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The Disease Ecology, Epidemiology, Clinical Manifestations, and Management of Emerging Cryptococcus gattii Complex
1Environmental and Occupational Health Sciences, School of Public Health, Louisiana State University Health Sciences Center (LSUHSC), New Orleans, LA; School of Medicine, Louisiana State University Health Sciences Center (LSUHSC), New Orleans, LA.
Abstract:
Cryptococcus neoformans, a soil-dwelling fungus found worldwide, can cause cryptococcosis, an opportunistic fungal infection of the lungs and central nervous system. One former member of the C neoformans complex, Cryptococcus gattii, has caused meningitis in immunosuppressed and immunocompetent persons in endemic regions in Africa and Asia. Between 1999 and 2004, C gattii caused outbreaks of human cryptococcosis in unexpected, nonendemic, nontropical regions on Vancouver Island, Canada, and throughout the US Pacific Northwest and California. C gattii was recognized as an emerging species with several genotypes and a unique environmental relationship with trees that are often encountered in the wilderness and in landscaped parks. Because C gattii infections have a high case-fatality rate, wilderness medicine clinicians should be aware of this emerging pathogen, its disease ecology and risk factors, its expanding geographic distribution in North America, and its ability to cause fatal disease in both immunosuppressed and immunocompetent persons.
Insights
Cryptococcus gattii, an emerging fungal pathogen, causes severe meningitis in immunocompromised and healthy individuals. This fungus, previously linked to endemic areas, has expanded its range, posing a significant health risk.
Area of Science:
- Mycology
- Infectious Diseases
- Environmental Health
Background:
- Cryptococcus neoformans causes opportunistic infections globally.
- Cryptococcus gattii, a related fungus, causes meningitis in endemic regions.
- C. gattii outbreaks occurred in non-endemic areas of North America (1999-2004).
Purpose of the Study:
- To inform wilderness medicine clinicians about the emerging threat of Cryptococcus gattii.
- To highlight the expanding geographic distribution and disease ecology of C. gattii.
- To emphasize the high fatality rate of C. gattii infections.
Main Methods:
- Literature review on C. gattii epidemiology and clinical manifestations.
- Analysis of outbreak data from North America.
- Review of C. gattii's environmental associations, particularly with trees.
Main Results:
- C. gattii has emerged as a pathogen in non-endemic, non-tropical regions.
- The fungus exhibits distinct genotypes and an association with trees in wilderness and park settings.
- Infections can be fatal in both immunocompromised and immunocompetent individuals.
Conclusions:
- C. gattii is an emerging infectious disease with a widening geographic range.
- Clinicians must recognize C. gattii's risk factors, ecology, and potential for severe outcomes.
- Awareness is crucial for managing C. gattii infections in diverse populations and environments.
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