Mycoses最新文献

Background: Trichophyton quinckeanum is a zoophilic dermatophyte causing mouse favus, that was only sporadically detected in Germany for decades. Since 2014, an increasing number of isolates have been found in central Germany, giving rise to dermatophyte skin infections and skin appendix infections like tinea capitis or even kerion Celsi.

Objectives: The goal of this study was to characterize the specific features of dermatophyte infections due to T. quinckeanum.

Methods: We collected the data of 550 isolates of T. quinckeanum from Germany between March 2014 and December 2024 in the laboratory in Mölbis, Germany, in order to identify specific features of the zoophilic dermatophyte infection.

Results: To our knowledge, we present the highest number of cases ever published. Infection rates show a yearly recurring increase in autumn and winter months, whereas infection rates in spring and summer months are typically low. The peak of infections in the current epidemic in central Germany was seen in 2021. Mainly children, teenagers and young adults are affected.

Conclusions: T. quinckeanum has now become a relevant pathogen in Germany and surrounding countries. Even though the current epidemic is in decline, it is to be expected that in the future, infection rates will again correlate with the cyclic mouse population numbers, as they are the main source of infection. Climate change may also play an important role for mouse populations. Transmission to humans typically occurs via an intermediate host like cats (and less likely dogs), which is why pet owners are most at risk.

Background: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic respiratory infection with increasing prevalence and mortality worldwide. Coinfection with chronic pulmonary aspergillosis (CPA) is a significant complication of NTM-PD, often complicating treatment and resulting in poor prognosis.

Objective: In this multicentre, retrospective cohort study, we examined the epidemiology, comorbidities, risk factors for CPA coinfection and long-term prognosis of patients with NTM-PD infected with CPA in Japan.

Methods: Patients aged ≥ 18 years with newly diagnosed NTM-PD who visited 18 hospitals between 2010 and 2017 in Kyushu, Japan, were included. Medical records were reviewed for patient characteristics, mycobacterial species, laboratory data, radiological features, Aspergillus coinfection and all-cause mortality rates. Risk factors for CPA coinfection were analysed using multiple logistic regression, and survival analysis was performed before and after propensity score matching with risk factors.

Results: Among 1304 patients with NTM-PD, 45 (3.5%) were diagnosed with CPA, including 42 with chronic progressive pulmonary aspergillosis. The risk factors for CPA coinfection included male sex, chronic obstructive pulmonary disease, oral corticosteroid use and cavity formation. All-cause mortality was significantly higher in patients with NTM-PD with CPA than in those without CPA (log-rank test, p < 0.001; crude hazard ratio [HR], 3.98). Survival analysis after propensity score matching suggested CPA was an independent poor prognostic factor (log-rank test, p = 0.036; adjusted HR, 1.59).

Conclusion: CPA is an independent poor prognostic factor in patients with NTM-PD. Clinicians must consider CPA when treating patients with NTM-PD, particularly those with high-risk factors, to ensure timely diagnosis and management.

Background: Trichophyton mentagrophytes ITS genotype VII (TMVII) has recently been identified as a cause of genital infections, raising concerns about its potential as an emerging sexually transmitted pathogen. However, the epidemiology and clinical features of TMVII infection remain poorly understood.

Objectives: To systematically review published TMVII cases and characterise its demographic distribution, transmission patterns, clinical manifestations and treatment outcomes.

Methods: A comprehensive literature review was conducted, including all published molecularly confirmed TMVII cases. Data on demographics, infection sites, co-infections and treatments were extracted and analysed.

Results: A total of 124 TMVII cases from 10 studies were included. Among 60 cases with detailed clinical data, tinea genitalis (36.7%) and tinea faciei/barbae/capitis (51.7%) were the common infection types. TMVII infection predominantly affected men who have sex with men (64%), with high co-infection rates of HIV (29.6%) and gonorrhoea (42.6%). Most cases were reported in France (49%) and Germany (35%), suggesting possible local transmission. Oral terbinafine (250 mg/day for 4-8 weeks) achieved a 64.4% cure rate (38/59 courses), while limited data indicated itraconazole and griseofulvin were also effective. Fluconazole showed no therapeutic efficacy.

Conclusion: TMVII can be transmitted through sexual activities, particularly affecting MSM and individuals with concomitant STDs. Current evidence suggests that oral terbinafine is effective, meanwhile other antifungals need further observation. Increased focus is warranted on the clinical management and monitoring of TMVII infection.

Background: Invasive fungal diseases (IFD) pose significant challenges in paediatric oncology. Their management is complicated by limited paediatric-specific evidence, lack of standardised protocols and variability in resources across centres. This study assessed current practices and addressed the challenges in the prevention, diagnosis and treatment of IFDs in paediatric oncology centres across Germany, Austria and Switzerland.

Methods: A questionnaire was distributed to senior paediatric oncologists in 70 paediatric oncology centres across Germany, Austria and Switzerland, gathering data on centre infrastructure, infectious disease (ID) expertise, annual cumulative IFD incidence in 2023, diagnostic tools, antifungal prophylaxis, treatment and follow-up practices for IFD. Responses were analysed descriptively.

Results: Sixty-two centres responded, with a median of 56 (IQR 40-75) new oncological diagnoses per centre; 54.8% of centres managed allogeneic HCT patients. IFDs were reported in 88.7% of centres, with a median cumulative IFD incidence of 4.6% (IQR 3.0%-5.9%). No significant association was found between cumulative IFD incidence and the number of transplants, antifungal prophylaxis protocols and availability of ID consultation services. ID consultation was available in 58.1% of centres, with 24/7 support provided in 41.7% of these centres. Larger centres more frequently had paediatric ID specialists, ID consultation services and access to therapeutic drug monitoring.

Conclusions: The observed heterogeneity in mycology expertise and IFD management strategies across centres reflects the inherent complexity of IFDs and the diagnostic and therapeutic uncertainties amid limited evidence. Strengthening oncology-ID networks and implementing digital consultation platforms may promote high-quality, equitable care, particularly for those with fewer in-house resources.

Background: Due to the paucity of fungal elements in the tissue, the sensitivity of histopathological tests for the diagnosis of cutaneous sporotrichosis remains low, particularly for low-virulent Sporothrix species.

Objectives: We retrospectively analysed and re-evaluated the role of histopathological examination in the diagnosis of cutaneous sporotrichosis caused by Sporothrix globosa.

Methods: Retrospective analysis and pathological reassessment were conducted for 69 sporotrichosis cases caused by S. globosa between 2013 and 2024. Statistical analysis using prevalence ratios was conducted to characterise the clinicopathological and epidemiological aspects.

Results: Histopathological examination revealed mixed inflammatory cell infiltration and granulomatous changes in all cases. Periodic acid-Schiff (PAS) staining was performed in 29 tissue specimens, with positivity observed in 4 cases (13.8%, 4/29). Following supplemental staining and re-evaluation of the slides, PAS staining revealed positivity in 50.7% (35/69) of cases, demonstrating yeast forms (91.4%, 32/35) with asteroid bodies (n = 2) and rare hyphae (n = 1).

Conclusions: Currently, the role of histopathological examination in the diagnosis of sporotrichosis is limited. Our study showed that the frequency of detecting S. globosa based on histopathological examination is considerably high. Nevertheless, achieving high positive rates necessitates the collaborative efforts of experienced mycologists. The predominance of suppurative granulomas or neutrophils is related to the presence of the fungus in tissue sections from human patients.

Background: Trichophyton mentagrophytes species complex comprises dermatophytes responsible for common superficial fungal infections affecting keratinised tissues. Recent shifts in taxonomy and increasing antifungal resistance-necessitate an updated understanding of this fungal complex.

Objective: This narrative review provides a comprehensive update on the taxonomy, host immune response and clinical genotyping of the T. mentagrophytes complex, with a focus on zoonotic and anthropophilic infections in humans.

Methods: A comprehensive literature search was conducted across PubMed and Scopus using MeSH terms and relevant keywords related to T. mentagrophytes, T. interdigitale, and T. indotineae. Eligible English-language publications up to March 2025-including original research, case reports, reviews and guidelines-were included.

Results: The T. mentagrophytes complex includes several genotypes with distinct transmission profiles. Genotypes III/III* are primarily zoonotic; genotype VII is sexually transmitted, especially in MSM populations; genotype VIII (T. indotineae) is anthropophilic and associated with terbinafine resistance. Infection involves keratinocyte adhesion, enzymatic skin barrier degradation and activation of pro-inflammatory cytokines and antimicrobial peptides. Both innate and adaptive immunity, particularly Th1 and Th17 responses, are critical for fungal clearance, whereas chronic infections are associated with impaired T-cell function and skewed Th2 responses.

Conclusion: Emerging genotypes and drug resistance within the T. mentagrophytes complex pose increasing clinical challenges. Awareness of transmission patterns, immune evasion mechanisms and resistance profiles is essential for accurate diagnosis and effective management of dermatophytosis.

Background: Identification of filamentous fungi still poses a major challenge to laboratories. Matrix assisted laser desorption/ionisation time of flight mass spectrometry (MALDI-TOF MS) is a promising tool, since it offers low-cost and fast results. Different MALDI-TOF MS systems are available for routine laboratories. This is a comprehensive head-to-head comparison of three devices and the respective reference spectrum databases.

Materials and methods: A set of 77 pre-characterised isolates of filamentous fungi was measured (in duplicates) parallelly with three MALDI-TOF MS systems after 24 h, 48 h and 72 h of incubation: (1) Biotyper smart ('BT', Bruker Daltonics),(2) EXS2600 ('EXS', Zybio) and (3) VITEK MS PRIME ('VITEK', bioMérieux).

Results: After three measurements, no valid results at the species level ('green category') were obtained for 18%, 21% and 14% of isolates by BT, EXS and VITEK. Depending on the MALDI-TOF MS system, validity rates ranged from 58%-82% for the different time points. Correct and valid results were obtained for 82%, 73% and 81% of isolates by BT, EXS and VITEK. BT was the system that required the most duplicate measurements. EXS displayed the highest rate of misidentification events. VITEK had the highest rate of unidentified isolates, which were featured within its database.

Conclusion: Based on our experience, all three devices proved to be suitable for routine diagnostics. The timepoint of measurement had a major impact on the quality of analysis and should be considered by the user. Lowering the validity cut-off levels might increase the performance of the EXS system.

Introduction: Dermatophytosis is a chronic public health issue in India, often requiring systemic antifungals. Itraconazole (ITZ) is commonly used, but conventional forms show variable absorption. Super-bioavailable itraconazole (SUBA-ITZ) offers improved pharmacokinetics, though clinical comparisons are limited.

Objective: To compare the efficacy, safety, relapse, and recurrence rates of three oral ITZ formulations-Conventional ITZ 100 mg (C-ITZ), SUBA-ITZ 65 mg, and SUBA-ITZ 50 mg-in superficial dermatophytosis.

Methods: In this open-label, randomised study at a tertiary hospital, 150 patients with confirmed tinea corporis, cruris, or faciei were equally assigned to: Group A: C-ITZ 100 mg BID Group B: SUBA-ITZ 65 mg BID Group C: SUBA-ITZ 50 mg BID Treatment lasted 6 weeks without topical antifungals. Assessments were done at 3 and 6 weeks; relapse and recurrence were monitored telephonically at 3 and 6 months.

Results: All groups showed similar clinical response at 6 weeks (BSA, PGA, KOH negativity), with no significant differences. At 3 months, Group C had significantly lower relapse and recurrence (10.2%) than Group B (31.1%, 28.9%) and Group A (23.9%, 26.1%) (p < 0.05). By 6 months, differences were not significant.

Conclusion: All three itraconazole formulations demonstrated comparable short-term efficacy in treating superficial dermatophytosis. These findings underscore the need for larger, long-term randomised controlled trials to optimise itraconazole dosing strategies.

Background: Central nervous system (CNS) histoplasmosis occurs in 5%-10% of patients with disseminated histoplasmosis, is sparsely described in the literature and is highly morbid.

Objectives: To evaluate clinical characteristics and outcomes of patients with CNS and non-CNS disseminated histoplasmosis.

Methods: In this retrospective case-control study, we matched 45 cases of CNS histoplasmosis with 45 controls with disseminated histoplasmosis without CNS involvement by hospital and date of encounter. Data were collected from three hospitals from January 2000 to December 2022 using histoplasmosis-related ICD-9/10 codes. Patients were classified as confirmed (Histoplasma growth on cerebrospinal fluid [CSF] or CNS culture), probable (positive CSF Histoplasma antigen or antibody), or possible (positive urine or serum Histoplasma antigen plus either CSF WBC ≥ 5 cells/μL or abnormalities on CNS imaging, with no other evident cause) CNS histoplasmosis.

Results: CNS (n = 45) and non-CNS disseminated histoplasmosis (n = 45) patients had similar demographic and clinical characteristics, although persons living with HIV (PLWH) were more prevalent in the CNS histoplasmosis group (93.3% and 80.0%, respectively, p = 0.019). CSF profiles (CSF WBC, glucose and total protein) and MRI brain imaging were normal in 28.2% and 21.9% of CNS histoplasmosis patients, respectively. CNS histoplasmosis patients were severely ill, with 34.1% requiring ICU care and Glasgow Outcome Scores of 1-4 in 51.1% of patients at discharge. In-hospital mortality was 6.7% for CNS vs. 13.3% for disseminated histoplasmosis (p = 0.215).

Conclusions: In this large CNS histoplasmosis cohort, we found an increased prevalence of PLWH in CNS vs. non-CNS disseminated histoplasmosis. Similar to prior CNS histoplasmosis cohorts, we report relatively high rates of normal CSF profiles (28.2%) and MRI brain imaging (21.9%). We also found significant morbidity in patients with CNS histoplasmosis, data which were not reported in prior cohorts.

Objectives: This study aimed to systematically evaluate and compare the performance of two laboratory-developed assays (LDAs) and three commercially available real-time PCR assays for the detection of Candida auris. The analytical sensitivity, specificity and limit of detection (LOD) of each assay were assessed, alongside their clinical sensitivity in identifying C. auris colonisation.

Methods: Ten C. auris strains representing five clades, as well as genetically related yeasts, common yeast species, and dermatophytes, were used to assess assay sensitivity and cross reactivity. Clinical and environmental samples were collected from patients during an outbreak and tested with three commercial PCR assays (AurisID, Fungiplex, FungiXpert) and two LDAs (CDC LDA, EMC LDA). LOD was determined using Probit analysis. Diagnostic sensitivity was evaluated by comparing the detection rate of each individual assay to the total detection rate of all assays combined.

Results: The EMC LDA exhibited the highest analytical sensitivity, with a LOD of 8 conidia/reaction, followed by CDC LDA (16 conidia/reaction), AurisID and FungiXpert (19 conidia/reaction), and Fungiplex (596 conidia/reaction). Specificity testing revealed cross-reactivity in the CDC LDA and AurisID assays with C. pseudohaemulonii at high conidia levels, while no cross-reactivity was observed in the other assays. EMC LDA showed the highest clinical sensitivity (100%), whereas Fungiplex had the lowest positivity rate (71%). No false positives were observed in negative control swabs for any assay.

Conclusions: Real-time PCR is a crucial tool for the rapid and sensitive detection of C. auris , especially in clinical settings where timely identification is essential for effective patient management and infection control. Numerous PCR assays are available for this purpose; however, our study demonstrates that the sensitivity of these assays can vary significantly. The observed differences underscore the importance of establishing international reference standards and proficiency panels to enhance the accuracy and comparability of assay performance across different studies and laboratories.