Medical mycology最新文献

Candidemia is associated with high morbidity and mortality. Delayed initiation of effective and appropriate antifungal therapy correlates with increased patient mortality, emphasizing the importance of rapid antifungal susceptibility testing (AFST). Usual commercial methods, such as the standard E-test, are time-consuming, often requiring a minimum of 48 h. This study aimed to evaluate the performance of direct E-test (ET-dir) directly from positive blood culture bottles, with the goal of reducing turnaround time and improving clinical decision-making. A total of 160 yeast positive blood cultures were included over a 4-year period, comprising 85 Candida albicans. The minimum inhibitory concentrations (MICs) of fluconazole, voriconazole, amphotericin B, and anidulafungin were determined using ET-dir and compared to ET method (ET-sd). Essential agreement, categorical agreement, error rates, and bias were analyzed for all species and specifically for C. albicans. The essential agreement between ET-dir and ET-sd exceeded 87% for all antifungal agents and reached ≥90% for fluconazole. The categorical agreement was above 90% for all agents, and error rates remained within acceptable limits except for anidulafungin. For C. albicans, 23 of 24 performance data met acceptability criteria, with essential agreement ≥90% for all agents except fluconazole. ET-dir results were interpretable within 24 h for 93.7% of strains, providing at least a 24-h time gain over ET-sd. ET-dir is a reliable and rapid AFST method for candidemia, meeting most performance criteria compared to ET-sd while significantly reducing turnaround time. Its routine implementation could enable faster adaptation of antifungal therapy, ensuring that treatments are optimized based on susceptibility results.

This study characterizes the molecular epidemiology of Sporothrix species in Shanxi Province, a low-prevalence region in China, providing real data on genetic profiles and antifungal susceptibility patterns. Clinical records of sporotrichosis cases from a tertiary hospital in Shanxi (2019-2024) were retrospectively analyzed. Isolates were identified through multilocus sequencing targeting the internal transcribed spacer, calmodulin, β-tubulin, and mating-type locus genes, with phylogenetic analysis. Antifungal susceptibility testing against seven agents was performed for both yeast and mycelial phases. Additionally, a review of Chinese case reports (2015-2025) was conducted to collect and summarize data on Sporothrix species identification across the country. All 11 isolates were confirmed as Sporothrix globosa, displaying high genetic similarity to the strains reported in most regions of China in previous studies. Terbinafine, ketoconazole, and itraconazole demonstrated good activity. Yeast-phase susceptibility was significantly higher for amphotericin B, itraconazole, and voriconazole (P < .05, compared to the mycelial phase). Geospatial analysis indicated S. globosa dominance in reported areas, with persistent surveillance gaps in western China. This study from Shanxi provides a comprehensive overview of S. globosa as the predominant etiological agent in the region, consistent with the distribution pattern observed throughout China. Terbinafine demonstrated the highest in vitro activity against S. globosa.

Meyerozyma guilliermondii represents an opportunistic pathogen complex threatening immunocompromised patients, notably those with cancer, leading to candidemia characterized by increasing incidence and high mortality risk. However, understanding of candidemia in cancer patients is limited. This study aims to elucidate the epidemiological and clinical features of candidemia by the M. guilliermondii species complex (MGSC) in cancer patients, thereby enhancing disease diagnosis and treatment. A systematic review was performed, analyzing cases from 1967 to 2024 documented in PubMed, Scopus, Embase, and Web of Science using specific terms related to M. guilliermondii and cancer. Additionally, two cancer-related invasive candidiasis cases by M. guilliermondii sensu stricto from Jiangxi Cancer Hospital were included. The review identified 282 cases, with 225 specifying tumor types: 114 hematologic malignancies and 111 solid tumors. A significant increase in cases was noted over the last two decades (92.2%). Predominantly, adults were affected, with a male-to-female ratio of 97:53. Among the precisely identified species in recent years, M. guilliermondii sensu stricto was the most recorded species (83.6%), with nine cases of candidemia due to M. caribbica in cancer patients. The overall mortality was 33.0%. Common factors included central venous catheter (CVC) placement (75.8%), prior broad-spectrum antibiotics (68.5%), and parenteral nutrition (46.1%). Timely CVC removal is crucial for cancer patients with prolonged CVC placement to prevent MGSC-related candidemia. Cancer patients with multiple risk factors are highly susceptible to MGSC-caused candidemia, which is increasing in incidence and mortality risk. Prompt antifungal therapy is essential for improving prognosis.

Background: Isavuconazole (ISA) is a treatment option for invasive fungal infections (IFIs) and is known for a favorable safety profile compared with other antifungal agents. However, comprehensive evidence regarding its efficacy and safety remains limited.

Objectives: This study aimed to assess the efficacy and safety of ISA compared with other antifungal agents through a systematic review and meta-analysis restricted to randomized controlled trials (RCTs), to provide more reliable estimates of its clinical effects.

Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive literature search was conducted using PubMed, the Cochrane Library, Web of Science, and ClinicalTrials.gov to identify RCTs comparing ISA with other antifungal agents. The primary outcomes were clinical response and mortality. Secondary outcomes included the incidence of adverse events, including serious, drug-related, and organ-specific toxicities. A subgroup analysis was conducted focusing on filamentous fungal infections, comparing ISA and voriconazole.

Results: Three RCTs met the inclusion criteria. No statistically significant differences were observed between ISA and comparator agents in terms of clinical response, mortality, or total and organ-specific adverse events. A trend toward fewer adverse events was noted in the ISA group. In the subgroup analysis, ISA and voriconazole showed similar efficacy and overall safety; however, the incidence of both drug-related adverse events and hepatobiliary disorders was significantly lower in the ISA group.

Conclusions: ISA demonstrated efficacy comparable to that of other antifungal agents, with a favorable safety profile in patients with IFIs, including filamentous fungal infections. This meta-analysis of RCTs provides high-quality evidence to support antifungal drug selection in clinical practice.

Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection in immunocompromised patients, with a complex diagnosis due to its colonizing role. Current guidelines recommend microbiological confirmation through direct microscopy of lower respiratory tract samples, 1,3-β-D-glucan (BDG) serum testing, or RT-PCR detection in lower respiratory samples. However, non-invasive diagnostic alternatives, such as oral wash RT-PCR combined with BDG serum levels, could be an option for non-intubated and non-candidates to bronchoscopy patients in a real clinical setting. A retrospective study analysed 49 patients with suspected PCP at Hospital Universitario La Paz (Madrid, Spain) between January 2020-March 2025. Patients underwent to serum BDG (Wako®, ≥ 7 pg/ml) and P. jirovecii RT-PCR in oral wash tests. The study assessed the impact of time of symptoms and treatment on microbiological findings and the clinical utility of combining tests for PCP diagnosis. Among the 49 patients, 12 (24.5%) had a positive P. jirovecii RT-PCR in oral wash, and 12 of them (85.7%) also had a positive BDG. Median BDG was 27.1 (interquartile range: 14.4-100.7) pg/ml for positive patients (P < .05). Patients with (+)BDG/RT-PCR showed a longer symptom duration compared to negative (P > .05). Previous PCP prophylaxis/treatment showed a reduction in P. jirovecii RT-PCR results (P > .05). Combining tests could be useful in patients who are not candidates for bronchoscopy (P < .05) and influenced treatment decisions, reducing unneeded PCP treatments in (-)RT-PCR/BDG in immunosuppressed patients with high pretest value. P. jirovecii RT-PCR in oral wash showed to be good screening assay in patients without PCP treatment/prophylaxis and BDG, as it appears to serve as a complementary diagnostic tool for confirming PCP infection, primarily in prolonged infectious conditions. This strategy could help optimize treatment decisions, reducing the need for invasive procedures. Further multicentric studies are needed to validate the combination test results and assess cost-effectiveness in clinical practice.

This study evaluated the virulence traits of non-Cryptococcus Tremellomycetes Papiliotrema flavescens (n = 5), Naganishia diffluens (n = 6), N. randhawae (n = 1), and Filobasidium magnum (n = 2). Virulence traits analyzed included capsule formation, melanin production, urease and phospholipase activity, hemolysin production, biofilm formation, and UV resistance. All yeasts produced capsule; melanin was detected in 78.6%, urease in 92.9%, and phospholipase in 85.7%; 42.9% were weak biofilm producers, and 33.3% survived UV exposure. These findings highlight that the fungi evaluated exhibit virulence attributes, underscoring the need for further research, including in vivo studies and genetic analyses, to clarify their pathogenic potential.

Given the limited evidence on the optimal caspofungin dose for patients with obesity and candidemia, this study aims to evaluate the clinical outcomes of the standard caspofungin dose in critically ill patients with obesity and candidemia. A multicenter, retrospective cohort study was conducted in three tertiary care hospitals in Saudi Arabia. Eligible critically ill patients with confirmed candidemia who received standard dose of caspofungin were stratified according to their Body Mass Index (BMI) at the time of caspofungin initiation into two groups: control (BMI: 18-29.9 kg/m2) or obese (BMI: ≥30 kg/m2). The primary outcome was the incidence of clinical success. All other outcomes were considered secondary. The significance level was set at a P-value of <.05, and statistical analysis was conducted using SAS 9.4 software. A total of 108 patients were included; forty-six (42.6%) were obese. There were no significant differences in terms of clinical success between the groups (aOR, 1.38; 95% CI, 0.54-3.54; P = .50). Microbiological success rate was numerically higher in the control group compared to obese patients (83.9% vs. 69.6%; P = .07); notably, the difference was statistically significant in the regression analysis (aOR, 3.40; 95% CI, 1.040-11.099; P = .04). No significant differences were observed in other outcomes, including time for microbiological success, treatment failure, infection recurrence within 90 days, mortality, and length of stay. In conclusion, patients with obesity had similar clinical success to control group; however, a lower microbiological success rate was observed in patients with obesity. Further research is needed to explore long-term implications of caspofungin therapy in obese patients with candidemia.

Widespread use of the 'unspecified coccidioidomycosis' code (B38.9) may negatively impact provider reimbursement and complicate study of disease burden. We sought to determine the frequency of B38.9 use in routine practice and assess how often it could be changed to a more specific code, what code that might be, and reasons for its initial use. To estimate the proportion of all coccidioidomycosis cases that were classified using the International Classification of Diseases-Tenth-Revision unspecified diagnosis code (B38.9), three real-world datasets were queried. Further, in January 2025, providers in coccidioidomycosis-endemic areas were invited to participate in an online electronic health record (EHR) audit to study their three most recent patients coded as B38.9 over the prior 12 months. The proportion of patients that could have received a more specific coccidioidomycosis code by provider was determined, as were the recommended alternative code(s), and reasons for the B38.9's initial use. Across queried datasets, 17.8-49.5% of coccidioidomycosis cases were coded as unspecified. We recruited 19 providers to audit EHRs of 53 patients, in which B38.9 was used. Thirty-six (67.9%) patients could have been assigned a more specific coccidioidomycosis code, including 14 (38.9%) to disseminated disease (B38.7). Common reasons for using B38.9 included evolving clinical assessment (37.0%), lack of coding expertise (22.2%), and entry errors (22.2%). In conclusion, a substantial proportion of coccidioidomycosis diagnoses are assigned to B38.9. Over two-thirds of these could have been better described using a more specific code. There is a need for educational efforts to promote more precise coding.

This multicentre retrospective study investigated the epidemiology, clinical characteristics, and fluconazole resistance rates of Candida species in osteoarticular infections across Turkey as well as the factors influencing complete recovery. Data were gathered from 73 adult patients diagnosed with proven or probable Candida-associated osteoarticular infections between 2015 and 2025 from 20 healthcare centres. The most common clinical presentation was spondylodiscitis, followed by the involvement of phalangeal bones in the hands and feet. Non-albicansCandida species accounted for 37/73 cases (50.7%), with Candida parapsilosis being the most frequent. Fluconazole resistance was low among C. albicans isolates (3%) but higher among non-albicans yeasts (27%). Bacterial co-infection, predominantly Gram-positive bacteria, was detected in 52.1% of cases. Diabetes was present in 50/73 patients (68.5%), particularly insulin-dependent diabetes, and was a prominent comorbidity that may have also contributed as a predisposing factor. Radiological detection of osteomyelitis was achieved in 69.9% of patients. Fluconazole was the most commonly used antifungal agent (74%) with a median treatment duration of 90 days. Multivariate analysis revealed that surgical debridement was significantly associated with a higher odds of clinical recovery (adjusted odds ratio [aOR], 5.764; 95% confidence interval [CI], 1.360-24.434; P = .017), whereas diabetes mellitus was significantly associated with a lower odds of total recovery (aOR, 0.205; 95% CI, 0.053-0.792; P = .022). In conclusion, this multicentre study provides epidemiological data and fluconazole resistance rates of Candida species causing osteoarticular infections in Turkey, highlights the occurrence of C. auris in this cohort, and identifies surgical intervention and diabetes mellitus as factors significantly associated with recovery.

Sporothrix brasiliensis is the leading cause of feline sporotrichosis in Brazil, an emerging zoonosis. Itraconazole (ITZ) is the first-line therapy; however, therapeutic failures and reports of ITZ-resistant isolates emphasize the need for new therapeutic options. This study evaluated the in vitro susceptibility profile of 25 Brazilian S. brasiliensis isolates to amorolfine hydrochloride (AMR) and ITZ. AMR evidenced fungicidal activity in 76% and fungistatic activity in 24% of isolates. All isolates were susceptible to ITZ. These findings support AMR as a promising antifungal candidate against S. brasiliensis and highlight the importance of continued surveillance of ITZ susceptibility, especially in endemic regions of Brazil.