Current status and advances in laboratory diagnosis and treatment of cryptococcosis

LIU Qi; LU Binghuai

doi:10.3969/j.issn.1674-3806.2025.07.04

Abstract：Cryptococcosis is one of the significant global fungal infectious diseases,primarily caused by Cryptococcus neoformans and Cryptococcus gattii.It is particularly harmful to immunodeficient populations such as those infected with human immunodeficiency virus(HIV).Multilocus sequence typing(MLST)is a widely used method for typing of Cryptococcus,with C.neoformans ST5 being the most prevalent sequence type.Laboratory diagnostic methods for cryptococcosis are gradually increasing.The traditional methods for diagnosing cryptococcosis,such as India ink staining and fungal culture,have their own advantages and disadvantages.Molecular biological methods offer new options for the rapid diagnosis of cryptococcosis.The drug resistance mechanisms of Cryptococcus are complex,primarily involving target gene(such as ERG11 and FCY2)mutations,ploidy variation and activation of stress pathways.In the treatment of cryptococcosis,the combination of amphotericin B and 5-flucytosine is the first-line regimen for severe cases.Meanwhile,the problem of drug resistance has also driven the exploration of new targets(such as virulence factors and stress regulatory proteins)and drugs[such as glycosylphosphatidylinositol(GPI)wall transfer protein 1(Gwt1)inhibitor APX001 and tetrazole compound VT-1598].Immunotherapy and combination therapy strategies have also shown promising potential.Based on the latest research progress,this paper reviews the typing methods,diagnostic advancements,common drug resistance mechanisms,and new treatment methods of Cryptococcus,aiming to provide new reference and enlightenment for the diagnosis and treatment of cryptococcosis.