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Vilas-Bôas AM, Andrade-Silva LE, Ferreira-Paim K, Mora DJ, Ferreira TB, Santos DDA, Borges AS, Melhem MDSC, Silva-Vergara ML. High genetic variability of clinical and environmental Cryptococcus gattii isolates from Brazil. Med Mycol 2021; 58:1126-1137. [PMID: 32343345 DOI: 10.1093/mmy/myaa019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Among Cryptococcus gattii genotypes, VGII has gained pivotal relevance in epidemiological, clinical and genetic contexts due to its association with several outbreaks in temperate regions and due to the high variability of this genotype. The aim of this study was to compare 25 isolates of C. gattii from the Southeast region of Brazil with previously described isolates from other regions of the country and around the world. Among the 25 isolates, 24 were VGII and one was VGI. All of them were newly identified. Three new allele types (AT) (AT47 for the URA5 locus, AT56 for the LAC1 locus, and AT96 for the IGS1 region) were also described. Compared with other Brazilian isolates, those from the Southeast region presented the greatest haplotype diversity. In general, the regions presented different sequence types (STs), and only nine STs were found in more than one location. GoeBURST analysis showed two large groups among the Brazilian isolates. The largest group consists of 59 STs predominantly from the North and Northeast regions; the other large group includes 57 STs from the Southeast and Midwest regions. In a global context the South American isolates presented the highest genetic diversity (STs = 145, haplotype diversity (Hd) = 0.999 and π = 0.00464), while the African populations showed the lowest genetic diversity (STs = 3, Hd = 0.667 and π = 0.00225). These results confirm that the Brazilian C. gattii VGII population is highly diverse and reinforce the hypothesis of dispersion of this genotype from South America.
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Affiliation(s)
- Anderson Mançan Vilas-Bôas
- Infectious Diseases Unit, Internal Medicine Department, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Leonardo Euripedes Andrade-Silva
- Infectious Diseases Unit, Internal Medicine Department, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Kennio Ferreira-Paim
- Department of Microbiology, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Delio José Mora
- Infectious Diseases Unit, Internal Medicine Department, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Thatiana Bragine Ferreira
- Infectious Diseases Unit, Internal Medicine Department, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Daniel de Assis Santos
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Aercio Sebastião Borges
- Universidade Federal de Uberlândia, Hospital de Clínicas de Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Mario Léon Silva-Vergara
- Infectious Diseases Unit, Internal Medicine Department, Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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Pinheiro SB, Sousa ES, Cortez ACA, da Silva Rocha DF, Menescal LSF, Chagas VS, Gómez ASP, Cruz KS, Santos LO, Alves MJ, Matsuura ABJ, Wanke B, Trilles L, Frickmann H, de Souza JVB. Cryptococcal meningitis in non-HIV patients in the State of Amazonas, Northern Brazil. Braz J Microbiol 2020; 52:279-288. [PMID: 33025379 DOI: 10.1007/s42770-020-00383-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
Cryptococcosis is a life-threatening fungal infection caused by the Cryptococcus neoformans/Cryptococcus gattii species complex. Most cases are recorded in patients suffering from HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). However, this infection also occurs in non-HIV patients with a proportion of 10-30% of all cases. The study aimed at the clinical and molecular characterization of non-HIV patients diagnosed with cryptococcosis at the Tropical Medicine Foundation (FMT-HVD) from July 2016 to June 2019. Medical records of respective patients were analyzed to describe the course of cryptococcosis in non-HIV patients. In addition, multi-locus sequence typing (MLST) was applied to identify the sequence types of the isolated Cryptococcus strains, to perform phylogenetic analysis, and to evaluate the isolates' genetic relationship to global reference strains. Antifungal susceptibility profiles to amphotericin B, fluconazole, and itraconazole were assessed by broth microdilution. From a total of 7 patients, 4 were female, the age range varied between 10 and 53 years (median of 36.3 years). Cryptococcal meningitis was the common clinical manifestation (100%). The period between onset of symptoms and confirmed diagnosis ranged from 15 to 730 days (mean value of 172.9 days), and the observed mortality was 57.1%. Of note, comorbidities of the assessed cryptococcosis patients comprised hypertension, diabetes mellitus, and intestinal tuberculosis. Genotyping applying PCR-RFLP of the URA5 gene identified all clinical isolates as C. gattii genotype VGII. Using MLST, it was possible to discriminate the sequence types ST20 (n = 4), ST5 (n = 3), and the newly identified sequence type ST560 (n = 1). The antifungals amphotericin B, fluconazole, and itraconazole showed satisfactory inhibitory activity (microdilution test) against all C. gattii VGII strains.
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Affiliation(s)
- Silviane Bezerra Pinheiro
- Pós Graduação em Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil.,Laboratório de Micologia, Instituto Nacional de Pesquisas da Amazônia, Manaus, Brazil
| | - Ednaira Sullany Sousa
- Pós Graduação em Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil.,Laboratório de Micologia, Instituto Nacional de Pesquisas da Amazônia, Manaus, Brazil
| | | | | | | | | | | | - Kátia Santana Cruz
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado - AM, Manaus, Brazil
| | | | | | | | - Bodo Wanke
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz - RJ, Rio de Janeiro, Brazil
| | - Luciana Trilles
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz - RJ, Rio de Janeiro, Brazil
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, External site at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Damasceno-Escoura AH, de Souza ML, de Oliveira Nunes F, Pardi TC, Gazotto FC, Florentino DH, Mora DJ, Silva-Vergara ML. Epidemiological, Clinical and Outcome Aspects of Patients with Cryptococcosis Caused by Cryptococcus gattii from a Non-endemic Area of Brazil. Mycopathologia 2018; 184:65-71. [PMID: 30415450 DOI: 10.1007/s11046-018-0304-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/19/2018] [Indexed: 11/28/2022]
Abstract
Cryptococcosis by Cryptococcus gattii occurs mainly in immunocompetent hosts, however, during the last decades, a growing number of cases in immunocompromised individuals have been noticed around the world. This report presents epidemiological, clinical and outcome aspects of patients with cryptococcosis caused by this species from a non-endemic area in Brazil. Of 278 Cryptococcus spp. clinical isolates recovered during the same period, 267 (96%) were molecularly identified as Cryptococcus neoformans VNI genotype and 11 (4%) as C. gattii VGII genotype by URA-5 RFLP. Of the 11 C. gattii patients, eight were male, mean age of 47.5 years. Of these, four were HIV-infected, one was kidney transplanted, one presented low CD4+ T cells values of unknown cause, another presented chronic liver disease meanwhile the remaining four were apparently immunocompetent. Disseminated disease and cryptococcal meningitis were present in four patients each. Most patients received amphotericin B plus fluconazole. Seven out of the 11 patients cured and four died before or during the therapy. The increased number of individuals with cryptococcosis by this species during the last decades needs to be carefully evaluated specially those who are HIV-infected. Nevertheless, Cryptococcus species differentiation is currently relevant in order to better know their relation with geographical, clinical host preference and outcome particularities.
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Affiliation(s)
- Alessandro Henrique Damasceno-Escoura
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Matheus Lucas de Souza
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Felipe de Oliveira Nunes
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Thiago César Pardi
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Fernanda Castro Gazotto
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Danilo Heitor Florentino
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Delio José Mora
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Mario León Silva-Vergara
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil.
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