Mycoses最新文献

Background: Epidemiological surveillance of Candidozyma sp. has become important because many species of this new genus have been reported to be responsible for nosocomial outbreaks and to exhibit elevated minimal inhibitory concentrations (MIC) to one or more classes of antifungal drugs.

Objectives: To describe the genetic relationships among Argentinian clinical isolates belonging to the Candidozyma genus and to study the molecular mechanisms associated with antifungal resistance.

Methods: We performed whole-genome sequencing of 41 isolates. Identification was based on ribosomal DNA sequencing and susceptibility testing was determined according to the EUCAST document. Phylogenetic analysis, non-synonymous mutations in genes associated with antifungal resistance and the presence of copy number variations (CNVs) were investigated.

Results: We identified 12 Candidozyma haemuli, 11 Candidozyma haemuli var. vulneris, 5 Cz. haemuli/ Cz. haemuli var. vulneris ITS hybrids, 8 Candidozyma duobushaemuli and 5 Candidozyma cf. pseudohaemuli. Phylogenetic analysis, together with clinical data, demonstrated nosocomial transmission events. In addition, Cz. haemuli and Cz. haemuli var. vulneris were not separated in the phylogenetic tree; the Cz. cf. pseudohaemuli isolates clustered distantly from the Cz. pseudohaemuli type strain. Most isolates were resistant to amphotericin B, and two Cz. haemuli isolates showed fluconazole resistance and Y132F mutation in ERG11. We did not find CNV in genes associated with antifungal resistance.

Conclusions: These findings highlight the need for epidemiological surveillance of these species and the study of molecular mechanisms associated with antifungal resistance. Furthermore, we propose a taxonomic revision for Cz. haemuli var. vulneris and Cz. pseudohaemuli based on genomic data.

Background: Although tinea capitis (TC) is most commonly diagnosed in children, several studies have also shown that it is far from unusual in adults.

Objectives: To determine the frequency and risk factors of TC in adults in Dakar, Senegal.

Patients and methods: A cross-sectional study including all patients who visited the Parasitology and Mycology Lab at Aristide Le Dantec University Hospital for suspicion of TC was conducted from 1 January 2015 to 31 December 2019. The diagnosis was performed using conventional techniques.

Results: In sum, 458 adults were included. The majority (89%) were female. The patients' mean age was 35 ± 12 years (ranges: 18-84). Of the 458, 92 (20%) were confirmed with TC. The frequency trend, by year, showed a significant decrease ranging from 26.3% in 2015 to 19.2% in 2019. By sex, females (20.5%) were more affected than males (17.6%). According to age, the elderly present the highest infestation rate (36.4%). TC was diagnosed alone in 91.3%. T. soudanense (57.6%) was the most common species, followed by M. audouinii (34.8%).

Conclusion: TC is frequent among adults in Senegal, particularly in women, and the main causal agent is T. soudanense. Its duration seems to indicate a chronic form previously acquired between 1 and 10 years ago. Thus, early management will be essential to avoid epidemic proportions.

Objectives: Tinea capitis remains a common fungal infection in children worldwide. Species identification is critical for determining the source of infection and reducing transmission. In conventional methods, macro- and microscopic analysis is time-consuming and results in slow fungal growth or low specificity. We propose a rapid real-time diagnostic PCR method that allows species-specific identification of dermatophytes, including the Microsporum canis complex, Trichophyton mentagrophytes complex, Trichophyton rubrum complex and Trichophyton tonsurans, in patients with tinea capitis.

Methods: Hair and scrapings samples were collected from 231 patients with tinea capitis who were positive for fungal elements via direct microscopy with potassium hydroxide. Each sample was subjected to a two-step real-time PCR (RT-PCR) assay, which was designed on the basis of differences in the DNA fragments of the internal transcribed spacer (ITS) and β-tubulin covering the Microsporum canis complex, T. mentagrophyte complex, T. rubrum complex, T. tonsurans, T. verrucosum, T. schoenleinii and N. gypseum.

Results: In total, 186/231 samples (80.52%) were positive for fungal culture. The two-step RT-PCR was positive in 215/231 samples (93.07%), among which 179 were culture positive. The combined efficacy was 96.81%, which was significantly different when the RT-PCR assays were performed in parallel with fungal culture. A total of 126 samples (54.55%) were identified as Microsporum canis by fungal culture, among which the positive rate of M. canis complex RT-PCR was 97.62% (123/126). A total of 45 samples were negative for fungal culture, of which 80.0% (36/45) were positive by RT-PCR, and the percentage of M. canis complex-positive samples was 53.33% (24/45). The RT-PCR assays were negative for 16/231 samples, among which 7 were culture positive, including M. canis (n = 3), T. violaceum (n = 3) and N. gypseum (n = 1).

Conclusion: We developed a new diagnostic assay system using a rapid real-time TaqMan PCR assay with specific primers that can be applied in routine laboratory practice for hair and skin samples of tinea capitis to detect dermatophytes and increase diagnostic efficiency.

Background: Superficial fungal infections are among the most common infections in world, they mainly affect skin, nails and scalp without further invasion. Superficial fungal diseases are conventionally diagnosed with direct microscopy, fungal culture or histopathology, treated with topical or systemic antifungal agents and prevented in immunocompetent patients by improving personal hygiene. However, conventional diagnostic tests can be time-consuming, also treatment can be insufficient or ineffective and prevention can prove to be demanding. Artificial Intelligence (AI) refers to a digital system having an intelligence akin to a human being. The concept of AI has existed since 1956, but hasn't been practicalised until recently. AI has revolutionised medical research in the recent years, promising to influence almost all specialties of medicine.

Objective: An increasing number of articles have been published about the usage of AI in cutaneous mycoses.

Methods: In this review, the key findings of articles about utilisation of AI in diagnosis, treatment and prevention of superficial fungal infections are summarised. Moreover, the need for more research and development is highlighted.

Results: Fifty-four studies were reviewed. Onychomycosis was the most researched superficial fungal infection. AI can be used diagnosing fungi in macroscopic and microscopic images and classify them to some extent. AI can be a tool and be used as a part of something bigger to diagnose superficial mycoses.

Conclusion: AI can be used in all three steps of diagnosing, treating and preventing. AI can be a tool complementary to the clinician's skills and laboratory results.

Background: Tinea corporis (TC) is a common fungal infection affecting 20%-25% of the global population. Though diagnosing TC is straightforward, treatment has become challenging due to the use of certain medications and lack of follow-up, leading to resistance. Andrea et al. proposed Tinea Corporis Score (TCS) to assess and provide follow-up care for TC. However, double tracing was its limitation. We proposed modified Tinea Corporis Score (mTCS) to overcome this limitation.

Aims and objectives: To compare mTCS with TCS and validate it.

Methodology: A comparative, noninterventional validation study was conducted over 18 months at the Department of Dermatology, JSS Hospital, JSSAHER. 140 out of the initially enrolled 182 patients were included. The Researchers 1 and 2 measured the area of involvement by mTCS and TCS, respectively, during baseline and follow-up.

Results: There was a significant difference in the mean areas calculated (mTCSTCS) (p value < 0.05). Both methods showed a positive correlation. However, mTCS was found to be less time-consuming (p value < 0.05) than TCS.

Conclusion: Both mTCS and TCS had a positive correlation and were found to be equally effective. However, mTCS took significantly less time, while overcoming tracing errors by measuring direct capture of preset grid images suggesting it to be a better alternative. These findings validate mTCS over TCS for better and faster evaluation of TC for good follow-up care and patient-tailored treatment.

Background: The epidemiology of vulvovaginal candidiasis (VVC) in Greece remains poorly reported and outdated.

Objectives: We therefore conducted a 2-year retrospective survey to assess the epidemiological aspects of the infection among symptomatic Greek patients.

Patients/methods: High vaginal swab samples were collected from adult women with clinically suspected VVC attending a private diagnostic laboratory in Athens. VVC was confirmed through microscopic examination of a wet mount preparation revealing yeasts and Candida-positive culture. Species were identified by MALDI-ToF MS, and in vitro susceptibility was determined according to the EUCAST-E.Def 7.4. Predisposing host factors were associated with the occurrence of the infection and isolated Candida spp. using Fisher's exact test, and epidemiological changes over time were analysed with the χ² test for trend.

Results: Among 1300 women screened, 283 VVC episodes were recorded among 233 (18%) patients, whereof 11 (5%) had recurrent VVC (RVVC) and 19 (8%) had mixed Candida infections. Coinfection with other pathogens and recent prior use of antifungals were associated with RVVC. Candida albicans was the most prevalent pathogen (50%), followed by Candida parapsilosis sensu stricto (SS) (35%), Nakaseomyces glabratus (former Candida glabrata) (10%), Pichia kudriavzevii (former Candida krusei) (3%), Candida orthopsilosis (1.5%) and Clavispora lusitaniae (former Candida lusitaniae) (0.5%). Regarding the RVVC cases, 54% were attributed to C. albicans, 37% to N. glabratus and 9% to C. parapsilosis SS. Resistance to fluconazole was found in 4% of C. albicans and 23% of N. glabratus strains with cross-resistance to other azoles. Fluconazole-resistant isolates were recovered from 5 of 11 RVVC patients, whereof 4 of 5 had previous exposure to azoles. During the study period, an increase in N. glabratus VVC and fluconazole resistance was noted.

Conclusions: VVC is common in our region, with C. albicans as the predominant species, followed by C. parapsilosis SS and N. glabratus. Fluconazole resistance is low in C. albicans but high in N. glabratus, emphasising the need for targeted antifungal strategies.

Background: Access to fungal disease diagnosis is crucial for reducing mortality, yet it varies widely across Argentina, especially outside Buenos Aires. In regions like Santa Fe and Paraná, where most healthcare facilities are under 150 beds, maintaining specialised mycology labs is challenging.

Objectives: This work describes the establishment and first-year results of a centralised Fungal Disease Response Centre (FDRC) and referral network serving this region, covering approximately 1 million inhabitants.

Methods: The FDRC provided tests from the WHO's Essential Diagnostic List, along with antifungal susceptibility testing and molecular diagnostics. Additionally, we offered continuous training, a courier service and digital tools for service requests and result reporting.

Methods: In 2023, the FDRC handled samples from 878 patients from 22 institutions, performing 1151 tests on 897 samples. Common tests included Aspergillus galactomannan quantification and molecular diagnostics, diagnosing 101 fungal infections including fungaemias, histoplasmosis, aspergillosis and deep-seated candidiasis. Average turnaround times were 6.2 h for antigen-based tests and 21.5 h for molecular tests.

Conclusions: This centralised service improved diagnosis speed and quality, overcoming limitations of smaller labs. It also enabled population-based studies, revealing higher-than-expected histoplasmosis prevalence. The FDRC's first-year results demonstrate that regional centralisation can enhance diagnostic quality, improve patient outcomes and advance epidemiological knowledge.

Background: Systemic endemic mycoses are systemic fungal infections typically found in tropical and subtropical regions. Their global incidence is rising, including in nonendemic countries, mainly due to migration and international travel. They are a major cause of morbidity and mortality worldwide, especially in immunocompromised patients. This study aimed to analyse incidence trends of endemic mycoses and their presentation in hospitalised patients in Spain from 1997 to 2021.

Methods: This retrospective, observational study drew data from the Spanish National Hospital Discharge Database. We used the diagnostic codes of the 9th and 10th International Classification of Diseases for histoplasmosis, coccidioidomycosis, paracoccidioidomycosis and talaromycosis, retrieving systemic endemic mycoses cases from the national public registry.

Results: Over the study period, 646 cases of histoplasmosis, 138 of coccidioidomycosis, 47 of paracoccidioidomycosis and 24 talaromycosis were reported, with a rising number of cases annually, driven mainly by an increase in histoplasmosis. A segmented linear regression predictive model with a 10-year forecast showed a steady increase, reaching 128 hospitalisations (95% confidence interval [CI] 87-168) in Spain in 2031. Overall, in-hospital mortality was 10.9%, higher in histoplasmosis (11.3%) and coccidioidomycosis (10.9%) and independently associated with immunosuppression for both histoplasmosis (adjusted odds ratio [aOR] 3.28, 95% CI 1.72-6.24; p < 0.001) and coccidioidomycosis (aOR 4.05, 95% CI 1.22-13.44; p = 0.022).

Conclusions: Hospitalisations for systemic endemic mycoses, especially histoplasmosis, are on the rise in Spain. Mortality is significant and primarily associated with immunosuppression. This trend is expected to continue in the coming years, underscoring the importance of maintaining hospital-based surveillance of endemic mycoses in nonendemic regions.

Background: Accurate identification of Fusarium species requires molecular identification. Treating fusariosis is challenging due to widespread antifungal resistance, high rates of treatment failure, and insufficient information relating antifungal susceptibility to the clinical outcome. Despite recent outbreaks in Mexico, there is limited information on epidemiology and antifungal susceptibility testing (AST).

Objectives: We aimed to analyse the distribution of Fusarium species from a referral centre in Mexico with DNA sequencing and to describe AST to the clinical outcome.

Methods: We conducted a retrospective study on clinical isolates of Fusarium. They were identified by translation elongation factor-1α gene amplification and sequencing. AST was performed to determine minimal inhibitory concentrations (MICs).

Results: A total of 35 Fusarium isolates from 26 patients were included. The most common was Fusarium solani species complex (FSSC) in 51.5%, of which Fusarium petroliphilum and Fusarium oxysporum species complex were the most frequent with 37% and 20%, respectively. AST did not show MICs above the epidemiological cut-off value. Fusariosis was diagnosed in 19 patients, mostly with hematologic neoplasm; the overall mortality rate was 32%.

Conclusions: Fusarium petroliphilum from the FSSC was found most frequently. Elevated mortality and MICs for all tested antifungals were found, with higher MIC50 among F. solani SC than F. oxysporum SC or F. fujikuroi SC.

Background: Infections with fluconazole-resistant Candida parapsilosis have been increasing in Israeli hospitals with unclear implications for patient outcomes.

Objectives: To determine the frequency, mechanisms, molecular epidemiology, and outcomes of azole-resistant C. parapsilosis bloodstream infections in four hospitals in Israel.

Patients/methods: C. parapsilosis bloodstream isolates were collected at four hospitals in central Israel during varying periods from 2005 to 2022. Antifungal susceptibility testing was done using CLSI broth microdilution. Risk factors for fluconazole resistance were investigated using logistic regression. ERG11 gene sequencing was performed on all isolates. Genetic relatedness was determined using multilocus microsatellite genotyping. Clinical cure, microbiological eradication, and mortality rates were compared between fluconazole-susceptible and resistant isolates.

Results: A total of 192 patient-specific C. parapsilosis isolates were analysed. Resistance to fluconazole and voriconazole was detected in 80 (41%) and 14 (7.2%) isolates, respectively. The ERG11 Y132F substitution was found in 91% of fluconazole-resistant and 1% of fluconazole-susceptible isolates. Increasing age, intensive care hospitalisation, haemodialysis, and recent exposure to antibiotics were risk factors for fluconazole-resistant C. parapsilosis. Distinct but related genotypes predominated at each centre, indicating extensive dissemination within hospitals and limited transmission among them. Fluconazole resistance was associated with increased likelihood of microbiological failure but no significant difference in clinical cure and mortality.

Conclusions: We found high rates of fluconazole resistance in C. parapsilosis, attributable to nosocomial spread of hospital-specific clones bearing the Y132F substitution. Fluconazole resistance was associated with a higher risk of microbiological but not clinical failure. Strategies to limit nosocomial transmission of C. parapsilosis are needed.