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Maternal–Fetal Transmission of Cryptococcus Gattii in Harbor Porpoise

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Maternal–Fetal Transmission of Cryptococcus Gattii in Harbor Porpoise LETTERS Oral Oncul, Yunus Atalay, Maternal–Fetal www.cdc.gov/EID/content/17/2/302- Yalcin Onem, Vedat Turhan, Ali appF.htm). The fi rst stomach chamber Acar, Yavuz Uyar, Transmission of contained two 3.5 cm × 2.5 cm raised, Dilek Y. Caglayik, Sezai Ozkan, Cryptococcus gattii centrally umbilicated ulcers and sev- and Levent Gorenek in Harbor Porpoise eral embedded anisakid nematodes. Author affi liations: Gulhane Military Medi- The uterus was gravid in the right cal Academy Haydarpasa Training Hospi- To the Editor: We report mater- horn with a mid-term fetus. No other tal, Istanbul, Turkey (O. Oncul, Y. Atalay, nal–fetal transmission of Cryptococ- gross lesions were identifi ed. Micro- Y. Onem, V. Turhan, A. Acar, S. Ozkan, L. cus gattii and death in a wild porpoise. scopically, the lung lesions correlated Gorenek); and Refi k Saydam National Pub- Cryptococcus neoformans and C. gat- with granulomatous to pyogranuloma- lic Health Agency, Ankara, Turkey (Y. Uyar, tii are 2 environmental, encapsulated tous infi ltrates, often with a myriad of D.Y. Caglayik) yeasts that cause invasive, potentially yeasts. life-threatening infections in humans The male fetus (length 30 cm, DOI: 10.3201/eid1702.100663 and animals (1). C. neoformans causes weight 2.4 kg), was examined sepa- disease in immunocompromised hosts, rately at a different facility than the References and C. gattii is also pathogenic in im- dam. It appeared grossly normal ex- 1. Tang YW, Li YL, Ye KL, Xu ZY, Ruo munocompetent hosts (2). Since 1999, ternally and was at a gestation of ≈5–6 SL, Fisher-Hoch SP, et al. Distribution of cryptococcosis caused by C. gattii months. Mediastinal lymph nodes had hantavirus serotypes Hantaan and Seoul has appeared on southern Vancouver mild granulomatous infl ammation and causing hemorrhagic fever with renal syn- drome and identifi cation by hemaggluti- Island (British Columbia, Canada) contained numerous yeasts morpho- nation inhibition assay. J Clin Microbiol. and nearby surrounding areas (2,3). logically consistent with Cryptococ- 1991;29:1924–7. Spread beyond Vancouver Island has cus spp. (online Appendix Figure, 2. Khan AS, Ksiazek TG, Peters CJ. Han- been documented along the Pacifi c panel B). The lymph nodes were par- tavirus pulmonary syndrome. Lancet. 1996;347:739–41. DOI: 10.1016/S0140- Northwest Coast, but the mechanism tially replaced with intracellular and 6736(96)90082-3 remains undetermined (4). extracellular mulilobulated yeast ag- 3. Klempa B, Tkachenko EA, Dzagurova A pregnant, dead, stranded, har- gregates (length 8–20 μm) with pale TK, Yunicheva YV, Morozov VG, Oku- bor porpoise (Phocoena phocoena) eosinophilic central regions and a thin lova NM, et al. Hemorrhagic fever with renal syndrome caused by 2 lineages of was reported on February 22, 2007, refractile wall peripherally bound by a Dobrava hantavirus, Russia. Emerg In- on western Whidbey Island, in Puget 5-μm nonstaining capsule. Around the fect Dis. 2008;14:617–25. DOI: 10.3201/ Sound, Washington State (48.2833°N, periphery of these aggregates, there eid1404.071310 122.7283°W). The carcass was iced were small numbers of macrophages 4. Ertek M, Buzgan T; Refi k Saydam Na- tional Public Health Agency; Ministry and necropsy was performed on Feb- and lymphocytes and fewer neutro- of Health, Ankara, Turkey. An outbreak ruary 24. Sampled tissues from the phils. Specifi c staining showed a caused by hantavirus in the Black Sea re- adult and fetus were divided: half prominent mucicarminophilic capsule gion of Turkey, January–May 2009. Euro fi xed in 10% formalin for histopatho- consistent with Cryptococcus spp. Surveill 2009;14: pii:19214. 5. European Network for Diagnostics of Im- logic analysis, and half frozen for an- Yeasts were found in the amniotic ported Viral Diseases (ENIVD) diagnosis cillary studies. fl uid and interspersed within the chori- criteria [cited 2010 Sep 22]. http://www. For histologic analysis, tissues oallantoic villi and submucosal vascu- enivd.de/FS/fs_encdiseases.htm were embedded in paraffi n, sectioned lature of the placenta. Mild multifocal 6. Laakkonen J, Kallio-Kokko H, Oktem MA, Blasdell K, Plyusnina A, Niemi- to 3–5 μm, and stained with hema- nonsuppurative myocarditis was de- maa J, et al. Serological survey for viral toxylin and eosin. Selected sections tected. However, no yeasts were seen pathogens in Turkish rodents. J Wildl Dis. were stained with mucicarmine. The in infl amed areas. There were no overt 2006;42:672–6. adult porpoise (length 177 cm, weight lesions in the remaining organs. 7. Oktem MA. Hantavirus and tick-borne en- cephalitis infections [in Turkish]. Ankem ≈57.7 kg) was in poor condition (re- Maternal and fetal tissues were Derg. 2009;23(Suppl 2):245–8. duced blubber layer). Both lungs were cultured for fungi, and diagnosis was exposed, extensively scavenged, fi rm, based on Gram stain (budding yeast- Address for correspondence: Vedat Turhan, and nodular; a sectioned surface exud- like cells), India ink stain (positive for Department of Infectious Diseases and Clinical ed clear to slightly opaque gelatinous encapsulated cells), hydrolysis of urea Microbiology, Gulhane Military Medical to mucinous discharge. Mediastinal (positive), and fi nal confi rmation by Academy Haydarpasa Training Hospital, lymph nodes were grossly enlarged, using API 20C Aux V3.0 (bioMérieux, Uskudar, Istanbul 34668, Turkey; email: multinodular, and fi rm with large num- Marcy l’Etoile, France). Canavanine- [email protected] bers of yeasts visible by microscopy glycine-bromthymol blue agar was (online Appendix Figure, panel A, used to differentiate between C. gattii 304 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 2, February 2011 LETTERS and C. neoformans (5). Molecular cases of C. gattii (8). Cryptococcal 5. Kwon-Chung KJ, Polacheck I, Bennett typing by restriction fragment length infection during pregnancy has been JE. Improved diagnostic medium for separation of Cryptococcus neoformans polymorphism was used to defi nitive- reported in humans and horses (9,10). var. neoformans (serotypes A and D) ly speciate and subtype C. gattii (6). This fetal case of cryptococcosis and Cryptococcus neoformans var. gat- Fungal culture showed heavy growth may have major human and animal tii (serotypes B and C). J Clin Microbiol. of Cryptococcus spp. from the dam health implications. Further studies 1982;15:535–7. 6. Kidd SE, Hagen F, Tscharke RL, Huynh (lungs, mediastinal lymph nodes, and should be undertaken to assess pos- M, Bartlett KH, Fyfe M, et al. A rare placenta) and fetus (mediastinal lymph sible fetal involvement, identify infec- genotype of Cryptococcus gattii caused nodes). Genotyping of primary iso- tions in pregnant females, and provide the cryptococcosis outbreak on Vancouver lates identifi ed VGIIa C. gattii in both information on risk reduction and im- Island (British Columbia, Canada). Proc Natl Acad Sci U S A. 2004;101:17258–63. animals. Test results for enteric patho- proving diagnosis and treatment. DOI: 10.1073/pnas.0402981101 gens, intestinal nematodes, morbillivi- 7. Kidd SE, Chow Y, Mak S, Bach PJ, Chen rus, and Brucella spp. were negative. Stephanie A. Norman, H, Hingston AO, et al. Characterization of Fetal infection was most likely Stephen Raverty, Erin Zabek, environmental sources of the human and Sandra Etheridge, animal pathogen Cryptococcus gattii in hematogenous, disseminated from a British Columbia, Canada, and the Pacifi c primary maternal pulmonary source John K.B. Ford, Northwest of the United States. Appl En- to the uterus and subsequently to pla- Linda M.N. Hoang, viron Microbiol. 2007;73:1433–43. DOI: cental vasculature and internal fetal and Muhammad Morshed 10.1128/AEM.01330-06 8. Kidd SE, Bach PJ, Hingston AO, Mak Author affi liations: Marine-Med: Marine tissues. Infection by aspiration or in- S, Chow Y, MacDougall L, et al. Cryp- gestion of contaminated amniotic fl u- Research, Epidemiology, and Veterinary tococcus gattii dispersal mechanisms, id was also possible. Although close Medicine, Bothell, Washington, USA (S.A. British Columbia, Canada. Emerg In- evaluation of the lung did not show Norman); Central Puget Sound Marine fect Dis. 2007;13:51–7. DOI: 10.3201/ eid1301.060823 Mammal Stranding Network, Greenbank, any discernible yeasts, the organism 9. Blanchard PC, Filkins M. Cryptococcal may have been present in an area other Washington, USA (S.A. Norman); British pneumonia and abortion in an equine fetus. than that sectioned. Columbia Ministry of Agriculture and Lands, J Am Vet Med Assoc. 1992;201:1591–2. During 1998–2007, ≈450 harbor Abbotsford, British Columbia, Canada (S. 10. Molnar-Nadasdy G, Haesky I, Reed J, Altshuler G. Placental cryptococcosis in a Raverty, E. Zabek, S. Etheridge); Fisher- and Dall’s porpoises (Phocoenoides mother with systemic lupus erythematosus. dalli) and Pacifi c white-sided dolphins ies and Oceans, Canada, Nanaimo, British Arch Pathol Lab Med. 1994;118:757–9. (Lagenorhynchus obliquidens) along Columbia, Canada (J.K.B. Ford); British the Pacifi c Northwest Coast were re- Columbia Center for Disease Control, Van- Address for correspondence: Stephanie A. covered and subjected to necropsy. couver, British Columbia, Canada (L.M.N. Norman, Marine-Med: Marine Research, Disseminated cryptococcosis caused Hoang, M. Morshed); and University of Brit- Epidemiology, and Veterinary Medicine, 24225 by C. gattii since 2000 was diagnosed ish Columbia, Vancouver (L.M.N. Hoang, 15th Pl SE, Bothell, WA 98021, USA; email: in 15 harbor porpoises, 10 Dall’s por- M. Morshed) [email protected] poises, 2 adult Pacifi c white-sided DOI: 10.3201/eid1702.101232 dolphins, and 3 unrecorded species (10 females, 15 males, and 5 unknown Letters References Letters commenting on recent articles sex; 24 adults, 4 juveniles, 1 fetus, and as well as letters reporting cases, 1 undocumented age; S. Raverty, un- 1. Ellis DH. Cryptococcus neoformans outbreaks, or original research are pub. data). var. gattii in Australia. J Clin Microbiol. 1987;25:430–1. welcome.
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