First Contemporary Case of Human Infection with
            <i>Cryptococcus gattii</i>
            in Puget Sound: Evidence for Spread of the Vancouver Island Outbreak

Upton, Arlo; Fraser, James S.; Kidd, Sarah; Bretz, Camille; Bartlett, Karen H.; Heitman, Joseph; Marr, Kieren A.

doi:10.1128/jcm.00593-07

Cited by 79 publications

(90 citation statements)

References 11 publications

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“…C. gattii (serotypes B and C) was originally predominantly found in subtropical regions but a newly recombined serotype B clone has emerged over the past 10 years as a cause of cryptococcal infections in animals and otherwise healthy humans on Vancouver Island [17]. More recently, this epidemic is spreading to the Pacific Northwest of the United States [18,19]. The outbreak clone appears to have descended from two alpha mating-type parents.…”

Section: Classification Of Cryptococcus Neoformans and C Gattiimentioning

confidence: 99%

Phenotypic Switching of Cryptococcus neoformans and Cryptococcus gattii

Jain

Fries

2008

Mycopathologia

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Microorganisms that live in fluctuating environments must constantly adapt their behavior to survive. The host constitutes an important microenvironment in opportunistic and primary fungal pathogens like Cryptococcus neoformans (C. neoformans) and Cryptococcus gattii (C. gattii). In clonal populations, adaptation may be achieved through the generation of diversity. For fungi phenotype switching constitutes a mechanism that allows them to change rapidly. Both C. neoformans and C. gattii undergo phenotypic switching, which allows them to be successful pathogens and cause persistent disease. Similar to other encapsulated microbes that exhibit phenotypic variation, phenotypic switching in Cryptococcus changes the polysaccharide capsule. Most importantly, in animal models phenotypic switching affects virulence and can change the outcome of infection. Virulence changes because C. neoformans and C. gattii switch variants elicit different inflammatory responses in the host. This altered host response can also affect the response to antifungal therapy and in some cases may even promote the selection of switch variants. This review highlights the similarity and difference between phenotypic switching in C. neoformans and C. gattii, the two dominant species that cause cryptococcosis in humans.

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Section: Classification Of Cryptococcus Neoformans and C Gattiimentioning

confidence: 99%

Phenotypic Switching of Cryptococcus neoformans and Cryptococcus gattii

Jain

Fries

2008

Mycopathologia

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“…In parallel with the emergence of case clusters, an explosion of C. gattii cases were reported, some after travel to areas of western North America where the disease is "newly endemic," including California, and others presenting as autochthonous cases (231,238,240,247,250). 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).…”

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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“…Since that time, both human and animal cryptococcoses have been recognized in Washington and Oregon (4,21,29). Many of these cases have been caused by subtype VGIIa, but VGIIb and VGIIc isolates also play a role in this emergence (4).…”

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confidence: 99%

Correlation of Genotype and In Vitro Susceptibilities of Cryptococcus gattii Strains from the Pacific Northwest of the United States

et al. 2010

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Cryptococcus gattii emerged in North America in 1999 as a human and veterinary pathogen on Vancouver Island, British Columbia. The emergent subtype, VGIIa, and the closely related subtype VGIIb can now be found in the United States in Washington, Oregon, and California. We performed multilocus sequence typing and antifungal susceptibility testing on 43 isolates of C. gattii from human patients in Oregon, Washington, California, and Idaho. In contrast to Vancouver Island, VGIIa was the most frequent but not the predominant subtype in the northwest United States. Antifungal susceptibility testing showed statistically significant differences in MICs between the subtypes. This is the first study to apply antifungal susceptibility testing to C. gattii isolates from the Pacific Northwest and the first to make direct comparisons between subtypes.

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First Contemporary Case of Human Infection with Cryptococcus gattii in Puget Sound: Evidence for Spread of the Vancouver Island Outbreak

Cited by 79 publications

References 11 publications

Phenotypic Switching of Cryptococcus neoformans and Cryptococcus gattii

Phenotypic Switching of Cryptococcus neoformans and Cryptococcus gattii

Cryptococcus gattii Infections

Correlation of Genotype and In Vitro Susceptibilities of Cryptococcus gattii Strains from the Pacific Northwest of the United States

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