title: Pneumocystis jiroveci in Portuguese immunocompromised patients: association of specific ITS genotypes with treatment failure, bad clinical outcome and childhood.
abstract: We analyzed the genetic variation among isolates of Pneumocystis jiroveci from Portuguese immunocompromised patients with PCP at the internal transcribed spacer (ITS) regions of the nuclear rRNA operon and at the dihydropteroate synthase (DHPS) gene. Pulmonary secretions from 42 patients with PCP corresponding to 43 episodes were studied. Demographic, immunological, and clinical data were obtained from all patients. By combining the two regions ITS1 and ITS2, we found 17 different ITS types of P. jiroveci, two of them were new types (Pb and Pe). The four most prevalent ITS types were Eg (23.3%), Eb and Ne (11.6% each), and Bi (9.3%). A single type was detected in 95.3% of the samples and 4.7% had mixed infections with three different ITS types. DHPS mutants were present in 17 (46%), and the wildtype was present in 20 (54%) of 37 isolates. No association was found between ITS and DHPS types and between DHPS types and therapy or response to anti-PCP treatment. Type Ne presented an association with negative response to anti-PCP treatment (P<0.001) and with death before 120 days after PCP diagnosis (P=0.025). Type Eb was significantly more common in children than in adults (P=0.001). Our data suggest an association of specific ITS genotypes with treatment failure, bad clinical outcome and childhood.
authors.affiliation: Instituto de Higiene e Medicina Tropical, Unidade de Protozoários Oportunistas/VIH e outras Protozooses, Unidade de Parasitologia e Microbiologia Médicas (UPMM), Rua da Junqueira 96, 1349-008, Lisboa, Portugal. omatos@ihmt.unl.pt
authors.forename: Olga
authors.initials: O
authors.lastname: Matos
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Shaoling
authors.initials: S
authors.lastname: Jin
authors.forename: Baozheng
authors.initials: B
authors.lastname: Li
authors.forename: Marina C
authors.initials: MC
authors.lastname: Costa
authors.forename: Luzia
authors.initials: L
authors.lastname: Gonçalves
authors.forename: Francisco
authors.initials: F
authors.lastname: Antunes
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D021901:DNA, Intergenic; D004094:Dihydropteroate Synthase / Q000235:genetics; D005260:Female; D014644:Genetic Variation; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008297:Male; D008875:Middle Aged; D009876:Operon; D045363:Pneumocystis carinii / Q000235:genetics*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D011174:Portugal; D016896:Treatment Outcome
chemical_list: D021901:DNA, Intergenic; D004094:Dihydropteroate Synthase