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Al-Odaini N, Li XY, Li BK, Chen XC, Huang CY, Lv CY, Pan KS, Zheng DY, Zheng YQ, Liao WQ, Cao CW. In vitro Antifungal Susceptibility Profiles of Cryptococcus neoformans var. grubii and Cryptococcus gattii Clinical Isolates in Guangxi, Southern China. Front Microbiol 2021; 12:708280. [PMID: 34447360 PMCID: PMC8383296 DOI: 10.3389/fmicb.2021.708280] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023] Open
Abstract
This study analyzed the in vitro drug sensitivity of Cryptococcus spp. from Guangxi, Southern China. One hundred three strains of Cryptococcus were recovered from 86 patients; 14 were HIV positive and 72 were HIV negative. Ninety-two strains were identified as Cryptococcus neoformans var. grubii, while 11 strains were identified as Cryptococcus gattii (5 C. gattii sensu stricto and 6 Cryptococcus deuterogattii). The recovered strains were tested against commonly used antifungal drugs (fluconazole, amphotericin B, 5-fluorocytosine, itraconazole, and voriconazole) and to novel antifungal drugs (posaconazole and isavuconazole) using CLSI M27-A4 method. The results showed that all isolates were susceptible to most antifungal drugs, of which the minimum inhibitory concentration (MIC) ranges were as follows: 0.05-4 μg/ml for fluconazole, 0.25-1 μg/ml for amphotericin B; 0.0625-2 μg/ml for 5-fluorocytosine, 0.0625-0.25 μg/ml for itraconazole, 0.0078-0.25 μg/ml for voriconazole, 0.0313-0.5 μg/ml for posaconazole, 0.0020-0.125 μg/ml for isavuconazole for C. neoformans var. grubii isolates, and 1-16 μg/ml for fluconazole, 0.125-1 μg/ml for 5-fluorocytosine, 0.25-1 μg/ml for amphotericin B, 0.0625-0.25 μg/ml for itraconazole, 0.0156-0.125 μg/ml for voriconazole, 0.0156-0.25 μg/ml for posaconazole, and 0.0078-0.125 μg/ml for isavuconazole for C. gattii isolates. Furthermore, some C. neoformans var. grubii isolates were found to be susceptible-dose dependent to 5-fluorocytosine and itraconazole. In addition, a reduction in the potency of fluconazole against C. gattii is possible. We observed no statistical differences in susceptibility of C. neoformans var. grubii and C. gattii in the tested strains. Continuous observation of antifungal susceptibility of Cryptococcus isolates is recommended to monitor the emergence of resistant strains.
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Affiliation(s)
- Najwa Al-Odaini
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
| | - Xiu-Ying Li
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
| | - Bing-Kun Li
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
| | - Xing-Chun Chen
- The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chun-Yang Huang
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
| | - Chun-Ying Lv
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
| | - Kai-Su Pan
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
| | - Dong-Yan Zheng
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
| | - Yan-Qing Zheng
- Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China.,Fourth People's Hospital of Nanning, Nanning, China
| | - Wan-Qing Liao
- Shanghai Key Laboratory of Medical Fungal Molecular Biology, Second Military Medical University, Shanghai, China
| | - Cun-Wei Cao
- Department of Dermatology and Venerology, First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Health Commission Key Lab of Fungi and Mycosis Research and Prevention, Nanning, China
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Pharkjaksu S, Chongtrakool P, Chayakulkeeree M, Mitrpant C, Angkasekwinai P, Bennett JE, Kwon-Chung KJ, Ngamskulrungroj P. Cryptococcus neoformans/gattii Species Complexes from Pre-HIV Pandemic Era Contain Unusually High Rate of Non-Wild-Type Isolates for Amphotericin B. Infect Drug Resist 2020; 13:673-681. [PMID: 32161475 PMCID: PMC7049752 DOI: 10.2147/idr.s235473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/11/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction The Cryptococcus neoformans/gattii species complexes are a leading cause of fatality among HIV-infected patients. Despite the unavailability of clinical breakpoints (CBPs) for antifungal agents, epidemiological cutoff values (ECVs) were recently proposed, and non-wild-type isolates for polyenes and azoles are being increasingly reported. However, the distributions of the susceptibility patterns for pre-HIV-era isolates have not been studied. Methods We determined the in vitro antifungal susceptibility patterns of 233 Cryptococcus isolates, collected at the National Institutes of Health, USA, in pre-HIV pandemic era, to study minimum inhibitory concentrations (MICs) to the important drugs for cryptococcosis and to compare the results with strain genotypes. Amphotericin B susceptibility was compared to published ECV of C. neoformans. Results The 233 Cryptococcus strains consisted of 89.7% C. neoformans species complex and 10.3% C. gattii species complex. Most were from clinical sources (189, 81.1%), and the major molecular type was VNI (146, 62.7%). The highest geometric mean (GM) was observed for fluconazole (GM = 0.96 µg/mL) while the lowest was for itraconazole (GM = 0.10 µg/mL). MICs to fluconazole in C. gattii species complex were significantly higher than C. neoformans species complex (p < 0.001). Moreover, C. neoformans/VNI strains showed significantly higher MICs than others such as C. neoformans/VNII to fluconazole (p < 0.0001) and C. deneoformans/VNIV to amphotericin B (p = 0.022) and fluconazole (p = 0.008). In our collection of 167 clinical C. neoformans species complex strains, 85 (50.9%), 24 (14.4%), and 3 (1.8%) strains had an amphotericin B (AMB)-MIC of 1, 2, and 4 µg/mL, respectively. The high percentage (66.9%, 79/118 strains) of non-wild-type clinical C. neoformans VNI strains, using an AMB-ECV of 0.5 µg/mL, was found. Moreover, 25 of 28 (89.3%) C. neoformans VNI strains from environmental and veterinary sources also had AMB-MICs above 0.5 µg/mL. In general, there was no significant difference in GM AMB-MIC of the clinical strains isolated from patients with (35 patients) and without (78 patients) prior AMB treatment (0.85 vs 0.76; p = 0.624). GM MIC of the environmental strains was not significantly different from that of the prior AMB-treatment strains (0.98 vs 0.76, p = 0.159) and the post-AMB-treatment strains (0.98 vs 0.85, p = 0.488). Conclusion The high rate of non-wild-type among these otherwise naive isolates to amphotericin B is unexpected. Confirmation with more strains from a later era is needed.
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Affiliation(s)
- Sujiraphong Pharkjaksu
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piriyaporn Chongtrakool
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Methee Chayakulkeeree
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermchai Mitrpant
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornpimon Angkasekwinai
- Department of Medical Technology, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - John E Bennett
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kyung J Kwon-Chung
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Popchai Ngamskulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Figueiredo TP, Lucas RCD, Cazzaniga RA, França CN, Segato F, Taglialegna R, Maffei CML. ANTIFUNGAL SUSCEPTIBILITY TESTING AND GENOTYPING CHARACTERIZATION OF Cryptococcus neoformans AND gattii ISOLATES FROM HIV-INFECTED PATIENTS OF RIBEIRÃO PRETO, SÃO PAULO, BRAZIL. Rev Inst Med Trop Sao Paulo 2016; 58:69. [PMID: 27680174 PMCID: PMC5048640 DOI: 10.1590/s1678-9946201658069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/26/2016] [Indexed: 12/20/2022] Open
Abstract
Cryptococcosis is a leading invasive fungal infection in immunocompromised patients.
Considering the high prevalence and severity of these infections in immunocompromised
patients attended at HC-FMRP-USP, the present research aimed to characterize the
clinical isolates of Cryptococcus strains by biochemical and
molecular methods and evaluate antifungal susceptibility of clinical isolates. Fifty
isolates from 32 HIV-positive patients were obtained at HC-FMRP-USP. Most of the
isolates (78.1%) were identified as C. neoformans, and 100% of
C. neoformans and C. gattii strains were
susceptible to amphotericin B, ketoconazole and fluconazole. All isolates were
classified as serotype A (grubbii variety) by PCR and most of them
were characterized in mating type MATa. PCR analysis of specific M13 microsatellite
sequence revealed that VNI type was predominant among C. neoformans,
while VGII was predominant among C. gattii. The strains did not show
a significant resistance to the antifungals tested, and Canavanine-Glycine-Bromthymol
Blue Agar (CGB) proved to be a reliable test presenting a good correlation with the
molecular characterization. C. neoformans isolated from disseminated
infections in the same patient showed molecular identity when different anatomical
sites were compared; besides, the studied strains did not present a significant
increase in resistance to antifungal agents. In addition, the homogeneity of the
molecular types and detection of the mating types suggested a low possibility of
crossing among the strains.
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Affiliation(s)
- Thais Pandini Figueiredo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica. 14049-900 Ribeirão Preto, SP, Brazil. E-mail: .,Universidade Federal de Ouro Preto, Núcleo de Inovação Tecnológica, 35400-000 Ouro Preto, MG, Brazil. E-mail:
| | - Rosymar Coutinho de Lucas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Bioquímica. 14049-900 Ribeirão Preto, SP, Brazil. E-mail: .,Universidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Departamento de Biologia. 14040-901 Ribeirão Preto, SP, Brazil. E-mail:
| | | | - Carolina Nunes França
- Universidade de Santo Amaro, UNISA, Pós Graduação em Ciências da Saúde, São Paulo, SP, Brazil. E-mail: .,Universidade Federal de São Paulo, UNIFESP, Departamento de Medicina, São Paulo, SP, Brazil. E-mail:
| | - Fernando Segato
- , Escola de Engenharia de Lorena, Departamento de Biotecnologia. 12602-810, Lorena, SP,Universidade de São Paulo Brazil. E-mail:
| | - Rafael Taglialegna
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biologia Celular, Molecular e Bioagentes Patogênicos. 14049-900 Ribeirão Preto, SP, Brazil. E-mails: ;
| | - Claudia Maria Leite Maffei
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biologia Celular, Molecular e Bioagentes Patogênicos. 14049-900 Ribeirão Preto, SP, Brazil. E-mails: ;
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Gutch RS, Nawange SR, Singh SM, Yadu R, Tiwari A, Gumasta R, Kavishwar A. Antifungal susceptibility of clinical and environmental Cryptococcus neoformans and Cryptococcus gattii isolates in Jabalpur, a city of Madhya Pradesh in Central India. Braz J Microbiol 2015; 46:1125-33. [PMID: 26691471 PMCID: PMC4704646 DOI: 10.1590/s1517-838246420140564] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/28/2014] [Indexed: 11/22/2022] Open
Abstract
In this study, we present antifungal susceptibility data of clinical and
environmental isolates of Central Indian Cryptococcus neoformans
(Serotype A, n = 8 and n = 50 respectively) and Cryptococcus gattii
(Serotype B, n = 01 and n = 04 respectively). Susceptibilities to fluconazole,
itraconazole and ketoconazole were determined by using NCCLS broth micro-dilution
methodology. The total number of resistant strains for fluconazole in case of
C. neoformans and C. gattii showed a significant
difference by using chi-square test (p < 0.05*), while considering fisher's exact
p value was nonsignificant (p > 0.05). However, the total number of resistant
strains for itraconazole and ketoconazole was not found statistically significant. A
comparison of geometric means of clinical and environmental strains of C.
gattii and C. neoformans was not found statistically
significant using student ‘t’ test (p value > 0.05 NS). Though less, the
antifungal data obtained in this study suggests that primary resistance among
environmental and clinical isolates of C. neoformans and C.
gattii against tested antifungal was present and C.
gattii comparatively was less susceptible than C.
neoformans var. grubii isolates to fluconazole than to
itraconazole and ketoconazole. A continuous surveillance of antifungal susceptibility
of clinical and environmental isolates of C. neoformans and
C. gattii is desirable to monitor the emergence of any resistant
strains for better management of cryptococcosis patients.
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Affiliation(s)
- Ruchi Sethi Gutch
- Department of Biological Sciences, Rani Durgavati University, Madhya Pradesh, India
| | - Shesh Rao Nawange
- Department of Biological Sciences, Rani Durgavati University, Madhya Pradesh, India
| | - Shankar Mohan Singh
- Department of Biological Sciences, Rani Durgavati University, Madhya Pradesh, India
| | - Ruchika Yadu
- Department of Biological Sciences, Rani Durgavati University, Madhya Pradesh, India
| | - Aditi Tiwari
- Department of Biological Sciences, Rani Durgavati University, Madhya Pradesh, India
| | - Richa Gumasta
- Department of Biological Sciences, Rani Durgavati University, Madhya Pradesh, India
| | - Arvind Kavishwar
- National Institute For Research In Tribal Health, Madhya Pradesh, India
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Abstract
Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans, although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.
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Favalessa OC, Lázera MDS, Wanke B, Trilles L, Takahara DT, Tadano T, Dias LB, Vieira AC, Novack GV, Hahn RC. FatalCryptococcus gattiigenotype AFLP6/VGII infection in a HIV-negative patient: case report and a literature review. Mycoses 2014; 57:639-43. [DOI: 10.1111/myc.12210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/21/2014] [Accepted: 05/25/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Olivia Cometti Favalessa
- Laboratório de Micologia; Faculdade de Medicina; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
| | | | - Bodo Wanke
- IPEC - Laboratório de Micologia; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Luciana Trilles
- IPEC - Laboratório de Micologia; FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Doracilde Terumi Takahara
- Laboratório de Micologia; Faculdade de Medicina; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
| | - Tomoko Tadano
- Hospital Universitário Júlio Müller; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
| | - Luciana Basili Dias
- Laboratório de Micologia; Faculdade de Medicina; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
| | - Ananda Castro Vieira
- Hospital Universitário Júlio Müller; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
| | - Glaúcia Vanessa Novack
- Hospital Universitário Júlio Müller; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
| | - Rosane Christine Hahn
- Laboratório de Micologia; Faculdade de Medicina; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
- Hospital Universitário Júlio Müller; Universidade Federal de Mato Grosso; Cuiabá MT Brazil
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Trpković A, Pekmezović M, Barać A, Crnčević Radović L, Arsić Arsenijević V. In vitro antifungal activities of amphotericin B, 5-fluorocytosine, fluconazole and itraconazole against Cryptococcus neoformans isolated from cerebrospinal fluid and blood from patients in Serbia. J Mycol Med 2012; 22:243-8. [DOI: 10.1016/j.mycmed.2012.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/17/2012] [Accepted: 06/21/2012] [Indexed: 11/29/2022]
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Lockhart SR, Iqbal N, Bolden CB, DeBess EE, Marsden-Haug N, Worhle R, Thakur R, Harris JR. Epidemiologic cutoff values for triazole drugs in Cryptococcus gattii: correlation of molecular type and in vitro susceptibility. Diagn Microbiol Infect Dis 2012; 73:144-8. [PMID: 22494557 DOI: 10.1016/j.diagmicrobio.2012.02.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 01/12/2023]
Abstract
Cryptococcus gattii causes infection in tropical and subtropical regions worldwide but has garnered increased attention since its 1999 emergence in North America. C. gattii can be divided into 4 molecular types that may represent cryptic species. Recent evidence has shown that azole antifungal MIC values differ among these molecular types. We tested a large collection of C. gattii isolates for susceptibility to 4 azole drugs. We found that isolates of molecular type VGII have the highest geometric mean (GM) fluconazole MIC values (8.6 μg/mL), while isolates of molecular type VGI have the lowest (1.7 μg/mL). For fluconazole, itraconazole, and voriconazole GM MIC values, VGI < VGIII < VGIV < VGII. The GM MIC values for posaconazole were similarly represented across molecular types, with the exception that VGII < VGIII and VGIV. We used the MIC values to establish preliminary epidemiologic cutoff values for each azole and molecular type of C. gattii.
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Affiliation(s)
- Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Li M, Liao Y, Chen M, Pan W, Weng L. Antifungal susceptibilities of Cryptococcus species complex isolates from AIDS and non-AIDS patients in Southeast China. Braz J Infect Dis 2012; 16:175-9. [DOI: 10.1016/s1413-8670(12)70301-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/11/2011] [Indexed: 11/29/2022] Open
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Silva DC, Martins MA, Szeszs MW, Bonfietti LX, Matos D, Melhem MSC. Susceptibility to antifungal agents and genotypes of Brazilian clinical and environmental Cryptococcus gattii strains. Diagn Microbiol Infect Dis 2012; 72:332-9. [PMID: 22341512 DOI: 10.1016/j.diagmicrobio.2011.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 11/26/2022]
Abstract
There are few reports concerning the in vitro antifungal susceptibility of clinical and environmental Cryptococcus gattii isolates. In this study, we performed polymerase chain reaction-restriction fragment length polymorphism to investigate the molecular subtypes of 50 clinical and 4 environmental Brazilian isolates of C. gattii and assessed their antifungal susceptibility for fluconazole (FLU) and amphotericin B (Amb) according to recent recommendations proposed for antifungal susceptibility testing of nonfermentative yeasts. Time-kill curve studies were performed using RPMI 1640 medium to analyze the fungicidal effect of AmB. We found 47 VGII (94%) molecular types and 3 VGI (6%) types among the clinical isolates. The environmental isolates were VGII (75%) subtype and VGI (25%) subtype. The FLU-MIC ranged from 1 to 64 mg L(-1), and MIC(50)/MIC(90) values were, respectively, 8/16 mg L(-1). For AmB, the MICs were low and homogeneous, ranging from 0.12 to 0.5 mg L(-1), for VGI or VGII. The time required to reach the fungicidal end point (99.9% killing) was 6 h for the majority of strains (64%), but viable cells of VGII were still present after 48 h of exposition. We pointed out the occurrence of high FLU-MICs for C. gattii isolates with highest values for VGII. Our data also suggest that the rate of killing of C. gattii by AmB is strain dependent, and viable cells of VGII genotype strains were still observed after an extended incubation time, addressing future studies to determine whether the in vitro fungicidal activity could be clinically relevant.
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Affiliation(s)
- Dayane C Silva
- Mycology Unit of Adolfo Lutz Institute, Public Health Reference Laboratory, Secretary of Health, São Paulo-SP, 01246-902, Brazil
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Trilles L, Meyer W, Wanke B, Guarro J, Lazéra M. Correlation of antifungal susceptibility and molecular type within the Cryptococcus neoformans/C. gattii species complex. Med Mycol 2011; 50:328-32. [PMID: 21859388 DOI: 10.3109/13693786.2011.602126] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Members of the Cryptococcus neoformans/C. gattii species complex are grouped into eight molecular types, differing in their epidemiology, disease severity and geographic range. Recent in vitro antifungal susceptibility studies of isolates of the complex revealed contradictory results. The objective of the present study was to assess if this variation is random or correlates with different molecular types by testing the in vitro antifungal susceptibility of 18 C. neoformans (VNI), 11 C. gattii (VGI) and 38 C. gattii (VGII) strains from Brazil to eight antifungal drugs using the CLSI microdilution method. We herein report that the molecular type VGII is the least susceptible genotype, followed by VGI and VNI. This indicates a clear correlation between antifungal susceptibilities and genotypes of the causative cryptococcosis agents, emphasizing the importance of determining the molecular type as part of the clinical diagnostic process to enable an informed decision as to the most appropriate antifungal treatment.
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Affiliation(s)
- Luciana Trilles
- Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. ocruz.br
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Chowdhary A, Randhawa HS, Sundar G, Kathuria S, Prakash A, Khan Z, Sun S, Xu J. In vitro antifungal susceptibility profiles and genotypes of 308 clinical and environmental isolates of Cryptococcus neoformans var. grubii and Cryptococcus gattii serotype B from north-western India. J Med Microbiol 2011; 60:961-967. [DOI: 10.1099/jmm.0.029025-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 11007, India
| | - Harbans Singh Randhawa
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 11007, India
| | - Gandhi Sundar
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 11007, India
| | - Shallu Kathuria
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 11007, India
| | - Anupam Prakash
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 11007, India
| | - Ziauddin Khan
- Mycology Reference Laboratory, Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Sheng Sun
- Institute of Infectious Disease Research, Michael G. DeGroote School of Medicine, and Department of Biology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Jianping Xu
- Institute of Infectious Disease Research, Michael G. DeGroote School of Medicine, and Department of Biology, McMaster University, Hamilton, ON L8S 4K1, Canada
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Guinea J, Hagen F, Peláez T, Boekhout T, Tahoune H, Torres-Narbona M, Bouza E. Antifungal susceptibility, serotyping, and genotyping of clinicalCryptococcus neoformansisolates collected during 18 years in a single institution in Madrid, Spain. Med Mycol 2010; 48:942-8. [DOI: 10.3109/13693781003690067] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Chau TT, Mai NH, Phu NH, Nghia HD, Chuong LV, Sinh DX, Duong VA, Diep PT, Campbell JI, Baker S, Hien TT, Lalloo DG, Farrar JJ, Day JN. A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam - high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease. BMC Infect Dis 2010; 10:199. [PMID: 20618932 PMCID: PMC2910700 DOI: 10.1186/1471-2334-10-199] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 07/09/2010] [Indexed: 11/14/2022] Open
Abstract
Background Most cases of cryptococcal meningitis occur in patients with HIV infection: the course and outcome of disease in the apparently immunocompetent is much more poorly understood. We describe a cohort of HIV uninfected Vietnamese patients with cryptococcal meningitis in whom underlying disease is uncommon, and relate presenting features of patients and the characteristics of the infecting species to outcome. Methods A prospective descriptive study of HIV negative patients with cryptococcal meningitis based at the Hospital for Tropical Diseases, Ho Chi Minh City. All patients had comprehensive clinical assessment at baseline, were cared for by a dedicated study team, and were followed up for 2 years. Clinical presentation was compared by infecting isolate and outcome. Results 57 patients were studied. Cryptococcus neoformans var grubii molecular type VN1 caused 70% of infections; C. gattii accounted for the rest. Most patients did not have underlying disease (81%), and the rate of underlying disease did not differ by infecting species. 11 patients died while in-patients (19.3%). Independent predictors of death were age ≥ 60 years and a history of convulsions (odds ratios and 95% confidence intervals 8.7 (1 - 76), and 16.1 (1.6 - 161) respectively). Residual visual impairment was common, affecting 25 of 46 survivors (54.3%). Infecting species did not influence clinical phenotype or outcome. The minimum inhibitory concentrations of flucytosine and amphotericin B were significantly higher for C. neoformans var grubii compared with C. gattii (p < 0.001 and p = 0.01 respectively). Conclusion In HIV uninfected individuals in Vietnam, cryptococcal meningitis occurs predominantly in people with no clear predisposing factor and is most commonly due to C. neoformans var grubii. The rates of mortality and visual loss are high and independent of infecting species. There are detectable differences in susceptibility to commonly used antifungal drugs between species, but the clinical significance of this is not clear.
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Affiliation(s)
- Tran Th Chau
- Hospital for Tropical Diseases, Quan, Ho Chi Minh City, Vietnam
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Nayak R, Xu J. Effects of sertraline hydrochloride and fluconazole combinations onCryptococcus neoformansandCryptococcus gattii. Mycology 2010. [DOI: 10.1080/21501203.2010.487054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
The incidence of invasive mycoses is increasing, especially among patients who are immunocompromised or hospitalized with serious underlying diseases. Such infections may be broken into two broad categories: opportunistic and endemic. The most important agents of the opportunistic mycoses are Candida spp., Cryptococcus neoformans, Pneumocystis jirovecii, and Aspergillus spp. (although the list of potential pathogens is ever expanding); while the most commonly encountered endemic mycoses are due to Histoplasma capsulatum, Coccidioides immitis/posadasii, and Blastomyces dermatitidis. This review discusses the epidemiologic profiles of these invasive mycoses in North America, as well as risk factors for infection, and the pathogens' antifungal susceptibility.
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Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis 2010; 50:291-322. [PMID: 20047480 PMCID: PMC5826644 DOI: 10.1086/649858] [Citation(s) in RCA: 1700] [Impact Index Per Article: 121.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
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Affiliation(s)
- John R Perfect
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Maria Soares B, Assis Santos D, Meire Kohler L, da Costa César G, Roberto de Carvalho I, dos Anjos Martins M, Silva Cisalpino P. Infección cerebral causada por Cryptococcus gattii: caso clínico y sensibilidad a los antifúngicos. Rev Iberoam Micol 2008. [DOI: 10.1016/s1130-1406(08)70057-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Antifungal susceptibilities among different serotypes of Cryptococcus gattii and Cryptococcus neoformans. Antimicrob Agents Chemother 2008; 53:309-11. [PMID: 18955539 DOI: 10.1128/aac.01216-08] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We measured antifungal activity against 128 cryptococcal isolates (86 of C. neoformans and 42 of C. gattii) to determine if differences in serotype susceptibility exist. Contrary to previous results, we found no serotype susceptibility differences. Isavuconazole, posaconazole, and voriconazole demonstrated excellent potency against each isolate and serotype, including isolates with reduced fluconazole susceptibilities.
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Solla I, Morano LE, Vasallo F, Cuenca-Estrella M. [Cryptococcus gattii meningitis: observation in a Spanish patient]. Enferm Infecc Microbiol Clin 2008; 26:395-6. [PMID: 18588823 DOI: 10.1157/13123846] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gomez-Lopez A, Zaragoza O, Dos Anjos Martins M, Melhem M, Rodriguez-Tudela J, Cuenca-Estrella M. In vitro susceptibility of Cryptococcus gattii clinical isolates. Clin Microbiol Infect 2008; 14:727-30. [DOI: 10.1111/j.1469-0691.2008.02021.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Meis JF, Gould IM, Fu W, Colombo AL, Rodriguez-Noriega E. Results from the ARTEMIS DISK Global Antifungal Surveillance study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol 2007; 45:1735-45. [PMID: 17442797 PMCID: PMC1933070 DOI: 10.1128/jcm.00409-07] [Citation(s) in RCA: 247] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fluconazole in vitro susceptibility test results for 205,329 yeasts were collected from 134 study sites in 40 countries from June 1997 through December 2005. Data were collected for 147,776 yeast isolates tested with voriconazole from 2001 through 2005. All investigators tested clinical yeast isolates by the CLSI M44-A disk diffusion method. Test plates were automatically read and results recorded with a BIOMIC image analysis system. Species, drug, zone diameter, susceptibility category, and quality control results were collected quarterly. Duplicate (same patient, same species, and same susceptible-resistant biotype profile during any 7-day period) and uncontrolled test results were not analyzed. Overall, 90.1% of all Candida isolates tested were susceptible (S) to fluconazole; however, 10 of the 22 species identified exhibited decreased susceptibility (<75% S) on the order of that seen with the resistant (R) species C. glabrata and C. krusei. Among 137,487 isolates of Candida spp. tested against voriconazole, 94.8% were S and 3.1% were R. Less than 30% of fluconazole-resistant isolates of C. albicans, C. glabrata, C. tropicalis, and C. rugosa remained S to voriconazole. The non-Candida yeasts (8,821 isolates) were generally less susceptible to fluconazole than Candida spp. but, aside from Rhodotorula spp., remained susceptible to voriconazole. This survey demonstrates the broad spectrum of these azoles against the most common opportunistic yeast pathogens but identifies several less common yeast species with decreased susceptibility to antifungal agents. These organisms may pose a future threat to optimal antifungal therapy and emphasize the importance of prompt and accurate species identification.
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Affiliation(s)
- M A Pfaller
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
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