title: Longitudinal clinical findings and outcome among patients with Cryptococcus gattii infection in British Columbia.
abstract: BACKGROUND
  Cryptococcus gattii (Cg) infection emerged in British Columbia in 1999. A longitudinal, clinical description of patients has not been reported.
  
  
  METHODS
  Medical records were reviewed for Cg patients identified through surveillance (1999-2007). Risk factors for Cg mortality were explored using multivariate Cox regression; longitudinal patterns in serum cryptococcal antigen (SCrAg) titers and the probability of chest cryptococcomas over time were estimated using cubic B-splines in mixed-effects regression models.
  
  
  RESULTS
  Among 152 patients, 111 (73.0%) were culture confirmed. Isolated lung infection was present in 105 (69.1%) patients; 47 (30.9%) had central nervous system infection, with or without lung involvement. Malignancy was the provisional diagnosis in 64 (42.1%) patients. Underlying diseases were present in 91 (59.9%) patients; 23 (15.1%) were immunocompromised, and 23 (15.1%) had asymptomatic disease. There were only 2 (1.8%) culture positive relapses, both within 12 months of follow-up. The estimated median time to resolution of lung cryptococcomas and decline in SCrAg titer to <1:8 was 2.8 and 2.9 years, respectively. Cg-related and all-cause mortality among culture-confirmed cases at 12 months' follow-up was 23.3% and 27.2%, respectively. Cg-related mortality was associated with age >50 years (hazard ratio [HR], 15.6; 95% confidence interval [CI], 1.9-130.5) and immunocompromise (HR, 5.8; CI, 1.5-21.6). All Cg-related mortality occurred among culture-positive cases within 1 year of diagnosis.
  
  
  CONCLUSIONS
  Cryptococcomas and serum antigenemia were slow to resolve. However, late onset of failed therapy or relapse was uncommon, suggesting that delayed resolution of these findings does not require prolongation of treatment beyond that recommended by guidelines.
authors: Division of Infectious Diseases, St Paul's Hospital University of British Columbia Division of Infectious Diseases, Vancouver General Hospital.
authors: Peter
authors: P
authors: Phillips
authors: University of British Columbia British Columbia Centre for Disease Control.
authors: Eleni
authors: E
authors: Galanis
authors: British Columbia Centre for Disease Control.
authors: Laura
authors: L
authors: MacDougall
authors: British Columbia Centre for Disease Control.
authors: Mei Y
authors: MY
authors: Chong
authors: British Columbia Centre for Disease Control.
authors: Robert
authors: R
authors: Balshaw
authors: University of British Columbia British Columbia Centre for Disease Control Division of Respirology, University of British Columbia, Vancouver.
authors: Victoria J
authors: VJ
authors: Cook
authors: University of British Columbia Division of Infectious Diseases, Vancouver General Hospital.
authors: William
authors: W
authors: Bowie
authors: University of British Columbia Division of Infectious Diseases, Vancouver General Hospital.
authors: Theodore
authors: T
authors: Steiner
authors: University of British Columbia British Columbia Centre for Disease Control.
authors: Linda
authors: L
authors: Hoang
authors: University of British Columbia British Columbia Centre for Disease Control.
authors: Muhammad
authors: M
authors: Morshed
authors: University of British Columbia Division of Infectious Diseases, Royal Jubilee Hospital, Victoria.
authors: Wayne
authors: W
authors: Ghesquiere
authors: University of British Columbia Division of Infectious Diseases, Nanaimo Regional Hospital.
authors: David M
authors: DM
authors: Forrest
authors: University of British Columbia Department of Microbiology, Vancouver General Hospital.
authors: Diane
authors: D
authors: Roscoe
authors: University of British Columbia Department of Microbiology, Vancouver General Hospital.
authors: Patrick
authors: P
authors: Doyle
authors: University of British Columbia Department of Microbiology.
authors: Pamela C
authors: PC
authors: Kibsey
authors: University of British Columbia Division of Respirology, Royal Jubilee Hospital, Victoria.
authors: Thomas
authors: T
authors: Connolly
authors: University of British Columbia Division of Infectious Diseases, Surrey Memorial Hospital, British Columbia, Canada.
authors: Yazdan
authors: Y
authors: Mirzanejad
authors: British Columbia Centre for Disease Control.
authors: Darby
authors: D
authors: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000946:Antigens, Fungal / Q000097:blood; D001955:British Columbia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003453:Cryptococcosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D056285:Cryptococcus gattii / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008137:Longitudinal Studies; D008168:Lung / Q000000981:diagnostic imaging / Q000469:parasitology*; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000946:Antigens, Fungal
keywords: Cryptococcus gattii; cryptococcal antigen; cryptococcomas; cryptococcosis