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Oliveira NK, Bhattacharya S, Gambhir R, Joshi M, Fries BC. Novel ABC Transporter Associated with Fluconazole Resistance in Aging of Cryptococcus neoformans. J Fungi (Basel) 2022; 8:677. [PMID: 35887434 PMCID: PMC9320417 DOI: 10.3390/jof8070677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022] Open
Abstract
Cryptococcus neoformans causes meningoencephalitis in immunocompromised individuals, which is treated with fluconazole (FLC) monotherapy when resources are limited. This can lead to azole resistance, which can be mediated by overexpression of ABC transporters, a class of efflux pumps. ABC pump-mediated efflux of FLC is also augmented in 10-generation old C. neoformans cells. Here, we describe a new ABC transporter Afr3 (CNAG_06909), which is overexpressed in C. neoformans cells of advanced generational age that accumulate during chronic infection. The Δafr3 mutant strain showed higher FLC susceptibility by FLC E-Test strip testing and also by a killing test that measured survival after 3 h FLC exposure. Furthermore, Δafr3 cells exhibited lower Rhodamine 6G efflux compared to the H99 wild-type cells. Afr3 was expressed in the Saccharomyces cerevisiae ADΔ strain, which lacks several drug transporters, thus reducing background transport. The ADΔ + Afr3 strain demonstrated a higher efflux with both Rhodamine 6G and Nile red, and a higher FLC resistance. Afr3-GFP localized in the plasma membrane of the ADΔ + Afr3 strain, further highlighting its importance as an efflux pump. Characterization of the Δafr3 mutant revealed unattenuated growth but a prolongation (29%) of the replicative life span. In addition, Δafr3 exhibited decreased resistance to macrophage killing and attenuated virulence in the Galleria mellonella infection model. In summary, our data indicate that a novel ABC pump Afr3, which is upregulated in C. neoformans cells of advanced age, may contribute to their enhanced FLC tolerance, by promoting drug efflux. Lastly, its role in macrophage resistance may also contribute to the selection of older C. neoformans cells during chronic infection.
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Affiliation(s)
- Natalia Kronbauer Oliveira
- Department of Microbiology and Immunology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Somanon Bhattacharya
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Rina Gambhir
- Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (R.G.); (M.J.)
| | - Manav Joshi
- Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (R.G.); (M.J.)
| | - Bettina C. Fries
- Department of Microbiology and Immunology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
- Veterans Administration Medical Center, Northport, NY 11768, USA
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2
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Zhang M, Zhou Z, Wang D, Zhou A, Song G, Chen X, Guo J, Wu W. OUP accepted manuscript. Med Mycol 2022; 60:6517704. [PMID: 35099022 DOI: 10.1093/mmy/myac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Min Zhang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Ziyi Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Dongjiang Wang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Aiping Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Guobin Song
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Xingchun Chen
- Department of Clinical Laboratory, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 530021, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jian Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
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Comparison of MIC Test Strip and Sensititre YeastOne with the CLSI and EUCAST Broth Microdilution Reference Methods for In Vitro Antifungal Susceptibility Testing of Cryptococcus neoformans. Antimicrob Agents Chemother 2020; 64:AAC.02261-19. [PMID: 32015025 DOI: 10.1128/aac.02261-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/23/2020] [Indexed: 12/26/2022] Open
Abstract
We compared MIC test strip (MTS) and Sensititre YeastOne (SYO) methods with EUCAST and CLSI methods for amphotericin B, 5-fluocytosine, fluconazole, voriconazole, and isavuconazole against 106 Cryptococcus neoformans isolates. The overall essential agreement between the EUCAST and CLSI methods was >72% and >94% at ±1 and ±2 dilutions, respectively. The essential agreements between SYO and EUCAST/CLSI for amphotericin B, 5-flucytosine, fluconazole, and voriconazole were >89/>93% and between MTS and EUCAST/CLSI were >57/>75%. Very major error rates were low for amphotericin B and fluconazole (<3%) and a bit higher for the other drugs (<8%).
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4
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Nishikawa MM, Almeida-Paes R, Brito-Santos F, Nascimento CR, Fialho MM, Trilles L, Morales BP, da Silva SA, Santos W, Santos LO, Fortes ST, Cardarelli-Leite P, Lázera MDS. Comparative antifungal susceptibility analyses of Cryptococcus neoformans VNI and Cryptococcus gattii VGII from the Brazilian Amazon Region by the Etest, Vitek 2, and the Clinical and Laboratory Standards Institute broth microdilution methods. Med Mycol 2020; 57:864-873. [PMID: 30657975 DOI: 10.1093/mmy/myy150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/09/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022] Open
Abstract
Early diagnosis, efficient clinical support, and proper antifungal therapy are essential to reduce death and sequels caused by cryptococcosis. The emergence of resistance to the antifungal drugs commonly used for cryptococcosis treatment is an important issue of concern. Thus, the in vitro antifungal susceptibility of clinical strains from northern Brazil, including C. neoformans VNI (n = 62) and C. gattii VGII (n = 37), to amphotericin B (AMB), 5-flucytosine, fluconazole, voriconazole, and itraconazole was evaluated using the Etest and Vitek 2 systems and the standardized broth microdilution (CLSI-BMD) methodology. According to the CLSI-BMD, the most active in vitro azole was voriconazole (C. neoformans VNI modal MIC of 0.06 μg/ml and C. gattii VGII modal MIC of 0.25 μg/ml), and fluconazole was the least active (modal MIC of 4 μg/ml for both fungi). Modal MICs for amphotericin B were 1 μg/ml for both fungi. In general, good essential agreement (EA) values were observed between the methods. However, AMB presented the lowest EA between CLSI-BMD and Etest for C. neoformans VNI and C. gattii VGII (1.6% and 2.56%, respectively, P < .05 for both). Considering the proposed Cryptococcus spp. epidemiological cutoff values, more than 97% of the studied isolates were categorized as wild-type for the azoles. However, the high frequency of C. neoformans VNI isolates in the population described here that displayed non-wild-type susceptibility to AMB is noteworthy. Epidemiological surveillance of the antifungal resistance of cryptococcal strains is relevant due to the potential burden and the high lethality of cryptococcal meningitis in the Amazon region.
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Affiliation(s)
| | - Rodrigo Almeida-Paes
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, INI/Fiocruz, Rio de Janeiro, RJ
| | - Fabio Brito-Santos
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, INI/Fiocruz, Rio de Janeiro, RJ
| | | | - Miguel Madi Fialho
- Fungal Section, National Institute of Quality Control in Health, INCQS/Fiocruz, Rio de Janeiro, RJ
| | - Luciana Trilles
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, INI/Fiocruz, Rio de Janeiro, RJ
| | | | - Sérgio Alves da Silva
- Quality Management board, National Institute for Quality Control in Health, INCQS/ Fiocruz, Rio de Janeiro, RJ
| | - Wallace Santos
- Department of Pharmacy, Federal University of Pará, Belém, PA
| | | | | | - Paola Cardarelli-Leite
- Molecular Biology Section, National Institute for Quality Control in Health, INCQS/ Fiocruz, Rio de Janeiro, RJ
| | - Márcia Dos Santos Lázera
- Mycology Laboratory, Evandro Chagas National Institute of Infectious Diseases, INI/Fiocruz, Rio de Janeiro, RJ
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5
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Cryptococcus neoformans Epidemiological Cutoff Values. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0295-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Morales BP, Junior IN, Trilles L, Bertho AL, Oliveira RDVCD, Nishikawa MM, Elias MDS, Wanke B, Lazéra MDS. Determination of the minimum inhibitory concentration of Cryptococcus neoformans and Cryptococcus gattii against fluconazole by flow cytometry. Med Mycol 2014; 52:90-8. [PMID: 23808405 DOI: 10.3109/13693786.2013.806827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent studies have used flow cytometry (FCM) as an important alternative method to determine the antifungal susceptibility of yeasts compared to the broth microdilution Clinical and Laboratory Standards Institute (CLSI) reference procedure. We present a comparative study of the broth microdilution method and flow cytometry to assess the in vitro antifungal susceptibility of Cryptococcus neoformans (n = 16) and C. gattii (n = 24) to fluconazole. The minimum inhibitory concentration (MIC) assays by flow cytometry were defined as the lowest drug concentration that showed ∼50% of the count of acridine orange negative cells compared to that of the growth control. Categorical classification showed all C. neoformans isolates were susceptible to fluconazole. Three isolates of C. gattii were susceptible dose-dependent and the remaining 21 isolates were classified as susceptible. MICs comparison of both methodologies demonstrated 100% categorical agreement of the results obtained for C. neoformans and C. gattii. The MICs obtained with the CLSI-approved method and flow cytometry were compared by the Spearman correlation test and a significant Pv = 0.001. The flow cytometric method has the advantage of analyzing a large and constant number of cells in less time, i.e., 9 h incubation for fluconazole using acridine orange versus 72 h for broth microdilution method. In conclusion, the two methods were comparable and flow cytometry method can expedite and improve the results of in vitro susceptibility tests of C. neoformans and C. gattii against fluconazole and also allows comparative studies in vitro/in vivo more rapidly, which along with clinical data, could assist in selecting the most appropriate treatment choice.
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7
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Mahabeer Y, Chang CC, Naidu D, Dorasamy A, Lewin S, Ndung'u T, Moosa MY, French M, Mlisana K, Coovadia Y. Comparison of Etests and Vitek 2 ® to broth microdilution for the susceptibility testing of Cryptococcus neoformans. Diagn Microbiol Infect Dis 2014; 80:294-8. [PMID: 25277745 DOI: 10.1016/j.diagmicrobio.2014.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/15/2014] [Accepted: 09/06/2014] [Indexed: 11/29/2022]
Abstract
We determined the susceptibility of 102 clinical isolates Cryptococcus neoformans from Durban, South Africa, to amphotericin B, fluconazole, flucytosine, and voriconazole using broth microdilution (BMD) according to the Clinical and Laboratory Standards Institute M27-A3 document and compared these results with Etest and Vitek 2(®). Essential agreement (EA) of Etest and Vitek 2(®) compared to BMD was determined. Low MICs that were below the epidemiological cutoff values of the 4 antifungal agents tested were demonstrated by all isolates. The EA of Etests for fluconazole, amphotericin, and voriconazole was 95.1%, 83.3%, and 91.2%, respectively, and for Vitek 2(®) EA for fluconazole, amphotericin, and flucytosine was 97.1%, 95.1%, and 97.1%, respectively. The Vitek 2(®) showed good agreement with BMD and is a suitable alternative. Etests demonstrated good EA for azoles only. Clinical cryptococcal isolates from Durban remain susceptible to current recommended antifungal therapy.
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Affiliation(s)
- Yesholata Mahabeer
- Department of Medical Microbiology, National Health Laboratory Services, Durban, South Africa; School of Laboratory Medicine and Medical Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Christina C Chang
- Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne, Australia; Centre of Biomedical Research, Burnet Institute, Melbourne, Australia; HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa
| | - Dianithi Naidu
- Department of Medical Microbiology, National Health Laboratory Services, Durban, South Africa
| | - Afton Dorasamy
- KwaZulu-Natal Research Institute for Tuberculosis and HIV, Durban, South Africa
| | - Sharon Lewin
- Department of Infectious Diseases, Alfred Hospital, Monash University, Melbourne, Australia; Centre of Biomedical Research, Burnet Institute, Melbourne, Australia
| | - Thumbi Ndung'u
- School of Laboratory Medicine and Medical Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; HIV Pathogenesis Programme, University of KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Research Institute for Tuberculosis and HIV, Durban, South Africa
| | - Mohammed-Yunus Moosa
- Department of Infectious Diseases, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Martyn French
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia; Department of Clinical Immunology, Royal Perth Hospital and PathWest Laboratory Medicine, Perth, Australia
| | - Koleka Mlisana
- Department of Medical Microbiology, National Health Laboratory Services, Durban, South Africa; School of Laboratory Medicine and Medical Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Yacoob Coovadia
- Department of Medical Microbiology, National Health Laboratory Services, Durban, South Africa; School of Laboratory Medicine and Medical Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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8
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Gangadhar KN, Adhikari K, Srichana T. Synthesis and evaluation of sodium deoxycholate sulfate as a lipid drug carrier to enhance the solubility, stability and safety of an amphotericin B inhalation formulation. Int J Pharm 2014; 471:430-8. [DOI: 10.1016/j.ijpharm.2014.05.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/20/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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9
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Trpković A, Pekmezović M, Barać A, Crnčević Radović L, Arsić Arsenijević V. In vitro antifungal activities of amphotericin B, 5-fluorocytosine, fluconazole and itraconazole against Cryptococcus neoformans isolated from cerebrospinal fluid and blood from patients in Serbia. J Mycol Med 2012; 22:243-8. [DOI: 10.1016/j.mycmed.2012.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/17/2012] [Accepted: 06/21/2012] [Indexed: 11/29/2022]
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10
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Comparative analysis of the Vitek 2 antifungal susceptibility system and E-test with the CLSI M27-A3 broth microdilution method for susceptibility testing of Indian clinical isolates of Cryptococcus neoformans. Mycopathologia 2012; 173:427-33. [PMID: 22354778 DOI: 10.1007/s11046-012-9528-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
Abstract
The emergence of antifungal resistance among Cryptococcus neoformans isolates is a matter of great concern. The Clinical and Laboratory Standards Institute (CLSI) broth microdilution reference method (BMD) for antifungal susceptibility testing of C. neoformans is tedious and time-consuming. Consequently, there is a greater need for a reproducible in vitro susceptibility testing method for use in clinical microbiology laboratories. By random amplified polymorphic DNA analysis, the 62 Indian clinical isolates were characterized as Cryptococcus neoformans var. grubii. We evaluated the susceptibilities of these isolates for amphotericin B (AMB) and fluconazole (FLC) by two commercial techniques, i.e., Vitek 2 and E-test against the CLSI M27-A3 BMD. The essential agreement (EA) between the Vitek 2 and E-test with the reference procedure for FLC was similar (82.2%). For AMB, EA of 92 and 76% was obtained with E-test and Vitek 2. Excellent categorical agreement (CA) (98.3% and 100% by Vitek 2 and E-test, respectively) was obtained for AMB. The CA for FLC was 81 and 77.4% by Vitek 2 and E-test. We conclude that both E-test and Vitek 2 system have acceptable levels of accuracy for susceptibility testing of both the drugs. Both of them could identify fluconazole-resistant strains. Vitek 2 could be used for testing susceptibility of voriconazole and 5-flucytosine also at the same time.
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Chuealee R, Wiedmann TS, Srichana T. Physicochemical properties and antifungal activity of amphotericin B incorporated in cholesteryl carbonate esters. J Pharm Sci 2010; 100:1727-35. [PMID: 21374610 DOI: 10.1002/jps.22398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/02/2010] [Accepted: 10/13/2010] [Indexed: 11/09/2022]
Abstract
The antifungal activity of amphotericin B (AmB) incorporated in three cholesteryl carbonate esters (CCEs), sodium cholesteryl carbonate, cholesteryl palmityl carbonate, and dicholesteryl carbonate, was examined to assess their potential for use in a dry powder aerosol. Formulations containing dissolved AmB were stable for 6 months. The particle size varied inversely with liquid crystalline content with observed mass median aerodynamic diameters ranging from 4 to 8 μ m. This was consistent with the visual appearance of the liquid crystals as being low density and free flowing at room temperature. When dispersed in water, the presence of the CCE reduced the rate and extent of AmB release, consistent with the estimated liquid crystal/water partition coefficient. Nevertheless, the rate of AmB release was always sufficient to kill the fungus as established with bioactivity studies. AmB formulated with CCE as a dry powder appears to be promising for use in treating lung fungal infections.
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Affiliation(s)
- Rabkwan Chuealee
- Department of Pharmaceutical Technology and Drug Delivery System Excellence Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkla 90112, Thailand
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12
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Mazuelos EM, García AIA. Aspectos microbiológicos de la criptococosis en la era post-TARGA. Enferm Infecc Microbiol Clin 2010; 28 Suppl 1:40-5. [DOI: 10.1016/s0213-005x(10)70007-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khan ZU, Randhawa HS, Chehadeh W, Chowdhary A, Kowshik T, Chandy R. Cryptococcus neoformans serotype A and Cryptococcus gattii serotype B isolates differ in their susceptibilities to fluconazole and voriconazole. Int J Antimicrob Agents 2009; 33:559-63. [PMID: 19195846 DOI: 10.1016/j.ijantimicag.2008.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 11/11/2008] [Accepted: 11/11/2008] [Indexed: 11/27/2022]
Abstract
This study presents antifungal susceptibility data for environmental isolates of Cryptococcus neoformans serotype A (n=32) and Cryptococcus gattii serotype B (n=18) to fluconazole and voriconazole employing disc diffusion and Etest methods. The disc diffusion test was performed on Mueller-Hinton agar as recommended by the Clinical and Laboratory Standards Institute (CLSI). For comparison, the disc diffusion test and Etest were also performed on RPMI-1640 agar supplemented with 2% glucose. The plates were incubated at 35 degrees C and read after 48h. Comparison of geometric mean inhibition zone diameters revealed that C. gattii isolates were significantly less susceptible than C. neoformans isolates to fluconazole (P=0.001) and voriconazole (P<0.0001). Similar results were obtained on RPMI agar by disc diffusion test and Etest, showing significantly reduced susceptibility for C. gattii isolates. Notwithstanding differences in the susceptibilities of the two species to fluconazole and voriconazole, they appeared susceptible according to the CLSI breakpoints recommended for some Candida spp. To what extent these differences in the susceptibilities of C. neoformans and C. gattii impact on the therapeutic management of cryptococcosis is unclear, although some studies have reported less favourable response in cases caused by the latter species.
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Affiliation(s)
- Z U Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait.
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Kantarcioğlu AS, Boekhout T, Yücel A, Altas K. Susceptibility testing of Cryptococcus diffluens against amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole and posaconazole. Med Mycol 2008; 47:169-76. [PMID: 18654925 DOI: 10.1080/13693780802213407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Cryptococcus diffluens is a recently re-established species that shares several phenotypic features with Cryptococcus neoformans. We evaluated the application of the Clinical Laboratory Standards Institute (CLSI, formerly NCCLS) macro- and microbroth dilution methods and the E-test agar diffusion method to determine the in vitro susceptibilities of known strains of C. diffluens against amphotericin B (AMB), flucytosine (5-FC), fluconazole (FLC), itraconazole (ITC) and the novel triazoles, voriconazole (VRC) and posaconazole (PSC). Seven strains were found to be resistant in vitro to AMB (MICs >/=2 microg/ml), five were resistant to 5-FC (MICs of >/=32 microg/ml), four were resistant to FLC (MICs of FLC >/=32 microg/ml) and nine were resistant to ITC (MICs of ITC >1 microg/ml). In contrast, VRC and PSC showed good in vitro activity against C.diffluens strains, even those with elevated MICs to amphotericin B and/or established azoles. Most of the isolates were inhibited by 0.5 microg/ml of both VRC and PSC. A clinical isolate showing phenotypic switching exhibited elevated MICs to both agents, i.e., VRC (>16 microg/ml) and PSC (>8 microg/ml).
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Affiliation(s)
- A Serda Kantarcioğlu
- Cerrahpasa Medical Faculty, Dept. of Microbiology and Clinical Microbiology, Deep Mycosis Laboratory, Istanbul University, Istanbul, Turkey
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15
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Khan ZU, Randhawa HS, Kowshik T, Chowdhary A, Chandy R. Antifungal susceptibility of Cryptococcus neoformans and Cryptococcus gattii isolates from decayed wood of trunk hollows of Ficus religiosa and Syzygium cumini trees in north-western India. J Antimicrob Chemother 2007; 60:312-6. [PMID: 17553813 DOI: 10.1093/jac/dkm192] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We present antifungal susceptibility data on environmental isolates of Cryptococcus neoformans (serotype A, n=117) and Cryptococcus gattii (serotype B, n=65) cultured from decayed wood of trunk hollows of Ficus religiosa and Syzygium cumini trees. METHODS Susceptibilities to amphotericin B, fluconazole, ketoconazole, itraconazole and voriconazole were determined by using Etest. The MICs were read after 48 h as per the guidelines provided by the manufacturer. RESULTS The MIC90s and susceptibility ranges for C. neoformans isolates were as follows: 0.094 (0.004-0.25) mg/L for amphotericin B, 4 (0.032-12) mg/L for fluconazole, 0.094 (0.004-0.75) mg/L for itraconazole, 0.064 (0.002-0.19) mg/L for ketoconazole, and 0.047 (0.006-0.125) mg/L for voriconazole, whereas for C. gattii isolates these were 0.125 (0.023-0.5) mg/L for amphotericin B, 8 (0.032-16) mg/L for fluconazole, 0.75 (0.006-2) mg/L for itraconazole, 0.125 (0.003-0.19) mg/L for ketoconazole, and 0.094 (0.004-0.125) mg/L for voriconazole. A comparison of the geometric means of MICs (mg/L) revealed that C. gattii was less susceptible than C. neoformans to amphotericin B (0.075 versus 0.051, P=0.0003), fluconazole (2.912 versus 2.316, P=0.003), itraconazole (0.198 versus 0.0344, P<0.0001), ketoconazole (0.072 versus 0.037, P<0.0001), and voriconazole (0.045 versus 0.023, P<0.0001). CONCLUSIONS The antifungal susceptibility data obtained in this study indicate that the occurrence of primary resistance among environmental isolates of C. neoformans serotype A and C. gattii serotype B is rare, and serotype B isolates are less susceptible than serotype A isolates.
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Affiliation(s)
- Zia U Khan
- Mycology Reference Laboratory, Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
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16
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Pedroso RDS, Ferreira JC, Candido RC. In vitro susceptibility to antifungal agents of environmental Cryptococcus spp. isolated in the city of Ribeirão Preto, São Paulo, Brazil. Mem Inst Oswaldo Cruz 2006; 101:239-43. [PMID: 16862315 DOI: 10.1590/s0074-02762006000300002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 04/05/2006] [Indexed: 11/21/2022] Open
Abstract
Infections by Cryptococcus strains other than C. neoformans have been detected in immunocompromised patients. Of these strains, three are considered human pathogens: C. albidus, C. laurenttii, and C. uniguttulatus. This study deals with the in vitro susceptibility of Cryptococcus to drugs such as amphotericin B, itraconazole, fluconazole, and 5-fluorocytosine. Environmental Cryptococcus isolates (50) distributed as follows: C. neoformans var. neoformans (16), C. albidus (17), C. laurentii (14), and C. uniguttulatus (3) were evaluated by the micro and macrodilution techniques, according to EUCAST and NCCLS recommendations, respectively. Considering both methodologies the respective minimal inhibitory concentrations (MIC) were 0.125 and 2 microg/ml for amphotericin B, 0.06 and 8 microg/ml for itraconazole, and 0.5 and more than 64 microg/ml for fluconazole and 5-fluorocytosine. Agreement percentages for the two methodologies were 100% for amphotericin B and fluconazole for all the strains tested. For itraconazole, the agreement percentage was 81.3% in the C. neoformans strain and 100% for all the others. All species had a agreement percentage of 94.1 to 100% when susceptibility to 5-fluorocytosine was tested. It is concluded that environmental isolates of C. neoformans var. neoformans, C. albidus, C. laurentii, and C. uniguttulatus may show high MICs against certain drugs, suggesting in vitro primary resistance to the antifungals tested.
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Affiliation(s)
- Reginaldo dos Santos Pedroso
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, 14040-903, Brasil.
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17
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Abdel-Salam HA. In vitro susceptibility of Cryptococcus neoformans clinical isolates from Egypt to seven antifungal drugs. Mycoses 2005; 48:327-32. [PMID: 16115103 DOI: 10.1111/j.1439-0507.2005.01137.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The in vitro susceptibility of 29 clinical isolates of Cryptococcus neoformans to fluconazole, miconazole, itraconazole, ketoconazole, flucytosine, nystatin and amphotericin B was tested by broth and colorimetric microdilution methods. Most of the isolates showed uniform patterns of susceptibility to the used antifungal agents. Only three isolates exhibited resistance [fourfold or greater rise in the minimum inhibitory concentrations (MICs)] to the tested antifungal drugs. The MIC50 and MIC90 were 0.5-8 mg l(-1) for 5-flucytosine, 0.2-8.25 mg l(-1) for nystatin, 0.5-16 mg l(-1) for fluconazole and 0.2-12.5 mg l(-1) for miconazole. However, MIC50 and MIC90 were in narrow range for the clinical yeast isolates in both methods used and showed 0.5-1 mg l(-1) for amphotericin B and 0.016-0.25 mg l(-1) for both ketoconazole and itraconazole. The combination of fluconazole plus flucytosine showed greater synergistic and fungicidal activity compared with that of fluconazole plus amphotericin B or the use of individual drugs.
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Affiliation(s)
- Hassan A Abdel-Salam
- Department of Microbiology, Faculty of Pharmacy, University of Zagazig, Zagazig, Egypt.
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18
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Rimek D, Haase G, Lück A, Casper J, Podbielski A. First report of a case of meningitis caused by Cryptococcus adeliensis in a patient with acute myeloid leukemia. J Clin Microbiol 2004; 42:481-3. [PMID: 14715811 PMCID: PMC321734 DOI: 10.1128/jcm.42.1.481-483.2004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Revised: 09/20/2003] [Accepted: 10/12/2003] [Indexed: 11/20/2022] Open
Abstract
Cryptococcus adeliensis is a recently described new fungal species which has been isolated from decaying algae in Terre Adelie, Antarctica. We report the first known case of meningitis caused by C. adeliensis in a patient with acute myeloid leukemia undergoing allogeneic peripheral blood stem cell transplantation.
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Affiliation(s)
- Dagmar Rimek
- Department of Medical Microbiology and Hospital Hygiene, University of Rostock, Rostock, Germany.
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Maxwell MJ, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Evaluation of Etest method for determining voriconazole and amphotericin B MICs for 162 clinical isolates of Cryptococcus neoformans. J Clin Microbiol 2003; 41:97-9. [PMID: 12517832 PMCID: PMC149576 DOI: 10.1128/jcm.41.1.97-99.2003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of the Etest for voriconazole and amphotericin B susceptibility testing of 162 isolates of Cryptococcus neoformans was assessed against the National Committee for Clinical Laboratory Standards (NCCLS) broth microdilution method. The NCCLS method employed RPMI 1640 broth medium, and MICs were read after incubation for 72 h at 35 degrees C. MICs were determined by Etest for all 162 isolates with RPMI 1640 agar containing 2% glucose (RPG agar) and were read after incubation for 72 h at 35 degrees C. The Etest results for both voriconazole and amphotericin B correlated well with reference MICs. Agreement was 94% for voriconazole and 99% for amphotericin B. When discrepancy was noted between the results obtained by Etest and broth microdilution for voriconazole, the Etest generally provided a higher MIC. The Etest method using RPG agar appears to be a useful method for determining the susceptibility of C. neoformans to voriconazole and amphotericin B.
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Affiliation(s)
- M J Maxwell
- Department of Pathology, University of Iowa College of Medicine and College of Public Health, Iowa City, Iowa 52242, USA
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20
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Averbuch D, Boekhoutt T, Falk R, Engelhard D, Shapiro M, Block C, Polacheck I. Fungemia in a cancer patient caused by fluconazole-resistant Cryptococcus laurentii. Med Mycol 2002; 40:479-84. [PMID: 12462527 DOI: 10.1080/mmy.40.5.479.484] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report the recent isolation of Cryptococcus laurentii from the blood of a patient given the diagnosis of ganglioneuroblastoma. The organism was identified using physiological and molecular characteristics, including morphology, carbohydrate and nitrate assimilation, urease activity, inability to form melanin on appropriate media, positive staining with diazonium blue B and sequence analysis of the D1/D2 domain of 26S ribosomal DNA. The isolate was resistant to fluconazole and 5-fluorocytosine using both the Etest and a broth microdilution assay. Repeated recovery of the organism from different blood cultures, and the patient's good response to treatment with amphotericin B support its etiological role. C. laurentii has rarely been implicated as a cause of clinically significant infections. The identity of reported isolates has not always been adequately documented, and some appear to have been isolated from lesions caused by Cryptococcus neoformans, emphasizing the true rarity of disease due to this fungus.
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Affiliation(s)
- D Averbuch
- Department of Pediatrics,The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Meletiadis J, Mouton JW, Meis JFGM, Bouman BA, Verweij PE. Comparison of the Etest and the sensititre colorimetric methods with the NCCLS proposed standard for antifungal susceptibility testing of Aspergillus species. J Clin Microbiol 2002; 40:2876-85. [PMID: 12149345 PMCID: PMC120664 DOI: 10.1128/jcm.40.8.2876-2885.2002] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The susceptibilities of 25 clinical isolates of Aspergillus fumigatus, A. flavus, A. terreus, A. nidulans, and A. ustus to itraconazole and amphotericin B were determined by an agar diffusion-dilution method (the Etest method) and a colorimetric broth microdilution method (the Sensititre method); and the results were compared with those obtained by the NCCLS proposed standard M-38P method for antifungal susceptibility testing of filamentous fungi. Various MIC endpoints for the three methods were determined visually by four different observers in three blinded experiments, and the reproducibilities among the observers (interobserver agreement) and among the replicates (interexperimental agreement) as well as the levels of agreement between the NCCLS, the Etest, and the Sensititre methods were calculated. High levels of reproducibility (within 1 twofold dilution) were found for the NCCLS method (>95%) with the MIC-0 endpoint (complete inhibition of growth) for both drugs and with the MIC-1 endpoint (slight growth) for itraconazole and for the Sensititre method (>90%) with all MIC endpoints, although for the latter the interexperimental agreement for itraconazole was comparatively lower (83 to 93%). The Etest method was less reproducible (67 to 87%) for both drugs. Using the recommended MIC endpoints, high levels of agreement (within one twofold dilution) between the NCCLS and the Sensititre methods for all species were found for amphotericin B (>77%) but not for itraconazole (<66%), for which the MICs by the Sensititre method were up to 3 twofold dilutions lower than the corresponding MICs by the NCCLS method. The use of the first blue well as an endpoint for the Sensititre method and 48 h of incubation improved the levels of agreement with the NCCLS method. Low levels of agreement between the NCCLS and the Etest methods using the recommended MIC endpoints were found for most species, especially after 48 h of incubation (<50%), when the MICs obtained by the Etest method were up to 9 twofold dilutions higher than the corresponding MICs obtained by the NCCLS method. Relatively better agreement was found after 24 h, although it was species dependent, with the highest levels of agreement (>82%) found for A. terreus and A. ustus for amphotericin B and A. fumigatus for both drugs. Overall, better agreement was found when MIC-0 was used as the MIC endpoint for the NCCLS method for both drugs and when the MICs by the Etest method were determined after 48 h of incubation for itraconazole and after 24 h of incubation for amphotericin B.
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Affiliation(s)
- Joseph Meletiadis
- Department of Medical Microbiology, University Medical Center Nijmegen, The Netherlands
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Wolf DG, Falk R, Hacham M, Theelen B, Boekhout T, Scorzetti G, Shapiro M, Block C, Salkin IF, Polacheck I. Multidrug-resistant Trichosporon asahii infection of nongranulocytopenic patients in three intensive care units. J Clin Microbiol 2001; 39:4420-5. [PMID: 11724855 PMCID: PMC88559 DOI: 10.1128/jcm.39.12.4420-4425.2001] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trichosporon asahii (Trichosporon beigelii) infections are rare but have been associated with a wide spectrum of clinical manifestations, ranging from superficial involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. We report on the recent recovery of T. asahii isolates with reduced susceptibility in vitro to amphotericin B (AMB), flucytosine, and azoles from six nongranulocytopenic patients who exhibited risk factors and who developed either superficial infections (four individuals) or invasive infections (two individuals) while in intensive care units. The latter two patients responded clinically and microbiologically to AMB treatment. All six isolates were closely related according to random amplified polymorphic DNA studies and showed 71% similarity by amplified fragment length polymorphism analysis, suggesting a common nosocomial origin. We also review the literature pertaining to T. asahii infections and discuss the salient characteristics of this fungus and recent taxonomic proposals for the genus.
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Affiliation(s)
- D G Wolf
- Department of Clinical Microbiology and Infectious Diseases, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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