First Autochthonous Case of Cryptococcal Meningitis in an Immunocompetent Host Due to Cryptococcus gattii VGIin Northern Italy

Global warming impact on the expansion of fundamental niche of Cryptococcus gattii VGI in Europe

In the present study, we analysed how geographical distribution of the fungal pathogen Cryptococcus gattii VGI in Europe and Mediterranean area has evolved in the last four decades based on the climatic changes, and we tried to predict the scenario for the next decade. Niche modelling by Maxent analysis showed that recent climate changes have significantly affected the distribution of the fungus revealing a gradual expansion of the fundamental niche from 1980 to 2009 followed by an impressive increase in the last decade (2010-2019) during which the environmental surface suitable for the fungal survival was more than doubled. In the next decade, our model predicted an increase in the area of distribution of C. gattii VGI from the coasts of the Mediterranean basin towards the more internal sub-continental areas. On the basis of these predictions, an increase of cases of cryptococcosis due to C. gattii VGI is expected in the next decade and a constant monitoring of the epidemiology of this fungal pathogen represents a crucial strategy to detect the onset of future outbreaks.

First report of cryptococcosis due to Cryptococcus gattii sensu stricto VGI in an Ivorian HIV negative patient

INTRODUCTION

Cryptococcus gattii species complex is endemic to tropical and subtropical regions and is described as a causative agent of cryptococcosis in immunocompetent individuals.

CASE PRESENTATION

We describe the first case of cryptococcosis in a HIV-negative patient from Ivory Coast infected by Cryptococcus gattii sensu stricto VGI. Isolates were recovered from cerebrospinal fluid (CSF) prior to systemic antifungal treatment up to 42 days after detection of the presence of yeasts in the CSF. Eighteen isolates were recovered, genetic diversity and antifungal susceptibility analyses were performed. All the isolates belonged to the Cryptococcus gattii sensu stricto (B;VGI) and were identified as a new sequence type (ST) 553 by Multilocus Sequence Typing (MLST) analyses. Susceptibility testing showed that all the strains had a wild-type phenotype for fluconazole, amphotericin B and flucytosine. Treatment with fluconazole (1200mg/day) was initiated with success.

CONCLUSION

This is the first case report of the presence of C. gattii sensu stricto VGI in a HIV-negative ivorian patient and the second report of the presence of species from the C. gattii complex species in this country.