953. Infections caused by the emerging pathogen Cryptococcus gattii, which often manifests and pneumonia and requires culture for differentiation from the more common C. neoformans, are increasing in frequency in the US
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 227198-1_J Harris Cryptococcus Inf Poster.pdf (2.1 MB)
  • Background:  

    Infections caused by the emerging pathogen Cryptococcus gattii, which often manifests and pneumonia and requires culture for differentiation from the more common C. neoformans, are increasing in frequency in the US.  We conducted a survey using the EIN to learn how US infectious disease physicians recognize, diagnose, and treat cryptococcal infections.

    Methods:  

    During Feb-Mar 2011, web-based surveys were distributed to 1,342 EIN-member infectious disease physicians in four US census regions (West, South, Northeast, and Midwest).

    Results:  

    Of 1,342 survey recipients, 792 (59%) responded; 288 (36%) respondents in 43 states reported seeing cryptococcosis patients in the past year, and the remaining respondents were excluded from further analysis. Higher proportions of respondents from the West (41%), compared with the South (23%), Midwest (27%), or Northeast (29%) reported that >25% of their cryptococcosis patients had cryptococcal pneumonia. Nearly all (95%) respondents reported using a cryptococcal antigen test for diagnosis; 74% obtain a culture. Of 199 respondents who knew if their clinical lab differentiated C. neoformans from C. gattii, 66% responded that their lab differentiates routinely or when requested, and 34% indicated that their lab does not differentiate; this frequency was similar across census regions. A higher frequency of respondents from the West (44%) compared with the Midwest (5%), Northeast (10%), or South (3%) reported having consulted on a patient with C. gattii. No consensus was established on changes in therapy after identifying C. gattii; only 22% of respondents would add flucytosine to the induction regimen, and other changes in treatment were less common.

    Conclusion: 

    C. gattii infections are occurring throughout the country, but are infrequently noted among cryptococcosis patients outside of the West. This may be due to infrequent speciation or true lack of C. gattii disease outside of western states. Although most respondents reported regularly requesting cultures for their cryptococcosis patients, many laboratories reportedly cannot differentiate C. gattii from C. neoformans; this may result in geographically nonspecific underdiagnosis of C. gattii infections. 


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

    Sally Ann Iverson, DVM1, Phillip M. Polgreen, MD2,3, Susan E. Beekmann, RN, MPH2,3, Tom Chiller, MD, MPH4 and Julie Harris, PhD, MPH4, (1)Cornell University College of Veterinary Medicine, Ithaca, NY, (2)Emerging Infections Network, Iowa City, IA, (3)University of Iowa Carver College of Medicine, Iowa City, IA, (4)Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    S. A. Iverson, None

    P. M. Polgreen, None

    S. E. Beekmann, None

    T. Chiller, None

    J. Harris, None

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