Shifting epidemiology and microbiological profiles of cryptococcosis in a Brazilian tertiary center: A descriptive study of 94 patients.

Background: The epidemiology of cryptococcosis is shifting, with an increasing number of cases occurring among non-HIV immunosuppressed individuals. In this context of a new epidemiological presentation of the disease, further studies are needed to better describe the microbiological profiles associated with different immune status.

Aims: To characterize cryptococcosis cases according to immune status, focusing on species distribution and time to culture positivity.

Methods: We conducted a retrospective study of patients with positive Cryptococcus spp. cultures from various biological materials between 2017 and 2022 at a Brazilian tertiary hospital. Clinical and laboratory data were extracted, including immune status, biological sample type, Cryptococcus species, and time to positivity in aerobic and fungal cultures. Patients were classified into HIV-positive, non-HIV immunosuppressed, or non-immunosuppressed/non-HIV. Descriptive analyses were performed.

Results: Among the 94 patients analyzed, 29 (30.9%) were HIV-positive, 39 (41.5%) were non-HIV immunosuppressed, and 19 (20.2%) were non-immunosuppressed/non-HIV. A total of 288 isolates were identified, predominantly Cryptococcus neoformans (72/94, 76.6%), but Cryptococcus gattii (17/94, 18%) infection was non-neglectable. The mean time to culture positivity was 5 days (range 2-24 days) for aerobic cultures and 10 days (range 0-63 days) for fungal cultures.

Conclusions: This work reinforces the need for future studies to better represent non-HIV immunosuppressed patients, to address infections caused by C. gattii, and to consider the wide variability in culture growth time as a diagnostic limitation.