Association between a specific Pneumocystis jiroveci dihydropteroate synthase mutation and failure of pyrimethamine/sulfadoxine prophylaxis in human immunodeficiency virus-positive and -negative patients
Association between a specific Pneumocystis jiroveci dihydropteroate synthase mutation and failure of pyrimethamine/sulfadoxine prophylaxis in human immunodeficiency virus-positive and -negative patients
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DOI：
10.1086/378239
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发表时间：
2003-10-01
影响因子：
6.4
通讯作者：
Hauser, PM
中科院分区：
文献类型：
--
作者：
Nahimana, A;Rabodonirina, M;Hauser, PM
为了探讨不同预防性磺胺类药物与耶氏肺孢子虫二氢蝶酸合酶（DHPS）基因型之间的可能关联，我们采用聚合酶链反应-单链构象多态性技术检测了158例免疫抑制患者（38例HIV阴性和120例HIV阳性）临床标本中DHPS的多态性。158例患者中有57例（36.1%）感染了突变型DHPS基因型。所有在接受乙胺嘧啶/磺胺嘧啶（PM/SD）预防治疗时发生耶氏肺孢子虫肺炎（PcP）的患者（n=14）均具有携带DHPS的菌株，该菌株在第57位有氨基酸变化（Pror->Ser）。在144例未接受预防治疗的患者中，仅20例（14%）存在这种突变（P <0.001）。在特定医院住院是Jiroveci疟原虫携带相同DHPS突变的独立风险因素，这间接支持了人与人之间的传播可能影响突变株的传播。
To investigate the possible association between different prophylactic sulfa drugs and the genotype of the Pneumocystis jiroveci dihydropteroate synthase ( DHPS) gene, we examined DHPS polymorphisms in clinical specimens from 158 immunosuppressed patients ( 38 HIV-negative and 120 HIV-positive), using polymerase chain reaction-single-strand conformation polymorphism. Fifty-seven (36.1%) of 158 patients were infected with a mutant DHPS genotype. All patients who developed P. jiroveci pneumonia (PcP) while receiving pyrimethamine/sulfadoxine (PM/SD) prophylaxis (n=14) had a strain harboring DHPS with an amino acid change at position 57 ( Pror-->Ser). This mutation was only present in 20 ( 14%) of 144 patients not receiving prophylaxis (P < .001). Hospitalization in a specific hospital was an independent risk factor for having P. jiroveci harboring the same DHPS mutation, which indirectly supports that interhuman transmission may affect the dissemination of the mutant strains.