Cited by 531Fungal Infections and StudiesYeasts and Rust Fungi StudiesBacterial Infections and Vaccines

The DOI matches its Crossref record; 256 of the 257 references it cites were found in a registry or an index; none of the 178 sources its claims cite is checked for support yet.

Cryptococcus neoformans and Cryptococcus gattii, the Etiologic Agents of Cryptococcosis

Open access
Kwon-Chung, K. J., Fraser, J. A., Doering, T. L., Wang, Z. A., Janbon, G., Idnurm, A., Bahn, Y.-S.·2014·Cold Spring Harbor Perspectives in Medicine

Abstract

Cryptococcus neoformans and Cryptococcus gattii are the two etiologic agents of cryptococcosis.They belong to the phylum Basidiomycota and can be readily distinguished from other pathogenic yeasts such as Candida by the presence of a polysaccharide capsule, formation of melanin, and urease activity, which all function as virulence determinants.Infection proceeds via inhalation and subsequent dissemination to the central nervous system to cause meningoencephalitis.The most common risk for cryptococcosis caused by C. neoformans is AIDS, whereas infections caused by C. gattii are more often reported in immunocompetent patients with undefined risk than in the immunocompromised.There have been many chapters, reviews, and books written on C. neoformans.The topics we focus on in this article include species description, pathogenesis, life cycle, capsule, and stress response, which serve to highlight the specializations in virulence that have occurred in this unique encapsulated melanin-forming yeast that causes global deaths estimated at more than 600,000 annually. HISTORY OF THE ETIOLOGIC AGENTS AND CRYPTOCOCCOSISC ryptococcus neoformans was first isolated from peach juice by Sanfelice in 1894 in Italy and was named Saccharomyces neoformans (Sanfelice 1894).In the same year, Busse provided the first description of a case of cryptococcosis (Busse 1894) and isolated a yeast culture from a sarcoma-like lesion in the infected young woman's tibia.Busse called the fungus Saccharomyces, while naming the disease Sac-

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes the biology, taxonomy, ecology, epidemiology, pathogenesis, and virulence determinants of *Cryptococcus neoformans* and *Cryptococcus gattii*, the two agents of cryptococcosis. It emphasizes the three classical virulence traits — polysaccharide capsule, melanin formation, and growth at mammalian body temperature — along with newer work on sensing/signaling and stress-response pathways.

Key findings

  • Cryptococcosis is acquired by inhalation of desiccated yeast cells or basidiospores (1.5–3.5 µm), which reach the distal airways; in immunocompromised hosts the fungus disseminates hematogenously across the blood–brain barrier to cause meningoencephalitis, which is uniformly fatal if untreated. The global burden is estimated at close to 1 million cases with 700,000 deaths annually (Park et al. 2009); the abstract cites global deaths estimated at more than 600,000 annually.
  • *C. neoformans* infection is predominantly associated with AIDS and other immunocompromising conditions, whereas *C. gattii* infection occurs more often in immunocompetent patients; pulmonary infection is considerably more common with *C. gattii*, and mouse studies show *C. neoformans*-infected mice die of CNS infection while *C. gattii*-infected mice die of pulmonary infection.
  • Worldwide, *C. neoformans* molecular type VNI predominates (63% of isolates), followed by VNII/VNIII (6% each) and VNIV (5%); *C. gattii* accounts for <20% of cryptococcosis globally, with VGI most common (9%), then VGII (7%), VGIII (3%), and VGIV (1%) among 2046 isolates.
  • Azole heteroresistance, caused by reversible disomy of chromosomes containing resistance genes (chromosome 1 always duplicating first, then chromosome 4 and others stepwise), is suggested to be the most common cause of azole treatment failure during suppression therapy in AIDS patients.

Methods

  • Narrative review article (Cold Spring Harbor Perspectives in Medicine) synthesizing historical, taxonomic, ecological, epidemiological, and molecular literature on *C. neoformans* and *C. gattii*.
  • No primary data collection; the paper compiles findings from cited studies, including molecular typing, genome comparisons, animal infection models, and clinical/epidemiological surveys.
  • Topics covered include species description, pathogenesis, life cycle, capsule, melanin, thermotolerance, degradation enzymes, metal/gas/light sensing, and stress-signaling pathways (HOG, Mpk1, calcineurin, cAMP/PKA, UPR).

Limitations

  • The paper states that a consensus on how to treat the *C. neoformans*/*C. gattii* species complex taxonomically has yet to be achieved, and that elevating the eight major haploid molecular types to species status is controversial.
  • The paper notes that understanding of the host response to cryptococci is mostly based on animal data, and that the genetic basis of capsule size regulation has not been elucidated; the glycosyltransferases mediating capsule synthesis are largely uncharacterized.
  • Evident from the text: several statements rest on single or few cited studies (e.g., the GM-CSF autoantibody finding in immunocompetent *C. gattii* patients), and the review repeatedly flags open questions (e.g., whether light-sensing mutants' virulence defect relates to known traits, whether ROS/RNS events in *C. gattii* occur in *C. neoformans*).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1101/cshperspect.a019760

Cites

256 of 256 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 178 cited sources checked · 0 supported · 0 flagged

Show all 107 claims

  • Probably not a substantial claim. 29
  • It may state two separate claims as one. 67
85 of 85
  • The paper relies on this without support.

    The ability to grow at 37°C is essential for any microbial pathogen to cause invasive disease.

    “Although the ability to grow at 37 ˚C is not sufficient by itself to be a mammalian pathogen, it is essential for any microbial pathogen to be able to cause invasive disease.”
  • The paper relies on this without support.

    Iron can be either limiting or in excess in a host depending on health status.

    “Iron can be either limiting or in excess in a host depending on health status.”
  • The paper relies on this without support.

    O2 and CO2 vary in concentration in different parts of the body, lower or higher, respectively, than the natural environment in which Cryptococcus species reside.

    “O 2 and CO 2 vary in concentration in different parts of the body, lower or higher, respectively, than the natural environment in which Cryptococcus species reside.”
  • The paper relies on this without support.

    There are a number of genetically diverged subspecies within each agent of cryptococcosis.

    “There are a number of genetically diverged subspecies within each agent of cryptococcosis.”
  • The paper relies on this without support.

    Upon entering the host, Cryptococcus is subjected to drastic changes in CO2 levels from 0.0036% (ambient air) to 5%.

    “Finally, upon entering the host, Cryptococcus is subjected to drastic changes in CO 2 levels from 0.0036% (ambient air) to 5%.”
5 of 5

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Citations

Cites

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Show all 257 references

1 of the 257 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Kurtzman CP, Fell JW, Boekhout T), pp. 1661-1745. Elsevier, Amsterdam.
  2. Hsueh YP, Lin X, Kwon-Chung KJ, Heitman J. 2011b. Sexual reproduction of Cryptococcus. In Cryptococcus: From hu- man pathogen to model yeast (ed. Heitman J, et al.), pp. 81-96. ASM, Washington, DC.
  3. Mitchell TG, Castaneda E, Niersen K, Wanke BMSL. 2011. Environmental niches for Cryptococcus neoformans and Cryptococcus gattii. In Cryptococcus: From human patho- gen to model yeast (ed. Heitman J, et al.), pp. 237-259.
  4. Perfect JR. 2010. Cryptococcus neoformans In Principles and practice of infectious diseases (ed. Mandell GL, et al.), pp. 3287-3303. Churchill Livingstone, Philadelphia.
  5. C. neoformans and C. gattii in Cryptococcosis Cite this article as Cold Spring Harb Perspect Med 2014;4:a019760 2014; doi: 10.1101/cshperspect.a019760 Cold Spring Harb Perspect Med

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Metadata

Authors
Kwon-Chung, K. J., Fraser, J. A., Doering, T. L., Wang, Z. A., Janbon, G., Idnurm, A., & Bahn, Y.-S.
Affiliations
  • National Institutes of Health (US)
  • The University of Queensland (AU)
  • Washington University in St. Louis (US)
  • Institut Pasteur (FR)
  • University of Missouri–Kansas City (US)
  • Yonsei University (KR)
Venue
Cold Spring Harbor Perspectives in Medicine
Published
2014-07-01
Volume
4
Issue
7
Pages
a019760-a019760
ISSN
2157-1422 (ISSN-L)
OpenAlex
W2160571905
Cited by
531
References
257
Citations by year
2026: 28 · 2025: 42 · 2024: 50 · 2023: 70 · 2022: 53 · 2021: 53 · 2020: 64 · 2019: 47 · 2018: 45 · 2017: 36 · 2016: 21 · 2015: 16 · 2014: 4
Type
posted content
Language
en
Open access
Locations
  • Cold Spring Harbor Perspectives in Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Research Foundation (109623)
  • National Research Foundation of Korea
  • National Institutes of Health
  • U.S. Public Health Service (87794, 102882, 78795, 109623)
  • National Institute of Allergy and Infectious Diseases (R01AI087794, R01AI102882, R21AI109623, R01AI078795)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
  • Life Sciences › Immunology and Microbiology › Microbiology › Yeasts and Rust Fungi Studies
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords
Cryptococcus neoformans, Cryptococcus gattii, cryptococcosis, fungal pathogenesis, virulence factors, polysaccharide capsule, melanin, urease activity, meningoencephalitis, AIDS, immunocompetent patient, life cycle, stress response
MeSH terms
Cryptococcosis, Cryptococcus neoformans, Enzymes, Genotype, Humans, Life Cycle Stages, Melanins, Terminology as Topic, Phenotype, Stress, Physiological, Signal Transduction, Drug Resistance, Multiple, Fungal, Virulence Factors, Host-Pathogen Interactions, Cryptococcus gattii, Fungal Capsules

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