A Study Of Genotype And In Vitro Drug Sensitivity Of 51Cryptococcus Neoformans In Fujian Area

Purposes: 1) To analyze the clinical data of 51 patients who were confirmed by cerebrospinal fluid(CSF) cryptococcus cultivation from 2010 to 2014 in Fujian province. 2) To analyze the genotype of 51 clinical isolated strains. 3) To observe in vitro antifungal drug sensitivity of 51 strains cryptococcus clinical strains, such as amphotericin B, fluconazole, fluorine cytosine, voriconazole, itraconazole.Methods: 1) Collect the epidemiology, clinical characteristics, treatment prognosis from the 51 cases. 2) Identify the genetypes of isolated strains with the application of PCR fingerprint technology based on microsatellite M13(5’-GAGGGTGGCGGTTCT-3’) for single primer PCR. 3) Analyzethe MIC value of antifungal drugs amphotericin B, fluconazole, fluorine cytosine, voriconazole, itraconazole with ATB Fungus3 method from French Melies; compare the difference of sensitivity to common antifungal drugs in different genotype strains.Results: 1) Clinical manifestations: 51 patients with sex ratio of 1.26:1; The onset age < 50 years old accounted for 74.5%; primary intracranial pressure3250mm H2 O accounted for 78.4%; 86.2% with basic diseases,among which AIDS accounted for 21.6%; 2 weeks mortality rate is 3.9%; 10 weeks mortality is 9.8%. 2) Genotyping: from 51 strains isolated from clinical cryptococcus infection cases, 41 strains(73.77%) are considered as the VNⅠgenotype strains; 5 strains(8.20%) as VNⅡ genotype strains; 1 strains(3.28%) genotype strains as VN Ⅲ; 4 strains(14.75%) as the VG Ⅰ genotype, without detecting other genotypes. 47 strains are considered as cryptococcus neoformans, 4 as cryptococcus giitta. 3) in vitro drug sensitivity: MIC value of amphotericin B, fluconazole, itraconazole, voriconazole, fluorine cytosine range from 0.5~2 mg/l, 1~4 mg/l, 0.125~4 mg/l, 0.0625~0.25 mg/l, 4~16 mg/l. There is no statistical difference of MIC values between different cryptococcus genetypes.Conclusions: 1) Cryptococcus neoformans meningitis(meningoencephalitis) is prominent with increased intracranial pressure; most of them have other basic diseases often with AIDS of high mortality; 2) Cryptococcus clinical strains isolated from clinical patients in our province are mainly VNI genotype strains; different genotypes bear no obvious relation with mortality; 3) Most cryptococcus clinical strains in our province are sensitive to common antifungal drugs, like amphotericin B, fluconazole, itraconazole, fluorine cytosine and voriconazole;there is no significant difference for these five drugs in vitro susceptibility in various genotypes and species.