645. Cryptococcus gattii Infections in Non-Immunocompromised Patients in the Northern Territory of Australia
Session: Abstracts: Mycology
Friday, October 22, 2010

The incidence of Cryptococcus infection in the Northern Territory (NT) of Australia is high. Most isolates are C. gattii and tend to occur in immunocompetent, remote-dwelling Indigenous people. Previously reported outcomes were good with adherence to treatment.


The pathology database was searched for all positive cultures for C. gattii and C. neoformans, for all positive latex Cryptococcal antigen tests on serum and cerebrospinal fluid, from 2000-2010. A clinical database was also searched. The medical record was reviewed to ascertain diagnostic, laboratory and outcome data for all cases. Cases were compared with 90 previous published cases from the NT.


20 cases of Cryptococcal infection from were identified in non-immunocompromised patients. 14 (70%) cases were confirmed C. gattii by culture. Three cases were confirmed as C. neoformans. Cases were from both the tropical north and semi-arid centre of the NT. 19 cases (95%) occurred in Aboriginal Australians, a relative risk of 43 compared with non-Aboriginal NT residents. Six (30%) cases had pulmonary infection alone, four (20%) central nervous system alone, and ten (50%) had both sites involved. All cases were treated with conventional or liposomal amphotericin and flucytosine, followed by oral fluconazole. Drug toxicity was common. Three cases underwent lobectomy and four had neurosurgical procedures. Death occurred in five (25%) cases (all culture-confirmed C. gattii, all in Indigenous people). Healthcare-associated infections or other healthcare complications contributed to all deaths. A further 2 (10%) cases had permanent neurological deficit.  


Cryptococcal infection, particularly C. gattii, is common in remote-dwelling NT residents. This concerning mortality rate is higher than previous Northern Territory studies and current data from British Columbia, and suggests an urgent need for further research into the environmental niche, diagnosis and treatment of C.  gattii in remote Northern Australia.

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

Krispin M. Hajkowicz, MBBS, FRACP , Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
Allen C. Cheng, MBBS, FRACP, MPH, PhD , Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Bart J. Currie, FRACP , Menzies School of Health Research, Darwin, Australia


K. M. Hajkowicz, None

A. C. Cheng, None

B. J. Currie, None

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