Analyses of Pediatric Isolates of
            <i>Cryptococcus neoformans</i>
            from South Africa

Miglia, Kathleen J.; Govender, Nelesh P.; Rossouw, Jennifer; Meiring, Susan; Mitchell, Thomas G.

doi:10.1128/jcm.01277-10

Cited by 37 publications

(40 citation statements)

References 52 publications

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“…When analyzing the data obtained for the period 2006-2010, it was observed that cryptococcosis is seen in all ages, even in the boundaries of life; between them we found 2 patients less than 15 years of age, which is in agreement with the low proportion of children known to develop cryptococcosis in global reports, even in endemic areas for this disease, except Brazil, where the prevalence in children is higher (19,9%) (16,(36)(37)(38)(39).…”

Section: Discussionsupporting

confidence: 82%

Criptococosis en Colombia: resultados de la encuesta nacional, 2006-2010

et al. 2012

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Introduction: A survey on cryptococcosis is being conducted regularly in Colombia since 1997. We present hereby the results corresponding to patients diagnosed from 2006 to 2010. Objective: To analyze the data obtained during this period. Materials and methods:Retrospective analysis of the corresponding surveys. Results: A total of 526 surveys originating from 72% of the Colombian political divisions were received during the 5-year period. Most patients (76.6%) were males and 74.9% were 21-50 years old. The most prevalent risk factor was HIV infection (83.5%) with cryptococcosis defining AIDS in 23% of the cases. In the general population the estimated mean annual incidence rate for cryptococcosis was 2.4 x 10 6 inhabitants while in AIDS patients this rate rose to 3.3 x 10 3 . In 474 surveys stating clinical features, most frequent complaints were headache 84.5%, fever 63.4%, nausea and vomiting 57.5%, mental alterations 46.3%, meningeal signs 33.0%, cough 26.4% and visual alterations 24.5%. Neurocryptococcosis was recorded in 81.8% of the cases. Laboratory diagnosis was based on direct examination, culture and latex in 29.3% cases. From 413 Cryptococcus isolates analyzed, 95.6% were identified as C. neoformans var. grubii, 1% C. neoformans var. neoformans, and 3.4% C. gattii. Treatment was reported for 71.6% of the cases with amphotericin B alone or in combination with fluconazole prescribed in 28%. Conclusions: Surveys done through passive surveillance continue to be sentinel markers for HIV infection and represent a systematic approach to the study of opportunistic problems regularly afflicting AIDS patients since cryptococcosis requires no compulsory notification in Colombia. Author contributions:Patricia Escandón: played an important role in writing and preparing the manuscript, in charge of the surveillance at the Instituto Nacional de Salud, controlled receipt of questionnaires. Catalina de Bedout: in charge of the mycological diagnosis for all Corporación para Investigaciones Biológicas cases, established links with physicians in charge of patients, controlled receipt of questionnaires and performed the susceptibility testing in all isolates. Jairo Lizarazo: physician in charge of the patients from Norte de Santander, checked the questionnaire's contents for medical accuracy, analyzed the data through statistical analysis. Clara Inés Agudelo: worked all long in the surveillance study, played an important role in preparation of the manuscript and in the analysis of the data, including statistical tests. Ángela Tobón: examined many of the Corporación para Investigaciones Biológicas patients, filled in the corresponding questionnaires, supervised the clinical aspects of most patients and served as a consultant for other physicians in charge of cryptococcosis patients. Solmara Bello: in charge of the mycological diagnosis for Instituto Nacional de Salud cases. Ángela Restrepo: surveillance of the whole program, contacting physicians and serving as consultant for all participants, analyzing data, writing of ...

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Section: Discussionsupporting

confidence: 82%

Criptococosis en Colombia: resultados de la encuesta nacional, 2006-2010

et al. 2012

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“…grubii and all four patients with C. gattii. In these cases, reinfection with strains of the same rare genotypes would require regular exposure to these strains, which is not consistent with the reported distribution of genotypes in the environment (18,19,25).…”

Section: Discussionmentioning

confidence: 45%

“…grubii in South Africa (18,19,25,26). Although MLST genotyping has been somewhat standardized (15), many studies vary the protocol or employ other methods, and there is no universal nomenclature for designating VNI genotypes.…”

Section: Discussionmentioning

confidence: 99%

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Multilocus Sequence Typing of Serially Collected Isolates of Cryptococcus from HIV-Infected Patients in South Africa

Wyk¹,

Govender

Mitchell

et al. 2014

J Clin Microbiol

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cPatients with cryptococcal meningitis in sub-Saharan Africa frequently relapse following treatment. The natural history and etiology of these recurrent episodes warrant investigation. Here, we used multilocus sequence typing (MLST) to compare the molecular genotypes of strains of Cryptococcus neoformans and Cryptococcus gattii isolated from serial episodes of cryptococcal meningitis that were separated by at least 110 days. The most common MLST genotypes among the isolates were the dominant global clinical genotypes (M5 and M4) of molecular type VNI, as well as the VNI genotypes apparently restricted to southern Africa. In addition, there was considerable genetic diversity among these South African isolates, as 15% of the patients had unique genotypes. Eleven percent of the patients were reinfected with a genetically different strain following their initial diagnosis and treatment. However, the majority of serial episodes (89%) were caused by strains with the same genotype as the original strain. These results indicate that serial episodes of cryptococcosis in South Africa are frequently associated with persistence or relapse of the original infection. Using a reference broth microdilution method, we found that the serial isolates of 11% of the patients infected with strains of C. neoformans var. grubii with identical genotypes exhibited >4-fold increases in the MICs to fluconazole. Therefore, these recurrent episodes may have been precipitated by inadequate induction or consolidation of antifungal treatment and occasionally may have been due to increased resistance to fluconazole, which may have developed during the chronic infection.

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“…Leucocytes (elements/mL) Glucose (g/L) Proteins (g/L) Chloride (mEq/L) route of contamination might be the inhalation of spores of the pathogens contained in the air [9,38,19].…”

Section: Cryptococcosismentioning

confidence: 99%