<i>Cryptococcus</i><i> gattii</i> in the United States: Genotypic Diversity of Human and Veterinary Isolates

<div><p>Background</p><p><i>Cryptococcus</i><i>gattii</i> infections are being reported in the United States (US) with increasing frequency. Initially, US reports were primarily associated with an ongoing <i>C</i><i>. gattii</i> outbreak in the Pacific Northwest (PNW) states of Washington and Oregon, starting in 2004. However, reports of <i>C</i><i>. gattii</i> 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.</p> <p>Methodology/Principal Findings</p><p>During 2005–2013, a total of 273 <i>C</i><i>. gattii</i> 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 <i>C</i><i>. gattii</i> 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 MAT<b>a</b>.</p> <p>Conclusions/Significance</p><p>We provide the most comprehensive report to date of genotypic diversity of US <i>C</i><i>. gattii</i> isolates both inside and outside of the PNW. <i>C</i><i>. gattii</i> 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.</p> </div>