The status of cryptococcosis in Latin America

Abstract

Cryptococcosis is a life-threatening fungal infection caused by the encapsulated yeasts Cryptococcus neoformans and C. gattii, acquired from the environment. In Latin America, as occurring worldwide, C. neoformans causes more than 90% of the cases of cryptococcosis, affecting predominantly patients with HIV, while C. gattii generally affects otherwise healthy individuals. In this region, cryptococcal meningitis is the most common presentation, with amphotericin B and fluconazole being the antifungal drugs of choice. Avian droppings are the predominant environmental reservoir of C. neoformans, while C. gattii is associated with several arboreal species. Importantly, C. gattii has a high prevalence in Latin America and has been proposed to be the likely origin of some C. gattii populations in North America. Thus, in the recent years, significant progress has been made with the study of the basic biology and laboratory identification of cryptococcal strains, in understanding their ecology, population genetics, host-pathogen interactions, and the clinical epidemiology of this important mycosis in Latin America.

Fig. 1. : distribution of Cryptococcus neoformans and C. gattii identified at molecular type level (n = 3486), recovered from clinical, environmentala or veterinary sources in Latin America. Molecular data have been combined from studies reported in Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Uruguay, and Venezuela (Table III). Data from Bolivia, Costa Rica, Dominican Republic, El Salvador, Haiti, Nicaragua, and Panama about the molecular typing of cryptococcal strains has not been reported. a: C. neoformans has been mostly recovered from avian droppings, decaying organic matter, and soil (Casali et al. 2003, Ribeiro et al. 2006, Lugarini et al. 2008, Ribeiro and Ngamskulrungroj 2008, Andrade-Silva et al. 2010, Illnait-Zaragozi et al. 2010a, Souza et al. 2010, Ferreira-Paim et al. 2011, Canónico-González et al. 2013, Castro e Silva et al. 2016). C. gattii is associated with several tree species (Escandón et al. 2006, Trilles et al. 2008, Costa et al. 2009, Refojo et al. 2009, Escandón et al. 2010, Firacative et al. 2011, Mazza et al. 2013, Anzai et al. 2014, Cattana et al. 2014, Brito-Santos et al. 2015, Vélez and Escandón 2017).

Fig. 2. : geographic distribution of Cryptococcus neoformans and C. gattii isolates from Latin America, identified at the molecular type level (n = 3486). Molecular data have been combined from studies reported in Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Uruguay, and Venezuela (Table III). Data from Bolivia, Costa Rica, Dominican Republic, El Salvador, Haiti, Nicaragua, and Panama regarding the molecular typing of cryptococcal strains have not been reported.