Posted on the Pediatric SuperSite on July 23, 2010
U.S. cases of C. gattii coming from the Pacific Northwest
CDC researchers are advising physicians to consider
Cryptococcus gattii as a possible etiology of a
cryptococcal infection among people living in or traveling to the Pacific
Northwest.
The CDC researchers said since Jan. 1, 2004, 60 human
cases of C. gattii have been reported to the CDC, but not all cases were
associated with the C. gattii outbreak on Vancouver Island and in
mainland British Columbia, Canada.
C. gattii is subcategorized into four genotypes:
VGI, VGII, VGIII and VGIV. According to researchers, VGII is most commonly
associated with the United States and British Columbia outbreaks; it is
uncommon in other C. gattii-endemic parts of the world, where VGI is
isolated most frequently. VGII is further broken down into three subtypes:
VGIIa, VGIIb and VGIIc. VGIIa and VGIIc were reported in Oregon in 2004 and
2005; before then, the VGIIc subtype had not been previously found.
The first 14 U.S. cases were reported in Oregon between
2004 and 2007.
In response, in 2008, the CDC, state and local public
health authorities and the British Columbia CDC developed the Cryptococcus
gattii Public Health Working Group. Epidemiologists collected isolates and
sent them to the CDC for genotyping.
In 2009, the group developed a formal surveillance
system housed at the CDC. Included in the system are standardized human and
veterinary case reports, which include questions about patient demographics,
health history and illness onset and course. The reports are completed by state
or local health departments via patient interviews or interviews with family
members.
As of July, 60 human cases from California (n=1), Idaho
(n=1), Oregon (n=43) and Washington (n=15) were reported to the CDC. Travel
history was available for 52 patients, 46 of whom had not traveled to British
Columbia or other C. gattii-endemic areas. Outcomes were known for 45
patients; nine died because of the infection and six died with the infection.
More than half of the patients were male (54%) and the
age range was 15 to 95 years; the highest proportion of patients (45%) were
between the ages of 50 and 69 years. Eighty-one percent of patients for whom
such information was known had an underlying condition, possibly predisposing
them to infection. Three of these patients had HIV infections. Of all 60
isolates, 50% were subtype VGIIa, 32% were VGIIc, 10% were VGIIb, 5% were VGI
and 3% were VGIII. Pneumonia was the most common clinical finding among 57% of
patients.
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