title: Pneumocystis jiroveci dihydropteroate synthase gene mutations among colonized individuals and Pneumocystis pneumonia patients from Spain.
abstract: Cotrimoxazole, an association of trimethoprim and sulfamethoxazole, and dapsone, are mainstays for the prophylaxis and treatment of Pneumocystis pneumonia (PcP). The inability to culture Pneumocystis prevents routine susceptibility testing and detection of drug resistance. Instead, molecular techniques have been used to detect Pneumocystis jiroveci dihydropteroate synthase (DHPS) mutations that cause sulfa resistance in other microorganisms. The most frequent DHPS mutations occur at nucleotide positions 165 and 171, which lead to an amino acid change at positions 55 and 57. Several studies suggest that these mutations are associated with the failure of chemoprophylaxis for PcP. The aim was to establish the frequency and characteristics of P jiroveci DHPS mutations among colonized individuals and PcP patients from Spain. A total of 50 colonized individuals and 25 PcP patients were studied. DHPS polymorphisms were identified by restriction fragment length polymorphism assay. The analysis provided a rate of 28% of DHPS gene mutations in our population, with the presence of all possible polymorphisms described. The presence of mutations was higher in PcP patients than in colonized subjects (40% vs 22%), probably because of the chemoprophylaxis used in PcP patients. The comparison between patients with and without DHPS mutations did not show statistical differences due to age, sex, steroid use, sulfa drug exposure, or smoking. A high rate of DHPS mutations in our area of Spain, not only confined to patients previously exposed to sulfa drugs, is shown in this study. As well as PcP patients, colonized individuals who harbor P jiroveci strains with DHPS mutations could play a major role in the transmission cycle of these mutations, representing a reservoir and source of infection for susceptible individuals. Further research is thus warranted to assess the true scope of the problem and to design rational preventive strategies.
authors.affiliation: Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, and CIBER de Epidemiología y Salud Pública, Seville, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Friaza
authors.forename: Rubén
authors.initials: R
authors.lastname: Morilla
authors.forename: Nieves
authors.initials: N
authors.lastname: Respaldiza
authors.forename: Carmen
authors.initials: C
authors.lastname: de la Horra
authors.forename: Enrique J
authors.initials: EJ
authors.lastname: Calderón
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004271:DNA, Fungal; D004094:Dihydropteroate Synthase / Q000235:genetics* / Q000378:metabolism; D004197:Disease Reservoirs / Q000382:microbiology; D025141:Drug Resistance, Fungal; D005260:Female; D005500:Follow-Up Studies; D015966:Gene Expression Regulation, Fungal; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D009154:Mutation; D016533:Mycological Typing Techniques; D045363:Pneumocystis carinii / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000235:genetics* / Q000635:transmission; D016133:Polymerase Chain Reaction; D018570:Risk Assessment; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim; D004094:Dihydropteroate Synthase