title: Most cases of cryptococcal meningitis in HIV-uninfected patients in Vietnam are due to a distinct amplified fragment length polymorphism-defined cluster of Cryptococcus neoformans var. grubii VN1.
abstract: Cryptococcal disease most commonly occurs in patients with an underlying immune deficit, most commonly HIV infection, and is due to Cryptococcus neoformans var. grubii. Occasionally disease due to this variety occurs in apparently immunocompetent patients. The relationship between strains infecting immunosuppressed and immunocompetent patients is not clear. Amplified fragment length polymorphism (AFLP) analysis was used to characterize the relationship between strains infecting HIV-infected and uninfected patients. Isolates from 51 HIV-uninfected patients and 100 HIV-infected patients with cryptococcal meningitis were compared. C. neoformans var. grubii VNI was responsible for infections in 73% of HIV-uninfected and 100% of HIV-infected patients. AFLP analysis defined two distinct clusters, VNIγ and VNIδ. The majority (84%) of isolates from HIV-uninfected patients were VNIγ, compared with only 38% of isolates from HIV-infected patients (odds ratio, 8.30; 95% confidence interval [CI], 3.04 to 26.6; P < 0.0001). In HIV-uninfected patients, underlying disease was less frequent in those with VNIγ infections. Two clusters of C. neoformans var. grubii VN1 are responsible for the majority of cases of cryptococcal meningitis in Vietnam. The distribution of these clusters differs according to the immune status of the host.
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. jday@oucru.org
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Day
authors.forename: Thu N
authors.initials: TN
authors.lastname: Hoang
authors.forename: Anh V
authors.initials: AV
authors.lastname: Duong
authors.forename: Chau T T
authors.initials: CT
authors.lastname: Hong
authors.forename: Pham T
authors.initials: PT
authors.lastname: Diep
authors.forename: James I
authors.initials: JI
authors.lastname: Campbell
authors.forename: Tran P M
authors.initials: TP
authors.lastname: Sieu
authors.forename: Tran T
authors.initials: TT
authors.lastname: Hien
authors.forename: Tien
authors.initials: T
authors.lastname: Bui
authors.forename: Maciej F
authors.initials: MF
authors.lastname: Boni
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
authors.forename: Dee
authors.initials: D
authors.lastname: Carter
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054458:Amplified Fragment Length Polymorphism Analysis; D016000:Cluster Analysis; D003455:Cryptococcus neoformans / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D004271:DNA, Fungal / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000382:microbiology*; D008875:Middle Aged; D017720:Molecular Epidemiology; D016533:Mycological Typing Techniques; D014744:Vietnam; D055815:Young Adult
chemical_list: D004271:DNA, Fungal