Peter Phillips1, Eleni Galanis2, Laura MacDougall3, Mei Y Chong3, Robert Balshaw3, Victoria J Cook4, William Bowie5, Theodore Steiner5, Linda Hoang2, Muhammad Morshed2, Wayne Ghesquiere6, David M Forrest7, Diane Roscoe8, Patrick Doyle8, Pamela C Kibsey9, Thomas Connolly10, Yazdan Mirzanejad11, Darby Thompson3. 1. Division of Infectious Diseases, St Paul's Hospital University of British Columbia Division of Infectious Diseases, Vancouver General Hospital. 2. University of British Columbia British Columbia Centre for Disease Control. 3. British Columbia Centre for Disease Control. 4. University of British Columbia British Columbia Centre for Disease Control Division of Respirology, University of British Columbia, Vancouver. 5. University of British Columbia Division of Infectious Diseases, Vancouver General Hospital. 6. University of British Columbia Division of Infectious Diseases, Royal Jubilee Hospital, Victoria. 7. University of British Columbia Division of Infectious Diseases, Nanaimo Regional Hospital. 8. University of British Columbia Department of Microbiology, Vancouver General Hospital. 9. University of British Columbia Department of Microbiology. 10. University of British Columbia Division of Respirology, Royal Jubilee Hospital, Victoria. 11. University of British Columbia Division of Infectious Diseases, Surrey Memorial Hospital, British Columbia, Canada.
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.
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 Cgpatients 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: Peter R Williamson; Joseph N Jarvis; Anil A Panackal; Matthew C Fisher; Síle F Molloy; Angela Loyse; Thomas S Harrison Journal: Nat Rev Neurol Date: 2016-11-25 Impact factor: 42.937
Authors: John W Baddley; Sharon C-A Chen; Carrie Huisingh; Kaitlin Benedict; Emilio E DeBess; Eleni Galanis; Brendan R Jackson; Laura MacDougall; Nicola Marsden-Haug; Hanna Oltean; John R Perfect; Peter Phillips; Tania C Sorrell; Peter G Pappas Journal: Clin Infect Dis Date: 2021-10-05 Impact factor: 20.999