Cryptococcus deuterogattii is one of the species within the C. gattii complex. It is endemic in Northern (Amazonas, Pará, and Rondônia) and Northeastern (Piauí, Pernambuco, and Bahia) Brazil. This study aimed to analyze the clinical features and antifungal susceptibility of C. deuterogattii isolates. This was a prospective cohort of patients aged ≥18 years diagnosed with cryptococcosis caused by C. gattii , admitted to a referral hospital in Northeastern Brazil between October 2020 and April 2025. Lineage identification was performed using MALDI-TOF, and antifungal susceptibility testing followed the CLSI M27-A4 protocol. The study was approved by the institutional Research Ethics Committee (protocol no. 5.275.155). Eight patients were included, and all isolates belonged to the species C. deuterogattii (VGII). Seven clinical isolates were autochthonous cases from Ceará, five originating from Fortaleza and two from the mountainous region (Baturité massif). Only one case was imported from Pará. The median age was 51.5 years, and 62.5% were male. HIV coinfection was identified in 37.5% of cases (3/8), and the median CD4+ T lymphocyte count was 18 cells/mm³. Environmental risk exposure was identified among HIV-negative patients, including contact with birds (3/5), construction work (2/5), and inhalation of eucalyptus (2/5). Central nervous system involvement was observed in 87.5% (7/8) of patients. Cryptococcoma was identified in 75% of cases (6/8). Death occurred in 62.5% of patients (5/8). Altered mental status was observed only among patients who died (Glasgow <15). The most significant cerebrospinal fluid abnormalities were observed mainly in patients who died, including higher median cell counts (178 vs. 5 cells/mm³) and protein levels (105 vs. 31 mg/dL). Regarding antifungal susceptibility, minimum inhibitory concentrations (MIC, mg/L) ranged as follows: amphotericin B 0.016–0.5; fluconazole 0.125–8.0; 5-fluorocytosine 1.0–2.0; voriconazole 0.016–0.25; and isavuconazole 0.016–0.031, with no in vitro resistant isolates identified. Ceará emerges as a new endemic region for C. deuterogattii infections. Clinical severity and intense inflammatory response in the central nervous system may be contributing to the high lethality observed in this case series. Surveillance and molecular studies are needed to improve understanding and management of this infection.
Júnior et al. (Sun,) studied this question.