Cryptococcus gattii molecular type VGII as agent of meningitis in a healthy child in Rio de Janeiro, Brazil: report of an autochthonous case

Abstract

Cryptococcus gattii causes meningoencephalitis in immunocompetent hosts, occurring endemically in some tropical and subtropical regions. Recently, this fungus was involved in an outbreak in Vancouver Island and British Columbia (Canada). In this temperate region, the VGII type is predominant. The paper describes an autochthonous case of meningoencephalitis by C. gattii VGII in a previously health child in Rio de Janeiro, considered nonendemic region of Brazil. The fungus was identified by biochemical tests and the molecular type was determined by URA5-RFLP. The present report highlights the need for clinical vigilance for primary cryptococcal meningitis in nonendemic areas.

Cryptococcus gattii Infections

“…Single cases of infection have also been reported in the United States, including New England (85,243,247), New Mexico (272), and Florida (253); Europe (91,95,106,245); Asia, including Japan and Singapore (227,246,249); and South America (223,256). Most recently, Harris et al reported 25 cases, inclusive of previously described patients (247,253) diagnosed between 2009 and 2012, from Montana, Alabama, California, Hawaii, and Michigan; none of these patients had traveled to areas of C. gattii endemicity (251).…”

“…Pinto Junior et al reported a child residing in Rio de Janeiro with C. gattii genotype VGII infection who had no history of travel outside the city (223). Given that VGII is the predominant molecular type (VGI is uncommon) in north/northeastern Brazil but not in the southern part of the country, those authors postulated that the ecological niche of this genotype may be expanding (223).…”

“…Pinto Junior et al reported a child residing in Rio de Janeiro with C. gattii genotype VGII infection who had no history of travel outside the city (223). Given that VGII is the predominant molecular type (VGI is uncommon) in north/northeastern Brazil but not in the southern part of the country, those authors postulated that the ecological niche of this genotype may be expanding (223). Support for the notion that the niche of the VGII genotype is evolving is the observation of infection caused by molecular type VGIIa in a Japanese patient in Tokyo with no history of travel to an area of known endemicity; VGIIa genotype strains have not previously been documented in Japan (249).…”

“…Small epidemiological studies suggest that C. gattii molecular genotype VGII predominates in infected children in north/northeast Brazil and that VGI is uncommon (221,222). Infection in immunocompetent children in southern and southeastern Brazil has also been reported (223,224,256). Among 16,192 episodes of cryptococcosis (due to both C. neoformans and C. gattii) in predominantly HIV-infected persons in South Africa from 2005 to 2007 (232), a bimodal distribution of infection was noted, with a peak in children Ͻ1 year old and a second peak in those aged 5 to 10 years.…”

Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil)

“…However, C. gattii acts predominantly as a primary pathogen, attacking immunocompetent hosts, including children and young adults in North and Northeast, and is therefore considered endemic to the states of Amazonas (AM), Pará (PA), Roraima, Piauí (PI), Pernambuco and Bahia . The southern and southeastern regions show sporadic infections by C. gattii (Severo et al 2009, Mora et al 2010, Pinto Junior et al 2010). In PI, previous studies have shown that cryptococcosis caused by C. gattii is strongly associated with human immunodeficiency virus (HIV)-negative patients, afflicting a significant portion of children and young adults (Cavalcanti 1995, Martins 2003.…”