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      Ecoepidemiology of Cryptococcus gattii in Developing Countries

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          Abstract

          Cryptococcosis is a systemic infection caused by species of the encapsulated yeast Cryptococcus. The disease may occur in immunocompromised and immunocompetent hosts and is acquired by the inhalation of infectious propagules present in the environment. Cryptococcus is distributed in a plethora of ecological niches, such as soil, pigeon droppings, and tree hollows, and each year new reservoirs are discovered, which helps researchers to better understand the epidemiology of the disease. In this review, we describe the ecoepidemiology of the C. gattii species complex focusing on clinical cases and ecological reservoirs in developing countries from different continents. We also discuss some important aspects related to the antifungal susceptibility of different species within the C. gattii species complex and bring new insights on the revised Cryptococcus taxonomy.

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          Most cited references103

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          Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america.

          Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
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            Phylogenetic species recognition and species concepts in fungi.

            The operational species concept, i.e., the one used to recognize species, is contrasted to the theoretical species concept. A phylogenetic approach to recognize fungal species based on concordance of multiple gene genealogies is compared to those based on morphology and reproductive behavior. Examples where Phylogenetic Species Recognition has been applied to fungi are reviewed and concerns regarding Phylogenetic Species Recognition are discussed.
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              Cryptococcus: from environmental saprophyte to global pathogen.

              Cryptococcosis is a globally distributed invasive fungal infection that is caused by species within the genus Cryptococcus which presents substantial therapeutic challenges. Although natural human-to-human transmission has never been observed, recent work has identified multiple virulence mechanisms that enable cryptococci to infect, disseminate within and ultimately kill their human host. In this Review, we describe these recent discoveries that illustrate the intricacy of host-pathogen interactions and reveal new details about the host immune responses that either help to protect against disease or increase host susceptibility. In addition, we discuss how this improved understanding of both the host and the pathogen informs potential new avenues for therapeutic development.
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                Author and article information

                Journal
                J Fungi (Basel)
                J Fungi (Basel)
                jof
                Journal of Fungi
                MDPI
                2309-608X
                03 November 2017
                December 2017
                : 3
                : 4
                : 62
                Affiliations
                [1 ]Postgraduate Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology, Federal University of Parana, Coronel Francisco Heráclito dos Santos Avenue, Jardim das Américas, 81531-980 Curitiba, Brazil; queiroz.telles@ 123456uol.com.br
                [2 ]CAPES Foundation, Ministry of Education of Brazil, 70040-020 Brasília, Brazil
                [3 ]Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), 6532 SZ Nijmegen, The Netherlands; f.hagen@ 123456gmail.com (F.H.); jacques.meis@ 123456gmail.com (J.F.M.)
                [4 ]Centre of Expertise in Mycology Radboudumc/CWZ, 6532 SZ Nijmegen, The Netherlands
                [5 ]Laboratory of Mycology, Hospital de Clínicas, Federal University of Parana, 80060-000 Curitiba, Brazil; rosangela.lameirapinheiro@ 123456gmail.com (R.L.P.); laboratoriomarisol@ 123456gmail.com (M.D.M.)
                [6 ]Communitarian Health Department, Hospital de Clínicas, Federal University of Parana, 80060-000 Curitiba, Brazil
                Author notes
                [* ]Correspondence: patriciaherkert@ 123456gmail.com ; Tel.: +55-41-3360-1573
                Author information
                https://orcid.org/0000-0002-5068-1102
                Article
                jof-03-00062
                10.3390/jof3040062
                5753164
                29371578
                70a41d66-6d98-4954-899c-3bc5e101af22
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 September 2017
                : 30 October 2017
                Categories
                Review

                cryptococcus,cryptococcosis,reservoirs,developing countries,ecoepidemiology

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