Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort.
Background Cryptococcus gattii is a globally endemic pathogen causing disease in apparently immune-competent hosts. We describe a 22-year cohort study from Australia's Northern Territory to evaluate trends in epidemiology and management, and outcome predictors. Methods A retrospective cohort st...
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ftdoajarticles:oai:doaj.org/article:78dd248a68444213967872d9d94409fe 2023-05-15T15:14:50+02:00 Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. Jennifer A O'Hern Adrian Koenen Sonja Janson Krispin M Hajkowicz Iain K Robertson Sarah E Kidd Robert W Baird Steven Yc Tong Joshua S Davis Phillip Carson Bart J Currie Anna P Ralph 2023-03-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0011162 https://doaj.org/article/78dd248a68444213967872d9d94409fe EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0011162 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0011162 https://doaj.org/article/78dd248a68444213967872d9d94409fe PLoS Neglected Tropical Diseases, Vol 17, Iss 3, p e0011162 (2023) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2023 ftdoajarticles https://doi.org/10.1371/journal.pntd.0011162 2023-03-26T01:31:13Z Background Cryptococcus gattii is a globally endemic pathogen causing disease in apparently immune-competent hosts. We describe a 22-year cohort study from Australia's Northern Territory to evaluate trends in epidemiology and management, and outcome predictors. Methods A retrospective cohort study of all C. gattii infections at the northern Australian referral hospital 1996-2018 was conducted. Cases were defined as confirmed (culture-positive) or probable. Demographic, clinical and outcome data were extracted from medical records. Results 45 individuals with C. gattii infection were included: 44 Aboriginal Australians; 35 with confirmed infection; none HIV positive out of 38 tested. Multifocal disease (pulmonary and central nervous system) occurred in 20/45 (44%). Nine people (20%) died within 12 months of diagnosis, five attributed directly to C. gattii. Significant residual disability was evident in 4/36 (11%) survivors. Predictors of mortality included: treatment before the year 2002 (4/11 versus 1/34); interruption to induction therapy (2/8 versus 3/37) and end-stage kidney disease (2/5 versus 3/40). Prolonged antifungal therapy was the standard approach in this cohort, with median treatment duration being 425 days (IQR 166-715). Ten individuals had adjunctive lung resection surgery for large pulmonary cryptococcomas (median diameter 6cm [range 2.2-10cm], versus 2.8cm [1.2-9cm] in those managed non-operatively). One died post-operatively, and 7 had thoracic surgical complications, but ultimately 9/10 (90%) treated surgically were cured compared with 10/15 (67%) who did not have lung surgery. Four patients were diagnosed with immune reconstitution inflammatory syndrome which was associated with age <40 years, brain cryptococcomas, high cerebrospinal fluid pressure, and serum cryptococcal antigen titre >1:512. Conclusion C. gattii infection remains a challenging condition but treatment outcomes have significantly improved over 2 decades, with eradication of infection the norm. Adjunctive surgery for the ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 17 3 e0011162 |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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English |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Jennifer A O'Hern Adrian Koenen Sonja Janson Krispin M Hajkowicz Iain K Robertson Sarah E Kidd Robert W Baird Steven Yc Tong Joshua S Davis Phillip Carson Bart J Currie Anna P Ralph Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Cryptococcus gattii is a globally endemic pathogen causing disease in apparently immune-competent hosts. We describe a 22-year cohort study from Australia's Northern Territory to evaluate trends in epidemiology and management, and outcome predictors. Methods A retrospective cohort study of all C. gattii infections at the northern Australian referral hospital 1996-2018 was conducted. Cases were defined as confirmed (culture-positive) or probable. Demographic, clinical and outcome data were extracted from medical records. Results 45 individuals with C. gattii infection were included: 44 Aboriginal Australians; 35 with confirmed infection; none HIV positive out of 38 tested. Multifocal disease (pulmonary and central nervous system) occurred in 20/45 (44%). Nine people (20%) died within 12 months of diagnosis, five attributed directly to C. gattii. Significant residual disability was evident in 4/36 (11%) survivors. Predictors of mortality included: treatment before the year 2002 (4/11 versus 1/34); interruption to induction therapy (2/8 versus 3/37) and end-stage kidney disease (2/5 versus 3/40). Prolonged antifungal therapy was the standard approach in this cohort, with median treatment duration being 425 days (IQR 166-715). Ten individuals had adjunctive lung resection surgery for large pulmonary cryptococcomas (median diameter 6cm [range 2.2-10cm], versus 2.8cm [1.2-9cm] in those managed non-operatively). One died post-operatively, and 7 had thoracic surgical complications, but ultimately 9/10 (90%) treated surgically were cured compared with 10/15 (67%) who did not have lung surgery. Four patients were diagnosed with immune reconstitution inflammatory syndrome which was associated with age <40 years, brain cryptococcomas, high cerebrospinal fluid pressure, and serum cryptococcal antigen titre >1:512. Conclusion C. gattii infection remains a challenging condition but treatment outcomes have significantly improved over 2 decades, with eradication of infection the norm. Adjunctive surgery for the ... |
format |
Article in Journal/Newspaper |
author |
Jennifer A O'Hern Adrian Koenen Sonja Janson Krispin M Hajkowicz Iain K Robertson Sarah E Kidd Robert W Baird Steven Yc Tong Joshua S Davis Phillip Carson Bart J Currie Anna P Ralph |
author_facet |
Jennifer A O'Hern Adrian Koenen Sonja Janson Krispin M Hajkowicz Iain K Robertson Sarah E Kidd Robert W Baird Steven Yc Tong Joshua S Davis Phillip Carson Bart J Currie Anna P Ralph |
author_sort |
Jennifer A O'Hern |
title |
Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. |
title_short |
Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. |
title_full |
Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. |
title_fullStr |
Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. |
title_full_unstemmed |
Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. |
title_sort |
epidemiology, management and outcomes of cryptococcus gattii infections: a 22-year cohort. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2023 |
url |
https://doi.org/10.1371/journal.pntd.0011162 https://doaj.org/article/78dd248a68444213967872d9d94409fe |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 17, Iss 3, p e0011162 (2023) |
op_relation |
https://doi.org/10.1371/journal.pntd.0011162 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0011162 https://doaj.org/article/78dd248a68444213967872d9d94409fe |
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https://doi.org/10.1371/journal.pntd.0011162 |
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PLOS Neglected Tropical Diseases |
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e0011162 |
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