Cryptococcus gattii infections in multiple states outside the US Pacific Northwest

Emerg Infect Dis. 2013 Oct;19(10):1620-6. doi: 10.3201/eid1910.130441.


Clonal VGII subtypes (outbreak strains) of Cryptococcus gattii have caused an outbreak in the US Pacific Northwest since 2004. Outbreak-associated infections occur equally in male and female patients (median age 56 years) and usually cause pulmonary disease in persons with underlying medical conditions. Since 2009, a total of 25 C. gattii infections, 23 (92%) caused by non-outbreak strain C. gattii, have been reported from 8 non-Pacific Northwest states. Sixteen (64%) patients were previously healthy, and 21 (84%) were male; median age was 43 years (range 15-83 years). Ten patients who provided information reported no past-year travel to areas where C. gattii is known to be endemic. Nineteen (76%) patients had central nervous system infections; 6 (24%) died. C. gattii infection in persons without exposure to known disease-endemic areas suggests possible endemicity in the United States outside the outbreak-affected region; these infections appear to differ in clinical and demographic characteristics from outbreak-associated C. gattii. Clinicians outside the outbreak-affected areas should be aware of locally acquired C. gattii infection and its varied signs and symptoms.

Keywords: Cryptococcus; Pacific Northwest; United States; fungal; fungi; gattii; meningitis; pneumonia.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cryptococcosis / immunology
  • Cryptococcosis / microbiology
  • Cryptococcosis / mortality*
  • Cryptococcus gattii / genetics
  • Cryptococcus gattii / immunology*
  • Disease Outbreaks
  • Female
  • Genotype
  • Humans
  • Lung Diseases, Fungal / immunology
  • Lung Diseases, Fungal / microbiology
  • Lung Diseases, Fungal / mortality*
  • Male
  • Middle Aged
  • Phylogeny
  • United States / epidemiology
  • Young Adult