Possible Development of Resistance to Fluconazole During Suppressive Therapy for AIDS-Associated Cryptococcal Meningitis

Armengou, Arola; Porcar, C; Mascaró, Jaume; García‐Bragado, F.

doi:10.1093/clinids/23.6.1337-a

Cited by 60 publications

(53 citation statements)

References 4 publications

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“…The C. neoformans susceptibility to fluconazole could be an important predictor of treatment success and MICs can be useful to monitor possible development of resistance during therapy and to identify primary resistance (1,3,4,13,14,15,19). Table 2 shows that YNB-1 provided higher MICs than RPMI 1640 medium.…”

Section: Resultsmentioning

confidence: 99%

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Different culture media applied to the study of Cryptococcus neoformans susceptibility to amphotericin B and fluconazole

Alves¹,

Oliveira

Goulart

et al. 2002

Braz. J. Microbiol.

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This study compared the performance of three culture media used for the determination of minimal inhibitory concentration (MIC) of amphotericin B and fluconazole against 48 Cryptococcus neoformans strains. For amphotericin B the media employed were RPMI 1640 medium, as indicated by NCCLS as reference, Yeast Nitrogen Base (YNB) as proposed by Ghannoum et al. (YNB-1), Antibiotic medium 3 (AM3) indicated by others, and YNB as proposed by us (YNB-2). In YNB-1, amphotericin B showed broader MIC ranges, varying from 0.125 µg/ml to 1.0 µg/ml; in RPMI 1640 medium and YNB-2 the MICs were similar and in AM3 the MIC ranges were narrower. The same pattern was observed for MIC 90%. For fluconazole the media employed were RPMI 1640 and YNB-1. The MIC ranges were broader and elevated when YNB-1 was employed. MIC 50% were 2.0 µg/ml in RPMI 1640 medium and 4.0 µg/ml in YNB-1. Our results indicate that RPMI 1640 supplemented with 2% glucose allowed a good growth at 48h; YNB as recommended by Ghannoum et al. provided a broader MIC range, AM3 provided a narrow MIC range for amphotericin B, and YNB-2 was very similar to RPMI 1640 medium.

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Section: Resultsmentioning

confidence: 99%

“…Amphotericin B (8,9,10,17) and fluconazole-C. neoformans-resistant strains were detected in antifungal susceptibility tests (1,13,14,15).…”

Section: Introductionmentioning

confidence: 99%

Different culture media applied to the study of Cryptococcus neoformans susceptibility to amphotericin B and fluconazole

Alves¹,

Oliveira

Goulart

et al. 2002

Braz. J. Microbiol.

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“…It may be added in this context that relapses in patients with AIDSassociated cryptococcosis are often due to deterioration of the host immune function rather than to an increase in MICs (Witt et al, 1996). However, a rising MIC of fluconazole has been implicated in clinical relapse in patients with AIDS-associated cryptococcal meningitis (Paugam et al, 1994;Birley et al, 1995;Currie et al, 1995;Armengou et al, 1996;Berg et al, 1998;Davey et al, 1998;Aller et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

In vitro antifungal susceptibility profiles and genotypes of 308 clinical and environmental isolates of Cryptococcus neoformans var. grubii and Cryptococcus gattii serotype B from north-western India

Chowdhary

Randhawa

Sundar

et al. 2011

Journal of Medical Microbiology

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“…In total, 11.2% of the strains were resistant to fluconazole, and 65% were susceptible-dose dependent (57). Furthermore, the emergence of azole resistance has been documented for AIDS patients undergoing long-term fluconazole therapy (17,449). Recent epidemiological studies observed that isolates collected from different geographic regions have altered susceptibilities to fluconazole, as emerging resistance was documented among isolates from the Asia-Pa-cific, Africa/Middle East, and Latin America regions but not among isolates from Europe or North America (458).…”

Section: Cryptococcus Neoformans Drug Resistance: the Azolesmentioning

confidence: 99%

Regulatory Circuitry Governing Fungal Development, Drug Resistance, and Disease

Shapiro

Robbins

Cowen

2011

Microbiol Mol Biol Rev

492

547

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SUMMARY Pathogenic fungi have become a leading cause of human mortality due to the increasing frequency of fungal infections in immunocompromised populations and the limited armamentarium of clinically useful antifungal drugs. Candida albicans , Cryptococcus neoformans , and Aspergillus fumigatus are the leading causes of opportunistic fungal infections. In these diverse pathogenic fungi, complex signal transduction cascades are critical for sensing environmental changes and mediating appropriate cellular responses. For C. albicans , several environmental cues regulate a morphogenetic switch from yeast to filamentous growth, a reversible transition important for virulence. Many of the signaling cascades regulating morphogenesis are also required for cells to adapt and survive the cellular stresses imposed by antifungal drugs. Many of these signaling networks are conserved in C. neoformans and A. fumigatus , which undergo distinct morphogenetic programs during specific phases of their life cycles. Furthermore, the key mechanisms of fungal drug resistance, including alterations of the drug target, overexpression of drug efflux transporters, and alteration of cellular stress responses, are conserved between these species. This review focuses on the circuitry regulating fungal morphogenesis and drug resistance and the impact of these pathways on virulence. Although the three human-pathogenic fungi highlighted in this review are those most frequently encountered in the clinic, they represent a minute fraction of fungal diversity. Exploration of the conservation and divergence of core signal transduction pathways across C. albicans , C. neoformans , and A. fumigatus provides a foundation for the study of a broader diversity of pathogenic fungi and a platform for the development of new therapeutic strategies for fungal disease.

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Possible Development of Resistance to Fluconazole During Suppressive Therapy for AIDS-Associated Cryptococcal Meningitis

Cited by 60 publications

References 4 publications

Different culture media applied to the study of Cryptococcus neoformans susceptibility to amphotericin B and fluconazole

Different culture media applied to the study of Cryptococcus neoformans susceptibility to amphotericin B and fluconazole

In vitro antifungal susceptibility profiles and genotypes of 308 clinical and environmental isolates of Cryptococcus neoformans var. grubii and Cryptococcus gattii serotype B from north-western India

Regulatory Circuitry Governing Fungal Development, Drug Resistance, and Disease

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