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Volume 9, Number 7—July 2003

Dispatch

Sulfa Resistance and Dihydropteroate Synthase Mutants in Recurrent Pneumocystis carinii Pneumonia

Aimable Nahimana*, Meja Rabodonirina†, Jannik Helweg-Larsen‡, Isabelle Meneau*, Patrick Francioli*, Jacques Bille*, and Philippe M. Hauser*1Comments to Author 
Author affiliations: *Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; †Université Claude-Bernard, Lyon, France; ‡Hvidovre Hospital, Copenhagen, Denmark

Main Article

Table

Pneumocystis carinii DHPS and PCR-SSCP genotyping in AIDS patients with recurrent pneumoniaa

Patient no. Cityb Age Date of episode 1/
date of episode 2/
interval (mo) CD4/mm3 Prophylaxis
at PCP episodec Treatment Outcome of
treatment P. carinii
PCR-SSCP type DHPS genotyped
1
Co
29
7/16/1993
9
D
CO → Pe
Success
6
WT



6/8/1994 (11)
0
P
CO
Success
6
M1
2
Ly
36
1/31/1994
58
D
A
Success
7
M2



5/18/1995 (16)
16
CO
A
Success
7
M3
3
Co
51
8/19/1994
0
No
CO → C/Pe
Success
6
WT/M1



12/23/1994 (4)
0
P
T
Success
6
M1
4
Ly
32
11/23/1994
75
No
CO
Success
2, 5
WT/M3



3/23/1995 (4)
35
No
CO
Deathf
2, 5
M3
5
Ly
28
4/19/1995
70
No
A
Success
7, 8
WT



3/1/1996 (11)
98
CO
P
Success
7
M3
6
Co
35
11/16/1995
2
D
P → COe
Success
6
M1



5/6/1996 (6)
1
D
CO
Success
6
M1
7
CF
41
2/3/1998
7
CO
P
Success
6
M3



7/22/1998 (5)
7
P
C/P
Success
6
M3
8
La
28
11/24/1990
53
No
T
Success
6, 10
WT



7/29/1991 (8)
18
No
CO
Success
7
WT
9
Co
25
12/8/1992
0
No
CO
Success
5
WT



11/5/1993 (11)
0
No
CO
Success
7
WT
10
Co
35
3/22/1993
10
No
CO → Pe
Success
18
WT



10/28/1994 (7)
0
P
CO → Pe
Deathf
6
WT
11
Ly
23
3/30/1994
22
No
CO → Ae
Success
4, 7
M3



3/28/1995 (12)
26
P
D+T → Ae
Success
5
M3
12
Ly
46
9/21/1994
61
No
CO
Success
15
WT



10/21/1996 (25)
16
P
P+A
Success
3
WT
13
Ly
43
10/12/1994
50
No
CO
Success
1, 2
M2
3/25/1996 (17) 5 PM/SD P+A Success 1, 3 M2

      aPCP, Pneumocystis carinii; DHPS, dihydropteroate synthase; PCR, polymerase chain reaction; SSCP, single-strand conformation polymorphism
      bCo, Copenhagen (Denmark); CF, La Chaux-de-Fonds (Switzerland); La, Lausanne (Switzerland); Ly, Lyon (France).
      cA, atovaquone; CO, cotrimoxazole; C/P, clindamycin/primaquine; D, dapsone; D+T, dapsone and trimethoprim; P, pentamidine; P+A, pentamidine and atovaquone; PM/SD (pyrimethamine/sulfadoxine inhibitors of dihydrofolate reductase (DHFR) and DHPS, respectively); T, trimetrexate (an inhibitor of DHFR).
      dWT, wild type (Thr55 Pro57); M1, mutant 1 (Ala55 Pro57); M2, mutant 2 (Thr55 Ser57); M3, mutant 3 (Ala55 Ser57 double mutant).
      eSwitch of molecules because of toxicity for patients 3, 6, and 11 and because of toxicity and treatment failure for patients 1 and 10.
      fCaused by PCP.

Main Article

1Aimable Nahimana contributed to the design of the study, analyzed the samples by polymerase chain reaction and DNA sequencing, and wrote the draft of the manuscript. Meja Rabodonirina and Jannik Helweg-Larsen reviewed medical charts and provided bronchoalveolar lavage specimens. All authors contributed to the analysis of data and writing of the paper. Philippe M. Hauser initiated and supervised all aspects of the study.

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