Abstract

The agents of cryptococcosis C. neoformans and C. gattii are important agents of meningoencephalitis in immunocompromised and immunocompetent hosts, respectively. They are grouped into eight major molecular types, VNI-VNIV for C. neoformans and VGI-VGIV for C. gattii. These major molecular types differ in their host range, epidemiology, antifungal susceptibility and geographic distribution. To enable a rapid identification of the major molecular types and potential hybrids within the two species specific probes based on the PLB1 gene in combination with hyperbranched rolling circle amplification (HRCA) were developed. HRCA was applied to 76 cryptococcal strains, 10 strains each representing the 7 haploid major molecular types, 4 VNIII hybrid strains and 2 inter-species hybrid strains. All strains were correctly identified to the major molecular type and or hybrid type using HRCA alone. To increase the sensitivity a semi-nested PCR step was developed, which will enable the identification of the molecular types/hybrids directly from clinical samples, harboring a low copy number of DNA (40 copies). Thus, HRCA based on the PLB1 locus alone and in combination with a semi-nested PCR showed to be a specific and sensitive methodology, with a great potential to be used on clinical specimens for the direct diagnosis of the agents of cryptococcosis, including hybrid strains, enabling a rapid and patient tailored treatment choice of this disease.

Highlights

  • Cryptococcosis is a systemic mycosis acquired by inhalation of infectious propagules produced by the basidiomycetous yeasts Cryptococcus neoformans and C. gattii.Most clinical laboratories do not routinely identify the isolates to species level

  • The current study aimed to develop specific probes in combination with hyperbranched rolling circle amplification (HRCA) to identify the eight major molecular types (VNI-VNIV and VGI-VGIV) within this species complex

  • Unlike for the loci SOD1, GPD1 and LAC1, for which different primer pairs are needed to amplify these loci form either C. neoformans or C. gattii, which would require a previous identification of both species

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Summary

Introduction

Cryptococcosis is a systemic mycosis acquired by inhalation of infectious propagules (desiccated yeasts cells or spores) produced by the basidiomycetous yeasts Cryptococcus neoformans and C. gattii. Most clinical laboratories do not routinely identify the isolates to species level. Cryptococcosis is associated with a significant morbidity and mortality and is the most common invasive fungal infection in HIV patients, with an estimated incidence of 1 million cases annually [1], mainly caused by. C. gattii on the other hand affects mostly immunocompetent individuals [2,3]. Molecular epidemiological studies have identified eight major molecular types within both species. The C. neoformans molecular types correlate with the serotypes: VNI/AFLP1, serotype A; VNII/AFLP1A, serotype A; VNIII/

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