We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Retrospective Study of the Epidemiology and Clinical Manifestations of Cryptococcus gattii Infections in Colombia from 1997–2011.
- Authors
Lizarazo, Jairo; Escandón, Patricia; Agudelo, Clara Inés; Firacative, Carolina; Meyer, Wieland; Castañeda, Elizabeth
- Abstract
Background: Cryptococcosis due to Cryptococcus gattii is endemic in various parts of the world, affecting mostly immunocompetent patients. A national surveillance study of cryptococcosis, including demographical, clinical and microbiological data, has been ongoing since 1997 in Colombia, to provide insights into the epidemiology of this mycosis. Methodology/Principal Findings: From 1,209 surveys analyzed between 1997–2011, 45 cases caused by C. gattii were reported (prevalence 3.7%; annual incidence 0.07 cases/million inhabitants/year). Norte de Santander had the highest incidence (0.81 cases/million/year), representing 33.3% of all cases. The male: female ratio was 3.3∶1. Mean age at diagnosis was 41±16 years. No specific risk factors were identified in 91.1% of patients. HIV infection was reported in 6.7% of patients, autoimmune disease and steroids use in 2.2%. Clinical features included headache (80.5%), nausea/vomiting (56.1%) and neurological derangements (48.8%). Chest radiographs were taken in 21 (46.7%) cases, with abnormal findings in 7 (33.3%). Cranial CT scans were obtained in 15 (33.3%) cases, with abnormalities detected in 10 (66.7%). Treatment was well documented in 30 cases, with most receiving amphotericin B. Direct sample examination was positive in 97.7% cases. Antigen detection was positive for all CSF specimens and for 75% of serum samples. C. gattii was recovered from CSF (93.3%) and respiratory specimens (6.6%). Serotype was determined in 42 isolates; 36 isolates were serotype B (85.7%), while 6 were C (14.3%). The breakdowns of molecular types were VGII (55.6%), VGIII (31.1%) and VGI (13.3%). Among 44 strains, 16 MLST sequence types (ST) were identified, 11 of them newly reported. Conclusions/Significance: The results of this passive surveillance study demonstrate that cryptococcosis caused by C. gattii has a low prevalence in Colombia, with the exception of Norte de Santander. The predominance of molecular type VGII is of concern considering its association with high virulence and the potential to evolve into outbreaks. Author Summary: Cryptococcosis is caused by Cryptococcus neoformans and C. gattii, with the most serious manifestation of disease being infection of the central nervous system (CNS). C. neoformans tends to cause disease in immunosuppressed patients, especially those infected with HIV, while C. gattii affects immunocompetent patients preferentially. C. gattii is usually endemic in tropical and subtropical areas. However, highly virulent strains have recently emerged in temperate areas, such as British Columbia in Canada and the Pacific Northwest of the United States. The Colombian national cryptococcal survey characterized the demographic, clinical manifestations and microbiological aspects of C. gattii cryptococcosis. An annual average incidence of infection of 0.07 cases/million inhabitants/year was determined. In contrast, in Norte de Santander the incidence reached 0.81 cases/million inhabitants/year. The national prevalence was 3.7% among all forms of cryptococcosis. Involvement of the CNS (88%) was the commonest clinical manifestation of cryptococcosis. Molecular type VGII, which is the same molecular type as described in the recent outbreaks of this mycosis, was the most prevalent. Overall, clinical C. gattii strains from Colombia showed great genetic diversity. This work contributes to knowledge of the global epidemiology of cryptococcosis and its clinical behavior in Colombian patients.
- Subjects
COLOMBIA; FUNGAL virulence; SYMPTOMS; CENTRAL nervous system infections; CLINICAL epidemiology; Q fever; CRYPTOCOCCUS; CRYPTOCOCCUS neoformans
- Publication
PLoS Neglected Tropical Diseases, 2014, Vol 8, Issue 11, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0003272