Cryptococcosis by Cryptococcus neoformans/Cryptococcus gattii Species Complexes in non-HIV-Infected Patients in Southeastern Brazil

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.

Early clinical and microbiological predictors of outcome in hospitalized patients with cryptococcal meningitis

“…However, other factors may be associated with and interfere with the immune response of patients, such as age and the presence of other comorbidities [63,[75][76][77]. As described in studies conducted in Southern Brazil, C. neoformans VNI overtake the others in this study, and among C. gattii complex, C. deuterogattii was exclusive [78][79][80][81][82].…”

Cryptococcus: History, Epidemiology and Immune Evasion

“…The most common variants of C. gattii are the globally distributed VGI and VGII, both responsible for causing most cases of C. gattii cryptococcosis in immunocompetent individuals [28,29]. The variants of C. gattii are more frequent in warmer morphoclimatic domains, such as the predominant VGII in the Brazilian territory, with findings in the Amazon biome [30][31][32], clinical isolates from the Brazilian Northeast [33], Central-West [34] and the Brazilian Southeast [35][36][37], as well as in northern Australia and the islands of Papua New Guinea [8]. However, there is a trend of VGII findings causing outbreaks of C. gattii in temperate regions around the world, as has been observed with large numbers of domestic animals infected with C. gattii reported in western Australia [38], in outbreaks of C. gattii in North America from Vancouver Island in Canada, which resulted in cases of infections both in wildlife and domestic animals [39,40], along with an outbreak of cases in immunocompetent and immunocompromised humans in 1999 [41].…”

Phytochemical Analysis and Antifungal Potentiating Activity of Extracts from Loquat (Eriobotrya japonica) against Cryptococcus neoformans Clinical Isolates

“…The global incidence of cryptococcosis is estimated to kill over 180,000 people per year, with 75% of deaths occurring in sub-Saharan Africa, and the mortality of cryptococcal meningitis in low-income countries may exceed 70% [ 3 ]. Despite substantial improvement in the management of clinical events like AIDS, the numbers of cases of cryptococcosis remain very high [ 4 – 6 ]. Although several antifungal agents such as amphotericin B, azoles, and 5-flucytosine are available for treatment, side effects associated with amphotericin B and antifungal drug resistance hamper the efficacy of these antifungals.…”