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Background The rare occurrence of cryptococcosis caused by Cryptococcus gattii sensu lato (C. gattii s.l.) leads to the difficulties in studying the molecular epidemiology of this globally emerging disease. Objectives To establish the molecular epidemiological profile of C. gattii s.l. in Taiwan, and understand the genetic relationship between locally endemic and global isolates. Methods A nationwide survey on environmental C. gattii s.l. in Taiwan was conducted from 2017 to 2019. The geographic distribution and molecular epidemiology based on multilocus sequence typing (MLST) data of the environmental isolates were compared with 18 previously collected clinical isolates. Phylogenetic analysis was performed to elucidate the genetic relationship between the global isolates and the isolates endemic to Taiwan. Results From a total of 622 environmental samples, 104 (16.7%) were positive for C. gattii s.l.. Seven sequence types were identified among the environmental isolates. The genetic population structure showed that the environmental and clinical isolates were closely linked by sequence types and geographical locations. Phylogenetic analysis revealed the association between the C. gattii s.l. isolates in Taiwan and those from South America and South Asia. The recombination test suggested that, in Taiwan, the C. gattii sensu stricto (C. gattii s.s). isolates undergo clonal reproduction and sexual recombination, whereas C. deuterogattii isolates were clonal. Conclusions The molecular epidemiology of environmental C. gattii s.l. isolates is closely linked to the clinical isolates. Phylogenetic analysis of the environmental isolates provides an insight into the mechanisms underlying reproduction and dispersal of C. gattii s.l. in Taiwan.

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FDG PET/CT imaging has been used in various medical fields, including neoplastic and infectious diseases, for a long time. We reported a 62-year-old man with fever, chronic cough, arthralgia of the left side of the hip, and body weight loss. Chest radiograph showed increased infiltration in both upper lungs, and the acid-fast stain of sputum was positive. Whole-body PET/CT scan revealed a lesion with intense FDG uptake in the joint of the side left of the hip. Osteoarthritis of the hip was initially impressed by an orthopedist. However, tuberculous arthritis was subsequently confirmed by deep pus culture.

Pseudomonas stutzeri (P. stutzeri) is a Gram-negative, non-fermenting rod. It is a rare pathogen; therefore, its isolation is often associated with colonization or contamination. We herein describe the first reported case of necrotizing pneumonia caused by P. stutzeri in a non-HIV infected patient with previously undiagnosed pulmonary tuberculosis. The isolate was found to be antibiotic resistant, which led to the failure of the initial treatment. This case highlights the unique presentation of necrotizing pneumonia caused by P. stutzeri and the importance of emerging antimicrobial resistance in P. stutzeri.