<i>Cryptococcus gattii</i>, Florida, USA, 2011

Kunadharaju, Rajesh; Choe, Ulyee; Harris, Julie; Lockhart, Shawn R.; Greene, John N.

doi:10.3201/eid1903.121399

Cited by 21 publications

(24 citation statements)

References 8 publications

(8 reference statements)

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“…More recently, C . gattii patients were identified from southern California, Georgia, Rhode Island, New Mexico, Florida, and North Carolina, although the North Carolina patient likely acquired his infection in California [7,26,43–48]. In this study, we identified C .…”

Section: Discussionmentioning

confidence: 95%

“…US cases outside the PNW, especially in California, have been noted in the past [23,26,38–42], but increased awareness of C . gattii infections associated with the PNW outbreak may have increased awareness of and surveillance for cases from other US states [4,43–48]. Here we report the distribution and genotypic variability of 273 human and veterinary isolates of C .…”

Section: Introductionmentioning

confidence: 93%

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Cryptococcus gattii in the United States: Genotypic Diversity of Human and Veterinary Isolates

et al. 2013

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Background Cryptococcus gattii infections are being reported in the United States (US) with increasing frequency. Initially, US reports were primarily associated with an ongoing C . gattii outbreak in the Pacific Northwest (PNW) states of Washington and Oregon, starting in 2004. However, reports of C . gattii infections in patients from other US states have been increasing since 2009. Whether this is due to increasing frequency of disease, greater recognition within the clinical community, or both is currently unknown.Methodology/Principal FindingsDuring 2005–2013, a total of 273 C . gattii isolates from human and veterinary sources in 16 US states were collected. Of these, 214 (78%) were from the Pacific Northwest (PNW) and comprised primarily the clonal C . gattii genotypes VGIIa (64%), VGIIc (21%) and VGIIb (9%). The 59 isolates from outside the PNW were predominantly molecular types VGIII (44%) and VGI (41%). Genotyping using multilocus sequence typing revealed small clusters, including a cluster of VGI isolates from the southeastern US, and an unrelated cluster of VGI isolates and a large cluster of VGIII isolates from California. Most of the isolates were mating type MATα, including all of the VGII isolates, but one VGI and three VGIII isolates were mating type MATa .Conclusions/SignificanceWe provide the most comprehensive report to date of genotypic diversity of US C . gattii isolates both inside and outside of the PNW. C . gattii may have multiple endemic regions in the US, including a previously-unrecognized endemic region in the southeast. Regional clusters exist both in California and the Southeastern US. VGII strains associated with the PNW outbreak do not appear to have spread substantially beyond the PNW.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 93%

Cryptococcus gattii in the United States: Genotypic Diversity of Human and Veterinary Isolates

et al. 2013

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“…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). In Australia, despite heightened awareness, no increase in the number cases has been observed (most large institutions care for 2 to 3 patients annually).…”

Section: Epidemiology Of Human Infectionmentioning

confidence: 93%

“…Byrnes et al described a patient with a cryptococcoma in the thigh, which progressed to disseminated infection despite surgical resection and antifungal therapy (68). Another patient from Florida had disease in the femur together with lung and CNS infection (253). Finally, C. gattii fungemia was detected in 10 patients in one series (130), but its prevalence either alone or in the setting of CNS or other infection is unknown, since blood cultures are not taken routinely.…”

Section: Sites Of 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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“…The majority of isolates in the Pacific Northwest have been of the VGII molecular type (21), which has been found to be more virulent than other cryptococcal molecular type (10,11) and less susceptible to the triazoles (22,23). More-recent evidence has suggested that additional C. gattii molecular types and subtypes may also be prevalent, may be associated with substantial morbidity (4), and may represent a previously unrecognized and ongoing epidemic (6,24,25). Furthermore, it has been proposed that C. gattii and C. neoformans infections represent distinct clinical syndromes (24,26), and regimens for treatment of C. gattii infections longer than those used in C. neoformans infections have demonstrated improved outcomes (27).…”

Section: Discussionmentioning

confidence: 99%

Phenotypic Differences of Cryptococcus Molecular Types and Their Implications for Virulence in a Drosophila Model of Infection

et al. 2014

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f Compared to Cryptococcus neoformans, little is known about the virulence of the molecular types in Cryptococcus gattii. We compared in vitro virulence factor production and survival data using a Drosophila model of infection to further characterize the phenotypic features of different cryptococcal molecular types. Forty-nine different isolates were inoculated into wild-type flies and followed for survival. In vitro, isolates were assessed for growth at 30 and 37°C, melanin production, capsule size, resistance to H 2 O 2 , and antifungal susceptibility. A mediator model was used to assess molecular type and virulence characteristics as predictors of survival in the fly model. VGIII was the most virulent molecular type in flies (P < 0.001). At 30°C, VGIII isolates grew most rapidly; at 37°C, VNI isolates grew best. C. gattii capsules were larger than those of C. neoformans (P < 0.001). Mediator model analysis found a strong correlation of Drosophila survival with molecular type and with growth at 30°C. We found molecular-type-specific differences in C. gattii in growth at different temperatures, melanin production, capsule size, ability to resist hydrogen peroxide, and antifungal susceptibility, while growth at 30°C and the VGIII molecular type were strongly associated with virulence in a Drosophila model of infection.

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Cryptococcus gattii, Florida, USA, 2011

Cited by 21 publications

References 8 publications

Cryptococcus gattii in the United States: Genotypic Diversity of Human and Veterinary Isolates

Cryptococcus gattii in the United States: Genotypic Diversity of Human and Veterinary Isolates

Cryptococcus gattii Infections

Phenotypic Differences of Cryptococcus Molecular Types and Their Implications for Virulence in a Drosophila Model of Infection

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