Mycoses最新文献

Background: Since rifabutin has less severe drug interactions, it is preferred over rifampin when administered concomitantly with azole antifungals. However, limited data exist to evaluate this interaction.

Methods: This was a single-centre study of hospitalised patients who received concomitant isavuconazole and rifabutin prior to plasma isavuconazole therapeutic drug monitoring. Isavuconazole was administered at a standard dose of isavuconazonium sulphate 372 mg every 8 h for six doses followed by 372 mg every 24 h.

Results: Of the seven patients included, the median age (range) was 53 years (33-67), 71% (5/7) were solid organ transplant recipients and no patients had underlying cirrhosis. The median (range) corrected 24-h steady-state isavuconazole was 2.7 mg/L (0.7-3.7) and 86% (6/7) had an isavuconazole level > 1 mg/L. The median (range) area under the curve (AUC 24), half-life (T_½) and clearance (Cl) were 85 mg/L h (33-112), 13.1 h (6.8-17.8) and 4 L/h (3.1-10.7), respectively.

Conclusion: This study demonstrates that isavuconazole trough concentrations are often maintained above 1 mg/L despite patients being on concomitant rifabutin. However, therapeutic drug monitoring is mandatory in this setting. Further research is warranted to confirm these results.

Background: Typing Aspergillus species is crucial for understanding the sources of infection in hospital environments.

Objectives: This study analysed clinical and air samples as well as their relationship with the clinical forms of aspergillosis. Additionally, we examined the usefulness of the Short Tandem Repeats (STR) technique with two highly discriminatory markers for analysing the Aspergillus fumigatus (A. fumigatus) profile.

Patients/methods: Seventy-five air samples (September 2013-July 2014) and 116 clinical samples (2009-2014) were collected in a university hospital. Seventy-two samples were typed by STR with two markers, MC3 and MC5.

Results: Of the 75 air samples collected, 10 were positive in the Bone Marrow Transplant unit, a ventilated unit with HEPA filters as were 18 in the Haematology ward, a naturally ventilated unit. Of the 116 clinical samples of Aspergillus spp., 95 were identified as A. fumigatus. High diversity was found, with 42 genotypes in 67 clinical samples and four in five environmental samples. Most isolates were collected during the demolition and renovation of the Emergency unit in the Hospital from 2013 to 2014. Genotype 1 was found in several units during different years. Despite the heterogeneity, identical genotypes were observed three times at short intervals in the same or different wards. Some of these identical genotypes were confirmed as possible clones by genome sequencing while others' genotyping matches failed to be confirmed.

Conclusion: Despite the diversity of clinical and environmental samples, useful correlations can be established in invasive aspergillosis surveillance programs by using this simple STR method as a preliminary step.

Fungal infections are increasingly recognised as a global health challenge, responsible for millions of cases annually and substantial mortality, especially in immunocompromised individuals. Yet, the diagnosis of these infections remains notoriously difficult, often delayed by slow culture-based methods or hindered by the high cost and infrastructure demands of molecular diagnostics. In recent years, infrared (IR) spectroscopy has emerged as a promising alternative, offering rapid, cost-effective and reagent-free identification of human pathogenic fungi. This review provides an in-depth examination of how IR-based techniques, specifically, mid-infrared (MIR) and near-infrared (NIR) spectroscopy, are being applied in medical mycology. We explore the underlying chemical principles and highlight how recent advances in multivariate analysis and machine learning have enhanced their diagnostic accuracy. Studies have demonstrated the capacity of IR spectroscopy to accurately identify and type major fungal pathogens, while also providing insights into antifungal resistance profiles and outbreak tracking. While challenges remain, particularly regarding protocol standardisation and expansion of spectral databases, IR spectroscopy stands out as a valuable diagnostic strategy, especially in resource-limited settings. By reducing diagnostic time and cost, and expanding accessibility, IR-based methods have the potential to transform the clinical management of fungal infections, contributing to faster decision-making and improved patient outcomes.

Background: Recent literature indicates a decline in rates of candidemia in the general population.

Objectives: To analyse temporal trends in candidemia among patients with solid tumours and haematological malignancies admitted to a dedicated cancer centre.

Methods: We retrospectively reviewed all episodes of candidemia from July 2008 to June 2020 (12-year period). The incidence of candidemia was estimated as the number of new cases per 1000 patient days of hospital admission quarterly. A linear regression model was used to analyse changes in incidence rates.

Results: Over a 12-year period a total of 212 episodes of candidemia were identified with 90 (42.5%) occurring in patients with haematological malignancies and 122 (57.5%) in patients with solid tumours. The overall incidence of candidemia was 0.49 episodes per 1000 patient-days of admission per quarter. There was a significant decline in the incidence of candidemia overtime for the overall cohort (from 0.81 to 0.21 patient days per quarter, p < 0.001). This decline was statistically significant in patients with solid tumours (from 0.91 to 0.18 patient days per quarter, p < 0.001) with only a downward trend noted in patients with haematological malignancies (from 0.65 to 0.25 patient days per quarter, p = 0.052).

Conclusions: We observed a global decline in episodes of candidemia in patients with malignancies mainly driven by a decrease in patients with solid tumours. Patients with haematological malignancies continue to experience considerable rates of candidemia.

Background: Data on the epidemiology, diagnostic methods and evidence-based recommended treatment methods for children with mucormycosis who have undergone Haematopoietic stem cell transplantation (HSCT) are limited.

Objective: Summarise past recommendations and the latest literature on the treatment of HSCT in children with mucorin infection and clarify the epidemiology, diagnosis, treatment and outcomes of this invasive fungal disease.

Methods: A comprehensive search for full-text studies involving humans that were published in English between January 2000 and December 2022 was conducted in Ovid MEDLINE and Ovid Embase using various key words and MeSH terms.

Results: A total of 951 articles were identified in the initial database search, of which 28 (32 individual patients) were included in the final analysis. The majority of HSCT recipients (14/26, 54%) had a diagnosis of mucormycosis within 30 days posttransplant, with a median time from transplant to diagnosis of 19 (27 patients; IQR, 13-213) days. Pulmonary mucormycosis (9/32, 28%) and disseminated mucormycosis (9/32, 28%) were the most commonly observed manifestations in paediatric patients after HSCT. Targeted antifungal therapy was used in 27 patients. Iv AmB formulations were the most commonly administered first-line treatment (26/27, 96%). Compared with iv AmB monotherapy, initial treatment with combination antifungal therapy appeared to improve all-cause mortality [3/10 (30%) vs. 6/17 (35%)].

Conclusions: The results of the present review will help to determine the pathology, diagnosis, treatment and outcomes of this invasive fungal disease.

Invasive candidiasis is a life-threatening infection associated with high morbidity, mortality and healthcare costs in both general and critical care settings. Timely diagnosis and adequate antifungal treatment are essential to improving patient outcomes and limiting unnecessary use of healthcare resources. This review explores the relationship between early Candida clearance with antifungal therapy, clinical outcomes, resistance patterns and economic impact. It also evaluates the role of diagnostic markers in facilitating early and accurate identification of candidaemia, enabling more precise and effective clinical management. Special attention is given to the challenges of managing candidaemia in critically ill and neutropenic patients, highlighting the need for tailored and timely interventions in these vulnerable populations.

Background: Cat-transmitted sporotrichosis caused by Sporothrix brasiliensis is increasingly reported in the last three decades within Brazil. Recently, other South American countries like Argentina and Chile also reported cases, while the number of reported cases in Paraguay, a Brazilian neighbour, remains quite limited with 10 feline and three human cases. Importantly, early diagnosis and disease awareness facilitate effective treatment and allow strategies to prevent spread.

Objectives: Here, we describe two previously reported and 11 novel human sporotrichosis cases by S. brasiliensis from Paraguay, diagnosed from 2017 to 2025.

Methods: Clinical and epidemiological data of patients were collected, fungal isolates were phenotypically analysed with microscopy, and short tandem repeat (STR) genotyping was used for species identification and to determine genetic relatedness between isolates.

Results: From the 13 human patients, 11 were diagnosed with sporotrichosis after contact with cats, while two reported ant bites as the source. All patients reported subcutaneous lesions with lymphocutaneous spread and were treated successfully, resulting in complete resolution of the lesions, despite late recognition of the disease and prior antibiotic treatment. STR genotyping revealed a unique genotype for four cases, all imported from Brazil, including the two ant-associated isolates, all patients had a history of first symptoms while still in Brazil, but later after moving to Paraguay the diagnosis was made. All other isolates were allocated to the previously identified Rio de Janeiro (RJ) clade, originating from Brazil and known to be more widespread in Brazil.

Conclusions: Altogether, we report the probable first two cases of transmission by ants for S. brasiliensis , and all cases result from direct import or spread from Brazil.

Background: Tinea capitis remains a public health concern, especially in children, with evolving trends. Data from Nanchang, China, regarding comparative analyses between adults and children is limited.

Objectives: This study aimed to analyze the clinical and epidemiological characteristics, pathogen spectrum, risk factors, and household transmission of tinea capitis in Nanchang from 2022 to 2024, comparing features between adult and pediatric patients.

Methods: A single-center retrospective study was conducted involving 239 patients (170 children, 69 adults) diagnosed with confirmed tinea capitis. Demographic, clinical, and risk factor data were collected. Pathogens were identified via microscopy, culture, and molecular methods.

Results: Significant increases were observed in adult cases (28.87% vs. historical 9.73%), particularly among postmenopausal women. Anthropophilic pathogens dominated overall (65.42%), but zoophilic species increased significantly (32.71% vs. historical 16.96%). Clinical types differed: black dot tinea predominated in adults (81.16%), while kerion (42.94%) was more common in children. Animal contact was a key risk factor for children (55.29%). Household transmission occurred in 22.90% of surveyed families, with 100% pathogen concordance and frequent asymptomatic adult carriers (50% of affected households).

Conclusions: Notable differences exist between children and adult tinea capitis in Nanchang, with trends showing increasing adult cases and a shift towards zoophilic pathogens. Prevention strategies should be tailored to specific age groups and transmission modes, emphasising household screening and management of human and animal sources.

Background: Dermatophytes are the most common agents of superficial mycoses in humans and animals. In a model of Trichophyton benhamiae dermatophytosis in its natural host (guinea pig), the most overexpressed gene was subtilisin 6 (SUB6). Given the availability of powerful genetic and immunological tools in mice, murine models of dermatophytosis should be developed using strains that can mimic natural infections.

Objective: The aim of this study was to test a strain of Trichophyton mentagrophytes isolated from a rodent in a murine skin infection model, to characterise the expression of key host and fungal genes and investigate the role of SUB6 in virulence by mimicking a natural infection as closely as possible.

Results: A phylogenetic tree was generated to better discriminate the T. mentagrophytes strains isolated from animals. The T. mentagrophytes TIMM 2789 strain used in this study is genotype IV, specific to rodents. Infection induced symptoms and lesions, including hair follicle invasion, typical of acute superficial dermatophytosis. Early overexpression of genes encoding specific cytokines revealed the involvement of the Th1, Th2 and Th17 responses by the host, and the overexpression of the fungal SIDC gene underscores the importance of iron acquisition during infection. The use of deleted and complemented SUB6 strains revealed that SUB6 does not appear to be necessary for fungal virulence, while SUB5 overexpression suggests a compensatory mechanism.

Conclusion: This study demonstrates the crucial importance of carefully selecting the most appropriate dermatophyte strain for the animal species in the experimental model used.

Invasive pulmonary aspergillosis (IPA) is increasingly recognised in intensive care units (ICU) affecting not only patients with classical immunosuppressive conditions but also other severely ill patients, including those with respiratory viral infections (influenza, COVID-19), advanced chronic obstructive pulmonary disease or acute and chronic liver diseases. Several expert panels have proposed definitions of IPA in different ICU settings. However, practical recommendations for its diagnostic and therapeutic approaches are scarce. Moreover, these approaches can be influenced by different parameters that may vary across countries including the case mix of ICU patients, the incidence of IPA, the prevalence of azole resistance and the availability of diagnostic tests and antifungal drugs. For these reasons, the Fungal Infection Network of Switzerland (FUNGINOS) has appointed a panel of different specialists to develop a practical guideline for the management of IPA in ICU. This article provides the executive summary of the panel conclusions and recommendations regarding the epidemiology, diagnosis, definitions and therapy of IPA in ICU.