Molecular epidemiology and antifungal susceptibility of Cryptococcus neoformans isolates from Ugandan AIDS patients |
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| Affiliation: | 1. Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, USA (MP, JZ, SM);2. University of California San Francisco, San Francisco, California, USA (MT);3. Uganda Cancer Institute, Kampala, Uganda (EM);4. Mycology Reference Laboratory, Center for Medical Mycology, Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio USA, USA;1. Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer;2. Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA;3. Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA;4. Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA;5. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA;1. Service des maladies infectieuses, CHU Ibn Rochd, Casablanca, Maroc;2. Laboratoire de parasitologie-mycologie, CHU Ibn Rochd, Casablanca, Maroc;3. Laboratoire d’épidémiologie, FACULTE de médecine de pharmacie de Casablanca, Casablanca, Maroc;1. Clinical Biology Laboratory, Yaoundé Central Hospital, Cameroon;2. National Institute of Statistics, Yaoundé, Cameroon;3. UMI 233 UM1-IRD-UCAD-UY1 « TransVIHMI » laboratoire de parasitologie et mycologie médicale UFR pharmacie, université de Montpellier 1, 34093 Montpellier, France;4. Antimicrobial Agents Unit (AMAU), Laboratory for Phytobiochemistry and Medicinal Plants Study, Department of Biochemistry, Faculty of Science, University of Yaoundé I, Cameroon;1. Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Wood Building 6107, Philadelphia, PA 19104, USA;2. Department of Neurosurgery, Aga Khan University Hospital, 3rd Parklands Avenue, Limuru Road, P.O. Box 30270 - 00100. Nairobi, Kenya;3. Department of Neurosurgery, University of Nairobi, Kenyatta National Hospital, Ngong Road, P O BOX 20, Nairobi, Kijabe 00220, Kenya;4. Division of Neurosurgery, Department of Surgery, College of Health Sciences, Addis Ababa University, 0000 0001 1250 5688, grid.7123.7, P.O. Box 9086, Churchill Avenue, Addis Ababa, Ethiopia;5. Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Jonas Lies veg 87, N-5021 Bergen, Norway;6. NIHR Global Health Research Group on Neurotrauma, Division of Neurosurgery, Box 167, Cambridge Biomedical Campus, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK, CB2 0QQ;7. Department of Critical Care, AIC Kijabe Hospital, PO Box 20, Kijabe 00220, Kenya;8. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall Suite 600, Pittsburgh, PA 15213, USA |
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| Abstract: | Little is known of the antifungal susceptibility patterns and molecular epidemiology of Cryptococcus neoformans from tropical regions. We studied 164 clinical isolates of C. neoformans from 120 Ugandan AIDS patients with cryptococcal meningitis by analyzing their electrophoretic karyotypes and antifungal susceptibility profiles. Computer-assisted analysis of karyotype patterns was performed to generate dendrograms. MICs of fluconazole and flucytosine were determined by reference methods. A total of 43 distinguishable DNA types were identified among the 164 isolates. Only 30 patients (25%) were infected with their own unique strain of C. neoformans, whereas 75% of the patients shared their infecting strain with at least one other patient. Among 17 patients with more than one CSF isolate of C. neoformans, sequential isolates were identical or highly related in 12 (71%) and were different in five patients (29%). The isolates were susceptible to both fluconazole and flucytosine and there were no instances in which a stepwise increase in either fluconazole or flucytosine MICs was observed among serial isolates. These findings suggest that the epidemiology of cryptococcal disease in AIDS patients from tropical regions may be somewhat different from that observed in more temperate climates. |
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