Current epidemiology and implication for microbiological diagnosis of cryptococcal infections in Korea
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Cryptococcosis is a major invasive fungal infection affecting both immunocompromised andimmunocompetent hosts worldwide and is mainly caused by Cryptococcus neoformansand Cryptococcus gattii. C. neoformans accounts for 90% of all infections and primarilycauses central nervous system infections. Although C. gattii is primarily found in tropicaland subtropical regions, infections have recently been reported in temperate areas such asKorea. Genetic studies in Korea indicated that most C. neoformans strains are of the VNIST5 type and show genetic homogeneity. In contrast, genetic studies on C. gattii are limited. Cryptococcosis is diagnosed using microscopy, serological tests, culture, and moleculartests. Although it can be detected in the cerebrospinal fluid or body fluids using the Indiaink method, confirmation through culture is essential for a definitive diagnosis. Cryptococcalantigen testing is economical, highly sensitive, and specific; therefore, it is widely used forthe diagnosis of cryptococcosis. Molecular methods have recently been introduced; however,their applications remain limited. The recommended treatment for cryptococcal infectionsincludes amphotericin B alone or in combination with flucytosine or fluconazole. Secondaryresistance to flucytosine and fluconazole is common. The Clinical and Laboratory StandardsInstitute and European Committee on Antimicrobial Susceptibility Testing recommend thebroth microdilution method. Several commercial methods for antifungal susceptibility testinghave been developed and are currently in use; however, more data are required to establishbreakpoints
Abstract
Cryptococcosis is a major invasive fungal infection affecting both immunocompromised andimmunocompetent hosts worldwide and is mainly caused by Cryptococcus neoformansand Cryptococcus gattii. C. neoformans accounts for 90% of all infections and primarilycauses central nervous system infections. Although C. gattii is primarily found in tropicaland subtropical regions, infections have recently been reported in temperate areas such asKorea. Genetic studies in Korea indicated that most C. neoformans strains are of the VNIST5 type and show genetic homogeneity. In contrast, genetic studies on C. gattii are limited. Cryptococcosis is diagnosed using microscopy, serological tests, culture, and moleculartests. Although it can be detected in the cerebrospinal fluid or body fluids using the Indiaink method, confirmation through culture is essential for a definitive diagnosis. Cryptococcalantigen testing is economical, highly sensitive, and specific; therefore, it is widely used forthe diagnosis of cryptococcosis. Molecular methods have recently been introduced; however,their applications remain limited. The recommended treatment for cryptococcal infectionsincludes amphotericin B alone or in combination with flucytosine or fluconazole. Secondaryresistance to flucytosine and fluconazole is common. The Clinical and Laboratory StandardsInstitute and European Committee on Antimicrobial Susceptibility Testing recommend thebroth microdilution method. Several commercial methods for antifungal susceptibility testinghave been developed and are currently in use; however, more data are required to establishbreakpoints
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