TY - JOUR T1 - Clinical and microbiological characteristics of cryptococcosis in Singapore: predominance of Cryptococcus neoformans compared with Cryptococcus gattii. AU - Chan,Monica, AU - Lye,David, AU - Win,Mar Kyaw, AU - Chow,Angela, AU - Barkham,Tim, Y1 - 2014/07/11/ PY - 2014/02/20/received PY - 2014/05/19/revised PY - 2014/05/20/accepted PY - 2014/7/15/entrez PY - 2014/7/16/pubmed PY - 2015/11/6/medline KW - Cryptococcus KW - Epidemiology KW - Fungus KW - HIV KW - Opportunistic infection KW - Serotype SP - 110 EP - 5 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 26 N2 - OBJECTIVES: To describe the clinical features, treatments, outcomes, and subtype prevalence of cryptococcosis in Singapore. METHODS: All patients with laboratory confirmed cryptococcal infections admitted from 1999 to 2007 to a teaching hospital in Singapore were reviewed retrospectively. Identification and molecular types of Cryptococcus neoformans variants and Cryptococcus gattii were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serotypes were inferred with a multiplex PCR method. RESULTS: Of 62 patients with cryptococcosis, C. neoformans var. grubii was the predominant subtype (in 95%), affecting mainly immunocompromised hosts (91%) with HIV infection (80%). Patients with HIV were younger (median age 36.5 vs. 49.5 years, p=0.006) and less likely to present with an altered mental status (14% vs. 50%, p=0.013). In contrast, delayed treatment (median 7 days vs. 2 days, p=0.03), pulmonary involvement (58% vs. 14%, p=0.03), and initial treatment with fluconazole (25% vs. 2%, p=0.02) were more common in HIV-negative patients. C. gattii was uncommon, affecting only three patients, all of whom were immunocompetent and had disseminated disease with pulmonary and neurological involvement. All C. gattii were RFLP type VG II, serotype B and all C. neoformans var. grubii were RFLP type VN I, serotype A, except for one that was RFLP type VN II. CONCLUSION: C. neoformans var. grubii, subtype VN I, was the predominant subtype in Singapore, infecting younger, mainly immunocompromised hosts with HIV. C. gattii was uncommon, causing pulmonary manifestations in older, immunocompetent patients and were RFLP type VG II. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/25018090/Clinical_and_microbiological_characteristics_of_cryptococcosis_in_Singapore:_predominance_of_Cryptococcus_neoformans_compared_with_Cryptococcus_gattii_ DB - PRIME DP - Unbound Medicine ER -