bacillisporus in that 39% of characterized strains are of the MAT a mating type ( 16– 18). In contrast, the MAT a allele is more highly represented in the VGIIIc subtype of C. deuterogattii have an apparent α unequal number of MAT a and MATα isolates, and very few MAT a strains of these species have been isolated from nature or patients ( 15). gattii species complex the mating type locus ( MAT) is a gene cluster containing alleles of one of two idiomorphs, MAT a or MATα, and determines mating compatibility ( 14). Notably, the MAT a allele is underrepresented in all molecular types of the C. For example, multiple molecular subtypes exist in C. Using multi-locus sequence typing (MLST), each lineage can be further divided into additional molecular subtypes. New phylogenetic analyses and other evidence supports that each of the VG types actually represent a different species: C. gattii isolates have been classified as the same species but were separated into five different VG/AFLP molecular types: VGI, VGII, VGIII, VGIV, and AFLP10. gattii to disease is thought to range from 2 to 12 months based on the reported cases of exposure, but may be longer ( 11). gattii establish infection when desiccated yeast cells or spores are inhaled from the environment into the lungs, in some cases causing pneumonia, and then disseminating to the central nervous system to cause meningoencephalitis. neoformans, suggesting that previously unrecognized immune system defects may contribute to disease susceptibility ( 10). A 2014 study associated the presence of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies as a risk factor for central nervous system infections of C. gattii subtypes often infect otherwise healthy subjects and are thought to have more restricted geographical niches ( 9). neoformans, which is dispersed worldwide and infects primarily immunocompromised individuals, certain C. gattii are responsible for the vast majority of human and animal infections. Among the more than 30 Cryptococcus species, C. With the increased mobilization of people, animals, and goods, early recognition among health care providers and the public is an essential component in preventing additional infectious disease cases.Ĭryptococcus is a fungal pathogen responsible for nearly 220,000 human infections per year ( 6- 8). Additionally, international travel exposes tourists to a variety of diseases and infectious agents they may not otherwise encounter, and with antibiotic and antifungal resistance in human pathogens on the rise, the ability to combat infectious diseases is compromised ( 4, 5). Globalization and population expansion have increased the spread of infectious diseases despite strong efforts to counter these threats to public health. Despite modern medical advances and successful efforts to reduce the spread of infectious agents, infectious diseases still account for an estimated 13 million deaths per year, compared to the approximately 40 million non-infectious deaths, the majority of which occur in developing countries ( 2, 3).

tuberculosis and pneumonia) were the leading cause of death 150 years ago, but at the turn of the 21 st century the main cause of death changed from infectious diseases to physiopathological illnesses (e.g. The patient tested positive for anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies, supporting earlier reports that implicate these autoantibodies as a risk factor a risk factor associated with C. gattii infection during his travel to region three years prior and the infection was dormant for an extended period of time before causing disease.

deuterogattii reference strain R265, indicating that the infecting strain is derived from the highly clonal outbreak strains in the PNW. Whole genome sequencing revealed >99.99% identity to the C. gattii species complex and belonging to the C. In agreement with the phenotypic results, MLST provides genotypic evidence that assigns the infecting organism within in the C. Phenotypic evidence shows the fungal mass isolated from the patient’s brain is C. He had traveled to Seattle and Vancouver three years earlier and Costa Rica four months prior to presentation. Here we report a clinical case of a 69-year-old, HIV-negative man from North Carolina who was diagnosed with a fungal brain mass by magnetic resonance imaging (MRI) and pathology. The Pacific Northwest (PNW), Vancouver Island, Oregon, and Washington have been the location of an ongoing Cryptococcus gattii outbreak since the 1990s, and there is evidence that the outbreak is expanding along the West Coast into California.

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