22 years of Cryptococcus gattii infections: epidemiology, management and outcomes.

What is it about?

Cryptococcus gattii is an environmental fungus responsible for invasive infection, predominately in the central nervous system (CNS) and lungs. We have found First Nations Australians in this region have one of the highest incidences of Cryptococcus gattii infection in the world, with rates possibly increasing. Mortality was associated with end stage kidney disease, diagnosis in earlier years of the study, and unplanned interruptions to intravenous treatment. Whilst mortality improved through the study, neurological disability such as visual or hearing impairment following cure continues to be seen and is associated with brain cryptococcomas and high cerebral spinal fluid (CSF) pressure at diagnosis or during treatment. Blocked CSF shunts are uncommon and concerns of such potential complications should not preclude necessary surgical intervention for persisting increased CSF opening pressures or hydrocephalus which has been associated with poor outcome. Infection recurrence or persistence was associated with large pulmonary cryptococcomas (over 3cm diameter) not undergoing pulmonary surgery and we recommend that surgery be considered for any pulmonary cryptococcoma with a diameter over 2 to 3cm. Eradication of infection can be expected provided there is adequate therapy but may require very prolonged antifungal treatment.

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Photo by Vladimir Haltakov on Unsplash

Photo by Vladimir Haltakov on Unsplash

Why is it important?

There is little evidence to guide the management of Cryptococcus gattii infections and guidelines and recommendations are based on extrapolation from trials in C. neoformans infections, individual case reports and series, and expert opinion. It can cause infection in both immunocompetent and immunocompromised individuals and is known to be accompanied by significant morbidity and mortality. This study is important as it aims to fill some of this evidence gap and provide better guidance for the management of this infection.

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