Mycopathologia最新文献

Background: With the increasing incidence of fungal infection in China, the need for rapid and accurate diagnosis of mycosis is crucial. Therefore, it is necessary to understand the diagnosis capacity for mycosis.

Methods: A cross-sectional online survey was conducted across all 31 provincial-level regions in China from August 2023 to April 2024. The survey comprised 77 questions evaluating fungal diagnostic methods, including culture, microscopy, molecular tests, and related biomarkers. Data from 1,009 valid responses were stratified by hospital tier (tertiary A vs. non-tertiary A) and regional GDP levels to analyze on-site testing capacity and outsourcing patterns.

Results: Among the 1,009 respondents, 78.5% were from tertiary A hospitals. Mycology testing was more commonly performed in tertiary hospitals compared to other. Traditional mycological diagnostic methods showed no significant differences in application across regions, regardless of economic development. However, disparities emerged in novel tests, particularly molecular diagnostics: hospitals in low-GDP regions were more likely to outsource molecular testing or lack in-house capacity.

Conclusions: China's fungal diagnostic capacity remains concentrated in tertiary A hospitals and high-GDP regions. Future efforts should prioritize expanding molecular testing access and optimizing resource distribution across all healthcare settings.

Blastobotrys allociferrii is a yeast involved in human infection and colonization. Here, we present the first draft genome of B. allociferrii, which has been isolated from a human sample (CBS 18616).

Sporotrichosis is a fungal disease caused by the infection of Sporothrix spp. The reference standard method for the diagnosis of sporotrichosis is still the mycological culture from clinical samples. Molecular methods have been developed to facilitate the diagnosis of the disease. The aim of the study was to compare two Polymerase Chain Reaction (PCR) techniques, using species-specific primers and nested PCR, to diagnose human sporotrichosis directly from tissues of patients treated at a public hospital in Pernambuco, Brazil. Tissue fragments samples were subjected to DNA extraction followed by PCR using species-specific primers for S. brasiliensis and S. schenckii and nested PCR. Positive DNA bands for S. brasiliensis were amplified in both methods. Our findings suggest that PCR is an important tool for the rapid and accurate diagnosis of sporotrichosis in humans. Histological analysis of the same number of patients, who had a tissue fragment analyzed by species-specific primers or nested PCR, showed yeast-like cells by periodic acid of Shiff staining in only 10%. Considering hematoxylin and eosin staining, only one case was diagnosed as deep mycosis and the other cases had nonspecific diagnoses. The present work compared different molecular tools for the diagnosis of sporotrichosis from clinical samples. As far as we know, the comparison of these methodologies is pioneering and has the advantage of improving diagnosis and early detection in patients with sporotrichosis caused by Sporothrix sensu lato, especially in new endemic areas, as well as the possibility of implementing these tools in the diagnostic routine.

Fungal infections have emerged as a significant public health concern, especially with the increasing incidence of severe mycoses caused by pathogens such as Aspergillus fumigatus, Candida auris, Candida albicans, and Cryptococcus neoformans. These fungi, listed as critical priorities by the World Health Organization, pose a heightened risk due to rising antifungal resistance and their severe impact on immunocompromised individuals. This article, coordinated by the Portuguese Association of Medical Mycology, highlights the importance of adopting a One Health perspective to address fungal threats comprehensively. Drawing on interdisciplinary collaboration, the association aims to foster greater awareness, improve diagnostic capabilities, and stimulate research and public health policies in Portugal but also at global level. The paper outlines key strategies for surveillance, prevention, and innovation in fungal diagnostics and therapeutics. Moreover, it emphasizes the urgent need for national coordination and international cooperation in managing fungal infections, advocating for integrative approaches that link human, animal, and environmental health. By presenting a consolidated overview of current challenges and future priorities, this work seeks to enhance preparedness and response mechanisms in the face of escalating fungal threats.

Introduction: Invasive candidiasis is a serious healthcare associated infection with a high mortality rate. Emergence of the multi-drug-resistant species Candida (Candidozyma) auris over the past two decades poses further challenges. We aimed to study the epidemiology, clinical profile and outcomes of non-neutropenic adults with C. auris candidemia in comparison with candidemia due to other species.

Methods: We conducted a retrospective study of all non-neutropenic adult patients admitted to our tertiary care centre with blood culture proven candidemia between January 2019 and September 2024. We retrospectively collected their clinical data and investigation records via hospital's electronic records and document management systems.

Results: Out of a total of 372 candidemia episodes, 85 (22.8%) were caused by C. auris, which was the second most common species after C.tropicalis. The incidence of candidemia overall as well as C. auris candidemia increased during the SARS-COV2 pandemic. In comparison to other species, C. auris candidemia was associated with prolonged hospital stay, prior antifungal exposure, a lower SOFA score and was common in patients on ECMO. Candida endocarditis was associated with persistent candidemia and long, tunnelled lines. C. auris showed 100% resistance to fluconazole and very low rate of susceptibility to amphotericin B: only echinocandins were reliably effective. A negative beta-D glucan (BDG) value was seen in a quarter of patients with both C. auris as well as with other species. Overall survival at 28 days was only 40%. Advanced age and a high SOFA score were associated with higher mortality. C. auris was associated with a lower mortality overall but was not associated with higher mortality in a multi-variate analysis.

Conclusion: Multi-drug-resistant Candida (Candidozyma) auris has emerged as a major nosocomial pathogen in Indian ICUs since the SARS-COV-2 pandemic, especially later in the course of hospital stay and with prior antifungal exposure. A negative BDG result alone cannot be used for withholding or discontinuing antifungals. Echinocandins are the empiric antifungals of choice for candidemia in view of the current epidemiology and resistance profile.

Objectives: Invasive candidiasis, including candidaemia, is associated with high morbidity and mortality. Diagnosis is traditionally based on blood culture, which lacks sensitivity. Therefore, additional tools such as PCR-based diagnostic methods are increasingly used. The T2MR technology is based on polymerase chain reaction and detection of the PCR product involving magnetic resonance technology. In this study, we compare the T2Candida in a clinical routine setting to conventional blood culture in order to explore its usefulness, strengths and weaknesses in its daily application.

Methods: This retrospective analysis was performed at the Vienna University Hospital with clinical routine samples submitted between April 2021 and May 2024. Sensitivity, specificity, positive predictive value, negative predictive value and accordance were calculated with blood culture as reference method. Patients with a positive T2Candida result but a negative result in blood culture were assessed according to a clinical case definition. Based on direct detection in blood by alternative methods (e.g. blood culture, alternative PCR), 1-3-beta-D-Glucan, patient risk factors and detection of the same species in other sample materials, each result was categorised as "proven", "probable", "possible", "improbable" or "not assessable".

Results: 2105 samples from 1447 unique patients were submitted for analysis during the study period. 94 samples were positive (4.5%) in the T2Candida, with 4 samples positive for more than one target. 26 out of these 94 (27.7%) were also positive in blood culture. 339 (16.1%) samples were invalid. The most frequent species detected was Candida albicans/tropicalis with 57 detections. Overall sensitivity of the T2Candida panel in our setting was 0.62 (95% CI 0.41-0.80) and specificity was 0.96 (95% CI 0.95-0.97). Cases detected by the T2Candida panel were assessed as proven (n = 28), probable (n = 11), possible (n = 29), improbable (n = 15) and not assessable (n = 15). Median time-to-result was 3.9 h for the T2Candida compared to a median time-to-positivity of blood culture ranging from 22.7 to 42.0 h depending on the species.

Conclusions: The introduction of the T2Candida panel led to a substantial rise in patients diagnosed with invasive candidiasis. Combination of both the T2Candida panel and conventional blood culture led to the detection of more positive samples than each test alone.

Systemic candidiasis caused by Candida albicans has become a serious issue due to high morbidity and mortality. It is very important to develop novel and effective antifungal agents due to the increasing resistance to commonly used drugs such as fluconazole (FLC). In our previous research, the essential oil of Carica papaya L. seed (PSEO) was extracted and in vitro studies demonstrated that PSEO exhibited strong antifungal activity against C. albicans. It is crucial to investigate the therapeutic effect of PSEO in vivo to develop it into a viable antifungal agent. This study aimed to investigate acute toxicity of PSEO and its in vivo effects on a systemic candidiasis model in mice induced with both FLC-sensitive and -resistant C. albicans. The results showed that PSEO showed no acute toxicity up to 100 mg/kg. PSEO and FLC can improve the water intake, food intake, and mental state of systemic candidiasis model mice. The body weight of the infected mice recovered, the survival rate and splenic index increased, the fungal burden decreased, and pathological damage was alleviated to varying degrees. Moreover, the higher the dose of PSEO, the more pronounced the effect. PSEO exhibited significantly better efficacy than FLC against FLC-resistant C. albicans-induced systemic candidiasis. These findings indicate that PSEO holds great promise as a natural, novel, and effective agent for clinical treatment of C. albicans infections, especially for drug-resistant C. albicans infections. This study provides a theoretical basis for the rational development and utilization of papaya seeds.

Mannose-binding lectin (MBL) contributes to innate immunity against Aspergillus fumigatus. We assessed the role of reduced MBL levels in asthma patients with and without allergic bronchopulmonary aspergillosis (ABPA). In this prospective cross-sectional study, we enrolled 154 adults: 48 with asthma, 27 with Aspergillus-sensitized asthma (ASA, A. fumigatus-IgE ≥ 0.35 kUA/L), and 79 with ABPA. Serum MBL levels were quantified using enzyme-linked immunosorbent assay. Reduced MBL levels were defined using three thresholds (< 200, < 359, and < 500 ng/mL). The prevalence of reduced MBL levels did not differ significantly among the groups at any threshold. However, mean MBL levels were significantly lower in patients with ABPA (961 ng/mL) compared to asthma (1159 ng/mL) and ASA (1593 ng/mL; p = 0.048). Among ABPA patients, reduced MBL levels (≤ 359 ng/mL) were not associated with significant differences in clinical features, immunological markers, lung function, or radiology.