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Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest

BACKGROUND: Cryptococcus gattii is a fungal pathogen causing an emerging outbreak in the United States Pacific Northwest (PNW). Treatment guidelines for cryptococcosis are primarily based on data from C. neoformans infections; applicability to PNW C. gattii infection is unknown. We evaluated the rel...

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Autores principales: Smith, Rachel M., Mba-Jonas, Adamma, Tourdjman, Mathieu, Schimek, Trisha, DeBess, Emilio, Marsden-Haug, Nicola, Harris, Julie R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929541/
https://www.ncbi.nlm.nih.gov/pubmed/24586423
http://dx.doi.org/10.1371/journal.pone.0088875
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author Smith, Rachel M.
Mba-Jonas, Adamma
Tourdjman, Mathieu
Schimek, Trisha
DeBess, Emilio
Marsden-Haug, Nicola
Harris, Julie R.
author_facet Smith, Rachel M.
Mba-Jonas, Adamma
Tourdjman, Mathieu
Schimek, Trisha
DeBess, Emilio
Marsden-Haug, Nicola
Harris, Julie R.
author_sort Smith, Rachel M.
collection PubMed
description BACKGROUND: Cryptococcus gattii is a fungal pathogen causing an emerging outbreak in the United States Pacific Northwest (PNW). Treatment guidelines for cryptococcosis are primarily based on data from C. neoformans infections; applicability to PNW C. gattii infection is unknown. We evaluated the relationship between initial antifungal treatment and outcomes for PNW C.gattii patients. METHODS: Cases were defined as culture-confirmed invasive C. gattii infections among residents of Oregon and Washington States during 2004–2011. Clinical data were abstracted from medical records through one year of follow-up. Recommended initial treatment for central nervous system (CNS), bloodstream, and severe pulmonary infections is amphotericin B and 5-flucytosine; for non-severe pulmonary infections, recommended initial treatment is fluconazole. Alternative initial treatment was defined as any other initial antifungal treatment. RESULTS: Seventy patients survived to diagnosis; 50 (71%) received the recommended initial treatment and 20 (29%) received an alternative. Fewer patients with pulmonary infections [21 (64%)] than CNS infections [25 (83%)] received the recommended initial treatment (p = 0.07). Among patients with pulmonary infections, those with severe infections received the recommended initial treatment less often than those with non-severe infections (11% vs. 83%, p<0.0001). Eight patients with severe pulmonary infections received alternative initial treatments; three died. Four patients with non-severe pulmonary infections received alternative initial treatments; two died. There was a trend towards increased three-month mortality among patients receiving alternative vs. recommended initial treatment (30% vs. 14%, p = 0.12), driven primarily by increased mortality among patients with pulmonary disease receiving alternative vs. recommended initial treatment (42% vs. 10%, p = 0.07). CONCLUSIONS: C.gattii patients with pulmonary infections – especially severe infections – may be less likely to receive recommended treatment than those with CNS infections; alternative treatment may be associated with increased mortality. Reasons for receipt of alternative treatment among C.gattii patients in this area should be investigated, and clinician awareness of recommended treatment reinforced.
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spelling pubmed-39295412014-02-25 Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest Smith, Rachel M. Mba-Jonas, Adamma Tourdjman, Mathieu Schimek, Trisha DeBess, Emilio Marsden-Haug, Nicola Harris, Julie R. PLoS One Research Article BACKGROUND: Cryptococcus gattii is a fungal pathogen causing an emerging outbreak in the United States Pacific Northwest (PNW). Treatment guidelines for cryptococcosis are primarily based on data from C. neoformans infections; applicability to PNW C. gattii infection is unknown. We evaluated the relationship between initial antifungal treatment and outcomes for PNW C.gattii patients. METHODS: Cases were defined as culture-confirmed invasive C. gattii infections among residents of Oregon and Washington States during 2004–2011. Clinical data were abstracted from medical records through one year of follow-up. Recommended initial treatment for central nervous system (CNS), bloodstream, and severe pulmonary infections is amphotericin B and 5-flucytosine; for non-severe pulmonary infections, recommended initial treatment is fluconazole. Alternative initial treatment was defined as any other initial antifungal treatment. RESULTS: Seventy patients survived to diagnosis; 50 (71%) received the recommended initial treatment and 20 (29%) received an alternative. Fewer patients with pulmonary infections [21 (64%)] than CNS infections [25 (83%)] received the recommended initial treatment (p = 0.07). Among patients with pulmonary infections, those with severe infections received the recommended initial treatment less often than those with non-severe infections (11% vs. 83%, p<0.0001). Eight patients with severe pulmonary infections received alternative initial treatments; three died. Four patients with non-severe pulmonary infections received alternative initial treatments; two died. There was a trend towards increased three-month mortality among patients receiving alternative vs. recommended initial treatment (30% vs. 14%, p = 0.12), driven primarily by increased mortality among patients with pulmonary disease receiving alternative vs. recommended initial treatment (42% vs. 10%, p = 0.07). CONCLUSIONS: C.gattii patients with pulmonary infections – especially severe infections – may be less likely to receive recommended treatment than those with CNS infections; alternative treatment may be associated with increased mortality. Reasons for receipt of alternative treatment among C.gattii patients in this area should be investigated, and clinician awareness of recommended treatment reinforced. Public Library of Science 2014-02-19 /pmc/articles/PMC3929541/ /pubmed/24586423 http://dx.doi.org/10.1371/journal.pone.0088875 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
spellingShingle Research Article
Smith, Rachel M.
Mba-Jonas, Adamma
Tourdjman, Mathieu
Schimek, Trisha
DeBess, Emilio
Marsden-Haug, Nicola
Harris, Julie R.
Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest
title Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest
title_full Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest
title_fullStr Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest
title_full_unstemmed Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest
title_short Treatment and Outcomes among Patients with Cryptococcus gattii Infections in the United States Pacific Northwest
title_sort treatment and outcomes among patients with cryptococcus gattii infections in the united states pacific northwest
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929541/
https://www.ncbi.nlm.nih.gov/pubmed/24586423
http://dx.doi.org/10.1371/journal.pone.0088875
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