获得性免疫缺陷综合征患者的新生隐球菌基因多态性研究

本文旨在调查2003 年1 月― 2007 年12 月分离自上海地区获得性免疫缺陷综合征( AIDS) 患者的新生隐球菌临床株的配型及基因型分布特征, 为隐球菌病的诊疗提供科学依据。首先以M13 为单引物对模板DNA 进行聚合酶链反应( PCR) 扩增, 参照标准株指纹图将临床株鉴定至基因型; 同时对12 株来自AIDS 患者的新生隐球菌临床株的内转录间隔区( ITS) 基因进行PCR 扩增、序列分析, 以CLUSTAL W1. 83 软件多重比对分析ITS序列的差别,MEGA3. 1 软件处理数据, NJ 法绘制系统进化树, Bootstrapping 法对系统进化树结果进行统计学检验, 区分新生隐球菌格鲁比变种、新生变种及格特变种菌株; 最后选用特异性引物PCR 特异性扩增相关基因, 鉴定α和a 配型。结果显示, 分离自上海地区的12 株隐球菌临床株中, 9 株( 75% ) 为VNⅠ基因型/ α配型菌株,3 株( 25%) 为VNⅡ基因型/ α配型菌株, 且ITS基因序列分析可将各临床株鉴定至变种水平。本研究提示, 分离自上海地区AIDS患者的新生隐球菌临床株存在一定的遗传多态性, 以VNⅠ基因型/ α配型菌株为主, 有少量VNⅡ基因型/ α配型菌株。     

新疆首次临床分离新生隐球菌菌株分子鉴定、基因分型及体外药物敏感性研究

目的对新疆首次临床分离的5株新生隐球菌进行分子鉴定、RAPD-PCR基因分型及体外药物敏感性研究。方法5株新生隐球菌分子鉴定采用核糖体DNA大亚基(LSU rDNA)D1/D2基因区域分子鉴定。分子分型采用引物SEQ-6结合RAPD-PCR法扩增5株新疆临床分离新生隐球菌菌株及5株由上海长征医院提供分离自上海新生隐球菌菌株,根据扩增产物带型进行基因型判定。采用临床实验室标准化协会(CLSI)的酵母微量液基稀释法(M27-A3)测定5株新疆临床分离新生隐球菌菌株对6种抗真菌药(伏立康唑、伊曲康唑、两性霉素B、特比萘芬、氟康唑、5-氟胞嘧啶)的体外敏感性。结果 5株新疆临床分离隐球菌菌株经过D1/D2区域序列分析在基因Bank中比对后鉴定为新生隐球菌。5株新疆临床分离新生隐球菌和5株上海新生隐球菌菌株经RAPD-PCR法扩增,带型显示分为A、B、C、D 4个基因型,其中新疆5株菌株A型1株、其余4株均为B型,上海菌株B型为1株,C型3株、D型1株,5株新疆临床分离新生隐球菌株对伏立康唑、伊曲康唑、两性霉素B、特比萘芬的MIC值(μg/mL)范围依次为:0.062 5~0.25、0.25~1、0.125~0.5、1~2,对氟康唑、5-氟胞嘧啶MIC值较高,MIC值范围依次为:4~16、8~32。结论新疆临床分离5株隐球菌株采用D1/D2基因序列鉴定为新生隐球菌。RAPD-PCR分型显示新疆临床分离5株新生隐球菌株以B型基因型为主。A型和B型对伏立康唑、两性霉素B敏感,对伊曲康唑、特比萘芬剂量依赖型敏感,对氟康唑、5-氟胞嘧啶耐药。     

34例HIV患者新生隐球菌感染分子流行病学及临床特点分析

目的了解HIV患者新生隐球菌感染的分子流行病学及其临床特点,为HIV患者新生隐球菌感染的预防和治疗提供依据。方法收集首次分离自HIV患者的新生隐球菌34株,回顾性分析患者一般资料;VITEK MS质谱仪进行菌种鉴定,ATB Fungus3测定新生隐球菌对5种抗真菌药物的MIC值;利用PCR对特异性引物扩增,确定变种和交配型;多位点序列分型(MLST)对菌株进行分子遗传学分析。结果 34株新生隐球菌绝大部分分离自中年男性,且主要来自脑脊液(73.5%)标本;初次脑脊液压力平均为(27.26±11.52)mmH2O,CD4细胞计数中位数28cells/μL(3~163cells/μL),脑脊液白细胞中位计数32(2~110)×106/L,蛋白质定量中位数为362 mg/L(160~2 730 mg/L),葡萄糖含量中位数为2.28mmol/L(1.50~5.98mmol/L);所有菌株对5种抗真菌药均敏感,且所有菌株均为Aα、VNⅠ型;MLST分析共检出3种ST型,ST5(n=32)、ST32(n=1)和ST186(n=1)。结论近两年本地区HIV合并新生隐球菌感染主要以中年男性多见,常规实验室检查缺乏特异性,对临床常用抗真菌药物耐药性不强,ST5是其感染的主要克隆系。     

云南省艾滋病患者新生隐球菌药物敏感性与临床分析CSCD

目的了解云南省艾滋病患者中新生隐球菌病的病原分离部位、耐药性及临床治疗效果。方法对2010年1月至2020年12月临床总共分离的424株新生隐球菌,用VITEK2 Compact全自动微生物分析仪鉴定菌种,ATB FUNGUS 3检测5种抗真菌药物的敏感性,并对临床资料进行分析。结果424株新生隐球菌以脑脊液检出比例最高,占62.50%(265/424);血液次之,占30.90%(131/424);第三是痰液,占2.83%(12/424)。424株新生隐球菌对唑类抗真菌药物伊曲康唑和伏立康唑MIC范围均≤2μg/mL,多烯类的两性霉素B MIC范围≤4μg/mL,氟康唑及5-氟胞嘧啶的MIC范围≤64μg/mL。对两性霉素B、氟康唑、5-氟胞嘧啶的敏感性分别为95.28%(404/424)、80.66%(342/424)、75.71%(321/424)。5种抗真菌药物的流行病学折点分别为:5-氟胞嘧啶和氟康唑16μg/mL;两性霉素B、伊曲康唑和伏立康唑0.5μg/mL。结论新生隐球菌对两性霉素B的敏感性较好,而氟康唑及5-氟胞嘧啶在多年的临床用药过程中已慢慢出现非敏感菌株,伊曲康唑和伏立康唑MIC范围≤2μg/mL。新生隐球菌药敏试验结果为临床医生用药提供参考依据。新生隐球菌病治疗首选两性霉素B与5-氟胞嘧啶联合治疗。隐球菌作为临床重要的致病真菌,实验室及临床均应给予高度重视。     

不同毒力差异基因型的新生隐球菌MLST分型及交配型鉴定研究

目的：了解及比较两组毒力差异明显的新生隐球菌格鲁比变种的多位点序列分型（MLST）的特点并进行交配型鉴定。方法采用多位点序列分型（MLST）的方法,设计7个看家基因（CAP59,GPD1,LAC1,PLB1,SOD1,URA5和IGS1）的引物,扩增并分析来源分别为环境和临床的各10株新生隐球菌格鲁比变种的基因型,并鉴定实验菌株交配型,与多位点微卫星分型（MLMT）结果对比,比较不同基因分型方法在分类中的稳定性和可靠性。结果在微卫星分型中为MLMT-36的10株环境分离株,MLST分型为ST-15,而在微卫星分型中为MLMT-13型的10株临床分离株,MLST分型为ST-32,所有菌株交配型均为MAT-α。结论MLST分型结果与MLMT分型结果高度一致,提示以上两种分子分型技术在真菌分类鉴定研究中可显示对于其分离背景及进化来源的高分辨率及稳定性。     

新生隐球菌COP9复合体基因CSN6的敲除与鉴定

目的构建新生隐球菌COP9复合体蛋白元件Csn6的基因同源重组敲除框,并通过基因枪转化系统敲除CSN6基因。方法应用生物信息学方法获得COP9复合体蛋白元件的基因信息,采用套叠PCR的方法,构建包含报告基因NEO和CSN6基因ORF两侧上下游同源DNA片段的同源重组框。应用基因枪将其转化入新生隐球菌感受态细胞,通过PCR和DNA测序对遗传霉素(G418)耐受的阳性克隆子进行筛选与验证。结果成功构建了新生隐球菌基因突变株csn6裣。结论 COP9复合体亚基CSN6基因突变株的构建,为今后新生隐球菌COP9复合体的分子致病机制研究奠定基础。     

新生隐球菌的生态学,流行病学,分子生物学及临床研究

在我国，对新生隐球菌已进行了较系统的研究，生态学方面，由鸽粪分离的环境株具有表型的多态性，包括新生变种的Ａ、Ｄ血清型及尿素酶阴性株，而这些多态性菌株均已在临床发现。分子生物学方面，Ｇ＋Ｃｍｏｌ％和核型已被进行分析。由ＰＦＧＥ分析所得到的有意义的信息是两个变种和５种血清型新生隐球菌株具有明显不同的核型谱。临床方面，研制的一种新的可同时检测酚氧化酶和尿素酶的培养基可用于该菌的临床鉴定。使用一种高渗培养     

新生隐球菌的生态学、流行病学、分子生物学及临床研究

在我国,对新生隐球菌(Cryptococcus neoformans)已进行了较系统的研究。生态学方面,,由鸽粪分离的环境株具有表型的多态性,包括新生变种的A、D血清型及尿素酶阴性株,而这些多态性菌株均已在临床发现。分子生物学方面,G+Cmol％和核型已被进行分析。,由PFGE分析所得到的有意义的信息是两个变种和5种血清型新生隐球菌株具有明显不同的核型谱。临床方面,研制的一种新的可同时检测酚氧化酶和尿素酶的培养基可用于该菌的临床鉴定。使用一种高渗培养基诱导出于该菌的L-型,提示在感染期间L-型的形成可能与该病的慢性过程与复发有关。已证实氟康唑对治疗新生隐球菌病有良好的效果。进一步应重视联合治疗的可能性,例如使用氟康唑加二性霉素B脂质体。总之在我国对新生隐球菌的系统性研究已经初步开始进行,许多有意义的结果已经得到并且将进一步得到。     

人类巨细胞病毒UL133基因在临床低传代株中的多态性研究

人类巨细胞病毒在多次传代后,会表现出不同的毒力水平.与临床低传代株Toledo相比,实验室高传代株AD169缺失了19个开放阅读框(ORF).这19个基因被认为是与HCMV致病性最可能相关的一组基因,研究这些基因的多态性对揭示HCMV致病性的遗传基础具有指导意义.UL133基因是这19个ORF中的一个.以临床低传代株Toledo和Merlin为对照,分析了23个临床病毒株UL133基因的遗传多态性.序列分析表明,UL133基因具有一定的多态性,Toledo株、Merlin株与我们分离到的临床株一起可分为3个基因型:G1、G2和G3.G2、G3型毒株均能导致先天性感染.没有发现UL133基因型与患儿临床疾病的必然关联.     

中国广西地区格特隐球菌菌种复合体的基因型分析

目的探讨中国广西地区格特隐球菌菌种复合体的基因型特点、种群结构特征和全球菌株的进化关系。方法收集2014—2018年间分离自临床确诊为隐球菌病患者的隐球菌临床株,利用CGB培养基初步筛选格特隐球菌菌种复合体。采用多位点序列分型方法(MLST)确定基因型。通过MEGA7软件构建系统发育树,利用R语言进行主成分分析。使用微量肉汤稀释法M27-A3方案行体外抗真菌药物敏感性检验。结果120株临床隐球菌中,分离出11株格特隐球菌菌种复合体,6株属于C.deuterogattii(AFLP6/VGII),5株属于C.gattii sensus stricto(AFLP4/VGI)。分离自广西的AFLP6/VGII呈遗传多样性,主要起源进化自南美巴西格特隐球菌菌种复合体。11株分离菌株均对常用抗真菌药物敏感。结论中国广西可能出现高致病性AFLP6/VGII,对格特隐球菌菌种复合体进行有效的全国性监测是必要的。     

Molecular typing of clinical and environmental Cryptococcus neoformans isolates in the Brazilian state Rio Grande do Sul

In Brazil, 4.5% of the AIDS-related opportunistic infections are caused by Cryptococcus neoformans. This pathogen is a ubiquitous environmental basidiomycetous encapsulated yeast, commonly found in soil and avian excreta. The present study investigates further the population structure of clinical and environmental C. neoformans isolates from south Brazil. One hundred five clinical and 19 environmental (pigeon excreta and Eucalyptus spp.) isolates from the Brazilian state Rio Grande do Sul were characterized based on morphological, biochemical, molecular and serological data. The majority of the clinical and environmental isolates analyzed belonged to C. neoformans var. grubii serotype A (89.5 and 52.6%, respectively), were mating type alpha (98.1 and 94.7%, respectively) and were phospholipase-positive (94.3 and 73.7%, respectively). PCR-fingerprinting with the microsatellite-specific primer M13 and the minisatellite-specific primer (GACA)(4) grouped the majority of the isolates into the molecular type VNI (89.5 of the clinical and 52.6% of the environmental isolates). Our results add considerable new information to the few available data on ecology, molecular biology and epidemiology of C. neoformans in the southern region of Brazil.     

Isolation of Cryptococcus neoformans from environmental samples in Alicante

A study of the incidence of Cryptococcus neoformans in Alicante was carried out in environmental samples from the cities of Alicante and Santa Pola. The samples were pigeons faeces and Eucalyptus camaldulensis tissues. This study shows that the prevalence of the yeast in faeces from captive pigeons is higher (81.5%) than in the same samples from urban pigeons (16.3%). Regarding the biotype and varieties, a 79.3% of the isolates belonged to C. neoformans, and all of them were C. neoformans var. neoformans. None of the E. camaldulensis samples showed C. neoformans growth, although some Cryptococcus laurentii strains were isolated from flowers.     

Serotype and PCR-fingerprints of Clinical and Environmental isolates of Cryptococcus neoformans in Chiang Mai,Thailand

From May 1999 to April 2000, serotypes of clinical and environmental isolates of Cryptococcus neoformans were studied in Chiang Mai province, northern Thailand. Three hundred and eighty-five environmental samples, of which 100 were dove droppings, 55 pigeon droppings and 230 eucalyptus flower, were collected from 7 Amphoes in Chiang Mai. C. neoformans was isolated from 45 of 100 (45.0%) dove dropping samples, 9 of 55 (16.4%) pigeon dropping samples and 2 of 230 (0.9%) eucalyptus flower samples. Serotypes of 56 environmental isolates and 75 clinical isolates of C. neoformans,obtained during the same period, were determined by the slide agglutination test. Fifty-six environmental and 74 clinical isolates belonged to C. neoformans serotype A (C. neoformans var. grubii), and only one clinical isolate belonged to C. neoformans serotype AD. The isolation of C. neoformans var. grubii from eucalyptus flower samples suggests contamination of avian droppings. PCR-fingerprinting, using (GACA)4 as a primer, discriminated 131 clinical and environmental isolates into 2 groups (group I and II). Seventy-five clinical and 54 environmental isolates were of group I, which had two major specific bands of approximately 1,250 and 960 base pairs. Two environmental isolates, one from pigeon excreta and the other from a eucalyptus flower sample were of group II, which had two major specific bands of approximately 1,180 and 500 base pairs.     

Chromosome length polymorphism in Cryptococcus neoformans clinical and environmental isolates

A protocol for intact DNA preparation from the basidiomycetous yeast Cryptococcus neoformans has been developed and applied to karyotyping C. neoformans isolates displaying different degrees of capsule formation. A total of 46 strains have been analyzed: 23 (50%) isolated from environmental samples (pigeon droppings), all of them belonging to C. neoformans var. neoformans; and 23 (50%) from clinical samples (human and veterinarian) including 10 isolates of C. neoformans var. neoformans and 13 isolates of C. neoformans var. gattii. Our results showed a global genome size ranging from 14.2 to 20.9 Mb for variety neoformans and from 7.9 to 16.8 Mb for variety gattii. The karyotype diversity was very high for variety neoformans (29 different patterns for the 33 analyzed strains) and lower for variety gattii (six different patterns for 13 strains). No grouping among variety neoformans strains from the same origin was found indicating very high genome diversity for this variety, irrespectively of the origin of the strains.     

Superoxide dismutase in Cryptococcus neoformans varieties gattii, grubi, and neoformans

Some clear dissimilarities occur among the varieties of Cryptococcus neoformans but there are few studies about the differences among individual yeast antioxidant enzymes. The total superoxide dismutase (SOD) activities and the copper, zinc-depend SOD (Cu,ZnSOD) and manganese-dependent SOD (MnSOD) isoenzymes of five reference C. neoformans strains belonged to A, B, C, AD and D serotypes (Table I) and other nine C. neoformans isolates (Table II) were determined. There were significant differences (p < 0.01 and p < 0.05) in total SOD activity among the varietie gattii (serotype C) and the other varieties. Cu,ZnSOD showed difference (p < 0.05) between A and D serotypes. These results point out a variety and serotype-independent SOD activity in C. neoformans reference strains and the other isolates that were evaluated.     

Isolation of Cryptococcus neoformans var. grubii (serotype A) from pigeon droppings in Seoul, Korea

Seventy-two pigeon dropping samples were collected from 26 different localities in Seoul and investigated for the occurrence of Cryptococcus neoformans. Seventeen samples from 8 different localities were found to be positive for C. neoformans. All isolates were obtained from withered pigeon droppings. Identification and serotyping of the isolates were determined by means of serological testing and DNA fingerprinting. All isolates belonged to C. neoformans var. grubbi (serotype A).     

Molecular characterization and evaluation of virulence factors of Cryptococcus laurentii and Cryptococcus neoformans strains isolated from external hospital areas

Cryptococcosis is a common opportunistic fungal infection that is mainly caused by the species Cryptococcus neoformans and Cryptococcus gattii, but there have recently been several reports of infection by non-neoformans Cryptococcus species. The aims of this study were to genetically characterize Cryptococcus spp. isolated from external hospital areas in Minas Gerais State, Brazil, and to evaluate their pathogenic potential, analyzing their phospholipase and melanin production and the capacity for capsule enlargement. Seventy-three different samples were collected: 62 from bird droppings and 11 from tree detritus. C.?neoformans alone was isolated from 43.8% of the samples, Cryptococcus laurentii alone from 23.3% and both fungi were found together in 10.9%. C. laurentii was exclusively isolated from 45% (5/11) of the tree samples (Anacardium occidentale, Guazuma ulmifolia, Mangifera indica and Ficus benjamina). Among the 51 C. neoformans isolates, 47 were classified as type VNI and four as type VNII. All of the C. neoformans isolates were of MATα type. Among the 21 isolates of C. laurentii genotyped using the URA5-RFLP technique, 16 amplified a 1.6kb amplicon which produced a specific restriction profile in 15 isolates. In C.?neoformans, 76.4% of the isolates were capable of capsule enlargement in the induction medium and 92.1% were phospholipase producers. In C. laurentii, 7.4% of the isolates were capable of capsule enlargement and 85.1% were phospholipase producers. Characterization of the genotypes and the pathogenic potential of the Cryptococcus spp. isolates studied may contribute towards better understanding of the epidemiology of cryptococcosis and the ecology of agents causing this disease in our region.     

In vitro susceptibility to antifungal agents of environmental Cryptococcus spp. isolated in the city of Ribeirão Preto, São Paulo, Brazil

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.     

Molecular typing and antifungal susceptibility of clinical sequential isolates of Cryptococcus neoformans from Sao Paulo State, Brazil

The antifungal susceptibility profiles and the genetic variability of 83 sequential clinical isolates of Cryptococcus neoformans, including four Cryptococcus gattii isolates, obtained from 38 Sao Paulo AIDS patients with cryptococcal meningitis were assessed by electrophoretic karyotyping and random amplified polymorphic DNA (RAPD) analysis. The majority of the Cryptococcus neoformans isolates were highly susceptible to amphotericin B and fluconazole. Twenty percent of the minimum inhibitory concentration values for amphotericin B varied from 0.5 to 1 micro g mL(-1). For fluconazole, 22% occurred in the range 8-16 mug mL(-1). Sequential isolates from nine patients showed a trend towards lower susceptibility to fluconazole, flucytosine, itraconazole and amphotericin B. The results of molecular typing by electrophoretic karyotyping and RAPD analysis showed the presence of 22 electrophoretic karyotypes (EK) and 15 RAPD profiles that were highly correlated. Our results provided evidence for the occurrence of genetic changes in some strains associated with microevolution during the course of infection. We also observed both microevolution and simultaneous coinfection with two distinct Cryptococcus neoformans strains in one patient. In some patients, we found changed EK- and RAPD patterns in association with increased MIC values.     

Identification of Novel Hybrids Between Cryptococcus neoformans var. grubii VNI and Cryptococcus gattii VGII

Cryptococcus neoformans and Cryptococcus gattii are pathogenic yeasts causing meningoencephalitis in immunocompromised and immunocompetent hosts. The fungus is typically haploid, and sexual reproduction occurs normally between individuals with opposite mating types, α and a. C. neoformans var. grubii (serotype A) is comprised of molecular types VNI, VNII, and VNB, and C. neoformans var. neoformans (serotype D) contains the molecular type VNIV. Additionally, diploid or aneuploid AD hybrids (VNIII) have been reported. C. gattii contains the molecular types VGI, VGII, VGIII, and VGIV, which encompass both serotypes B and C. To identify possible hybrid strains, URA5-RFLP analysis was performed on 350 globally obtained clinical, environmental, and veterinary isolates. Four clinical isolates from cerebrospinal fluid showed combination patterns of C. neoformans var. grubii and C. gattii: Brazil (n = 2), Colombia (n = 1), and India (n = 1). These strains were monokaryotic and diploid or aneuploid. M13 PCR fingerprinting showed that they contained fragments of both proposed parental groups. Luminex IGS genotyping identified these isolates as hybrids with two different molecular type combinations: three VNI/VGII and one VNI/VGI. Blue color development on CGB agar was delayed in three isolates and absent in one. C. gattii-specific PCR confirmed the presence of C. gattii in the hybrids. CAP59 allele-specific PCR revealed that all the hybrids contained both serotype A and B alleles. Determination of mating-type allelic patterns by PCR revealed that the isolates were αA aB. This is the first study discovering novel natural hybrids between C. neoformans molecular type VNI and C. gattii molecular type VGII.