title: Cryptococcus gattii infection in solid organ transplant recipients: description of Oregon outbreak cases.
abstract: Cryptococcus gattii was recognized as an emerging infection in the Pacific Northwest in 2004. Out of 62 total infections in Oregon since the outbreak, 11 were in solid organ transplant (SOT) recipients. SOT recipients were more likely to have disseminated disease and higher mortality than normal hosts, who mostly had isolated mass lesions. The median time from transplantation to C. gattii diagnosis was 17.8 months. The primary sites of infection were lung (n = 4), central nervous system (n = 3), or both (n = 4). The Oregon-endemic strain, VGII (subtypes IIa and IIc) was present in 10 of 11 patients; the median fluconazole minimum inhibitory concentration (MIC) was 12 μg/mL (range 2-32 μg/mL) for this strain. We found C. gattii infection among organ transplant recipients was disseminated at diagnosis, had low cerebrospinal fluid cryptococcal antigen titers, and was associated with an elevated fluconazole MIC and high attributable mortality.
authors: Division of Infectious Diseases, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
authors: G N
authors: GN
authors: Forrest
authors: Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon, USA.|Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention, Portland, Oregon, USA.
authors: P
authors: P
authors: Bhalla
authors: Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention, Portland, Oregon, USA.
authors: E E
authors: EE
authors: DeBess
authors: Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon, USA.
authors: K L
authors: KL
authors: Winthrop
authors: Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors: S R
authors: SR
authors: Lockhart
authors: Division of Infectious Diseases, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
authors: J
authors: J
authors: Mohammadi
authors: Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention, Portland, Oregon, USA.
authors: P R
authors: PR
authors: Cieslak
mesh_terms: D000946:Antigens, Fungal / Q000134:cerebrospinal fluid*; D003453:Cryptococcosis / Q000175:diagnosis* / Q000382:microbiology; D056285:Cryptococcus gattii / Q000145:classification / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D066027:Transplant Recipients
chemical_list: D000946:Antigens, Fungal; D015725:Fluconazole
keywords: Cryptococcus gattii; antifungals; immunosuppression; organ transplantation