Cryptococcus neoformans is a common cause of meningoencephalitis among AIDS patients. Several C. neoformans virulence factors have been identified, but the relative importance of particular factors is unknown. This study examined the corrrelation of the virulence of 18 C. neoformans var. grubii isolates from AIDS patients with the expression of several well-described virulence factors. The LD 50 at 15 days after intracranial inoculation of ICR mice was <100 c.f.u. for 22 % of isolates, 100-1000 for 28 %, 1000-10 000 for 11 % and >20 000 for 39 %. Higher cryptococcal concentrations in brains were noted for isolates with lower LD 50 (P=0?002). In survival studies, no immunocompetent BALB/c mice (nu/") infected with 36LD 50 of three virulent isolates (LD 50 =62, 99, 1280) survived beyond 23 days, whereas 100 %, 90 % and 90 % of mice infected with 20 000 c.f.u. of three hypovirulent isolates (LD 50 >20 000) survived for 60 days (P<0?0001). Even among BALB/c nude (nu/nu) mice, survival rates over 60 days were 100 %, 70 % and 50 %, respectively, for the hypovirulent isolates. Growth rate at 37 6C and capsule size within brains correlated with LD 50 by univariate (P=0?0001 and 0?028, respectively) and multivariate (P=0?017 and 0?016, respectively) analyses. There was no correlation between LD 50 and capsule size in vitro, phospholipase activity, melanin formation, proteinase activity and fluconazole MIC. In conclusion, AIDS patients are susceptible to infection by C. neoformans isolates of wide-ranging virulence, including isolates that are markedly hypovirulent. The virulence of a given isolate reflects a composite of factors rather than the contribution of a dominant factor. Growth at 37 6C and capsule size in vivo make particularly important contributions.
INTRODUCTIONCryptococcus neoformans is a yeast-like fungus that is generally found in soil with a high content of avian guano or vegetative debris (Casadevall & Perfect, 1998;Mitchell & Perfect, 1995). Infections of humans, believed to be acquired by inhalation of small yeast cells or basidiospores, are often clinically silent. In fact, the most commonly recognized manifestation of cryptococcal disease (cryptococcosis) is not pneumonia but rather meningitis or meningoencephalitis. Cryptococcal central nervous system (CNS) infections and other forms of cryptococcosis are largely, but not exclusively, diseases of persons with AIDS or other immunosuppressed conditions. The pathogenesis of cryptococcosis reflects the interaction between host susceptibility, immune response to the infecting organism, and the virulence potential of the given C. neoformans strain. In North America, over 90 % of cases are caused by strains of serotype A, C. neoformans var. grubii, which are believed to be more pathogenic than strains of serotype D, C. neoformans var. neoformans (Mitchell & Perfect, 1995;Casadevall & Perfect, 1998).3These authors contributed equally to this work.