Cryptococcus neoformans is an opportunistic fungal pathogen that can cause lethal cryptococcal meningitis (CM) in immunocompromised individuals such as those with HIV/AIDS. In addition, cryptococcal infections occasionally arise in immunocompetent individuals or those with previously undiagnosed immunodeficiencies. The course of cryptococcosis is highly variable in both patient groups and there is rapidly growing evidence that genetic polymorphisms may have a significant impact on the trajectory of disease. Here we review what is currently known about the nature of these polymorphisms and their impact on host response to C. neoformans infection. Thus far, polymorphisms in Fc gamma receptors (FcγRs), Mannose Binding Lectin (MBL), Dectin-2, Toll-like Receptors (TLRs) and macrophage colony stimulating factor (M-CSF) have been associated with susceptibility to cryptococcal disease. Notably, however, in some cases the impact of these polymorphisms depends on the genetic background of the population; for example, the FCGR3A 158 F/V polymorphism was associated with an increased risk of cryptococcal disease in both HIV-positive and HIV-negative white populations, but not in Han Chinese patients. In most cases, the precise mechanism by which the identified polymorphisms influence disease progression remains unclear, although impaired fungal recognition and phagocytosis by innate immune cells appears to play a major role. Finally, we highlight outstanding questions in the field and emphasise the need for future research to include more diverse populations in their genetic association studies.
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