1
|
Poplin V, Smith C, Caceres DH, Herkert PF, Jegede O, Thompson GR, Baddley JW, Schwartz IS, Kubat R, Deka MA, Toda M, Lockhart SR, Chiller T, Hagen F, Bahr NC. Geographical distribution of the Cryptococcus gattii species complex: a systematic review. THE LANCET. MICROBE 2024:100921. [PMID: 39191262 DOI: 10.1016/s2666-5247(24)00161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 08/29/2024]
Abstract
The taxonomy of the Cryptococcus gattii species complex continues to evolve, and has been divided into five pathogenic species. The objective of this systematic review was to summarise the geographical distribution of the C gattii species complex and the species within the C gattii species complex. We searched PubMed for articles related to human, animal, ecological, or laboratory-based studies of C gattii species complex isolates with traceable geographical origin published from January, 1970, until September, 2021. Having extracted their geographical origin, we used ArcMap to construct maps according to the highest degree of resolution allowed by their reported taxonomy, to reflect the most likely area of transmission on the basis of published reports of human isolates. 604 such articles were included in the study. This review indicated that although C gattii species complex isolates have been reported globally, understanding their heterogeneous geographical distribution by species can have implications for researchers and clinicians in formulating research questions and considering diagnostic quandaries.
Collapse
Affiliation(s)
- Victoria Poplin
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS, USA.
| | - Clarissa Smith
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA; Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Diego H Caceres
- Immuno-Mycologics (IMMY), Norman, OK, USA; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands; Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Patricia F Herkert
- Faculty of Medicine, Centro Universitário de Pato Branco, UNIDEP, Pato Branco, Brazil
| | - Olujimi Jegede
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS, USA
| | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA; Department of Medical Microbiology and Immunology, University of California Davis Medical Center, Sacramento, CA, USA
| | - John W Baddley
- Division of Infectious Diseases, Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA
| | - Ryan Kubat
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS, USA
| | - Mark A Deka
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mitsuru Toda
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas, Kansas City, KS, USA; Division of Infectious Diseases and International Medicine, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
2
|
Coussement J, Heath CH, Roberts MB, Lane RJ, Spelman T, Smibert OC, Longhitano A, Morrissey O, Nield B, Tripathy M, Davis JS, Kennedy KJ, Lynar SA, Crawford LC, Crawford SJ, Smith BJ, Gador-Whyte AP, Haywood R, Mahony AA, Howard JC, Walls GB, O'Kane GM, Broom MT, Keighley CL, Bupha-Intr O, Cooley L, O'Hern JA, Jackson JD, Morris AJ, Bartolo C, Tramontana AR, Grimwade KC, Au Yeung V, Chean R, Woolnough E, Teh BW, Chen SCA, Slavin MA. Current Epidemiology and Clinical Features of Cryptococcus Infection in Patients Without Human Immunodeficiency Virus: A Multicenter Study in 46 Hospitals in Australia and New Zealand. Clin Infect Dis 2023; 77:976-986. [PMID: 37235212 DOI: 10.1093/cid/ciad321] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/02/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Patients without human immunodeficiency virus (HIV) are increasingly recognized as being at risk for cryptococcosis. Knowledge of characteristics of cryptococcosis in these patients remains incomplete. METHODS We conducted a retrospective study of cryptococcosis in 46 Australian and New Zealand hospitals to compare its frequency in patients with and without HIV and describe its characteristics in patients without HIV. Patients with cryptococcosis between January 2015 and December 2019 were included. RESULTS Of 475 patients with cryptococcosis, 90% were without HIV (426 of 475) with marked predominance in both Cryptococcus neoformans (88.7%) and Cryptococcus gattii cases (94.3%). Most patients without HIV (60.8%) had a known immunocompromising condition: cancer (n = 91), organ transplantation (n = 81), or other immunocompromising condition (n = 97). Cryptococcosis presented as incidental imaging findings in 16.4% of patients (70 of 426). The serum cryptococcal antigen test was positive in 85.1% of tested patients (319 of 375); high titers independently predicted risk of central nervous system involvement. Lumbar puncture was performed in 167 patients to screen for asymptomatic meningitis, with a positivity rate of 13.2% where meningitis could have been predicted by a high serum cryptococcal antigen titer and/or fungemia in 95% of evaluable cases. One-year all-cause mortality was 20.9% in patients without HIV and 21.7% in patients with HIV (P = .89). CONCLUSIONS Ninety percent of cryptococcosis cases occurred in patients without HIV (89% and 94% for C. neoformans and C. gattii, respectively). Emerging patient risk groups were evident. A high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.
Collapse
Affiliation(s)
- Julien Coussement
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher H Heath
- Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Washington, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Matthew B Roberts
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | | | - Tim Spelman
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Burnet Institute, Melbourne, Victoria, Australia
- University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | | | - Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Blake Nield
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Monica Tripathy
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Joshua S Davis
- John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Karina J Kennedy
- ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Sarah A Lynar
- Royal Darwin and Palmerston Hospitals, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Lucy C Crawford
- Royal Darwin and Palmerston Hospitals, Darwin, Northern Territory, Australia
| | | | | | | | - Rose Haywood
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | | | - Genevieve B Walls
- Middlemore Hospital, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Gabrielle M O'Kane
- Gosford Hospital, Gosford, New South Wales, Australia
- Wyong Hospital, Hamlyn Terrace, New South Wales, Australia
| | - Matthew T Broom
- North Shore Hospital, Auckland, New Zealand
- Waitakere Hospital, Auckland, New Zealand
| | | | | | | | - Jennifer A O'Hern
- Royal Darwin and Palmerston Hospitals, Darwin, Northern Territory, Australia
- Launceston General Hospital, Launceston, Tasmania, Australia
| | | | | | | | - Adrian R Tramontana
- Western Health, Footscray, Victoria, Australia
- Western Clinical School, Melbourne Medical School, University of Melbourne, St. Albans, Victoria, Australia
| | - Katherine C Grimwade
- Tauranga Hospital, Hauora a Toi Bay of Plenty, Tauranga, New Zealand
- Whakatane Hospital, Hauora a Toi Bay of Plenty, Whakatane, New Zealand
| | | | - Roy Chean
- Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Emily Woolnough
- St. John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
O’Hern JA, Koenen A, Janson S, Hajkowicz KM, Robertson IK, Kidd SE, Baird RW, Tong SYC, Davis JS, Carson P, Currie BJ, Ralph AP. Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. PLoS Negl Trop Dis 2023; 17:e0011162. [PMID: 36877729 PMCID: PMC10019644 DOI: 10.1371/journal.pntd.0011162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/16/2023] [Accepted: 02/12/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Cryptococcus gattii is a globally endemic pathogen causing disease in apparently immune-competent hosts. We describe a 22-year cohort study from Australia's Northern Territory to evaluate trends in epidemiology and management, and outcome predictors. METHODS A retrospective cohort study of all C. gattii infections at the northern Australian referral hospital 1996-2018 was conducted. Cases were defined as confirmed (culture-positive) or probable. Demographic, clinical and outcome data were extracted from medical records. RESULTS 45 individuals with C. gattii infection were included: 44 Aboriginal Australians; 35 with confirmed infection; none HIV positive out of 38 tested. Multifocal disease (pulmonary and central nervous system) occurred in 20/45 (44%). Nine people (20%) died within 12 months of diagnosis, five attributed directly to C. gattii. Significant residual disability was evident in 4/36 (11%) survivors. Predictors of mortality included: treatment before the year 2002 (4/11 versus 1/34); interruption to induction therapy (2/8 versus 3/37) and end-stage kidney disease (2/5 versus 3/40). Prolonged antifungal therapy was the standard approach in this cohort, with median treatment duration being 425 days (IQR 166-715). Ten individuals had adjunctive lung resection surgery for large pulmonary cryptococcomas (median diameter 6cm [range 2.2-10cm], versus 2.8cm [1.2-9cm] in those managed non-operatively). One died post-operatively, and 7 had thoracic surgical complications, but ultimately 9/10 (90%) treated surgically were cured compared with 10/15 (67%) who did not have lung surgery. Four patients were diagnosed with immune reconstitution inflammatory syndrome which was associated with age <40 years, brain cryptococcomas, high cerebrospinal fluid pressure, and serum cryptococcal antigen titre >1:512. CONCLUSION C. gattii infection remains a challenging condition but treatment outcomes have significantly improved over 2 decades, with eradication of infection the norm. Adjunctive surgery for the management of bulky pulmonary C. gattii infection appears to increase the likelihood of durable cure and likely reduces the required duration of antifungal therapy.
Collapse
Affiliation(s)
- Jennifer A. O’Hern
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- * E-mail: (APR); (JAO)
| | - Adrian Koenen
- Department of General Surgery, Royal Darwin Hospital, Darwin, Australia
| | - Sonja Janson
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | | | - Iain K. Robertson
- College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Sarah E. Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
| | - Robert W. Baird
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Department of Health, Darwin, Australia
| | - Steven YC Tong
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joshua S. Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Phillip Carson
- Department of General Surgery, Royal Darwin Hospital, Darwin, Australia
| | - Bart J. Currie
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Anna P. Ralph
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- * E-mail: (APR); (JAO)
| |
Collapse
|
4
|
Sim BZ, Conway L, Smith LK, Fairhead L, Der YS, Payne L, Binotto E, Smith S, Hanson J. The aetiology and clinical characteristics of cryptococcal infections in Far North Queensland, tropical Australia. PLoS One 2022; 17:e0265739. [PMID: 35353860 PMCID: PMC8966997 DOI: 10.1371/journal.pone.0265739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 12/17/2022] Open
Abstract
Cryptococcal infections are an important cause of morbidity and mortality in tropical Australia. This retrospective audit was conducted to characterise the aetiology, temporospatial epidemiology, and clinical course of 49 cryptococcal infections in Far North Queensland between 1 January 1999 and 31 December 2019. Cryptococcus gattii was identified in 15/32 (47%) in whom it was possible to speciate the organism. Among these 15 patients, 13 (87%) had a rural residential address, 10 (67%) were Indigenous Australians and 11 (73%) presented during the May-November dry season. When compared to the 17 patients with Cryptococcus neoformans infection, patients with C. gattii were less likely to be immunocompromised (0/15 versus 8/17 (47%), p = 0.003). Neurosurgery was necessary in 5/15 C. gattii cases and 3/17 (18%) C. neoformans cases (p = 0.42). Outcomes were generally good with 42/49 (86%) cases—and 14/15 (93%) with C. gattii infection—surviving to hospital discharge. These positive outcomes are likely to be explained by the development of standardised treatment guidelines during the study period, low rates of comorbidity in the patients with C. gattii infection and access to liposomal amphotericin and neurosurgical support in the well-resourced Australian healthcare system.
Collapse
Affiliation(s)
- Beatrice Z. Sim
- Department of Medicine, Cairns Hospital, Cairns, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Luke Conway
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Laura K. Smith
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Lee Fairhead
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Yi Shan Der
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Lara Payne
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Enzo Binotto
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
| |
Collapse
|
5
|
Gador‐Whyte AP, Harris J, Gunanayagam K, Walton A, Hughes A, Athan E. Cryptogenic neuropsychiatric presentations diagnostic delay in
Cryptococcus gattii
meningoencephalitis at a regional Australian tertiary hospital. Med J Aust 2022; 216:69-70. [DOI: 10.5694/mja2.51384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | - Eugene Athan
- Barwon Health Geelong VIC
- Deakin University Geelong VIC
| |
Collapse
|
6
|
Gong S, Sivabalan P, Eisen DP. Hearing impairment as an unusual presenting sign of Cryptococcus gattii meningoencephalitis. BMJ Case Rep 2021; 14:14/4/e239040. [PMID: 33863766 PMCID: PMC8055112 DOI: 10.1136/bcr-2020-239040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hearing loss is an unusual presenting feature of Cryptococcus gattii meningoencephalitis. Two cases of HIV-negative patients who presented with hearing loss are discussed and a literature review of published cases was conducted. Possible mechanisms for hearing loss with C. gattii infection are explored. This case series aims to raise awareness among clinicians that hearing loss can be a concerning feature in patients with persistent headache necessitating further investigation.
Collapse
Affiliation(s)
- Sophie Gong
- Internal Medicine, Queensland Health, Brisbane, Queensland, Australia .,Infectious Diseases, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Pirathaban Sivabalan
- Infectious Diseases, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Damon P Eisen
- Infectious Diseases, Townsville Hospital and Health Service, Townsville, Queensland, Australia.,Division of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|