Clinical Analysis And In Vitro Susceptibility Test Of 65 Cases Of Cryptococcosis

Objective:To determine the characteristics of cryptococcosis in Zhejiang Province and the characteristics of the patient population.To determine the changes of resistance of clinical Cryptococcus to antifungal drugs.Methods:The Cryptococcus strains preserved in the clinical microbiology laboratory of Sir Run Run Shaw hospital from January 2013 to July 2018 were collected and reidentified by VITEK-2 and MALDI-TOF.The strains identified as Cryptococcus were further tested for antifungal drug sensitivity in vitro to determine the MICs to flucytosine,amphotericin B,fluconazole,itraconazole and voriconazole.The clinical data of patients were statistically analyzed,including age,gender,location of infection,symptoms,signs,diagnostic methods,treatment,prognosis and so on.Results:From January 2013 to July 2018,65 strains of Cryptococcus were collected from Sir Run Run Shaw Hospital,Zhejiang University,School of medicine,which mainly isolated from cerebrospinal fluid and lung samples.64 strains were Cryptococcus neoformans var.grubii and 1 strain was Cryptococcus gattii.There werre 39 cases of non-disseminated cryptococcosis,including 13 cases of pulmonary cryptococcosis and 26 cases of cryptococcal meningitis.There were 26 cases of disseminated cryptococcosis,including 16 cases of pulmonary involvement and 19 cases of central nervous system involvement.The main symptoms of all patients with central nervous system involvement were headache(37/46,80.4%)and fever(38/46,82.6%).The main symptoms of all patients with lung involvement were fever(16/29,55.2%)and cough(17/29,58.6%).32.3%(21/65)of the patients had no risk factors for Cryptococcus infection.There were 8 patients(12.3%)with poor prognosis due to the progress of Cryptococcus infection.The MIC90(MIC range)of antifungal agents was flucytosine? 4(?4)mg/L,amphotericin B ?0.5(?0.5)mg/L,fluconazole 8(?1??)128)mg/L,Itraconazole 0.25(?0.125?? 4)mg/L,voriconazole 0.25(?0.06to? 8)mg/L,respectively.The resistance of Cryptococcus strains to flucytosine,amphotericin B,fluconazole,itraconazole and voriconazole had no significant difference with time(P>0.05).Conclusion:The main pathogen of cryptococcosis in Sir Run Run Shaw Hospital,Zhejiang University,School of medicine,was mainly Cryptococcus neoformans var,grubii.Cryptococcal meningitis and pulmonary cryptococcosis were the main infections.The main manifestations of cryptococcal meningitis were fever and headache,while the main manifestations of pulmonary cryptococcosis were cough and fever.32.3%patients were apparently immunocompetent.Cryptococcus is generally sensitive to amphotericin B,flucytosine,fluconazole,voriconazole,and itraconazole.