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Tropical Illness Reaches Pacific Northwest

Potentially Deadly Fungal Infection Often Strikes Healthy People

By Charlene Laino
WebMD Health News

Reviewed by Louise Chang, MD

Oct. 31, 2008 (Washington D.C.) -- A deadly fungal infection that typically strikes people in tropical climates has found its way to the Pacific Northwest, researchers report.

Since 2004, 19 cases of disease caused by Cryptococcus gattii have been documented in Oregon and Washington, says Sarah West, MD, of Oregon Health and Science University in Portland.

"Unfortunately, their outcomes have been rather poor. About 20% of the patients died, and those who survived were very sick and required prolonged hospitalization," she tells WebMD.

Among the symptoms are confusion, headache, shortness of breath, and cough. Patients are typically treated with the antifungal drugs Vfend or Noxafil, West says.

"We're still trying to figure out the best treatment," she says.

The findings were described at a joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America.

Healthy People Stricken

The outbreak, while relatively small, is noteworthy because about half of the cases occurred in healthy people, says Paul Auwaerter, MD, of Johns Hopkins, who served on the committee that chose which studies to highlight at the meeting.

"Typically, we only see cryptococcal infections in people with compromised immune systems," such as those with AIDS, he tells WebMD.

A Cryptococcus gattii outbreak was also reported in 1999 in Vancouver Island, in British Columbia, Canada. "But none of the patients stricken in Washington and Oregon had prior travel to the island," so the outbreaks appear unrelated," West says.

She adds that doctors do not yet know how the fungus is transmitted.

The outbreak in the Northwest may be only the "the tip of the iceberg. My prediction is that we'll see much more of this," says W. Ian Lipkin, MD, of Columbia University's Mailman School of Public Health in New York City.

Fungal infections are often treated like a stepchild to other infectious diseases, he says.

"There is a larger burden of fungal disease than we currently recognize. Fungal diseases are under-emphasized in the emerging infectious disease portfolio as being not as worthy as viral or bacterial infections, although this view is changing," he says.

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