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Rev. Soc. Bras. Med. Trop ; 54: e01692021, 2021. tab
Article in English | LILACS | ID: biblio-1340829


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.

Humans , Cryptococcosis/diagnosis , Cryptococcosis/epidemiology , Cryptococcus neoformans/genetics , Cryptococcus gattii/genetics , Polymorphism, Restriction Fragment Length , Brazil/epidemiology , Genotype
Arq. ciências saúde UNIPAR ; 24(1): 3-7, jan-abr. 2020.
Article in Portuguese | LILACS | ID: biblio-1095737


Criptococose é uma doença grave que afeta tanto imunocomprometidos quanto imunocompetentes, com isso analisar a virulência é fundamental para novas terapêuticas. Objetivo: Analisar a capacidade de virulência e susceptibilidade aos antifúngicos de Cryptococcus spp. isolados de líquor de pacientes de hospital do norte do Paraná. Métodos: A partir de dois isolados clínicos C. neoformans e C. gattii, realizou-se a confirmação da identificação. Para a virulência, avaliou-se o tamanho da cápsula, capacidade de sobrevivência após exposição a neutrófilos, produção de melanina e urease. No antifungigrama por difusão em disco utilizou-se: anfotericina B, cetoconazol, voriconazol, itraconazol e miconazol. Resultados: C. gattii destaca-se por maior desenvolvimento da cápsula além da melhor capacidade de sobreviver a fagocitose em relação ao C. neoformans. No antifungigrama, ambos os isolados se apresentam sensíveis às drogas estudadas. Conclusão: Esses achados contribuem para a compreensão das diferentes patogêneses entre C. gattii e C. neoformans.

Cryptococcosis is a serious disease that can affect both immunocompromised and immunocompetent individuals, thus the virulence analysis is fundamental for the development of new treatments. Objective: To analyze the virulence and susceptibility of Cryptococcus spp. isolated from cerebrospinal fluid of patients from a hospital in the north of Paraná. Methods: From two clinical isolates, C. neoformans and C. gattii were confirmed and identified. For virulence, capsule size, survival capacity after exposure to neutrophils, melanin production and urease were evaluated. In the disc-diffusion method, the following antifungals were used: amphotericin B, ketoconazole, voriconazole, itraconazole and miconazole Results: It was observed that C. gattii presents greater results for development of the capsule beside presenting the best ability to survive phagocytosis in relation to C. neoformans. In the disc-diffusion method, both isolates presented sensitivity to the studied drugs. Conclusion: These findings contribute to the understanding of the different pathogens between C. gattii and C. neoformans.

Cryptococcosis/virology , Virulence Factors/analysis , Antifungal Agents/analysis , Phagocytosis , Urease/urine , Yeasts/virology , Capsules/analysis , Pharmaceutical Preparations , Amphotericin B/analysis , Itraconazole , Cryptococcus neoformans/virology , Agar/analysis , Cryptococcus gattii/virology , Voriconazole , Melanins/analysis , Miconazole , Neutrophils/virology
Braz. j. infect. dis ; 24(1): 7-12, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089323


ABSTRACT Background: This study aims to explore the epidemiology, clinical profile and strain characteristics of cryptococcosis from 2013 to 2017 in a major teaching hospital in China. Methods: Trends in antifungal drug susceptibility of 217 consecutive non-repetitive cryptococcal isolates collected from patients of an university hospital in China were analyzed between 2013 and 2017. Of those, 98 isolates were conserved for identification by internal transcribed spacer (ITS) sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system. Multilocus sequence typing (MLST) was used to designate molecular types. Clinical characteristics of the 98 patients with cryptococcosis during the period of 2013-2017 were retrospectively evaluated. Results: There was a trend for gradual increase in the MIC range of fluconazole was from 2013 to 2017. The conserved 98 clinical cryptococcal isolates included 97 C. neoformans and one C. gattii, and 90 (91.8%) isolates belonged to ST5 genotype VNI. Out of the 98 patients with cryptococcosis, 28 (28.6%) were HIV-infected and 32 (32.7%) had no underlying diseases. HIV-infected patients had higher mortality than HIV-uninfected patients (28.6% vs 14.3%, p = 0.147). Conclusions: Most of the patients with cryptococcosis were not HIV-infected in this study, while patients with HIV had a higher mortality. Reduced susceptibility to fluconazole was observed among C. neoformans isolates, most of them belonged to ST5 genotype VNI having an impact on the effective dose of fluconazole.

Humans , Male , Female , Adult , Middle Aged , Cryptococcosis/microbiology , Cryptococcosis/epidemiology , Hospitals, University/statistics & numerical data , Time Factors , Microbial Sensitivity Tests , China/epidemiology , Cross-Sectional Studies , Retrospective Studies , Statistics, Nonparametric , Cryptococcosis/drug therapy , Cryptococcus neoformans/isolation & purification , Cryptococcus neoformans/drug effects , Cryptococcus neoformans/genetics , Cryptococcus gattii/isolation & purification , Cryptococcus gattii/drug effects , Cryptococcus gattii/genetics , Multilocus Sequence Typing , Genotype , Antifungal Agents/therapeutic use
J. venom. anim. toxins incl. trop. dis ; 26: e20200023, 2020. tab, graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1135136


Endemic systemic mycoses remain a health challenge, since these opportunistic diseases are increasingly infecting immunosuppressed patients. The simultaneous use of antifungal compounds and other drugs to treat infectious or non-infectious diseases has led to several interactions and undesirable effects. Thus, new antifungal compounds should be investigated. The present study aimed to evaluate the activity of liriodenine extracted from Annona macroprophyllata on agents of systemic mycoses, with emphasis on the genus Paracoccidioides. Methods: The minimum inhibitory concentration (MIC) and minimum fungicide concentration (MFC) were determined by the microdilution method. The cellular alterations caused by liriodenine on a standard P. brasiliensis (Pb18) strain were evaluated by transmission and scanning electron microscopy. Results: Liriodenine was effective only in 3 of the 8 strains of the genus Paracoccidioides and in the Histoplasma capsulatum strain, in a very low concentration (MIC of 1.95 µg.mL-1); on yeasts of Candida spp. (MIC of 125 to 250 µg.mL-1), including C. krusei (250 µg.mL-1), which has intrinsic resistance to fluconazole; and in Cryptococcus neoformans and Cryptococcus gattii (MIC of 62.5 µg.mL-1). However, liriodenine was not effective against Aspergillus fumigatus at the studied concentrations. Liriodenine exhibited fungicidal activity against all standard strains and clinical isolates that showed to be susceptible by in vitro tests. Electron microscopy revealed cytoplasmic alterations and damage to the cell wall of P. brasiliensis (Pb18). Conclusion: Our results indicate that liriodenine is a promising fungicidal compound that should undergo further investigation with some chemical modifications.(AU)

Paracoccidioides , Microscopy, Electron , Microbial Sensitivity Tests , Cryptococcus neoformans , Cryptococcus gattii , Mycoses , Antifungal Agents/isolation & purification
Rev. Soc. Bras. Med. Trop ; 53: e20190422, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136889


Abstract INTRODUCTION: The average annual incidence of cryptococcosis in Colombia is 0.23 cases per 100,000 inhabitants in the general population, and 1.1 cases per 1000 in inhabitants with Acquired Immune Deficiency Syndrome (AIDS). In addition, the causal fungus has been isolated from the environment, with serotypes A-B and C in different regions. This study aims to determine the genetic association between clinical and environmental isolates of C. neoformans/C. gattii in Colombia. METHODS: Multilocus sequence typing (MLST) was used to identify possible clones, providing information about the epidemiology, ecology, and etiology of this pathogen in Colombia. RESULTS: A total of 110 strains, both clinical (n=61) and environmental (n=49), with 21 MLST sequence types (ST) of C. neoformans (n=14STs) and C. gattii (n=7STs) were identified. The STs which shared clinical and environmental isolate sources were grouped in different geographical categories; for C. neoformans, ST93 was identified in six departments, ST77 in five departments; and for C. gattii, ST25 was identified in three departments and ST79 in two. CONCLUSIONS: High genetic diversity was found in isolates of C. neoformans/gattii by MLST, suggesting the presence of environmental sources harboring strains which may be sources of infection for humans, especially in immunocompromised patients; these data contribute to the information available in the country on the distribution and molecular variability of C. neoformans and C. gattii isolates recovered in Colombia.

Humans , Cryptococcosis , Cryptococcus neoformans , Cryptococcus gattii , Genetic Variation , Mycological Typing Techniques , Colombia , Multilocus Sequence Typing , Genotype
Rev. patol. trop ; 49(4)2020.
Article in English | LILACS | ID: biblio-1177458


The following case is of a 59-year-old man, undergoing no medication, with no pathological history or others risk factors, who presented dizziness, fever and asthenia twenty days before admission. The patient was admitted for investigation when the asthenia intensified, followed by seizures. On admission, blood count, biochemical tests and chest computed tomography were normal, a serological test for anti-HIV proved negative, while the magnetic resonance of the brain showed signs suggestive of meningoencephalitis. Cerebrospinal fluid (CSF) analysis suggested bacterial meningitis due to increased leukocytes with a predominance of polymorphonuclear cells, reduced glucose and increased proteins as well as positive Gram cocci in pairs by Gram and negative fungi by India ink test. Treatment with ceftriaxone was started. Since there was no significant improvement, CSF analysis was repeated on the seventh day of treatment. Intracranial pressure was measured by manometry (29 mmHg) and CSF analysis showed the presence of encapsulated yeasts similar to Cryptococcus neoformans by the India ink test. The treatment was modified to liposomal amphotericin B and flucytosine; the intracranial hypertension was controlled by repeated CSF punctures. After fourteen days of antifungal treatment, the patient presented visual turbidity and bilateral papillar edema, so corticosteroid therapy was prescribed. The evolution was favorable, with progressive resolution of symptoms, improvement of CSF parameters and visual acuity. The patient was discharged eight weeks after admission, with outpatient guidance. Corticosteroid therapy associated with antifungal therapy proved to be beneficial in this case, since following the introduction of corticosteroids there was progressive visual improvement.

Humans , Visual Acuity , Optic Neuritis , Meningitis, Bacterial , Adrenal Cortex Hormones , Cryptococcus gattii
Univ. salud ; 21(3): 288-292, Sep.-Dic. 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1043550


Resumen Introducción: En Colombia, la criptococosis es una infección fúngica invasiva poco frecuente. Objetivo: Reportar el caso clínico de un niño con meningoencefalitis por Cryptococcus gattii que tenía como factor de riesgo una disfunción inmune asociada a cirrosis, un factor de riesgo descrito en adultos pero no reportado en niños. Materiales y métodos: Se realizó una revisión no sistemática de la literatura y un resumen de los aspectos más relevantes de la historia clínica. Resultados: Se presenta el caso de un paciente masculino de 16 años con antecedente de cirrosis quien consultó por un cuadro clínico de 8 días de evolución de fiebre, emesis persistente, cefalea frontal, fotofobia y tinitus. Al examen físico no presentaba alteraciones neurológicas. En el estudio del líquido cefalorraquídeo las pruebas moleculares directas fueron positivas para Cryptococcus neoformans/gattii y el cultivo reportó crecimiento de Cryptococcus gattii. Conclusión: En este caso se destaca la importancia de sospechar infecciones oportunistas en pacientes que tienen inmunodeficiencia no solo secundaria a las infecciones por VIH, sino también a la producida por otros factores que alteran la respuesta inmunológica como la cirrosis.

Abstract Introduction: In Colombia, cryptococcosis is a rare invasive fungal infection. Objective: To report the clinical case of a child with Cryptococcus gattii meningoencephalitis whose risk factor was immune dysfunction associated with cirrhosis, a risk factor described in adults which in the reviewed literature has not been reported in children. Materials and methods: A non-systematic review of the literature and a summary of the most relevant aspects of the clinical history were performed. Results: We present the case of a 16-year-old male patient with a history of cirrhosis who came for consultation with a clinical presentation of 8 days of fever, persistent emesis, frontal headache, photophobia and tinnitus. The physical examination did not present neurological alterations. In the study of cerebrospinal fluid, he presented positive direct molecular tests for Cryptococcus neoformans/gattii and the culture reported growth of Cryptococcus gattii. Conclusion: In this case, the importance of suspecting opportunistic infections in patients who have immunodeficiencies not only secondary to HIV infections, but also to those caused by other factors that alter the immune response such as cirrhosis is highlighted.

Adolescent , Child , Cryptococcus gattii , Fibrosis , Meningoencephalitis , Mycoses
Rev. Soc. Bras. Med. Trop ; 52: e20180194, 2019.
Article in English | LILACS | ID: biblio-1041522


Abstract INTRODUCTION Cryptococcosis is the second most frequent cause of opportunistic infections in human immunodeficiency virus (HIV) patients in Colombia. We aimed to determine the prevalence of cryptococcosis in the Colombian department of Atlántico. METHODS An active search for cryptococcosis cases was conducted between 2015 and 2017 in health institutions by distributing surveys to clinicians and characterizing samples phenotypically and genotypically. RESULTS Thirty-eight cryptococcosis cases were identified (81.6% men, 76.3% HIV patients). The calculated annual prevalence was 5.08/1 million inhabitants. Cryptococcus neoformans var. grubii VNI was isolated in 34 cases. CONCLUSIONS These results provide the basis for passive surveillance of cryptococcosis.

Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Cryptococcosis/epidemiology , Phenotype , Prevalence , Colombia/epidemiology , Cryptococcosis/microbiology , Cryptococcus neoformans/isolation & purification , Cryptococcus gattii/isolation & purification , Molecular Typing , Genotype , Middle Aged
Prensa méd. argent ; 104(10): 510-515, dic 2018. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1046997


La criptococosis es una micosis grave de distribución universal, que afecta principalmente a huéspedes inmunocomprometidos. Es una de las principales causas de morbilidad y mortalidad en los pacientes infectados con el virus de la inmunodeficiencia humana (HIV). Provoca al menos 620 000 muertes al año, representando entre el 13% al 44% de la mortalidad en pacientes HIV positivos según datos de cohortes correspondientes a países en desarrollo. (1, 2) La letalidad de la criptococosis meníngea en estudios de Argentina y Brasil muestra valores que van desde el 26% hasta el 63%. El complejo Cryptococcus neoformans/ Cryptococcus gattii, es el responsable de esta enfermedad. Existen alrededor de 70 especies pero solo dos de ellas son patógenas para el hombre: C. neoformans y C. gattii. Se reconocen 8 genotipos de este complejo, C. neoformans: VNI y VNII (C. neoformans var. grubii), VNIII (C. neoformans híbrido intervariedad AD), VNIV (C. neoformans var. neoformans) y C. gattii: genotipos VGI, VGII, VGIII y VGIV. Se han descripto híbridos interespecie VNIV/VGI, VNI/VGI, VNI/VGII. Se estudiaron 207 aislamientos de Cryptococcus, elegidos aleatoriamente, de un total de 2593 pacientes con diagnóstico de criptococosis diseminada. A los mismos se les realizó la genotipificación mediante una PCR-RFLP del gen URA5, y posterior digestión enzimática con enzimas Sau96I y HhaI. De las 207 cepas estudiadas, 174 fueron VNI (84,05%), 14 VNII (6,76%), 10 VNIII (4,83%), 2 VNIV (0,97%), 3 VGI (1,45%), 3 VGII de (1,45%) y 1 VGIII (0,49%).

Cryptococcosis is a severe worldwide mycosis, which mainly affects immunocompromised hosts and is a major cause of morbidity and mortality in HIV-infected patients. It causes 620,000 annual deaths, accounting for 13-44 % of mortality in HIV-positive individuals in developing countries. Mortality rates of meningeal cryptococcosis in studies from Argentina and Brazil go from 26 to 63 %. Cryptococcus neoformans/Cryptococcus gattii is the species complex responsible for this disease. There are about 70 species, however, only two are human pathogens: C. neoformans and C. gattii. C. neoformans genotypes are VNI and VNII (C. neoformans var. grubii), VNIII (C. neoformans intervariety hybrid AD), VNIV (C. neoformans var. neoformans). C. gattii genotypes are VGI, VGII, VGIII and VGIV. Interspecies hybrids were described: VNIV/VGI, VNI/VGI, VNI/ VGII. A total of 207 Cryptococcus isolates were randomly selected from 2593 patients with diagnosis of disseminated cryptococcosis. Genotyping was performed by PCRRFLP of UR A5 gene with restriction enzyme digestion using Sau96I and HhaI enzymes. Among the 207 studied isolates, 174 resulted VNI (84.05%), 14 VNII (6.76%), 10 VNIII (4.83%), 2 VNIV (0.97%), 3 VGI (1.45%), 3 VGII (1.45%) and 1 VGIII (0.49%).

Humans , Cross-Sectional Studies/statistics & numerical data , Morbidity , HIV/isolation & purification , Meningitis, Cryptococcal/epidemiology , Cryptococcus neoformans/isolation & purification , Cryptococcus gattii/isolation & purification , Genotype
Rev. Soc. Bras. Med. Trop ; 51(4): 485-492, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-957449


Abstract INTRODUCTION: This study aimed to describe cryptococcal meningitis (CM) cases and the associated demographic, clinical, and microbiological data obtained from cities in the State of Mato Grosso do Sul in the Midwestern region of Brazil. METHODS: The data from 129 patients with laboratory-confirmed CM admitted from 1997 to 2014 were retrospectively reviewed. The molecular types of Cryptococcus neoformans and Cryptococcus gattii isolated from cerebrospinal fluid were analyzed to determine their geographic distribution. RESULTS: The patients had a mean age of 37 years and consisted mostly of men (76.7%). Most of the Cryptococcus isolates were obtained from patients infected with human immunodeficiency virus (HIV) and included 105 (87.5%) and 5 (55.6%) isolates of C. neoformans and C. gattii complexes, respectively. A restriction fragment length polymorphism (RFLP) analysis of URA5 revealed that most of the isolates were C. neoformans molecular type VNI (89.1%), whereas the molecular types VGII (7%) and VNII (3.9%) were observed less frequently. Notably, 65% of the cases with a time from symptom onset to laboratory diagnosis of more than 60 days resulted in fatalities, and sequelae were observed among the patients who survived. CONCLUSIONS: The present study documents the occurrence of neurocryptococcosis, which is mainly caused by C. neoformans VNI, in Mato Grosso do Sul, Brazil, with probable autochthonous cases in the Brazilian Pantanal, the world's largest tropical wetland, and a biome where cryptococcosis has not yet been explored.

Humans , Male , Female , Child , Adolescent , Adult , Young Adult , DNA, Fungal/analysis , Meningitis, Cryptococcal/epidemiology , Cryptococcus neoformans/isolation & purification , Cryptococcus gattii/isolation & purification , Rural Population , Socioeconomic Factors , Urban Population , Brazil/epidemiology , DNA, Fungal/cerebrospinal fluid , Polymerase Chain Reaction , Retrospective Studies , Meningitis, Cryptococcal/cerebrospinal fluid , Meningitis, Cryptococcal/microbiology , Cryptococcus neoformans/genetics , Cryptococcus gattii/genetics , Genotype , Middle Aged
Mem. Inst. Oswaldo Cruz ; 113(7): e170554, 2018. tab, graf
Article in English | LILACS | ID: biblio-894940


Cryptococcosis is a life-threatening fungal infection caused by the encapsulated yeasts Cryptococcus neoformans and C. gattii, acquired from the environment. In Latin America, as occurring worldwide, C. neoformans causes more than 90% of the cases of cryptococcosis, affecting predominantly patients with HIV, while C. gattii generally affects otherwise healthy individuals. In this region, cryptococcal meningitis is the most common presentation, with amphotericin B and fluconazole being the antifungal drugs of choice. Avian droppings are the predominant environmental reservoir of C. neoformans, while C. gattii is associated with several arboreal species. Importantly, C. gattii has a high prevalence in Latin America and has been proposed to be the likely origin of some C. gattii populations in North America. Thus, in the recent years, significant progress has been made with the study of the basic biology and laboratory identification of cryptococcal strains, in understanding their ecology, population genetics, host-pathogen interactions, and the clinical epidemiology of this important mycosis in Latin America.

Humans , Cryptococcosis/prevention & control , Cryptococcus neoformans , Cryptococcus gattii , Latin America/epidemiology
Mem. Inst. Oswaldo Cruz ; 113(7): e170473, 2018. tab
Article in English | LILACS | ID: biblio-894939


Cryptococcus species are the causative agents of cryptococcal meningitis, a significant source of mortality in immunocompromised individuals. Initial work on the molecular epidemiology of this fungal pathogen utilized genotyping approaches to describe the genetic diversity and biogeography of two species, Cryptococcus neoformans and Cryptococcus gattii. Whole genome sequencing of representatives of both species resulted in reference assemblies enabling a wide array of downstream studies and genomic resources. With the increasing availability of whole genome sequencing, both species have now had hundreds of individual isolates sequenced, providing fine-scale insight into the evolution and diversification of Cryptococcus and allowing for the first genome-wide association studies to identify genetic variants associated with human virulence. Sequencing has also begun to examine the microevolution of isolates during prolonged infection and to identify variants specific to outbreak lineages, highlighting the potential role of hyper-mutation in evolving within short time scales. We can anticipate that further advances in sequencing technology and sequencing microbial genomes at scale, including metagenomics approaches, will continue to refine our view of how the evolution of Cryptococcus drives its success as a pathogen.

Humans , Phylogeny , Genetic Variation , Cryptococcus gattii/genetics , Multilocus Sequence Typing , Phylogeography , Phylogeny , DNA, Fungal , Cryptococcus gattii/pathogenicity , Phylogeography , Genotype
Article in English | LILACS | ID: biblio-842787


ABSTRACT Cryptococcosis is a major invasive fungal disease related worldwide with the AIDS population. New reports of HIV/AIDS cases to the national public health surveillance system (SIVIGILA) in Colombia have shown that there is a growing community at risk of contracting cryptococcosis throughout the country who do not have access to ART. Even though the most prevalent species Cryptococcus neoformans is mainly associated with the HIV population, we report a fatal case of cryptococcosis in an AIDS patient in Barranquilla, associated with Cryptococcus gattii VGI, isolated from blood culture.

Humans , Female , Middle Aged , AIDS-Related Opportunistic Infections/microbiology , Cryptococcosis/diagnosis , Cryptococcus gattii/genetics , AIDS-Related Opportunistic Infections/diagnosis , Colombia , Cryptococcus gattii/isolation & purification , Fatal Outcome , Genotype
Infection and Chemotherapy ; : 142-145, 2017.
Article in English | WPRIM | ID: wpr-105542


Cryptococcus spp. other than Cryptococcus neoformans or Cryptococcus gattii were previously considered saprophytes and thought to be non-pathogenic to humans. However, opportunistic infections associated with non-neoformans and non-gattii species, such as Cryptococcus laurentii and Cryptococcus albidus, have increased over the past four decades. We experienced a case of cryptococcosis caused by non-neoformans and non-gattii spp. in a 47-year-old female with refractory acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation. The patient underwent salvage chemotherapy with fluconazole prophylaxis and subsequently developed neutropenic fever with multiple erythematous umbilicated papules. A skin biopsy revealed fungal hyphae and repetitive blood cultures showed yeast microorganisms that were identified later as C. laurentii by Vitek-II®. Skin lesions and fever began to improve with conventional amphotericin B therapy. The treatment regimen was continued for 21 days until the disseminated cryptococcosis was completely controlled.

Amphotericin B , Biopsy , Cryptococcosis , Cryptococcus gattii , Cryptococcus neoformans , Cryptococcus , Drug Therapy , Female , Fever , Fluconazole , Hematopoietic Stem Cell Transplantation , Humans , Hyphae , Leukemia, Myeloid, Acute , Middle Aged , Opportunistic Infections , Skin Manifestations , Skin , Yeasts
An. bras. dermatol ; 91(6): 832-834, Nov.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-837990


Abstract Cryptococcosis is a fungal infection of opportunistic behavior that is unusual in immunocompetent patients. We report a rare case of disseminated cryptococcosis with cutaneous involvement in an immunocompetent individual. During hospitalization, Cryptococcus gattii was isolated from skin lesions, lung and spinal fluid. The diagnosis of disseminated cryptococcosis was confirmed and treatment was established. The patient showed improvement. Due to the probable clinical severity of the disease and the possibility that skin lesions may be the first manifestation of this illness, prompt diagnosis must be established and treatment provided.

Humans , Male , Adult , Cryptococcosis/immunology , Cryptococcosis/pathology , Dermatomycoses/immunology , Dermatomycoses/pathology , Cryptococcus gattii/isolation & purification , Immunocompetence , Skin/microbiology , Skin/pathology , Treatment Outcome , Cryptococcosis/drug therapy , Dermatomycoses/drug therapy , Lymphocytosis/complications , Lung/microbiology , Antifungal Agents/therapeutic use
Mem. Inst. Oswaldo Cruz ; 111(10): 642-648, Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-796905


The propagules of the fungal species Cryptococcus neoformans and C. gattii, whose varieties are distributed world wide, are the primary cause of cryptococcosis, a life threatening disease. The study of environmental and clinical isolates of Cryptococcosis is an important contribution to the epidemiology and ecology of the fungus. The aim of this work was to determine the presence of C. neoformans and C. gattii in the environment in Bogotá, Colombia’s capital city and to establish the relation between clinical and environmental isolates in the period 2012-2015. From a total of 4.116 environmental samples collected between October 2012 - March 2014, 35 were positive for C. neoformans var. grubii. From 55 cryptococcosis cases reported in Bogotá during 2012-2015, 49 isolates were recovered. From those, 94% were identified as C. neoformans var. grubii molecular type VNI; 4% as VNII and 1,2% as C. neoformans var neoformans VNIV. The 84 detected clinical and environmental isolates studied had a similarity between 49-100% according with molecular typing. The correlation between environmental and clinical samples confirms the hypothesis that patients acquire the disease from environmental exposure to the fungal propagules.

Humans , Male , Female , Cryptococcosis/microbiology , Cryptococcus gattii/isolation & purification , Cryptococcus neoformans/isolation & purification , Environmental Microbiology , Cities , Colombia , Cryptococcus gattii/genetics , Cryptococcus neoformans/genetics , DNA Fingerprinting , DNA, Fungal , Genotype , Molecular Typing , Mycological Typing Techniques
Comun. ciênc. saúde ; 27(2): 159-166, abr. 2016. tab
Article in Portuguese | LILACS | ID: biblio-907587


Objetivo: descrever a distribuição molecular do Cryptococcus gattii no Brasil por meio de revisão de estudos publicados até 2016. Fonte de dados: Revisão bibliográfica de estudos publicados até 2016 no sítio DeCS BVS com os descritores nos idiomas português, Inglês e espanhol. O critério de inclusão foi: abordar resultados de caracterização molecular de C. gattii no Brasil. Critérios de exclusão: artigos sem texto completo e artigos sem informações moleculares de C. gattii. Síntese de dados: Inclui se dez publicações entre 2008 e 2016 que contêm informações sobre a caracterização molecular de C. gattii de isolados encontrados nas quatro regiões do Brasil. Conclusões: C. gattii é endêmico nas regiões Norte e Nordeste do Brasil, mas pode ser encontrado em fontes primárias nas demais regiões. O tipo molecular mais predominante foi o VGII, responsável por cerca de 80% dos casos. VGII apresentou uma alta variabilidade genética. O VGII encontrado na região Nordeste é diferente do encontrado na região Norte.

Objective: describe the distribution of Cryptococcus gattii molecular types in Brazil by reviewing studies published until 2016. Source of data: Review of studies published until 2016 in the DeCS BVS site in Portuguese, English or Spanish. The inclusion criterion was description of molecular typing of C. gattii isolates obtained in Brazil. Manuscripts without full text and without molecular information on C. gattii were excluded. Synthesis of the collected data: We have included ten publications ranging from 2008 to 2016 containing information about the molecular characterization of C. gattii isolates from the four geographic regions of Brazil. Conclusions: C. gattii is endemic in the North and Northeast regions of Brazil, but can also be found in the other regions. The predominant molecular type was VGII, accounting for about 80% of the cases. VGII has very high genetic variability. VGII isolates from the Northeast region are distinct from those found in the North.

Male , Humans , Cryptococcosis , Cryptococcus , Cryptococcus gattii , Fungi , Mycoses
São Paulo; s.n; 2016. [86] p.


Cepas de Cryptococcus gattii e C. neoformans têm potencial para desenvolver resistência in vitro ao fluconazol (FCL), o que poderia explicar as constantes falhas terapêuticas e recidivas observadas em pacientes com criptococose e sob terapia com este fármaco... O objetivo deste estudo foi investigar o nível de heterorresistência a FCL em 100 cepas, incluindo C. gattii e C. neoformans de origem ambiental e clínica (uma por paciente), provenientes de 3 coleções de culturas (1987-2013)...Os CIMs de FCL variaram entre 0,12 a 64 mg/L e foi demonstrado que todas as 100 cepas manifestaram heterorresistência (NHF entre 8 e 128 mg/L) com indução de até 256 mg/L. De 13 cepas avaliadas para estabilidade da heterorresistência, todas permaneceram estáveis até 9 passagens diárias em meio isento de FCL. Observou-se que o nível de heterorresistência a FCL foi cepa-dependente e em C. gattii maior do que em C. neoformans. Constatou-se que essa resposta adaptativa é estável com difícil reversão. O estudo sobre heterorresistência revela um mecanismo adaptativo para sobrevivência sob estresse de exposição ao FCL e pode oferecer informações úteis para compreensão da resistência observada em pacientes sob terapia azólica de longo prazo.

Strains of Cryptococcus gattii and C. neoformans have the potential to develop fluconazole (FCL) resistance in vitro, which could explain the therapeutic failure and relapses observed in Cryptococcosis patients undergoing therapy with this drug... The objective of this study was to investigate the level of heteroresistance to FCL in 100 strains, including C. gattii and C. neoformans from environmental and clinical origin (one per patient) from 3 culture collections (1987-2013)... The FCL-CIMs for the 100 strains varied between 0.12 and 64 mg/L and all 100 strains expressed heteroresistance (NHF between 8 and 128 mg/L) induced up to 256 mg/L. All 13 strains evaluated for stability heteroresistance remained stable up to 9 daily passes at free FCL culture medium. It was observed that the level of FCL heteroresistance was strain dependent and for C. gattii was higher than for C. neoformans. It was found that this adaptive response is stable with hard reversion. The heteroresistance study reveals an adaptive mechanism for survival under stress exposure to FCL and can provide useful information for understanding the resistance observed in patients ongoing long-term azole therapy. .

Humans , Antifungal Agents , Cryptococcus gattii , Cryptococcus neoformans , Fluconazole , Microbial Sensitivity Tests