Multi-Locus Sequence Typing-Based Genetic Analysis, Antifungal Resistance, and Clinical Prognosis of Cryptococcus neoformans Infections in HIV-Infected Patients in Northern China

Am J Trop Med Hyg. 2024 Oct 8;111(6):1184-1191. doi: 10.4269/ajtmh.24-0242. Print 2024 Dec 4.

Abstract

This study aimed to investigate the molecular epidemiological characteristics and drug sensitivity of Cryptococcus from HIV-infected patients and their relationship with patients' prognosis. Seventy-six strains were collected and identified to the species level by matrix-assisted laser desorption ionization-time of flight mass spectrometry, confirmed by internal transcribed spacer sequencing. Multi-locus sequence typing was used for the typing of Cryptococcus, and its antifungal susceptibility was tested using FUNGUS 3. The clinical outcomes of the patients were reviewed at 3-, 6-, 9-, and 12-month follow-ups. All strains were Cryptococcus neoformans var. grubii classified into seven sequence types (STs) dominated by ST5, ST31, and a new ST702 strain. The 6- and 9-month survival rates were highest for patients infected with ST31, ST32, and ST174. The antifungal resistant rates were 13.2%, 2.6%, and 1.4% for fluconazole, amphotericin B, and 5-fluorocytosine. Except itraconazole, the minimum inhibitory concentration (MIC) values and wild type (WT)/non-wild type (NWT) of Cryptococcus for antifungal drugs were not related to the clinical prognosis of HIV-infected patients with cryptococcal infection. ST5 was the main ST type, and the new ST702 type was found in a patient who died in a short period of time. Cryptococcus neoformans var. grubii had a relatively high antifungal drug resistance rate to fluconazole. The WT strain accounted for the highest proportions for 5-fluorocytosine, amphotericin B, fluconazole, voriconazole, and itraconazole. The MIC values of Cryptococcus for first-line antifungal drugs showed no relationship with clinical prognosis, implying that MIC values cannot be used to predict the clinical outcome of these patients.

MeSH terms

  • Adult
  • Amphotericin B / pharmacology
  • Amphotericin B / therapeutic use
  • Antifungal Agents* / pharmacology
  • Antifungal Agents* / therapeutic use
  • China / epidemiology
  • Cryptococcosis* / drug therapy
  • Cryptococcosis* / epidemiology
  • Cryptococcosis* / microbiology
  • Cryptococcus neoformans* / classification
  • Cryptococcus neoformans* / drug effects
  • Cryptococcus neoformans* / genetics
  • Cryptococcus neoformans* / isolation & purification
  • Drug Resistance, Fungal* / genetics
  • Female
  • Fluconazole / pharmacology
  • Fluconazole / therapeutic use
  • HIV Infections* / complications
  • Humans
  • Male
  • Microbial Sensitivity Tests*
  • Middle Aged
  • Multilocus Sequence Typing*
  • Prognosis

Substances

  • Antifungal Agents
  • Amphotericin B
  • Fluconazole