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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 1

Clinical characteristics of patients with Cryptococcus gattii infection outside the US Pacific Northwest, 2010–2012*

Characteristic, n = 25† No. (%)‡
Demographic
Male sex 21 (84)
Sign or symptom
Headache 16 (67)
Blurred vision§ 8 (62)
Nausea 11 (46)
Fatigue 11 (46)
Weight loss 10 (42)
Vomiting 10 (42)
Cough 8 (33)
Fever 7 (29)
Loss of appetite§ 3 (25)
Neck stiffness 5 (20)
Chills 4 (17)
Dyspnea 4 (17)
Night sweats 3 (13)
Photophobia 3 (13)
Chest pain§ 1 (8)
Papilledema 2 (8)
Muscle pain 2 (8)
Seizure 1 (4)
Underlying conditions (C. gattii molecular type)
None 16 (64)
Immunocompromising 5 (20)
Pulmonary sarcoidosis (VGI) 1
Diabetes, liver transplant (VGIIb)# 1
Unspecified immunocompromising condition (VGIII)# 1
Congenital hyper-IgE, i.e., Job syndrome (VGI) 1
Active lung cancer, receiving chemotherapy (VGIII) 1
Other underlying condition 4 (16)
History of prostate cancer, not on treatment (VGIII) 1
Diabetes, COPD, aortic stenosis (VGI) 1
Diabetes, RHD, restrictive lung disease, history of skin cancer (not on treatment) (VGI)# 1
Diabetes (VGIII) 1
Cryptococcomas (among those with images)§
Lung, n = 23 14 (61)
Brain, n = 20 10 (50)
Lung and brain, n = 18 5 (28)
Sites with evidence of infection
Any CNS site (CSF or brain) 19 (76)
Any pulmonary site (lung or sputa) 9 (36)
CNS only 12 (48)
CNS and pulmonary only 3 (12)
Pulmonary only 5 (20)
Blood only 1 (4)
CNS and blood only 2 (8)
CNS, blood, and pulmonary 1 (4)
CNS and leg tissue 1 (4)
Outcome
Hospitalized 23 (92)
ICU admission‡ 10 (48)
Died of C. gattii infection 6 (24)

*COPD, chronic obstructive pulmonary disease; RHD, rheumatic heart disease; CNS, centeral nervous system; CSF, cerebrospinal fluid; ICU, intensive care unit.
†Patients’ median age was 43 years (range 15–83 years).
‡Proportions represent patients with available data. Complete data were not available for all patients.
§Data not available for all patients.
#Died of their cryptococcal infections.

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