Mycoses最新文献

Background: Serum 1,3-β-d-glucan (BDG) tests are frequently used for diagnosing invasive candidiasis. However, BDG tests remain negative in many patients with candidemia, and factors influencing the probability for positive test results are poorly understood.

Objectives: To study clinical and microbiological factors predictive of a positive BDG test, as well as the association of a positive BDG test with mortality in patients with candidemia.

Methods: In a retrospective cohort of patients with candidemia, BDG was analysed by the Glucatell assay and the Wako Beta-Glucan Test. Predisposing conditions, focus of infection and other variables were retrieved from medical charts and laboratory databases. Their association with a positive BDG test, and the association between positive BDG and death was tested in univariate analysis and multivariable logistic regression.

Results: We included 134 patients with candidemia. Positive BDG and a non-abdominal deep-seated focus of infection (e.g., hematogenously disseminated infection and deep mediastinal/pleural candidiasis) were positively correlated in univariate and multivariable analyses [Wako adjusted odds ratio 9.11 (95% CI 1.66-172, p = 0.039), Glucatell adjOR 9.14 (95% CI 1.66-172, p = 0.039)]. Having a positive BDG test increased the risk for 90 days mortality after controlling for potential confounders, mainly age, septic shock, and ICU admission [Wako adjOR 4.73 (95% CI 1.71-14.7, p = 0.0043), Glucatell adjOR 3.59 (95% CI 1.33-10.6, p = 0.015)].

Conclusions: In patients with candidemia, a positive BDG test is more common in the presence of a concomitant non-abdominal deep-seated infection. Patients with a positive BDG test have a higher 90-day mortality.

Background: Studies analysing the readability of online materials about dermatomycoses were very limited.

Objectives: This study evaluated the readability of online materials related to superficial skin fungal infections in English, German, French, Italian, Spanish and Polish.

Methods: The terms 'dermatomycosis', 'dermatophytosis' and 'trichophytosis' translated into included languages were searched using the Google search engine. The first 50 records in each language were screened for suitability. Articles that were accessible, relevant to dermatological fungal infections and aimed at patient education were included. The LIX score was utilised to assess readability.

Results: In general, 167 articles out of 900 screened (19%) were analysed. The overall mean LIX score was 56 ± 7, which classified articles as very difficult to comprehend. The most readable were articles retrieved with the search term 'trichophytosis' with a mean LIX score of 49 ± 3, followed by 'dermatophytosis' with 54 ± 8 and 'dermatomycosis' with 58 ± 7 (p < 0.001). The most readable articles were in English (48 ± 7) and Spanish (50 ± 5), followed by German (54 ± 4), French (55 ± 6), Italian (59 ± 5) and Polish (63 ± 4) (p < 0.001). The increase in the number of analysed articles was correlated with a higher average LIX score (p = 0.036, R² = 0.708).

Conclusions: Low availability and readability of online patient materials related to superficial skin fungal infections could hinder patient understanding, leading to improper antifungal use, increased recurrence rates and the risk of antifungal resistance. The dermatologists should take action to ensure adequate online materials in Internet-based society.

Background: Onychomycosis is common in older adults and can be difficult to treat owing to slower nail growth, increased nail thickness, comorbidities, and concomitant medications. Oral treatments can be complicated by contraindications, drug-drug interactions, and adverse effects. Topical treatments such as efinaconazole 10% solution may be beneficial for treating older adults.

Objectives: To evaluate the efficacy/safety of efinaconazole 10% solution in adults aged ≥ 65 years with toenail onychomycosis.

Patients/methods: In two multicenter, double-blind, phase 3 studies (NCT01008033; NCT01007708), patients with mild to moderate toenail onychomycosis were randomised (3:1) to once-daily efinaconazole or vehicle for 48 weeks, with a 4-week follow-up. Pooled data for participants aged ≥ 65 years were analysed post hoc (n = 162 efinaconazole, n = 56 vehicle). The primary endpoint was complete cure (0% involvement of target toenail plus mycologic cure [negative KOH and fungal culture]) at week 52. Treatment-emergent adverse events (TEAEs) were assessed throughout.

Results: At week 52, a significantly greater proportion of older adults (aged 65-71 years) achieved complete cure with efinaconazole than vehicle (13.6% vs. 3.6%; p < 0.05). Complete/almost complete cure rate was also significantly greater (≤ 5% involvement and mycologic cure; 19.1% vs. 5.4%; p = 0.01), and over half (59.2%) of participants achieved mycologic cure with efinaconazole versus 12.5% with vehicle (p < 0.001). Treatment-related TEAE rates with efinaconazole were low (6.0%) and similar to the overall study population.

Conclusions: Efinaconazole 10% solution showed similar efficacy/safety in participants aged ≥ 65 years to the overall phase 3 population, despite potential age-related nail changes. These results demonstrate the benefits of efinaconazole in older patients with onychomycosis.

Background: Fungal keratitis is a significant cause of ocular morbidity globally. There is a lack of contemporary local data in Western Australia.

Methods: A retrospective chart review of fungal keratitis cases at two tertiary hospitals in Perth, Western Australia identified between 1 January 2006 and 31 December 2022. Data on patient demographics, isolated organisms, risk factors, clinical features, outcomes, and management were collected and analysed.

Results: There were 68 cases of clinically significant fungal keratitis with positive culture results from corneal scrapes. The most commonly isolated pathogens were Fusarium species (37%), Candida species (28%), Scedosporium species (10%), and Aspergillus species (9%). The most common predisposing risk factors were prior use of topical corticosteroids (40%), contact lens wear (35%), ocular surface disease (without a corneal graft) (25%), ocular trauma (including organic matter exposure) (18%), and a previous corneal graft procedure (16%). Corneal perforation occurred in 25% of cases. A high proportion, 22 episodes in 18 eyes (26%), of patients required therapeutic penetrating keratoplasty, and 6% required evisceration.

Conclusions: Results were largely consistent with previous studies in the Australian context. Fusarium species and Candida albicans were the most common pathogens isolated. Prior topical corticosteroid use was the most common predisposing risk factor, followed closely by contact lens wear and ocular surface disease. A large proportion of patients experienced corneal perforations and required penetrating keratoplasty.

Introduction: The yeast Candida vulturna is a member of the Candida haemulonii species complex, like its close relative Candida auris. Members of this species complex, including C. vulturna, often display reduced susceptibility to one or more antifungal classes. Human invasive infections by C. vulturna are increasingly reported in various countries, while the first identification of this fungus, isolated from a flower, occurred less than 10 years ago. The purpose of this review is to compile all reported outbreaks and cases and describe the characteristics of this emerging yeast.

Methods: PubMed, Scopus, Web of Science and Google Scholar were reviewed for publications until April 14, 2025. Records in English were found by using the keyword Candida (Candidozyma) vulturna, and were included if cases were invasive infections.

Results: All reported 94 cases were exclusively from the last 10 years, often in Asian or Latin American countries and included three outbreaks in Brazil, Vietnam and China. Patients displayed diverse clinical characteristics with an overall low mortality rate of 18%. Most studies (n = 11) performed antifungal susceptibility testing (AFST) with microbroth dilution methods and found reduced susceptibility to azoles and amphotericin B. The ERG11^P135S mutation was shown to confer azole resistance, although the mechanism behind amphotericin B resistance has not been uncovered. Identification by MALDI-ToF routinely misidentified C. vulturna as C. pseudohaemulonii or C. duobushaemulonii, leaving molecular identification by ITS sequencing or whole genome sequencing as the only available methods for accurate species determination.

Conclusion: Although C. vulturna is still a rare yeast, cases are increasingly reported in tropical regions. The yeast has outbreak potential, in addition to reduced susceptibility to azoles and amphotericin B. Treatment with echinocandins showed favourable outcomes with a low mortality rate.

Background: The recent rise in the global incidence of fluconazole resistance in C. parapsilosis has become a significant public health concern. Epidemiological studies suggest that fluconazole resistance in C. parapsilosis spreads through endemic clones. We, therefore, investigated the molecular epidemiology of fluconazole-resistant C. parapsilosis in our centre.

Methods: C. parapsilosis isolates from 2016 through 2022 were investigated for antifungal susceptibility. Fluconazole-resistant isolates were analysed for ERG11 mutation using Sanger sequencing. Gene expression profiles of ERG11, CDR1 and MDR1 were assessed by real-time qPCR. The epidemiological relationship of resistant and susceptible isolates of C. parapsilosis was investigated using short tandem repeat typing. Additionally, biofilm production and cell wall ergosterol contents were also quantified and compared.

Results: Among 572 C. parapsilosis isolates, 48 (8.4%) were resistant to fluconazole. Of 28 recoverable resistant isolates, 17.9% (5/28) were wild-type and 82.1% (23/28) harboured the following ERG11 mutations: Y132F (n = 3), K143R (n = 10) and K143R + R398I (10/28). Significant fold-changes were observed in ERG11 (p = 0.037) and MDR1 (p = 0.008) gene expressions in fluconazole resistant compared to susceptible isolates. Contrary to global reports, STR typing suggested a limited clonal transmission of resistant C. parapsilosis with multiple introductions of resistant isolates in our centre. On fluconazole exposure, ergosterol content significantly increased (p < 0.01) in resistant isolates, particularly in isolates harbouring ERG11^{K143R + R398I} mutations. In contrast, fluconazole-susceptible isolates formed comparatively higher baseline biofilm (p < 0.05) than resistant isolates with ERG11^K143R mutation.

Conclusion: The current study underscores the need for continuous molecular surveillance and tailored therapeutic options for effective management of fluconazole resistance in C. parapsilosis.

Background: Azoles target Cyp51A and Cyp51B in Aspergillus fumigatus. Mutations in cyp51A are known as the primary mechanisms of azole resistance. However, not all of them cause azole resistance. Among them, mutations related to improved susceptibility have not been reported so far. We found that two isolates that carry frameshift or nonsense mutations in cyp51A are more susceptible to azoles, even to fluconazole (FLCZ) (IC₅₀: frameshift, 32 μg/mL; nonsense, 32 μg/mL) compared to other azole-susceptible strains (IC₅₀: > 256 μg/mL).

Objectives: We investigated the contribution of these two mutations to azole sensitivity and their effect on Cyp51A functions.

Methods: We transformed an experimental strain, AfS35, by replacing cyp51A^WT with each of the mutated cyp51A and measured its MICs to azoles. We also evaluated the functions of mutated Cyp51A after suppression of Cyp51B, based on the notion that Cyp51A and Cyp51B complement each other.

Results: Induction of mutated cyp51A in AfS35 led to higher susceptibility to FLCZ (IC₅₀: frameshift, 32-64 μg/mL; nonsense, 32 μg/mL). Transformants carrying either of the mutated cyp51A could not survive when cyp51B was suppressed, indicating that these cyp51A mutations result in Cyp51A dysfunction. Furthermore, a cyp51A-deleted mutant strain also showed increased susceptibility to FLCZ (IC₅₀: 32 μg/mL), similar to cyp51A dysfunctional strains, while a cyp51B-deleted mutant strain showed unchanged susceptibility (IC₅₀: > 256 μg/mL) from AfS35.

Conclusions: It was suggested that FLCZ can inhibit Cyp51B rather than Cyp51A and that this unequal inhibition leads to higher azole susceptibility of the two isolates harbouring Cyp51A dysfunction.

Background: Trichophyton indotineae has emerged as a significant global dermatophyte, associated with recalcitrant dermatophytosis and increasing antifungal resistance.

Materials and methods: This study evaluates therapeutic outcomes in T. indotineae infections. We conducted a systematic review and meta-analysis of individual patient data adhering to PRISMA guidelines, including studies published before December 2023 from six electronic databases. Only studies with confirmed T. indotineae by rDNA sequencing and therapeutic outcome data were included.

Results: A total of 27 publications with 81 cases were included. T. indotineae infections affected both genders equally, with 25% having prior steroid use, which was significantly associated with non-improvement. Resistance to terbinafine was observed in 85.3% of cases. Oral itraconazole was significantly associated with a cure. The restricted median time to complete clinical cure was 11.50 weeks, with a recurrence rate of 19.7%.

Conclusions: The effective management of T. indotineae infections is essential, given the significant challenges posed by antifungal resistance.

Background: Fusarium species are emerging pathogens known to cause both superficial and disseminated human infections. Aerosolized Fusarium species in healthcare settings have been associated with nosocomial fusariosis, particularly in patients with severe immunosuppression.

Objectives: To analyse the phylogenetic relationships of clinical and hospital environmental Fusarium isolates and assess their susceptibility to available antifungal agents.

Methods: Clinical Fusarium isolates were procured from four hospitals in Taiwan, with environmental air and water sampling collected at Kaohsiung Chang Gung Memorial Hospital (KCGMH). All clinical and hospital environmental Fusarium isolates were identified through gene sequencing of translation elongation factor 1-α and internal transcribed spacer regions of ribosomal DNA. Antifungal susceptibility testing followed the CLSI M38-A3 broth microdilution method.

Results: A total of 41 clinical and 4 hospital environmental Fusarium isolates were identified, belonging to five species complexes (SC): F. solani SC (FSSC) (62.8%), F. fujikuroi SC (FFSC) (14.0%), F. incarnatum-equiseti SC (11.6%), F. dimerum SC (7.0%), and F. oxysporum SC (4.7%). Phylogenetic analysis revealed that clinical Fusarium isolates from KCGMH were closely related to environmental Fusarium isolates from air samples at the same hospital. Amphotericin B exhibited high activity against most Fusarium species. With the exception of FFSC, other Fusarium SC demonstrated significantly elevated MIC values to itraconazole, voriconazole, posaconazole, and isavuconazole.

Conclusions: FSSC was the most prevalent SC in Taiwan, exhibiting higher MIC values for azoles than FFSC isolates. The clinical Fusarium isolates were observed to form clusters with the corresponding environmental isolates. The potential of airborne nosocomial infections in the healthcare environment cannot be overlooked.

Background: Aspergillus infections pose significant challenges in clinical management due to rising resistance rates and limited diagnostic accuracy. Superficial infections, particularly in immunocompetent individuals, are often understudied, despite their prevalence in specific populations.

Objectives: This study aimed to characterise the distribution and antifungal susceptibility patterns of Aspergillus isolates from a tertiary hospital in Shandong, China, and evaluate the performance of matrix-assisted laser desorption time-of-flight (MALDI-TOF) mass spectrometry versus multi-gene sequencing for species identification.

Patients/methods: A total of 120 Aspergillus isolates were collected from patients with localised aspergillosis (nails, external auditory canal, cornea, sub-throat secretions) between 2020 and 2021. Species identification was performed using MALDI-TOF and multi-gene sequencing (ITS, BenA, CaM, RPB2). Antifungal susceptibility testing was conducted for micafungin, azoles (itraconazole, voriconazole, posaconazole, fluconazole), and amphotericin B following standard protocols.

Results: Species Identification: MALDI-TOF identified 52.5% of isolates to the species level, whereas multi-gene sequencing achieved 100% accuracy. Aspergillus terreus was the most prevalent species (38.3%). Antifungal Susceptibility: Micafungin showed the highest resistance rate (40%), followed by amphotericin B (reduced susceptibility in 31.7%). Azoles demonstrated low resistance (3.3%-6.7%) except for fluconazole (21.7%). Clinical Correlates: Superficial infections were most common in middle-aged/elderly patients (68.3%), frequently linked to external trauma (41.7%) or environmental exposure (35.8%).

Conclusions: Multi-gene sequencing outperformed MALDI-TOF for Aspergillus identification. A. terreus dominance and micafungin resistance highlight regional epidemiological trends. Natamycin and nystatin remain cost-effective first-line topical options. Enhanced surveillance in trauma-prone and environmentally exposed populations is warranted.