Central nervous system infection due to Cryptococcus gattii sensu lato in India: Analysis of clinical features, molecular profile and antifungal susceptibility

Abstract

Cryptococcus gattii species complex has evolved as a pathogen in the last two decades causing infection among both immunocompetent and immunocompromised hosts. We aimed to analyse the clinical features of CNS infection caused by C. gattii sensu lato, molecular and antifungal susceptibility profile of this pathogen. Cases diagnosed to have CNS cryptococcosis were included in the study. Cryptococcus recovered from patient's specimen was identified by standard protocol. Species confirmation, mating type and molecular type determination were performed by PCR based methods. Antifungal susceptibility was tested in VITEK2C to amphotericin B, 5-flucytosine, fluconazole and voriconazole. Among 199 cases, 20 (10%) were due to C. gattii, comprising of 75% cryptococcal meningitis and 25% cryptococcoma cases. Young adult males were commonly affected. Headache and vomiting were prominent symptoms and 50% were immunocompromised. Among the isolates, 75%, 20% and 5% were C. tetragattii, C. gattii sensu stricto and C. bacillisporus respectively and all had mating type α. Four (20%) isolates of C. tetragattii and the only isolate of C. bacillisporus were resistant to fluconazole. The most common species isolated from south India is C. tetragattii. The study contributes to the epidemiology of C. gattii and reiterates the need for genotyping and antifungal susceptibility testing.

Direct Antiviral Mechanisms of Interferon-Gamma

“…IFNG also attenuates neuronal transmission of HSV-1 ( 83 84 ). HSV-1 and other alpha-herpesviruses establish latency in the sensory nervous system ( 86 ). Periodical reactivation prompts the production of infectious virus in sensory ganglia, leading to the transport of virions to the axon of the neurons and subsequently to surrounding epithelial tissue ( 86 ).…”

“…HSV-1 and other alpha-herpesviruses establish latency in the sensory nervous system ( 86 ). Periodical reactivation prompts the production of infectious virus in sensory ganglia, leading to the transport of virions to the axon of the neurons and subsequently to surrounding epithelial tissue ( 86 ). Thus, movement from neuronal cell bodies to axon termini, called anterograde transport, is an essential characteristic of alpha-herpesviruses for survival and propagation to other hosts.…”

Ecoepidemiology of Cryptococcus gattii in Developing Countries

“…C. gattii s.s (genotype AFLP4/VGI) was isolated from patients with meningitis in Malaysia [ 80 , 81 ] and India [ 76 ]; this species was also reported in clinical samples from Korean, Taiwanese, and Thai patients [ 79 , 82 , 83 ]. China has reported cryptococcosis cases in HIV-positive, HIV-negative, and immunocompetent patients [ 71 , 72 , 73 , 74 , 75 ].…”

Neglecting Genetic Diversity Hinders Timely Diagnosis of Cryptococcus Infections

“…cryptococcal meningitis cases (2,(11)(12)(13). Importantly, C. tetragattii was involved in 13% to 20% of the HIV-associated cryptococcal meningitis cases (13,14).…”