title: Antifungal drug susceptibility of Cryptococcus neoformans from clinical sources in Nairobi, Kenya.
abstract: The serotypes and mating types of 80 clinical isolates of Cryptococcus neoformans from Kenya were studied and subjected to broth microdilution susceptibility testing to amphotericin B (AMP), flucytosin, fluconazole (FLC), itraconazole (ITC) and miconazole (MCZ). The isolates included C. neoformans var. grubii- 75 of 80 (serotype A; 93.7%), C. neoformans var. neoformans- three of 80 (3.8%) and C. neoformans var. gattii- two (serotype B; 2.5%). Mating experiment confirmed all the isolates to be alpha-mating type. Seventy-eight (97.5%) of the isolates had minimum inhibitory concentration (MIC) of < or =0.5 microg ml(-1) to AMP and at 1 microg ml(-1), 100% of the isolates were inhibited. Flucytosin resistance was observed in 21% with MIC in which 90% of the isolates were inhibited (MIC90) of 64 microg ml(-1). Only 23.8% of the strains were susceptible to FLC with 65% susceptible dose-dependent (SDD) and 11.2% resistant. Itraconazole susceptibility was 61.3% while the rest were either SDD or resistant. The MIC90 for ITC and MCZ were 0.5 and 2 microg ml(-1) respectively. The study reports the serotypes, mating types and highlights the existence of azoles resistance in C. neoformans in Nairobi which calls for antifungal drug resistance surveillance as prophylactic use of FLC increases because of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in sub-Saharan Africa.
authors.affiliation: Mycology Laboratory, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya. kiptobi@yahoo.com
authors.forename: Christine C
authors.initials: CC
authors.lastname: Bii
authors.forename: Koichi
authors.initials: K
authors.lastname: Makimura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Abe
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Taguchi
authors.forename: Olga M
authors.initials: OM
authors.lastname: Mugasia
authors.forename: Gutura
authors.initials: G
authors.lastname: Revathi
authors.forename: Njeri C
authors.initials: NC
authors.lastname: Wamae
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kamiya
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D001393:Azoles / Q000494:pharmacology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003455:Cryptococcus neoformans / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D025141:Drug Resistance, Fungal; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016919:Meningitis, Cryptococcal / Q000453:epidemiology* / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D012703:Serotyping
chemical_list: D000935:Antifungal Agents; D001393:Azoles