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Background  Cryptococcosis is caused by a fungi of the  Cryptococcus neoformans/Cryptococcus gattii  complex and is a severe concern for public health worldwide.  C. neoformans  species are globally distributed, and  C. gattii  species are mostly found in America, Australia, and Sub-Saharan Africa.  Cryptococcus  usually infects an immunocompromised population; however, the majority of cryptococcosis in China has been reported in patients without any recognizable immunosuppression, i.e., HIV infection. To date, very few studies investigated this disease in South Central China.    Methods  The present study recruited 230 clinically suspected cryptococcosis cases in the last 5 years at two hospitals in Jiangxi Province, South Central China. All isolated strains were subjected to multilocus sequence typing (MLST) and phylogenetic analysis. Serotype and mating type were assessed by PCR,  in vitro  antifungal susceptibility was assessed by the CLSI-M27-A3 protocol.    Results  A total of 230 patients were identified as infected by  C. neoformans , including 12 cases with  Talaromyces marneffei  coinfection. All seven MLST markers were successfully amplified and used to identify the ST genotype in 199 strains.  C. gattii  strains were not detected. In contrast to previous studies, 59.3% of the patients had an immunocompromised status, and 61.9% of these patients were infected with HIV. All isolates manifested serotype A and mating type α. The ST5 genotype was common (89.5%) in the Jiangxi region, and three novel genotypes (ST656, ST657, and ST658 in six isolates) were detected in the present study. A total of 86 of the isolates (43.2%) were not sensitive to fluconazole at a MIC 50  ≥ 8 μg/ml, most of the isolates were resistant to amphotericin B, and nearly all isolates were resistant to itraconazole and posaconazole. Resistances to 5-Flucytosine and voriconazole were very rare.    Conclusions  The results of the present study indicated that C.  neoformans  is the predominant species for cryptococcosis in Jiangxi Province, and a large proportion of the strains were not sensitive to fluconazole, which may be related to treatment failure and relapse. A high percentage of HIV-related C.  neoformans  infections was reported in Jiangxi, supporting a previous hypothesis that cryptococcosis is more frequent among the HIV-infected population in China. Continuous monitoring of species distribution and antifungal sensitivity is important for the investigation of this severe disease in the Jiangxi region.

frontiers in cellular and infection microbiology

High Prevalence of HIV-Related Cryptococcosis and Increased Resistance to Fluconazole of the Cryptococcus neoformans Complex in Jiangxi Province, South Central China