Genotype and mating type distribution within clinicalCryptococcus neoformansandCryptococcus gattiiisolates from patients with cryptococcal meningitis in Uberaba, Minas Gerais, Brazil

Abstract

We molecularly characterized 81 cryptococcal isolates recovered from cerebrospinal fluid samples of 77 patients diagnosed between 1998 and 2007 as having cryptococcal meningitis in Uberaba Minas Gerais, Brazil. Fifty-seven (74%) were male with a mean age 35.6 years. Seventy-two (88.9%) of the isolates were from 68 AIDS patients and cryp-tococcosis was the first AIDS-defining condition in 38 (55.9%) patients. Cryptococcosis and AIDS were simultaneously diagnosed in 25 (65.8%) of these 38 patients. Genotypes were characterized through the use of URA5 restriction fragment length polymorphisms analysis, the genetic variability was determined using PCR-fingerprinting with the minisatellite-specific primer M13, and the mating type and serotypes were established by PCR. Seventy-six of the 81 isolates were Cryptococcus neoformans (93.8%), while the remaining five were C. gattii (6.1%), but all were mating type alpha. C. neoformans isolates were genotype VNI (serotype A), while C. gattii isolates were VGII. Four of the latter isolates were identical, but only two were from AIDS patients. Six of the nine isolates from non-AIDS patients were VNI. PCR fingerprints of the isolates from two of the three AIDS patients with clinical relapse were 100% identical. The predominance of VNI and mating type alpha is in accordance with data from other parts of the world. The occurrence of VGII in Minas Gerais indicates a geographical expansion within Brazil.

Genotypes of Cryptococcus neoformans and Cryptococcus gattii as agents of endemic cryptococcosis in Teresina, Piauí (northeastern Brazil)

“…Previous studies attest that C. neoformans VNI is strongly associated with AIDS throughout Brazil with a higher incidence in the South and Southeast. This result can be explained by the fact that these Regions include the largest cities in the country, where anthropic actions are more evident (Horta et al 2002, Nishikawa et al 2003, Matsumoto et al 2007, Mora et al 2010. Moreover, the ease of obtaining environmental isolates of C. neoformans VNI in urban areas of the South and Southeast Brazil strongly suggest that immunocompromised hosts living in these areas may be continuously exposed to inhalation of viable propagules of this fungus in their everyday life (Igreja et al 2004).…”

“…However, C. gattii acts predominantly as a primary pathogen, attacking immunocompetent hosts, including children and young adults in North and Northeast, and is therefore considered endemic to the states of Amazonas (AM), Pará (PA), Roraima, Piauí (PI), Pernambuco and Bahia . The southern and southeastern regions show sporadic infections by C. gattii (Severo et al 2009, Mora et al 2010, Pinto Junior et al 2010). In PI, previous studies have shown that cryptococcosis caused by C. gattii is strongly associated with human immunodeficiency virus (HIV)-negative patients, afflicting a significant portion of children and young adults (Cavalcanti 1995, Martins 2003.…”

Analyses of Pediatric Isolates of Cryptococcus neoformans from South Africa

“…Data from the pre-and post-AIDS eras in developed countries indicate that approximately 60% to 85% of symptomatic cases of C. neoformans occurred among adult males (2,6,9,10,14,16,23,40,54). Most studies of C. neoformans in children involved small numbers of patients and reported a higher prevalence in males (Ͼ60%) (22) or a lack of gender bias (1,13,23,34,60).…”

Cryptococcus gattii Infections

“…Small epidemiological studies suggest that C. gattii molecular genotype VGII predominates in infected children in north/northeast Brazil and that VGI is uncommon (221,222). Infection in immunocompetent children in southern and southeastern Brazil has also been reported (223,224,256). Among 16,192 episodes of cryptococcosis (due to both C. neoformans and C. gattii) in predominantly HIV-infected persons in South Africa from 2005 to 2007 (232), a bimodal distribution of infection was noted, with a peak in children Ͻ1 year old and a second peak in those aged 5 to 10 years.…”