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Pneumocystis pneumonia.

F J L Robberts1, L J Chalkley, L D Liebowitz

  • 1Department of Medical Microbiology, Tygerberg Hospital, University of Stellenbosch, PO Box 19063, Tygerberg, 7505. lourensr@sun.ac.za

SADJ : Journal of the South African Dental Association = Tydskrif Van Die Suid-Afrikaanse Tandheelkundige Vereniging
|April 5, 2003
PubMed
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Pneumocystis jiroveci pneumonia is a concern for South African AIDS patients. Sulphonamide resistance, linked to gene mutations, may cause treatment failures.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Molecular Epidemiology

Background:

  • Pneumocystis jiroveci pneumonia (PCP) is a significant opportunistic infection in individuals with Acquired Immunodeficiency Syndrome (AIDS).
  • Prophylactic co-trimoxazole is commonly administered to South African AIDS patients with CD4 counts below 200 cells/microliter.
  • Observed treatment and prophylaxis failures suggest the potential emergence of sulphonamide-resistant Pneumocystis jiroveci strains.

Purpose of the Study:

  • To highlight the potential clinical challenge of sulphonamide resistance in Pneumocystis jiroveci in South Africa.
  • To discuss the molecular basis of sulphonamide resistance in Pneumocystis jiroveci.
  • To underscore the utility of strain typing for molecular epidemiology.

Main Methods:

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  • Review of existing literature on Pneumocystis jiroveci pneumonia and sulphonamide resistance.
  • Discussion of the genetic mutations associated with sulphonamide resistance (dihydropteroate synthase gene codons 55 and 57).
  • Consideration of the role of molecular epidemiological tools like strain typing.

    • Main Results:

    • Sulphonamide resistance in Pneumocystis jiroveci is a documented phenomenon globally.
    • Specific point mutations in the dihydropteroate synthase gene are identified as the cause of resistance.
    • The prophylactic use of co-trimoxazole in immunocompromised patients may exert selective pressure for resistant strains.

    Conclusions:

    • Sulphonamide-resistant Pneumocystis jiroveci poses a potential threat to effective PCP management in South Africa.
    • Understanding the genetic basis of resistance is crucial for diagnostics and treatment strategies.
    • Molecular strain typing is a valuable method for tracking the epidemiology of resistant strains.