Volume 21, Number 10—October 2015
CME ACTIVITY - Synopsis
Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013
Table
Summary of characteristics of 6 case-patients with cryptococcosis, Arkansas, USA, 2013*
Pt. no. |
Age, y/
sex |
Underlying condition(s) |
Symptoms at initial presentation |
Admission diagnosis |
ICU
dates, 2013 |
Steroid administered |
C. neoformans culture collection date, 2013 |
Days from admission to C. neoformans diagnosis |
Infection site(s) |
Serum CrAg |
MLST pattern |
Culture date to death |
Steroid treatment |
1 | 73/F | Diabetes, metastatic non–small cell lung cancer | Cough, shortness of breath, hemoptysis for 1–2 wks | Pneumonia with respiratory failure and sepsis | Apr 6–10 | No | Apr 6 | 1 | Lung | Negative | A | 5 d | None before positive culture |
2 | 51/F | Diabetes, renal failure, hemodialysis | Shortness of breath for 1 d | Pneumonia with sepsis | Mar 15–May 1 with intermittent transfers to floor | Hydrocortisone taper | May 1 | 45 | Blood | NO | B | 3 d | Hydrocortisone for 8 d |
3 | 78/M | Chronic lymphocytic leukemia | Weakness and failure to thrive | Severe anemia and acute renal failure | Apr 10–14 | Oral prednisone | May 9 | 21 | Blood | NO | A | 2 d | Methylprednisolone for 1 d, followed by prednisone taper starting at 100 mg for 3 d, 80 mg for 3 d, 40 mg for 3 d, 20 mg for 12 d |
4 | 67/M | Diabetes, renal transplant | Dizziness, nausea, vomiting for 2 wk | Gastroparesis soon revised to CM and BSI | Not admitted to ICU | No | May 9 | 1 | Blood, CSF, urine | >1:512 | B | ~4 mo | None (not included in cohort analysis because not admitted to ICU) |
5 | 82/M | Coronary artery disease, emphysema | Pleuritic chest pain for 1 d | Rule out myocardial infarction, soon revised to pneumonia with sepsis and respiratory failure | Jun 9–14 | Hydrocortisone taper | Jun 12 | 4 | Lung | NO | C | 3 d | Hydrocortisone for 4 d |
6 |
53/F |
Well-controlled asthma |
Shortness of breath and fever for 3 d |
Pneumonia with respiratory failure and sepsis |
Dec 9–31 |
Hydrocortisone and methylprednisolone |
Dec 31 |
22 |
Blood |
NO |
C |
1 d |
Hydrocortisone for 8 d and methylprednisolone
for 5 d |
*Pt., patient; ICU, intensive care unit; C. neoformans, Cryptococcus neoformans; CrAg, cryptococcal antigen; MLST, multilocus sequence typing; NO, not obtained; CM, cryptococcal meningitis; BSI, bloodstream infection; CSF, cerebrospinal fluid. |