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2014 ; 27
(4
): 980-1024
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Cryptococcus gattii infections
#MMPMID25278580
Chen SC
; Meyer W
; Sorrell TC
Clin Microbiol Rev
2014[Oct]; 27
(4
): 980-1024
PMID25278580
show ga
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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