Analysis of clnical features of cryptococcosis and antifungal susceptibility of clinical isolates in Korea

BACKGROUND: Cryptoccosis which is emerged as important opportunistic infection in immunosuppressed pateint is caused by Cryptococcus neoformans/C. gattii. Cryptococcus neoformans/C. gattii has four subtypes (VNI, VNII, VNIII, VNIV for C. neoformans, VGI, VGII, VGIII, VGIV for C.gattii). Each subtypes shows different geographic distributions and antifungal susceptibility. We analyzed clinical features of cryptococcosis and antifungal susceptiblity of clinical isolates. METHODS: We analyzed retrospetively 43 cases of cryptococcosis diagnosed in Ajou University hospital from 1995 to 2011. For antifungal susceptibility data, 78 clinical isolates of Cryptococcus neoformans/C. gattii was tested of each MIC via CLSI broth microdilution test and vitek 2 system. Additionally we investigated the reliability of vitek 2 system comparing to CLSI broth microdilution test. RESULT: Total 43 patients was diagnosed (2.68 cases/year) and male to female ratio was 1.7:1. Cryptococcosis occurred in various immunocompromised conditions and even immunocompetent hosts(20.9%). Overall mortality rate was 32.5%(14/42) and mortality rate of meningitis and pneumonia with septicemia were 33%(6/18) and 75%(3/4). MIC90 and MIC range for fluconazole, amphotericin B, and voriconazole by broth microdilution test were 8 μg/ml(1-16 μg/ml), 0.5 μg/ml(0.06-0.5 μg/ml) and 0.125 μg/ml(0.03-0.25 μg/ml). MIC range and MIC90 for fluconazole, amphotericin B, flucytosine by Vitek 2 system were 2 μg/ml(1-8 μg/ml), 0.5 μg/ml(0.25-0.5 μg/ml), 1 μg/ml(1-32 μg/ml). Essential agreement and categorical agreement of Vitek 2 system compared to broth microdilution test were 91.8%, 95.8% and very major, major and minor discrepancy were 0%, 0% and 0.41% respectively. CONCLUSION: Cryptococcosis occurred in various immunocompromised conditions and even immunocompetent hosts as meningitis, pneumonia, pulmonary nodule, septicemia and skin infection. Despite of proper treatment overall mortality was high up to 32.5%. Resistant strain was few against fluconazole, amphotericin B, flucytosine and voriconazole. Vitek 2 system can be considered as reliable alternative antifungal susceptibility test.

Author dc:creator

• 강, 은정

Contributors dc:contributor

• 최, 영화
• 대학원 의학과
• 106850

• 크립토코쿠스증
• Cryptococcus neoforman
• Cryptococcus gattii
• 임상양상
• 항진균제 감수성 검사
• CLSI broth microdilution test
• Vitek 2 system

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000013387
000000013387

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/8622