1
|
de Holanda Fonseca DL, Silva DMWD, de Albuquerque Maranhão FC. Molecular characterization of clinical and environmental isolates from the Cryptococcus neoformans/C. Gattii species complexes of Maceió, Alagoas, Brazil. Braz J Microbiol 2024; 55:1369-1380. [PMID: 38619732 PMCID: PMC11153433 DOI: 10.1007/s42770-024-01313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Cryptococcosis is one of the major life-threatening opportunistic/systemic fungal diseases of worldwide occurrence, which can be asymptomatic or establish pneumonia and meningoencephalitis mainly in immunosuppressed patients, caused by the Cryptococcus neoformans and C. gattii species complexes. Acquisition is by inhaling fungal propagules from avian droppings, tree hollows and decaying wood, and the association of the molecular types with geographic origin, virulence and antifungal resistance have epidemiological importance. Since data on cryptococcosis in Alagoas are limited, we sought to determine the molecular types of etiological agents collected from clinical and environmental sources. We evaluated 21 isolates previously collected from cerebrospinal fluid and from environment sources (pigeon droppings and tree hollows) in Maceió-Alagoas (Brazil). Restriction fragment length polymorphism of URA5 gene was performed to characterize among the eight standard molecular types (VNI-VNIV and VGI-VGIV). Among isolates, 66.67% (14) were assigned to C. neoformans VNI - 12 of them (12/14) recovered from liquor and 2 from a tree hollow (2/14). One isolate from pigeon droppings (4.76%) corresponded to C. neoformans VNIV, while five strains from tree hollows and one from pigeon droppings (6, 28.57%) to C. gattii VGII. VNI-type was present in clinical and environmental samples and most C. neoformans infections were observed in HIV-positive patients, while types VNIV and VGII were prevalent in environmental sources in Alagoas. This is the first molecular characterization of Cryptococcus spp. in Alagoas, our study provides additional information on the ecoepidemiology of Cryptococcus spp. in Brazil, contributing to a closer view of the endemic species.
Collapse
Affiliation(s)
| | - Denise Maria Wanderlei da Silva
- Institute of Biological and Health Sciences, Sector of Microbiology, Laboratory of Clinical Microbiology, Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Fernanda Cristina de Albuquerque Maranhão
- Institute of Biological and Health Sciences, Sector of Microbiology, Laboratory of Clinical Microbiology, Federal University of Alagoas, Av. Lourival de Melo Mota, S/N, Tabuleiro do Martins, Maceió, 57072-900, Alagoas, Brazil.
| |
Collapse
|
2
|
Tan X, Zhang Y, Zhou J, Chen W, Zhou H. Construction and validation of a nomogram model to predict the poor prognosis in patients with pulmonary cryptococcosis. PeerJ 2024; 12:e17030. [PMID: 38487258 PMCID: PMC10939030 DOI: 10.7717/peerj.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Background Patients with poor prognosis of pulmonary cryptococcosis (PC) are prone to other complications such as meningeal infection, recurrence or even death. Therefore, this study aims to analyze the influencing factors in the poor prognosis of patients with PC, so as to build a predictive nomograph model of poor prognosis of PC, and verify the predictive performance of the model. Methods This retrospective study included 410 patients (78.1%) with improved prognosis of PC and 115 patients (21.9%) with poor prognosis of PC. The 525 patients with PC were randomly divided into the training set and validation set according to the ratio of 7:3. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm was used to screen the demographic information, including clinical characteristics, laboratory test indicators, comorbidity and treatment methods of patients, and other independent factors that affect the prognosis of PC. These factors were included in the multivariable logistic regression model to build a predictive nomograph. The receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) were used to verify the accuracy and application value of the model. Results It was finally confirmed that psychological symptoms, cytotoxic drugs, white blood cell count, hematocrit, platelet count, CRP, PCT, albumin, and CD4/CD8 were independent predictors of poor prognosis of PC patients. The area under the curve (AUC) of the predictive model for poor prognosis in the training set and validation set were 0.851 (95% CI: 0.818-0.881) and 0.949, respectively. At the same time, calibration curve and DCA results confirmed the excellent performance of the nomogram in predicting poor prognosis of PC. Conclusion The nomograph model for predicting the poor prognosis of PC constructed in this study has good prediction ability, which is helpful for improving the prognosis of PC and further optimizing the clinical management strategy.
Collapse
Affiliation(s)
- Xiaoli Tan
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yingqing Zhang
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianying Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenyu Chen
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hua Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
3
|
Andrade-Silva LE, Vilas-Boas A, Ferreira-Paim K, Andrade-Silva J, Santos DDA, Ferreira TB, Borges AS, Mora DJ, Melhem MDSC, Silva-Vergara ML. Genotyping Analysis of Cryptococcus deuterogattii and Correlation with Virulence Factors and Antifungal Susceptibility by the Clinical and Laboratory Standards Institute and the European Committee on Antifungal Susceptibility Testing Methods. J Fungi (Basel) 2023; 9:889. [PMID: 37754997 PMCID: PMC10532325 DOI: 10.3390/jof9090889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
Data about the relationship between their molecular types, virulence factors, clinical presentation, antifungal susceptibility profile, and outcome are still limited for Cryptococcus deuterogattii. This study aimed to evaluate the molecular and phenotypic characteristics of 24 C. deuterogattii isolates from the southeast region of Brazil. The molecular characterization was performed by multilocus sequence typing (MLST). The antifungal susceptibility profile was obtained according to CLSI-M27-A3 and EUCAST-EDef 7.1 methods. The virulence factors were evaluated using classic techniques. The isolates were divided into four populations. The molecular analysis suggests recombinant events in most of the groups evaluated. Resistance and susceptibility dose-dependent to fluconazole were evidenced in four isolates (16%) by EUCAST and in four isolates (16%) by CLSI methods. The agreement at ±two dilutions for both methods was 100% for itraconazole, ketoconazole, and voriconazole, 96% for amphotericin B, and 92% for fluconazole. Significant differences in virulence factor expression and antifungal susceptibility to itraconazole and amphotericin B were found. The mixed infection could be suggested by the presence of variable sequence types, differences in virulence factor production, and decreased antifungal susceptibility in two isolates from the same patient. The data presented herein corroborate previous reports about the molecular diversity of C. deuterogattii around the world.
Collapse
Affiliation(s)
- Leonardo Euripedes Andrade-Silva
- Infectious Diseases Unit, Internal Medicine Department, Federal University of Triangulo Mineiro, Uberaba 38001-170, MG, Brazil; (A.V.-B.); (K.F.-P.); (J.A.-S.); (T.B.F.); (M.L.S.-V.)
| | - Anderson Vilas-Boas
- Infectious Diseases Unit, Internal Medicine Department, Federal University of Triangulo Mineiro, Uberaba 38001-170, MG, Brazil; (A.V.-B.); (K.F.-P.); (J.A.-S.); (T.B.F.); (M.L.S.-V.)
| | - Kennio Ferreira-Paim
- Infectious Diseases Unit, Internal Medicine Department, Federal University of Triangulo Mineiro, Uberaba 38001-170, MG, Brazil; (A.V.-B.); (K.F.-P.); (J.A.-S.); (T.B.F.); (M.L.S.-V.)
| | - Juliana Andrade-Silva
- Infectious Diseases Unit, Internal Medicine Department, Federal University of Triangulo Mineiro, Uberaba 38001-170, MG, Brazil; (A.V.-B.); (K.F.-P.); (J.A.-S.); (T.B.F.); (M.L.S.-V.)
| | - Daniel de Assis Santos
- Microbiology Department, Biological Sciences Institute, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil;
| | - Thatiana Bragine Ferreira
- Infectious Diseases Unit, Internal Medicine Department, Federal University of Triangulo Mineiro, Uberaba 38001-170, MG, Brazil; (A.V.-B.); (K.F.-P.); (J.A.-S.); (T.B.F.); (M.L.S.-V.)
| | - Aercio Sebastião Borges
- Infectious Diseases Unit, Internal Medicine Department, Federal University of Uberlândia, Uberlândia 38496-017, MG, Brazil
| | - Delio Jose Mora
- Center of Health Sciences, Federal University of Sul da Bahia, Teixeira de Freitas 85866-000, BA, Brazil;
| | | | - Mario Léon Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Federal University of Triangulo Mineiro, Uberaba 38001-170, MG, Brazil; (A.V.-B.); (K.F.-P.); (J.A.-S.); (T.B.F.); (M.L.S.-V.)
| |
Collapse
|
4
|
Wang Y, Gu Y, Shen K, Cui X, Min R, Sun S, Feng C, Chen Y, Wang L, Ma G, Chen B, Ni Y, Zhong H, Shi Y, Su X. The management and outcome of cryptococcosis in patients with different immune statuses and treatment protocols: A multicenter real-world study in Jiangsu Province - China. J Mycol Med 2023; 33:101389. [PMID: 37099991 DOI: 10.1016/j.mycmed.2023.101389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE The incidence of cryptococcosis is increasing in non-immunocompromised patients. However, the evidence on proper management is inadequate in this population. We conducted this multi-center real-world study in pulmonary cryptococcosis patients with different immune statuses, so as to provide practical evidence for optimized clinical management of cryptococcosis, especially for mild-to-moderate immunodeficient diseases patients. METHODS This is a prospective observational study. The clinical data of patients with proven cryptococcosis were collected and analyzed from 7 tertiary teaching hospitals in Jiangsu Province, China from January, 2013 to December, 2018. Proven cases include pulmonary cryptococcosis, cryptococcal meningitis, cryptococcemia and cutaneous cryptococcosis. Patients were followed up over 24 months. According to their immune status, patients with cryptococcosis were divided into three groups, namely immunocompetent group (IC), mild-to-moderate immunodeficient diseases group (MID), severe immunodeficient diseases group (SID). Meanwhile, pulmonary crypotococcosis (PC) and extrapulmonary crypotococcosis (EPC) were also classified and analyzed. RESULTS 255 proven cases of cryptococcosis were enrolled. Finally, 220 cases completed the follow-up. 143 proven cases (65.0%) were immunocompetent (IC), 41 cases (18.6%) were MID, and 36 cases (16.4%) were SID. 174 cases (79.1%) were PC and 46 cases (20.9%) were EPC. The mortality was significantly higher in SID and MID patients [47.2% (SID) vs. 12.2% (MID) vs. 0.0% (IC), p<0.001]. The mortality was also significantly higher in EPC patients [45.7% vs. 0.6% (PC), p<0.001]. Patients with alternative initial antifungal treatment had higher mortality than patients with guideline recommended initial treatment [23.1% vs. 9.5%, p=0.041]. In MID group, the mortality of receiving alternative initial antifungal treatment was significantly higher than recommended initial treatment [2/3 vs. 3/34(8.8%), p=0.043]. In pulmonary cryptococcosis patients with MID, the mortality was very similar to IC group [0.0% vs. 0.0% (IC)], lower than SID group [0.0% vs. 11.1% (SID), p=0.555]. However, in extrapulmonary cryptococcosis patients with MID, the mortality was significantly higher than that in IC [62.5% vs. 0.0% (IC)], and similar to SID patients [62.5% vs. 59.3% (SID)]. CONCLUSION The immune status exert a significant influence on the management and prognosis of cryptococcosis patients. The mortality of cryptococcosis patients with MID is higher than that of immunocompetent patients. For MID patients with pure pulmonary cryptococcosis, it is acceptable to take the treatment recommended as IC patients. For the MID patients with extrapulmonary cryptococcosis, the mortality is high and the initial treatment should follow the regimen for SID patients. Following the recommended treatment regimen in the IDSA guideline can reduce mortality in patients with cryptococcosis. Starting on alternative initial antifungal treatment may bring worse outcomes.
Collapse
Affiliation(s)
- Yu Wang
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Yu Gu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Kunlu Shen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China, 510000
| | - Xuefan Cui
- Department of Respiratory Medicine, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China, 210002
| | - Rui Min
- Department of Respiratory Medicine, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China, 210002
| | - Siqing Sun
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Nanjing, Nanjing, China, 210002
| | - Chunlai Feng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China, 213000
| | - Yanbin Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China, 215000
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China, 210002
| | - Guoer Ma
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China, 212000
| | - Bilin Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Yueyan Ni
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Huanhuan Zhong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China, 510000.
| |
Collapse
|
5
|
De Jesus DFF, De Freitas ALD, De Oliveira IM, De Almeida LC, Bastos RW, Spadari CDC, Melo ASDA, Santos DDA, Costa-Lotufo LV, Reis FCG, Rodrigues ML, Stefani HA, Ishida K. Organoselenium Has a Potent Fungicidal Effect on Cryptococcus neoformans and Inhibits the Virulence Factors. Antimicrob Agents Chemother 2023; 67:e0075922. [PMID: 36815840 PMCID: PMC10019174 DOI: 10.1128/aac.00759-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/14/2023] [Indexed: 02/24/2023] Open
Abstract
Cryptococcosis therapy is often limited by toxicity problems, antifungal tolerance, and high costs. Studies approaching chalcogen compounds, especially those containing selenium, have shown promising antifungal activity against pathogenic species. This work aimed to evaluate the in vitro and in vivo antifungal potential of organoselenium compounds against Cryptococcus neoformans. The lead compound LQA_78 had an inhibitory effect on C. neoformans planktonic cells and dispersed cells from mature biofilms at similar concentrations. The fungal growth inhibition led to an increase in budding cells arrested in the G2/M phase, but the compound did not significantly affect structural cell wall components or chitinase activity, an enzyme that regulates the dynamics of the cell wall. The compound also inhibited titan cell (Tc) and enlarged capsule yeast (NcC) growth and reduced the body diameter and capsule thickness associated with increased capsular permeability of both virulent morphotypes. LQA_78 also reduced fungal melanization through laccase activity inhibition. The fungicidal activity was observed at higher concentrations (16 to 64 μg/mL) and may be associated with augmented plasma membrane permeability, ROS production, and loss of mitochondrial membrane potential. While LQA_78 is a nonhemolytic compound, its cytotoxic effects were cell type dependent, exhibiting no toxicity on Galleria mellonella larvae at a dose ≤46.5 mg/kg. LQA_78 treatment of larvae infected with C. neoformans effectively reduced the fungal burden and inhibited virulent morphotype formation. To conclude, LQA_78 displays fungicidal action and inhibits virulence factors of C. neoformans. Our results highlight the potential use of LQA_78 as a lead molecule for developing novel pharmaceuticals for treating cryptococcosis.
Collapse
Affiliation(s)
| | | | | | | | - Rafael Wesley Bastos
- Center of Biosciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | | | - Daniel de Assis Santos
- Institute of Biomedical Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Flavia C. G. Reis
- Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
- Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marcio L. Rodrigues
- Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Brazil
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Kelly Ishida
- Institute of Biomedical Sciences, University of São Paulo (USP), São Paulo, Brazil
| |
Collapse
|
6
|
Cryptococcus spp. and Cryptococcosis: focusing on the infection in Brazil. Braz J Microbiol 2022; 53:1321-1337. [PMID: 35486354 PMCID: PMC9433474 DOI: 10.1007/s42770-022-00744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 03/25/2022] [Indexed: 11/02/2022] Open
Abstract
Cryptococcosis is a global fungal infection caused by the Cryptococcus neoformans/Cryptococcus gattii yeast complex. This infection is acquired by inhalation of propagules such as basidiospores or dry yeast, initially causing lung infections with the possibility of progressing to the meninges. This infection mainly affects immunocompromised HIV and transplant patients; however, immunocompetent patients can also be affected. This review proposes to evaluate cryptococcosis focusing on studies of this mycosis in Brazilian territory; moreover, recent advances in the understanding of its virulence mechanism, animal models in research are also assessed. For this, literature review as realized in PubMed, Scielo, and Brazilian legislation. In Brazil, cryptococcosis has been identified as one of the most lethal fungal infections among HIV patients and C. neoformans VNI and C. gattii VGII are the most prevalent genotypes. Moreover, different clinical settings published in Brazil were described. As in other countries, cryptococcosis is difficult to treat due to a limited therapeutic arsenal, which is highly toxic and costly. The presence of a polysaccharide capsule, thermo-tolerance, production of melanin, biofilm formation, mechanisms for iron use, and morphological alterations is an important virulence mechanism of these yeasts. The introduction of cryptococcosis as a compulsory notification disease could improve data regarding incidence and help in the management of these infections.
Collapse
|
7
|
Reis RS, Bonna ICF, Antonio IMDS, Pereira SA, do Nascimento CRS, Ferraris FK, Brito-Santos F, Ferreira Gremião ID, Trilles L. Cryptococcus neoformans VNII as the Main Cause of Cryptococcosis in Domestic Cats from Rio de Janeiro, Brazil. J Fungi (Basel) 2021; 7:jof7110980. [PMID: 34829267 PMCID: PMC8621350 DOI: 10.3390/jof7110980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Cryptococcosis is a systemic fungal disease acquired from contaminated environments with propagules of the basidiomycetous yeasts of the Cryptococcus neoformans and C. gattii species complexes. The C. neoformans species complex classically comprises four major molecular types (VNI, VNII, VNIII, and VNIV), and the C. gattii species complex comprises another four (VGI, VGII, VGIII, and VGIV) and the newly identified molecular type VGV. These major molecular types differ in their epidemiological and ecological features, clinical presentations, and therapeutic outcomes. Generally, the most common isolated types are VNI, VGI, and VGII. The epidemiological profile of cryptococcosis in domestic cats is poorly studied and cats can be the sentinels for human infections. Therefore, the present study aimed to determine the molecular characterization of Cryptococcus spp. isolated from domestic cats and their dwellings in the metropolitan area of Rio de Janeiro, Brazil. A total of 36 Cryptococcus spp. strains, both clinical and environmental, from 19 cats were subtyped using multilocus sequence typing (MLST). The ploidy was identified using flow cytometry and the mating type was determined through amplification with specific pheromone primers. All strains were mating type alpha and 6/36 were diploid (all VNII). Most isolates (63.88%) were identified as VNII, a rare molecular type, leading to the consideration that this genotype is more likely related to skin lesions, since there was a high percentage (68.75%) of cats with skin lesions, which is also considered rare. Further studies regarding the molecular epidemiology of cryptococcosis in felines are still needed to clarify the reason for the large proportion of the rare molecular type VNII causing infections in cats.
Collapse
Affiliation(s)
- Rosani Santos Reis
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro 21040-900, Brazil; (R.S.R.); (I.C.F.B.); (F.B.-S.)
| | - Isabel Cristina Fábregas Bonna
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro 21040-900, Brazil; (R.S.R.); (I.C.F.B.); (F.B.-S.)
| | - Isabela Maria da Silva Antonio
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals (Lapclin-Dermzoo)/INI/Fiocruz, Rio de Janeiro 21040-900, Brazil; (I.M.d.S.A.); (S.A.P.); (I.D.F.G.)
| | - Sandro Antonio Pereira
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals (Lapclin-Dermzoo)/INI/Fiocruz, Rio de Janeiro 21040-900, Brazil; (I.M.d.S.A.); (S.A.P.); (I.D.F.G.)
| | | | - Fausto Klabund Ferraris
- Pharmacology Laboratory/INCQS/Fiocruz. Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil;
| | - Fábio Brito-Santos
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro 21040-900, Brazil; (R.S.R.); (I.C.F.B.); (F.B.-S.)
| | - Isabella Dib Ferreira Gremião
- Laboratory of Clinical Research on Dermatozoonoses in Domestic Animals (Lapclin-Dermzoo)/INI/Fiocruz, Rio de Janeiro 21040-900, Brazil; (I.M.d.S.A.); (S.A.P.); (I.D.F.G.)
| | - Luciana Trilles
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro 21040-900, Brazil; (R.S.R.); (I.C.F.B.); (F.B.-S.)
- Correspondence:
| |
Collapse
|
8
|
Yan Z, Deng W, Wang Y, Liu Y, Sun H, Xia R, Zeng W, Geng J, Chen G, He X, Xu J, Wu CL, Miao Y. Case Report: Malacoplakia Due to E. coli With Cryptococcus albidus Infection of a Transplanted Kidney in a Patient With Recurrent Urinary Tract Infection. Front Med (Lausanne) 2021; 8:721145. [PMID: 34595189 PMCID: PMC8476786 DOI: 10.3389/fmed.2021.721145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Colonization of Cryptococcus rarely occurs in a graft. This study reports a case of malacoplakia and cryptococcoma caused by E. coli and Cryptococcus albidus in a transplanted kidney, with detailed pathology and metagenome sequencing analysis. Case Presentation: We presented a case of cryptococcoma and malacoplakia in the genitourinary system including the transplant kidney, bladder, prostate, and seminal vesicles caused by Cryptococcus albidus and Escherichia coli in a renal-transplant recipient. Metagenome sequencing was conducted on a series of samples obtained from the patient at three different time points, which we termed Phase I (at the diagnosis of cryptococcoma), Phase II (during perioperative period of graftectomy, 3 months after the diagnosis), and Phase III (2 months after graftectomy). Sequencing study in the Phase I detected two and four sequences of C. albidus respectively in cerebrospinal fluid (CSF) and feces, with resistant Escherichia coli 09-02E presented in urine and renal mass. A 3-month antibiotic treatment yielded a smaller bladder lesion but an enlarged allograft lesion, leading to a nephrectomy. In the Phase II, two sequences of C. albidus were detected in CSF, while the E. coli 09-02E continued as before. In the Phase III, the lesions were generally reduced, with one C. albidus sequence in feces only. Conclusions: The existence and clearance of Cryptococcus sequences in CSF without central nervous system symptoms may be related to the distribution of infection foci in vivo, the microbial load, and the body's immunity. Overall, this study highlights the need for enhanced vigilance against uncommon types of Cryptococcus infections in immunocompromised populations and increased concern about the potential correlation between E. coli and Cryptococcus infections.
Collapse
Affiliation(s)
- Ziyan Yan
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenfeng Deng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuchen Wang
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanna Liu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Hengbiao Sun
- Department of Laboratory, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Renfei Xia
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenli Zeng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Geng
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gui Chen
- Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Xiaolong He
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jian Xu
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chin-Lee Wu
- Departments of Urology and Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Yun Miao
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
9
|
Nascimento E, Barião PHG, Kress MRVZ, Vilar FC, Santana RDC, Gaspar GG, Martinez R. Cryptococcosis by Cryptococcus neoformans/Cryptococcus gattii Species Complexes in non-HIV-Infected Patients in Southeastern Brazil. Rev Soc Bras Med Trop 2021; 54:e01692021. [PMID: 34495255 PMCID: PMC8437442 DOI: 10.1590/0037-8682-0169-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/16/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION: The clinical manifestations of cryptococcosis are usually associated with the infecting agents Cryptococcus neoformans (CN) and C. gattii (CG) species complexes and the host. In this study, non-HIV-infected patients, at a university hospital in southeastern Brazil, had epidemiological and clinical data associated with cryptococcal disease and isolated Cryptococcus species: CN - 24 patients and CG - 12 patients. METHODS: The comparison was comprised of demographic data, predisposing factors, clinical and laboratory manifestations, and outcomes of cryptococcosis patients treated between 2000 and 2016. Immunocompetent and immunosuppressed patients were also compared, irrespective of the infecting species. Cryptococcus spp. were genotyped by PCR-RFLP analysis of the URA5 gene. RESULTS: Infections by the CN species complex (100% VNI genotype) were associated with drug immunosuppression and fungemia, and patients infected with the CG species complex (83% VG II and 17% VGI genotypes) had more evident environmental exposure and higher humoral response. CN and CG affected patients with or without comorbidities. CONCLUSIONS: Diabetes mellitus, other chronic non-infectious diseases, and alcoholism were likely predisposing factors for infection by both CN and CG species. Immunocompetent patients, independent of the infecting Cryptococcus species complexes, showed a higher occurrence of meningitis and a trend toward less fungal dissemination and longer survival than immunosuppressed hosts.
Collapse
Affiliation(s)
- Erika Nascimento
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Patrícia Helena Grizante Barião
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Ribeirão Preto, SP, Brasil
| | - Marcia Regina von Zeska Kress
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Ribeirão Preto, SP, Brasil
| | - Fernando Crivelenti Vilar
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Rodrigo de Carvalho Santana
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Gilberto Gambero Gaspar
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Roberto Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| |
Collapse
|
10
|
Wilmes D, Coche E, Rodriguez-Villalobos H, Kanaan N. Fungal pneumonia in kidney transplant recipients. Respir Med 2021; 185:106492. [PMID: 34139578 DOI: 10.1016/j.rmed.2021.106492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
Fungal pneumonia is a dreaded complication encountered after kidney transplantation, complicated by increased mortality and often associated with graft failure. Diagnosis can be challenging because the clinical presentation is non-specific and diagnostic tools have limited sensitivity and specificity in kidney transplant recipients and must be interpreted in the context of the clinical setting. Management is difficult due to the increased risk of dissemination and severity, multiple comorbidities, drug interactions and reduced immunosuppression which should be applied as an important adjunct to therapy. This review will focus on the main causes of fungal pneumonia in kidney transplant recipients including Pneumocystis, Aspergillus, Cryptococcus, mucormycetes and Histoplasma. Epidemiology, clinical presentation, laboratory and radiographic features, specific characteristics will be discussed with an update on diagnostic procedures and treatment.
Collapse
Affiliation(s)
- D Wilmes
- Division of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - E Coche
- Division of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - H Rodriguez-Villalobos
- Division of Microbiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - N Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| |
Collapse
|
11
|
Naicker SD, Magobo RE, Maphanga TG, Firacative C, van Schalkwyk E, Monroy-Nieto J, Bowers J, Engelthaler DM, Shuping L, Meyer W, Govender NP. Genotype, Antifungal Susceptibility, and Virulence of Clinical South African Cryptococcus neoformans Strains from National Surveillance, 2005-2009. J Fungi (Basel) 2021; 7:jof7050338. [PMID: 33925754 PMCID: PMC8146981 DOI: 10.3390/jof7050338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
In South Africa, Cryptococcus neoformans is the most common cause of adult meningitis. We performed multi locus sequence typing and fluconazole susceptibility testing of clinical C. neoformans isolates collected from 251 South African patients with cryptococcosis through national surveillance from 2005 to 2009. We examined the association between clinical characteristics of patients and genotype, and the effect of genotype on in-hospital mortality. We performed whole genome phylogenetic analysis of fifteen C. neoformans isolates with the molecular type VNB and tested their virulence in a Galleria mellonella model. Most isolates had the molecular type VNI (206/251, 82%), followed by VNII (25/251, 10%), VNB (15/251, 6%), and VNIV (5/251, 2%); 67 sequence types were identified. There were no differences in fluconazole minimum inhibitory concentration (MIC) values among molecular types and the majority of strains had low MIC values (MIC50 of 1 µg/mL and MIC90 of 4 µg/mL). Males were almost twice as likely of being infected with a non-VNI genotype (adjusted odds ratio [OR]: 1.65, 95% confidence interval [CI]: 0.25–10.99; p = 0.61). Compared to patients infected with a VNI genotype, those with a non-VNI genotype had a 50% reduced adjusted odds of dying in hospital (95% CI: 0.03–7.57; p = 0.62). However, for both these analyses, our estimates had wide confidence intervals spanning 1 with large p-values. Fifteen VNB strains were not as virulent in a G. mellonella larval model as the H99 reference strain. A majority of these VNB strains belonged to the VNBII clade and were very closely related by phylogenetic analysis.
Collapse
Affiliation(s)
- Serisha D. Naicker
- Center for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg 2192, South Africa; (R.E.M.); (T.G.M.); (E.v.S.); (L.S.); (N.P.G.)
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2001, South Africa
- Correspondence: ; Tel.: +27-11-555-0491
| | - Rindidzani E. Magobo
- Center for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg 2192, South Africa; (R.E.M.); (T.G.M.); (E.v.S.); (L.S.); (N.P.G.)
| | - Tsidiso G. Maphanga
- Center for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg 2192, South Africa; (R.E.M.); (T.G.M.); (E.v.S.); (L.S.); (N.P.G.)
| | - Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 111611 Bogota, Colombia;
| | - Erika van Schalkwyk
- Center for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg 2192, South Africa; (R.E.M.); (T.G.M.); (E.v.S.); (L.S.); (N.P.G.)
| | - Juan Monroy-Nieto
- Pathogen and Microbiome Division, Translational Genomics Research Institute, Phoenix, AZ 85004, USA; (J.M.-N.); (J.B.); (D.M.E.)
| | - Jolene Bowers
- Pathogen and Microbiome Division, Translational Genomics Research Institute, Phoenix, AZ 85004, USA; (J.M.-N.); (J.B.); (D.M.E.)
| | - David M. Engelthaler
- Pathogen and Microbiome Division, Translational Genomics Research Institute, Phoenix, AZ 85004, USA; (J.M.-N.); (J.B.); (D.M.E.)
| | - Liliwe Shuping
- Center for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg 2192, South Africa; (R.E.M.); (T.G.M.); (E.v.S.); (L.S.); (N.P.G.)
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Center for Infectious Diseases and Microbiology, Westmead Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW 2006, Australia
- Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
- Research and Educational Network, Westmead Hospital, Western Sydney Local Health District, Westmead, NSW 2145, Australia
| | - Nelesh P. Govender
- Center for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg 2192, South Africa; (R.E.M.); (T.G.M.); (E.v.S.); (L.S.); (N.P.G.)
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2001, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town 7701, South Africa
| |
Collapse
|
12
|
Firacative C, Meyer W, Castañeda E. Cryptococcus neoformans and Cryptococcus gattii Species Complexes in Latin America: A Map of Molecular Types, Genotypic Diversity, and Antifungal Susceptibility as Reported by the Latin American Cryptococcal Study Group. J Fungi (Basel) 2021; 7:jof7040282. [PMID: 33918572 PMCID: PMC8069395 DOI: 10.3390/jof7040282] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/20/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Cryptococcosis, a potentially fatal mycosis, is caused by members of the Cryptococcus neoformans and Cryptococcus gattii species complexes. In Latin America, cryptococcal meningitis is still an important health threat with a significant clinical burden. Analysis of publicly available molecular data from 5686 clinical, environmental, and veterinary cryptococcal isolates from member countries of the Latin American Cryptococcal Study Group showed that, as worldwide, C. neoformans molecular type VNI is the most common cause of cryptococcosis (76.01%) in HIV-infected people, followed by C. gattii molecular type VGII (12.37%), affecting mostly otherwise healthy hosts. These two molecular types also predominate in the environment (68.60% for VNI and 20.70% for VGII). Among the scarce number of veterinary cases, VGII is the predominant molecular type (73.68%). Multilocus sequence typing analysis showed that, in Latin America, the C. neoformans population is less diverse than the C. gattii population (D of 0.7104 vs. 0.9755). Analysis of antifungal susceptibility data showed the presence of non-wild-type VNI, VGI, VGII, and VGIII isolates in the region. Overall, the data presented herein summarize the progress that has been made towards the molecular epidemiology of cryptococcal isolates in Latin America, contributing to the characterization of the genetic diversity and antifungal susceptibility of these globally spreading pathogenic yeasts.
Collapse
Affiliation(s)
- Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
- Correspondence: ; Tel.: +57-1-297-0200 (ext. 3404)
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Research and Education Network Westmead Hospital, Faculty of Medicine and Health, Sydney Medical School-Westmead Clinical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Sydney 2145, Australia;
| | - Elizabeth Castañeda
- Grupo de Microbiología, Instituto Nacional de Salud, Bogota 111321, Colombia;
| |
Collapse
|
13
|
The interplay of phenotype and genotype in Cryptococcus neoformans disease. Biosci Rep 2021; 40:226594. [PMID: 33021310 PMCID: PMC7569153 DOI: 10.1042/bsr20190337] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Cryptococcus neoformans is an opportunistic fungal pathogen that causes life-threatening meningitis primarily in immunocompromised individuals. In order to survive and proliferate during infection, C. neoformans must adapt to a variety of stresses it encounters within the host. Patient outcome depends on the interaction between the pathogen and the host. Understanding the mechanisms that C. neoformans uses to facilitate adaptation to the host and promote pathogenesis is necessary to better predict disease severity and establish proper treatment. Several virulence phenotypes have been characterized in C. neoformans, but the field still lacks a complete understanding of how genotype and phenotype contribute to clinical outcome. Furthermore, while it is known that C. neoformans genotype impacts patient outcome, the mechanisms remain unknown. This lack of understanding may be due to the genetic heterogeneity of C. neoformans and the extensive phenotypic variation observed between and within isolates during infection. In this review, we summarize the current understanding of how the various genotypes and phenotypes observed in C. neoformans correlate with human disease progression in the context of patient outcome and recurrence. We also postulate the mechanisms underlying the genetic and phenotypic changes that occur in vivo to promote rapid adaptation in the host.
Collapse
|
14
|
Associations between Cryptococcus Genotypes, Phenotypes, and Clinical Parameters of Human Disease: A Review. J Fungi (Basel) 2021; 7:jof7040260. [PMID: 33808500 PMCID: PMC8067209 DOI: 10.3390/jof7040260] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022] Open
Abstract
The genus Cryptococcus contains two primary species complexes that are significant opportunistic human fungal pathogens: C. neoformans and C. gattii. In humans, cryptococcosis can manifest in many ways, but most often results in either pulmonary or central nervous system disease. Patients with cryptococcosis can display a variety of symptoms on a spectrum of severity because of the interaction between yeast and host. The bulk of our knowledge regarding Cryptococcus and the mechanisms of disease stem from in vitro experiments and in vivo animal models that make a fair attempt, but do not recapitulate the conditions inside the human host. To better understand the dynamics of initiation and progression in cryptococcal disease, it is important to study the genetic and phenotypic differences in the context of human infection to identify the human and fungal risk factors that contribute to pathogenesis and poor clinical outcomes. In this review, we summarize the current understanding of the different clinical presentations and health outcomes that are associated with pathogenicity and virulence of cryptococcal strains with respect to specific genotypes and phenotypes.
Collapse
|
15
|
Pinheiro BG, Pôssa AP, Della Terra PP, de Carvalho JA, Ricci G, Nishikaku AS, Hahn RC, de Camargo ZP, Rodrigues AM. A New Duplex PCR-Assay for the Detection and Identification of Paracoccidioides Species. J Fungi (Basel) 2021; 7:169. [PMID: 33652623 PMCID: PMC7996757 DOI: 10.3390/jof7030169] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022] Open
Abstract
Paracoccidioidomycosis (PCM) is a life-threatening systemic fungal infection caused by members of the Paracoccidioides brasiliensis complex and P. lutzii. Routine diagnoses of PCM down to the species level using classical mycological approaches are unspecific due to overlapping phenotypes. There is an urgent need for specific, sensitive, and cost-effective molecular tools to diagnose PCM. Variation among the exon-2 of the gp43 gene was exploited to design species-specific primer pairs to discriminate between members of the P. brasiliensis complex and P. lutzii in a duplex PCR assay. Primer-BLAST searches revealed highly species-specific primers, and no significant region of homology was found against DNA databases except for Paracoccidioides species. Primers PbraCx-F and PbraCx-R targeting P. brasiliensis DNA produced an amplicon of 308 bp, while primers Plu-F and Plu-R targeting P. lutzii DNA generated an amplicon of 142 bp. The lower limit of detection for our duplex PCR assay was 1 pg of gDNA. A panel of 62 Paracoccidioides revealed 100% specificity (AUC = 1.000, 95%CI 0.972-1.000, p < 0.0001) without cross-reacting with other medically relevant fungi or human DNA. As a proof of concept, we demonstrated the accurate identification of the P. brasiliensis complex (n = 7) or P. lutzii (n = 6) from a broad range of formalin-fixed, paraffin-embedded (FFPE) tissues of PCM patient's organs. In four cases, FFPE PCR results confirmed, for the first time, co-infection due to P. brasiliensis (S1) and P. lutzii in the same biopsy. Our duplex PCR assay is useful to detect and differentiate members of the P. brasiliensis complex and P. lutzii, providing clinical laboratories with an important tool to be applied routinely, especially in atypical cases such as those featuring negative serology and positive mycological examination of clinical specimens as well as for the investigation of putative co-infection cases. This will likely benefit thousands of infected patients every year in a wide area of the Americas.
Collapse
Affiliation(s)
- Breno Gonçalves Pinheiro
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil; (B.G.P.); (A.P.P.); (P.P.D.T.); (J.A.d.C.); (Z.P.d.C.)
| | - Ana Paula Pôssa
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil; (B.G.P.); (A.P.P.); (P.P.D.T.); (J.A.d.C.); (Z.P.d.C.)
- Department of Medicine, Discipline of infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil
| | - Paula Portella Della Terra
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil; (B.G.P.); (A.P.P.); (P.P.D.T.); (J.A.d.C.); (Z.P.d.C.)
- Department of Medicine, Discipline of infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil
| | - Jamile Ambrósio de Carvalho
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil; (B.G.P.); (A.P.P.); (P.P.D.T.); (J.A.d.C.); (Z.P.d.C.)
| | - Giannina Ricci
- Centro de Diagnóstico e Pesquisa em Biologia Molecular Dr. Ivo Ricci, São Paulo 13561020, Brazil; (G.R.); (A.S.N.)
| | - Angela Satie Nishikaku
- Centro de Diagnóstico e Pesquisa em Biologia Molecular Dr. Ivo Ricci, São Paulo 13561020, Brazil; (G.R.); (A.S.N.)
| | - Rosane Christine Hahn
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá 78060900, Brazil;
- Júlio Muller University Hospital, Federal University of Mato Grosso, Cuiabá 78048902, Brazil
| | - Zoilo Pires de Camargo
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil; (B.G.P.); (A.P.P.); (P.P.D.T.); (J.A.d.C.); (Z.P.d.C.)
- Department of Medicine, Discipline of infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Discipline of Cellular Biology, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil; (B.G.P.); (A.P.P.); (P.P.D.T.); (J.A.d.C.); (Z.P.d.C.)
- Department of Medicine, Discipline of infectious Diseases, Federal University of São Paulo (UNIFESP), São Paulo 04023062, Brazil
| |
Collapse
|
16
|
Nishikaku AS, Soldá MV, Ricci G, Ponzio V, Pagliari C, Medina-Pestana JO, de Franco MF, Colombo AL. Correlation between clinical outcome and tissue inflammatory response in kidney transplant recipients with cryptococcosis. Pathog Dis 2020; 78:5908379. [PMID: 32945853 DOI: 10.1093/femspd/ftaa054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
Cryptococcosis is the second most common invasive fungal infection reported in renal transplant recipients. Tissue granulomatous inflammation is necessary to contain Cryptococcus infection. This study aims to analyze the granuloma patterns and in situ expression of regulatory T (Treg) immune response in tissue samples from 12 renal transplant recipients with cryptococcosis. Fungal isolates were molecularly identified as Cryptococcus neoformans species complex. A detailed characterization of granulomas in tissue samples from 12 kidney transplant recipients with cryptococcosis was described by checking six lung and six skin biopsies by conventional histology and for immunohistochemical detection of CD4 and Treg markers: forkhead box P3 (FoxP3), interleukin (IL)-10 and transforming-growth factor (TGF)-β. Granulomas were classified as compact, loose or mixed. Patients with mixed (n = 4) and compact (n = 3) granulomatous inflammation patterns were associated with a better prognosis and presented a higher number of CD4+FoxP3+T cells compared to the group of patients with loose granulomas. In counterpart, three out of five patients with loose granulomas died with cryptococcosis. We suggest that Treg may have a protective role in the tissue response to Cryptococcus infection given its association with compact and mixed granulomas in patients with better clinical outcomes.
Collapse
Affiliation(s)
- Angela S Nishikaku
- Laboratório Especial de Micologia, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Marcel V Soldá
- Laboratório Especial de Micologia, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Giannina Ricci
- Laboratório Especial de Micologia, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Vinicius Ponzio
- Laboratório Especial de Micologia, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.,Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, SP, Brazil
| | - Carla Pagliari
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - José O Medina-Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, SP, Brazil
| | - Marcello F de Franco
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Arnaldo Lopes Colombo
- Laboratório Especial de Micologia, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
17
|
da Silva LB, Bock D, Klafke GB, Sanchotene KO, Basso RP, Benelli JL, Poester VR, da Silva FA, Trilles L, Severo CB, Stevens DA, Xavier MO. Cryptococcosis in HIV-AIDS patients from Southern Brazil: Still a major problem. J Mycol Med 2020; 30:101044. [PMID: 33046394 DOI: 10.1016/j.mycmed.2020.101044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/23/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Cryptococcus neoformans is an opportunistic pathogen that causes ∼15% mortality in AIDS patients. Rio Grande City, Rio Grande do Sul (RS), Brazil, has the highest national rate of HIV/AIDS, considering cities with population more than 100,000 habitants. OBJECTIVE We aimed to evaluate the clinical and epidemiological profile of cryptococcosis in a reference service for HIV-AIDS patients in the South region of Brazil, over seven years. Material and methods A retrospective study was performed including all cryptococcosis cases diagnosed at the University Hospital, Federal University of Rio Grande (UH-FURG) between January 2010 and December 2016. RESULTS Seventy cases of cryptococcosis were diagnosis from 2010 to 2016 in the UH-FURG in the seven years of the study. These numbers were responsible for 2.1% to 8.1% of the hospitalizations/year for HIV patients. All were caused by C. neoformans infection (95% C. neoformans var. grubii VNI and 5% C. neoformans var. grubii VNII). Neurocryptococcosis was the major clinical manifestation and cryptococcosis was the HIV- defining condition in 40% of patients. The period of hospitalization was an average of 39.3 days (SD=31.3), and more than half of patients (53%; 37/70) died after a mean of 82 days. DISCUSSION The present study showed the importance of cryptococcosis as an AIDS-defining disease in HIV-AIDS patients in a tertiary hospital from Southern Brazil. More investment is necessary to reduce the impact of this opportunistic mycosis in HIV-AIDS patients from southern Brazil.
Collapse
Affiliation(s)
- L B da Silva
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - D Bock
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil
| | - G B Klafke
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil
| | - K O Sanchotene
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - R P Basso
- Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - J L Benelli
- Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - V R Poester
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - F A da Silva
- Mycology Laboratory of National Institute of Infectology, Foundation Oswaldo Cruz (INI-FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - L Trilles
- Mycology Laboratory of National Institute of Infectology, Foundation Oswaldo Cruz (INI-FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - C B Severo
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - D A Stevens
- California Institute for Medical Research, San Jose, California, USA and Div. of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA
| | - M O Xavier
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil.
| |
Collapse
|
18
|
Li Y, Zou M, Yin J, Liu Z, Lu B. Microbiological, Epidemiological, and Clinical Characteristics of Patients With Cryptococcal Meningitis at a Tertiary Hospital in China: A 6-Year Retrospective Analysis. Front Microbiol 2020; 11:1837. [PMID: 32849436 PMCID: PMC7403485 DOI: 10.3389/fmicb.2020.01837] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
Cryptococcal meningitis, mainly caused by Cryptococcus neoformans/gattii species complexes, is a lethal infection in both immunosuppressive and immunocompetent populations. We characterized 110 Cryptococcus strains collected from Xiangya Hospital of Central South University in China during the 6-year study period between 2013 and 2018, and performed their antifungal susceptibility testing. Furthermore, the clinical features, laboratory and imaging data, treatment strategies and outcomes of the subjects were retrospectively analyzed. Of 110 Cryptococcus strains, C. neoformans species complexes accounted for 96.4% (106/110), including C. neoformans sensu stricto (VNI molecular type, 95.5%, 105/110) and Cryptococcus deneoformans (VNIV molecular type, 0.9%, 1/110), and Cryptococcus deuterogattii (VGII molecular type) accounted for 3.6% (4/110). The strains were further classified into 17 individual sequence types (STs) by using multilocus sequence typing (MLST). 89.1% (98/110) were represented by ST5; seven C. deuterogattii strains and one Cryptococcus deneoformans strain were assigned as ST7 and ST260, respectively. Antifungal minimal inhibitory concentrations above the epidemiological cutoff values (ECVs) were found mainly in C. neoformans species complexes strains (nine for amphotericin B, nine for fluconazole and seven for 5-fluorocytosine). Furthermore, 60.9% (67/110) of the subjects were male, and 40.0% (44/110) did not have underlying diseases. Hepatic diseases (hepatitis/HBV carrier status and cirrhosis) were the most common underlying health conditions (11.8%, 13/110), followed by autoimmune disorders (10.9%, 12/110) and chronic kidney disease (6.36%, 7/110). Only 4.5% (5/110) of the patients were HIV/AIDS positives. For clinical presentation, headache (77.3%, 85/110), fever (47.3%, 52/110), and stiff neck (40.9%, 45/110) were commonly observed. The mortality rate was 35.0% (36/103). In conclusion, our data were characterized by a high prevalence of the Cryptococcal meningitis patients without HIV/AIDS and other underlying health conditions, a relatively high non-wild-type rate of fluconazole and amphotericin B resistance, and low genetic diversity in Cryptococcus strains. The present study will provide evidence for further improvement of the diagnosis and treatment of cryptococcosis in China.
Collapse
Affiliation(s)
- Yanbing Li
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxiang Zou
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jun Yin
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqing Liu
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Binghuai Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Guangdong Key Laboratory for Emerging Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, China
| |
Collapse
|
19
|
Ferreira GDSA, Watanabe ALC, Trevizoli NDC, Jorge FMF, Couto CDF, de Campos PB, Caja GON. Transmission of cryptococcosis by liver transplantation: A case report and review of literature. World J Hepatol 2020; 12:253-261. [PMID: 32547692 PMCID: PMC7280860 DOI: 10.4254/wjh.v12.i5.253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/24/2020] [Accepted: 04/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cryptococcosis is a fungal infection caused by the yeast-like encapsulated basidiomycetous fungus of the Cryptococcus neoformans (C. neoformans) species complex. These fungi are ubiquitous in soil and bird droppings, and infection by them is an important global health concern, particularly in immunosuppressed patients, such as organ transplant recipients and those infected by the human immunodeficiency virus. The fungus usually enters the body through the respiratory tract, but extremely rare cases of infection acquired by transplantation of solid organs have been reported.
CASE SUMMARY We report a case of disseminated cryptococcosis in a liver transplant recipient, diagnosed 2 wk after the procedure. The patient initially presented with fever, hyponatremia and elevated transaminase levels, manifesting intense headache after a few days. Blood cultures were positive for C. neoformans. Liver biopsy showed numerous fungal elements surrounded by gelatinous matrix and sparse granulomatous formations. Magnetic resonance imaging of the brain showed multiple small lesions with low signal in T2, peripheric enhancement and edematous halo, diffuse through the parenchyma but more concentrated in the subcortical regions. Treatment with amphotericin B for 3 wk, followed by maintenance therapy with fluconazole, led to complete resolution of the symptoms. The recipients of both kidneys from the same donor also developed disseminated cryptococcosis, confirming the transplant as the source of infection. The organ donor lived in a rural area, surrounded by tropical rainforest, and had negative blood cultures prior to organ procurement.
CONCLUSION This case highlights the risk of transmission of fungal diseases, specifically of C. neoformans, through liver graft during liver transplantation.
Collapse
Affiliation(s)
| | - Andre Luis Conde Watanabe
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70673900, Brazil
| | | | | | - Carolina de Fatima Couto
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70673900, Brazil
| | - Priscila Brizolla de Campos
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70673900, Brazil
| | - Gabriel Oliveira Nunes Caja
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70673900, Brazil
| |
Collapse
|
20
|
Transmission of cryptococcosis by liver transplantation: A case report and review of literature. World J Hepatol 2020. [DOI: 10.4254/wjh.v12.i5.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
21
|
Pllana-Hajdari D, Cogliati M, Čičmak L, Pleško S, Mlinarić-Missoni E, Mareković I. First Isolation, Antifungal Susceptibility, and Molecular Characterization of Cryptococcus neoformans from the Environment in Croatia. J Fungi (Basel) 2019; 5:jof5040099. [PMID: 31614885 PMCID: PMC6958495 DOI: 10.3390/jof5040099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to investigate the presence of Cryptococcus neoformans species complex isolates from environmental sources in Croatia and to determine their molecular types and antifungal susceptibility. Swab samples of tree hollows and bird excreta in the soil beneath trees were collected. Samples included 472 (92.73%) samples obtained from tree hollows and 37 (7.27%) samples from bird excreta. Four C. neoformans species complex isolates were recovered from tree hollow swabs along the Mediterranean coast, while there were no isolates recovered from bird excreta or from the continental area. Three isolates were identified as molecular types VNI and one as VNIV. All tested antifungals showed high in vitro activity against the four isolates. This is the first report proving the presence of C. neoformans species complex in the environment of Croatia. The results of the study suggest a major risk of exposure for inhabitants living along the Croatian coast and that both VNI and VNIV molecular types can be expected in clinical cases of cryptococcosis. Susceptibility to antifungals confirmed that no resistance should be expected in patients with cryptococcosis at the present time.
Collapse
Affiliation(s)
- Donjeta Pllana-Hajdari
- Department of Molecular Microbiology, National Institute of Public Health, Prishtina 10 000, Kosovo.
| | - Massimo Cogliati
- Laboratorio di Micologia Medica, Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano 20133, Italy.
| | - Ljiljana Čičmak
- Department for Parasitology and Mycology, Croatian Institute for Public Health, Zagreb 10 000, Croatia.
| | - Sanja Pleško
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb 10 000, Croatia.
| | - Emilija Mlinarić-Missoni
- Department for Parasitology and Mycology, Croatian Institute for Public Health, Zagreb 10 000, Croatia.
| | - Ivana Mareković
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb 10 000, Croatia.
| |
Collapse
|
22
|
Selb R, Fuchs V, Graf B, Hamprecht A, Hogardt M, Sedlacek L, Schwarz R, Idelevich EA, Becker SL, Held J, Küpper-Tetzel CP, McCormick-Smith I, Heckmann D, Gerkrath J, Han CO, Wilmes D, Rickerts V. Molecular typing and in vitro resistance of Cryptococcus neoformans clinical isolates obtained in Germany between 2011 and 2017. Int J Med Microbiol 2019; 309:151336. [PMID: 31444102 DOI: 10.1016/j.ijmm.2019.151336] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/05/2019] [Accepted: 07/31/2019] [Indexed: 02/07/2023] Open
Abstract
Cryptococcosis is a fungal infection of the central nervous system predominantly caused by Cryptococcus neoformans in immunocompromised patients. In several countries worldwide, up to 50% of isolates show in vitro resistance to clinically used antifungals including fluconazole. No prospective data on susceptibility to antifungal drugs are available for Germany. In this study, we characterised all C. neoformans isolates collected from individual patients' samples at the German reference laboratory for cryptococcosis 2011 and 2017 (n = 133) by multi-locus sequence typing and phenotypic drug susceptibility testing. We identified serotype A/genotype VNI isolates belonging to clonal complexes previously described from Europe, Africa, Asia and South America as the most prevalent agents of cryptococcosis in Germany. Overall, we observed minimal inhibitory concentrations (MICs) above the epidemiological cut-offs (ECVs) in 1.6% of isolates regarding fluconazole and 2.3% of isolates regarding 5-flucytosine. Here, two C. neoformans var. grubii isolates displayed decreased drug susceptibility to fluconazole, one of them additionally to 5-flucytosine. We also found 5-flucytosine MICs above the ECV for two C. neoformans var. neoformans isolates. We identified a novel mutation in the ERG11 gene which might be associated with the elevated fluconazole MIC in one of the isolates. The clinical importance of the detected in vitro resistance is documented by patient histories showing relapsed infection or primary fatal disease. Of note, sertraline demonstrated antifungal activity comparable to previous reports. Systematic collection of susceptibility data in combination with molecular typing of C. neoformans is important to comprehensively assess the spread of isolates and to understand their drug resistance patterns.
Collapse
Affiliation(s)
- Regina Selb
- European Public Health Microbiology Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Vidmante Fuchs
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Barbara Graf
- Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, Goethe University Hospital, Frankfurt/Main, Germany
| | - Ludwig Sedlacek
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Roman Schwarz
- MVZ Dr. Stein and colleagues, Moenchengladbach, Germany
| | - Evgeny A Idelevich
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Jürgen Held
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Claus P Küpper-Tetzel
- Medical Department II, Infectious Diseases Unit, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Ilka McCormick-Smith
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Daniela Heckmann
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Jasmin Gerkrath
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Chang-Ok Han
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Dunja Wilmes
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany
| | - Volker Rickerts
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch-Institute, Berlin, Germany.
| |
Collapse
|
23
|
Tsai WC, Lien CY, Lee JJ, Huang CR, Tsai NW, Chang CC, Lu CH, Chang WN. The clinical characteristics of adult cryptococcal meningitis patients who died within one year of treatment with a focus on those with early mortality. J Clin Neurosci 2019; 67:80-84. [PMID: 31227408 DOI: 10.1016/j.jocn.2019.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/24/2019] [Accepted: 06/09/2019] [Indexed: 02/08/2023]
Abstract
Cryptococcal meningitis (CM) is a serious infectious disease of the central nervous system, and associated brain injuries can be found in the very early stage of disease. In this study, 92 adult CM patients (59 men, 33 women; median age 54.66 years, range 20-86 years) were enrolled, and their clinical, laboratory, neuroimaging features and therapeutic outcomes were analyzed. Two main clinical comparative analyses of the clinical characteristics and laboratory and neuroimaging features were made in this study. The first compared clinical differences between the survivors and non-survivors of all enrolled patients, and the second compared differences between the following three groups: Group I, the patients who died within 14 days of initiating treatment; Group II, the patients who died within 15 days to 1 year of initiating treatment, and Group III, the patients who survived for more than 1 year after initiating treatment. Prognostic factors including initial altered consciousness, increased cerebrospinal fluid (CSF) lactate level and the presence of cryptococcemia were significantly different between the different groups. The patients with early mortality had a higher CSF lactate level and higher rate of cryptococcemia. The presence of cryptococcemia was an important prognostic factor, and the patients with cryptococcemia had a higher incidence of positive CSF India ink stain. Further large-scale studies are needed to delineate the clinical and laboratory features of CM patients with early mortality.
Collapse
Affiliation(s)
- Wan-Chen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Yi Lien
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jun-Jun Lee
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chi-Ren Huang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|