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

Publication ,  Journal Article
Byrnes, EJ; Li, W; Lewit, Y; Perfect, JR; Carter, DA; Cox, GM; Heitman, J
Published in: PLoS One
June 10, 2009

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.

Duke Scholars

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

June 10, 2009

Volume

4

Issue

6

Start / End Page

e5851

Location

United States

Related Subject Headings

  • Virulence
  • Thigh
  • Southeastern United States
  • Serotyping
  • North Carolina
  • Molecular Epidemiology
  • Middle Aged
  • Male
  • Humans
  • Genotype
 

Citation

APA
Chicago
ICMJE
MLA
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Byrnes, E. J., Li, W., Lewit, Y., Perfect, J. R., Carter, D. A., Cox, G. M., & Heitman, J. (2009). First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen. PLoS One, 4(6), e5851. https://doi.org/10.1371/journal.pone.0005851
Byrnes, Edmond J., Wenjun Li, Yonathan Lewit, John R. Perfect, Dee A. Carter, Gary M. Cox, and Joseph Heitman. “First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen.PLoS One 4, no. 6 (June 10, 2009): e5851. https://doi.org/10.1371/journal.pone.0005851.
Byrnes EJ, Li W, Lewit Y, Perfect JR, Carter DA, Cox GM, et al. First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen. PLoS One. 2009 Jun 10;4(6):e5851.
Byrnes, Edmond J., et al. “First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen.PLoS One, vol. 4, no. 6, June 2009, p. e5851. Pubmed, doi:10.1371/journal.pone.0005851.
Byrnes EJ, Li W, Lewit Y, Perfect JR, Carter DA, Cox GM, Heitman J. First reported case of Cryptococcus gattii in the Southeastern USA: implications for travel-associated acquisition of an emerging pathogen. PLoS One. 2009 Jun 10;4(6):e5851.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

June 10, 2009

Volume

4

Issue

6

Start / End Page

e5851

Location

United States

Related Subject Headings

  • Virulence
  • Thigh
  • Southeastern United States
  • Serotyping
  • North Carolina
  • Molecular Epidemiology
  • Middle Aged
  • Male
  • Humans
  • Genotype