Abstract
To determine whether particular environmental, medical, or behavioral risk factors existed among Cryptcoccus gattii–infected persons compared with the general population, we conducted a sex-matched case−control study on a subset of case-patients in British Columbia (1999–2001). Exposures and underlying medical conditions among all case-patients (1999–2007) were also compared with results of provincial population–based surveys and studies. In case−control analyses, oral steroids (matched odds ratio [MOR] 8.11, 95% confidence interval [CI] 1.74–37.80), pneumonia (MOR 2.71, 95% CI 1.05–6.98), and other lung conditions (MOR 3.21, 95% CI 1.08–9.52) were associated with infection. In population comparisons, case-patients were more likely to be >50 years of age (p<0.001), current smokers (p<0.001), infected with HIV (p<0.001), or have a history of invasive cancer (p<0.001). Although C. gattii is commonly believed to infect persons with apparently healthy immune systems, several immunosuppressive and pulmonary conditions seem to be risk factors.
Highlights
To determine whether particular environmental, medical, or behavioral risk factors existed among Cryptcoccus gattii–infected persons compared with the general population, we conducted a sex-matched case−control study on a subset of case-patients in British Columbia (1999–2001)
Cryptococcus gattii emerged on Vancouver Island, British Columbia (BC), Canada, in 1999, resulting in one of the highest incidences of this infection worldwide [1,2]
HIV status and geographic exposure were included as part of the case definition for patients from whom culture results were unavailable because hospitalization rates had increased sharply in this population group in 1999, signaling the onset of the C. gattii outbreak in British Columbia [2]
Summary
To determine whether particular environmental, medical, or behavioral risk factors existed among Cryptcoccus gattii–infected persons compared with the general population, we conducted a sex-matched case−control study on a subset of case-patients in British Columbia (1999–2001). C. gattii is commonly believed to infect persons with apparently healthy immune systems, several immunosuppressive and pulmonary conditions seem to be risk factors. The natural reservoir of C. gattii seems to be soil and plant debris, and it has been associated with numerous tree species [3,4]. When inhaled, this encapsulated basidiomycetous yeast may infect humans as well as diverse. The risk for disseminated infection among HIV-positive persons with cryptococcal infection was almost 4× higher for those who smoked at the time of diagnosis than for those who did not [17]
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