Cryptococcus gattii infections in multiple states outside the US Pacific Northwest.

Clonal VGII subtypes (outbreak strains) of Cryptococcus gattii have caused an outbreak in the US Pacific Northwest since 2004. Outbreak-associated infections occur equally in male and female patients (median age 56 years) and usually cause pulmonary disease in persons with underlying medical conditions. Since 2009, a total of 25 C. gattii infections, 23 (92%) caused by non-outbreak strain C. gattii, have been reported from 8 non-Pacific Northwest states. Sixteen (64%) patients were previously healthy, and 21 (84%) were male; median age was 43 years (range 15-83 years). Ten patients who provided information reported no past-year travel to areas where C. gattii is known to be endemic. Nineteen (76%) patients had central nervous system infections; 6 (24%) died. C. gattii infection in persons without exposure to known disease-endemic areas suggests possible endemicity in the United States outside the outbreak-affected region; these infections appear to differ in clinical and demographic characteristics from outbreak-associated C. gattii. Clinicians outside the outbreak-affected areas should be aware of locally acquired C. gattii infection and its varied signs and symptoms.

Boar hunting and brucellosis caused by Brucella suis.

Brucellosis remains as a significant public health concern in many areas where the infection persists in domestic hosts (i.e. goats, cattle, and domestic swine) with subsequent risk of transmission to human populations. Brucellosis caused by B. suis remains an important threat to human populations in many countries exposed to domestic and feral swine. In the U.S., swine brucellosis has been under control for many years. Meanwhile, it is a widespread infection among feral swine, particularly in the Southeastern United States; and exposure to infected animals pose a growing threat to humans. We present the case of a 31-year male hunter who six weeks after a knife injury to his hand while field dressing a wild boar, developed a febrile illness associated with hematologic abnormalities and splenic abscesses caused by Brucella suis infection.

Management of Cryptococcus gattii meningoencephalitis.

Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the CNS and cause meningitis or meningoencephalitis. Most cases occur in immunosuppressed hosts, including patients with HIV/AIDS, patients receiving immunosuppressing drugs, and solid organ transplant recipients. However, cryptococcosis also occurs in individuals with apparently healthy immune systems. A growing number of cases are caused by C gattii, with infections occurring in both immunosuppressed and immunocompetent individuals. In the majority of documented cases, treatment of C gattii infection of the CNS requires aggressive management of raised intracranial pressure along with standard antifungal therapy. Early cerebrospinal fluid evacuation is often needed through placement of a percutaneous lumbar drain or ventriculostomy. Furthermore, pharmacological immunosuppression with a high dose of dexamethasone is sometimes needed to ameliorate a persistently increased inflammatory response and to reduce intracranial pressure. In this Grand Round, we present the case of an otherwise healthy adolescent female patient, who, despite aggressive management, succumbed to C gattii meningoencephalitis. We also present a review of the existing literature and discuss optimum clinical management of meningoencephalitis caused by C gattii.

Cryptococcus gattii: an emerging fungal pathogen in the Southeastern United States.

The authors present a case of severe meningoencephalitis with cryptococcomas and hydrocephalus due to Cryptococcus gattii of the molecular type VGI in an otherwise healthy man native to Southwest Georgia without any history of travel. Clinicians need to be aware of this fungal emerging pathogen in the Southern United States.