Cryptococcal meningitis in non-HIV patients in the State of Amazonas, Northern Brazil

• Published in: Brazilian journal of microbiology Vol. 52; no. 1; pp. 279 - 288
• Main Authors: Pinheiro, Silviane Bezerra, Sousa, Ednaira Sullany, Cortez, Ana Claúdia Alves, da Silva Rocha, Diego Fernando, Menescal, Lizandra Stephany Fernandes, Chagas, Valéria Soares, Gómez, Aline Stephanie Pérez, Cruz, Kátia Santana, Santos, Lucilaide Oliveira, Alves, Marla Jalene, Matsuura, Ani Beatriz Jackisch, Wanke, Bodo, Trilles, Luciana, Frickmann, Hagen, de Souza, João Vicente Braga
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-03-2021; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; AIDS; Amphotericin B; Biomedical and Life Sciences; Clinical isolates; Clinical Microbiology - Research Paper; Cryptococcosis; Diabetes mellitus; Fluconazole; Food Microbiology; Fungal infections; Fungi; Fungicides; Genetic relationship; Genotypes; Genotyping; HIV; Human immunodeficiency virus; Hypertension; Intestine; Itraconazole; Life Sciences; Medical Microbiology; Medical records; Meningitis; Microbial Ecology; Microbial Genetics and Genomics; Microbiology; Multilocus sequence typing; Mycology; Patients; Phylogeny; Polymerase chain reaction; Restriction fragment length polymorphism; Strains (organisms); Tuberculosis; Brazil; Cryptococcal meningitis; Case series; MLST; Amazon; HIV-negative; VGII genotype; Cryptococcus gattii
• ISSN: 1517-8382; 1678-4405
• DOI: 10.1007/s42770-020-00383-1

Cryptococcosis is a life-threatening fungal infection caused by the
Cryptococcus neoformans
/
Cryptococcus gattii
species complex. Most cases are recorded in patients suffering from HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). However, this infection also occurs in non-HIV patients with a proportion of 10–30% of all cases. The study aimed at the clinical and molecular characterization of non-HIV patients diagnosed with cryptococcosis at the Tropical Medicine Foundation (FMT-HVD) from July 2016 to June 2019. Medical records of respective patients were analyzed to describe the course of cryptococcosis in non-HIV patients. In addition, multi-locus sequence typing (MLST) was applied to identify the sequence types of the isolated
Cryptococcus
strains, to perform phylogenetic analysis, and to evaluate the isolates’ genetic relationship to global reference strains. Antifungal susceptibility profiles to amphotericin B, fluconazole, and itraconazole were assessed by broth microdilution. From a total of 7 patients, 4 were female, the age range varied between 10 and 53 years (median of 36.3 years). Cryptococcal meningitis was the common clinical manifestation (100%). The period between onset of symptoms and confirmed diagnosis ranged from 15 to 730 days (mean value of 172.9 days), and the observed mortality was 57.1%. Of note, comorbidities of the assessed cryptococcosis patients comprised hypertension, diabetes mellitus, and intestinal tuberculosis. Genotyping applying PCR-RFLP of the
URA5
gene identified all clinical isolates as
C. gattii
genotype VGII. Using MLST, it was possible to discriminate the sequence types ST20 (
n
 = 4), ST5 (
n
 = 3), and the newly identified sequence type ST560 (
n
 = 1). The antifungals amphotericin B, fluconazole, and itraconazole showed satisfactory inhibitory activity (microdilution test) against all
C. gattii
VGII strains.