Mycopathologia最新文献

Candidozyma auris (formerly Candida auris) is an emerging pathogenic yeast associated with healthcare outbreaks worldwide. Despite increasing reports across Europe, no published data have previously described cases in Scotland. Here, we report the first detections of C. auris in Scotland, as submitted to ARHAI Scotland. Eight cases (seven colonisations, one infection) were identified to date across four NHS Scotland boards, all linked to repatriation or recent hospitalisation abroad. To contextualise these findings, we reviewed publicly available literature and surveillance data for Western and Northern Europe, identifying considerable variation in case numbers and highlighting Scotland's position among countries with the lowest reported cases. All Scottish cases were imported, underscoring the importance of targeted screening of patients with international healthcare exposure. These findings inform preparedness planning and support recommendations for strengthened surveillance to prevent onward transmission.

Aim: To evaluate the efficacy and safety of four antifungal regimens in treating non-HIV and non-transplant (NHNT) cryptococcal meningitis (CM) patients with high cryptococcal count (≥ 10,000/ml).

Methods: A retrospective analysis was conducted on 135 NHNT CM patients with high cryptococcal count who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2008 to 2023. Patients were categorized into four groups based on the antifungal regimen used during the induction period (Group1: Amphotericin B-deoxycholate (AmB-d) + 5-flucytosine (5-FC) + Voriconazole (VOR); Group2: AmB-d + 5-FC + Fluconazole (FLU); Group3: AmB-d + 5-FC; Group4: 5-FC + FLU). Treatment outcomes were assessed by comparing responses at 10 weeks.

Results: Baseline characteristics were comparable across the four groups. After 2 weeks of follow-up, the positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) of Group1 (1/30; 3.3%) was significantly lower (p < 0.05) than that of Group2 and Group4 (Group2: 11/45; 24.4%; Group4: 22/43; 51.2%); the frequency of anemia in Group1(24/30; 80.0%) was significantly higher (p < 0.05) than that of Group3 and Group4 (Group3: 6/15; 40.0%; Group4: 20/43; 46.5%); and the frequency of renal impairment in Group1 (20/30; 66.7%) was significantly higher (p < 0.05) than that of Group2 and Group4 (Group2: 16/45; 35.6%; Group4: 4/43; 9.3%). Multivariate analysis showed significant associations between treatment groups and the 10-week unsuccessful outcome, with Group 1 having the lowest odds ratio (OR 0.04, 95% CI 0.01-0.22, p < 0.001) when compared to the reference group (Group 3, AmB-d + 5-FC).

Conclusions: Our observations suggested potential benefits of the AmB-d + 5-FC + VOR regimen over AmB-d + 5-FC and 5-FC + FLU for NHNT CM patients. However, clinicians must closely monitor potential side effects, particularly anemia and renal impairment, associated with this regimen.

Background: Triazoles are widely used for treatment and prevention of invasive aspergillosis (IA) but can cause serious drug-drug interactions (DDIs) with chemotherapeutic (CT) and immunosuppressant (IS) agents via CYP3A4 inhibition. The frequency of triazole-CT or IS concurrent administration in hematologic malignancies (HM) patients newly admitted with IA is largely unknown.

Methods: We studied US IQVIA claims including adults with ≥ 1 claim for an inpatient stay with a diagnosis code for IA from October 1, 2015-November 30, 2022 and evidence of systemic antifungal therapy for ≥ 3 days during the hospitalization. The cohort was limited to patients with ≥ 1 HM diagnosis code within 6 months prior to IA admission. Utilization of triazoles with CT and/or ISs known to have moderate-to-severe pharmacokinetic (PK) interactions was described.

Results: Triazoles, predominantly isavuconazole (61.0%) and voriconazole (53.6%), were administered in 97.2% of 317 patients with IA. Of these, 241 (78.2%) received an interacting CT and/or IS. Potentially interacting agents administered with a triazole included corticosteroids (70.8%), calcineurin or mammalian target of rapamycin (mTOR) inhibitors (25.0%) (84.4% tacrolimus), alkylating agents (14.0%) (76.7% cyclophosphamide), venetoclax (9.7%), anthracyclines (6.2%), and vincristine (5.8%).

Conclusions: Concurrent administration of triazole with potential PK interactions with CT or IS agents occurred in most HM patients admitted for IA. Choosing alternative antifungals, therapeutic drug monitoring of triazoles or selective ISs, and dosage adjustment of CT/IS agents may mitigate the risk of adverse DDIs. New antifungal agents without serious DDIs with CT and/or IS agents are needed for treatment of IA to reduce the risk of serious adverse events.

The yeast Candidozyma auris has emerged globally as a major threat to public health. Outbreaks are frequently reported and difficult to control. In the Netherlands, C. auris is rarely detected although national surveillance has been set up. Here, we present all Dutch C. auris cases reported from March 2018 until April 2025. Antifungal susceptibility testing (AFST) using broth microdilution and whole genome sequencing (WGS) were conducted to evaluate antifungal resistance and genetic relatedness. A total of 26 cases of C. auris infection or colonization were reported across 22 different medical institutions in the Netherlands. Most patients had a history of travel to countries with prior reports of C. auris and were hospitalized in foreign medical centers. All patients were admitted in isolation, and all but one remained in isolation for the duration of their hospitalization. WGS showed isolates belonged to clade I or III. Analysis of travel history, contact tracing and WGS data showed no evidence of nosocomial transmission. All isolates were non-wild type to fluconazole with many harboring corresponding mutations in ERG11. One isolate was non-wild type to 5FC and another one to echinocandins including rezafungin. The latter harbored a FKS1^F635Y mutation and was imported from Greece. To conclude, C. auris cases are steadily increasing in the Netherlands. Nonetheless, until now cases seem solely imported from abroad with no evidence for nosocomial transmission. This can be attributed to effective infection prevention and control policies. The C. auris isolates were all non-wild type for fluconazole and a single isolate was non-wild type for echinocandins.

Sporotrichosis is an implantation mycosis with a high incidence in Brazil. Diagnosing human sporotrichosis poses significant challenges, which can lead to increased morbidity and prolonged treatment duration. Direct examination of fresh biopsies using Blankophor represents a valuable tool for rapid diagnosis, offering high sensitivity.

Background: Otomycosis is a common fungal infection of the external auditory canal (EAC), with a higher incidence in tropical and subtropical regions. Epidemiological information on otomycosis in southern China is limited. This study aimed to characterize the clinical manifestations, otoendoscopic features, and pathogen distribution of otomycosis in southern China.

Methods: A retrospective analysis was conducted of 192 confirmed cases of otomycosis among patients at a tertiary hospital in Guangzhou, southern China.

Results: The most common presentation was ear pruritus, followed by hearing loss, aural fullness, otorrhea, tinnitus, and otalgia. Unilateral infection was more common than bilateral infection. The EAC was the primary site affected. Characteristic findings included crusts, congestion, fungoid substance, exudate, and swelling. These features (especially crusts, congestion, swelling, and fungoid substance) were significantly associated with fungal positivity. Of the 110 cases in which fungal pathogens were identified, the majority (103, 93.64%) were Aspergillus species including A. terreus (n = 69), A. flavus (n = 16), A. niger (n = 13), A. sclerotiorum (n = 2), A. oryzae (n = 1), A. sydowii (n = 1) and A. tamarii (n = 1); Candida species accounted for 4 isolates (3.64%), and one isolate each was identified for Cladophialophora, Trichophyton, and Scopulariopsis species (0.91%).

Conclusion: These findings provide region-specific insights that are crucial for guiding effective clinical diagnosis, prevention and empirical antifungal therapy. Antifungal therapy covering Aspergillus should be prioritized in this high-incidence area.

The yeasts of the genus Malassezia are part of the normal skin microbiota of a wide range of warm-blooded animals including humans. Within this genus, Malassezia pachydermatis is commonly found in the normal skin microbiota of a variety of animal hosts. Malassezia yeasts are considered lipid-dependent due to their inability to synthesize long chain fatty acids de novo. While M. pachydermatis is typically able to grow on Sabouraud's agar (SGA) without lipid supplementation, certain strains display an atypical lipid dependency and are unable to grow on SGA. The aim of this work was to study the genomic differences between atypical M. pachydermatis strains unable to grow on SGA and the reference strain. The genomes of three atypical lipid-dependent M. pachydermatis strains were sequenced using Illumina technology and compared with the reference genome of M. pachydermatis neotype strain CBS 1879. A total of 397 small variants with a high or moderate impact on the protein were observed in genes involved in lipid metabolism. Of those small variants observed we highlight the ones observed in 12 out of the 13 genes encoding secretory lipases and in the CKI1 gene that is unique to M. pachydermatis within the genus. The analysis of those small variations suggested a variation in their ability to adapt to environmental changes and their requirements to grow in different culture media.

The first case of Talaromyces marneffei infection diagnosed by next-generation sequencing (NGS) was reported in 2018. By 31st December 2024, the number of T. marneffei infections picked up by NGS has increased to a total of at least 241. Most cases were reported from China, reflecting both the regional importance of this infection and its widespread use of NGS for laboratory diagnosis of infectious diseases. Among the cases with clinical details reported, 136 were HIV-negative, which was probably the main reason why T. marneffei was not suspected and the diagnosis was subsequently made with the use of NGS. For these 136 HIV-negative patients, 62 were confirmed to have other forms of immunodeficiencies, such as anti-interferon gamma autoantibodies and post-renal/liver transplantation. The clinical presentations were usually non-specific. At least 18 patients were clinically diagnosed as tuberculosis, and empirical anti-tuberculosis therapy was prescribed to 13 patients and NGS was performed because they did not respond to or deteriorated while on anti-tuberculosis treatment. Apart from infectious diseases, at least another 11 patients were initially misdiagnosed to have benign or malignant tumours, the most common being carcinoma of the lung. The median time for detection of T. marneffei by NGS was 2 (range 1-6) days, which is significantly shorter than the median time for detection by fungal culture [7 (range 5-17) days] (P < 0.0001 by Mann-Whitney U test). NGS has emerged as a promising diagnostic tool for T. marneffei infections, especially for picking up cases in HIV-negative patients and rapid diagnosis.