Pub Date : 2026-01-06DOI: 10.1016/j.mycmed.2026.101600
Camille Cordier , Marie Desnos-Ollivier , Chloë Lemaire , Céline Goéminne , Jordan Leroy , Marjorie Cornu , Pauline Coulon , Séverine Loridant , Ady Assaf , Fanny Vuotto
Trichosporon spp. are ubiquitous basidiomycetous yeast-like fungi, widely distributed in the environment and commonly found in the skin and gastrointestinal microbiota. Trichosporon asahii is the most frequently implicated species in invasive trichosporonosis, usually followed by Trichosporon inkin. In recent years, the incidence of invasive fungal diseases (IFD) caused by rare yeasts of Trichosporon species has increased, predominantly affecting immunocompromised patients.
Since the late 1990s, several cases of IFD due to Trichosporon inkin sensu lato were reported in European hospitals (France, Spain and UK) in patients with history of thoracic surgery. Recently, Trichosporon austroamericanum has been identified as a new species phylogenetically related to T. inkin.
Here, we describe a fatal case of disseminated T. austroamericanum infection following heart transplantation, which was initially identified as T. inkin. Given the recent description of T. austroamericanum as a species closely related to T. inkin, we conducted a comprehensive review of all reported T. inkin sensu lato infections occurring after thoracic surgery.
{"title":"Invasive Trichosporon austroamericanum infection following heart transplantation: a case report and literature review of Trichosporon inkin sensu lato infections after thoracic surgery","authors":"Camille Cordier , Marie Desnos-Ollivier , Chloë Lemaire , Céline Goéminne , Jordan Leroy , Marjorie Cornu , Pauline Coulon , Séverine Loridant , Ady Assaf , Fanny Vuotto","doi":"10.1016/j.mycmed.2026.101600","DOIUrl":"10.1016/j.mycmed.2026.101600","url":null,"abstract":"<div><div><em>Trichosporon</em> spp. are ubiquitous basidiomycetous yeast-like fungi, widely distributed in the environment and commonly found in the skin and gastrointestinal microbiota. <em>Trichosporon asahii</em> is the most frequently implicated species in invasive trichosporonosis, usually followed by <em>Trichosporon inkin</em>. In recent years, the incidence of invasive fungal diseases (IFD) caused by rare yeasts of <em>Trichosporon</em> species has increased, predominantly affecting immunocompromised patients.</div><div>Since the late 1990s, several cases of IFD due to <em>Trichosporon inkin sensu lato</em> were reported in European hospitals (France, Spain and UK) in patients with history of thoracic surgery. Recently, <em>Trichosporon austroamericanum</em> has been identified as a new species phylogenetically related to <em>T. inkin</em>.</div><div>Here, we describe a fatal case of disseminated <em>T. austroamericanum</em> infection following heart transplantation, which was initially identified as <em>T. inkin</em>. Given the recent description of <em>T. austroamericanum</em> as a species closely related to <em>T. inkin</em>, we conducted a comprehensive review of all reported <em>T. inkin sensu lato</em> infections occurring after thoracic surgery.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101600"},"PeriodicalIF":1.8,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.mycmed.2025.101599
Dandan Gong , Weiyin Lin , Yaozu He , Huihua Zhang , Heping Zhao , Shaozhen Chen , Xuemei Ling , Pengle Guo , Xiaoping Tang , Linghua Li
Objective
To compare the long-term outcomes among AIDS patients with and without talaromycosis following initiation of antiretroviral therapy (ART).
Methods
This retrospective study included ART-naïve AIDS patients hospitalized at Guangzhou Eighth People's Hospital between January 1 and December 31, 2018. During the study period, ART was initiated in all patients per the standard of care. Virological outcomes, immunological responses, and mortality rates were assessed over the following five years.
Results
A total of 299 patients were included and 96 (32.1 %) were infected with Talaromyces marneffei. At baseline, patients with talaromycosis had a significantly lower CD4+ count (12.0 cells/μL vs. 41.0 cells/μL) and CD4+/CD8+ ratio (0.06 vs. 0.10) (all P < 0.01). By 60 months, the CD4+ count had significantly increased to 370.0 cells/μL in the talaromycosis group and to 427.5 cells/μL in the non-talaromycosis group. The CD4+/CD8+ ratio improved to 0.53 and 0.56. The incidence of immune non-responders (INRs) during 24–60 months of follow-up in the two groups were 66.7 % vs. 55.4 %, 58.0 % vs. 50.6 %, 56.9 % vs. 47.6 %, 46.8 % vs. 40.5 %, 43.8 % vs. 32.9 %, 42.6 % vs. 29.2 %, 39.1 % vs. 31.1 %, respectively. Generally, differences in immune reconstitution were evident during the first 24 months but became non-significant between 30 and 60 months. The rates of viral suppression in the non-talaromycosis and talaromycosis groups during the five-year follow-up were 77.0 % vs. 71.0 %, 92.9 % vs. 91.2 %, 92.7 % vs. 86.3 %, 94.9 % vs. 90.0 %, 90.8 % vs. 93.6 %, respectively, and were comparable between the two groups (P = 0.18, 0.96, 0.37, 0.47, and 0.83). Similarly, the cumulative mortality did not differ significantly (11.3 % vs. 15.0 %, P = 0.345).
Conclusion
ART has a sustained impact on immune reconstitution, and the long-term outcomes of AIDS patients with talaromycosis are not inferior to those without talaromycosis. Therefore, timely ART is critical for improving prognosis of AIDS patients with talaromycosis.
目的：比较开始抗逆转录病毒治疗（ART）后伴有和不伴有塔拉香霉病的艾滋病患者的长期预后。方法：回顾性研究纳入广州市第八人民医院2018年1月1日至12月31日住院的ART-naïve艾滋病患者。在研究期间，根据护理标准，所有患者都开始接受抗逆转录病毒治疗。在接下来的五年中，对病毒学结果、免疫反应和死亡率进行了评估。结果：共纳入299例患者，其中96例（32.1%）感染马尔尼菲Talaromyces marneffei。基线时，talaromyosis患者CD4+计数（12.0 cells/μL vs. 41.0 cells/μL）和CD4+/CD8+比值（0.06 vs. 0.10）均显著降低（P < 0.01）。到60个月时，黑曲霉病组CD4+计数明显增加，为370.0 cells/μL，非黑曲霉病组为427.5 cells/μL。CD4+/CD8+比值分别提高至0.53和0.56。两组患者随访24 ~ 60个月免疫无应答（INRs）发生率分别为66.7% vs 55.4%、58.0% vs 50.6%、56.9% vs 47.6%、46.8% vs 40.5%、43.8% vs 32.9%、42.6% vs 29.2%、39.1% vs 31.1%。一般来说，免疫重建的差异在前24个月是明显的，但在30至60个月之间变得不显著。在5年随访期间，非talaromyosis组和talaromyosis组的病毒抑制率分别为77.0% vs. 71.0%, 92.9% vs. 91.2%, 92.7% vs. 86.3%, 94.9% vs. 90.0%, 90.8% vs. 93.6%，两组之间具有可比性（P = 0.18, 0.96, 0.37, 0.47和0.83）。同样，累积死亡率也没有显著差异（11.3%比15.0%,P = 0.345）。结论：抗逆转录病毒治疗对免疫重建有持续的影响，伴他檀菌病的艾滋病患者的远期预后不逊于无他檀菌病的患者。因此，及时进行抗逆转录病毒治疗对于改善艾滋病合并塔兰菌病患者的预后至关重要。
{"title":"Long-term treatment outcomes among AIDS patients with and without talaromycosis: A retrospective study","authors":"Dandan Gong , Weiyin Lin , Yaozu He , Huihua Zhang , Heping Zhao , Shaozhen Chen , Xuemei Ling , Pengle Guo , Xiaoping Tang , Linghua Li","doi":"10.1016/j.mycmed.2025.101599","DOIUrl":"10.1016/j.mycmed.2025.101599","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the long-term outcomes among AIDS patients with and without talaromycosis following initiation of antiretroviral therapy (ART).</div></div><div><h3>Methods</h3><div>This retrospective study included ART-naïve AIDS patients hospitalized at Guangzhou Eighth People's Hospital between January 1 and December 31, 2018. During the study period, ART was initiated in all patients per the standard of care. Virological outcomes, immunological responses, and mortality rates were assessed over the following five years.</div></div><div><h3>Results</h3><div>A total of 299 patients were included and 96 (32.1 %) were infected with <em>Talaromyces marneffei</em>. At baseline, patients with talaromycosis had a significantly lower CD4<sup>+</sup> count (12.0 cells/μL vs. 41.0 cells/μL) and CD4<sup>+</sup>/CD8<sup>+</sup> ratio (0.06 vs. 0.10) (all <em>P</em> < 0.01). By 60 months, the CD4<sup>+</sup> count had significantly increased to 370.0 cells/μL in the talaromycosis group and to 427.5 cells/μL in the non-talaromycosis group. The CD4<sup>+</sup>/CD8<sup>+</sup> ratio improved to 0.53 and 0.56. The incidence of immune non-responders (INRs) during 24–60 months of follow-up in the two groups were 66.7 % vs. 55.4 %, 58.0 % vs. 50.6 %, 56.9 % vs. 47.6 %, 46.8 % vs. 40.5 %, 43.8 % vs. 32.9 %, 42.6 % vs. 29.2 %, 39.1 % vs. 31.1 %, respectively. Generally, differences in immune reconstitution were evident during the first 24 months but became non-significant between 30 and 60 months. The rates of viral suppression in the non-talaromycosis and talaromycosis groups during the five-year follow-up were 77.0 % vs. 71.0 %, 92.9 % vs. 91.2 %, 92.7 % vs. 86.3 %, 94.9 % vs. 90.0 %, 90.8 % vs. 93.6 %, respectively, and were comparable between the two groups (<em>P</em> = 0.18, 0.96, 0.37, 0.47, and 0.83). Similarly, the cumulative mortality did not differ significantly (11.3 % vs. 15.0 %, <em>P</em> = 0.345).</div></div><div><h3>Conclusion</h3><div>ART has a sustained impact on immune reconstitution, and the long-term outcomes of AIDS patients with talaromycosis are not inferior to those without talaromycosis. Therefore, timely ART is critical for improving prognosis of AIDS patients with talaromycosis.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101599"},"PeriodicalIF":1.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.mycmed.2025.101598
Yuqing Sun , Xiao Cui , Yulin Zhang
Aspergillus fumigatus (A. fumigatus) has a life-threatening effect in immunocompromised populations, underscore the vital role played by the interplay between the host immune response and this fungal pathogen. Alveolar macrophage (AM) situated within the alveolar spaces serve as the primal immune cells to engage with inhaled Aspergillus conidia. These AMs deploy various strategies to resist A. fumigatus assaults. Their capacity to eliminate A. fumigatus is contingent upon LC3-associated phagocytosis (LAP), an immunological safeguard against microbial intrusions. Furthermore, the propensity for apoptosis fosters frequent inter-macrophage transfer of A. fumigatus, thereby facilitating control over conidia germination. The activation of inflammasomes and the subsequent release of cytokines and chemokines also constitutes a crucial defensive mechanism employed by AM against A. fumigatus invasions. This review delves into the intricate immune reactions and protective manners mounted by macrophages during A. fumigatus infection. Unraveling the interactions between the host immune system and A. fumigatus could pave the way for innovative therapeutic interventions.
{"title":"The innate immune response to A. fumigatus in alveolar macrophages: Roles of LC3-associated phagocytosis, apoptosis and inflammation","authors":"Yuqing Sun , Xiao Cui , Yulin Zhang","doi":"10.1016/j.mycmed.2025.101598","DOIUrl":"10.1016/j.mycmed.2025.101598","url":null,"abstract":"<div><div><em>Aspergillus fumigatus</em> (<em>A. fumigatus</em>) has a life-threatening effect in immunocompromised populations, underscore the vital role played by the interplay between the host immune response and this fungal pathogen. Alveolar macrophage (AM) situated within the alveolar spaces serve as the primal immune cells to engage with inhaled Aspergillus conidia. These AMs deploy various strategies to resist A. fumigatus assaults. Their capacity to eliminate <em>A. fumigatus</em> is contingent upon LC3-associated phagocytosis (LAP), an immunological safeguard against microbial intrusions. Furthermore, the propensity for apoptosis fosters frequent inter-macrophage transfer of <em>A. fumigatus</em>, thereby facilitating control over conidia germination. The activation of inflammasomes and the subsequent release of cytokines and chemokines also constitutes a crucial defensive mechanism employed by AM against <em>A. fumigatus</em> invasions. This review delves into the intricate immune reactions and protective manners mounted by macrophages during <em>A. fumigatus</em> infection. Unraveling the interactions between the host immune system and <em>A. fumigatus</em> could pave the way for innovative therapeutic interventions.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101598"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145742303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.mycmed.2025.101595
Jade André de Souza , Roger Ferreira Gomes , Paula Reginatto , Gabriella da Rosa Monte Machado , Alexandre Meneghello Fuentefria
Fungal infections represent a significant public health challenge due to their high mortality rates, which can be exacerbated by the ability of fungi, especially Candida species, to form biofilms on medical devices. These opportunistic pathogens are causing candidemia in debilitated patients, contributing to increased hospitalization costs and prolonged recovery times. The existing antifungal therapy has some limitations, including high costs, significant toxicity and the emergence of fungal resistance. In this context, drug repositioning and combined therapy may be an alternative. The 8-hydroxiquinoline's derivatives, like nitroxoline (NTX), have shown biological activities, such as antibacterial and antifungal. This study evaluated the antibiofilm potential of NTX, both in its isolated form and in combination, as a new alternative against yeasts and biofilms of clinical interest. The combinations were tested using the checkerboard technique and the drugs were tested against Candida spp. and Trichosporon spp. biofilms at MIC, MICx2, MICx10 and MICx20. The triple combination of NTX, amphotericin B (AMB) and caspofungin (CSP) showed greater effectiveness, with synergic action, against most of the strains. NTX and its combination with AMB and CSP showed excellent action against Candida spp. and Trichosporon spp, being the most effective in reducing the metabolic activities of the biofilm cells. Hence, NTX and its combination showed a promising antifungal and antibiofilm potential, and its repositioning could represent an immediate and safe alternative in the routine of preventing and treating infections in patients using medical devices.
{"title":"Nitroxoline and its combination with antifungals: An alternative for the treatment of fungal biofilm","authors":"Jade André de Souza , Roger Ferreira Gomes , Paula Reginatto , Gabriella da Rosa Monte Machado , Alexandre Meneghello Fuentefria","doi":"10.1016/j.mycmed.2025.101595","DOIUrl":"10.1016/j.mycmed.2025.101595","url":null,"abstract":"<div><div>Fungal infections represent a significant public health challenge due to their high mortality rates, which can be exacerbated by the ability of fungi, especially <em>Candida</em> species, to form biofilms on medical devices. These opportunistic pathogens are causing candidemia in debilitated patients, contributing to increased hospitalization costs and prolonged recovery times. The existing antifungal therapy has some limitations, including high costs, significant toxicity and the emergence of fungal resistance. In this context, drug repositioning and combined therapy may be an alternative. The 8-hydroxiquinoline's derivatives, like nitroxoline (NTX), have shown biological activities, such as antibacterial and antifungal. This study evaluated the antibiofilm potential of NTX, both in its isolated form and in combination, as a new alternative against yeasts and biofilms of clinical interest. The combinations were tested using the checkerboard technique and the drugs were tested against <em>Candida</em> spp. and <em>Trichosporon</em> spp. biofilms at MIC, MICx2, MICx10 and MICx20. The triple combination of NTX, amphotericin B (AMB) and caspofungin (CSP) showed greater effectiveness, with synergic action, against most of the strains. NTX and its combination with AMB and CSP showed excellent action against <em>Candida</em> spp. and <em>Trichosporon</em> spp, being the most effective in reducing the metabolic activities of the biofilm cells. Hence, NTX and its combination showed a promising antifungal and antibiofilm potential, and its repositioning could represent an immediate and safe alternative in the routine of preventing and treating infections in patients using medical devices.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101595"},"PeriodicalIF":1.8,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145584335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.mycmed.2025.101596
Karima Gourari-Bouzouina , Zahia Boucherit-Otmani , Abdelfettah Seghir , Zahira Zakia Baba Ahmed-Kazi Tani , Imene Bendoukha , Abdeselem Benahmed , Mohammed Aissaoui , Kebir Boucherit
Cystic fibrosis (CF) is associated with recurring lung infections, which are commonly caused by Staphylococcus aureus and Candida species. These pathogens often form polymicrobial biofilms that are resistant to conventional treatments. Studying their interactions and testing effective therapies is essential for better CF infection control. The current study aimed to examine the antifungal and antibacterial activity of each alone against Candida species and S. aureus co-isolated in both states, planktonic and biofilm (single and polymicrobial biofilm), then in combination for the mixed biofilm of C. tropicalis-S. aureus24. Both Candida spp. and S. aureus isolates were sensitive to the tested antifungals and antibiotics in planktonic mode. However, in biofilm mode, SMICs were up to 32 times higher than SMICs for both species. Thus, all the strains tested are capable of forming biofilms. Treatment of multi-species biofilms (C. tropicalis1/S. aureus24) with combinations of antifungals and antibiotics (AmB/VAN, AmB/AK, AmB/GEN, AmB/CIP) and (Vrc/VAN, Vrc/AK, Vrc/GEN, Vrc/CIP) showed a significant reduction in SMICs compared with those obtained with the two antimicrobials separately. Calculation of the FICIs highlighted two types of interactions, synergistic and indifferent, between the antifungals and the antibiotics tested. The study shows that antifungal-antibiotic combinations can effectively reduce biofilm resistance in CF infections. These synergistic effects may improve treatment outcomes while lowering drug doses and resistance risk.
{"title":"Antimicrobial susceptibility testing of mixed biofilms formed by Candida spp. and Staphylococcus aureus co-isolated from the sputum of cystic fibrosis patients in Northwest Algeria","authors":"Karima Gourari-Bouzouina , Zahia Boucherit-Otmani , Abdelfettah Seghir , Zahira Zakia Baba Ahmed-Kazi Tani , Imene Bendoukha , Abdeselem Benahmed , Mohammed Aissaoui , Kebir Boucherit","doi":"10.1016/j.mycmed.2025.101596","DOIUrl":"10.1016/j.mycmed.2025.101596","url":null,"abstract":"<div><div>Cystic fibrosis (CF) is associated with recurring lung infections, which are commonly caused by <em>Staphylococcus aureus</em> and <em>Candida</em> species. These pathogens often form polymicrobial biofilms that are resistant to conventional treatments. Studying their interactions and testing effective therapies is essential for better CF infection control. The current study aimed to examine the antifungal and antibacterial activity of each alone against <em>Candida</em> species and <em>S. aureus</em> co-isolated in both states, planktonic and biofilm (single and polymicrobial biofilm), then in combination for the mixed biofilm of <em>C. tropicalis-S. aureus</em>24. Both <em>Candida</em> spp. and <em>S. aureus</em> isolates were sensitive to the tested antifungals and antibiotics in planktonic mode. However, in biofilm mode, SMICs were up to 32 times higher than SMICs for both species. Thus, all the strains tested are capable of forming biofilms. Treatment of multi-species biofilms (<em>C. tropicalis1/S. aureus24</em>) with combinations of antifungals and antibiotics (AmB/VAN, AmB/AK, AmB/GEN, AmB/CIP) and (Vrc/VAN, Vrc/AK, Vrc/GEN, Vrc/CIP) showed a significant reduction in SMICs compared with those obtained with the two antimicrobials separately. Calculation of the FICIs highlighted two types of interactions, synergistic and indifferent, between the antifungals and the antibiotics tested. The study shows that antifungal-antibiotic combinations can effectively reduce biofilm resistance in CF infections. These synergistic effects may improve treatment outcomes while lowering drug doses and resistance risk.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101596"},"PeriodicalIF":1.8,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.mycmed.2025.101597
Zhenzhen Wang, Lijuan Xiong, Kai Ma, Juan Liu, Kai Feng, Peng Yang
The purpose of this study was to investigate the etiological spectrum of yeast isolates and the sensitivity to antifungal drugs in our hospital, both during and after the COVID-19 pandemic. A retrospective analysis was conducted from Jan 2020 to Dec 2024, focusing on the results of fungal culture and identification from specimens in our hospital. For the genus Candida, the sensitivity to several antifungal drugs was assessed using the microdilution method (ATB Fungus 3). During the five-y study period, a total of 5776 fungal strains were identified, with Candida species being the most common. Antifungal susceptibility tests revealed differences in the sensitivity of Candida species to various antifungal drugs. Specifically, Candida species exhibited higher sensitivity to amphotericin B, while their sensitivity to itraconazole was relatively lower. C. albicans showed a temporary increase in resistance to certain antifungals (e.g., voriconazole and itraconazole) during 2022–2023, this trend was not sustained in 2024. While the fluctuation in resistance trends of non - albicans Candida species is normal. In conclusion, the changing resistance patterns and underlying mechanisms of Candida albicans warrant close attention. More caution should be exercised in selecting appropriate drugs for the clinical treatment of Candida species.
{"title":"Yeast Spectrum and antifungal susceptibility in a Hospital in Southwestern China: A retrospective Study (2020–2024)","authors":"Zhenzhen Wang, Lijuan Xiong, Kai Ma, Juan Liu, Kai Feng, Peng Yang","doi":"10.1016/j.mycmed.2025.101597","DOIUrl":"10.1016/j.mycmed.2025.101597","url":null,"abstract":"<div><div>The purpose of this study was to investigate the etiological spectrum of yeast isolates and the sensitivity to antifungal drugs in our hospital, both during and after the COVID-19 pandemic. A retrospective analysis was conducted from Jan 2020 to Dec 2024, focusing on the results of fungal culture and identification from specimens in our hospital. For the genus <em>Candida</em>, the sensitivity to several antifungal drugs was assessed using the microdilution method (ATB Fungus 3). During the five-y study period, a total of 5776 fungal strains were identified, with <em>Candida</em> species being the most common. Antifungal susceptibility tests revealed differences in the sensitivity of <em>Candida</em> species to various antifungal drugs. Specifically, <em>Candida</em> species exhibited higher sensitivity to amphotericin B, while their sensitivity to itraconazole was relatively lower. <em>C. albicans</em> showed a <strong>temporary increase</strong> in resistance to certain antifungals (e.g., voriconazole and itraconazole) during 2022–2023, this trend <strong>was not sustained</strong> in 2024. While the fluctuation in resistance trends of non - <em>albicans</em> Candida species is normal. In conclusion, the changing resistance patterns and underlying mechanisms of <em>Candida albicans</em> warrant close attention. More caution should be exercised in selecting appropriate drugs for the clinical treatment of <em>Candida</em> species.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101597"},"PeriodicalIF":1.8,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Vulvovaginal candidiasis (VVC) is a common infection affecting women of reproductive age, associated with various risk factors. Advances in diagnosis and treatment are ongoing, but antifungal resistance remains a concern. This study aimed to evaluate risk factors, species distribution, and antifungal susceptibility of yeast isolates from reproductive-age women at Zion Clinical Laboratory, Yaoundé, Cameroon.
Materials and Methods: A total of 305 women suspected of vaginitis were enrolled. Socio-demographic and risk factor data were collected. Vaginal swabs were cultured on Sabouraud dextrose agar and CHROMagar Candida. Species identification was performed using MALDI-TOF mass spectrometry. Antifungal susceptibility testing was conducted with the Sensititre Yeast One kit to determine minimal inhibitory concentrations (MICs) for multiple antifungals.
Results: The prevalence of VVC was 32.1 %, significantly associated with age (women aged 21 to 36 years showing higher susceptibility to VVC; P = 0.0001) and vaginal douching (P = 0.0004). Eleven yeast species were identified, with Candida albicans predominating (64.2 %), followed by C. orthopsilosis (15.1 %), Nakaseomyces glabratus (C. glabrata) (4.7 %), and C. tropicalis (3.8 %). Most isolates were highly susceptible (>90 %) to amphotericin B but showed reduced susceptibility to azoles, particularly fluconazole (Diflucan).
Conclusion: VVC affects nearly one-third of symptomatic reproductive-age women in this setting, with age and vaginal douching as significant risk factors. The predominance of C. albicans alongside diverse non-albicans species highlights the need for species-level identification. Reduced azole susceptibility stresses the importance of antifungal susceptibility testing to guide effective treatment and prevent resistance. Education on modifiable risk factors is also essential to reduce VVC incidence.
{"title":"Vulvo-vaginal candidiasis at the Zion Clinical Laboratory (Yaounde-Cameroon): risk factors, species distribution and antifungal susceptibility testing","authors":"Thierry Kammalac Ngouana , Aude Ngueguim Dougue , Vincent Ngouana , Romeo Fouemene Tsayem , Youssouf Hamdan Mahamat , Fabrice Fekam Boyom F , Stephane Ranque","doi":"10.1016/j.mycmed.2025.101590","DOIUrl":"10.1016/j.mycmed.2025.101590","url":null,"abstract":"<div><div>Background: Vulvovaginal candidiasis (VVC) is a common infection affecting women of reproductive age, associated with various risk factors. Advances in diagnosis and treatment are ongoing, but antifungal resistance remains a concern. This study aimed to evaluate risk factors, species distribution, and antifungal susceptibility of yeast isolates from reproductive-age women at Zion Clinical Laboratory, Yaoundé, Cameroon.</div><div>Materials and Methods: A total of 305 women suspected of vaginitis were enrolled. Socio-demographic and risk factor data were collected. Vaginal swabs were cultured on Sabouraud dextrose agar and CHROMagar <em>Candida</em>. Species identification was performed using MALDI-TOF mass spectrometry. Antifungal susceptibility testing was conducted with the Sensititre Yeast One kit to determine minimal inhibitory concentrations (MICs) for multiple antifungals.</div><div>Results: The prevalence of VVC was 32.1 %, significantly associated with age (women aged 21 to 36 years showing higher susceptibility to VVC; <em>P</em> = 0.0001) and vaginal douching (<em>P</em> = 0.0004). Eleven yeast species were identified, with <em>Candida albicans</em> predominating (64.2 %), followed by <em>C. orthopsilosis</em> (15.1 %), <em>Nakaseomyces glabratus</em> (<em>C. glabrata</em>) (4.7 %), and <em>C. tropicalis</em> (3.8 %). Most isolates were highly susceptible (>90 %) to amphotericin B but showed reduced susceptibility to azoles, particularly fluconazole (Diflucan).</div><div>Conclusion: VVC affects nearly one-third of symptomatic reproductive-age women in this setting, with age and vaginal douching as significant risk factors. The predominance of <em>C. albicans</em> alongside diverse non-<em>albicans</em> species highlights the need for species-level identification. Reduced azole susceptibility stresses the importance of antifungal susceptibility testing to guide effective treatment and prevent resistance. Education on modifiable risk factors is also essential to reduce VVC incidence.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"36 1","pages":"Article 101590"},"PeriodicalIF":1.8,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Penicillium is a ubiquitous fungus found in the soil, decaying plant material, freshwater, and other habitats. Although Penicillium species are generally harmless to humans, they can act as opportunistic pathogens in patients with a compromised immune system. Penicillium rolfsii is primarily known as an endophytic fungus with antioxidant and antibacterial properties, which has not been previously reported in culture tests from invasive human infections. This study reports the case of an eight-year-old boy who developed pneumonia following a near-drowning incident in a river, with P. rolfsii detected in sputum culture. The patient underwent cardiopulmonary resuscitation at the scene and was subsequently transferred to the intensive care unit at our hospital. Chest computed tomography confirmed severe aspiration pneumonia, and empirical treatment with ampicillin–sulbactam was initiated. Based on elevated β-D-glucan levels, voriconazole was added. Sputum cultures revealed the presence of Penicillium species, which were identified as P. rolfsii based on the β-tubulin gene sequence analysis. The treatment was successful, and the patient recovered. An environmental investigation of the plunge pool where the near-drowning incident occurred detected Penicillium species in the water samples. This is the first reported case of P. rolfsii being detected in culture tests of a human invasive infection, particularly in an otherwise healthy child. This case highlights the need for healthcare professionals to consider environmental fungi in Japanese river water as potential causes of invasive infections, such as pneumonia, particularly after near-drowning incidents.
青霉菌是一种普遍存在于土壤、腐烂的植物材料、淡水和其他栖息地的真菌。尽管青霉菌通常对人类无害，但在免疫系统受损的患者中，它们可以作为机会性病原体。罗尔夫西青霉主要被认为是一种具有抗氧化和抗菌特性的内生真菌，以前没有在侵袭性人类感染的培养试验中报道过。本研究报告了一名8岁男孩在河中溺水后发生肺炎的病例，痰培养中检测到罗尔夫氏杆菌。患者在现场接受心肺复苏，随后转至我院重症监护室。胸部计算机断层扫描证实严重吸入性肺炎，并开始使用氨苄青霉素-舒巴坦进行经验性治疗。根据β- d -葡聚糖水平升高，加入伏立康唑。痰培养显示存在青霉菌，根据β-微管蛋白基因序列分析鉴定为P. rolfsii。治疗很成功，病人康复了。对发生溺水事件的跳水池进行环境调查，在水样中检测到青霉菌。这是第一例在人类侵袭性感染培养试验中发现罗尔夫假单胞杆菌的报告病例，特别是在其他方面健康的儿童中。这个案例强调了医疗保健专业人员需要考虑日本河水中的环境真菌是侵袭性感染的潜在原因，例如肺炎，特别是在溺水事件发生后。
{"title":"Pediatric pneumonia involving Penicillium rolfsii isolated from sputum culture following a plunge pool near-drowning incident","authors":"Shiori Kitaya , Akira Watanabe , Takashi Yaguchi , Junya Nakade , Hatsumi Otani , Yusuke Matsuda , Tatsuya Kubo , Tomoko Azuma , Yui Ikehata , Hiroki Otani , Hiroka Yamazaki , Daichi Miyashita , Yasunari Tanaka , Yoshinori Takahashi , Yoshitaka Zaimoku , Megumi Oshima , Taizo Wada , Takumi Taniguchi , Hajime Kanamori","doi":"10.1016/j.mycmed.2025.101589","DOIUrl":"10.1016/j.mycmed.2025.101589","url":null,"abstract":"<div><div><em>Penicillium</em> is a ubiquitous fungus found in the soil, decaying plant material, freshwater, and other habitats. Although <em>Penicillium</em> species are generally harmless to humans, they can act as opportunistic pathogens in patients with a compromised immune system. <em>Penicillium rolfsii</em> is primarily known as an endophytic fungus with antioxidant and antibacterial properties, which has not been previously reported in culture tests from invasive human infections. This study reports the case of an eight-year-old boy who developed pneumonia following a near-drowning incident in a river, with <em>P. rolfsii</em> detected in sputum culture. The patient underwent cardiopulmonary resuscitation at the scene and was subsequently transferred to the intensive care unit at our hospital. Chest computed tomography confirmed severe aspiration pneumonia, and empirical treatment with ampicillin–sulbactam was initiated. Based on elevated β-D-glucan levels, voriconazole was added. Sputum cultures revealed the presence of <em>Penicillium</em> species, which were identified as <em>P. rolfsii</em> based on the β-tubulin gene sequence analysis. The treatment was successful, and the patient recovered. An environmental investigation of the plunge pool where the near-drowning incident occurred detected <em>Penicillium</em> species in the water samples. This is the first reported case of <em>P. rolfsii</em> being detected in culture tests of a human invasive infection, particularly in an otherwise healthy child. This case highlights the need for healthcare professionals to consider environmental fungi in Japanese river water as potential causes of invasive infections, such as pneumonia, particularly after near-drowning incidents.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 4","pages":"Article 101589"},"PeriodicalIF":1.8,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-28DOI: 10.1016/j.mycmed.2025.101588
Anis Chaari , Shaikha Ali Asheer , Muqtadir Malik , Mohamad Saif Khan , Manaf Alqahtani
Purpose
To describe the epidemiology of Candidozyma auris (Candida auris) candidemia, identify its predictive factors, and evaluate its prognostic impact in critically ill patients.
Methods
This retrospective study was conducted in the intensive care units (ICUs) of two tertiary hospitals. All adult patients with candidemia admitted between 01.01.2022, and 31.03.2024 were included. Two groups were compared: C. auris (CA) and non-Candidosyma auris (NCA) candidemia.
Results
A total of 51 patients were included, of whom 27 (52.9 %) had C. auris candidemia. C. auris candidemia was significantly associated to higher rate of colonisation with carbapenem-resistant Enterobacteriales (51.9 vs 20.8 %; p= 0.022). Additionally, patients in the CA group were more frequently exposed to ceftazidime – avibactam (40.7 % vs 8.3 %; p = 0.008), tigecycline (44.4 % vs 12.5 %; p = 0.012), and antifungals (74.1 % vs 33.3 %; p = 0.004). multivariate analysis identified previous exposure to antifungals as the only independent predictor of C. auris candidemia (OR = 6.5 CI95 % [1.7–25.3]; p=0.007).
Candidemia was associated with a higher incidence of septic shock (83.3 % vs 40.7 %; p=0.002), and increased need for mechanical ventilation (95.8 % vs 63 %; p=0.004) in patients with non-Candidosyma. auris fungemia.The 28-day mortality was 66.7 %, with no significant difference between CA and NCA groups (OR = 0.3 95 % CI [0.1–1.1]; p = 0.08).
Conclusion
Candidozyma auris has become the dominant isolate in our ICUs. Prior exposure to antifungals is the main predictive factor compared to NCA fungemia. Both CA and NCA exhibit similar 28-day mortality rates.
目的了解耳念珠菌（Candida auris）念珠菌病在危重症患者中的流行病学特点，确定其预测因素，评价其对预后的影响。方法对两所三级医院的重症监护病房进行回顾性研究。纳入2022年1月1日至2024年3月31日期间入院的所有成年念珠菌病患者。比较两组：耳念珠菌（CA）和非耳念珠菌（NCA）念珠菌血症。结果共纳入51例患者，其中27例（52.9%）为耳念珠菌。耳念珠菌与碳青霉烯耐药肠杆菌的定植率显著相关（51.9 vs 20.8%; p = 0.022）。此外，CA组患者更频繁地暴露于头孢他啶-阿维巴坦（40.7% vs 8.3%; p = 0.008）、替加环素（44.4% vs 12.5%; p = 0.012）和抗真菌药物（74.1% vs 33.3%; p = 0.004）。多因素分析发现，既往接触抗真菌药物是耳念珠菌感染的唯一独立预测因素（OR = 6.5 CI95 % [1.7-25.3]; p = 0.007）。念珠菌病与感染性休克发生率较高相关（83.3% vs 40.7%, p = 0.002），非念珠菌病患者机械通气需求增加（95.8% vs 63%, p = 0.004）。奥瑞丝fungemia。CA组和NCA组28天死亡率为66.7%，差异无统计学意义（OR = 0.3 95% CI [0.1-1.1]; p = 0.08）。结论耳念珠菌已成为icu的优势分离菌。与NCA真菌血症相比，先前暴露于抗真菌药物是主要的预测因素。CA和NCA的28天死亡率相似。
{"title":"Candidozyma auris candidemia in critically ill patients: epidemiology, predictive factors and prognostic impact","authors":"Anis Chaari , Shaikha Ali Asheer , Muqtadir Malik , Mohamad Saif Khan , Manaf Alqahtani","doi":"10.1016/j.mycmed.2025.101588","DOIUrl":"10.1016/j.mycmed.2025.101588","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the epidemiology of <em>Candidozyma auris</em> (<em>Candida auris</em>) candidemia, identify its predictive factors, and evaluate its prognostic impact in critically ill patients.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted in the intensive care units (ICUs) of two tertiary hospitals. All adult patients with candidemia admitted between 01.01.2022, and 31.03.2024 were included. Two groups were compared: <em>C. auris</em> (CA) and non-<em>Candidosyma auris</em> (NCA) candidemia.</div></div><div><h3>Results</h3><div>A total of 51 patients were included, of whom 27 (52.9 %) had <em>C. auris</em> candidemia. <em>C. auris</em> candidemia was significantly associated to higher rate of colonisation with carbapenem-resistant <em>Enterobacteriales</em> (51.9 vs 20.8 %; <strong><em>p</em></strong> <strong>= 0.022</strong>). Additionally, patients in the CA group were more frequently exposed to ceftazidime – avibactam (40.7 % vs 8.3 %; <em>p</em> = 0.008), tigecycline (44.4 % vs 12.5 %; <em>p</em> = 0.012), and antifungals (74.1 % vs 33.3 %; <em>p</em> = 0.004). multivariate analysis identified previous exposure to antifungals as the only independent predictor of <em>C. auris</em> candidemia (OR = 6.5 CI95 % [1.7–25.3]; <strong><em>p</em></strong> <strong>=</strong> <strong>0.007</strong>).</div><div>Candidemia was associated with a higher incidence of septic shock (83.3 % vs 40.7 %; <strong><em>p</em></strong> <strong>=</strong> <strong>0.002</strong>), and increased need for mechanical ventilation (95.8 % vs 63 %; <strong><em>p</em></strong> <strong>=</strong> <strong>0.004</strong>) in patients with <em>non-Candidosyma. auris</em> fungemia.The 28-day mortality was 66.7 %, with no significant difference between CA and NCA groups (OR = 0.3 95 % CI [0.1–1.1]; <em>p</em> = 0.08).</div></div><div><h3>Conclusion</h3><div><em>Candidozyma auris</em> has become the dominant isolate in our ICUs. Prior exposure to antifungals is the main predictive factor compared to NCA fungemia. Both CA and NCA exhibit similar 28-day mortality rates.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 4","pages":"Article 101588"},"PeriodicalIF":1.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.mycmed.2025.101587
Glory Bassey , Mary Alex-Wele , Usenobong Akpan , Love Okafor , Ofonime Benjamin , Nsisong Udoudo , Christian Ide , Edet Usun , Rosa Nwagboso , Aje Ogar , Anthony Offiong , Stella Chukwuma , Bassey Ekeng
Invasive fungal infections (IFIs) are life-threatening affecting all age groups. Several studies on IFIs in Nigeria are documented, but reviews describing their occurrence in the paediatric population are lacking in the literature. We conducted a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using the PubMed database, we identified case reports, series, and observational studies reporting IFIs in the Nigerian paediatric population from inception to December 2024. We identified a total of 114 cases of IFIs from 35 articles published between 1964 and 2023. Eight IFIs were identified including invasive candidiasis (59.6 %, n = 68), histoplasmosis (16.7 %, n = 19), pneumocystis pneumonia (2.6 %, n = 3), aspergillosis (2.6 %, n = 3), cryptococcosis (5.3 %, n = 6), entomophthoromycosis (7.9 %, n = 9), mucormycosis (2.6 %, n = 3) and eumycetoma (0.9 %, n = 1). Two (1.8 %) cases were reported as phycomycosis, and it was unclear whether these were cases of entomophthoromycosis or mucormycosis, as the fungal cultures were unsuccessful. Diagnosis was predominantly by culture (n = 59, 51.8 %) and histopathology (n = 30, 26.3 %). Outcomes were stated in 72 cases: 47 (41.2 %) recovered, 23 (20.2 %) died, one (0.9 %) lost to follow up and one (0.9 %) left against medical advice. Fatal outcomes were associated with delayed diagnosis and the lack of appropriate antifungals. IFIs are severely underdiagnosed in Nigerian children with significant gaps in the management of cases, including a low index of suspicion, delayed diagnosis, lack of diagnostics, especially the non-culture-based assays and poor accessibility to appropriate antifungal agents. Collaborative efforts to drive awareness and active surveillance of IFIs with funding for research targeted at the Nigerian paediatric population will mitigate these gaps.
{"title":"Invasive fungal infections in the Nigerian paediatric population: A systematic review","authors":"Glory Bassey , Mary Alex-Wele , Usenobong Akpan , Love Okafor , Ofonime Benjamin , Nsisong Udoudo , Christian Ide , Edet Usun , Rosa Nwagboso , Aje Ogar , Anthony Offiong , Stella Chukwuma , Bassey Ekeng","doi":"10.1016/j.mycmed.2025.101587","DOIUrl":"10.1016/j.mycmed.2025.101587","url":null,"abstract":"<div><div>Invasive fungal infections (IFIs) are life-threatening affecting all age groups. Several studies on IFIs in Nigeria are documented, but reviews describing their occurrence in the paediatric population are lacking in the literature. We conducted a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using the PubMed database, we identified case reports, series, and observational studies reporting IFIs in the Nigerian paediatric population from inception to December 2024. We identified a total of 114 cases of IFIs from 35 articles published between 1964 and 2023. Eight IFIs were identified including invasive candidiasis (59.6 %, <em>n</em> = 68), histoplasmosis (16.7 %, <em>n</em> = 19), pneumocystis pneumonia (2.6 %, <em>n</em> = 3), aspergillosis (2.6 %, <em>n</em> = 3), cryptococcosis (5.3 %, <em>n</em> = 6), entomophthoromycosis (7.9 %, <em>n</em> = 9), mucormycosis (2.6 %, <em>n</em> = 3) and eumycetoma (0.9 %, <em>n</em> = 1). Two (1.8 %) cases were reported as phycomycosis, and it was unclear whether these were cases of entomophthoromycosis or mucormycosis, as the fungal cultures were unsuccessful. Diagnosis was predominantly by culture (<em>n</em> = 59, 51.8 %) and histopathology (<em>n</em> = 30, 26.3 %). Outcomes were stated in 72 cases: 47 (41.2 %) recovered, 23 (20.2 %) died, one (0.9 %) lost to follow up and one (0.9 %) left against medical advice. Fatal outcomes were associated with delayed diagnosis and the lack of appropriate antifungals. IFIs are severely underdiagnosed in Nigerian children with significant gaps in the management of cases, including a low index of suspicion, delayed diagnosis, lack of diagnostics, especially the non-culture-based assays and poor accessibility to appropriate antifungal agents. Collaborative efforts to drive awareness and active surveillance of IFIs with funding for research targeted at the Nigerian paediatric population will mitigate these gaps.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 4","pages":"Article 101587"},"PeriodicalIF":1.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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