Cluster of<i>Cryptococcus neoformans</i>Infections in Intensive Care Unit, Arkansas, USA, 2013

Vallabhaneni, Snigdha; Haselow, Dirk; Lloyd, Spencer; Lockhart, Shawn R.; Moulton-Meissner, Heather; Lester, Laura; Wheeler, Gary; Gladden, L. Bruce; Garner, Kelley; Derado, Gordana; Park, Benjamin; Harris, Julie

doi:10.3201/eid2110.150249

Cited by 17 publications

(22 citation statements)

References 15 publications

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“…C. neoformans infections are rare in healthy adults; however, this fungal pathogen can cause complications in those with compromised immune systems (i.e., HIV patients) and can be acquired in a healthcare setting. 25 In kinetic kill experiments, N-arylated NH125 analogue 1 led to complete eradication of C. neoformans 66031 cells following 5 and 10 minute treatments at 50 μM (7-log reduction of viable fungal cells; Fig. 3A).…”

Section: Resultsmentioning

confidence: 92%

Rapid kill assessment of anN-arylated NH125 analogue against drug-resistant microorganisms

et al. 2019

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Section: Resultsmentioning

confidence: 92%

Rapid kill assessment of anN-arylated NH125 analogue against drug-resistant microorganisms

et al. 2019

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“…Clinical isolates from the six patients had three separate MLST patterns, suggesting either a point source consisting of multiple cryptococcus strains or an unknown non-point source. 57 The investigation revealed that short-term steroid use was associated with increased risk for cryptococcosis, which had not been previously described for this infection. 57 Thorough investigation of possible outbreaks of hospital-associated IFIs is needed to better understand their sources and to guide prevention measures.…”

Section: Health-care-associated Outbreaksmentioning

confidence: 73%

“…Furthermore, outbreaks often reveal emerging areas of concern that apply to IFIs in general. These topics include IFIs in new populations at risk due to factors such as travel or relocation, occupation, or immunosuppression; 37,39,57 IFIs associated with unusual events and sources such as natural disasters 43,45 and contaminated medications, often with unexpected pathogens; 68,71,72 and fungal pathogens appearing in geographic regions in which they have not been previously recognised. 22,31 …”

Section: Resultsmentioning

confidence: 99%

Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks

Benedict

Richardson

Vallabhaneni

et al. 2017

The Lancet Infectious Diseases

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107

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Several high-profile outbreaks have drawn attention to invasive fungal infections (IFIs) as an increasingly important public health problem. IFI outbreaks are caused by many different fungal pathogens and are associated with numerous settings and sources. In the community, IFI outbreaks often occur among people without predisposing medical conditions and are frequently precipitated by environmental disruption. Health-care-associated IFI outbreaks have been linked to suboptimal hospital environmental conditions, transmission via health-care workers’ hands, contaminated medical products, and transplantation of infected organs. Outbreak investigations provide important insights into the epidemiology of IFIs, uncover risk factors for infection, and identify opportunities for preventing similar events in the future. Well recognised challenges with IFI outbreak recognition, response, and prevention include the need for improved rapid diagnostic methods, the absence of routine surveillance for most IFIs, adherence to infection control practices, and health-care provider awareness. Additionally, IFI outbreak investigations have revealed several emerging issues, including new populations at risk because of travel or relocation, occupation, or immunosuppression; fungal pathogens appearing in geographical areas in which they have not been previously recognised; and contaminated compounded medications. This report highlights notable IFI outbreaks in the past decade, with an emphasis on these emerging challenges in the USA.

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“…Lumbar puncture, therefore, was not performed. Hospital-acquired (48 h or more after admission) pulmonary cryptococcal infections are very rare, with only three cases found in a literature review (Table 1 ) [ 6 , 11 , 12 ]. All reported cases had chronic lung disease, which has been reported as a risk factor for cryptococcal infection [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

An unusual case of reactivated latent pulmonary cryptococcal infection in a patient after short‐term steroid and azathioprine therapy: a case report

Pan

Chen

et al. 2021

BMC Pulm Med

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Background Cryptococcus is one of the major fungal pathogens infecting the lungs. Pulmonary cryptococcal infection is generally considered a community-acquired condition caused by inhalation of dust contaminated with fungal cells from the environment. Here, we report a case developing pulmonary cryptococcosis 3 months after hospital admission, which has rarely been reported before. Case presentation A 73-year-old female patient who was previously immunocompetent experienced persistent dry cough for 2 weeks, 3 months after admission. Chest computed tomography (CT) showed a new solitary pulmonary nodule developed in the upper lobe of the left lung. Staining and culture of expectorated sputum smears were negative for bacteria, acid-fast bacilli, or fungus. The patient then underwent biopsy of the lesion. Histopathology findings and a positive serum cryptococcal antigen titer (1:8) indicated pulmonary cryptococcosis. Daily intravenous 400 mg fluconazole was administered initially followed by oral fluconazole therapy. Follow-up chest CT after 3 months of antifungal therapy showed complete disappearance of the pulmonary nodule. Respiratory symptoms of the patient also resolved. A complete investigation excluded the possibility of a patient-to-patient transmission or primarily acquiring the infection from the hospital environment. Based on the patient’s history of exposure to pigeons before admission and recent steroid and azathioprine use after admission for the treatment of myasthenic crisis, reactivation of a latent pulmonary cryptococcal infection acquired before admission, in this case, is impressed. Conclusions Although rarely reported, pulmonary cryptococcal infection should be included in the differential diagnosis of hospitalized patients with respiratory symptoms, especially in those with predisposing risk factors. Chest image studies and further surgical biopsy are needed for confirmation.

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Cluster ofCryptococcus neoformansInfections in Intensive Care Unit, Arkansas, USA, 2013

Abstract: Use of short-term steroids was a risk factor for infection.

Cited by 17 publications

References 15 publications

Rapid kill assessment of anN-arylated NH125 analogue against drug-resistant microorganisms

Rapid kill assessment of anN-arylated NH125 analogue against drug-resistant microorganisms

Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks

An unusual case of reactivated latent pulmonary cryptococcal infection in a patient after short‐term steroid and azathioprine therapy: a case report

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