Epidemiological and Clinical Characteristics, Antifungal Susceptibility, and MLST-Based Genetic Analysis of Cryptococcus Isolates in Southern Taiwan in 2013–2020

Abstract

Cryptococcal meningoencephalitis (CM) is a treatable condition, but it leads to excessive morbidity and mortality. We collected 115 non-duplicated Cryptococcus clinical isolates during 2013–2020 in southern Taiwan to perform antifungal susceptibility testing. Multi-locus sequence typing was performed on 96 strains from patients with CM (n = 47) or cryptococcemia (n = 49). In addition, the epidemiological and clinical characteristics of patients with CM during 2013–2020 (n = 47) were compared with those during 2000–2010 (n = 46). During 2013–2020, only one C. neoformans isolate (0.9%) had a fluconazole minimum inhibitory concentration of >8 μg/mL. Amphotericin B (AMB), flucytosine (5FC), and voriconazole were highly active against all C. neoformans/C. gattii isolates. The most common sequence type was ST5. Among these 47 patients with CM, cerebrospinal fluid cryptococcal antigen (CSF CrAg) titer >1024 was a significant predictor of death (odds ratio, 48.33; 95% CI, 5.17–452.06). A standard induction therapy regimen with AMB and 5FC was used for all patients during 2013–2020, but only for 2.2% of patients in 2000–2010. The in-hospital CM mortality rate declined from 39.1% during 2000–2010 to 25.5% during 2013–2020, despite there being significantly younger patients with less CSF CrAg >1024 during 2000–2010. The study provides insight into the genetic epidemiology and antifungal susceptibility of Cryptococcus strains in southern Taiwan. The recommended antifungal drugs, AMB, 5FC, and FCZ, remained active against most of the Cryptococcus strains. Early diagnosis of patients with CM and adherence to the clinical practice guidelines cannot be overemphasized to improve the outcomes of patients with CM.

What’s New in Cryptococcus gattii: From Bench to Bedside and Beyond

“…MLST has revealed geographical associations with clonal populations with increased heterogeneity possibly related to the origins of the species; for example, C. gattii , may have spread from Australia and Northern Brazil to North America and Canada [ 28 , 29 ] whereas for C. neoformans, ST5 is the predominant serotype in China and Taiwan, ST93 in Brazil, ST41 in Japan and the US, with greater diversity in African countries [ 16 , 28 , 29 , 30 , 31 , 32 ].…”

Cryptococcus tetragattii Meningitis Associated with Travel, Taiwan

“…We identified the organism as C. gattii ; its score value was 1.92 by Bruker Biotyper matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system (Bruker Daltonics GmbH, https://www.bruker.com ). We performed multilocus sequence typing (MLST) and phylogenetic analysis MLST for 7 genetic loci, including CAP59 , GPD1 , IGS1, LAC1 , PLB1 , SOD1 , and the URA5 region, as previously described ( 2 ), and detected C. gattii ST576. We deposited sequence data of the 7 foci from MLST into GenBank (accession nos.…”

“…OP828681–87). The URA5 gene restriction fragment length polymorphism of the C. gattii isolate performed as previously described ( 3 ); the results showed that this isolate belonged to the VGIV genotype, C. tetragattii (CMU-3028) ( 2 ).…”

“…Author affiliation: Universidad Autonónoma de Nuevo León, Monterrey, Mexico DOI: https://doi.org/10.3201/eid2902.221199 M onkeypox virus (MPXV) is a zoonotic pathogen that causes mpox (formerly monkeypox), a febrile rash disease, in humans. It has caused multiple outbreaks in the past (1) but recently acquired international attention because of a multicountry outbreak of mpox cases with no epidemiologic link to MPXVendemic regions (2). During January-June 2022, a total of 3,413 laboratory-confirmed cases and 1 death were reported to the World Health Organization (3).…”

Cryptococcal granulomas of basal ganglia due to <i>Cryptococcus neoformans</i> in a cat: a case report and literature review

“…grubii isolated from patients and pigeon droppings in Asia are ST 4, 5, 6, and 93 [ 13 ]. ST 31 is relatively rare in humans in Taiwan and Asian areas [ 5 , 13 ]. The only reference of cats infected by ST 31 manifests as nasal or facial masses and ulcers but without involving the CNS [ 14 ].…”