title: Clinical and microbiological characteristics of cryptococcosis in Singapore: predominance of Cryptococcus neoformans compared with Cryptococcus gattii.
abstract: OBJECTIVE
  To describe the clinical features, treatments, outcomes, and subtype prevalence of cryptococcosis in Singapore.
  
  
  METHODS
  All patients with laboratory confirmed cryptococcal infections admitted from 1999 to 2007 to a teaching hospital in Singapore were reviewed retrospectively. Identification and molecular types of Cryptococcus neoformans variants and Cryptococcus gattii were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serotypes were inferred with a multiplex PCR method.
  
  
  RESULTS
  Of 62 patients with cryptococcosis, C. neoformans var. grubii was the predominant subtype (in 95%), affecting mainly immunocompromised hosts (91%) with HIV infection (80%). Patients with HIV were younger (median age 36.5 vs. 49.5 years, p=0.006) and less likely to present with an altered mental status (14% vs. 50%, p=0.013). In contrast, delayed treatment (median 7 days vs. 2 days, p=0.03), pulmonary involvement (58% vs. 14%, p=0.03), and initial treatment with fluconazole (25% vs. 2%, p=0.02) were more common in HIV-negative patients. C. gattii was uncommon, affecting only three patients, all of whom were immunocompetent and had disseminated disease with pulmonary and neurological involvement. All C. gattii were RFLP type VG II, serotype B and all C. neoformans var. grubii were RFLP type VN I, serotype A, except for one that was RFLP type VN II.
  
  
  CONCLUSIONS
  C. neoformans var. grubii, subtype VN I, was the predominant subtype in Singapore, infecting younger, mainly immunocompromised hosts with HIV. C. gattii was uncommon, causing pulmonary manifestations in older, immunocompetent patients and were RFLP type VG II.
authors.affiliation: Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore. Electronic address: chnmonica@gmail.com.
authors.forename: Monica
authors.initials: M
authors.lastname: Chan
authors.affiliation: Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Lye
authors.affiliation: Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Mar Kyaw
authors.initials: MK
authors.lastname: Win
authors.affiliation: Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore.
authors.forename: Angela
authors.initials: A
authors.lastname: Chow
authors.affiliation: Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Tim
authors.initials: T
authors.lastname: Barkham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology*; D056285:Cryptococcus gattii / Q000302:isolation & purification*; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore; D055815:Young Adult
keywords: Cryptococcus; Epidemiology; Fungus; HIV; Opportunistic infection; Serotype