Molecular Epidemiology and Antifungal Susceptibility of Cryptococcus neoformans: A First Report of Clinical Isolates from Shanxi Province, China

Xia Li,1,* Xinyu Guo,2,* Mengying Liu,2 Ziping Song,2 Yuying Kang,2 Yukai Jing,1 Ruijun Zhang2 1Department of Clinical Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, People’s Republic of China; 2Department of Dermatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yukai Jing, Department of Clinical Laboratory, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99# Longcheng Street, Xiaodian District, Taiyuan, 030032, People’s Republic of China, Email [email protected] Ruijun Zhang, Department of Dermatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99# Longcheng Street, Xiaodian District, Taiyuan, 030032, People’s Republic of China, Email [email protected]: Cryptococcus neoformans is a critical fungal pathogen, and continuous surveillance of its molecular epidemiology and antifungal susceptibility is essential for clinical management. However, relevant data from many regions of China (including Shanxi Province) remain limited. This study aimed to provide the first molecular epidemiological description and antifungal susceptibility profile of C. neoformans clinical isolates from Shanxi Province, China, and to establish crucial baseline data for this region.Patients and Methods: A retrospective analysis was conducted on all clinical isolates of C. neoformans (n=8) collected between 2014 and 2024 from a major regional hospital in Shanxi Province, China. All the isolates were subjected to molecular typing (serotype, mating type, genotype, and sequence type) and antifungal susceptibility testing.Results: All 8 clinical isolates were identified as C. neoformans, with 100% consistency in key genetic features: serotype A, MATα mating type, VNI genotype, and ST5 sequence type. Antifungal susceptibility testing revealed low minimum inhibitory concentrations (MICs) for five common antifungals (fluconazole, amphotericin B, 5-fluorocytosine, itraconazole, voriconazole), with all 8 isolates (100%) falling within the wild-type epidemiological cut-off values (ECVs), notably, four of the eight strains (50%) showed higher MIC values (2 μg/mL) for fluconazole compared with the remaining isolates.Conclusion: This study provides the first baseline data on the molecular epidemiology and antifungal susceptibility of C. neoformans in Shanxi Province. The exclusive presence of the susceptible ST5 lineage is consistent with the predominant pattern reported in China. These findings underscore the importance of establishing region-specific surveillance systems to monitor potential future shifts in the molecular epidemiology or antifungal resistance of C. neoformans, thereby supporting effective clinical management of related infections.Keywords: Cryptococcus neoformans, molecular epidemiology, antifungal susceptibility, baseline data, Shanxi Province, China