| Objective:(1)To explore the composition of Cryptococcus neoformans variants in Guangxi and the sensitivity of antifungal drugs in vitro,to enrich the epidemiological data of Cryptococcus neoformans in China;(2)Combined with the variants of Cryptococcus neoformans and drug sensitivity in vitro,the clinical data and prognosis of patients with Cryptococcus neoformans in Guangxi were analyzed to improve the clinical understanding of the diagnosis and treatment of cryptococcosis;(3)To explore the value of cryptococcal gold method of cryptococcal capsular polysaccharide antigen in the early diagnosis of cryptococcosis.Methods: From May 2014 to July 2019,Cryptococcus neoformans cultured positively from patients with sterile body fluids or tissue specimens from the First Affiliated Hospital of Guangxi Medical University and with complete patient data were studied as follows:(1)The German Bruker Company MALDI-TOF MS was used to identify all strains;(2)According to the M27-A3 protocol recommended by CLSI in the United States,92 strains of Cryptococcus neoformans were tested for commonly used antifungal drugs(fluconazole,amphotericin B,5-fluorocytosine,itraconazole,voriconazole)and new antifungal drugs(Posaconazole,Isaconazole)in vitro drug sensitivity;(3)Retrospectively analyze and summarize the basic conditions,underlying diseases,clinical symptoms,treatment,and prognosis of patients included in the study;(4)Retrospectively analyze the results of Cryptococcus capsularis polysaccharide antigens from different parts of the enrolled patients,and analyze the value of the detection of capsular polysaccharide antigens from specimens of different sources for the early diagnosis of cryptococcosis.Results:(1)75 patients were included in the study,a total of 92 strains of Cryptococcus neoformans,and 17 strains were serial strains.Among the 92 strains of Cryptococcus neoformans,80 strains were from cerebrospinal fluid(86.96%),7 strains were from lung tissue(7.61%),3 strains were from alveolar lavage fluid(3.26%),and 2 strains were from skin(2.17%).(2)Using the MALDI-TOF MS method,92 Cryptococcus neoformans variants were identified as all Cryptococcus neoformans grubii variants;(3)92 strains of Cryptococcus neoformans are sensitive to most antifungal drugs,which the minimum inhibitory concentration ranges of fluconazole,amphotericin B,5-fluorocytosine,itraconazole,voriconazole,posaconazole,and isaconazole are respectively 0.25 to 4 ug/ml,0.0625 to 1 ug/ml,0.0625 to 8 ug/ml,0.0156 to 0.25 ug/ml,0.0078 to 0.25 ug/ml,0.0039 to 0.5 ug/ml,0.0020 ~0.125 ug/ml.There was no significant difference in drug sensitivity in vitro between the series of 17 patients.(4)Of the 75 patients,51 were male(68.0%)and 24 were female(32.0%).The male to female ratio was 2.125:1.The average age of onset was(46.59 ± 14.25)years.The occupational distribution was mainly farmers.Of the75 patients,14 patients(17.33%,14/75)were HIV positive,61 patients were HIV negative,and the majority of non-HIV patients had no underlying disease(65.57%,40/61),and the remaining 34.43%(11/61)combined with one or more basic diseases.There were 21 cases of disseminated cryptococcosis,54 cases of non-disseminated cryptococcosis,including 8 cases of pulmonary cryptococcosis,46 cases of cryptococcal meningitis(encephalitis).The clinical manifestations of patients with central nervous system involvement are mainly headache and fever,and those with lung involvement mainly have fever and cough as the first symptoms.Among 75 patients,the cure rate was 34.67%(26/75),the improvement rate accounted for 30.67%(23/75),34.67%(26/75)patients died,and the mortality rate of disseminated cryptococcosis was 40.0%(8/20),the mortality rate of cryptococcal meningitis was 36.96%(17/46),and the mortality rate of pulmonary cryptococcosis was 12.5% ??(1/8).There was no statistically significant difference in the therapeutic effect between the group without underlying disease and the underlying disease(P>0.05).(5)In this study,the positive rate of CSF ink stained smear was 86.21%,and the positive rate of CSF cryptococcal gold method to detect capsular polysaccharide antigen was100%.The positive rate of Cryptococcus capsularis polysaccharide antigen in different specimens was 95.83%(serum)、100%(CSF)、80.00%(BALF).Conclusion:(1)The causative bacteria of cryptococcosis in the First Affiliated Hospital of Guangxi Medical University are mainly Cryptococcus neoformans grubii variants,and the above strains are generally sensitive to amphotericin B,5-fluorocytosine,fluconazole,voriconazole,itraconazole,Posaconazole and Isaconazole;(2)The patients with cryptococcosis in our area are mainly young and middle-aged people with no obvious underlying diseases.The nervous system is mainly affected by fever and headache,and the lung is affected by Cough and fever are the main manifestations.Disseminated cryptococcosis and cryptococcal meningitis(encephalitis)have a high mortality rate,and the prognosis of pulmonary cryptococcosis is relatively good;(3)The detection of capsular polysaccharide antigen by colloidal gold method can guide crypto In the early diagnosis of coccidiosis,the titer is positively correlated with the severity and prognosis of the disease. |
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