Mycoses最新文献

Background: Surgery is the primary treatment method for non-invasive fungal sinusitis, but challenges include prolonged postoperative inflammation recovery and high recurrence rates. Existing evidence regarding the role of antifungal therapy in enhancing postoperative recovery and reducing recurrence rates in non-invasive fungal sinusitis remains inconclusive. This meta-analysis aimed to systematically evaluate the impact of antifungal therapy on postoperative outcomes in non-invasive fungal sinusitis.

Methods: An eight-database systematic search was performed through March 1, 2025. Primary outcomes included relapse rate and total effective rate, with secondary outcomes consisting of adverse reaction incidence and average epithelialisation time. Subgroup analysis based on antifungal administration routes was also performed.

Results: The antifungal therapy group had significantly lower relapse rates (Odds Ratio [OR] = 0.27, 95% Confidence Interval [CI]: 0.18-0.40, p < 0.00001) and higher total effective rates (OR = 5.41, 95% CI: 3.17-9.23, p < 0.00001) compared to controls. Subgroup analysis showed that topical antifungal therapy (OR = 0.20, 95% CI: 0.12-0.32, p < 0.00001) had a more significant difference in relapse rates than systemic antifungal therapy (OR = 0.54, 95% CI: 0.27-1.05, p = 0.07).

Conclusions: Antifungal therapy after surgery for non-invasive fungal sinusitis, particularly topical antifungal therapy, is beneficial. However, the evidence is limited by the low quality of available studies. Future studies with larger sample sizes, multicentre designs and double-blind randomised controlled trials (RCTs) are necessary to validate these conclusions.

Background: The diagnostic cut-off values for IgG antibodies against recombinant Aspergillus fumigatus (rAsp) antigens in allergic bronchopulmonary aspergillosis (ABPA) remain unclear.

Objectives: To derive and validate diagnostic cut-offs for IgG antibodies against rAsp f 1, f 2 and f 4 in ABPA and assess their diagnostic performance in distinguishing ABPA from asthma.

Methods: In this case-control study, we prospectively enrolled consecutive subjects with asthma and ABPA. We measured serum IgG levels against rAsp f 1, rAsp f 2 and rAsp f 4 using a fluorescent enzyme immunoassay. Subjects were randomly split into derivation (50%) and validation (50%) cohorts. Cut-offs were derived using receiver operating characteristic (ROC) curves and Youden's index. Additionally, we performed Bayesian latent class analysis (BLCA) using two-component Gaussian mixture models to derive unbiased cut-offs. Diagnostic performance was assessed using sensitivity, specificity and the area under the ROC curve (AUROC).

Results: Of 375 participants, 261 had ABPA and 114 had asthma. ROC-derived AUROC values for rAsp f 1, f 2 and f 4-IgG were 0.63, 0.47 and 0.52, while the cut-off values were 10.1 mgA/L, 10.3 mgA/L and 10.5 mgA/L, respectively. Sensitivity was ≤ 42% for all antigens, while specificity exceeded 89%. BLCA yielded cut-offs of 18.6, 14.9 and 13.7 mgA/L for f 1, f 2 and f 4, respectively, with similarly poor sensitivity and high specificity.

Conclusions: IgG antibodies against rAsp f 1, f 2 and f 4 exhibit high specificity but poor sensitivity in identifying ABPA, limiting their utility as standalone diagnostic markers.

Sexually transmitted dermatophyte infections are an emerging public health concern, with increasing incidence reported across multiple countries. These infections are mainly spread through direct skin-to-skin contact during sexual activity and are more commonly found in individuals with high-risk sexual practices. The likelihood of infection is heightened by frequent pubic hair grooming or regular use of shared spaces like gyms and saunas. Clinically, presentations are often severe, widespread and atypical, which may delay diagnosis or lead to misidentification. Accurate species-level identification is critical and increasingly reliant on molecular sequencing techniques, including ITS and tef1α regions, which are also valuable for strain surveillance and contact tracing. Management strategies should emphasise systemic antifungal therapy, with consideration for adjunctive topical agents or antibiotics in cases of secondary infection. Individualised treatment plans may require extended therapy durations or combination regimens to ensure clinical resolution. In addition to pharmacologic intervention, education on hygiene practices, risk of reinfection and the importance of environmental decontamination and follow-up care is essential for preventing recurrence and curbing transmission.

Background: The differential diagnosis of invasive pulmonary aspergillosis (IPA), pulmonary mucormycosis (PM), bacterial pneumonia (BP) and pulmonary tuberculosis (PTB) are challenging due to overlapping clinical and imaging features. Manual CT lesion segmentation is time-consuming, deep-learning (DL)-based segmentation models offer a promising solution, yet disease-specific models for these infections remain underexplored.

Objectives: We aimed to develop and validate dedicated CT segmentation models for IPA, PM, BP and PTB to enhance diagnostic accuracy. Methods：Retrospective multi-centre data (115 IPA, 53 PM, 130 BP, 125 PTB) were used for training/internal validation, with 21 IPA, 8PM, 30 BP and 31 PTB cases for external validation. Expert-annotated lesions served as ground truth. An improved 3D U-Net architecture was employed for segmentation, with preprocessing steps including normalisations, cropping and data augmentation. Performance was evaluated using Dice coefficients. Results：Internal validation achieved Dice scores of 78.83% (IPA), 93.38% (PM), 80.12% (BP) and 90.47% (PTB). External validation showed slightly reduced but robust performance: 75.09% (IPA), 77.53% (PM), 67.40% (BP) and 80.07% (PTB). The PM model demonstrated exceptional generalisability, scoring 83.41% on IPA data. Cross-validation revealed mutual applicability, with IPA/PTB models achieving > 75% Dice for each other's lesions. BP segmentation showed lower but clinically acceptable performance ( ＞72%), likely due to complex radiological patterns.

Conclusions: Disease-specific DL segmentation models exhibited high accuracy, particularly for PM and PTB. While IPA and BP models require refinement, all demonstrated cross-disease utility, suggesting immediate clinical value for preliminary lesion annotation. Future efforts should enhance datasets and optimise models for intricate cases.

Introduction: Fungaemia due to non-Candida and non-Cryptococcus yeasts is uncommon but clinically significant, particularly in immunocompromised hosts. We aimed to describe the epidemiology, microbiology and outcomes of bloodstream infections (BSIs) caused by these organisms.

Methods: We identified all BSIs due to non-Candida and non-Cryptococcus yeasts over a 20-year period using statewide laboratory and administrative health databases.

Results: Seventy-five unique episodes were identified. The most frequent genera were Trichosporon (n = 31, 41.3%), Rhodotorula (n = 26 34.7%) and Saccharomyces (n = 10, 13.3%) species. Antifungal susceptibility testing performed in 33 (44%) episodes revealed high MICs (> 16 mg/L) to echinocandins for Trichosporon and Rhodotorula species. Fluconazole MICs were universally elevated ( $\ge$  32 mg/L) in Rhodotorula spp. but lower in Saccharomyces cerevisiae (2-4 mg/L). Voriconazole and posaconazole had good in vitro activity across all genera where tested. Thirty-day mortality was 22.7%, with the highest rate observed in S. cerevisiae (50.0%). Mortality was associated with malignancy (aHR 4.71, 95% CI 1.00-22.25), heart failure (aHR 11.31, 95% CI 1.66-77.14) and intensive care unit (ICU) admission (aHR 7.05, 95% CI 0.99-50.36). The presence of a central line may be protective (aHR 0.17, 95% CI 0.03-1.04). Rhodotorula infection was associated with lower mortality on univariable analysis (HR 0.11, 95% CI 0.14-0.86) compared with Trichosporon species.

Conclusion: Although rare, fungaemia due to non-Candida and non-Cryptococcus yeasts is associated with significant mortality and antifungal resistance. Species identification and susceptibility testing are crucial to guide treatment. Increased awareness is essential in high-risk patients, particularly those with malignancy, heart failure, or requiring ICU admission.

Background: Cryptococcus bloodstream infections (BSIs) or cryptococcaemia are severe opportunistic infections with high mortality, predominantly affecting immunocompromised individuals or those with end-stage organ disease. Population-based studies examining infection trends and associations between host factors, geography, antifungal resistance, and clinical outcomes are few.

Methods: Blood cultures with growth of Cryptococcus species were retrospectively identified over a 20-year period (January 1, 2000-December 31, 2019) from a state-wide database. Clinical, microbiological and outcome information was also obtained. Survival analyses were used to establish associations between clinical or microbiological characteristics and mortality.

Results: A total of 118 cryptococcaemia episodes (115 patients) were identified, with Cryptococcus neoformans complex causing 98 episodes (83.1%). HIV-associated infections represented 28 episodes (23.7%), with non-HIV episodes (n = 90) more likely to be associated with comorbidities including solid organ transplantation, malignancy, chronic kidney disease, and rheumatological conditions. Overall, 30-day all-cause mortality was 34%, with higher mortality in non-HIV-associated cases (41.7% vs. 12.5%, HR 0.29; 95% CI 0.09-0.94). Of C. neoformans complex isolates with a fluconazole MIC $\ge$ 8 mg/L, 6 (46%) were observed in the most recent 5-year period. Thirty-day (p = 0.85) and 1-year (p = 0.35) mortality increased in a stepwise fashion with increasing fluconazole MIC values in C. neoformans complex infection. Fifty-three episodes (49.1%) documented isolated cryptococcaemia. Patients with additional sites of infection, including CNS involvement, experienced longer hospital stays. Those living in a regional or remote area (HR 1.33; 95% CI 0.68-2.61) or with older age (HR 1.02; 95% CI 1.00-1.04) experienced higher rates of death, although these findings were not statistically significant.

Conclusion: Cryptococcus BSI is a highly lethal condition, particularly among non-HIV infected individuals. We highlight the prognostic importance of blood culture collection in patients with suspected cryptococcal infection. Identifying contemporary risk factors for mortality is critical to understanding what drives poor outcomes. There is a need for continued surveillance of fluconazole susceptibility among Cryptococcus species.

Introduction: Invasive fungal infections (IFI) are a major clinical challenge, particularly in immunocompromised patients, and are associated with high morbidity and mortality. With the increasing prevalence of immunosuppressive conditions and ageing populations, the incidence of IFI is rising globally.

Objective: This survey aims to evaluate the diagnostic and therapeutic capacities for IFI in Belgium, the Netherlands, and Luxembourg (Benelux), a region of high azole-resistance among Aspergillus fumigatus isolates.

Methods: A survey evaluating the diagnostic and therapeutic capacity for IFI was conducted in the Benelux. Data were collected from specialists via an online case report form between March and September 2023. The survey addressed patient characteristics, access to microbiology labs, diagnostic methods (microscopy, culture, molecular diagnostics, etc.), IFI incidence, and the availability of antifungal drugs and therapeutic drug monitoring.

Results: In total, 32 hospitals responded to the questionnaire (12 [38%] from the Netherlands, 19 [59%] from Belgium and one [3%] from Luxembourg). Antifungal susceptibility tests were available in 29 institutions (91%), constituting 84% of the centres in Belgium and 100% for the Netherlands (p = 0.265). Aspergillus PCR testing was available in 12 centres in Belgium (63%) while in 11 centres in the Netherlands (92%, p = 0.108). Mucorales PCR testing was available in 56% of centres. Treatment with at least one amphotericin B formulation was only available in 84% of the responding centres. Therapeutic drug monitoring (TDM), although recommended, was possible for voriconazole in 26 centres (81%) while for posaconazole in 24 centres (75%). Significantly more testing (diagnostic tests and TDM) was outsourced in Belgium compared to the Netherlands (p < 0.001).

Conclusions: Antifungal susceptibility testing is widely available in Belgium and the Netherlands, but implementation in areas with high azole resistance for Aspergillus fumigatus is not yet universal, and techniques vary. Tests for coinfections, like Mucorales PCR, were only available in half of the centres. More testing is outsourced in Belgium, likely due to differences in reference centre organisation, country size, transport, and reimbursement. Delays in diagnosis can impact patient outcomes, so awareness of test availability and transport times is crucial.

Introduction: Invasive candidiasis is a life-threatening fungal infection associated with high mortality rates. Adherence to clinical practice guidelines (CPG) has been shown to improve patient outcomes. This study aimed to evaluate physician compliance with CPG following the implementation of care bundles and locally developed CPG and to assess the impact of CPG implementation on patient mortality.

Methods: This quasi-experimental study utilised a historical cohort control design. Candidemia patients treated at Siriraj Hospital in Bangkok, Thailand, from November 2021 to April 2024 were enrolled. A prospective cohort group received CPG for invasive candidiasis, modified from ESCMID recommendations, covering eight facets. Education care bundles, including clinical policy, training, infographic sheets, leaflets and SMS alerts, were also implemented. Each CPG item was scored as 0, 1 or 2, representing non-compliance, partial compliance and full compliance, respectively. A total compliance score below eight indicates poor compliance. Physician compliance and 30-day mortality rates were analysed.

Results: A total of 112 patients were included in the study: 56 in the historical control group and 56 in the prospective intervention group. Both groups exhibited similar baseline characteristics and risk factors for candidemia. Following the implementation of the CPG and care bundles, physician compliance significantly improved across several metrics. Notable increases were observed in: initiating anti-fungal therapy within 24 h (OR = 6.00, 95% CI [2.41-14.96], p < 0.001), receipt of appropriate anti-fungal therapy, specifically with echinocandins or amphotericin B (OR = 9.17, 95% CI [1.11-75.96], p = 0.03), catheter removal or source control within 48 h (OR = 37.17, 95% CI [4.68-295.39], p < 0.001), obtaining blood cultures at least every other day (OR = 19.15, 95% CI [7.35-49.86],p < 0.001), continuing anti-fungal therapy for at least 14 days after the first negative culture (OR = 3.30, 95% CI [1.42-7.67], p = 0.005), conducting echocardiography (0% vs. 16.1%, p = 0.003), performing fundoscopy (OR = 5.24, 95% CI [1.79-15.30], p = 0.001). There was a significant improvement in compliance scores, with ≥ 8 being more prevalent in the intervention group compared to controls (OR = 5.39, 95% CI [1.98-14.69], p < 0.001). The mean compliance score was 8 ± 2 in the control group and 11 ± 2 in the intervention group (p < 0.001). Additionally, the all-cause 30-day mortality rate decreased significantly from 55.4% in the control group to 35.7% in the intervention group (OR = 0.45, 95% CI [0.21-0.96], p = 0.04).

Conclusions: The implementation of CPG and care bundles for invasive candidiasis significantly enhanced physician compliance and improved patient survival. These findings support the continued adoption of CPG and care bundles in the management of invasive candidiasis.

Background: Small studies have used various serological methods to evaluate the response to paracoccidioidomycosis (PCM) treatment, with limited use of counterimmunoelectrophoresis (CIE). This study assessed CIE titres during and after PCM therapy and their prognostic value for serological negativity.

Methods: In this retrospective study, we reviewed medical records of patients with positive serology in proven or probable PCM from 2006 to 2021 at University of São Paulo. We performed multivariate logistic regression to identify independent variables associated with CIE titre negativity.

Results: This study included 144 participants, totalling 979 serology samples analysed, with a predominance of middle-aged adults (median age 50 years), males (n = 112, 78%) and chronic form (n = 112, 78%). Trimethoprim-sulfamethoxazole (n = 79, 55%) and itraconazole (n = 55, 38%) were the drugs most commonly used. The median treatment time was 24 months (IQR 16-37). Median initial CIE titre was 1:32 (IQR 1:16-1:128). Thirty-seven patients (26%) had a negative CIE titre, and 105 patients (73%) had CIE titres ≤ 1:4 at the last medical appointment. In multivariate analysis, only positive direct microscopy examination (OR 0.32, p = 0.043) was an independent factor related to non-negativity serology. The time to negativity was shorter in female sex and negative microscopy.

Conclusion: The serology using CIE presented a strong association with clinical response, making it a valuable method for monitoring patients with PCM. Most patients achieved CIE titres ≤ 1:4 during antifungal therapy, which was strongly associated with a successful clinical response.

Acute myeloid leukaemia (AML) patients undergoing venetoclax (VEN)-based regimens are at risk for invasive fungal infections (IFIs), but the benefit of antifungal prophylaxis (AFP) in this setting remains uncertain. We evaluated the efficacy of AFP in preventing invasive fungal infections (IFI), improving overall survival (OS) and best response among AML patients treated with VEN-based therapies. A systematic search of PubMed, EMBASE and Cochrane databases was conducted for studies comparing AFP use to no prophylaxis in AML patients under VEN-based regimens. Data were synthesised using Bayesian meta-analysis. Seven retrospective studies involving 960 patients were included. The pooled analysis yielded an odds ratio (OR) of 0.84 (95% credible interval: 0.39-1.59) for probable or confirmed IFIs with AFP use. The computed probability of OR < 1 for IFI infection was 74.8% for probable or confirmed IFIs and 71.8% for confirmed IFIs, indicating substantial uncertainty and no clear evidence of a real effect. AFP did not significantly alter OS (hazard ratio = 0.82, 95% confidence interval: 0.58-1.16) or response rates. Mould-active antifungals were underutilised in most studies, and the most used antifungals were fluconazole (35.2%) and posaconazole (34.8%). Our analysis highlights the need for prospective studies and risk stratification to evaluate the role of mould-active agents in this population.