Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Infect Dis. 2011 Dec;53(12):1188-95. doi: 10.1093/cid/cir723. Epub 2011 Oct 19.
Cryptococcus gattii (Cg) has caused increasing infections in the US Pacific Northwest (PNW) since 2004. We describe this outbreak and compare clinical aspects of infection in the United States among patients infected with different Cg genotypes.
Beginning in 2005, PNW state health departments conducted retrospective and prospective passive surveillance for Cg infections, including patient interviews and chart reviews; clinical isolates were genotyped at the US Centers for Disease Control and Prevention (CDC). We examined symptom frequency and underlying conditions in US patients with Cg infection and modeled factors associated with death.
From 1 December 2004 to July 2011, 96 Cg infections were reported to the CDC. Eighty-three were in patients in or travelers to the PNW, 78 of which were genotypes VGIIa, VGIIb, or VGIIc (outbreak strains). Eighteen patients in and outside the PNW had other molecular type Cg infections (nonoutbreak strains). Patients with outbreak strain infections were more likely than those with nonoutbreak-strain infections to have preexisting conditions (86% vs 31%, respectively; P < .0001) and respiratory symptoms (75% vs 36%, respectively; P = .03) and less likely to have central nervous system (CNS) symptoms (37% vs 90%, respectively; P = .008). Preexisting conditions were associated with increased pneumonia risk and decreased risk of meningitis and CNS symptoms. Nineteen (33%) of 57 patients died. Past-year oral steroid use increased odds of death in multivariate analysis (P = .05).
Clinical differences may exist between outbreak-strain (VGIIa, VGIIb, and VGIIc) and nonoutbreak-strain Cg infections in the United States. Clinicians should have a low threshold for testing for Cg, particularly among patients with recent travel to the PNW.
自 2004 年以来，隐球菌（Cryptococcus gattii，Cg）在美国太平洋西北地区（PNW）导致的感染不断增加。我们描述了此次暴发，并比较了美国不同 Cg 基因型感染患者的临床特征。
自 2005 年起，PNW 州卫生部门对 Cg 感染进行了回顾性和前瞻性被动监测，包括对患者进行访谈和病历审查；美国疾病控制与预防中心（CDC）对临床分离株进行基因分型。我们研究了美国 Cg 感染患者的症状发生频率和基础疾病，并建立了与死亡相关的因素模型。
2004 年 12 月 1 日至 2011 年 7 月，CDC 共报告了 96 例 Cg 感染。其中 83 例发生在 PNW 地区或到过该地区的旅行者中，78 例为 VGIIa、VGIIb 或 VGIIc 基因型（暴发株）。PNW 地区内外的 18 例患者患有其他分子类型 Cg 感染（非暴发株）。与非暴发株感染患者相比，暴发株感染患者更有可能存在基础疾病（分别为 86%和 31%，P<0.0001）和呼吸系统症状（分别为 75%和 36%，P=0.03），较少出现中枢神经系统（CNS）症状（分别为 37%和 90%，P=0.008）。基础疾病与肺炎风险增加和脑膜炎及 CNS 症状风险降低相关。57 例患者中有 19 例（33%）死亡。多变量分析显示，过去 1 年中使用口服皮质类固醇会增加死亡的风险（P=0.05）。
在美国，暴发株（VGIIa、VGIIb 和 VGIIc）与非暴发株 Cg 感染之间可能存在临床差异。对于最近到过 PNW 的患者，临床医生应高度怀疑 Cg 感染，及时进行检测。
