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European Journal of Clinical Microbiology & Infectious Diseases

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Open Access 01-07-2012 | Article

Microbiological characteristics of clinical isolates of Cryptococcus spp. in Bahia, Brazil: molecular types and antifungal susceptibilities

Authors: C. S. Matos, A. de Souza Andrade, N. S. Oliveira, T. F. Barros

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 7/2012

Abstract

To determine the profiles of susceptibility to antifungal and the genotypes of clinical isolates of Cryptococcus in Bahia, Brazil, 62 isolates were collected from cases of meningitis in the period from 2006 to 2010. Their susceptibilities to fluconazole, itraconazole, amphotericin B and 5-flucytosine were determined by the broth microdilution technique described by the Clinical and Laboratory Standards Institute and genotyping of the URA5 gene was accomplished by restriction fragment length polymorphism. C. neoformans accounted for 79% of the identified yeast and C. gattii represented the remaining 21%. Evaluation of the genotypes determined that 100% of the C. gattii isolates belong to the VGII genotype, and 98% of the C. neoformans isolates belong to the VNI genotype. Determination of susceptibility revealed isolates resistant to fluconazole (4.8%), 5-flucytosine (1.6%) and amphotericin B (3.2%); the stratification of sensitivity results for each species showed significant differences in susceptibility to azoles. This study is the first to describe the susceptibility profiles of molecular and clinical isolates of Cryptococcus in Bahia, Brazil. The high percentage of C. gattii isolates belonging to the VGII genotype and its lower susceptibility to antifungal agents highlight the importance of knowing which species are involved in cryptococcal infections in northeastern Brazil.

Casadevall A, Perfect JR (1998) Cryptococcus neoformans. ASM Press, Washington

Kwon-Chung KJ, Varma A (2006) Do major species concepts support one, two or more species within Cryptococcus neoformans? FEMS Yeast Res 6:574–587PubMedCrossRef

Park JB, Wannemuehler KA, Marston NG, Pappas PG, Chiller TM (2009) Estimation of the current global burden of cryptococcal meningitis among person living with HIV/AIDS. AIDS 23:525–530PubMedCrossRef

Kidd SE, Hagen F, Tscharke RL, Huynh M, Bartlett KH, Fyfe M (2004) A rare genotype of Cryptococcus gattii caused the cryptococcosis outbreak on Vancouver Island (British Columbia Canada). Proc Natl Acad Sci USA 101:17258–17263PubMedCrossRef

Byrnes EJ III, Bildfell R, Frank SA, Mitchell TG, Marr K, Heitman J (2009) Molecular evidence that the Vancouver Island Cryptococcus gattii outbreak has expanded into the United States Pacific Northwest. J Infect Dis 199:1081–1086PubMedCrossRef

Lockhart SR, Harris J (2010) Cryptococcus gattii: clinical importance and emergence in North America. Curr Fungal Infect Rep. doi:10.1007/s12281-010-0021-y

Trilles L, Lazéra MS, Wanke B, Oliveira RV, Barbosa GG, Nishikawa MM, Morales BP, Meyer W (2008) Regional pattern of the molecular types of Cryptococcus neoformans and Cryptococcus gattii in Brazil. Memórias do Instituto Oswaldo Cruz 103:455–462PubMedCrossRef

Costa SPSE, Lazéra MS, Santos WRA, Morales BP, Bezerra CCF, Nishikawa MM, Barbosa GG, Trilles L, Nascimento JLM, Wanke B (2009) First isolation of Cryptococcus gattii molecular type VGII and Cryptococcus neoformans molecular type VNI from environmental sources in the city of Belém, Pará, Brazil. Memórias do Instituto Oswaldo Cruz 104:662–664CrossRef

Alspaugh JA, Perfect JR (2002) Cryptococcal meningitis. Curr Treat Opin Infect Dis 4:75–80

10.

Lin X, Heitman J (2006) The biology of the Cryptococcus neoformans species complex. Annu Rev Microbiol 60:69–105PubMedCrossRef

11.

Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen M, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC (2010) Clinical practice guidelines for the management of Cryptococcal disease: 2010—infectious diseases society of America. Clin Infect Dis 50:291–322PubMedCrossRef

12.

Chandenier J, Adou-Bryn KD, Douchet C, Sar B, Kombila M, Swinne D, Therizol-Ferly M, Buisson Y, Richard-Lenovle D (2004) In vitro activity of amphotericin B, fluconazole, and voriconazole against 162 Cryptococcus neoformans isolates from Africa and Cambodia. Eur J Clin Microbiol Infect Dis 23:506–508PubMedCrossRef

13.

Perkins A, Gomez-Lopez A, Mellado E, Rodriguez-Tudela JL, Cuenca-Estrella M (2005) Rates of antifungal resistance among Spanish clinical isolates of Cryptococcus neoformans var. neoformans. J Antimicrob Chemother 56:1144–1147PubMedCrossRef

14.

Thompson GR III, Wiederhold NP, Fothergill AW, Vallor AC, Wickes BL, Patterson TF (2009) Antifungal susceptibilities among different serotypes of Cryptococcus gattii and Cryptococcus neoformans. Antimicrob Agents Chemother 53:309–311PubMedCrossRef

15.

Brandt ME, Pfaller MA, Hajjeh RA, Hamill RJ, Pappas PG, Reingold AL, Rimland D, Warnock DW, Cryptococcal Disease Active Surveillance Group (2001) Trends in antifungal drug susceptibility of Cryptococcus neoformans isolates in the United States: 1992 to 1994 and 1996 to 1998. Antimicrob Agents Chemother 45:3065–3069PubMedCrossRef

16.

Pfaller MA, Messer SA, Boyken L, Rice C, Tendolkar S, Hollis RJ, Doern GN, Diekema DJ (2005) Global trends in the antifungal susceptibility of Cryptococcus neoformans (1990 to 2004). J Clin Microbiol 43:2163–2167PubMedCrossRef

17.

Aller AI, Claro R, Castro C, Serrano C, Colom MF, Martin-Mazuelos E (2007) Antifungal susceptibility of Cryptococcus neoformans isolates in HIV-infected patients to fluconazole, itraconazole, and voriconazole in Spain: 1994–1996 and 1997–2005. Chemotherapy 53:300–305PubMedCrossRef

18.

Pfaller AM, Diekema DJ, Gibbs DL, Newell VA, Bijie H, Dzierzanowska D, Klimko NN, Letscher-Bru V, Lisalova M, Muehlethaler K, Rennison C, Zaidi M, and the Global Antifungal Surveillance Group (2009) Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-year analysis of susceptibilities of noncandidal yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol 47:117–123PubMedCrossRef

19.

Bicanic T, Wood R, Bekker LG, Darder M, Meintjes G, Harrison TS (2005) Antiretroviral roll-out, antifungal roll-back: access to treatment for Cryptococcal meningitis. Lancet Infect Dis 5:530–531PubMedCrossRef

20.

Bii CC, Makimura K, Abe S, Taguchi H, Mugasin OM, Revathi G, Wamae N, Kamiya S (2006) Antifungal drug susceptibility of Cryptococcus neoformans from clinical sources in Nairobi, Kenya. Mycoses 50:25–30CrossRef

21.

Kwon-Chung KJ (1975) A new genus, Filobasidiella, the perfect state of Cryptococcus neoformans. Mycol 67:1197–1200CrossRef

22.

Kwon-Chung KJ, Polacheck I, Bennett JE (1982) Improved diagnostic medium for separation of Cryptococcus neoformans var. neoformans (serotypes A and D) and Cryptococcus neoformans var. gattii (serotypes B and C). J Clin Microbiol 15:535–537PubMed

23.

Meyer W, Castaneda A, Jackson S, Huynh M, Castaneda E, the Ibero American Cryptococcal Study Group (2003) Molecular typing of IberoAmerican Cryptococcus neoformans isolates. Emerg Infect Dis 9:189–195PubMed

24.

Clinical Laboratory Standards Institute (CLSI) (2008) Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard, third edition. CLSI document M27-A3. Wayne, PA

25.

Bolano A, Stinchi S, Preziosi R, Bistoni F, Allegrucci M, Baldelli F, Martini A, Cardinali G (2001) Rapid methods to extract DNA and RNA from Cryptococcus neoformans. FEMS Yeast Res 1:221–224PubMed

26.

MacDougall L, Fyfe M, Romney M, Starr M, Galanis E (2011) Risk factors for Cryptococcus gattii infection, British Columbia, Canada. Emerg Infect Dis 17:193–199PubMed

27.

Centers for Disease Control and Prevention (CDC) (2010) Emergence of Cryptococcus gattii—Pacific Northwest, 2004–2010. MMWR Morb Mortal Wkly Rep 59:865–868

28.

Lester SJ, Malik R, Bartlett KH, Duncan CG (2011) Cryptococcosis; update and emergence of Cryptococcus gattii. Vet Clin Pathol 1–14

29.

Nishikawa MM, Lazéra MS, Barbosa GG, Trilles L, Balassiano BR, Macedo RCL, Bezerra CCF, Pérez MA, Cardarelli P, Wanke B (2003) Serotyping of 467 Cryptococcus neoformans isolates from clinical and environmental sources in Brazil: analysis of host and regional patterns. J Clin Microbiol 41:73–74PubMedCrossRef

30.

Santos WR, Meyer W, Wanke B, Costa SPSE, Trilles L, Nascimento JLM, Medeiros R, Morales BP, Bezerra CCF, Macêdo RCL, Ferreira SO, Barbosa GG, Perez MA, Nishikawa MM, Lazéra MS (2008) Primary endemic Cryptococcus gattii by molecular type VGII in the state of Pará, Brazil. Memórias do Instituto Oswaldo Cruz 103:813–818PubMed

31.

Matsumoto MT, Fusco-Almeida AM, Bazea LC, Melhem MSC, Mendes Ginnini MJS (2007) Genotyping, serotyping and determination of mating-type of Cryptococcus neoformans clinical isolates from São Paulo state, Brazil. Revista do Instituto de Medicina Tropical de São Paulo 49:41–47PubMedCrossRef

32.

Almeida AMF, Matsumoto MT, Baeza LC, Oliveira e Silva RB, Kleiner AAP, Melhem MSC, Giannini MJSM, the Laboratory Group on Cryptococcosis (2007) Molecular typing and antifungal susceptibility of clinical sequential isolates of Cryptococcus neoformans from Sao Paulo State, Brazil. FEMS Yeast Res 7:152–164PubMedCrossRef

33.

Silva PR, Rabelo RAS, Terra APS, Teixeira DNS (2008) Susceptibility to antifungal agents among Cryptococcus neoformans varieties isolated from patients at a university hospital. Revista da Sociedade Brasileira de Medicina Tropical 41:158–162PubMed

34.

Favalessa OC, Ribeiro LC, Tadano T, Fontes CJF, Dias FB, Coelho BPA, Hahn RC (2009) First description of phenotypic profile and in vitro drug susceptibility of Cryptococcus spp. yeast isolated from HIV-positive and HIV-negative patients in State of Mato Grosso. Revista da Sociedade Brasileira de Medicina Tropical 42:661–665PubMedCrossRef

35.

Casali AK, Goulart L, Silva LK Rosa e, Ribeiro AM, Amaral AA, Alves SH, Schrank A, Meyer W, Vainstein H (2003) Molecular typing of clinical and environmental Cryptococcus neoformans isolates in the Brazilian state of Rio Grande do Sul. FEMS Yeast Res 3:405–415PubMedCrossRef

36.

Igreja RP, Lazera MS, Wanke B, Galhardo MC, Kidd SE, Meyer W (2004) Molecular epidemiology of Cryptococcus neoformans isolates from AIDS patients of the Brazilian city, Rio de Janeiro. Med Mycol 42:229–238PubMedCrossRef

37.

Sriburee P, Khayhan S, Khamwan C, Panjaisee S, Tharavichitkul P (2004) Serotype and PCR-fingerprints of clinical and environmental isolates of Cryptococcus neoformans in Chiang Mai, Thailand. Mycopatologia 158:25–31CrossRef

38.

Morera-López Y, Torres-Rodríguez JM, Jiménez-Cabello T, Baró-Tomás T, Alía-Aponte C, Lázera MS (2005) DNA fingerprinting pattern and susceptibility to antifungal drugs in Cryptococcus neoformans variety grubii isolates from Barcelona city and rural environmental samples. Mycopathologia 160:9–14PubMedCrossRef

39.

Chen M, Li CY, Wu SX, Tang XT, Feng B, Yao ZR, Pan WH, Liao HQ, Quan ZX (2010) Molecular epidemiology of Cryptococcus neoformans species complex isolates from HIV-positive and HIV-negative patients in southeast China. Front Med China 4:117–126CrossRef

40.

Choi YH, Ngamskulrungroj P, Varma A, Sionov E, Hwang SM, Carriconde F, Meyer W, Litvintseva AP, Lee WG, Shin JH, Kim EC, Lee KW, Choi TY, Lee YL, Kwon-Chung KJ (2010) Prevalence of the VNIc genotype of Cryptococcus neoformans in non-HIV-associated cryptococcosis in the Republic of Korea. FEMS Yeast Res 10:769–778PubMedCrossRef

41.

Stephen C (2002) Multispecies outbreak of cryptococcosis on southern Vancouver Island, British Columbia. Can Vet J 43:792–794PubMed

42.

Kanafani ZA, Perfect JR (2008) Resistance to antifungal agents: mechanisms and clinical impact. Clin Infect Dis 46:120–128PubMedCrossRef

43.

Pemán J, Cantón E, Espinel-Ingroff A (2009) Antifungal drug resistance mechanisms. Expert Rev Anti-Infect Ther 7:453–460PubMedCrossRef

44.

Gomes-Lopez A, Zaragoza O, Dos Anjos M, Melhem MC, Rodriguez-Tudela JL, Cuenca-Estrella M (2008) In vitro susceptibility of Cryptococcus gattii clinical isolates. Clin Microbiol Infect 14:716–730CrossRef

45.

Khan ZU, Randhawa HS, Chehadeh A, Kowshik T, Chandy R (2009) Cryptococcus neoformans serotype A and Cryptococcus gattii serotype B isolates differ in their susceptibilities to fluconazol and voriconazol. Int J Antimicrob Agents 33(6):559–563. doi:10.1016/j.ijantimicag.2008.11.007

46.

Torres-Rodríguez JM, Alvarado-Ramírez E, Murciano F, Sellart M (2008) MICs and minimum fungicidal concentrations of posaconazole, voriconazole and fluconazole for Cryptococcus neoformans and Cryptococcus gattii. J Antimicrob Chemother 62:205–206PubMedCrossRef

47.

Calvo BM, Colombo AL, Fischman O, Santiago A, Thompson L, Lazera M, Telles F, Fukushima K, Nishimura K, Tanaka R, Myiajy M, Moretti-Branchini ML (2001) Antifungal susceptibilities, varieties, and electrophoretic karyotypes of clinical isolates of Cryptococcus neoformans from Brazil, Chile, and Venezuela. J Clin Microbiol 39:2348–2350PubMedCrossRef

48.

Moraes EMP, Prímola NS, Hamdan JS (2002) Antifungal susceptibility of clinical and environmental isolates of Cryptococcus neoformans to four antifungal drugs determined by two techniques. Mycoses 46:164–168CrossRef

49.

Speed B, Dunt D (1995) Clinical and host differences between infections with the two varieties of Cryptococcus neoformans. Clin Infect Dis 21:28–34PubMedCrossRef

50.

Drew RH, Townsend ML (2010) Antifungal drug resistance: clinical relevance and impact of antifungal drug use. Curr Fungal Infect Rep 4:129–136CrossRef

Title: Microbiological characteristics of clinical isolates of Cryptococcus spp. in Bahia, Brazil: molecular types and antifungal susceptibilities
Authors: C. S. Matos
A. de Souza Andrade
N. S. Oliveira
T. F. Barros
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 7/2012
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-011-1488-3

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