Mycoses最新文献

Background: Microsporum canis, a dermatophyte commonly associated with pets, is a leading cause of severe tinea capitis. The increasing prevalence of antifungal resistance among dermatophytes poses a significant global health challenge.

Objectives: This study aims to define the updated antifungal susceptibility profile of M. canis to enhance treatment strategies for dermatophyte infections.

Methods: This study analysed 348 M. canis isolates from mainland China for their susceptibility to 11 antifungal agents, following the CLSI M38-A3 guidelines. Additionally, we investigated the susceptibility of M. canis to antifungal agents and analysed the correlation between in vitro drug susceptibility and clinical outcomes in 54 cases of tinea capitis.

Results: The majority of strains showed low MICs to all 11 drugs. We described the upper limits of wild-type (WT) minimal inhibitory concentrations (UL-WT) for 10 of these agents; however, no clear resistance patterns were identified through MIC distribution analysis. Notably, fluconazole had the highest MICs among the tested classes, while the novel agent olorofim showed superior activity. Resistance was detected in two strains to griseofulvin (MIC 64 μg/mL), one to fluconazole (MIC 64 μg/mL) and two to terbinafine (MIC 16 μg/mL). Although azoles and terbinafine remain effective against M. canis. Clinical outcomes indicate that terbinafine may be less effective in treating M. canis infections.

Conclusion: Establishing a clinical breakpoint for M. canis is urgently needed to improve treatment protocols. While azoles and griseofulvin are still recommended for M. canis infections, ongoing surveillance of dermatophyte species and their susceptibility to antifungal agents is crucial to guide treatment strategies.

Introduction: The unique natural and social environments of East Asia may shape the characteristics of fungal skin diseases. However, there is a notable absence of thorough comparative analyses on this subject.

Methods: This research undertook a comprehensive analysis of the epidemiology and disease burden of fungal dermatoses across five East Asian countries (China, Japan, Republic of Korea, Democratic People's Republic of Korea and Mongolia) via the Global Burden of Disease (GBD) database from 1990 to 2021. Descriptive statistical analyses, joinpoint analyses and age-period-cohort (APC) modelling techniques were applied. Systematic assessments were conducted for trends in the incidence, prevalence and disability-adjusted life-years (DALYs) of fungal skin diseases within each country.

Results: This study revealed an overall declining trend in the burden of fungal skin diseases across five East Asian countries from 1990 to 2021, with a particularly marked decrease from 2000 to 2010. In China, the average annual percentage change (AAPC) was -0.1333%, whereas in Japan, it was -0.0281%. However, a notable rise in DALYs among individuals aged 70 and above, particularly in China and Japan. Conversely, Democratic People's Republic of Korea and Mongolia experienced less substantial declines in incidence. These shifts underscore marked intercountry differences, illustrating the influence of socioeconomic factors and health policies.

Conclusion: Fungal skin diseases remain a public threat in East Asian countries. It is important to develop regional, targeted strategies for the prevention and control of fungal skin diseases, with the potential to improve the effectiveness of public health interventions and reduce the regional burden of disease.

A niche in the context of microorganisms defines the specific ecological role or habitat inhabited by microbial species within an ecosystem. For the human commensal Malassezia, the skin surface is considered its primary niche, where it adapts to the skin environment by utilising lipids as its main carbon and energy source. However pathogenic characteristics of Malassezia include the production of allergens, immune modulation and excessive lipid utilisation, which result in several diseases such as pityriasis versicolor, seborrheic dermatitis, Malassezia folliculitis and atopic dermatitis. Recent studies have revealed Malassezia colonisation in internal organs, including the lungs, gut, genitourinary tract, eyes, ears and breast milk. In these organs, Malassezia is associated with diseases linked to respiratory conditions, neurological disorders, gastrointestinal diseases and genital infections. The immune system plays a critical role in shaping Malassezia prevalence, with factors like, immune suppressive drugs and underlying health conditions influencing susceptibility. Accurate diagnosis of Malassezia-related skin disorders is challenging due to its unique growth requirements, but molecular fingerprinting assays and sequencing methods, particularly ITS sequencing, offer precise identification. Treatment involves antifungal drugs, corticosteroids and phytocompounds, yet recurrent infections highlight the need for more targeted therapeutic strategies addressing Malassezia's pathogenic characteristics. Understanding the complex interactions between Malassezia and the host organs is crucial for diagnosis, treatment and prevention and exploring its potentially beneficial roles in health and disease. This review highlights the current findings on the intricate interactions between Malassezia and the diverse ecosystem of the human body, underscoring the complexity of these associations and emphasising their multifaceted role in health and disease.

Background: Trichophyton indotineae, formerly described as T. mentagrophytes rDNA-ITS genotype VIII, has recently been identified as a novel species within the T. mentagrophytes complex. It has rapidly replaced T. rubrum as the predominant dermatophyte. In this study, skin dermatophyte isolates collected from patients in Iran were sequence-analysed for species identification. Additionally, the current prevalence of T. indotineae was compared with data from the previous decade.

Methods: A total of 194 dermatophyte isolates were collected from patients in four cities across Iran between July and December 2023, with 73 isolates of the T. mentagrophytes complex from the past decade also included. DNA was extracted from fresh colonies, and the internal transcribed spacer (ITS) 1-5.8S rDNA-ITS2 region was PCR-amplified and sequenced, followed by bioinformatic sequence analysis.

Results: Out of the 194 dermatophyte isolates, 132 samples (68.04%) were identified as T. indotineae, followed by T. tonsurans (14.43%), T. rubrum (7.22%), Microsporum canis (4.64%), T. interdigitale (3.61%), T. mentagrophytes (1.55%) and Arthroderma benhamiae (0.51%). Sequence analysis of 73 isolates from the past decade showed T. indotineae as the most frequently identified species (43.83%), followed by T. interdigitale (32.88%), T. mentagrophytes (21.92%) and Nannizzia fulva (1.37%). These findings indicate an increasing prevalence of T. indotineae in Iran in recent years. We analysed 214 T. mentagrophytes/T. interdigitale isolates, identifying 164 as T. indotineae, including 26 with nucleotide variations. A phylogenetic tree highlighted the genetic diversity within the species complex.

Conclusion: The alarmingly high prevalence of the potentially drug-resistant species T. indotineae signals the necessity of continuous surveillance of skin dermatophytosis in the community.

Background: Few ex vivo studies have investigated the virulence factors of fungi causing onychomycosis. The effect of nail polish in predisposing or protecting against onychomycosis remains debatable.

Objectives: This ex vivo study aimed to identify the nail invasion ability of dermatophytes, non-dermatophytes and yeast, with and without nail polishing, in the nails of young and elderly individuals.

Methods: Six fungal species were tested: dermatophytes (Trichophyton rubrum, T. mentagrophytes, Microsporum canis), non-dermatophytes (Neoscytalidium dimidiatum, Fusarium spp.) and Candida albicans. Nail plates from eight volunteers (four aged ≥ 70 years; four aged < 70 years) were divided into polished and non-polished groups, incubated with each fungus and evaluated at 2, 4 and 8 weeks. Positive results were determined the presence of fungal hyphae or pseudohyphae penetrating the nail plate, with the enlargement of invasive fungal elements confirmed by histology.

Results: At 2 weeks, N. dimidiatum exhibited the highest nail invasion rate (15/16, 93.75%), whereas C. albicans showed the lowest (1/16, 6.25%). Fungal penetration into nail plates increased with longer incubation durations. At 8 weeks, C. albicans did not invade any polished nail plates; however, the difference in invasion rates between polished and unpolished nail plates was not statistically significant. Additionally, age did not significantly affect the invasion of most fungi in this ex vivo study.

Conclusions: This ex vivo study supported the concept that fungal virulence is the main determining factor for nail invasion. N. dimidiatum caused the most and fastest nail plate penetration. Nail polishing may slow the penetration of low-virulence organisms.

Background: Superficial fungal infections (SFI) are contagious conditions affecting the skin and its appendages, caused by various fungal species. Monitoring the distribution of common pathogens and identifying at-risk patient groups are essential for effective management and prevention.

Objectives: This study investigates the characteristics of SFI in Poland's Malopolska region from 2017 to 2019, focusing on etiological agents, infection sites and risk factors.

Patients/methods: A retrospective analysis was conducted on 4522 mycological cultures from 3594 patients, incorporating demographic data (age, sex), sample sites and mycological test results.

Results: Among the 1175 positive mycological tests recorded from 959 patients, Trichophyton rubrum-primarily affecting toenails and feet-and Candida albicans-mainly targeting fingernails-were the most common pathogens across all age groups. Children exhibited a higher incidence of infections caused by Microsporum canis, Malassezia furfur and T. mentagrophytes. In contrast, Scopulariopsis brevicaulis was more frequently identified in individuals over 60 years old.

Conclusions: The observed trends in SFI characteristics at our centre during the pre-pandemic period align with global epidemiological data. However, further studies are warranted to address existing gaps in understanding the epidemiology of SFI and to refine preventive and therapeutic strategies.

Background: Although cutaneous mycoses are a global public health problem, very few data are available in the Democratic Republic of Congo (DRC).

Objectives: This study aimed to describe the retrospective clinical epidemiology of dermatomycosis and their associated risk factors in dermatological consultations in Kinshasa, DRC.

Methods: A retrospective study based on the medical records of patients seen in the departments of dermatology of 2 major hospitals in Kinshasa from March 2000 to August 2023 was carried out. The diagnosis of the various types of dermatomycoses was established based on the dermatologist's clinical examination. Patient demographic and clinical data were collected for study purposes.

Results: Of 27,439 patients consulted at the two sites, 1142 were diagnosed with dermatomycosis (4.16%). Young women aged 27 (17-43) were most affected. Diagnosed patients shared a history of skin mycoses (26%), use of skin-lightening products (19%) and diabetes mellitus (9.6%). Among these patients, 59.3% suffered from dermatophytosis (tinea), 39.1% from malassesiosis and 1.2% from candidal dermatosis. While tinea was predominantly found in children (81.88%, p < 0.001), pruritus and pain in the lesions were preferentially reported by the dermatophytosis patients [65.25% (p < 0.001) and 79.1% (p < 0.001), respectively]. Tinea corporis (45.5%), tinea capitis (20.4%), tinea pedis (19.3%) and onychomycosis (10.2%) were the main nosological entities in the dermatophytosis group, and their distribution on the body surface depended on patients' age (p < 0.001) and sex (p = 0.012).

Conclusions: Dominated by dermatophytosis, dermatomycosis are frequent in dermatological consultations in Kinshasa. While clinical diagnosis remains an important element in the description of dermatomycosis, a better epidemiological understanding would also require biological identification of the fungi involved, which was lacking in this study.

Background: Pemphigus is a life-threatening autoimmune disease characterised by blistering skin and/or mucous membranes. The present study aimed to determine the prevalence of fungal infections in the pemphigus population.

Methods: Different databases were searched to gain access to all studies on the prevalence of fungal infections published up to the 31st of May 2024. The pooled rate prevalence of fungal infections with a 95% confidence interval (CI) was calculated using the random effects model.

Results: A total of 1012 studies were identified, out of which 18 were included in meta-analyses. The random-effects estimates of the prevalence of fungal infection in the pemphigus population were 0.18% (95% CI: 9%-31%). Based on the findings, it was determined that four genera of fungal infections were related to mucocutaneous lesions of individuals diagnosed with pemphigus. Among these fungi, the most prevalent were those belonging to the Candida species, with a particular emphasis on Candida albicans (87.61%). Additional isolated fungal species include Trichophyton rubrum (4.5%), Aspergillus species (1.8%), Pneumocystis jirovecii (1.2%), Malassezia furfur (0.78%), Microsporum canis (0.75%), Trichophyton mentagrohytes (0.65%), Microsporum audouinii (0.60%), and Trichophyton concentricum (0.45%).

Conclusions: The current study highlights the significance of fungal infection in individuals with pemphigus, suggesting that pemphigus and administration of immunosuppressive medicines such as corticosteroids may trigger an increased risk of fungal infections. Additionally, prompt diagnosis of fungal infections in individuals with pemphigus could help healthcare professionals prevent and treat serious infections, such as Pneumocystis jirovecii pneumonia (PJP), and potentially alleviate the economic impact of this condition.

Objective: Aspergillus sensitisation (AS) is seen in many patients with chronic pulmonary aspergillosis (CPA). However, the clinical relevance of AS in CPA remains unclear. In this study, we assess the clinical significance of AS in CPA.

Methods: We retrospectively analysed the data of CPA subjects, defining AS as Aspergillus fumigatus-IgE ≥ 0.35 kUA/L. We excluded subjects with asthma, allergic bronchopulmonary aspergillosis, chronic obstructive pulmonary disease (COPD) and diffuse parenchymal lung diseases (DPLD). The primary objective was to compare the demographic and clinical characteristics, lung functions (via spirometry) and treatment outcomes in CPA subjects with or without AS. The secondary objective was to explore the association between AS and airflow obstruction on spirometry using multivariable logistic regression analysis.

Results: We included 232 CPA subjects (119 females, 113 males) with a mean ± SD age of 42.1 ± 13.7 years. AS was present in 92 (39.7%) CPA patients (CPA-AS group). CPA-AS patients had higher SGRQ total scores, a higher prevalence of fungal ball, more frequent airflow obstruction and experienced more CPA relapses during follow-up compared to those without AS. Airflow obstruction was seen in 77/232 (33.2%) CPA patients. On multivariable logistic regression analysis, we found AS, increasing age and chronic fibrosing pulmonary aspergillosis independently associated with airflow obstruction on spirometry after adjusting for sex and other CPA categories. The relapse-free survival was significantly shorter in the CPA-AS group than in the CPA group.

Conclusion: AS is common in CPA and is independently associated with airflow obstruction. More studies are required to confirm our findings.

Background: Terbinafine resistance in dermatophytes is an increasing problem worldwide. Several outbreaks of terbinafine-resistant dermatophytosis are currently occurring in India and surrounding countries, and these recent years, European countries have also been affected by this issue. Currently, antifungal susceptibility testing of dermatophytes is not routinely performed in clinical laboratories.

Objectives: Given the current situation and associated public health concerns, there is an urgent need for accurate and rapid detection of terbinafine resistance in laboratories. Therefore, we evaluated different methods currently available for the detection of terbinafine resistance in dermatophytes.

Methods: Twenty-eight strains previously identified as T. indotineae/mentagrophytes/interdigitale were concurrently characterised using terbinafine gradient strips (HiMedia), EUCAST E.Def 11.0 microdilution, the DermaGenius resistance PCR assay (PathoNostics), and SQLE sequencing. These four methods were compared to terbinafine resistance characterisation obtained by whole genome sequencing (WGS).

Results: All four evaluated methods were able to detect terbinafine resistant strains either by showing high MICs (> 0.125 μg/mL) or by detecting SQLE substitutions.

Conclusions: The gradient strips, despite questionable essential agreement with EUCAST E.Def 11.0, can be an easy, fast and cheap method to screen terbinafine resistance among dermatophytes in clinical laboratories. The DermaGenius resistance PCR assay enables rapid detection of the most common substitutions in SQLE associated with terbinafine resistance. However, its inability to precisely determine specific substitutions on SQLE or identify new ones may pose a problem in the future. These limitations can be addressed by using SQLE sequencing or whole genome sequencing (WGS).