74-Year-Old Man From the Pacific Northwest With Fever and a Lung Mass

Garrett, Laurel; Marr, Kieren A.; West, Sarah; Allada, Gopal

doi:10.1378/chest.10-2964

Cited by 8 publications

(14 citation statements)

References 5 publications

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“…Smoking was also an independent risk factor, occurring in 36% of cases in a recent Australian study (130). Other cases of C. gattii cryptococcosis have been reported in smokers (231,272). Pregnancy has been proposed to be a risk factor, and in two studies, 2 of 26 and 1 of 49 patients were pregnant (29,130); however, the proportion of pregnant patients in a recent Australian study of C. gattii infections was not higher than that in the general female population of reproductive age.…”

Section: Epidemiology Of Human Infectionmentioning

confidence: 93%

“…On Vancouver Island, case-control studies identified an association between underlying lung conditions, including chronic obstructive pulmonary disease (COPD), and C. gattii infection. However, in population analyses, only current smokers (P Ͻ 0.001), not those with a history of COPD or asthma, were more likely to develop infection (231). Smoking was also an independent risk factor, occurring in 36% of cases in a recent Australian study (130).…”

Section: Epidemiology Of Human Infectionmentioning

confidence: 95%

“…In parallel with the emergence of case clusters, an explosion of C. gattii cases were reported, some after travel to areas of western North America where the disease is "newly endemic," including California, and others presenting as autochthonous cases (231,238,240,247,250). Single cases of infection have also been reported in the United States, including New England (85,243,247), New Mexico (272), and Florida (253); Europe (91,95,106,245); Asia, including Japan and Singapore (227,246,249); and South America (223,256).…”

Section: Epidemiology Of Human Infectionmentioning

confidence: 99%

“…In the U.S. outbreak, 31 of 57 (54%) patients developed pneumonia, and 20 of 61 (33%) patients had lung cryptococcomas (132). Patients considered to have acquired their infection in the northwest of North America also presented primarily with lung disease (231,237,240,250). While lung disease is common in Australia, affecting 63 to 67% of cases in three population-based studies, it occurs mostly in association with CNS disease (81% of cases) (28,29,130).…”

Section: Sites Of Infectionmentioning

confidence: 99%

“…Cough, dyspnea, chest pain, and hemoptysis are the most common symptoms of lung involvement, but asymptomatic pulmonary nodules or mass lesions (cryptococcomas) observed on chest X ray or CT scan (see Diagnostics, below) are not uncommon (130,198,240,252). Very large lesions are typical of disease due to C. gattii (215,231) and have been associated with Pancoast syndrome with respiratory stridor (205). Johannson et al reported a patient with lung infection accompanied by systemic symptoms with an unproductive cough and dyspnea (250).…”

Section: Clinical Findingsmentioning

confidence: 99%

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Cryptococcus gattii Infections

2014

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SUMMARY Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans , although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.

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Section: Epidemiology Of Human Infectionmentioning

confidence: 93%

Section: Epidemiology Of Human Infectionmentioning

confidence: 95%

Section: Epidemiology Of Human Infectionmentioning

confidence: 99%

Section: Sites Of Infectionmentioning

confidence: 99%

Section: Clinical Findingsmentioning

confidence: 99%

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Cryptococcus gattii Infections

2014

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Pulmonary Cryptococcosis

Chang

Sorrell

Chen

2015

Semin Respir Crit Care Med

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Inhalation of Cryptococcus into the respiratory system is the main route of acquisition of human infection, yet pulmonary cryptococcosis goes mostly unrecognized by many clinicians. This delay in diagnosis, or misdiagnosis, of lung infections is due in part to frequently subtle clinical manifestations such as a subacute or chronic cough, a broad differential of diagnostic possibilities for associated pulmonary masses (cryptococcomas) and, on occasion, negative respiratory tract cultures. Hematogenous dissemination from the lung can result in protean manifestations, the most severe of which is meningoencephalitis. There are few clinical studies of pulmonary cryptococcosis and its pathogenesis is poorly understood. The main purpose of this review is to describe the epidemiology, clinical presentation, diagnosis, and treatment of pulmonary cryptococcosis to increase clinician's awareness of this diagnostic possibility and to enhance clinical management. Useful pointers to the approach and management of pulmonary cryptococcosis and the implications of disseminated disease are included, together with recommendations for future research.

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