Abstract
To retrospectively investigate the epidemiology of cryptococcosis in Ljubljana, Slovenia. Forty-six sequentially obtained isolates from 19 patients were subjected to amplified fragment length polymorphism (AFLP) genotyping, microsatellite typing, mating- and serotype PCRs and antifungal susceptibility testing. Majority of the isolates were Cryptococcus deneoformans (n=29/46; 63%) followed by Cryptococcus neoformans (n=16/46; 34.8%) and their interspecies hybrid (n=1/46; 2.2%). Mating-type α was predominant, two mating-type a C. deneoformans isolates and one mating-type a/α isolate were observed. Several mixed infections were found by microsatellite typing; one patient had a persisting C. deneoformans infection for>2.5years. For C. deneoformans, the in vitro antifungal MIC90 and susceptibility ranges were for amphotericin B 0.25µg/ml (0.031-0.25µg/ml), 5-fluorocytosine 0.25µg/ml (0.063-4µg/ml), fluconazole 8µg/ml (0.5-16µg/ml), voriconazole 0.063µg/ml (0.008-0.125µg/ml), posaconazole 0.063µg/ml (0.008-0.063µg/ml) and itraconazole 0.063µg/ml (0.031-0.125µg/ml). For C. neoformans, these values were for amphotericin B 0.25µg/ml (0.063-0.5µg/ml), 5-fluorocytosine 1µg/ml (0.063-1µg/ml), fluconazole 16µg/ml (0.5-64µg/ml), voriconazole 0.125µg/ml (0.008-0.25µg/ml), posaconazole 0.063µg/ml (0.008-0.063µg/ml) and itraconazole 0.063µg/ml (0.031-0.125µg/ml). Majority of the cases were caused by C. deneoformans; mating-type α was predominant. Several mixed infections were identified by AFLP genotyping and microsatellite typing. Despite antifungal therapy, a cryptococcal isolate could persist for years. Voriconazole, itraconazole and posaconazole were the most potent antifungal drugs.
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