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Volume 18, Number 6—June 2012

Letter

Recognition and Diagnosis of Cryptococcus gattii Infections in the United States

Sally Ann IversonComments to Author , Tom Chiller, Susan Beekmann, Philip M. Polgreen, and Julie Harris
Author affiliations: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (S.A. Iverson); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (T. Chiller, J. Harris); University of Iowa Carver College of Medicine, Iowa City, Iowa, USA (S. Beekmann, P.M. Polgreen)

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Table

Physician responses, by US region, to a survey about cryptococcosis, February–March 2011*

Question and responses No. (%) responding physicians†
Overall, n = 286 Northeast, n = 48 Midwest, n = 63 South, n = 113 West, n = 62
No. patients with cryptococcosis seen during the past year
1–4 218 (76) 41 (85) 55 (87) 71 (63) 51 (82)
5–8 49 (17) 6 (13) 7 (11) 29 (26) 7 (11)
9–12 12 (4) 1 (2) 1 (2) 8 (7) 3 (5)
>12 7 (2) 0 0 5 (4) 1 (2)
Percentage of patients with cryptococcal pneumonia, with or without meningitis
0–25 213 (75) 39 (81) 49 (78) 89 (79) 36 (59)
26–50 33 (12) 1 (2) 6 (10) 13 (12) 13 (21)
51–75 8 (3) 1 (2) 1 (2) 4 (4) 2 (3)
76–100 31 (11) 7 (15) 7 (11) 7 (6) 10 (16)
Method used to obtain a diagnosis of cryptococcosis (all that apply)
Cryptococcal antigen test 272 (95) 48 (100) 58 (92) 110 (97) 56 (90)
Microscopy 95 (33) 16 (33) 13 (21) 42 (37) 24 (39)
Culture 210 (73) 33 (69) 50 (79) 82 (73) 45 (73)
Histopathology 75 (26) 10 (21) 10 (16) 31 (27) 24 (39)
Any combination of tests that does not include culture 76 (27) 15 (31) 13 (21) 31 (27) 17 (27)
Clinical laboratory routinely or on request can differentiate Cryptococcus neoformans from C. gattii 131 (66) 20 (67) 28 (68) 48 (64) 35 (66)
Percentage of cryptococcal infection cases in HIV-uninfected patients
0–25 154 (54) 32 (68) 26 (41) 70 (62) 26 (44)
26–50 48 (17) 5 (11) 15 (24) 16 (14) 12 (20)
51–75 32 (11) 3 (6) 9 (14) 11 (10) 9 (15)
76–100 51 (18) 7 (15) 13 (21) 16 (14) 12 (20)
Diagnosed cryptococcal infections in HIV-uninfected patients with no known risk factors for infection during past 5 y 78 (27) 6 (13) 13 (21) 26 (23) 33 (53)
Considers species of Cryptococcus as a factor of interest in diagnosis or when treating a patient 179 (63) 22 (46) 36 (57) 71 (63) 50 (81)
Considered C. gattii infection as a differential diagnosis for pneumonia in a person from the US Pacific Northwest 153 (54) 19 (40) 29 (46) 63 (56) 42 (68)
Ever treated or consulted on a patient known to have C. gattii infection 38 (13) 5 (10) 3 (5) 3 (3) 27 (44)

*The survey was conducted by the Emerging Infections Network among physician members; responses are from providers who had seen any patients with cryptococcosis during the preceding year. Region is defined by the 4 census regions: Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont), Midwest (Indiana, Illinois, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin), South (Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia), West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, New Mexico, Nevada, Oregon, Washington, Wyoming).
†Not all respondents answered all questions.
‡Excludes “don’t know” responses.

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