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A flucytosine-resistant Cryptococcus neoformans (serotype D) strain isolated in turkey from cutaneous lesions
1Department of Microbiology and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, 34303 Cerrahpasa, Istanbul, Turkey. s.kantarcioglu@superonline.com
Abstract:
A Cryptococcus neoformans strain from cutaneous lesions of a patient with thrombotic thrombocytopenia purpura was tested for in vitro susceptibility against seven conventional antifungal agents. The strain was susceptible to fluconazole, itraconazole, ketoconazole and miconazole but was resistant to 5-fluorocytosine (5-FC). Minimal inhibitory concentration (MIC) values obtained against amphotericin B and terbinafine were 1 and 4 microg ml(-1), respectively. The isolate belonged to serotype D. Few human cases of cryptococcosis have been reported over the last 50 years in Turkey. This is the first C. neoformans isolate in Turkey shown to have primary resistance to 5-FC. Primary resistance to flucytosine is rarely reported in C. neoformans and may be associated with treatment failure in some cases.
Insights
This study identified a Cryptococcus neoformans strain resistant to 5-fluorocytosine (5-FC) in Turkey. This antifungal resistance is rare and may impact cryptococcosis treatment outcomes.
Area of Science:
- Medical Mycology
- Antimicrobial Resistance
- Infectious Diseases
Background:
- Cryptococcosis is a serious fungal infection, particularly in immunocompromised individuals.
- Antifungal susceptibility testing is crucial for guiding treatment decisions.
- Primary antifungal resistance in Cryptococcus neoformans is uncommon.
Observation:
- A Cryptococcus neoformans strain was isolated from cutaneous lesions of a patient with thrombotic thrombocytopenia purpura.
- The isolate belonged to serotype D.
- In vitro testing evaluated susceptibility to seven antifungal agents.
Findings:
- The Cryptococcus neoformans strain demonstrated susceptibility to fluconazole, itraconazole, ketoconazole, and miconazole.
- The strain exhibited resistance to 5-fluorocytosine (5-FC).
- Minimal inhibitory concentrations (MICs) were 1 µg/mL for amphotericin B and 4 µg/mL for terbinafine.
Implications:
- This is the first reported case of primary 5-fluorocytosine resistance in Cryptococcus neoformans in Turkey.
- Primary resistance to 5-FC can be associated with treatment failure in cryptococcosis.
- The findings highlight the importance of monitoring antifungal resistance patterns in endemic regions.