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First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen.

Byrnes EJ, Li W, Lewit Y, Perfect JR, Carter DA, Cox GM, Heitman J - PLoS ONE (2009)

Bottom Line: Two clinical isolates, one from a transplant recipient in San Francisco and the other from Australia, were identical to the North Carolina clinical isolate at all markers tested.Closely related isolates that differ at only one or a few noncoding markers are present in the Australian environment.Taken together, these findings support a model in which C. gattii VGI was transferred from Australia to California, possibly though an association with its common host plant E. camaldulensis, and the patient was exposed in San Francisco and returned to present with disease in North Carolina.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC, USA.

ABSTRACT
In 2007, the first confirmed case of Cryptococcus gattii was reported in the state of North Carolina, USA. An otherwise healthy HIV negative male patient presented with a large upper thigh cryptococcoma in February, which was surgically removed and the patient was started on long-term high-dose fluconazole treatment. In May of 2007, the patient presented to the Duke University hospital emergency room with seizures. Magnetic resonance imaging revealed two large CNS lesions found to be cryptococcomas based on brain biopsy. Prior chest CT imaging had revealed small lung nodules indicating that C. gattii spores or desiccated yeast were likely inhaled into the lungs and dissemination occurred to both the leg and CNS. The patient's travel history included a visit throughout the San Francisco, CA region in September through October of 2006, consistent with acquisition during this time period. Cultures from both the leg and brain biopsies were subjected to analysis. Based on phenotypic and molecular methods, both isolates were C. gattii, VGI molecular type, and distinct from the Vancouver Island outbreak isolates. Based on multilocus sequence typing of coding and noncoding regions and virulence in a heterologous host model, the leg and brain isolates are identical, but the two differed in mating fertility. Two clinical isolates, one from a transplant recipient in San Francisco and the other from Australia, were identical to the North Carolina clinical isolate at all markers tested. Closely related isolates that differ at only one or a few noncoding markers are present in the Australian environment. Taken together, these findings support a model in which C. gattii VGI was transferred from Australia to California, possibly though an association with its common host plant E. camaldulensis, and the patient was exposed in San Francisco and returned to present with disease in North Carolina.

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Related in: MedlinePlus

Imaging from diagnosis through recovery depicting the clinical course of C. gattii infection.A) MRI imaging of the upper thigh cryptococcoma. B) CT imaging of a pulmonary nodule, likely to be a cryptococcal granuloma. C–D) MRI imaging of brain cryptococcomas after seizure presentation at the emergency room. E–F) MRI imaging of brain cryptococcomas after long-term fluconazole treatment, with reduced mass.
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pone-0005851-g001: Imaging from diagnosis through recovery depicting the clinical course of C. gattii infection.A) MRI imaging of the upper thigh cryptococcoma. B) CT imaging of a pulmonary nodule, likely to be a cryptococcal granuloma. C–D) MRI imaging of brain cryptococcomas after seizure presentation at the emergency room. E–F) MRI imaging of brain cryptococcomas after long-term fluconazole treatment, with reduced mass.

Mentions: The patient is a 46-year-old male with an unremarkable past medical history who noticed a hard mass on his medial right thigh. The mass enlarged over the course of three weeks, but was not painful, and the patient had no other symptoms. His primary care physician evaluated the mass with a magnetic resonance imaging (MRI) scan, which showed a 5×4×4 centimeter mass in the inner mid right thigh involving the adductor magnus muscle. The mass had mild heterogeneous enhancement on T2 imaging (Figure 1A) and some changes consistent with limited surrounding edema. The radiographic appearance was most consistent with a malignancy, and he underwent further radiographic investigation with chest, abdominal, and pelvic computed tomography (CT) scans.


First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen.

Byrnes EJ, Li W, Lewit Y, Perfect JR, Carter DA, Cox GM, Heitman J - PLoS ONE (2009)

Imaging from diagnosis through recovery depicting the clinical course of C. gattii infection.A) MRI imaging of the upper thigh cryptococcoma. B) CT imaging of a pulmonary nodule, likely to be a cryptococcal granuloma. C–D) MRI imaging of brain cryptococcomas after seizure presentation at the emergency room. E–F) MRI imaging of brain cryptococcomas after long-term fluconazole treatment, with reduced mass.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2689935&req=5

pone-0005851-g001: Imaging from diagnosis through recovery depicting the clinical course of C. gattii infection.A) MRI imaging of the upper thigh cryptococcoma. B) CT imaging of a pulmonary nodule, likely to be a cryptococcal granuloma. C–D) MRI imaging of brain cryptococcomas after seizure presentation at the emergency room. E–F) MRI imaging of brain cryptococcomas after long-term fluconazole treatment, with reduced mass.
Mentions: The patient is a 46-year-old male with an unremarkable past medical history who noticed a hard mass on his medial right thigh. The mass enlarged over the course of three weeks, but was not painful, and the patient had no other symptoms. His primary care physician evaluated the mass with a magnetic resonance imaging (MRI) scan, which showed a 5×4×4 centimeter mass in the inner mid right thigh involving the adductor magnus muscle. The mass had mild heterogeneous enhancement on T2 imaging (Figure 1A) and some changes consistent with limited surrounding edema. The radiographic appearance was most consistent with a malignancy, and he underwent further radiographic investigation with chest, abdominal, and pelvic computed tomography (CT) scans.

Bottom Line: Two clinical isolates, one from a transplant recipient in San Francisco and the other from Australia, were identical to the North Carolina clinical isolate at all markers tested.Closely related isolates that differ at only one or a few noncoding markers are present in the Australian environment.Taken together, these findings support a model in which C. gattii VGI was transferred from Australia to California, possibly though an association with its common host plant E. camaldulensis, and the patient was exposed in San Francisco and returned to present with disease in North Carolina.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, NC, USA.

ABSTRACT
In 2007, the first confirmed case of Cryptococcus gattii was reported in the state of North Carolina, USA. An otherwise healthy HIV negative male patient presented with a large upper thigh cryptococcoma in February, which was surgically removed and the patient was started on long-term high-dose fluconazole treatment. In May of 2007, the patient presented to the Duke University hospital emergency room with seizures. Magnetic resonance imaging revealed two large CNS lesions found to be cryptococcomas based on brain biopsy. Prior chest CT imaging had revealed small lung nodules indicating that C. gattii spores or desiccated yeast were likely inhaled into the lungs and dissemination occurred to both the leg and CNS. The patient's travel history included a visit throughout the San Francisco, CA region in September through October of 2006, consistent with acquisition during this time period. Cultures from both the leg and brain biopsies were subjected to analysis. Based on phenotypic and molecular methods, both isolates were C. gattii, VGI molecular type, and distinct from the Vancouver Island outbreak isolates. Based on multilocus sequence typing of coding and noncoding regions and virulence in a heterologous host model, the leg and brain isolates are identical, but the two differed in mating fertility. Two clinical isolates, one from a transplant recipient in San Francisco and the other from Australia, were identical to the North Carolina clinical isolate at all markers tested. Closely related isolates that differ at only one or a few noncoding markers are present in the Australian environment. Taken together, these findings support a model in which C. gattii VGI was transferred from Australia to California, possibly though an association with its common host plant E. camaldulensis, and the patient was exposed in San Francisco and returned to present with disease in North Carolina.

Show MeSH
Related in: MedlinePlus