Cryptococcus neoformans in Siriraj Hospital 1994-1995.

ABSTRACT

One-hundred twenty strains of C.neoformans were cultured from the 104 patients (25 female, 79 male patients) admitted in Siriraj Hospital, Mahidol University, Bangkok, during January 1994 – December 1995. All patients were suffering from cryptococcal meningitis. Four female patients were diagnosed as systemic lupus erythematosus and one girl as acute lymphoblastic leukemia. The other 99 patients were diagnosed as having AIDS. The average duration of hospitalization for female and male patients was 19.3 and 23.7 days, respectively. Four female patients (16%) and sixteen male patients (20%) died, and the rest were discharged after improvement. The median initial latex agglutination test was 1864. Biochemical testing of C.neoformans cultured from 104 patients by using both canavanine-glycinebromthymol blue agar and glycine cycloheximide medium identified 103 C.neoformans var neoformans and 1. C.neoformans var gattii. PCR fingerprinting using two primers, the single-oligonucleotide primer (GACA)4 and the phage M13 core sequence (5’ GAGGGTGGXGGXTCT 3’), revealed 102 serotype A, 1 serotype D (from AIDS patient) and 1 serotype B (from systemic lupus erythematosus patient). The phage M13 core sequence primer revealed more bands than the (GACA)4 primer. We could not differentiate by fingerprinting serotype A affecting various underlying diseases patients. Patients suffered from only one serotype of C.neoformans. The fingerprint pattern was stable under the stress of various drug therapy regimens and after subculturing in the laboratory; thus PCR fingerprinting has emerged as an important method for use in epidemiological studies. C.neoformans is susceptible to various antifungal agents, namely amphotericin B, flucytosine, fluconazole and itraconazole, in the therapeutic range.