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Volume 21, Number 10—October 2015

CME ACTIVITY - Synopsis

Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013

Snigdha VallabhaneniComments to Author , Dirk Haselow, Spencer Lloyd, Shawn R. Lockhart, Heather Moulton-Meissner, Laura Lester, Gary Wheeler, Linda Gladden, Kelley Garner, Gordana Derado, Benjamin Park, and Julie R. Harris
Author affiliations: Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Vallabhaneni, S. Lloyd, S. Lockhart, H. Moulton-Meissner, L. Lester, G. Derado, B. Park, J.R. Harris); Arkansas Department of Health, Little Rock, Arkansas, USA (D. Haselow, L. Lester, G. Wheeler, L. Gladden, K. Garner)

Main Article

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.

Main Article

Page created: September 11, 2015
Page updated: September 11, 2015
Page reviewed: September 11, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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