Cryptococcosis in Atlántico, Colombia: An approximation of the prevalence of this mycosis and the distribution of the etiological agent in the environment

Abstract

Introduction: Cryptococcosis is an invasive disease acquired by inhalation of infectious propagules from the environment. Currently, compulsory notification of the spread of this disease is not required in Colombia. However, reporting of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome cases to the National Surveillance System has suggested that there is a growing population at risk of contracting cryptococcosis. Few studies have described the occurrence of cryptococcosis in Colombia. Therefore, in this study, we examined the pathology of this disease in Atlántico, Colombia and determined the distributions of Cryptococcus neoformans and Cryptococcus gattii in the environment. Methods: Clinical samples/isolates were gathered from cases of cryptococcosis previously diagnosed at health institutions in Atlántico, and surveys were completed by clinicians. The environmental study considered 32 sampling points and three tree species, i.e., Quickstick (Gliricidia sepium), Almond (Terminalia catappa), and Pink trumpet (Tabebuia rosea). Environmental and clinical samples/ isolates were analyzed for phenotypic and genotypic confirmation. Results: From 1997-2014, 41 cases of cryptococcosis were reported. The mean patient age was 40.5 years (range: 18-63 years); 76% were men, and 78% were HIV positive. Isolation was possible in 38 cases (C. neoformans, molecular type VNI in 37 cases and C. gattii, molecular type VGI in one case). In 2012- 2014, 2,068 environmental samples were analyzed with a positivity of 0.4% (C. neoformans, molecular type VNI) in Almond and Pink trumpet trees. Conclusions: Cryptococcus neoformans, molecular type VNI had a higher prevalence than C. gattii and was associated with human exposure and the pathogenesis of cryptococcosis in this geographical region.