642. Public Health Surveillance for Cryptococcus Gattii: An Emerging Disease in the United States Pacific Northwest
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Since 2004, reports of human cryptococcosis caused by the fungal pathogen Cryptococcus gattii (Cg) have increased in the Pacific Northwestern United States (PNW). These reports have followed an ongoing outbreak in British Columbia, Canada (BC), in which at least 218 patients have been infected. In September 2009, CDC and PNW states began passive surveillance to understand the extent of the pathogen’s spread and its epidemiology in the US. 

Methods:

Cases were retrospectively (since 2004) and prospectively identified from clinical laboratories and clinicians. A case was defined as a culture-confirmed infection with Cg in a resident of Washington, Oregon, Idaho, or California. Case report forms, which included data on demographics, symptoms, underlying conditions, and outcome, were collected by state and local health departments. Patient isolates were sent to CDC for species confirmation and subtyping using multi-locus sequence typing.

Results:

As of April 30, 2010, 57 cases were reported to CDC from Oregon (42), Washington (13), Idaho (1), and California (1). Case reports increased annually, from one in 2004 to 15 in 2009. Isolate subtypes included 27 (47%) VGIIa, 19 (33%) VGIIc, six (11%) VGIIb, and three (5%) VGI and two (4%) VGIII. Median patient age was 55 years (range, 15-95); 46% were female. Of 45 patients with data; 38 (83%) had an underlying immunocompromising condition, including a solid organ transplant, HIV, history of cancer, or recent corticosteroid use. Of 43 case-patients with data, 38 (88%) were hospitalized. Of 44 case-patients whose outcome was known, 6 (14%) died with Cg but from another cause; 9 (20%) died of Cg infection.

Conclusion:

Cg is an emerging and serious infection in the PNW. The PNW case-fatality rate is higher than in BC; reasons may be due to a higher frequency of reported underlying conditions or a higher proportion of infections with subtype VGIIa. Continued, expanded surveillance is essential to better characterize the populations at risk.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Julie Harris, PhD, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Shawn Lockhart, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Nicola Marsden-Haug, MPH , Washington State Department of Health, Shoreline, WA
Ron Wohrle, DVM , Washington Department of Health, Olympia, WA
Cyndi Free , Washington Department of Health, Olympia, WA
Emilio DeBess, DVM , Oregon Division of Public Health, Portland, OR
Tom Chiller, MD, MSTMH , Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

J. Harris, None

S. Lockhart, None

N. Marsden-Haug, None

R. Wohrle, None

C. Free, None

E. DeBess, None

T. Chiller, None

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