Clinical strains of Cryptococcus neoformans VNI non-wild type for azoles from Maceió, Alagoas, Brazil.

Cryptococcosis is a concerning fungal disease caused by encapsulated yeasts of the Cryptococcus neoformans/C. gattii species complexes, which can spread systemically, leading to meningitis with a high mortality. Treatment of cryptococcosis is a time-consuming process, relies on antifungals of limited distribution, and varies in effectiveness due to differing susceptibility profiles, particularly to azoles. This research aimed to evaluate the antifungal susceptibility of Cryptococcus spp. strains to amphotericin B, ketoconazole, fluconazole, and itraconazole, using clinical strains. Cryptococcus spp. strains were identified through India ink test and urease/phenoloxidase production, with species differentiation using canavanine-glycine-bromothymol blue (CGB) agar. Minimum inhibitory concentrations (MICs) for the antifungals were determined using the Etest (episometer test). Twelve clinical isolates collected from nine patients at Hospital Escola Dr. Hélvio Auto in Maceió, Alagoas, were identified as C. neoformans type VNI. The MIC ranges were amphotericin B (0.023 - 0.25 μg/mL); ketoconazole (0.047 - 3 μg/mL); fluconazole (1 - >256 μg/mL); and itraconazole (0.032 - 2 μg/mL). Notably, some strains exhibited MIC values exceeding the epidemiological cutoff values for fluconazole and itraconazole, indicating a non-wild type (non-WT) phenotype. This study identified C. neoformans VNI strains with reduced azole susceptibility, emphasizing the need for antifungal resistance monitoring to guide treatment strategies.