging (no further information); normal head imaging
None
82/F CA 263 Died before diagnosis/cryptococcal infection H/o squamous cell carcinoma (not on treatment), CHF, RHD, endocarditis, restrictive lung disease, diabetes. Pseudomonas aeruginosa infection. Fatigue, WL 15,900 ND Lung only VGI NA Pneumonia, right upper lung cryptococcoma None

*Cg,, Crylptococcus gattii ; GA, Georgia; HA, headache; BV, blurred vision; WL, weight loss; ND, no data. CNS, central nervous system; CA, California; NS, neck stiffness; NM, New Mexico; AMS, altered mental status; NA, not applicable; ESRD, end-stage renal disease; VRE: vancomycin-resistant Enterococcus infection; CHF, congestive heart failure. RHD: rheumatic heart disease.

Main Article

Page created: September 20, 2013
Page updated: September 20, 2013
Page reviewed: September 20, 2013
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external