Mycopathologia最新文献

To date, the transmission patterns and epidemiological characteristics of the zoonotic dermatophyte Microsporum canis in southwestern Guizhou, China, remain poorly understood. This study employed a multiphase approach integrating retrospective analysis of seven years of dermatophytosis data with a prospective cross-sectional survey of skin infections in cats and dogs conducted from February 2024 to August 2024. A total of 51 M. canis isolates-34 derived from humans and 17 from cats and dogs-were systematically analyzed to assess genotypic, phenotypic, physiological, and MAT gene distribution profiles. Sequencing of the ITS, tubb, and rpb2 loci revealed high genetic homogeneity across all isolates. With the exception of the human-derived strain JYP 21030b, in which amplification at the MAT locus failed, all isolates were identified as MAT1-1 genotype. Clinically, infections in both humans and animals were predominantly localized to the scalp. Physiological assessments revealed that animal-origin strains exhibited enhanced thermotolerance and more robust urease production compared to human-origin strains. Notably, evidence of distant hybridization between M. canis (JYP 21030b) and T. mentagrophytes var. interdigitale (JYP 21030a) was observed, accompanied by dynamic changes and diversity in mating type genes, which may correlate with distinct clinical and physiological traits. In conclusion, M. canis remains the predominant zoonotic dermatophyte responsible for dermatophytosis in humans and companion animals in this region. Despite limited molecular divergence, differences in enzymatic activity and thermal growth profiles suggest functionally driven phenotypic adaptability, with animal-origin strains demonstrating heightened environmental resilience and potential for host switching. Furthermore, the occurrence of interspecies hybridization offers a novel explanation for the paradox of low genetic variation coupled with observable phenotypic heterogeneity, thereby providing new insights into the transmission dynamics, ecological adaptation, and public health implications of M. canis.

Introduction: Talaromyces marneffei (TM) infection is an emerging global threat that increasingly affects immunocompromised individuals, including those with HIV/AIDS. This study aims to systematically analyze the clinical characteristics and treatment regimens of TM infection in HIV-positive patients, with a focus on exploring the optimal timing for antifungal therapy.

Design: A retrospective cross-sectional analysis was performed on 96 HIV-positive patients with TM infection from the Fourth People's Hospital of Nanning, Guangxi. The analysis included symptom manifestations, symptom combination patterns, laboratory test results, co-infection status, complications, and a comprehensive evaluation of treatment regimens, including medication types, combination strategies, and timing of administration.

Results: The study divided patients into three groups: rapid progression death group, stable progression death group, and survival group, to dissect the heterogeneity of the disease (the first two groups collectively constitute the Death Group, representing all deceased patients). Through statistical modeling and visual data exploration, a critical value of one month for medication timing was determined. Further multivariate analysis revealed that medication timing exceeding one month was identified as an independent risk factor for patient mortality. Renal impairment and serum albumin levels < 30 g/dL were identified as poor prognostic factors, while fever and hepatosplenomegaly were associated with a better prognosis, reflecting the body's immune response capacity.

Conclusions: The conclusions of this study provide empirical evidence for early empirical treatment of TM infection, explicitly defining the critical therapeutic time window as within 1 month of symptom onset. This information is crucial for improving patient outcomes and managing TM infection in immunocompromised populations.

Background: To characterize the clinical features and therapeutic outcomes of fungal keratitis caused by Plectosphaerella cucumerina.

Materials and methods: A retrospective analysis was conducted on 13 patients diagnosed with P. cucumerina keratitis from July 2018 to April 2024. Clinical manifestations, microbiological identification, antifungal susceptibility profiles, treatment regimens, and prognostic indicators were evaluated.

Results: All the 13 patients were farmers, and 6 of them had a history of trauma or the presence of a foreign body prior to the onset of symptoms. The main clinical manifestations were chronic progressive shallow corneal and middle stromal layer ulceration with dry ulcer surface, and moss formation was visible in 7 patients (7/13). No obvious immune ring structure and satellite lesions were observed in all patients. In vivo confocal microscopy (IVCM) showed that the mycelia showed medium strong reflection, some of them were changed like bamboo joints, most of them were 2-3 μm in diameter, and the arrangement was relatively neat and fasciculate. The Angle between the mycelia was small and most of them were acute angles. Drug sensitivity test showed that Amphotericin B, voriconazole and itraconazole were the main sensitive antifungal drugs. The main treatment was sensitive antifungal drugs combined with local lesion resection and voriconazole matrix injection. 2 cases with deep ulcers were treated with corneal transplantation.

Conclusions: P. cucumerina keratitis is relatively rare but distinct clinical entity. Diagnosis can be aided by corneal scraping, microbiological culture and IVCM. Emphasizing a comprehensive treatment approach involving medication, debridement, and surgical intervention is crucial to promote rapid healing of the ulcer.

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.