Two isolates of Candida glabrata from the same stool sample from a bone marrow transplant recipient treated with fluconazole, and designated 1084-L for large colonies on yeast extract-peptone-dextrose-agar and 1084-S for small colonies, were analysed. In-vitro susceptibility tests with a commercially available disk diffusion procedure showed that isolate 1084-L had a susceptibility pattern typical of wild-type strains of C. glabrata with sensitivity to polyenes and the presence of resistant colonies randomly distributed within the inhibition zones for all azole compounds except tioconazole. In contrast, isolate 1084-S, which was found by pulsed-field gel electrophoresis and random amplification of polymorphic DNA to be genetically closely related to isolate 1084-L, exhibited cross-resistance to the azole compounds except tioconazole. Determination of MICs by the E-test method confirmed these results, showing that isolate 1084-S had greater sensitivity to amphotericin B and complete resistance to ketoconazole and fluconazole. Growth on agar plates containing glucose or glycerol as the sole carbon source suggested that the resistant isolate had a respiratory deficiency, which was further demonstrated by flow cytometric analysis of the fluorescence of rhodamine 123-stained blastoconidia. Restriction endonuclease analysis of mitochondrial DNA (mtDNA) established the mitochondrial origin of the respiratory deficiency. However, PCR amplification of the mtDNA with primers ML1 and ML6, as well as transmission electron microscopy, suggested a partial deletion of the mtDNA analogous to that described for rho- petite mutants of Saccharomyces cerevisiae. Together, these results provided evidence that the selection of azole-resistant petite mutants of C. glabrata may occur in vivo after fluconazole administration, which might explain, therefore, clinical failure of antifungal therapy.

译文

:分析了来自两个接受氟康唑处理的骨髓移植受者相同粪便样品的光滑念珠菌分离物,分别将其在酵母提取物-pe-葡萄糖-琼脂上的大菌落命名为1084-L,在小菌落上命名为1084-S。使用市售的磁盘扩散程序进行的体外药敏试验表明,分离株1084-L具有典型的光滑毛孢菌野生型药敏模式,对多烯敏感,并且所有菌落均在抑制区内随机分布有抗性菌落。噻康唑以外的其他唑化合物。相反,通过脉冲场凝胶电泳和多态性DNA的随机扩增发现分离株1084-S在遗传上与分离株1084-L密切相关,除噻康唑外,对唑类化合物表现出交叉耐药性。通过E-test法测定MIC证实了这些结果,表明分离物1084-S对两性霉素B的敏感性更高,对酮康唑和氟康唑的完全耐药性。在含有葡萄糖或甘油作为唯一碳源的琼脂平板上生长表明该抗性分离株具有呼吸道缺陷,这通过若丹明123染色的球孢子菌荧光的流式细胞术分析进一步证实。线粒体DNA(mtDNA)的限制性核酸内切酶分析确定了呼吸不足的线粒体起源。但是,用引物ML1和ML6进行mtDNA的PCR扩增以及透射电镜观察,表明部分mtDNA缺失,类似于酿酒酵母变节菌突变体中所述。在一起,这些结果提供了证据,在给予氟康唑后,可能在体内发生了光滑毛孢梭菌的耐唑性娇小突变体的选择,因此,这可能解释了抗真菌治疗的临床失败。

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