Phaeohyphomycosis (PHM) is a fungal infection caused by a group of dematiaceous (darkly pigmented) fungi. In this study, we describe a successfully treated case of PHM caused by Exophiala oligosperma in a 68-year-old liver transplant recipient who presented with painful erythematous subcutaneous nodules on his lower left limb. Treatment involved a combination of antifungal drugs and surgical excision. We performed review of 13 cases of PHM in liver transplant recipients reported from 2000 to 2024. Eight patients presented with skin and subcutaneous tissue involvement and limbs were the most frequently affected areas. The median time after liver transplant to the diagnosis of PHM was 6 months. Laboratory diagnosis mainly relied on histopathology. Eleven patients received systemic antifungal therapy and seven underwent surgical excision. Full recovery was observed in eleven cases. Altogether, PHM in solid organ transplant recipients is a rare infection and early diagnosis is critical for a favorable outcome.
{"title":"Phaeohyphomycosis caused by Exophiala oligosperma in liver transplant recipient: case report and literature review","authors":"Regielly Caroline Raimundo Cognialli , Bram Spruijtenburg , Leonardo Filipetto Ferrari , Denise Semchechen Hnatiuk , Alcindo Pissaia Junior , Nubia Leilane Barth Schierling , Germana Davila dos Santos , Vânia Aparecida Vicente , Eelco F.J. Meijer , Flávio Queiroz-Telles","doi":"10.1016/j.mycmed.2025.101558","DOIUrl":"10.1016/j.mycmed.2025.101558","url":null,"abstract":"<div><div>Phaeohyphomycosis (PHM) is a fungal infection caused by a group of dematiaceous (darkly pigmented) fungi. In this study, we describe a successfully treated case of PHM caused by <em>Exophiala oligosperma</em> in a 68-year-old liver transplant recipient who presented with painful erythematous subcutaneous nodules on his lower left limb. Treatment involved a combination of antifungal drugs and surgical excision. We performed review of 13 cases of PHM in liver transplant recipients reported from 2000 to 2024. Eight patients presented with skin and subcutaneous tissue involvement and limbs were the most frequently affected areas. The median time after liver transplant to the diagnosis of PHM was 6 months. Laboratory diagnosis mainly relied on histopathology. Eleven patients received systemic antifungal therapy and seven underwent surgical excision. Full recovery was observed in eleven cases. Altogether, PHM in solid organ transplant recipients is a rare infection and early diagnosis is critical for a favorable outcome.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 3","pages":"Article 101558"},"PeriodicalIF":2.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297480","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 : 2025-06-07DOI: 10.1016/j.mycmed.2025.101559
Gustavo Abraham Canales-Azcona , Abraham Castellanos-Maldonado , Héctor Raúl Ibarra-Sifuentes , Yadhira María González-Amador
Coccidioidomycosis is a fungal infection endemic to arid regions. Although it usually presents as a pulmonary infection, extrapulmonary dissemination is rare, and cervical lymphadenitis is even more unusual with fewer than five cases reported in the literature. Diagnosis of this disease remains a clinical challenge due to its rarity and similarity to other clinical entities. A 34-year-old woman with lupus nephritis on immunosuppressive therapy presented with a painful cervical mass associated with unquantified fever of six weeks of evolution. The patient is a resident of Coahuila, Mexico, in a region adjacent to the Texas–Mexico border. Diagnostic imaging and excisional biopsy with histopathology and culture confirmed cervical lymphadenitis due to Coccidioides. Treatment with oral fluconazole (Diflucan) was started, achieving complete clinical resolution after 12 months. This case highlights the importance of considering different fungal infections in immunocompromised patients presenting with lymphadenopathy. Early diagnosis by biopsy and culture, as well as specific antifungal treatment are essential to obtain favorable results.
{"title":"Coccidioidomycosis Lymphadenitis in a patient with Lupus nephritis: A case report","authors":"Gustavo Abraham Canales-Azcona , Abraham Castellanos-Maldonado , Héctor Raúl Ibarra-Sifuentes , Yadhira María González-Amador","doi":"10.1016/j.mycmed.2025.101559","DOIUrl":"10.1016/j.mycmed.2025.101559","url":null,"abstract":"<div><div>Coccidioidomycosis is a fungal infection endemic to arid regions. Although it usually presents as a pulmonary infection, extrapulmonary dissemination is rare, and cervical lymphadenitis is even more unusual with fewer than five cases reported in the literature. Diagnosis of this disease remains a clinical challenge due to its rarity and similarity to other clinical entities. A 34-year-old woman with lupus nephritis on immunosuppressive therapy presented with a painful cervical mass associated with unquantified fever of six weeks of evolution. The patient is a resident of Coahuila, Mexico, in a region adjacent to the Texas–Mexico border. Diagnostic imaging and excisional biopsy with histopathology and culture confirmed cervical lymphadenitis due to Coccidioides. Treatment with oral fluconazole (Diflucan) was started, achieving complete clinical resolution after 12 months. This case highlights the importance of considering different fungal infections in immunocompromised patients presenting with lymphadenopathy. Early diagnosis by biopsy and culture, as well as specific antifungal treatment are essential to obtain favorable results.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 3","pages":"Article 101559"},"PeriodicalIF":2.2,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517151","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 : 2025-05-15DOI: 10.1016/j.mycmed.2025.101552
S. Umamaheshwari , S.M. Neelambike , S.A. Shankarnarayan , K.S. Kumarswamy , S. Gopal , H. Prakash , S.M. Rudramurthy
{"title":"Corrigendum to “Clinical profile, antifungal susceptibility, and molecular characterization of Candida auris isolated from patients in a South Indian surgical ICU.” [J Mycol Med (2021) 101176]","authors":"S. Umamaheshwari , S.M. Neelambike , S.A. Shankarnarayan , K.S. Kumarswamy , S. Gopal , H. Prakash , S.M. Rudramurthy","doi":"10.1016/j.mycmed.2025.101552","DOIUrl":"10.1016/j.mycmed.2025.101552","url":null,"abstract":"","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101552"},"PeriodicalIF":2.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069323","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 : 2025-04-29DOI: 10.1016/j.mycmed.2025.101553
Yeyang Zhang , Pengle Guo , Yaozu He , Qinzhi Zhang , Longping Yang , Yingchun Ke , Yu Meng , Feilong Xu , Xiaopin Tang , Linghua Li
Background
We evaluated Talaromyces marneffei mannoprotein (Mp1p) antigen in urine to create a practical, rapid diagnostic tool for early treatment and reduced mortality.
Methodology/Principal Findings
This prospective cross-sectional study assessed the sensitivity and specificity of Mp1p detection in urine samples from 215 AIDS patients at Guangzhou Eighth People's Hospital, enrolled between March 2022 and January 2023, using ELISA and fluorescence immunochromatography (FIC). In both the Talaromycosis and non-talaromycosis groups, most patients were male, comprising 82.5 % and 88.6 %, respectively. The median age was 42 years for the talaromycosis group and 48 years for the non-talaromycosis group. All patients were HIV-infected, with median CD4+ T cell counts of 47 cells/μL for talaromycosis and 187 cells/μL for non-talaromycosis. Among detection methods, ELISA showed the highest sensitivity (77.5 %, 95 % CI: 61.5–89.2 %) and specificity (97.1 %, 95 % CI: 93.5–99.1 %) for the Mp1p antigen in urine. The Positive Predictive Value (PPV), Negative Predictive Value (NPV), and kappa coefficient were 79.5 % (31/39), 94.9 % (167/176), and 0.739, respectively. The Area Under the Curve (AUC) accuracy for distinguishing patients with talaromycosis was 85.8 % (95 % CI, 76.9–94.9 %). The sensitivity, specificity, PPV, NPV, and kappa value of the Mp1p antigen (Ag) in urine following FIC were 67.5 % (95 % CI: 50.9–81.4 %), 94.9 % (95 % CI: 90.5–97.6 %), 75 % (27/36), 92.7 % (166/179), and 0.649, respectively. Combining urine Mp1p Ag ELISA with serum Mp1p Ag FIC achieved the highest specificity (96 %), PPV (82.1 %), and kappa value (0.767). In contrast, the urine Mp1p Ag ELISA and serum GM Ag pairing showed the highest sensitivity (92.5 %) and NPV (98.1 %).
Conclusions
Identification of the Mp1p antigen (Ag) in urine has been shown to be a reliable method for differentiating coinfections in AIDS patients, serving as a supplementary tool for early detection in clinical settings.
研究背景：我们对尿中的曼尼菲Talaromyces marneffei甘露蛋白（Mp1p）抗原进行检测，以期为早期治疗和降低死亡率创造一种实用、快速的诊断工具。本前瞻性横断面研究评估了2022年3月至2023年1月在广州第八人民医院登记的215例艾滋病患者尿液样本中Mp1p检测的敏感性和特异性，采用ELISA和荧光免疫层析（FIC）。在塔拉芳香菌病组和非塔拉芳香菌病组中，大多数患者为男性，分别占82.5%和88.6%。talaromyosis组的中位年龄为42岁，而非talaromyosis组的中位年龄为48岁。所有患者均为hiv感染，塔香菌病患者CD4+ T细胞中位数为47个细胞/μL，非塔香菌病患者为187个细胞/μL。ELISA检测尿液中Mp1p抗原的灵敏度最高（77.5%,95% CI: 61.5 ~ 89.2%），特异性最高（97.1%,95% CI: 93.5 ~ 99.1%）。阳性预测值（PPV）为79.5%(31/39)，阴性预测值（NPV）为94.9% (167/176)，kappa系数为0.739。曲线下面积（Area Under The Curve， AUC）鉴别talaromyosis患者的准确率为85.8% （95% CI, 76.9 - 94.9%）。FIC患者尿液中Mp1p抗原（Ag）的敏感性、特异性、PPV、NPV、kappa值分别为67.5% （95% CI: 50.9 ~ 81.4%）、94.9% （95% CI: 90.5 ~ 97.6%）、75%（27/36）、92.7%（166/179）、0.649。尿液Mp1p Ag ELISA与血清Mp1p Ag FIC联合检测特异性最高（96%），PPV最高（82.1%），kappa值最高（0.767）。相比之下，尿液Mp1p Ag ELISA和血清GM Ag配对的灵敏度最高（92.5%），NPV最高（98.1%）。结论尿液中Mp1p抗原（Ag）的鉴定已被证明是鉴别艾滋病患者合并感染的可靠方法，可作为临床早期检测的辅助工具。
{"title":"MP1P antigen detection in urine samples could improve the rapid screening and diagnosis of talaromycosis marneffei","authors":"Yeyang Zhang , Pengle Guo , Yaozu He , Qinzhi Zhang , Longping Yang , Yingchun Ke , Yu Meng , Feilong Xu , Xiaopin Tang , Linghua Li","doi":"10.1016/j.mycmed.2025.101553","DOIUrl":"10.1016/j.mycmed.2025.101553","url":null,"abstract":"<div><h3>Background</h3><div>We evaluated <em>Talaromyces marneffei</em> mannoprotein (Mp1p) antigen in urine to create a practical, rapid diagnostic tool for early treatment and reduced mortality.</div></div><div><h3>Methodology/Principal Findings</h3><div>This prospective cross-sectional study assessed the sensitivity and specificity of Mp1p detection in urine samples from 215 AIDS patients at Guangzhou Eighth People's Hospital, enrolled between March 2022 and January 2023, using ELISA and fluorescence immunochromatography (FIC). In both the Talaromycosis and non-talaromycosis groups, most patients were male, comprising 82.5 % and 88.6 %, respectively. The median age was 42 years for the talaromycosis group and 48 years for the non-talaromycosis group. All patients were HIV-infected, with median CD4+ <em>T</em> cell counts of 47 cells/μL for talaromycosis and 187 cells/μL for non-talaromycosis. Among detection methods, ELISA showed the highest sensitivity (77.5 %, 95 % CI: 61.5–89.2 %) and specificity (97.1 %, 95 % CI: 93.5–99.1 %) for the Mp1p antigen in urine. The Positive Predictive Value (PPV), Negative Predictive Value (NPV), and kappa coefficient were 79.5 % (31/39), 94.9 % (167/176), and 0.739, respectively. The Area Under the Curve (AUC) accuracy for distinguishing patients with talaromycosis was 85.8 % (95 % CI, 76.9–94.9 %). The sensitivity, specificity, PPV, NPV, and kappa value of the Mp1p antigen (Ag) in urine following FIC were 67.5 % (95 % CI: 50.9–81.4 %), 94.9 % (95 % CI: 90.5–97.6 %), 75 % (27/36), 92.7 % (166/179), and 0.649, respectively. Combining urine Mp1p Ag ELISA with serum Mp1p Ag FIC achieved the highest specificity (96 %), PPV (82.1 %), and kappa value (0.767). In contrast, the urine Mp1p Ag ELISA and serum GM Ag pairing showed the highest sensitivity (92.5 %) and NPV (98.1 %).</div></div><div><h3>Conclusions</h3><div>Identification of the Mp1p antigen (Ag) in urine has been shown to be a reliable method for differentiating coinfections in AIDS patients, serving as a supplementary tool for early detection in clinical settings.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101553"},"PeriodicalIF":2.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927434","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 : 2025-04-19DOI: 10.1016/j.mycmed.2025.101551
Zhaowei Jin , Danqing Wu , Yangnan Chen , Yanqiu Long , Yan Liu , Zhiyun Zheng , Shuangying Gui , Yuzhe Huang , Ning He
Ketoconazole (KCZ), an imidazole antifungal drug, is constrained by its low solubility and poor stability, restricting its effective absorption and bioavailability. This study introduces a KCZ-loaded microsponge based film coating agent (KCZ-MSF), designed to enhance the transdermal absorption and bioavailability of KCZ. The KCZ-MS was prepared by emulsion solvent evaporation method and the composition of the prescription was optimized by Box-Behnken design (BBD). Moreover, characterization of the optimized KCZ-MS was conducted using scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). The film coating agent's preparation was further optimized through orthogonal experiments, converting the optimized KCZ-MS into a film coating agent suitable for topical skin application. The KCZ-MS showed a spherical porous structure with a mean particle size of 22.42 ± 8.45 μm, a drug loading efficiency of 20.74 %, entrapment efficiency of 92.12 %, and good compatibility between the drug and excipients. The optimized KCZ-MSF displayed good physical properties. In vitro transdermal experiments revealed that the skin retention of KCZ-MSF surpassed that of commercially available KCZ cream at 6, 12, and 24 h. The pharmacokinetic experiment results indicate that the area under the curve (AUC0–24) of KCZ-MSF 420.71 ± 21.77 μg/(g·h) is 2.05 times that of KCZ film coating agent (KCZ-F) and 1.29 times that of commercially available ketoconazole cream. Therefore, KCZ-MSF presents a more promising platform for the treatment of superficial skin fungal infections.
{"title":"Ketoconazole-loaded microspone film coating agent for superficial fungal infection: design, preparation and characterization","authors":"Zhaowei Jin , Danqing Wu , Yangnan Chen , Yanqiu Long , Yan Liu , Zhiyun Zheng , Shuangying Gui , Yuzhe Huang , Ning He","doi":"10.1016/j.mycmed.2025.101551","DOIUrl":"10.1016/j.mycmed.2025.101551","url":null,"abstract":"<div><div>Ketoconazole (KCZ), an imidazole antifungal drug, is constrained by its low solubility and poor stability, restricting its effective absorption and bioavailability. This study introduces a KCZ-loaded microsponge based film coating agent (KCZ-MSF), designed to enhance the transdermal absorption and bioavailability of KCZ. The KCZ-MS was prepared by emulsion solvent evaporation method and the composition of the prescription was optimized by Box-Behnken design (BBD). Moreover, characterization of the optimized KCZ-MS was conducted using scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). The film coating agent's preparation was further optimized through orthogonal experiments, converting the optimized KCZ-MS into a film coating agent suitable for topical skin application. The KCZ-MS showed a spherical porous structure with a mean particle size of 22.42 ± 8.45 μm, a drug loading efficiency of 20.74 %, entrapment efficiency of 92.12 %, and good compatibility between the drug and excipients. The optimized KCZ-MSF displayed good physical properties. <em>In vitro</em> transdermal experiments revealed that the skin retention of KCZ-MSF surpassed that of commercially available KCZ cream at 6, 12, and 24 h. The pharmacokinetic experiment results indicate that the area under the curve (<em>AUC</em><sub>0–24</sub>) of KCZ-MSF 420.71 ± 21.77 μg/(g·h) is 2.05 times that of KCZ film coating agent (KCZ-F) and 1.29 times that of commercially available ketoconazole cream. Therefore, KCZ-MSF presents a more promising platform for the treatment of superficial skin fungal infections.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101551"},"PeriodicalIF":2.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874773","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 : 2025-04-12DOI: 10.1016/j.mycmed.2025.101550
Neha Jaiswal, Awanish Kumar
Phenolic acids derived from the leaf of Vitex negundo have been widely recognized for their natural antifungal properties. This study evaluates the bioactive potential of these phenolic acids against Candida albicans, a significant fungal pathogen responsible for various infections in humans. The total phenolic content (TPC) of the plant extract was quantified using the Folin-Ciocalteu reagent and expressed in terms of gallic acid equivalent (GAE), with a TPC of 90.1 ± 3.36 mg GAE/g dry weight extract. The antioxidant activity, measured through the DPPH radical scavenging assay, demonstrated a substantial inhibition rate of 60.776 ± 2.32 % at 1 mg/mL concentration. LCMS analysis identified 18 phenolic acids, with p-coumaric acid showing the highest concentration at 34.3575 µg/ml. In-silico screening highlighted chlorogenic acid, caffeic acid, coumaric acid, and 2,4-dihydroxybenzoic acid having the top four compounds with antifungal potential, which was further validated through in-vitro assays. Caffeic acid emerged as the most potent anti-candidal agent (among these 4 shortlisted compounds) with an MIC of 64 ± 2.31 µg/ml, exhibiting both fungistatic and fungicidal effects. The FE-SEM analysis confirmed the complete eradication of C. albicans biofilm and significant membrane damage post-treatment with caffeic acid. These findings underscore the dual mechanisms of action, i.e., antioxidant and anti-candidal potential of V. negundo phenolic extracts, presenting them as promising candidates for developing natural anti-candidal therapeutics. Future research should explore the molecular interactions and potential synergistic effects with other antimicrobial agents to enhance efficacy and mitigate drug resistance development.
{"title":"Identification, quantification, and bioactivity of Vitex negundo phenolic acids as efficacious anti-candidal and antibiofilm agents targeting Candida albicans","authors":"Neha Jaiswal, Awanish Kumar","doi":"10.1016/j.mycmed.2025.101550","DOIUrl":"10.1016/j.mycmed.2025.101550","url":null,"abstract":"<div><div>Phenolic acids derived from the leaf of <em>Vitex negundo</em> have been widely recognized for their natural antifungal properties. This study evaluates the bioactive potential of these phenolic acids against <em>Candida albicans</em>, a significant fungal pathogen responsible for various infections in humans. The total phenolic content (TPC) of the plant extract was quantified using the Folin-Ciocalteu reagent and expressed in terms of gallic acid equivalent (GAE), with a TPC of 90.1 ± 3.36 mg GAE/g dry weight extract. The antioxidant activity, measured through the DPPH radical scavenging assay, demonstrated a substantial inhibition rate of 60.776 ± 2.32 % at 1 mg/mL concentration. LCMS analysis identified 18 phenolic acids, with p-coumaric acid showing the highest concentration at 34.3575 µg/ml. <em>In-silico</em> screening highlighted chlorogenic acid, caffeic acid, coumaric acid, and 2,4-dihydroxybenzoic acid having the top four compounds with antifungal potential, which was further validated through <em>in-vitro</em> assays. Caffeic acid emerged as the most potent anti-candidal agent (among these 4 shortlisted compounds) with an MIC of 64 ± 2.31 µg/ml, exhibiting both fungistatic and fungicidal effects. The FE-SEM analysis confirmed the complete eradication of <em>C. albicans</em> biofilm and significant membrane damage post-treatment with caffeic acid. These findings underscore the dual mechanisms of action, i.e., antioxidant and anti-candidal potential of <em>V. negundo</em> phenolic extracts, presenting them as promising candidates for developing natural anti-candidal therapeutics. Future research should explore the molecular interactions and potential synergistic effects with other antimicrobial agents to enhance efficacy and mitigate drug resistance development.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101550"},"PeriodicalIF":2.2,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863768","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}
Patients with severe liver disease (SLD) are prone to developing invasive pulmonary aspergillosis (IPA) due to immunodeficiency and microbial translocation, leading to high mortality rates. Although voriconazole is the first-line treatment for IPA, its use in patients with SLD is challenging due to the risk of hepatotoxicity. In this population, reduced hepatic blood flow and enzyme activity, compromised bile excretion, and increased intestinal permeability collectively affect voriconazole metabolism, resulting in a prolonged half-life, drug accumulation, and higher incidence of adverse events (AEs). Therapeutic drug monitoring (TDM) is essential to optimize voriconazole therapy, ensuring plasma concentrations within the therapeutic range (1.0-5.0 mg/L) while minimizing toxicity risks. This review highlights the risk factors for IPA in patients with SLD, the mechanisms of voriconazole-induced hepatotoxicity, its pharmacokinetics in this population, and current research on dose optimization. We emphasize the necessity of closely monitoring voriconazole plasma concentration, liver function, and inflammatory markers during treatment. For patients with SLD, we recommend a loading dose of 200 mg every 12 hours, with subsequent maintenance doses reduced to 1/4-1/3 of the standard dose, though the evidence remains limited. We call for large-scale clinical trials to define optimal dosing, efficacy, and safety of voriconazole for IPA in patients with SLD, providing clinicians with clearer treatment guidelines and improving patient outcomes.
{"title":"Voriconazole in the management of invasive pulmonary aspergillosis in patients with severe liver disease: balancing efficacy and hepatotoxicity","authors":"Caopei Zheng , Xin Zhang , Yingmin Ma , Yulin Zhang","doi":"10.1016/j.mycmed.2025.101549","DOIUrl":"10.1016/j.mycmed.2025.101549","url":null,"abstract":"<div><div>Patients with severe liver disease (SLD) are prone to developing invasive pulmonary aspergillosis (IPA) due to immunodeficiency and microbial translocation, leading to high mortality rates. Although voriconazole is the first-line treatment for IPA, its use in patients with SLD is challenging due to the risk of hepatotoxicity. In this population, reduced hepatic blood flow and enzyme activity, compromised bile excretion, and increased intestinal permeability collectively affect voriconazole metabolism, resulting in a prolonged half-life, drug accumulation, and higher incidence of adverse events (AEs). Therapeutic drug monitoring (TDM) is essential to optimize voriconazole therapy, ensuring plasma concentrations within the therapeutic range (1.0-5.0 mg/L) while minimizing toxicity risks. This review highlights the risk factors for IPA in patients with SLD, the mechanisms of voriconazole-induced hepatotoxicity, its pharmacokinetics in this population, and current research on dose optimization. We emphasize the necessity of closely monitoring voriconazole plasma concentration, liver function, and inflammatory markers during treatment. For patients with SLD, we recommend a loading dose of 200 mg every 12 hours, with subsequent maintenance doses reduced to 1/4-1/3 of the standard dose, though the evidence remains limited. We call for large-scale clinical trials to define optimal dosing, efficacy, and safety of voriconazole for IPA in patients with SLD, providing clinicians with clearer treatment guidelines and improving patient outcomes.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101549"},"PeriodicalIF":2.2,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844234","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 : 2025-03-29DOI: 10.1016/j.mycmed.2025.101546
Mariana Lanna , Josefina Lovatto , João N. de Almeida Junior , Eduardo A. Medeiros , Arnaldo L. Colombo , Guillermo García-Effron
Candidozyma auris (Candida auris) is an emerging multidrug-resistant fungal pathogen that poses a significant public health threat worldwide, particularly in Latin America, where resources for controlling outbreaks may be limited. Since the first case was reported in Venezuela in 2012, the fungus has spread to several other Latin American countries, including Colombia, Panama, Brazil, Mexico, Chile, Peru, and Argentina, manifesting as isolated cases or outbreaks, with varying prevalence. This review provides a comprehensive overview of the epidemiology and microbiological characteristics of C. auris in Latin America. Using data from 2012 to 2024, we examined epidemiological trends, antimicrobial resistance patterns, and the molecular mechanisms underlying resistance in Latin American isolates. Additionally, we discuss factors that may facilitate the spread of C. auris in the region.
Countries near the equator tend to have higher incidences of C. auris and a greater prevalence of antifungal resistance. Immigration and medical tourism may further contribute to the spread of C. auris to southern countries. However, the lack of laboratory resources and trained personnel remains the primary risk factor for the silent dissemination of C. auris in the region.
Conclusions: We emphasize the urgent need for coordinated public health responses to improve laboratory capabilities in Latin American hospitals, effectively combating the spread of this pathogen.
{"title":"Epidemiological and Microbiological aspects of Candidozyma auris (Candida auris) in Latin America: A literature review","authors":"Mariana Lanna , Josefina Lovatto , João N. de Almeida Junior , Eduardo A. Medeiros , Arnaldo L. Colombo , Guillermo García-Effron","doi":"10.1016/j.mycmed.2025.101546","DOIUrl":"10.1016/j.mycmed.2025.101546","url":null,"abstract":"<div><div>Candidozyma auris (Candida auris) is an emerging multidrug-resistant fungal pathogen that poses a significant public health threat worldwide, particularly in Latin America, where resources for controlling outbreaks may be limited. Since the first case was reported in Venezuela in 2012, the fungus has spread to several other Latin American countries, including Colombia, Panama, Brazil, Mexico, Chile, Peru, and Argentina, manifesting as isolated cases or outbreaks, with varying prevalence. This review provides a comprehensive overview of the epidemiology and microbiological characteristics of <em>C. auris</em> in Latin America. Using data from 2012 to 2024, we examined epidemiological trends, antimicrobial resistance patterns, and the molecular mechanisms underlying resistance in Latin American isolates. Additionally, we discuss factors that may facilitate the spread of <em>C. auris</em> in the region.</div><div>Countries near the equator tend to have higher incidences of <em>C. auris</em> and a greater prevalence of antifungal resistance. Immigration and medical tourism may further contribute to the spread of <em>C. auris</em> to southern countries. However, the lack of laboratory resources and trained personnel remains the primary risk factor for the silent dissemination of <em>C. auris</em> in the region.</div><div>Conclusions: We emphasize the urgent need for coordinated public health responses to improve laboratory capabilities in Latin American hospitals, effectively combating the spread of this pathogen.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101546"},"PeriodicalIF":2.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816996","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}
Phaeohyphomycosis is a rare fungal infection that presents significant challenges in diagnosis and treatment. Herein, we document a case of a cerebellar abscess caused by Cladophialophora bantiana. A 77-year-old woman with type 2 diabetes mellitus and a previous history of diffuse large B-cell lymphoma gradually developed ataxia and was transferred to an emergency department. Head imaging investigations indicated a cerebellar mass and the patient underwent an emergent endoscopic drainage. Although bacterial cultures of the drainage specimen yielded no growth, a dematiaceous fungus was isolated and subsequently identified as C. bantiana through ITS sequencing analysis. The patient received antifungal combination therapy, initially with liposomal amphotericin B and voriconazole, and finally posaconazole and 5-fluorocytosine. Brain abscesses caused by C. bantiana are rarely documented, and an optimal treatment strategy has yet to be established. Given the high fatality rate, an early surgical intervention is crucial for both diagnosis and treatment. The present case was successfully treated with minimally invasive surgical intervention alongside the antifungal combination therapy.
{"title":"Cerebellar abscess caused by Cladophialophora bantiana involving an elderly Japanese woman","authors":"Kenta Nakamoto , Hideharu Hagiya , Shinnosuke Fukushima , Kohei Oguni , Yukika Yokoyama , Koji Iio , Shuichiro Hirano , Takashi Yaguchi , Sayaka Ban , Akira Watanabe , Hiroki Okunobu , Atsuhito Suyama , Marina Kawaguchi , Yousuke Sazumi , Fumio Otsuka","doi":"10.1016/j.mycmed.2025.101548","DOIUrl":"10.1016/j.mycmed.2025.101548","url":null,"abstract":"<div><div>Phaeohyphomycosis is a rare fungal infection that presents significant challenges in diagnosis and treatment. Herein, we document a case of a cerebellar abscess caused by Cladophialophora bantiana. A 77-year-old woman with type 2 diabetes mellitus and a previous history of diffuse large B-cell lymphoma gradually developed ataxia and was transferred to an emergency department. Head imaging investigations indicated a cerebellar mass and the patient underwent an emergent endoscopic drainage. Although bacterial cultures of the drainage specimen yielded no growth, a dematiaceous fungus was isolated and subsequently identified as C. bantiana <em>through ITS sequencing analysis. The patient received antifungal combination therapy, initially with</em> liposomal amphotericin B and voriconazole, and finally posaconazole and 5-fluorocytosine. Brain abscesses caused by C. bantiana are rarely documented, and an optimal treatment strategy has yet to be established. Given the high fatality rate, an early surgical intervention is crucial for both diagnosis and treatment. The present case was successfully treated with minimally invasive surgical intervention alongside the antifungal combination therapy.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101548"},"PeriodicalIF":2.2,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737803","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 : 2025-03-27DOI: 10.1016/j.mycmed.2025.101547
Jose Antonio Soler-Simón , Diannet Quintero-García , Álvaro Pou-Blázquez , María José González-Abad , David Ruano-Domínguez , Amelia Martínez-de-Azagra-Garde , Montserrat Nieto-Moro , Marta Taida García-Ascaso
Introduction
invasive fungal infection is a serious problem in immunosuppressed patients, particularly those with hematological or oncological diseases. Recently, more cases of emerging pathogens, such as Magnusiomyces capitatus, have been reported.
Clinical case
a 4-year-old male diagnosed with stage IV sphenoidal Burkitt lymphoma, undergoing immunosuppressive treatment and with severe neutropenia, developed sepsis of abdominal origin, requiring admission to the Intensive Care Unit. He received empirical antibiotic and antifungal therapy, with isolation of M. capitatus in blood cultures and peritoneal fluid. Despite adjusting antifungal therapy, the patient died 15 days after due to the progression of the invasive fungal infection.
Discussion
M. capitatus infections are reported more frequently in immunocompromised patients. A review of pediatric cases published in the literature identified a total of 16 cases (8 males and 8 females, median age 6 years). Most cases had an underlying hemato-oncological disease and were in an immunosuppressed state. In contradistinction to what is observed in adults, only three cases (18.8 %) had received antifungal prophylaxis. M. capitatus is a dimorphic yeast that is intrinsically resistant to echinocandins and has a significant mortality rate, both in studied series and in ours (50 %).
Conclusions
a rapid and accurate diagnosis of M. capitatus infection is essential to control invasive fungal infection, which could improve patient survival.
{"title":"Invasive fungal infection caused by Magnusiomyces capitatus in a pediatric patient with Burkitt lymphoma: Case report and review of literature","authors":"Jose Antonio Soler-Simón , Diannet Quintero-García , Álvaro Pou-Blázquez , María José González-Abad , David Ruano-Domínguez , Amelia Martínez-de-Azagra-Garde , Montserrat Nieto-Moro , Marta Taida García-Ascaso","doi":"10.1016/j.mycmed.2025.101547","DOIUrl":"10.1016/j.mycmed.2025.101547","url":null,"abstract":"<div><h3>Introduction</h3><div>invasive fungal infection is a serious problem in immunosuppressed patients, particularly those with hematological or oncological diseases. Recently, more cases of emerging pathogens, such as <em>Magnusiomyces capitatus,</em> have been reported.</div></div><div><h3>Clinical case</h3><div>a 4-year-old male diagnosed with stage IV sphenoidal Burkitt lymphoma, undergoing immunosuppressive treatment and with severe neutropenia, developed sepsis of abdominal origin, requiring admission to the Intensive Care Unit. He received empirical antibiotic and antifungal therapy, with isolation of <em>M. capitatus</em> in blood cultures and peritoneal fluid. Despite adjusting antifungal therapy, the patient died 15 days after due to the progression of the invasive fungal infection.</div></div><div><h3>Discussion</h3><div><em>M. capitatus</em> infections are reported more frequently in immunocompromised patients. A review of pediatric cases published in the literature identified a total of 16 cases (8 males and 8 females, median age 6 years). Most cases had an underlying hemato-oncological disease and were in an immunosuppressed state. In contradistinction to what is observed in adults, only three cases (18.8 %) had received antifungal prophylaxis. <em>M. capitatus</em> is a dimorphic yeast that is intrinsically resistant to echinocandins and has a significant mortality rate, both in studied series and in ours (50 %).</div></div><div><h3>Conclusions</h3><div>a rapid and accurate diagnosis of <em>M. capitatus</em> infection is essential to control invasive fungal infection, which could improve patient survival.</div></div>","PeriodicalId":14824,"journal":{"name":"Journal de mycologie medicale","volume":"35 2","pages":"Article 101547"},"PeriodicalIF":2.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816998","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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