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Cryptococcus gattii complex infections in southern Brazil: Epidemiology, clinical features, management, and outcomes from a 33-year cohort.

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Τίτλος: Cryptococcus gattii complex infections in southern Brazil: Epidemiology, clinical features, management, and outcomes from a 33-year cohort.
Συγγραφείς: Carneiro BH; Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil.; Internal Medicine Department-Internal Medicine and Health Sciences Postgraduate Program, Federal University of Paraná, Curitiba 80060-240, Brazil., Raimundo Cognialli RC; Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil.; Basic Pathology Department-Microbiology, Parasitology and Pathology Postgraduate Program, Federal University of Paraná, Curitiba 81530-000, Brazil., Breda GL; Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil.; Internal Medicine Department-Internal Medicine and Health Sciences Postgraduate Program, Federal University of Paraná, Curitiba 80060-240, Brazil., França JCB; Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil., Ducroquet MA; Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil., Muro MD; Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil., Queiroz-Telles F; Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil.; Internal Medicine Department-Internal Medicine and Health Sciences Postgraduate Program, Federal University of Paraná, Curitiba 80060-240, Brazil.
Πηγή: Medical mycology [Med Mycol] 2026 Jul 01; Vol. 64 (7).
Τύπος έκδοσης: Journal Article; Observational Study
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Oxford University Press Country of Publication: England NLM ID: 9815835 Publication Model: Print Cited Medium: Internet ISSN: 1460-2709 (Electronic) Linking ISSN: 13693786 NLM ISO Abbreviation: Med Mycol Subsets: MEDLINE
Imprint Name(s): Publication: 2014- : Oxford : Oxford University Press
Original Publication: Oxford : Blackwell Science, c1998-
Ιατρικοί όροι (MeSH): Cryptococcus gattii*/isolation & purification , Cryptococcosis*/epidemiology , Cryptococcosis*/drug therapy, Brazil/epidemiology ; Antifungal Agents/therapeutic use ; Amphotericin B/therapeutic use ; Fluconazole/therapeutic use ; Deoxycholic Acid/therapeutic use ; Humans ; Male ; Middle Aged ; Female ; Adult ; Aged ; Treatment Outcome ; Drug Combinations ; Young Adult ; Cohort Studies
Περίληψη: Cryptococcus gattii complex has emerged as an important cause of invasive fungal disease in both immunocompetent and immunocompromised hosts, yet robust clinical and epidemiological data remain limited, particularly in Latin America. An observational study was conducted to describe and analyze the clinical characteristics and outcomes of all proven and probable cases of C. gattii complex infection managed at a tertiary referral center in southern Brazil from 1992 to 2025. A total of 39 cases were identified. The median age was 54 years, and 61.5% were male. Most patients (61.5%) were considered immunocompetent, although comorbidities were common. Headache (61.5%), altered mental status (33.3%), and fever (30.8%) were the most frequent symptoms overall. Pulmonary disease was the predominant clinical form (76.9%), but meningitis/meningoencephalitis was also common (69.2%). Nearly half (46.2%) had both pulmonary and neurological disease. Cryptococcomas were frequent (76.9%); the majority were managed without surgical intervention. Severe impairment of consciousness at presentation and cerebrospinal fluid protein levels above 92.15 mg/dl were significantly associated with mortality. Amphotericin B deoxycholate plus fluconazole was the most prescribed induction regimen, with a median duration of 3 weeks. The overall mortality was 20.5%. Immune reconstitution inflammatory syndrome occurred only among patients with cryptococcomas and was managed with glucocorticoids in most cases. The performance of the cryptococcal antigen (CrAg) test was excellent in both neurological and pulmonary diseases. This study highlights the clinical spectrum of C. gattii complex infection and supports the potential utility of shorter induction regimens (< 4 weeks), as well as the role of CrAg as a valuable diagnostic tool.
(© The Author(s) 2026. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com.)
Grant Information: 71396723.9.0000.0096 Hospital de Clínicas Federal University of Paraná Ethics Committee
Contributed Indexing: Keywords: Cryptococcus gattii; Brazil; clinical; cohort; cryptococcoma; cryptococcosis; epidemiology; outcomes
Local Abstract: [plain-language-summary] The Cryptococcus gattii complex comprises fungi capable of causing lung and brain infections even in healthy people. In this Brazilian research, clinical features were studied. Headache was the most common symptom, and mortality reached 20%. The results offer important insights for clinical management.
Substance Nomenclature: 0 (Antifungal Agents)
7XU7A7DROE (Amphotericin B)
8VZV102JFY (Fluconazole)
87687-70-5 (amphotericin B, deoxycholate drug combination)
005990WHZZ (Deoxycholic Acid)
0 (Drug Combinations)
Entry Date(s): Date Created: 20260630 Date Completed: 20260717 Latest Revision: 20260717
Update Code: 20260718
DOI: 10.1093/mmy/myag068
PMID: 42377913
Βάση Δεδομένων: MEDLINE
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  Data: Cryptococcus gattii complex infections in southern Brazil: Epidemiology, clinical features, management, and outcomes from a 33-year cohort.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Carneiro+BH%22&quot;&gt;Carneiro BH&lt;/searchLink&gt;; Hospital de Cl&#237;nicas, Federal University of Paran&#225;, Curitiba 80060-900, Brazil.; Internal Medicine Department-Internal Medicine and Health Sciences Postgraduate Program, Federal University of Paran&#225;, Curitiba 80060-240, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Raimundo+Cognialli+RC%22&quot;&gt;Raimundo Cognialli RC&lt;/searchLink&gt;; Hospital de Cl&#237;nicas, Federal University of Paran&#225;, Curitiba 80060-900, Brazil.; Basic Pathology Department-Microbiology, Parasitology and Pathology Postgraduate Program, Federal University of Paran&#225;, Curitiba 81530-000, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Breda+GL%22&quot;&gt;Breda GL&lt;/searchLink&gt;; Hospital de Cl&#237;nicas, Federal University of Paran&#225;, Curitiba 80060-900, Brazil.; Internal Medicine Department-Internal Medicine and Health Sciences Postgraduate Program, Federal University of Paran&#225;, Curitiba 80060-240, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Fran&#231;a+JCB%22&quot;&gt;Fran&#231;a JCB&lt;/searchLink&gt;; Hospital de Cl&#237;nicas, Federal University of Paran&#225;, Curitiba 80060-900, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Ducroquet+MA%22&quot;&gt;Ducroquet MA&lt;/searchLink&gt;; Hospital de Cl&#237;nicas, Federal University of Paran&#225;, Curitiba 80060-900, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Muro+MD%22&quot;&gt;Muro MD&lt;/searchLink&gt;; Hospital de Cl&#237;nicas, Federal University of Paran&#225;, Curitiba 80060-900, Brazil.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Queiroz-Telles+F%22&quot;&gt;Queiroz-Telles F&lt;/searchLink&gt;; Hospital de Cl&#237;nicas, Federal University of Paran&#225;, Curitiba 80060-900, Brazil.; Internal Medicine Department-Internal Medicine and Health Sciences Postgraduate Program, Federal University of Paran&#225;, Curitiba 80060-240, Brazil.
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  Data: Cryptococcus gattii complex has emerged as an important cause of invasive fungal disease in both immunocompetent and immunocompromised hosts, yet robust clinical and epidemiological data remain limited, particularly in Latin America. An observational study was conducted to describe and analyze the clinical characteristics and outcomes of all proven and probable cases of&#160;C. gattii complex infection managed at a tertiary referral center in southern Brazil from 1992 to 2025. A total of 39 cases were identified. The median age was 54 years, and 61.5% were male. Most patients (61.5%) were considered immunocompetent, although comorbidities were common. Headache (61.5%), altered mental status (33.3%), and fever (30.8%) were the most frequent symptoms overall. Pulmonary disease was the predominant clinical form (76.9%), but meningitis/meningoencephalitis was also common (69.2%). Nearly half (46.2%) had both pulmonary and neurological disease. Cryptococcomas were frequent (76.9%); the majority were managed without surgical intervention. Severe impairment of consciousness at presentation and cerebrospinal fluid protein levels above 92.15 mg/dl were significantly associated with mortality. Amphotericin B deoxycholate plus fluconazole was the most prescribed induction regimen, with a median duration of 3 weeks. The overall mortality was 20.5%. Immune reconstitution inflammatory syndrome occurred only among patients with cryptococcomas and was managed with glucocorticoids in most cases. The performance of the cryptococcal antigen (CrAg) test was excellent in both neurological and pulmonary diseases. This study highlights the clinical spectrum of C. gattii complex infection and supports the potential utility of shorter induction regimens (&amp;lt; 4 weeks), as well as the role of CrAg as a valuable diagnostic tool.&lt;br /&gt; (&#169; The Author(s) 2026. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com.)
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      – TitleFull: Cryptococcus gattii complex infections in southern Brazil: Epidemiology, clinical features, management, and outcomes from a 33-year cohort.
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