First Reported Case of Cryptococcus gattii in the Southeastern USA: Implications for Travel-Associated Acquisition of an Emerging Pathogen

Byrnes, Edmond J.; Li, Wenjun; Lewit, Yonathan; Perfect, John R.; Carter, Dee; Cox, Gary M.; Heitman, Joseph

doi:10.1371/journal.pone.0005851

Cited by 72 publications

(74 citation statements)

References 57 publications

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“…Theories on how these VGII subtypes may have arisen in North America are discussed above (see Epidemiology, Origin, and Evolution, above). Infection outside the Pacific Northwest has been caused by VGI and VGIII (242,243,251,272) as well as by subtype VGIIb and other, nonoutbreak subtypes of VGII (251).…”

Section: Epidemiology Of Human Infectionmentioning

confidence: 99%

Cryptococcus gattii Infections

2014

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SUMMARY Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans , although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.

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Section: Epidemiology Of Human Infectionmentioning

confidence: 99%

Cryptococcus gattii Infections

2014

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“…neoformans, the sibling species Cr. gattii is also a major pathogen, and caused an outbreak of infection on Victoria Island in British Columbia that is gradually spreading into the Pacific Northwest and beyond (39,40,78,127).…”

Section: Cryptococcus Neoformansmentioning

confidence: 99%

Fungal Sex and Pathogenesis

Butler

2010

Clin Microbiol Rev

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SUMMARYHuman fungal pathogens are associated with diseases ranging from dandruff and skin colonization to invasive bloodstream infections. The major human pathogens belong to theCandida,Aspergillus, andCryptococcusclades, and infections have high and increasing morbidity and mortality. Many human fungal pathogens were originally assumed to be asexual. However, recent advances in genome sequencing, which revealed that many species have retained the genes required for the sexual machinery, have dramatically influenced our understanding of the biology of these organisms. Predictions of a rare or cryptic sexual cycle have been supported experimentally for some species. Here, I examine the evidence that human pathogens reproduce sexually. The evolution of the mating-type locus in ascomycetes (includingCandidaandAspergillusspecies) and basidiomycetes (MalasseziaandCryptococcus) is discussed. I provide an overview of how sex is suppressed in different species and discuss the potential associations with pathogenesis.

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“…9 Moreover, since 2009, more than 25 autochthonous (non-outbreak) cases of C. gattii have been documented in other parts of the USA, the most common molecular types being VGI or VGIII. 34–37 Much of our knowledge on cryptococcosis has been derived from studies focused on C. neoformans infection in people with HIV. We now appreciate several unique features of CNS disease caused by C. gattii .…”

Section: Introductionmentioning

confidence: 99%

Management of Cryptococcus gattii meningoencephalitis

Franco‐Paredes

Womack

Bohlmeyer

et al. 2015

The Lancet Infectious Diseases

106

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Cryptococcosis is a fungal disease caused by Cryptococcus neoformans and Cryptococcus gattii. By inhalation and subsequent pulmonary infection, it may disseminate to the CNS and cause meningitis or meningoencephalitis. Most cases occur in immunosuppressed hosts, including patients with HIV/AIDS, patients receiving immunosuppressing drugs, and solid organ transplant recipients. However, cryptococcosis also occurs in individuals with apparently healthy immune systems. A growing number of cases are caused by C. gattii, with infections occurring in both immunosuppressed and immunocompetent individuals. In the majority of documented cases, treatment of C. gattii infection of the CNS requires aggressive management of raised intracranial pressure along with standard antifungal therapy. Early cerebrospinal fluid evacuation is often needed through placement of a percutaneous lumbar drain or ventriculostomy. Furthermore, pharmacological immunosuppression with a high dose of dexamethasone is sometimes needed to ameliorate a persistently increased inflammatory response and to reduce intracranial pressure. In this Grand Round, we present the case of an otherwise healthy adolescent female patient, who, despite aggressive management, succumbed to C. gattii meningoencephalitis. We also present a review of the existing literature and discuss optimum clinical management of meningoencephalitis caused by C. gattii.

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First Reported Case of Cryptococcus gattii in the Southeastern USA: Implications for Travel-Associated Acquisition of an Emerging Pathogen

Cited by 72 publications

References 57 publications

Cryptococcus gattii Infections

Cryptococcus gattii Infections

Fungal Sex and Pathogenesis

Management of Cryptococcus gattii meningoencephalitis

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