Cryptococcus gattii: Surveillance for an emerging infection in Oregon and Washington

Passive surveillance in Washington has identified 11 human and 16 animal cases. Active surveillance in Oregon, involving infection control nurses, medical laboratories, and veterinarians, has identified 31 human and 14 animal cases. We analyzed case reports to describe demographic and molecular characteristics in both states. Results: Washington: Of 11 human cases since 2006, 3 (27%) are female. The median age is 48 years (range: 16-76). Six had immunosuppressive conditions, 2 were previous smokers, and 3 had no identifiable risk factors. Three cases were asymptomatic. Eight presented with pneumonia or meningitis; 3 were fatal. The majority reside in northwestern Washington and are genotype VGIIa; however a southwestern Washington case was identified as VGIIc. Animal cases occurring in dogs, cats, porpoises, and birds were characterized by upper respiratory symptoms, subcutaneous nodules, pneumonia, central nervous system and ocular disorders, and lymphadenopathy. Oregon: Thirty-one human cases have been reported since 2005. Of 27 cases, the median age is 57 years (range: 16-95), 44% were female, and all except one resided along the I-5 corridor west of the Cascades. The majority were VGIIc (37%), with 33% identified as VGIIa and 15% VGIIb. Diagnostic samples included cerebrospinal fluid (29%), bronchial lavage (19%), lung tissue (16%), sputum (13%), and other/brain biopsy (22%). Fourteen animal cases have been reported since 2008, 36% of which were feline and 36% were canine. Other reported cases included sheep, elk, alpacas, and a porpoise. Most had respiratory disease, abscesses, chronic weight loss, lymphadenopathy, and, in one case, invasive kidney infection.