Cryptococcosis in Southern China: Insights from a Six-Year Retrospective Study in Eastern Guangdong

Abstract

Objective: Cryptococcosis is a fatal infection that can affect both immunocompetent and immunocompromised patients, and it is little understood in China's various regions. This research aimed to look at the epidemiology, risk factors, and antifungal susceptibility pattern of Cryptococcus neoformans in eastern Guangdong, China.

Methods: A six-year (2016-2022) retrospective study was conducted at Meizhou People's Hospital, China. Demographical, clinical, and laboratory data of cryptococcal patients were collected from hospital records and statistically analyzed using the chi-square and ANOVA tests.

Results: Overall, 170 cryptococcal infections were recorded, of which meningitis accounted for 78 (45.88%), cryptococcemia for 50 (29.41%), and pneumonia for 42 (24.7%). The number of cases increased 8-fold during the study duration. The median age of patients was 58 years (Inter quartile range: 47-66), and the high proportion of cases was from the male population (n = 121, 71.17%). The underlying diseases were identified only in 60 (35.29%) patients, of which 26 (15.29%) were severely immunocompromised, and 26 (15.29%) others were mildly immunocompromised. A statistically significant difference was reported for chronic renal failure, and anemia (p < 0.05) persisted in cases of three infection types. A high number of non-wild type (NWT) isolates were found against amphotericin B (n=13/145, 8.96%), followed by itraconazole (n=7/136, 5.15%) and voriconazole (n=4/158, 2.53%). Only six isolates (3.79%) were multidrug-resistant, four of which were from cryptococcemia patients. Compared to meningitis and pneumonia, cryptococcemia revealed a higher percentage of NWT isolates (p < 0.05).

Conclusion: In high-risk populations, cryptococcal infections require ongoing monitoring and management.

Keywords: Cryptococcus neoformans; antifungal susceptibility; cryptococcosis; epidemiology; risk factors.

Figure 1

The number of cryptococcal cases detected from different departments and sample sources during the study duration (2016 to 2021). *Other departments represent 4 cases in hepatology, 3 cases (each) from pediatrics and general practice departments, and 1 case (each) from surgery, hematology, stomatology, and cardiology.

Figure 2

Distribution of cryptococcal cases based on different age groups and gender during the study duration (2016 to 2021).

Figure 3

The distribution of WT/NWT and MIC ranges of different antifungal agents against the tested C. neoformans isolates tested in the current study. The brown bars indicate WT isolates, while the green bars are for NWT, and the purple line shows the ECVs for each antifungal agent according to CLSI guidelines (M57s). The ECV for amphotericin B is 0.5 mg/L, for 5-flucytosine and fluconazole is 8 mg/L, and for itraconazole, and voriconazole is 0.25 mg/L.