Emerging Cryptococcus gattii species complex infections in Guangxi, southern China

PLoS Negl Trop Dis. 2020 Aug 26;14(8):e0008493. doi: 10.1371/journal.pntd.0008493. eCollection 2020 Aug.

Abstract

The emergence and spread of cryptococcosis caused by the Cryptococcus gattii species complex has become a major public concern worldwide. C. deuterogattii (VGIIa) outbreaks in the Pacific Northwest region demonstrate the expansion of this fungal infection to temperate climate regions. However, infections due to the C. gattii species complex in China have rarely been reported. In this study, we studied eleven clinical strains of the C. gattii species complex isolated from Guangxi, southern China. The genetic identity and variability of these isolates were analyzed via multi-locus sequence typing (MLST), and the phylogenetic relationships among these isolates and global isolates were evaluated. The mating type, physiological features and antifungal susceptibilities of these isolates were also characterized. Among the eleven isolates, six belonged to C. deuterogattii, while five belonged to C. gattii sensu stricto. The C. deuterogattii strains from Guangxi, southern China were genetically variable and clustered with different clinical isolates from Brazil. All strains were MATα, and three C. deuterogattii isolates (GX0104, GX0105 and GX0147) were able to undergo sexual reproduction. Moreover, most strains had capsule and were capable of melanin production when compared to the outbreak strain from Canada. Most isolates were susceptible to antifungal drugs; yet one of eleven immunocompetent patients died of cryptococcal meningitis caused by C. deuterogattii (GX0147). Our study indicated that the highly pathogenic C. deuterogattii may be emerging in southern China, and effective nationwide surveillance of C. gattii species complex infection is necessary.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antifungal Agents / pharmacology
  • China
  • Cryptococcosis / epidemiology*
  • Cryptococcosis / parasitology*
  • Cryptococcus gattii / drug effects
  • Cryptococcus gattii / genetics*
  • Drug Resistance, Fungal
  • Female
  • Humans
  • Male
  • Middle Aged
  • Phylogeny

Substances

  • Antifungal Agents

Grants and funding

This study was supported by grants from the National Natural Science Foundation of China (Nos. 81571971 and 81271804) and the Natural Science Foundation of Guangxi Province of China (2017GXNSFAA198004, AB18221017 and 2018GXNSFAA294090). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.