Cryptococcosis in Kosovo: First Case Report and Genotypic Comparison to Environmental Isolates

Kosovo is a young country located in southeastern Europe where cases of cryptococcosis were never reported. Here, we report the first human case occurred in this country after the finding, 1 year before, of three Cryptococcus neoformans var. neoformans (VNIV) isolates from soil. A 28-years-old HIV-infected male patient resident in Kosovo was admitted in 2023 with acute meningitis. The patient was hospitalized, and cryptococcosis was diagnosed by isolation of the fungus from cerebrospinal fluid and confirmed by molecular methods. Combined antifungal therapy with liposomal amphotericin B and flucytosine was successfully administered, and the patient was fully recovered after 2 months and discharged in good conditions. The C. neoformans isolate presented a new VNIV genotype genetically related to the environmental isolates previously identified in the country. In contrast, it seems to have lost the ability to mate resulting unfertile after in vitro mating assays. All four isolates were sensitive to the tested antifungals. This study confirms that environmental C. neoformans VNIV strains circulating in Kosovo can cause infections in humans.