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Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study

Genetic diversity analyses were performed by sero-genotyping and multi-locus sequence typing on 252 cryptococcal isolates from 13 HIV-positive Ivorian patients followed-up for cryptococcal meningitis. Antifungal susceptibility analyses were performed according to the CLSI M27A3 method. The majority...

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Autores principales: Kassi, Fulgence Kondo, Drakulovski, Pascal, Bellet, Virginie, Roger, Frédéric, Chabrol, Amélie, Krasteva, Donika, Doumbia, Adama, Landman, Roland, Kakou, Aka, Reynes, Jacques, Delaporte, Eric, Menan, Hervé Eby Ignace, Bertout, Sébastien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886875/
https://www.ncbi.nlm.nih.gov/pubmed/31738768
http://dx.doi.org/10.1371/journal.pntd.0007812
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author Kassi, Fulgence Kondo
Drakulovski, Pascal
Bellet, Virginie
Roger, Frédéric
Chabrol, Amélie
Krasteva, Donika
Doumbia, Adama
Landman, Roland
Kakou, Aka
Reynes, Jacques
Delaporte, Eric
Menan, Hervé Eby Ignace
Bertout, Sébastien
author_facet Kassi, Fulgence Kondo
Drakulovski, Pascal
Bellet, Virginie
Roger, Frédéric
Chabrol, Amélie
Krasteva, Donika
Doumbia, Adama
Landman, Roland
Kakou, Aka
Reynes, Jacques
Delaporte, Eric
Menan, Hervé Eby Ignace
Bertout, Sébastien
author_sort Kassi, Fulgence Kondo
collection PubMed
description Genetic diversity analyses were performed by sero-genotyping and multi-locus sequence typing on 252 cryptococcal isolates from 13 HIV-positive Ivorian patients followed-up for cryptococcal meningitis. Antifungal susceptibility analyses were performed according to the CLSI M27A3 method. The majority (67.8%) of the isolates belonged to the Cryptococcus neoformans (serotype A) species complex, with 93% being VNI and 7% being VNII. Cryptococcus deuterogattii VGII (serotype B) represented 16.7% of the strains, while C. neoformans/C. deneoformans VNIII (serotype AD) hybrids accounted for 15.1% of the strains. One strain (0.4%) was not identifiable. Nine different sequence types (STs 5, 6, 23, 40, 93, 207, 311, and a new ST; 555) were identified in the C. neoformans population, while the C. deuterogattii population comprised the single ST 173. The distribution of the strains showed that, while the majority of patients (9/13) harboured a single sequence type, 4 patients showed mixed infections. These patients experienced up to 4 shifts in strain content either at the species and/or ST level during their follow-up. This evolution of diversity over time led to the co-existence of up to 3 different Cryptococcus species and 4 different ST within the same individual during the course of infection. Susceptibility testing showed that all strains were susceptible to amphotericin B while 3.6% of them had a none-wild type phenotype to 5-flucytosine. Concerning fluconazole, 2.9% of C.neoformans serotype A strains and 2.4% of C. deuterogattii had also respectively a none-wild type phenotype to this molecule. All C. neoformans x C. deneoformans serotype AD hybrids had however a wild type phenotype to fluconazole. The present study showed that mixed infections exist and could be of particular importance for care outcomes. Indeed, (i) the different Cryptococcus species are known to exhibit different virulence and different susceptibility patterns to antifungal drugs and (ii) the strains genetic diversity within the samples may influence the susceptibility to antifungal treatment.
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spelling pubmed-68868752019-12-13 Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study Kassi, Fulgence Kondo Drakulovski, Pascal Bellet, Virginie Roger, Frédéric Chabrol, Amélie Krasteva, Donika Doumbia, Adama Landman, Roland Kakou, Aka Reynes, Jacques Delaporte, Eric Menan, Hervé Eby Ignace Bertout, Sébastien PLoS Negl Trop Dis Research Article Genetic diversity analyses were performed by sero-genotyping and multi-locus sequence typing on 252 cryptococcal isolates from 13 HIV-positive Ivorian patients followed-up for cryptococcal meningitis. Antifungal susceptibility analyses were performed according to the CLSI M27A3 method. The majority (67.8%) of the isolates belonged to the Cryptococcus neoformans (serotype A) species complex, with 93% being VNI and 7% being VNII. Cryptococcus deuterogattii VGII (serotype B) represented 16.7% of the strains, while C. neoformans/C. deneoformans VNIII (serotype AD) hybrids accounted for 15.1% of the strains. One strain (0.4%) was not identifiable. Nine different sequence types (STs 5, 6, 23, 40, 93, 207, 311, and a new ST; 555) were identified in the C. neoformans population, while the C. deuterogattii population comprised the single ST 173. The distribution of the strains showed that, while the majority of patients (9/13) harboured a single sequence type, 4 patients showed mixed infections. These patients experienced up to 4 shifts in strain content either at the species and/or ST level during their follow-up. This evolution of diversity over time led to the co-existence of up to 3 different Cryptococcus species and 4 different ST within the same individual during the course of infection. Susceptibility testing showed that all strains were susceptible to amphotericin B while 3.6% of them had a none-wild type phenotype to 5-flucytosine. Concerning fluconazole, 2.9% of C.neoformans serotype A strains and 2.4% of C. deuterogattii had also respectively a none-wild type phenotype to this molecule. All C. neoformans x C. deneoformans serotype AD hybrids had however a wild type phenotype to fluconazole. The present study showed that mixed infections exist and could be of particular importance for care outcomes. Indeed, (i) the different Cryptococcus species are known to exhibit different virulence and different susceptibility patterns to antifungal drugs and (ii) the strains genetic diversity within the samples may influence the susceptibility to antifungal treatment. Public Library of Science 2019-11-18 /pmc/articles/PMC6886875/ /pubmed/31738768 http://dx.doi.org/10.1371/journal.pntd.0007812 Text en © 2019 Kassi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kassi, Fulgence Kondo
Drakulovski, Pascal
Bellet, Virginie
Roger, Frédéric
Chabrol, Amélie
Krasteva, Donika
Doumbia, Adama
Landman, Roland
Kakou, Aka
Reynes, Jacques
Delaporte, Eric
Menan, Hervé Eby Ignace
Bertout, Sébastien
Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study
title Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study
title_full Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study
title_fullStr Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study
title_full_unstemmed Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study
title_short Cryptococcus genetic diversity and mixed infections in Ivorian HIV patients: A follow up study
title_sort cryptococcus genetic diversity and mixed infections in ivorian hiv patients: a follow up study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886875/
https://www.ncbi.nlm.nih.gov/pubmed/31738768
http://dx.doi.org/10.1371/journal.pntd.0007812
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