viernes, 25 de junio de 2010

C. gattii infection in Man, Japan, 2007 | CDC EID

EID Journal Home > Volume 16, Number 7–July 2010

Volume 16, Number 7–July 2010
Cryptococcus gattii Genotype VGIIa Infection in Man, Japan, 2007
Koh Okamoto, Shuji Hatakeyama, Satoru Itoyama, Yoko Nukui, Yusuke Yoshino, Takatoshi Kitazawa, Hiroshi Yotsuyanagi, Reiko Ikeda, Takashi Sugita, and Kazuhiko Koike
Author affiliations: University of Tokyo Hospital, Tokyo, Japan (K. Okamoto, S. Hatakeyama, S. Itoyama, Y. Nukui, Y. Yoshino, T. Kitazawa, H. Yotsuyanagi, K. Koike); and Meiji Pharmaceutical University, Tokyo (R. Ikeda, T. Sugita)

Suggested citation for this article

We report a patient in Japan infected with Cryptococcus gattii genotype VGIIa who had no recent history of travel to disease-endemic areas. This strain was identical to the Vancouver Island outbreak strain R265. Our results suggest that this virulent strain has spread to regions outside North America.
Cryptococcus neoformans and C. gattii are closely related species of yeast; C. gattii was previously classified as C. neoformans var. gattii (1). Although both species cause pulmonary or central nervous system infections, they differ in their ecology, epidemiology, and pathobiology. C. neoformans is the most common Cryptococcus spp. worldwide and mainly affects immunocompromised hosts. In contrast, C. gattii mainly affects immunocompetent hosts and often forms mass-like lesions (cryptococcomas).

Multilocus sequence typing can be used to divide this species into 4 molecular genotypes, VGI–VGIV, which differ in epidemiology and virulence (1,2). C. gattii was believed to be restricted to tropical and subtropical areas such as Australia, Southeast Asia, and South America (1). However, in 1999, a C. gattii infection outbreak occurred on Vancouver Island, British Columbia, Canada (3), which has a temperate climate.

During the Vancouver Island outbreak, most human, animal, and environmental isolates obtained belonged to VGIIa (major genotype, 90%–95% of isolates) and VGIIb (minor genotype, 5%–10% of isolates) (2,3). These strains have now spread to mainland British Columbia and the Pacific Northwest region of the United States (1,4,5). The potential for further spread of this strain, particularly the VGIIa genotype, is a serious concern because it is highly virulent in mammals and can infect immunocompetent persons (2).

We report a case of cerebral cryptococcoma caused by C. gattii VGIIa (a strain identical to the Vancouver Island outbreak major genotype strain R265) in a patient from Japan who had no recent travel history to known disease-endemic areas.

The Patient
In 2007, a 44-year-old man (sign painter) from Japan who was not infected with HIV came to the University of Tokyo Hospital with a 2-month history of headache and loss of right-sided vision in both eyes (right homonymous hemianopsia). He had had a diagnosis of hyperglycemia 3 years before admission but had declined to seek medical treatment. His medical history was otherwise unremarkable. He was an ex-smoker who rarely consumed alcohol and was not taking any prescription medications (including corticosteroids or other immunosuppressive drugs). He had traveled to Guam in 1990 and Saipan in 1999 and had no other history of overseas travel. He reported exposure to his dog, and he did not spend time in wilderness areas. The patient often worked near construction sites in urban locations.

When hospitalized, the patient was afebrile and had stable vital signs. Physical examination showed agraphia (inability to write), anarithmia (inability to count numbers), right homonymous hemianopsia, and Romberg sign. Laboratory evaluations showed increased glucose (367 mg/dL) and hemoglobin A1c (10.5%) levels. Results of a complete blood cell count and hepatic and renal function tests were within normal limits. Levels of electrolytes and C-reactive protein were also within normal limits. Results of a test for antibodies to HIV-1/2 were negative.

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C. gattii infection in Man, Japan, 2007 | CDC EID

Suggested Citation for this Article
Okamoto K, Hatakeyama S, Itoyama S, Nukui Y, Yoshino Y, Kitazawa T, et al. Cryptococcus gattii genotype VGIIa infection in man, Japan, 2007. Emerg Infect Dis [serial on the Internet]. 2010 Jul [date cited].

DOI: 10.3201/eid1607.100106

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