Typing of Pneumocystis jirovecii isolates from Iranian immunosuppressed patients based on the Internal Transcribed Spacer (ITS) region of the rRNA gene.

Since there have been no published molecular studies of Pneumocystis jirovecii isolates from Iranian patients, we investigated the genotypes of such isolates recovered from HIV-infected patients, those undergoing cancer chemotherapy and patients with chronic obstructive pulmonary disease (COPD). P. jirovecii typing, based on ITS1 and ITS2 sequence analysis, was performed on 34 isolates from Iranian immunosuppressed patients. In total, 44 genotypes were detected of which relative to ITS1, eight known genotypes (A, B, C, E, G, H, N and O) and one novel sequence were noted. Eight known genotypes (b, c, e, g, h, i, j and n) were also found with ITS2. The most frequent ITS1 and ITS2 genotypes were E (21/44, 47.7%) and g (22/44, 50%), respectively. From determined haplotypes, the four most frequent ones were Eg (11/44, 25%), Gg (5/44, 11.3%), Gi (4/44, 9.1%), Ei (3/44, 6.8%), and Hg (3/44, 6.8%). Two novel haplotypes (Hb and Hi) were also identified, along with mixed infections as seven (20.5%) patients were found to have more than one haplotype. It is suggested that novel haplotypes in Iranian patients may be generated through sexual recombination within the host.