Cryptococcus species are encapsulated yeasts, with C. neoformans and C. gattii being the main human pathogenic species. This study analyzes the historical series of cryptococcosis cases in a quaternary referral hospital. Data were collected from hospitalized patients diagnosed with cryptococcosis between 2018 and 2025 using the Redcap platform and electronic medical records, along with a literature review. Fifty-eight cases were analyzed: 39 (67.2%) caused by C. neoformans , 13 (22.4%) by C. gattii , and 6 (10.3%) without positive culture. In the C. neoformans group, the median age was 49 years, 79.4% were male, and 84% were immunosuppressed (53% due to HIV). Meningeal involvement predominated (82%), followed by cryptococcemia (38.4%). Cerebrospinal fluid cryptococcal antigen (CrAg) was positive in 46.1%, and direct examination in 61.5%. The mean duration of induction therapy was 24.8 days, and consolidation/maintenance therapy averaged 443.9 days. Ventricular shunting was required in 5.1% of cases (one lumboperitoneal and one ventriculoperitoneal shunt). Mortality was 41%. Among C. gattii cases, the median age was 31 years, 61.5% were male, and 46.1% were immunosuppressed, with systemic lupus erythematosus being the most common cause (23%). The meningeal form was most frequent (69.2%), followed by pulmonary involvement (53.8%). At diagnosis, 69.2% had positive CrAg and 92% had positive direct examination in CSF. Induction therapy initially consisted of amphotericin B plus fluconazole and, after inclusion by the Brazilian Ministry of Health (2021), amphotericin B plus flucytosine, with a mean duration of 49 days. During maintenance, 69.2% received fluconazole and 7.6% itraconazole. Mean consolidation/maintenance duration was 533 days. Four patients remain under treatment; there were three interruptions and two deaths due to abandonment or death. During hospitalization, 23% required ventricular shunting (one lumboperitoneal and two ventriculoperitoneal). This historical series shows data consistent with the literature, with a higher incidence of C. neoformans and strong association with HIV, predominantly presenting as meningeal disease. Contrary to existing literature, half of C. gattii cases occurred in immunosuppressed patients. Although people living with HIV and transplant recipients are classic risk groups, increasing use of immunosuppressive therapies and population aging expand risk to other groups. Cryptococcosis presents with variable clinical manifestations, difficult management, and high morbidity and mortality, requiring continuous follow-up to ensure adherence, monitor toxicity, and prevent relapse.
Lima et al. (2026) studied this question.