[Cryptococcus meningitis, five years of experience and literature review].
The aim of this study was to determine the distribution and antifungal susceptibility profile of Cryptococcus spp. isolated from patients in northeast Romania.


METHODS
Fungi isolated from blood and cerebrospinal fluid (CSF) cultures were identified by ID32C strips (bioMerieux, France). Susceptibility testing was performed using ATB FUNGUS2 strips (bioMerieux, France).


RESULTS
A total of 20 significant strains have been isolated. Overall, Cryptococcus neoformans was the most frequent isolate (95%). We mention the first Cryptococcus albidus meningitis in Romania (strain with multiple resistance). All cryptococci tested were susceptible to amphotericin B with minimal inhibitory concentration (MIC) =1 microg/mL; 90% strains were susceptible to flucytosine. Resistance to fluconazole and itraconazole was observed in 2 and 1 case, respectively. Most of the patients had an associated infection, tuberculosis in 37.5% cases. Despite appropriate therapy 4 patients died (21%).


CONCLUSIONS
First choice induction therapy with amphotericin B plus flucytosine followed by fluconazole is highly recommended since resistance to antifungal agents is still very low.
Dorneanu
Olivia
O
Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină, Disciplina de Microbiologie.
Filip
Olga
O
Miftode
Egidia
E
Radu
Irina
I
Nicolau
Cristina
C
Damian
Ioana
I
Luca
V
V
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003455:Cryptococcus neoformans / Q000187:drug effects* / Q000302:isolation & purification; D025141:Drug Resistance, Fungal; D004359:Drug Therapy, Combination; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D012383:Romania / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole