Medical mycology最新文献

Aspergillus section Fumigati (ASF) comprises saprophytic moulds that naturally inhabit a wide range of biomes including cultivated soils where climatic factors and agricultural practices can influence the composition of fungal communities. Aspergillus fumigatus sensu stricto is the leading cause of invasive aspergillosis in immunocompromised individuals, but closely related species have also emerged as important pathogens. We analyzed 29 soil samples (13 from orchards and 16 from conventional agricultural soils) collected at different times and seasons. Interestingly, the 48 ASF strains isolated matched to only two species, typified as A. fumigatus sensu stricto (28) and A. udagawae (20). Significant differences in the prevalence of both species were observed. A higher recovery of A. fumigatus sensu stricto was obtained in spring and A. udagawae in summer and winter. Considering the agricultural production system, A. fumigatus sensu stricto was more prevalent in agroecological orchards and A. udagawae in conventional agricultural soils. Our results suggest that the presence of only these two species may be attributed to their distinctive biological characteristics and the climatic conditions prevailing in the study area. While the prevalence of A. fumigatus sensu stricto in agroecological orchards and A. udagawae in conventional agriculture, may be a result of the ecological impact of agricultural production systems. Our study provides empirical evidence in support of a potential model whereby the presence and distribution of ASF species in agricultural soils may be driven by two key factors: their biological characteristics and the use of agrochemical compounds for crop production.

We conservatively estimated the annual US fungal disease-related economic burden as $19.4 billion, including direct medical costs ($13.4 billion) of hospitalizations (n = 133 555) and outpatient visits (n = 13.4 million), $1.7 billion from absenteeism, and $4.3 billion from deaths (n = 7288). These findings underscore the need for fungal disease surveillance, treatment, and prevention efforts.

Allodiploid hybrid species, Aspergillus latus, belonging to section Nidulantes, is a hybrid of A. spinulosporus and an unknown species closely related to A. quadrilineatus and A. sublatus. This hybrid has often been misidentified as the species in section Nidulantes, such as A. nidulans, A. spinulosporus, A. sublatus, or other cryptic species. Aspergillus latus has not been reported in Japan as well as Asia so far. In this study, we screened 23 clinical strains identified as A. spinulosporus isolated in Japan from 2012 to 2023 and found seven A. latus strains. To characterize the A. latus strains, we conducted comprehensive phenotyping including morphological observation, whole genome sequences, and phylogenetic analysis based on calmodulin (CaM) gene. In addition, we conducted antifungal susceptibility testing for A. latus strains. As a result, the morphological characters of A. latus were more similar to those of A. spinulosporus compared to A. sublatus. However, the ascospore of A. latus differed from that of A. spinulosporus. Phylogenetic analysis revealed that different CaM alleles from the same isolate clustered separately with A. spinulosporus and A. sublatus, consistent with its hybrid origin. Furthermore, A. latus strains showed reduced susceptibility to caspofungin and amphotericin B compared to A. spinulosporus, while they were susceptible to azoles. Our results suggest that A. latus has been a causative pathogen of aspergillosis in Japan since 2013.

We characterized the genome of the clinical Trichophyton mentagrophytes genotype VII strain PG12DES. PG12DES genome harbored different virulence factors, including MEP-1, MEP-2, MEP-3, MEP-4, SUB-6, and ZAF-A. Phylogenetic analysis revealed that PG12DES was clonally related to a T. mentagrophytes strain isolated in Moldova in 2017. This study provides the genome characterization of a clinical strain from Italy and broadens the knowledge of the emergent genotype VII.

Candida auris has emerged as a major fungal pathogen responsible for persistent outbreaks, highlighting the importance of an effective screening strategy to control its spread in healthcare settings. Following a confirmed C. auris infection, we incorporated a specific qPCR assay into the screening process. Contact patients and environmental samples were screened weekly using culture and qPCR methods. We used these results to manage patients' cohorting, room disinfection, and new admissions in real time. The qPCR allowed us to identify 37 colonized patients and detect 47 contaminated environmental sites. While being specific, qPCR was more sensitive than culture in detecting C. auris colonization, enabling prompt infection control measures. This strategy was effective as the spread of C. auris in our institution was contained within 2 months. Our results support the inclusion of specific qPCR in the screening strategy for the early detection of C. auris in healthcare facilities.

Talaromyces marneffei (T. marneffei) co-infection remains a significant cause of mortality in people living with HIV (PLWH). Although early detection of individuals at high risk is essential, there remains a lack of markers to predict outcomes. This multicenter retrospective study analyzed 282 PLWH (95 treatment-naïve T. marneffei co-infected, 187 without opportunistic infections) to evaluate six inflammatory indices: systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-platelet ratio (NPR), and pan-immune inflammation value (PIV). Multivariate logistic regression and ROC analysis were performed to identify risk factors and prognostic performance. The results revealed that T. marneffei group exhibited significantly elevated levels of SII, NPR, NLR, and PLR (P <0.001), with lower LMR (P <0.001) and PIV levels (P =0.014). Logistic regression identified thrombocytopenia (P =0.026), hypoalbuminemia (P =0.031), and lower CD4+ T-cell counts (P =0.011) as independent predictors of HIV-TM coinfection. Among the T. marneffei group, survivors (n=80) and non-survivors (n=15) exhibited distinct inflammatory profiles: NLR demonstrated optimal mortality prediction (AUC=0.788, P <0.001), outperforming NPR (AUC=0.671, P <0.001). Multivariate analysis confirmed NLR as the sole mortality predictor (P =0.041), with restricted cubic spline analysis indicating a non-linear NLR-mortality relationship. In conclusion, we found that NLR represents a reliable prognostic marker for PLWH co-infected with T. marneffei.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been used for its immunomodulatory properties to enhance therapeutic outcomes and improve cure rates in fungal infections. However, the mechanisms of GM-CSF action in various fungal infections have not been systematically summarized in current literature, and the reliability and broad effectiveness of clinical data remain uncertain. This review provides a comprehensive analysis of how GM-CSF supports host defense against infections caused by specific fungal pathogens. These pathogens include yeasts (Candida spp., Cryptococcus spp.), filamentous fungi (Aspergillus spp., Mucorales, dematiaceous fungi), and thermally dimorphic fungi (Histoplasma capsulatum, Talaromyces marneffei, Paracoccidioides brasiliensis, and Blastomyces dermatitidis). These insights underscore the potential of GM-CSF as a promising adjunctive therapy in combating challenging fungal infections.

Aspergillus polymerase chain reaction (PCR) now employs standardised methodology and commercial options, with clinical performance validated through meta-analyses. The long-term availability of external quality assessment schemes drives performance and provides a currently untapped source of technical data. The Fungal PCR initiative and the Quality Control for Molecular Diagnostics (QCMD) combined forces to evaluate data from the Aspergillus PCR QCMD schemes between 2019 and 2022. Analysis showed inferior detection of non-fumigatus Aspergillus species (i.e.,Aspergillus niger) compared with A. fumigatus. Longitudinal evaluation showed the use of 'in-house' PCR methods by new participants when testing plasma generated lower positivity rates compared to commercial assays.

Despite advances in medical mycology, invasive Trichosporon spp. infections continue to be associated with high mortality rates. Limited data exist on the risk factors and outcomes of Trichosporon fungemia, particularly in our region. Therefore, this study aims to describe the risk factors, patient characteristics, antifungal susceptibility, and outcome of Trichosporon bloodstream infections at a tertiary care hospital in Saudi Arabia. This was a single-center retrospective chart review that included adult patients ≥ 16 years with positive blood cultures for Trichosporon spp. from January 2016 to December 2022. Descriptive statistics are presented using the mean for continuous variables and the number (percentage) for categorical variables. Ten patients with Trichosporon spp. isolated from blood cultures were eligible for inclusion in this study. The mean age was 58.1 years (range 17-83), with 70% male patients. Additionally, 40% had diabetes mellitus, and 40% had underlying malignancy. Trichosporon asahii was the predominant species in 90% of isolates. All patients had recent broad-spectrum antibiotic use, 80% were exposed to corticosteroids, and all had central venous catheters. One kidney transplant had an early recurrence of Trichosporon spp. fungemia. Four patients were cured of the infection, two were treated with voriconazole monotherapy, and two were treated with a combination of liposomal amphotericin B plus Voriconazole. Thirty-day all-cause mortality was 60%, with three deaths occurring before identification of the isolates. In conclusion, our study reported a predominance of Trichosporon asahii and a mortality rate of 60% in patients with Trichosporon fungemia. Challenges include delayed diagnosis, high mortality, and antifungal resistance, underscoring the need for further research to enhance treatment strategies and patient outcomes.