Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2013 Sep 3;8(9):e74737. doi: 10.1371/journal.pone.0074737. eCollection 2013.
Cryptococcusgattii infections are being reported in the United States (US) with increasing frequency. Initially, US reports were primarily associated with an ongoing C. gattii outbreak in the Pacific Northwest (PNW) states of Washington and Oregon, starting in 2004. However, reports of C. gattii infections in patients from other US states have been increasing since 2009. Whether this is due to increasing frequency of disease, greater recognition within the clinical community, or both is currently unknown.
METHODOLOGY/PRINCIPAL FINDINGS: During 2005-2013, a total of 273 C. gattii isolates from human and veterinary sources in 16 US states were collected. Of these, 214 (78%) were from the Pacific Northwest (PNW) and comprised primarily the clonal C. gattii genotypes VGIIa (64%), VGIIc (21%) and VGIIb (9%). The 59 isolates from outside the PNW were predominantly molecular types VGIII (44%) and VGI (41%). Genotyping using multilocus sequence typing revealed small clusters, including a cluster of VGI isolates from the southeastern US, and an unrelated cluster of VGI isolates and a large cluster of VGIII isolates from California. Most of the isolates were mating type MATα, including all of the VGII isolates, but one VGI and three VGIII isolates were mating type MATa.
CONCLUSIONS/SIGNIFICANCE: We provide the most comprehensive report to date of genotypic diversity of US C. gattii isolates both inside and outside of the PNW. C. gattii may have multiple endemic regions in the US, including a previously-unrecognized endemic region in the southeast. Regional clusters exist both in California and the Southeastern US. VGII strains associated with the PNW outbreak do not appear to have spread substantially beyond the PNW.
隐球菌 gattii 感染在美国（美国）的报道越来越频繁。最初，美国的报告主要与 2004 年开始在华盛顿州和俄勒冈州的太平洋西北地区（PNW）持续发生的 C. gattii 爆发有关。然而，自 2009 年以来，来自美国其他州的 C. gattii 感染患者的报告也在增加。这是由于疾病的频率增加，还是临床社区的认识提高，或者两者兼而有之，目前尚不清楚。
方法/主要发现：在 2005 年至 2013 年间，从美国 16 个州的人类和兽医来源共收集了 273 株 C. gattii 分离株。其中，214 株（78%）来自太平洋西北地区（PNW），主要包括克隆 C. gattii 基因型 VGIIa（64%）、VGIIc（21%）和 VGIIb（9%）。来自 PNW 以外的 59 株分离株主要是分子类型 VGIII（44%）和 VGI（41%）。使用多位点序列分型的基因分型显示出小的聚类，包括来自美国东南部的 VGI 分离株的聚类，以及一个不相关的 VGI 分离株聚类和加利福尼亚的 VGIII 分离株的大聚类。大多数分离株是交配型 MATα，包括所有的 VGII 分离株，但一个 VGI 和三个 VGIII 分离株是交配型 MATa。
结论/意义：我们提供了迄今为止最全面的美国 C. gattii 分离株基因型多样性报告，包括 PNW 内外的分离株。隐球菌 gattii 在美国可能有多个地方流行，包括东南部以前未被认识到的流行地区。加利福尼亚和美国东南部都存在区域聚类。与 PNW 爆发相关的 VGII 菌株似乎没有在 PNW 以外的地区大量传播。
