TABLE 4

Epidemiology and clinical features of major case series of Cryptococcus gattii infection c

ReferenceLocationNo. of patientsSite(s) of infectionHost status(es)Mortality rate (%)Induction antifungal therapyComplication(s) (no. of cases)Sequela(e) (no. or % of survivors with sequela)
218 PNG3 (all children)MeningesIC33cAMB (6 wk)Abnormal mentation (2), papilledema (2), retinal hemorrhage (1)None
213 PNG7 (1 child)MeningesIC43cAMB + 5FC (mean, 7 wk)Papilledema (3), blurred vision (3), deafness (1), seizures (1)Not specified
208 PNG82MeningesICNot statedNot specifiedVisual loss in 52.6% of survivorsVisual loss (52.6%)
209 PNG88MeningesIC34.1Not specifiedNot specifiedNot specified
211 PNG49MeningesIC22.4cAMB + 5FC; total dose of cAMB ranged from 890 mg to 2.4 gPapilledema (26), blurred vision (25), abnormal mentation (12), cranial nerve palsy (10), seizures (7), raised ICP (3/6)Visual loss (31%)
204 NT, Australia18CNS +/− lungPrimarily ICNot specified for C. gattii but 9.1 overallcAMB (range, 0.85 to 5 g)Not specifiedNot specified
27 Australia26CNS (26)IC15cAMB + 5FC (median, 2.4 g cAMB)Papilledema (13), abnormal mentation (8), focal signs (1), seizures (10), hydrocephalus (9)Moderate-to-severe neurological sequelae (8 patients)
28 Australia20Meninges (17), brain (7), lungs (13)IC0Not specified for C. gattii Hydrocephalus (4), focal signs (5)Neurological sequelae (7 patients)
29 Australia47Meninges (27), brain (10), lung (30), skin (3)IC (41), IS (5)Not specified Hydrocephalus (5)Not specified
215 NT, Australia12CNS +/− lung (8), lung only (4)Not specified33cAMB + 5FC (avg, 43 days)Hydrocephalus (at least 3)Not specified
130 Australia86CNS +/− lung (73), lung only (10)IC (62), IS (24)13.6AMB + 5FC (57 patients) (6 wk), FLU (9) (4 wk), AMB + 5FC (7) (2 wk), FLU (2) (not specified)Papilledema (9), abnormal mentation (18), cerebellar deficit (10), limb weakness (6), seizures (5), cranial nerve palsy (13), raised ICP (31; 42%), hydrocephalus (22; 30%)Neurological sequelae (20; 27%) a
98 South Africa46Mostly meningesHIV (29), non-HIV/unknown (18)35.6AMB (14), FLU (32), AMB + FLU (5)
96 Botswana29MeningesHIV (29)17AMB (14 days)
131 Canada3Lung + CNS (1), lung only (2)IC0AMB (1), FLU (2)NoneNone
198 Canada218Lung only (167), CNS only (17), CNS + lung (22), other (2)IC (148), IS (70)8.7 Not specifiedNot specified
230 Canada38 in case-control study b Meninges (10), lung (28)IC (not stated), IS (not stated)
132 USA (Pacific Northwest states)96; 83 outbreak infections, 13 nonoutbreak infectionsMeninges (29), Brain (6), lung (31)IC (62), IS (34)33Not specifiedPapilledema (3/49), blurred vision (9/49), seizures (4/49)
248 USA (non-Pacific Northwest states)25CNS (19), lung (9), CNS only (12), lung only (12), blood (3), leg (1)IC (20), IS (5)24AMB + 5FC (17 patients), AMB (1), FLU (1), unknown (2)Papilloedema (2), blurred vision (8), seizures (1), cranial nerve palsy (5/13), hydrocephalus (4/18)Not specified
239 Vietnam10MeningesHIV negative10cAMB + 5FC (Vietnamese national guidelines)Papilledema (5), abnormal mentation (1), blurred vision (4), focal signs (5)Overall, blindness in 6 patients, deafness in 1 patient, and neurological deficits in 14 patients, but data were not stratified by infecting Cryptococcus species
206 Brazil8UnknownIC (7), IS (HIV infection) (1) Not stratified by cryptococcal speciesNot stratified by cryptococcal species
220 Brazil11CNS alone (9), CNS and lung (2)IC18.2AMB (7), AMB + 5FC (5)Hydrocephalus (6)Blindness (4 patients)
222 Brazil21MeningesHIV (2), non-HIV (19)
221 Brazil25MeningesHIV (4), non-HIV (21)44
256 Brazil7 (previously unreported cases only)MeningesHIV (1), IC (6)14.3AMB only (5), AMB + FLU (2)
251 Brazil4MeningesHIV (2)50
  • a Cranial nerve lesions, epilepsy, memory impairment, and visual field loss.

  • b The case-control study identified oral steroid use, pneumonia, and other lung conditions to be associated with infection. In population comparisons, cases were more likely to be >50 years of age, to be current smokers, to have HIV infection, or to have a history of invasive cancer.

  • c Abbreviations: AMB, amphotericin B formulation; cAMB, conventional amphotericin B deoxycholate; CNS, central nervous system; 5FC, 5-flucytosine; IC, immunocompetent; ICP, intracranial pressure; IS, immunosuppressed; PNG, Papua New Guinea.