Electrophoretic karyotypes of C. neoformans serotype A recovered from Thai patients with AIDS.

Thirty-seven clinical isolates of C. neoformans were recovered from AIDS patients and all were serotype A according to standard typing tests. They were further analyzed using RAPD, PCR fingerprinting, and PFGE along with 2 additional reference isolates ATCC 34871 (serotype A) and RV 45981 (serotype D). Using 2 different RAPD primers, all of the clinical isolates and the reference serotype A (ATCC 34871) gave similar RAPD patterns while serotype D (RV 45981) gave distinctive pattern. Corresponding result was also obtained upon PCR by using a primer for microsatellite (GACA)4. However, using a primer specific to minisatellite M13+1, all PCR fingerprinting gave similar gel patterns (M1) for 35/37 of the clinical isolates and the reference serotype A while two clinical isolates generated different patterns called M2 and M3. The reference serotype D gave distinctive pattern called M4. PFGE gave 17 different karyotypes that could be categorized into 4 groups named EKA (1-6), EKB (1-5), EKC (1- 5) and EKD (1). The reference serotype A fell into group EKA as EKA6 while the reference serotype D fell into group EKC as EKC5. Among the clinical isolates, EKA group (20/37 isolates) and type EKA1 (16/20) dominated with only one isolate each for types EKA2 to EKA5. The next most prevalent was group EKB (12/37 isolates) which dominately fell in type EKB1 (8/12) and only one isolate each for types EKB2 to EKB5. Group EKC (4/37 isolates) and group EKD (1/37) had only one isolate for each type (EKC1 to EKC 4 and EKD1). The 2 predominant karyotypes (EKA1, 16/37 and EKB1, 8/37) may represent two originally common clones of C. neoformans expose among the patients. The high discriminatory power of PFGE infers the benefit of subtyping which lead to better understanding on the epidemiology and pathogenic potential of C. neoformans subtypes. Moreover, PCR fingerprinting and RAPD infer the feasibility of detail analysis between serotypes A and D for unencapsulated C. neoformans.

Modified antimicrobial disc susceptibility testing for nutritionally-variant streptococci.

Streptococci that were dependent for their growth upon staphylococci were isolated from a patient with sub-acute bacterial endocarditis and subsequently identified as nutritionally-variant streptococci (NVS). Failure of the isolate to grow on agar media supplemented with pyridoxal hydrochloride or L-cysteine, the known supporting growth factors for NVS, made conventional antimicrobial disc diffusion assay impossible. We modified the assay by co-inoculating Staphylococcus aureus resistant to the drugs being tested as a helper to support the growth of the NVS. Streaking S. aureus closely to the antibiotic discs that were placed above NVS resulted in the growth of satellite colonies of NVS that orbited the S. aureus and that produced a pattern of interrupted zones of growth inhibition. Using an alternative method--adding staphylococcal secreting factor(s) to a 10% staphylococcal cell-free culture supernatant and adding this to an antibiotic susceptibility testing medium,--we found that the NVS formed colonies that formed clear zones of growth inhibition around the disc. When the sizes of the growth inhibition zones produced by both these methods were compared with those recommened by the NCCLS, the NVS were found to be susceptible to penicillin, vancomycin, erythromycin, chloramphenicol, cefoperazone, cefamandole and ofloxacin and resistant to co-trimoxazole, gentamicin and tetracycline. Based on these findings, vancomycin was selected for treatment and the patient was cured of endocarditis. The correlation between the in vitro drug susceptibility testing and the in vivo clinical response indicated that the modified antibiotic susceptibility test is an appropriate method for establishing antibiotic regimens.