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

Gilberto Gambero Gaspar,Patrícia Helena Grizante Barião,Marcia Regina Von Zeska Kress,Rodrigo De Carvalho Santana,Erika Nascimento,Fernando Crivelenti Vilar,Roberto Martinez

doi:10.1590/0037-8682-0169-2021

Gilberto Gambero Gaspar, Patrícia Helena Grizante Barião + Show 5 more

Open Access

https://doi.org/10.1590/0037-8682-0169-2021

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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.

Highlights

The clinical manifestations of cryptococcosis are usually associated with the infecting agents Cryptococcus neoformans (CN) and C. gattii (CG) species complexes and the host
The data were analyzed according to the results of the Cryptococcus spp. genotyping, which were divided into two groups: 1) the CN group with 24 patients infected with species of the C. neoformans complex; and 2) the CG group with 12 patients infected with species of the C. gattii complex
The cryptococcal disease of non-HIV-infected patients evaluated in this study was mainly related to the genotypes VNI of CN (C. neoformans) and VGII of CG (C. deuterogattii), a finding similar to that observed in clinical isolates in Brazil[6,13]

Summary

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. 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. 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. In the last two decades, there has been a decline in the occurrence of opportunistic cryptococcosis in AIDS cases with a simultaneous increase in the incidence of cryptococcal disease in non-HIV-infected patients[1,2]. HIV seronegative patients infected with Cryptococcus spp. are a heterogeneous population that includes cases of therapeutic immunosuppression, comorbidities, solid organ transplantation, and immunocompetent individuals with no apparent comorbidity.

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