Cryptococcosis in HIV/AIDS patients in northern Brazil: Clinical aspects, molecular types and isolation of agents from environmental samples associated with patients

• Published in: Tropical medicine & international health 2022-04, Vol.27 (4), p.387-396
• Main Authors: Alves, Marla Jalene, Nascimento, Izabella Sadalla, Cruz, Katia Santana, Menescal, Victoria Violeta Fernandes, Menescal, Lizandra Stephanny Fernandes, Silva, Larissa Svetlana Cavalcante, Pinheiro, Silviane Bezerra, Gómez, Aline Stephanie Pérez, Souza, João Vicente Braga, Lazera, Marcia dos Santos, Jackisch‐Matsuura, Ani Beatriz
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome; AIDS; Amazonas; Brazil - epidemiology; Clinical aspects; Clinical isolates; Cryptococcosis; Cryptococcosis - epidemiology; Cryptococcus; Cryptococcus gattii; Cryptococcus neoformans; Diagnosis; Epidemiology; Fungal infections; Fungi; Genotype; Health care; Health care facilities; HIV; HIV/AIDS; Home environment; Households; Human immunodeficiency virus; Humans; Mixed infection; Patients; PCR‐RFLP; Public health
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13737

Objectives In the state of Amazonas, northern Brazil, cryptococcosis is endemic, with a predominance of Cryptococcus neoformans in individuals with HIV/AIDS, and Cryptococcus gattii VGII in non‐HIV individuals. This study analysed the clinical isolates and clinical–epidemiological characteristics of HIV/AIDS patients diagnosed with cryptococcosis in a tertiary healthcare facility in Manaus, Amazonas and investigated the presence of agents of cryptococcosis in environmental samples. Methods A survey was made of data from HIV/AIDS patients diagnosed with cryptococcosis between January 2017 and December 2019, and environmental samples were collected at the patients’ and their neighbours’ homes. The isolates were submitted to morphophysiological analysis and PCR‐RFLP typing to determine the molecular types. Results Clinical–epidemiological characteristics of 55 patients and 75 clinical isolates were analysed. Neurocriptococcosis was the clinical form observed in 98.2% (n = 54/55) of patients. A total of 38.1% (n = 21/55) of patients died within 100 weeks, of which 21.8% (n = 12/55) died less than a month after the diagnosis of cryptococcosis. C. neoformans VNI (n = 68/75), C. neoformans VNII (n = 1/75), C. gattii VGI (n = 3/75) and C. gattii VGII (n = 3/75) were identified. Mixed infection was observed in two patients, one by C. neoformans VNI and VNII and the other by C. neoformans VNI and C. gattii VGI. Cryptococcus VNI was detected in three (n = 3/51) households, one of a patient (n = 1/17) and two households that neighbour patients’ houses (n = 2/34). Conclusions This study demonstrated the prevalence of C. neoformans VNI, which is a cause of cryptococcosis in patients with HIV/AIDS in the state of Amazonas, and revealed a greater diversity of molecular types affecting these patients in the region than in previous studies. In the studied group, a high mortality rate was observed, which reflects the importance of early diagnosis, and evidences cryptococcosis as an AIDS‐defining disease and an important public health problem in the region. The home environment proved to be a potential source of infection/reinfection by C. neoformans VNI.