ArticleAntimicrobial agents and chemotherapy2017
High Prevalence of Pneumocystis jirovecii Dihydropteroate Synthase Gene Mutations in Patients with a First Episode of Pneumocystis Pneumonia in Santiago, Chile, and Clinical Response to Trimethoprim-Sulfamethoxazole Therapy.
Article in Antimicrobial agents and chemotherapy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed, 58 citations in OpenAlex.
- Strain-Dependent Protective Innate Immunity AgainstJournal of fungi (Basel, Switzerland) · 2026Article
- CRISPR-Cas12 Application for the Detection ofInternational journal of molecular sciences · 2025Article
- Molecular Study ofJournal of fungi (Basel, Switzerland) · 2024Article
- Analysis of Mutations inInfection and drug resistance · 2024Article
- Molecular Analysis of Dihydropteroate Synthase Gene Mutations inInternational journal of molecular sciences · 2023Article
- The Dual Benefit of Sulfasalazine on Pneumocystis Pneumonia-Related Immunopathogenesis and Antifungal Host Defense Does Not Require IL-4Rα-Dependent Macrophage Polarization.Infection and immunity · 2023Article
- Review
- Tackling the emerging threat of antifungal resistance to human health.Nature reviews. Microbiology · 2022Review
- Molecular mechanisms of acquired antifungal drug resistance in principal fungal pathogens and EUCAST guidance for their laboratory detection and clinical implications.The Journal of antimicrobial chemotherapy · 2022Review
- Sero-Epidemiology ofJournal of fungi (Basel, Switzerland) · 2022Article
- Update on Dihydropteroate Synthase (DHPS) Mutations inJournal of fungi (Basel, Switzerland) · 2021Review
- Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium.Antibiotics (Basel, Switzerland) · 2020Review
- Diagnosing Pneumocystis jirovecii pneumonia: A review of current methods and novel approaches.Medical mycology · 2020Review
- Consensus Multilocus Sequence Typing Scheme forJournal of fungi (Basel, Switzerland) · 2020Review
- Trimethoprim and other nonclassical antifolates an excellent template for searching modifications of dihydrofolate reductase enzyme inhibitors.The Journal of antibiotics · 2020Review
- Recent Advances in Nanotechnology-Aided Materials in Combating Microbial Resistance and Functioning as Antibiotics Substitutes.International journal of nanomedicine · 2020Review
- Article
- Article
- Genetic polymorphisms associated with treatment failure and mortality in pediatric Pneumocystosis.Scientific reports · 2019Article
- Efficacy of caspofungin combined with clindamycin for Pneumocystis jirovecii pneumonia in a systemic lupus erythematosus patient: A case report and literature review.Respiratory medicine case reports · 2019Article
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Authors and funding
11 authors at 5 institutions in 5 countries.
Funding
Abstract
Mutations in the dihydropteroate synthase (DHPS) gene of Pneumocystis jirovecii are associated with the failure of sulfa prophylaxis. They can develop by selection in patients receiving sulfa drugs or be acquired via person-to-person transmission. DHPS mutations raise concern about the decreasing efficacy of sulfa drugs, the main available therapeutic tool for Pneumocystis pneumonia (PCP). The prevalence of Pneumocystis DHPS mutations was examined in Pneumocystis isolates from 56 sulfa-prophylaxis-naive adults with a first episode of PCP from 2002 to 2010 in Santiago, Chile. Their clinical history was reviewed to analyze the effect of these mutations on response to trimethoprim-sulfamethoxazole (TMP-SMX) therapy and outcome. Mutant genotypes occurred in 22 (48%) of 46 HIV-infected patients and in 5 (50%) of 10 HIV-uninfected patients. Compared to patients with a wild-type genotype, those with mutant genotypes were more likely to experience sulfa treatment-limiting adverse reactions and to have a twice-longer duration of mechanical ventilation if mechanically ventilated. Specific genotypes did not associate with death, which occurred in none of the HIV-infected patients and in 50% of the non-HIV-infected patients. Chile has a high prevalence of DHPS mutations, which were presumably acquired through interhuman transmission because patients were not on sulfa prophylaxis. These results contrast with the low prevalence observed in other Latin American countries with similar usage of sulfa drugs, suggesting that additional sources of resistant genotypes may be possible. The twice-longer duration of mechanical ventilation in patients with mutant DHPS genotypes suggests a decreased efficacy of TMP-SMX and warrants collaborative studies to assess the relevance of DHPS mutations and further research to increase therapeutic options for PCP.
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