Cryptococcus gattii Infections

摘要: Understanding of the taxonomy and phylogeny Cryptococcus gattii has been advanced by modern molecular techniques. C. probably diverged from neoformans between 16 million 160 years ago, depending on dating methods applied, maintains diversity recombining in nature. South America is likely source virulent VGII types that have emerged North America. shares major virulence determinants with neoformans, although genomic transcriptomic studies revealed despite similar genomes, VGIIa VGIIb subtypes employ very different transcriptional circuits manifest differences phenotypes. Preliminary evidence suggests causes severe lung disease death without dissemination, whereas disseminates readily to central nervous system (CNS) meningoencephalitis. Overall, currently available data indicate VGI, VGII, VGIII more commonly affect nonimmunocompromised hosts, contrast VGIV. New, rapid, cheap diagnostic tests imaging modalities are assisting early diagnosis enabling better outcomes cerebral cryptococcosis. Complications CNS infection include increased intracranial pressure, neurological sequelae, development immune reconstitution syndrome, mortality rate low. isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens yet be determined; most cases, initial therapy amphotericin B 5-flucytosine recommended.