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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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