Mycoses最新文献

Background: Fusarium species are emerging pathogens known to cause both superficial and disseminated human infections. Aerosolized Fusarium species in healthcare settings have been associated with nosocomial fusariosis, particularly in patients with severe immunosuppression.

Objectives: To analyse the phylogenetic relationships of clinical and hospital environmental Fusarium isolates and assess their susceptibility to available antifungal agents.

Methods: Clinical Fusarium isolates were procured from four hospitals in Taiwan, with environmental air and water sampling collected at Kaohsiung Chang Gung Memorial Hospital (KCGMH). All clinical and hospital environmental Fusarium isolates were identified through gene sequencing of translation elongation factor 1-α and internal transcribed spacer regions of ribosomal DNA. Antifungal susceptibility testing followed the CLSI M38-A3 broth microdilution method.

Results: A total of 41 clinical and 4 hospital environmental Fusarium isolates were identified, belonging to five species complexes (SC): F. solani SC (FSSC) (62.8%), F. fujikuroi SC (FFSC) (14.0%), F. incarnatum-equiseti SC (11.6%), F. dimerum SC (7.0%), and F. oxysporum SC (4.7%). Phylogenetic analysis revealed that clinical Fusarium isolates from KCGMH were closely related to environmental Fusarium isolates from air samples at the same hospital. Amphotericin B exhibited high activity against most Fusarium species. With the exception of FFSC, other Fusarium SC demonstrated significantly elevated MIC values to itraconazole, voriconazole, posaconazole, and isavuconazole.

Conclusions: FSSC was the most prevalent SC in Taiwan, exhibiting higher MIC values for azoles than FFSC isolates. The clinical Fusarium isolates were observed to form clusters with the corresponding environmental isolates. The potential of airborne nosocomial infections in the healthcare environment cannot be overlooked.

Background: Aspergillus infections pose significant challenges in clinical management due to rising resistance rates and limited diagnostic accuracy. Superficial infections, particularly in immunocompetent individuals, are often understudied, despite their prevalence in specific populations.

Objectives: This study aimed to characterise the distribution and antifungal susceptibility patterns of Aspergillus isolates from a tertiary hospital in Shandong, China, and evaluate the performance of matrix-assisted laser desorption time-of-flight (MALDI-TOF) mass spectrometry versus multi-gene sequencing for species identification.

Patients/methods: A total of 120 Aspergillus isolates were collected from patients with localised aspergillosis (nails, external auditory canal, cornea, sub-throat secretions) between 2020 and 2021. Species identification was performed using MALDI-TOF and multi-gene sequencing (ITS, BenA, CaM, RPB2). Antifungal susceptibility testing was conducted for micafungin, azoles (itraconazole, voriconazole, posaconazole, fluconazole), and amphotericin B following standard protocols.

Results: Species Identification: MALDI-TOF identified 52.5% of isolates to the species level, whereas multi-gene sequencing achieved 100% accuracy. Aspergillus terreus was the most prevalent species (38.3%). Antifungal Susceptibility: Micafungin showed the highest resistance rate (40%), followed by amphotericin B (reduced susceptibility in 31.7%). Azoles demonstrated low resistance (3.3%-6.7%) except for fluconazole (21.7%). Clinical Correlates: Superficial infections were most common in middle-aged/elderly patients (68.3%), frequently linked to external trauma (41.7%) or environmental exposure (35.8%).

Conclusions: Multi-gene sequencing outperformed MALDI-TOF for Aspergillus identification. A. terreus dominance and micafungin resistance highlight regional epidemiological trends. Natamycin and nystatin remain cost-effective first-line topical options. Enhanced surveillance in trauma-prone and environmentally exposed populations is warranted.

Background and aim: Rapid chemiluminescence immunoassays (CLIA) have emerged as a promising alternative to traditional serological methods for the diagnosis of invasive aspergillosis (IA). The aim of this study was to compare the diagnostic performance of rapid CLIA tests in IA.

Methods: Patient group consisted of 17 patients who were diagnosed with probable IA according to EORTC/MSG criteria. Patients without invasive fungal infection (IFI) were defined as the control group, whereas healthy volunteers were also included. A total of 93 serum samples were used in this study. Platelia Aspergillus Ag test and Dynamiker Aspergillus Ag Kit, CLIA tests Aspergillus Galactomannan Detection Kit and Fungus (1-3) ꞵ-D-Glucan Detection Kit, were used. Specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Receiver operating characteristic (ROC) curve was used to evaluate the overall diagnostic performance of CLIA tests comparing FDA-approved GM ELISA test.

Results: The sensitivity of the CLIA galactomannan (CLIA GM) test was 70.6%, specificity 92.1%, PPV 66.7% and NPV 93.3% (p < 0.001), while the sensitivity of the CLIA beta-glucan (CLIA BDG) test was 88.2%, specificity 81.6%, PPV 51.7% and NPV 96.9% (p < 0.001). Using the PlateliaTM Aspergillus Ag Test as the reference method, the areas under the curve (AUC) of the ROC curve were 0.878 for CLIA BDG and 0.869 for CLIA GM.

Conclusions: CLIA-based tests were evaluated as being rapid diagnostic tests for IA since their NPVs were found to be very high. Integrating CLIA into clinical practice may significantly improve diagnostic efficiency and patient outcomes.

Background: Diagnosing chronic pulmonary aspergillosis (CPA) and its subtypes is essential for treatment and prognosis. In clinical practice, inexperienced doctors may overlook the presence of CPA due to overreliance on radiological results. Applying deep learning technology enhances multi-classification model performance.

Objective: To explore whether artificial intelligence generation technology and semisupervised learning can enhance model performance in CPA diagnosis and accurately classify CPA subtypes using small-sample datasets with skewed distributions and multiclass features.

Methods: This study developed a multi-classification model for CPA diagnosis and subtype differentiation using a multi-centre CT dataset. We augmented the small, skewed dataset with generation models and trained the deep learning model through a semi-supervised algorithm. Overfitting and poor validation generalisation issues were addressed with the internal dataset. The model, trained with different strategies, was evaluated on multiple internal and external test sets, measuring diagnostic performance via sensitivity, accuracy, F1 score, Matthews correlation coefficient, CK score and overall accuracy.

Results: A total of 39,387 chest CT images from 660 patients were split into training, validation and internal test sets. Additionally, 3337 chest CT images from 11 patients formed external test set 1, while 120 images from other studies made up external test set 2. The optimal model successfully diagnosed six CPA patients hidden in external test set 1 and classified their subtypes. In external test set 2, it achieved an ACC of 91% and an AUC of 0.92.

Conclusion: Using synthetic data and semi-supervised learning improved deep learning performance in diagnosing and classifying chronic pulmonary aspergillosis on chest CT images.

Background: Post-mycobacterial residual lung abnormality (PMLA) from prior tuberculous (PTLA) or non-tuberculous mycobacterial (PNTLA) lung infections predisposes to chronic pulmonary aspergillosis (CPA). However, the prevalence of CPA in patients with PMLA remains uncertain. We aimed to determine the prevalence of CPA in patients with PMLA.

Methods: We performed a systematic search of PubMed and Embase databases up to January 31, 2025, to identify studies reporting CPA prevalence in patients with PTLA or PNTLA (excluding those with active tuberculosis). The pooled prevalence was calculated using frequentist meta-analysis (primary outcome), with Bayesian and trim-and-fill methods as sensitivity analyses. Study heterogeneity (I²) and publication bias were assessed. We performed multivariable meta-regression to evaluate factors affecting heterogeneity.

Results: Thirty-one studies (4172 PTLA and 13,905 PNTLA) were included. Frequentist meta-analysis yielded a pooled CPA prevalence of 18% (95% confidence interval [CI], 11.6-25.4). Bayesian analysis with informative priors estimated prevalence of 7.1% (95% Credible Index, 4.5-10.4), and trim-and-fill adjustment for publication bias suggested prevalence to be 3.4% (95% CI, 0.69-7.7). On a multivariable analysis, we found CPA prevalence higher in hospital-based studies, high TB burden settings and studies with prospective or cross-sectional study designs; although CPA prevalence was higher in PTLA (23.1%) than in PNTLA (7%), it was not significantly different. We detected substantial heterogeneity (I² = 98.8%) and publication bias.

Conclusion: There is a high prevalence of CPA in patients with PMLA, particularly in TB-endemic regions and hospital settings. Patients with PMLA should be routinely screened for CPA in high prevalence settings.

Background: In mid-2024, German media reported increasing fungal infections by Trichophyton tonsurans linked to visits to barbershops. However, epidemiological data confirming a rise in tinea capitis and tinea corporis due to Trichophyton tonsurans are lacking.

Objectives: This study assesses dermatophyte species and clinical types of infections in German university hospitals in 2018 and 2023.

Patients/methods: This retrospective, multicentre study analyses mycological culture results from three Departments of Dermatology in Freiburg, Tübingen and Munich. The dermatophyte, along with the sampled body site, age and gender of the affected patient, was recorded.

Results: 1915 patients (male: 66.1%; mean age: 50 ± 24 years) with a dermatophyte-positive culture were identified. The most common dermatophyte was Trichophyton rubrum (2018: 78.7%; 2023: 66.3%) with tinea pedis and tinea unguium being the most prevalent types of infection. An increase in tinea corporis and tinea capitis was observed, with tinea capitis doubling from 4.3% to 9.3%. In 2023, Trichophyton tonsurans emerged as the prevailing dermatophyte (67.6%) in tinea capitis and as the second most frequent agent in tinea corporis (26.3%). This dominance of Trichophyton tonsurans was consistently observed across all three study centres. Trichophyton tonsurans affected patients presented a median age of 18 years in 2023 (vs. 9 years in 2018) and an amplified imbalance towards the male gender.

Conclusions: The pathogen spectrum and infection patterns have changed in Germany due to the increase of Trichophyton tonsurans infections. Intensified screening and hygiene measures, as well as adaptation of initial empiric treatment of tinea capitis, should be considered.

Background: In 2019, Trichophyton mentagrophytes genotype VII (TMVII) was identified in Germany as a cause of sexually transmitted tinea. Since 2023, it has been described in men who have sex with men (MSM) in France, Italy, and the United States. No cases have been reported in Spain.

Obectives: Our study aimed to assess the occurrence of TMVII in an STI clinic in Barcelona.

Patients/methods: We identified TMVII cases among all positive mycological skin/hair cultures between January 2020 and January 2025 by sequencing the internal transcribed spacer on isolates of T. mentagrophytes-interdigitale. We retrospectively collected demographic, clinical and treatment data and analysed the association between treatment received and outcome (cure vs. recurrence).

Results: Among 21 positive cultures, we obtained 15 isolates of T. mentagrophytes-interdigitale, of which 14 were sequenced and identified as TMVII. Patients with TMVII were all MSM; most were HIV positive (7) or negative on preexposure prophylaxis (6). Main sites of infection were pubogenital (6), buttocks-perianal (5) and beard (2). Six patients required multiple courses of treatment due to recurrence. Twenty-one courses of antifungal therapy were analysed, with an observed cure rate of 45% (5/11) for oral terbinafine vs. 80% (7/10) for topical agents (p = 0.39), and 0% (0/6) for ≤ 2-week courses vs. 80% (12/15) for 3-to-8-week courses (p < 0.01).

Conclusions: Our study confirms the presence of TMVII in Spain, supporting its circulation across Europe. Epidemiological profile and site of infection support sexual transmission. Patients responded to systemic or topical terbinafine but required longer-than-usual periods of treatment.

Candida auris (C. auris) is a therapeutic challenge due to the lack of definition of susceptibility breakpoints and the misidentification by biochemical tests, which leads to suboptimal therapy. Hence, our goal was to assess the treatment outcomes of C. auris infections at our institution.

Methods: A retrospective observational study between January 2019 and June 2022 that included confirmed C. auris infection cases. The primary endpoint was to assess the clinical outcomes of C. auris management. The secondary endpoints were to evaluate mycologic cure, 30 and 90-day infection recurrence, and 30-day all-cause mortality. Descriptive statistics were used to analyse our data.

Results: Fifty-six subjects were evaluated, with a mean age of 65.05 ± 16.86 years. Candidemia accounted for 62.7% of cases. Clinical cure was achieved in 57% of patients, and mycologic cure in 84.4%. Recurrence of C. auris infection occurred in 28.6% at 30 days and in 12.7% at 90 days. Thirty-day all-cause mortality occurred in 28.6% of patients. Multivariable logistic regression indicated that mycologic cure with Odds Ratio (OR) 6.96 (95% CI: 1.21-39.92), length in intensive care units (ICU) stay OR 0.132 (95% CI: 0.019-0.907), and baseline C-reactive protein (CRP) OR 0.990 (95% CI: 0.982-0.998) were the independent predictors of clinical cure.

Conclusion: Clinical cure of invasive C. auris infections was dependent on mycologic cure, length of ICU stays, and baseline CRP levels, with observed 30-day all-cause mortality up to 28.6%. Similarly to other reports, our isolates exhibited resistance to fluconazole and amphotericin B in most cases. Only two isolates demonstrated resistance to caspofungin and were deemed pan-resistant. Further multi-centre studies are needed to validate our findings.

Background: The Trichophyton mentagrophytes complex encompasses common dermatophytes causing superficial mycoses in humans and animals. The taxonomy of the complex is unstable, with conflicting views on the species status of some taxa, particularly T. indotineae and T. interdigitale. Due to the presence of intermediate genotypes, neither MALDI-TOF MS nor ITS rDNA sequencing can accurately distinguish all taxa in the complex, potentially contributing to clinical misdiagnoses.

Objectives: This research resolves phylogenetic relationships within the T. mentagrophytes complex. Based on these data, the taxonomical recommendations are suggested.

Methods: In order to resolve the phylogenetic relationship of the T. mentagrophytes complex, we employed Restriction Site-Associated DNA Sequencing (RADseq) to produce a high-resolution single nucleotide polymorphism (SNP) dataset from 95 isolates. The SNP-based analyses indicated the presence of two major genetic clusters corresponding to T. mentagrophytes (including T. indotineae) and T. interdigitale.

Results: Our results challenge the species status of T. indotineae because of insufficient genetic divergence from T. mentagrophytes. Therefore, we propose designating T. indotineae as T. mentagrophytes var. indotineae (or T. mentagrophytes ITS genotype VIII) to avoid further splitting of the complex and taxonomic inflation. Although T. interdigitale shows clearer genetic differentiation, its separation is incomplete and identification of some isolates is ambiguous when using routine methods, leading us to consider it a variety as well: T. mentagrophytes var. interdigitale.

Conclusions: We recommend using T. mentagrophytes as the overarching species name for all complex isolates. Where precise molecular identification is possible, the use of variety ranks is encouraged. Since identical resistance mechanisms are not specific to any genotype or dermatophyte species, identifying antifungal resistance is more important than differentiating closely related genotypes or populations.

This review provides an in-depth exploration of antifungal resistance in non-fumigatus Aspergillus species, mainly focusing on acquired resistance. The available data have been compiled and sometimes re-analysed. It highlights the increasing prevalence of resistance in non-fumigatus species belonging to Flavi, Terrei, Nigri, and Nidulantes Aspergillus sections, offering a detailed analysis of resistance detection methods and the global distribution of resistant strains. The review also thoroughly examines the molecular mechanisms behind resistance and raises key unresolved issues, such as the factors contributing to resistance selection and the clinical implications of in vitro resistance. Additionally, it addresses the challenges of treating infections caused by resistant Aspergillus species and cryptic species and discusses current and future strategies relying on combination therapy and newly developed antifungals. The conclusion emphasises the need for further research into resistance mechanisms and alternative treatments to address the rising threat of antifungal resistance in Aspergillus species.