Fisher D; Burrow, James; Lo D; Currie BJ

Author(s)

Fisher D

Burrow, James

Lo D

Currie BJ

Publication Date

1993-12-01

Abstract

Infection with Cryptococcus neoformans is common in the Northern Territory of Australia. Disease is life threatening and treatment is prolonged and often complicated by the need for surgery and difficulties with medical therapy. To document incidence, demography, risk factors, clinical features and outcomes of infection and to determine differences between gattii and neoformans varieties. Case records of all patients (n = 35) diagnosed with cryptococcal infection at the Royal Darwin Hospital between 1976 and 1992 were reviewed retrospectively. Current status of patients was ascertained. Variety identification of isolates was determined by growth in canavanine-glycine-bromthymol blue agar. Of the 35 patients, 23 had meningitis, ten had pneumonia, one had a dermal infection and one had fungaemia with no obvious focus. Twelve (52%) meningitis cases and two (20%) pneumonia cases had no predisposing disease. Thirteen (57%) meningitis cases had concomitant pulmonary cryptococcosis. Twenty-nine patients with Aboriginal and six were Caucasian, with a relative risk for Aboriginals compared with non-Aboriginals of 20.6 (95% CI 8.6-49.5). Arnhemland was the commonest location of infection, with an annual incidence in Aboriginals of 0.14/1000. Fourteen (78%) of 18 isolates tested were C. neoformans var. gattii. Management was characterised by the frequent need for adjunctive surgery and prolonged or repeat courses of systemic antifungal therapy. Despite this, long-term outcomes are encouraging with a mortality of 14% overall and 9% in meningitis patients. The river red gum (Eucalyptus camaldulensis) has a limited distribution in Arnhemland and ongoing studies are seeking alternative environmental sources of C. neoformans var. gattii.

Affiliation

Royal Darwin Hospital, Casuarina, NT, Australia..

Citation

Australian and New Zealand journal of medicine 1993-12; 23(6): 678-82

ISSN

0004-8291

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/8141697/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/6907

MESH subject

Adolescent

Adult

Aged

Child

Child, Preschool

Cryptococcus neoformans

Female

Humans

Incidence

Infant

Lung Diseases, Fungal

Male

Meningitis, Fungal

Middle Aged

Northern Territory

Risk Factors

Cryptococcosis

Title

Cryptococcus neoformans in tropical northern Australia: predominantly variant gattii with good outcomes.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Fisher D Burrow, James Lo D Currie BJ
Publication Date	1993-12-01
Abstract	Infection with Cryptococcus neoformans is common in the Northern Territory of Australia. Disease is life threatening and treatment is prolonged and often complicated by the need for surgery and difficulties with medical therapy. To document incidence, demography, risk factors, clinical features and outcomes of infection and to determine differences between gattii and neoformans varieties. Case records of all patients (n = 35) diagnosed with cryptococcal infection at the Royal Darwin Hospital between 1976 and 1992 were reviewed retrospectively. Current status of patients was ascertained. Variety identification of isolates was determined by growth in canavanine-glycine-bromthymol blue agar. Of the 35 patients, 23 had meningitis, ten had pneumonia, one had a dermal infection and one had fungaemia with no obvious focus. Twelve (52%) meningitis cases and two (20%) pneumonia cases had no predisposing disease. Thirteen (57%) meningitis cases had concomitant pulmonary cryptococcosis. Twenty-nine patients with Aboriginal and six were Caucasian, with a relative risk for Aboriginals compared with non-Aboriginals of 20.6 (95% CI 8.6-49.5). Arnhemland was the commonest location of infection, with an annual incidence in Aboriginals of 0.14/1000. Fourteen (78%) of 18 isolates tested were C. neoformans var. gattii. Management was characterised by the frequent need for adjunctive surgery and prolonged or repeat courses of systemic antifungal therapy. Despite this, long-term outcomes are encouraging with a mortality of 14% overall and 9% in meningitis patients. The river red gum (Eucalyptus camaldulensis) has a limited distribution in Arnhemland and ongoing studies are seeking alternative environmental sources of C. neoformans var. gattii.
Affiliation	Royal Darwin Hospital, Casuarina, NT, Australia..
Citation	Australian and New Zealand journal of medicine 1993-12; 23(6): 678-82
ISSN	0004-8291
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/8141697/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/6907
MESH subject	Adolescent Adult Aged Child Child, Preschool Cryptococcus neoformans Female Humans Incidence Infant Lung Diseases, Fungal Male Meningitis, Fungal Middle Aged Northern Territory Risk Factors Cryptococcosis
Title	Cryptococcus neoformans in tropical northern Australia: predominantly variant gattii with good outcomes.
Type of document	Journal Article
Entity Type	Publication

Cryptococcus neoformans in tropical northern Australia: predominantly variant gattii with good outcomes.

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