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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)

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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.

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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.
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