Volume 18, Number 6—June 2012
Letter
Recognition and Diagnosis of Cryptococcus gattii Infections in the United States
, Tom Chiller, Susan Beekmann, Philip M. Polgreen, and Julie Harris
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.