Dai Fang-Fang, Yu Yan-Hua, Lu Xin-Xin
Department of Clinical Laboratory, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Am J Trop Med Hyg. 2024 Oct 8;111(6):1184-1191. doi: 10.4269/ajtmh.24-0242. Print 2024 Dec 4.
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.
本研究旨在调查HIV感染患者中隐球菌的分子流行病学特征、药敏情况及其与患者预后的关系。收集76株菌株，采用基质辅助激光解吸电离飞行时间质谱仪鉴定至种水平，并通过内转录间隔区测序进行确认。采用多位点序列分型对隐球菌进行分型，使用FUNGUS 3检测其抗真菌药敏情况。在3个月、6个月、9个月和12个月的随访中回顾患者的临床结局。所有菌株均为新生隐球菌格鲁比变种，分为7种序列类型（STs），以ST5、ST31和新的ST702菌株为主。感染ST31、ST32和ST174的患者6个月和9个月生存率最高。氟康唑、两性霉素B和5-氟胞嘧啶的耐药率分别为13.2%、2.6%和1.4%。除伊曲康唑外，隐球菌对抗真菌药物的最低抑菌浓度（MIC）值及野生型（WT）/非野生型（NWT）与HIV感染合并隐球菌感染患者的临床预后无关。ST5是主要的ST类型，新的ST702类型在一名短期内死亡的患者中发现。新生隐球菌格鲁比变种对氟康唑的抗真菌耐药率相对较高。5-氟胞嘧啶、两性霉素B、氟康唑、伏立康唑和伊曲康唑的WT菌株占比最高。隐球菌对一线抗真菌药物的MIC值与临床预后无关，这意味着MIC值不能用于预测这些患者的临床结局。
