Cryptococcosis Serotypes Impact Outcome and Provide Evidence of Cryptococcus neoformans Speciation

Marie Desnosollivier,Sweta Patel,Dorothee Raouxbarbot,Joseph Heitman,Francoise Dromer, J L Achard,D Chabasse, J P Bouchara, S Bland, J P Bru, Marc Pulik, F Leturdu, X Lepeu, H Lefrand, C Jensen,M Ferrand, M Larrouy,M Bentata, C Bougesmichel, J Camuset, L Guillevin, B Jarrousse, M Robineau, J Rousset, B Couprie,M Dupon,H Dutronc,J Y Lacut,J L Pellegrin,J M Ragnaud,J F Viallard,F X Weill, M E Bougnoux, X Montreal, S Morelon,E Rouveix, P Granier, H De Montclos, Allison Desveaux, M Gavignet, A S Labussiere, M Mornet,L De Saintmartin, E Moalic, J Roucoules, J F Loriferne, G Otterbein, Jeanfraniois Desson, M Leporrier, C Duhamel, J Bonhomme, J M Korach, B Salles, C Sire, V Herve,Bertrand Souleau, J Beytout, M Cambon,D Pons, Paul Poirier,Yves Boussougant,Didier Dreyfuss, X Michon, P Vinceneux, G Belkacembelkaki, S R Bretagne, M Chousterman, P Grimberg,A S Lascaux, A Schaeffer,Alain Sobel, J L Bacri, G Berthelot,Alain Bonnin,Michel Duong, J Lopez, H Portier, F Dalle, Morgane Gauthier, O Salmon, J Bizet, J L Gaillard,C Perronne, M A Desailly, H Maisonneuve, J P Bedos, J Doll,O Eloy, J C Ghnassia, S Roussinbretagne, C Brocard, P Guiffault, A Layet,Alain Morel, Francoise Botterel, P Bouree,J F Delfraissy, Y Kertaimont,A Angoulvant,P Lozeron, K Rerat, Gerard Said, X Cricks,M L Darde, A Jaccard,B Bouteille, D Azjenberg, D Bouhour,E Dannaoui, X Mallet, D Peyramond, M A Piens,Christian Trepo, L Berardi, F Tremolieres, Yvon Berland, A Blancard,Lionel Collet, J Delmont, H Gallais, X Gamby, A Michel Nguyen,Jacques Moreau, Nathalie Petit, J M Sainty, J Sampolroubicek, M Bietrix, Meyer Nezri, A Fiacre, S Levy, C Chandesris, X La Torre, Pedro M Latorre Andres,Eliane M Billaud, F Boiffin, M Hamidou,O Morin, Bernard Planchon,F Raffi, D Villers,F Morio, P Clevenbergh, F De Salvador,P Dellamonica, X Durand,Martine Garitoussaint, Anette Romaru,M Texereau, L Bret, T Prazuk, D Poisson, X Bernard, Y Pacheco, B Becqgiraudon,C Kauffmannlacroix, J C Meurice, T Pasdeloup, J Deville,D Toubas,Cedric Arvieux, F Cartier, S Chevrier, B Degeilh, T Frouget, C Guiguen,P Le Cavorzin,J P Gangneux,Christian Michelet, V Noyon, Paulandre Abboud, Philippe Brasseur, Joel Leroy, Jeanfrancois Muir,L Favennec, P Babinet, F Fraisse, N Godineau,Samia Hamane, P Margent, D Mechali, Marie Thuong, Concepcion Lopez Soler, B Hery, J Y Leberre, Anna R Gregory, O Prevot, D Christmann, J M Waller,Valerie Letscherbru,O Bletry, P Cahen,D Zucman, B Fortier, X Aubert,Stephane Chadapaud, X Delbeck,Alain Lafeuillade, X Raoult,Eric Bonnet,Sophie Cassaing, A Gadroy,M D Linas,Jeanfrancois Magnaval,Patrice Massip, L Prudhomme,Laurent Sailler,V Baclet, C Coignard,Yves Mouton,Isabelle Ravaux, C Eloy, A Fur, L Rezzouk,Clotilde Fontier, E Mazards, M F Biava, Ph Canton, L Kures, C Rabaud,M Machouart, D Vittecocq, Elisabeth Chachaty, S Dellion, O Patey, Olivier Benveniste,Claude Bouchard, S Belaich,Claude Carbon, C Chochillon, J P Coulaud, V Descamps, Xavier Duval,Catherine Leport, F Lheriteau, P Longuet, H Mouas, F Vachon, J L Vilde, P Yeni, V Lavarde, C Piketty,Boyan Christoforov, J Dupouycamet, J P Luton,A Paugam,Marietherese Baixench,N Desplaces, G Raguin, Pierre Chevalier,Michel D Kazatchkine, A Meyrier, A Bernadou,Muriel Cornet, J P Marie, S Oudart, Martine Gayraud, Y Pean,Christine Aznar, B Dupont, H Poncelet, Amaury De Gouvelho,Clarisse Loyer, Odile Launay, Patrick Berche, V Mathe,Laurence Baril,Philippe Bossi, F Bricaire, J Carriere,A Datry,Serge Herson, Marc Jouan, Michele Levysoussan, C Mouquet, B Orcel, M M Thiebaut, J Frottier, Jeanbaptiste Guiardschmidt,B Lebeau, J L Meynard, M C Meyohas, J L Poirot,Pierreyves Le Roux, X Urban, F Daniel,J Gilquin, Jeanfrancois Timsit,C Lacroix, J C Brouet, J M Decazes,Francis Derouin, B Eurin, Jm Legall, C Legendre,S Neuville, Jeanpaul Escande, G Delzant,Gilberto Kac,Christophe Trivalle, Anne Boullie, Karine Boukrissitbon, O Lortholary,D Garciahermoso,Damien Hoinard

MBIO（2015）

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摘要

Cryptococcus neoformans is a human opportunistic fungal pathogen causing severe disseminated meningoencephalitis, mostly in patients with cellular immune defects. This species is divided into three serotypes: A, D, and the AD hybrid. Our objectives were to compare population structures of serotype A and D clinical isolates and to assess whether infections with AD hybrids differ from infections with the other serotypes. For this purpose, we analyzed 483 isolates and the corresponding clinical data from 234 patients enrolled during the CryptoA/D study or the nationwide survey on cryptococcosis in France. Isolates were characterized in terms of ploidy, serotype, mating type, and genotype, utilizing flow cytometry, serotype-and mating type-specific PCR amplifications, and multilocus sequence typing (MLST) methods. Our results suggest that C. neoformans serotypes A and D have different routes of multiplication (primarily clonal expansion versus recombination events for serotype A and serotype D, respectively) and important genomic differences. Cryptococcosis includes a high proportion of proven or probable infections (21.5%) due to a mixture of genotypes, serotypes, and/or ploidies. Multivariate analysis showed that parameters independently associated with failure to achieve cerebrospinal fluid (CSF) sterilization by week 2 were a high serum antigen titer, the lack of flucytosine during induction therapy, and the occurrence of mixed infection, while infections caused by AD hybrids were more likely to be associated with CSF sterilization. Our study provides additional evidence for the possible speciation of C. neoformans var. neoformans and grubii and highlights the importance of careful characterization of causative isolates. IMPORTANCE Cryptococcus neoformans is an environmental fungus causing severe disease, estimated to be responsible for 600,000 deaths per year worldwide. This species is divided into serotypes A and D and an AD hybrid, and these could be considered two different species and an interspecies hybrid. The objectives of our study were to compare population structures of serotype A and serotype D and to assess whether infections with AD hybrids differ from infections with serotype A or D isolates in terms of clinical presentation and outcome. For this purpose, we used clinical data and strains from patients diagnosed with cryptococcosis in France. Our results suggest that, according to the serotype, isolates have different routes of multiplication and high genomic differences, confirming the possible speciation of serotypes A and D. Furthermore, we observed a better prognosis for infections caused by AD hybrid than those caused by serotype A or D, at least for those diagnosed in France.

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