Mycoses最新文献

Background: Identification of filamentous fungi still poses a major challenge to laboratories. Matrix assisted laser desorption/ionisation time of flight mass spectrometry (MALDI-TOF MS) is a promising tool, since it offers low-cost and fast results. Different MALDI-TOF MS systems are available for routine laboratories. This is a comprehensive head-to-head comparison of three devices and the respective reference spectrum databases.

Materials and methods: A set of 77 pre-characterised isolates of filamentous fungi was measured (in duplicates) parallelly with three MALDI-TOF MS systems after 24 h, 48 h and 72 h of incubation: (1) Biotyper smart ('BT', Bruker Daltonics),(2) EXS2600 ('EXS', Zybio) and (3) VITEK MS PRIME ('VITEK', bioMérieux).

Results: After three measurements, no valid results at the species level ('green category') were obtained for 18%, 21% and 14% of isolates by BT, EXS and VITEK. Depending on the MALDI-TOF MS system, validity rates ranged from 58%-82% for the different time points. Correct and valid results were obtained for 82%, 73% and 81% of isolates by BT, EXS and VITEK. BT was the system that required the most duplicate measurements. EXS displayed the highest rate of misidentification events. VITEK had the highest rate of unidentified isolates, which were featured within its database.

Conclusion: Based on our experience, all three devices proved to be suitable for routine diagnostics. The timepoint of measurement had a major impact on the quality of analysis and should be considered by the user. Lowering the validity cut-off levels might increase the performance of the EXS system.

Introduction: Dermatophytosis is a chronic public health issue in India, often requiring systemic antifungals. Itraconazole (ITZ) is commonly used, but conventional forms show variable absorption. Super-bioavailable itraconazole (SUBA-ITZ) offers improved pharmacokinetics, though clinical comparisons are limited.

Objective: To compare the efficacy, safety, relapse, and recurrence rates of three oral ITZ formulations-Conventional ITZ 100 mg (C-ITZ), SUBA-ITZ 65 mg, and SUBA-ITZ 50 mg-in superficial dermatophytosis.

Methods: In this open-label, randomised study at a tertiary hospital, 150 patients with confirmed tinea corporis, cruris, or faciei were equally assigned to: Group A: C-ITZ 100 mg BID Group B: SUBA-ITZ 65 mg BID Group C: SUBA-ITZ 50 mg BID Treatment lasted 6 weeks without topical antifungals. Assessments were done at 3 and 6 weeks; relapse and recurrence were monitored telephonically at 3 and 6 months.

Results: All groups showed similar clinical response at 6 weeks (BSA, PGA, KOH negativity), with no significant differences. At 3 months, Group C had significantly lower relapse and recurrence (10.2%) than Group B (31.1%, 28.9%) and Group A (23.9%, 26.1%) (p < 0.05). By 6 months, differences were not significant.

Conclusion: All three itraconazole formulations demonstrated comparable short-term efficacy in treating superficial dermatophytosis. These findings underscore the need for larger, long-term randomised controlled trials to optimise itraconazole dosing strategies.

Background: Central nervous system (CNS) histoplasmosis occurs in 5%-10% of patients with disseminated histoplasmosis, is sparsely described in the literature and is highly morbid.

Objectives: To evaluate clinical characteristics and outcomes of patients with CNS and non-CNS disseminated histoplasmosis.

Methods: In this retrospective case-control study, we matched 45 cases of CNS histoplasmosis with 45 controls with disseminated histoplasmosis without CNS involvement by hospital and date of encounter. Data were collected from three hospitals from January 2000 to December 2022 using histoplasmosis-related ICD-9/10 codes. Patients were classified as confirmed (Histoplasma growth on cerebrospinal fluid [CSF] or CNS culture), probable (positive CSF Histoplasma antigen or antibody), or possible (positive urine or serum Histoplasma antigen plus either CSF WBC ≥ 5 cells/μL or abnormalities on CNS imaging, with no other evident cause) CNS histoplasmosis.

Results: CNS (n = 45) and non-CNS disseminated histoplasmosis (n = 45) patients had similar demographic and clinical characteristics, although persons living with HIV (PLWH) were more prevalent in the CNS histoplasmosis group (93.3% and 80.0%, respectively, p = 0.019). CSF profiles (CSF WBC, glucose and total protein) and MRI brain imaging were normal in 28.2% and 21.9% of CNS histoplasmosis patients, respectively. CNS histoplasmosis patients were severely ill, with 34.1% requiring ICU care and Glasgow Outcome Scores of 1-4 in 51.1% of patients at discharge. In-hospital mortality was 6.7% for CNS vs. 13.3% for disseminated histoplasmosis (p = 0.215).

Conclusions: In this large CNS histoplasmosis cohort, we found an increased prevalence of PLWH in CNS vs. non-CNS disseminated histoplasmosis. Similar to prior CNS histoplasmosis cohorts, we report relatively high rates of normal CSF profiles (28.2%) and MRI brain imaging (21.9%). We also found significant morbidity in patients with CNS histoplasmosis, data which were not reported in prior cohorts.

Objectives: This study aimed to systematically evaluate and compare the performance of two laboratory-developed assays (LDAs) and three commercially available real-time PCR assays for the detection of Candida auris. The analytical sensitivity, specificity and limit of detection (LOD) of each assay were assessed, alongside their clinical sensitivity in identifying C. auris colonisation.

Methods: Ten C. auris strains representing five clades, as well as genetically related yeasts, common yeast species, and dermatophytes, were used to assess assay sensitivity and cross reactivity. Clinical and environmental samples were collected from patients during an outbreak and tested with three commercial PCR assays (AurisID, Fungiplex, FungiXpert) and two LDAs (CDC LDA, EMC LDA). LOD was determined using Probit analysis. Diagnostic sensitivity was evaluated by comparing the detection rate of each individual assay to the total detection rate of all assays combined.

Results: The EMC LDA exhibited the highest analytical sensitivity, with a LOD of 8 conidia/reaction, followed by CDC LDA (16 conidia/reaction), AurisID and FungiXpert (19 conidia/reaction), and Fungiplex (596 conidia/reaction). Specificity testing revealed cross-reactivity in the CDC LDA and AurisID assays with C. pseudohaemulonii at high conidia levels, while no cross-reactivity was observed in the other assays. EMC LDA showed the highest clinical sensitivity (100%), whereas Fungiplex had the lowest positivity rate (71%). No false positives were observed in negative control swabs for any assay.

Conclusions: Real-time PCR is a crucial tool for the rapid and sensitive detection of C. auris , especially in clinical settings where timely identification is essential for effective patient management and infection control. Numerous PCR assays are available for this purpose; however, our study demonstrates that the sensitivity of these assays can vary significantly. The observed differences underscore the importance of establishing international reference standards and proficiency panels to enhance the accuracy and comparability of assay performance across different studies and laboratories.

Background: Serum 1,3-β-d-glucan (BDG) tests are frequently used for diagnosing invasive candidiasis. However, BDG tests remain negative in many patients with candidemia, and factors influencing the probability for positive test results are poorly understood.

Objectives: To study clinical and microbiological factors predictive of a positive BDG test, as well as the association of a positive BDG test with mortality in patients with candidemia.

Methods: In a retrospective cohort of patients with candidemia, BDG was analysed by the Glucatell assay and the Wako Beta-Glucan Test. Predisposing conditions, focus of infection and other variables were retrieved from medical charts and laboratory databases. Their association with a positive BDG test, and the association between positive BDG and death was tested in univariate analysis and multivariable logistic regression.

Results: We included 134 patients with candidemia. Positive BDG and a non-abdominal deep-seated focus of infection (e.g., hematogenously disseminated infection and deep mediastinal/pleural candidiasis) were positively correlated in univariate and multivariable analyses [Wako adjusted odds ratio 9.11 (95% CI 1.66-172, p = 0.039), Glucatell adjOR 9.14 (95% CI 1.66-172, p = 0.039)]. Having a positive BDG test increased the risk for 90 days mortality after controlling for potential confounders, mainly age, septic shock, and ICU admission [Wako adjOR 4.73 (95% CI 1.71-14.7, p = 0.0043), Glucatell adjOR 3.59 (95% CI 1.33-10.6, p = 0.015)].

Conclusions: In patients with candidemia, a positive BDG test is more common in the presence of a concomitant non-abdominal deep-seated infection. Patients with a positive BDG test have a higher 90-day mortality.

Background: Studies analysing the readability of online materials about dermatomycoses were very limited.

Objectives: This study evaluated the readability of online materials related to superficial skin fungal infections in English, German, French, Italian, Spanish and Polish.

Methods: The terms 'dermatomycosis', 'dermatophytosis' and 'trichophytosis' translated into included languages were searched using the Google search engine. The first 50 records in each language were screened for suitability. Articles that were accessible, relevant to dermatological fungal infections and aimed at patient education were included. The LIX score was utilised to assess readability.

Results: In general, 167 articles out of 900 screened (19%) were analysed. The overall mean LIX score was 56 ± 7, which classified articles as very difficult to comprehend. The most readable were articles retrieved with the search term 'trichophytosis' with a mean LIX score of 49 ± 3, followed by 'dermatophytosis' with 54 ± 8 and 'dermatomycosis' with 58 ± 7 (p < 0.001). The most readable articles were in English (48 ± 7) and Spanish (50 ± 5), followed by German (54 ± 4), French (55 ± 6), Italian (59 ± 5) and Polish (63 ± 4) (p < 0.001). The increase in the number of analysed articles was correlated with a higher average LIX score (p = 0.036, R² = 0.708).

Conclusions: Low availability and readability of online patient materials related to superficial skin fungal infections could hinder patient understanding, leading to improper antifungal use, increased recurrence rates and the risk of antifungal resistance. The dermatologists should take action to ensure adequate online materials in Internet-based society.

Background: Onychomycosis is common in older adults and can be difficult to treat owing to slower nail growth, increased nail thickness, comorbidities, and concomitant medications. Oral treatments can be complicated by contraindications, drug-drug interactions, and adverse effects. Topical treatments such as efinaconazole 10% solution may be beneficial for treating older adults.

Objectives: To evaluate the efficacy/safety of efinaconazole 10% solution in adults aged ≥ 65 years with toenail onychomycosis.

Patients/methods: In two multicenter, double-blind, phase 3 studies (NCT01008033; NCT01007708), patients with mild to moderate toenail onychomycosis were randomised (3:1) to once-daily efinaconazole or vehicle for 48 weeks, with a 4-week follow-up. Pooled data for participants aged ≥ 65 years were analysed post hoc (n = 162 efinaconazole, n = 56 vehicle). The primary endpoint was complete cure (0% involvement of target toenail plus mycologic cure [negative KOH and fungal culture]) at week 52. Treatment-emergent adverse events (TEAEs) were assessed throughout.

Results: At week 52, a significantly greater proportion of older adults (aged 65-71 years) achieved complete cure with efinaconazole than vehicle (13.6% vs. 3.6%; p < 0.05). Complete/almost complete cure rate was also significantly greater (≤ 5% involvement and mycologic cure; 19.1% vs. 5.4%; p = 0.01), and over half (59.2%) of participants achieved mycologic cure with efinaconazole versus 12.5% with vehicle (p < 0.001). Treatment-related TEAE rates with efinaconazole were low (6.0%) and similar to the overall study population.

Conclusions: Efinaconazole 10% solution showed similar efficacy/safety in participants aged ≥ 65 years to the overall phase 3 population, despite potential age-related nail changes. These results demonstrate the benefits of efinaconazole in older patients with onychomycosis.

Background: Fungal keratitis is a significant cause of ocular morbidity globally. There is a lack of contemporary local data in Western Australia.

Methods: A retrospective chart review of fungal keratitis cases at two tertiary hospitals in Perth, Western Australia identified between 1 January 2006 and 31 December 2022. Data on patient demographics, isolated organisms, risk factors, clinical features, outcomes, and management were collected and analysed.

Results: There were 68 cases of clinically significant fungal keratitis with positive culture results from corneal scrapes. The most commonly isolated pathogens were Fusarium species (37%), Candida species (28%), Scedosporium species (10%), and Aspergillus species (9%). The most common predisposing risk factors were prior use of topical corticosteroids (40%), contact lens wear (35%), ocular surface disease (without a corneal graft) (25%), ocular trauma (including organic matter exposure) (18%), and a previous corneal graft procedure (16%). Corneal perforation occurred in 25% of cases. A high proportion, 22 episodes in 18 eyes (26%), of patients required therapeutic penetrating keratoplasty, and 6% required evisceration.

Conclusions: Results were largely consistent with previous studies in the Australian context. Fusarium species and Candida albicans were the most common pathogens isolated. Prior topical corticosteroid use was the most common predisposing risk factor, followed closely by contact lens wear and ocular surface disease. A large proportion of patients experienced corneal perforations and required penetrating keratoplasty.

Introduction: The yeast Candida vulturna is a member of the Candida haemulonii species complex, like its close relative Candida auris. Members of this species complex, including C. vulturna, often display reduced susceptibility to one or more antifungal classes. Human invasive infections by C. vulturna are increasingly reported in various countries, while the first identification of this fungus, isolated from a flower, occurred less than 10 years ago. The purpose of this review is to compile all reported outbreaks and cases and describe the characteristics of this emerging yeast.

Methods: PubMed, Scopus, Web of Science and Google Scholar were reviewed for publications until April 14, 2025. Records in English were found by using the keyword Candida (Candidozyma) vulturna, and were included if cases were invasive infections.

Results: All reported 94 cases were exclusively from the last 10 years, often in Asian or Latin American countries and included three outbreaks in Brazil, Vietnam and China. Patients displayed diverse clinical characteristics with an overall low mortality rate of 18%. Most studies (n = 11) performed antifungal susceptibility testing (AFST) with microbroth dilution methods and found reduced susceptibility to azoles and amphotericin B. The ERG11^P135S mutation was shown to confer azole resistance, although the mechanism behind amphotericin B resistance has not been uncovered. Identification by MALDI-ToF routinely misidentified C. vulturna as C. pseudohaemulonii or C. duobushaemulonii, leaving molecular identification by ITS sequencing or whole genome sequencing as the only available methods for accurate species determination.

Conclusion: Although C. vulturna is still a rare yeast, cases are increasingly reported in tropical regions. The yeast has outbreak potential, in addition to reduced susceptibility to azoles and amphotericin B. Treatment with echinocandins showed favourable outcomes with a low mortality rate.

Background: The recent rise in the global incidence of fluconazole resistance in C. parapsilosis has become a significant public health concern. Epidemiological studies suggest that fluconazole resistance in C. parapsilosis spreads through endemic clones. We, therefore, investigated the molecular epidemiology of fluconazole-resistant C. parapsilosis in our centre.

Methods: C. parapsilosis isolates from 2016 through 2022 were investigated for antifungal susceptibility. Fluconazole-resistant isolates were analysed for ERG11 mutation using Sanger sequencing. Gene expression profiles of ERG11, CDR1 and MDR1 were assessed by real-time qPCR. The epidemiological relationship of resistant and susceptible isolates of C. parapsilosis was investigated using short tandem repeat typing. Additionally, biofilm production and cell wall ergosterol contents were also quantified and compared.

Results: Among 572 C. parapsilosis isolates, 48 (8.4%) were resistant to fluconazole. Of 28 recoverable resistant isolates, 17.9% (5/28) were wild-type and 82.1% (23/28) harboured the following ERG11 mutations: Y132F (n = 3), K143R (n = 10) and K143R + R398I (10/28). Significant fold-changes were observed in ERG11 (p = 0.037) and MDR1 (p = 0.008) gene expressions in fluconazole resistant compared to susceptible isolates. Contrary to global reports, STR typing suggested a limited clonal transmission of resistant C. parapsilosis with multiple introductions of resistant isolates in our centre. On fluconazole exposure, ergosterol content significantly increased (p < 0.01) in resistant isolates, particularly in isolates harbouring ERG11^{K143R + R398I} mutations. In contrast, fluconazole-susceptible isolates formed comparatively higher baseline biofilm (p < 0.05) than resistant isolates with ERG11^K143R mutation.

Conclusion: The current study underscores the need for continuous molecular surveillance and tailored therapeutic options for effective management of fluconazole resistance in C. parapsilosis.