Cryptococcal meningitis in non-HIV patients in the State of Amazonas, Northern Brazil.
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.
['Pinheiro|Silviane Bezerra|SB|', 'Sousa|Ednaira Sullany|ES|', 'Cortez|Ana Claúdia Alves|ACA|', 'da Silva Rocha|Diego Fernando|DF|', 'Menescal|Lizandra Stephany Fernandes|LSF|', 'Chagas|Valéria Soares|VS|', 'Gómez|Aline Stephanie Pérez|ASP|', 'Cruz|Kátia Santana|KS|', 'Santos|Lucilaide Oliveira|LO|', 'Alves|Marla Jalene|MJ|', 'Matsuura|Ani Beatriz Jackisch|ABJ|', 'Wanke|Bodo|B|', 'Trilles|Luciana|L|', 'Frickmann|Hagen|H|', 'de Souza|João Vicente Braga|JVB|http://orcid.org/0000-0002-3163-7499']
D000293:Adolescent D000328:Adult D000935:Antifungal Agents D001938:Brazil D002648:Child D056285:Cryptococcus gattii D003455:Cryptococcus neoformans D005260:Female D005843:Geography D015658:HIV Infections D006801:Humans D008297:Male D016919:Meningitis, Cryptococcal D008875:Middle Aged D058885:Multilocus Sequence Typing D016533:Mycological Typing Techniques D010802:Phylogeny D011446:Prospective Studies D055815:Young Adult
Cryptococcal meningitis Cryptococcus gattii MLST Amazon Case series HIV-negative VGII genotype