Academic Journal
Cryptococcus gattii complex infections in southern Brazil: Epidemiology, clinical features, management, and outcomes from a 33-year cohort.
| Title: | Cryptococcus gattii complex infections in southern Brazil: Epidemiology, clinical features, management, and outcomes from a 33-year cohort. |
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| Authors: | 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. |
| Source: | Medical mycology [Med Mycol] 2026 Jul 01; Vol. 64 (7). |
| Publication Type: | Journal Article; Observational Study |
| Language: | English |
| Journal Info: | 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- |
| MeSH Terms: | 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 |
| Abstract: | 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 |
| Database: | MEDLINE |
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