title: Study of dihydropteroate synthase (DHPS) gene mutations among isolates of Pneumocystis jiroveci.
abstract: OBJECTIVE
  Pneumocystis jiroveci (also known as P. carinii) causes fatal pneumonia in patients with AIDS and other immunocompromised patients. Co-trimoxazole (trimethoprim + sulphamethoxazole, TMP-SMZ) is the drug of choice for treatment and prophylaxis. Widespread use of sulpha medication has raised the possible selection of resistant P. jiroveci strains worldwide. Non-synonymous polymorphisms associated with sulpha resistance have been observed in P. jiroveci dihydropteroate synthase (DHPS) gene at codons 55 and 57. In view of this, we investigated mutation at DHPS locus amongst P. jiroveci isolates obtained at a tertiary care hospital in north India.
  
  
  METHODS
  Microscopic examination of P. jiroveci in 69 clinical samples obtained from patients suspected to have P. carinii pneumonia (PCP), was performed by Grocott's Gomori methenamine silver and direct fluorescent antibody staining. Molecular studies were carried out by polymerase chain reaction (PCR) using major surface glycoprotein (MSG) as the target gene. Investigations for DHPS mutations were carried at specific 55th and 57th codon using PCR-RFLP (restriction fragment length polymorphism) assay.
  
  
  RESULTS
  Microscopic examination detected P. jiroveci in four cases and MSG gene was amplified in five cases. Further, amplification of DHPS gene was successful in four of the five cases positive by MSG gene PCR. No point mutation was observed and all four isolates presented wild-type sequences at DHPS gene by RFLP analysis.
  
  
  CONCLUSIONS
  Although our findings suggest that in Indian subpopulation, point mutations in DHPS gene of P. jiroveci are not as common as in other parts of the developed world, further studies are needed.
authors.affiliation: Department of Microbiology, All India Institute of Medical Sciences New Delhi, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Tyagi
authors.forename: B R
authors.initials: BR
authors.lastname: Mirdha
authors.forename: Randeep
authors.initials: R
authors.lastname: Guleria
authors.forename: Anant
authors.initials: A
authors.lastname: Mohan
authors.forename: Kalpana
authors.initials: K
authors.lastname: Luthra
authors.forename: U B
authors.initials: UB
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004094:Dihydropteroate Synthase / Q000235:genetics*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009154:Mutation; D045363:Pneumocystis carinii / Q000201:enzymology / Q000235:genetics*; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies
chemical_list: D004094:Dihydropteroate Synthase