Mycoses最新文献

Background: Dermatophyte infections, which are among the most prevalent fungal infections globally, affect skin, hair and nails, accounting for significant morbidity. Epidemiological data on dermatophytosis in the UK are limited. One notable study in 2007 provided insights into the causative agents of dermatophyte infections in the UK; however, no extensive regional analysis has been published since.

Objectives: The aim of this study was to provide a contemporary understanding of the epidemiology and causative agents of dermatophytosis in South-East England.

Method: This retrospective laboratory database review analysed all samples of skin, hair and nail that underwent mycological examination (microscopy and culture) in a single diagnostic microbiology laboratory in South-East England over a period of 17 years (2006-2023).

Results: Between 2006 and 2023, a total of 34,624 samples were collected, with the majority being nail (n = 26,362), followed by skin (n = 8015), hair (n = 246) and one unknown sample type. Fungal culture yielded positive results in 22.0% (n = 7601) of samples, with dermatophytes comprising 89.4% (n = 6794) and non-dermatophyte moulds 4.8% (n = 366). Trichophyton species dominated dermatophyte isolates at 99.3% (n = 6745), followed by Microsporum (0.5%, n = 37) and Epidermophyton (0.2%, n = 12). Onychomycosis of toenails was the most common infection (n = 2774), predominantly affecting males (median age: 48 years); the cause was Trichophyton rubrum in 80.5% of cases, and infection was confirmed by positive direct microscopy in 80.3%. Tinea pedis (n = 416), conversely, was more common in females (median age: 50 years). Other dermatophyte infections included tinea corporis (n = 179), onychomycosis of the fingernails (n = 99), tinea cruris (n = 91), tinea capitis (n = 82), tinea manuum (n = 56) and tinea faciei (n = 14). Trichophyton rubrum was the primary causative agent across all body sites except for tinea capitis, where Trichophyton mentagrophytes (30.5%), Trichophyton violaceum (19.5%) and Trichophyton tonsurans (15.9%) prevailed. Non-anthropophilic species (n = 165) caused infection across all body sites, but most caused tinea capitis (25.5%) and tinea corporis (20.0%) and affected younger individuals (median age: 29 years). Trichophyton mentagrophytes was the most common non-anthropophilic dermatophyte. Over the 17 years, the prevalence of Trichophyton interdigitale declined by 20%, while Trichophyton rubrum increased from 78.4% in 2006 to 82.0% in 2023. No cases of Trichophyton indotineae were identified.

Conclusion: This study highlights the high prevalence of Trichophyton rubrum as a cause of dermatophyte infections in South-East England. Non-anthropophilic infections are rare and demographically distinct, guiding case management and public health strategies.

Objective: To describe the epidemiology, associated factors, spatial distribution, and temporal trends of mortality and in-hospital mortality related to systemic mycoses in Brazil, 2000-2024.

Methods: This is a nationwide ecological study combining temporal and spatial analyses using death certificates (DC; underlying and/or associated causes) and hospital admissions (HA; primary and/or secondary diagnoses) with in-hospital deaths. We estimated rate ratios (RR) with 95% confidence intervals (CI) interpreted as comparative mortality and in-hospital mortality rates between sociodemographic categories at the aggregate level, stratified by sex and age group; temporal trends were presented with the average annual percent change (AAPC) and 95% CIs; spatial heterogeneity was described across states. Outcomes were expressed as population-based rates (per 100,000 inhabitants).

Results: We identified 22,230 mycosis-related deaths among a total of 30,488,786 deaths (0.07%), corresponding to an overall mortality rate of 0.46 per 100,000 population. Mortality was higher in males (RR 2.91; 95% CI 2.51-3.38) and peaked at ages 60-69 years (RR 3.47; 95% CI 2.67-4.51). Nationwide mortality declined over time (AAPC -1.12; 95% CI -1.41 to -0.83). Deaths were geographically concentrated in the states of Rondônia, Mato Grosso, Goiás and Mato Grosso do Sul. We recorded a total of 4471 in-hospital deaths among 11,367,369 admissions (0.04%), yielding an in-hospital mortality rate of 0.09 per 100,000 population. In-hospital risk of death was higher in males (RR 2.12; 95% CI 1.55-2.89) and in those aged ≥ 70 years (RR 12.50; 95% CI 7.38-21.17). No significant nationwide trend was observed for in-hospital mortality (AAPC 0.64; 95% CI -1.20 to 2.59). Spatial distribution during the analysis period was heterogeneous, especially in the states of Rondônia, São Paulo, Rio de Janeiro, Paraíba and Paraná.

Conclusion: Our findings fill an important gap by jointly analysing long-term mortality and in-hospital mortality related to systemic mycoses at a nationwide scale, using two complementary information systems. Neglected mycoses remain an important cause of death in Brazil, including deaths during hospitalisation. Distinct individual-level and spatial patterns support the need for strengthened surveillance, prevention, control, and therapeutic strategies within the Brazilian Unified Health System.

Background: Conventional diagnostic methods for onychomycosis possess disadvantages related to limited sensitivity, extended turnaround times and strong reliance on operator expertise.

Objectives: To develop a molecular assay with high sensitivity and specificity for rapid detection of multiple fungal pathogens in nail specimens.

Methods: A multi-tube recombinase polymerase amplification (RPA) assay with fluorescent signal detection was developed, targeting pan-fungal, Trichophyton rubrum, T. interdigitale, pan-Candida, Candida albicans, pan-Trichosporon and pan-Aspergillus. The analytical sensitivity and specificity of the assay were evaluated using fungal strains, and its performance was assessed in 81 clinical nail specimens in parallel with calcofluor white fluorescence microscopy and fungal culture.

Results: The multi-tube RPA assay demonstrated a detection limit of 1 pg of genomic DNA for all targets, with a turnaround time of < 70 min. In the evaluation of 81 clinical nail specimens, Bayesian latent class analysis estimated sensitivities of 86.0% for multi-tube RPA, 67.0% for fungal culture and 77.0% for microscopy, with corresponding specificities of 85.0%, 89.0% and 87.0%. The positive and negative predictive values were 92.0% and 72.0% for multi-tube RPA, 93.0% and 55.0% for fungal culture, and 93.0% and 66.0% for microscopy.

Conclusion: Compared with fungal culture and microscopy, the multi-tube RPA assay demonstrated superior sensitivity while maintaining good specificity, facilitating the identification of fungal pathogens at the species level in nail specimens. Its operational simplicity, enhanced diagnostic performance and reduced processing times make it a promising alternative for the mycological diagnosis of onychomycosis.

Introduction: Relapses occur in up to 40% of patients after prolonged courses of antifungal treatment for chronic pulmonary aspergillosis (CPA). The factors predisposing to relapse remain poorly defined.

Methods: We conducted a retrospective study of adults treated for ≥ 6 months with oral azoles for CPA. Patients who completed antifungal therapy and were deemed not to require further treatment were included. Demographic, clinical, radiological and serological data at treatment completion were collected. CPA relapse was defined as symptomatic and radiological deterioration leading to re-initiation of antifungal therapy. Cox regression and Kaplan-Meier analyses were used to identify predictors of relapse and mortality.

Results: Among 125 patients (56% male; mean age 61 years), median treatment duration was 36 months. Thirty-two (26%) developed relapse; relapse rate at 1 year was 16%. Aspergillus sensitisation (specific IgE > 0.35 IU/mL) and elevated Aspergillus-specific IgG (> 40 mg/L) at treatment completion were independently associated with relapse (p < 0.05). No patient with IgG < 40 mg/L relapsed. Underlying lung disease (COPD or prior tuberculosis), extent of radiological involvement, or treatment duration were not significantly associated with relapse or mortality.

Conclusions: Aspergillus sensitisation and persistently elevated Aspergillus-specific IgG at the end of antifungal therapy were independent predictors of CPA relapse. These parameters may reflect ongoing fungal airway burden and can help identify patients requiring extended or closer post-treatment follow-up. Underlying comorbidities were not associated with relapse risk.

Background: Echinocandins are the first-line treatment for invasive candidiasis. Rezafungin is a novel echinocandin with improved pharmacokinetic properties that allow for once-weekly intravenous administration, offering potential advantages in complex clinical settings.

Objectives: We aimed to describe our real-world experience with rezafungin for the treatment of invasive fungal disease (IFD).

Patients: A retrospective analysis of consecutive patients treated with rezafungin for proven IFD at our center between September 2022 and December 2025 was conducted.

Results: We included 13 patients (mean age: 59.4 ± 17.8 years). Main predisposing conditions included immunosuppression (53.8% [solid organ transplantation in 30.8%]), solid cancer (30.8%) and recent surgical intervention (38.5%). Most frequent Candida species were C. albicans (38.5%), C. parapsilosis (30.8%) and Nakaseomyces glabratus (15.4%). One patient had necrotizing gingival infection due to Trichoderma longibrachiatum. Main types of IFD included intravascular Candida infection (38.5%) and surgical-site and intra-abdominal candidiasis (23.1% each). Reported reasons for initiating rezafungin were the presence of fluconazole-resistant isolates (53.8%), facilitating outpatient antifungal therapy (30.8%) and avoiding anticipated drug-drug interactions with triazoles (15.4%). No patient received rezafungin as a first-line treatment and most (92.3%) had been previously exposed to other echinocandins. Rezafungin was typically initiated upon clearance of follow-up blood cultures (80.0%). Median number of weekly doses was 4.0 (interquartile range: 3.0-5.5). Clinical cure (complete or partial response) by day +30 was achieved in all evaluable patients (100.0% [12/12]), with no treatment-emergent adverse events.

Conclusions: Rezafungin was effective and safe as salvage or consolidation therapy in patients with IFD, including deep-seated candidiasis.

Background: Candida (Candidozyma) auris is an emerging yeast that poses a significant global health threat due to its multidrug resistance and ability to cause healthcare-associated outbreaks. Genomic surveillance is essential for monitoring spread, transmission and antifungal resistance.

Objectives: To report the first identification and genomic characterisation of C. auris in the state of Minas Gerais, Southeast Brazil, and to investigate the genetic origin and diversity, resistance-associated mutations, and potential transmission dynamics during a hospital outbreak.

Methods: Eight C. auris isolates were collected during a hospital outbreak in Belo Horizonte, Minas Gerais, Brazil, including clinical samples from patients and environmental samples from surfaces in the Intensive Care Unit (ICU). Epidemiological investigation, whole-genome sequencing (WGS) and phylogenomic analyses were conducted to determine circulating clade, genetic diversity, outbreak origin and the presence of antifungal resistance mutations.

Results: All isolates were classified as clade IV and exhibited high genomic similarity to strains previously reported in northern Colombia (Caribbean coast). One isolate carried the ERG11 Y132F mutation, associated with fluconazole resistance, but this mutation was absent in another isolate from the same patient collected 1 day earlier, indicating mixed fungal populations. Environmental isolates clustered tightly with clinical strains, supporting surface-mediated transmission in the ICU.

Conclusions: This study describes the introduction and local spread of clade IV C. auris in Minas Gerais, Brazil. The findings underscore the critical role of genomic surveillance in identifying resistance mechanisms, tracing transmission pathways and guiding public health responses.

Background: Current international guidelines lack clear recommendations on the management of non-colonised patients undergoing intra-hospital transfer from the ward in which horizontal transmission of Candida auris is known to occur (defined as endemic for Candida auris) to wards with no horizontal transmission detected (defined as non-endemic wards), particularly regarding the timing and number of screening swabs needed to exclude colonisation.

Methods: Single-center prospective observational study at a tertiary-care hospital in Genoa, Italy, including adults transferred from the C. auris endemic-ICU (eICU) to non-endemic wards between January and December 2024. Patients who tested negative for C. auris colonisation both at eICU admission and at transfer, and who had ≥ 1 screening swab performed post-transfer, were included. Swabs (bilateral axilla/groin) were performed on Days 0-1, 2-3 after transfer, and then weekly, and tested for C. auris with real-time PCR. Patients were considered sufficiently screened to exclude colonisation if they underwent ≥ 2 swabs within the first 4 weeks after transfer.

Results: Among 462 patients transferred from the eICU, 440 (95.2%) were non-colonised. Among them, 275 (62.5%) met inclusion criteria, and 208 (75.6%) were considered sufficiently screened. C. auris colonisation was detected in 34/208 (16.3%) patients, with 21 (61.8%) positive in the first post-transfer swab. Among 99 patients who had a negative result of a swab performed within 1 day before transfer, 7 (7.1%) resulted later positive. C. auris candidemia occurred in 4/34 (11.8%) patients with colonisation detected post-transfer, compared to 1/35 (2.9%) patients found colonised during eICU stay, and none occurred in non-colonised individuals.

Conclusions: A single negative screening test at eICU discharge is insufficient to exclude colonisation, even if performed within 24 h from transfer. Repeated screening, ideally within the first 2 weeks post-transfer, is essential to detect colonisation and prevent further C. auris transmission.

Background: Invasive candidiasis (IC), life-threatening fungal infections with high economic burden, are often treated first-line with daily intravenous echinocandins. A new once weekly echinocandin, rezafungin, demonstrated statistically non-inferior efficacy and numerically shorter intensive care unit (ICU) stay compared to caspofungin in clinical trials, offering potential for earlier discharge.

Objective: To assess the cost-effectiveness of rezafungin versus daily echinocandins for the treatment of IC from a UK healthcare perspective.

Methods: An economic model was developed including a short-term decision tree (treatment duration ≤ 30 days) and a long-term Markov model (for lifetime outcomes). Considering the impact IC has on a patient's life expectancy and quality of life, a cost-utility analysis was performed. A cost-minimisation analysis assuming similar efficacy among echinocandins was included as scenario analysis. Treatment response was assessed at days 5/14 with nonresponders switching to second-line treatment. Patients with negative repeat blood cultures could step down to oral fluconazole. Rezafungin's weekly administration was estimated to lead to early discharge for 16% of patients. Risk of death was included. Efficacy and resource use estimates were from pooled trial data. Unit costs, utilities, long-term mortality were from published literature and UK databases.

Results: Rezafungin was estimated to be cost-saving compared to daily echinocandins (discounted incremental costs: -£6028 to -£6727 vs. daily echinocandins). Quality-adjusted life-years (QALYs) were similar (incremental QALY: 0.03 vs. daily echinocandins), resulting in rezafungin being cost-effective. Results were most sensitive to varying mortality and ICU length of stay.

Conclusion: Once weekly rezafungin is a cost-saving and cost-effective treatment option in IC from the UK healthcare perspective.

Background: Sporotrichosis is a dimorphic fungal infection of increasing global relevance. Although usually cutaneous or lymphocutaneous, disseminated disease occurs in immunocompromised hosts. Large-scale data on its epidemiology, treatment and outcomes remain limited.

Objectives: To characterise the clinical features, comorbidities, antifungal prescribing patterns and one-year mortality associated with sporotrichosis, with emphasis on patients with HIV and other forms of immunosuppression.

Patients/methods: We performed a retrospective global cohort study using the TriNetX Research Network. Adults (≥ 18 years) diagnosed with sporotrichosis were identified using ICD-9/10 codes (1995-2024). Demographics, comorbidities, laboratory parameters and antifungal prescriptions were analysed. The primary outcome was all-cause mortality at 1 year. Secondary outcomes included hospitalisation and admission to the intensive care unit (ICU).

Results: Among 2124 adults, the mean age was 52 years, and 56.5% were female. Nearly half of the cases originated internationally, with the southeastern United States accounting for the majority of domestic cases. Neoplasms (25%) and diabetes (11%) were the most common comorbidities. Lymphocutaneous disease was uncommon (9%), and disseminated infection occurred in 1% of cases. One-year mortality was 17%, with a higher risk among older adults and those with neoplasms, lymphocutaneous or disseminated infection or hyperferritinemia. Seventeen patients (0.8%) had HIV and were more likely to have pulmonary or disseminated disease. Itraconazole was the most commonly prescribed antifungal (52%), while the use of amphotericin B remained low (< 2%).

Conclusions: Sporotrichosis causes substantial global mortality. Outcomes appear driven by host factors and gaps in guideline-based management. Earlier recognition, optimised antifungal therapy, and use of inflammatory markers to guide risk stratification may improve outcomes and inform prevention strategies.