The status of cryptococcosis in Latin America

<div><p>Cryptococcosis is a life-threatening fungal infection caused by the encapsulated yeasts Cryptococcus neoformans and C. gattii, acquired from the environment. In Latin America, as occurring worldwide, C. neoformans causes more than 90% of the cases of cryptococcosis, affecting predominantly patients with HIV, while C. gattii generally affects otherwise healthy individuals. In this region, cryptococcal meningitis is the most common presentation, with amphotericin B and fluconazole being the antifungal drugs of choice. Avian droppings are the predominant environmental reservoir of C. neoformans, while C. gattii is associated with several arboreal species. Importantly, C. gattii has a high prevalence in Latin America and has been proposed to be the likely origin of some C. gattii populations in North America. Thus, in the recent years, significant progress has been made with the study of the basic biology and laboratory identification of cryptococcal strains, in understanding their ecology, population genetics, host-pathogen interactions, and the clinical epidemiology of this important mycosis in Latin America.</p></div

Retrospective Study of the Epidemiology and Clinical Manifestations of <i>Cryptococcus gattii</i> Infections in Colombia from 1997–2011

<div><p>Background</p><p>Cryptococcosis due to <i>Cryptococcus gattii</i> is endemic in various parts of the world, affecting mostly immunocompetent patients. A national surveillance study of cryptococcosis, including demographical, clinical and microbiological data, has been ongoing since 1997 in Colombia, to provide insights into the epidemiology of this mycosis.</p><p>Methodology/Principal Findings</p><p>From 1,209 surveys analyzed between 1997–2011, 45 cases caused by <i>C. gattii</i> were reported (prevalence 3.7%; annual incidence 0.07 cases/million inhabitants/year). Norte de Santander had the highest incidence (0.81 cases/million/year), representing 33.3% of all cases. The male: female ratio was 3.3∶1. Mean age at diagnosis was 41±16 years. No specific risk factors were identified in 91.1% of patients. HIV infection was reported in 6.7% of patients, autoimmune disease and steroids use in 2.2%. Clinical features included headache (80.5%), nausea/vomiting (56.1%) and neurological derangements (48.8%). Chest radiographs were taken in 21 (46.7%) cases, with abnormal findings in 7 (33.3%). Cranial CT scans were obtained in 15 (33.3%) cases, with abnormalities detected in 10 (66.7%). Treatment was well documented in 30 cases, with most receiving amphotericin B. Direct sample examination was positive in 97.7% cases. Antigen detection was positive for all CSF specimens and for 75% of serum samples. <i>C. gattii</i> was recovered from CSF (93.3%) and respiratory specimens (6.6%). Serotype was determined in 42 isolates; 36 isolates were serotype B (85.7%), while 6 were C (14.3%). The breakdowns of molecular types were VGII (55.6%), VGIII (31.1%) and VGI (13.3%). Among 44 strains, 16 MLST sequence types (ST) were identified, 11 of them newly reported.</p><p>Conclusions/Significance</p><p>The results of this passive surveillance study demonstrate that cryptococcosis caused by <i>C. gattii</i> has a low prevalence in Colombia, with the exception of Norte de Santander. The predominance of molecular type VGII is of concern considering its association with high virulence and the potential to evolve into outbreaks.</p></div

Distribution per department of the number, molecular type and STs of <i>Cryptococcus gattii</i> strains recovered in Colombia from 1997 to 2011.

<p>ND  =  ST was not determined.</p

Molecular type, mating type, allele types and sequence types of Colombian <i>Cryptococcus gattii</i> clinical strains.

<p>Note: *New allele or sequence type.</p><p>Molecular type, mating type, allele types and sequence types of Colombian <i>Cryptococcus gattii</i> clinical strains.</p

Clinical manifestations of patients with <i>Cryptococcus gattii</i> cryptococcosis in Colombia, 1997–2011.

<p>Clinical manifestations of patients with <i>Cryptococcus gattii</i> cryptococcosis in Colombia, 1997–2011.</p

Genetic relationship of the <i>Cryptococcus gattii</i> strains causing cryptococcosis in Colombia from 1997 to 2011.

<p>Sequence types identified for the first time in this study are indicated with an asterisk (*).</p

Distribution per year and molecular type of <i>Cryptococcus gattii</i> strains recovered in Colombia from 1997–2011.

<p>Distribution per year and molecular type of <i>Cryptococcus gattii</i> strains recovered in Colombia from 1997–2011.</p

Clinical, microbiological and molecular data of <i>Cryptococcus gattii</i> cryptococcosis cases in Colombia, 1997–2011.

<p>Clinical, microbiological and molecular data of <i>Cryptococcus gattii</i> cryptococcosis cases in Colombia, 1997–2011.</p

Distribution per age and gender of cryptococcosis cases reported in Colombia from 1997 to 2011.

<p>Distribution per age and gender of cryptococcosis cases reported in Colombia from 1997 to 2011.</p