Revista Iberoamericana De Micologia最新文献_第2页

Shifting epidemiology and microbiological profiles of cryptococcosis in a Brazilian tertiary center: A descriptive study of 94 patients 巴西三级中心隐球菌病的流行病学和微生物特征的变化：对94名患者的描述性研究。

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-07-01 Epub Date: 2025-09-18 DOI: 10.1016/j.riam.2025.07.002

Suzana Mesquita Ribeiro , Vítor Falcão de Oliveira , Ana Paula Cury , Hélio Rodrigues Gomes , Mariane Taborda , Adriana Satie Gonçalves Kono Magri , Guilherme Diogo Silva , Afonso Rafael da Silva Junior , Adriana Lopes Motta , Wdson Luis Lima Kruschewsky , Evangelina da Motta Pacheco Alves de Araujo , Marcello Mihailenko Chaves Magri

Background

The epidemiology of cryptococcosis is shifting, with an increasing number of cases occurring among non-HIV immunosuppressed individuals. In this context of a new epidemiological presentation of the disease, further studies are needed to better describe the microbiological profiles associated with different immune status.

Aims

To characterize cryptococcosis cases according to immune status, focusing on species distribution and time to culture positivity.

Methods

We conducted a retrospective study of patients with positive Cryptococcus spp. cultures from various biological materials between 2017 and 2022 at a Brazilian tertiary hospital. Clinical and laboratory data were extracted, including immune status, biological sample type, Cryptococcus species, and time to positivity in aerobic and fungal cultures. Patients were classified into HIV-positive, non-HIV immunosuppressed, or non-immunosuppressed/non-HIV. Descriptive analyses were performed.

Results

Among the 94 patients analyzed, 29 (30.9%) were HIV-positive, 39 (41.5%) were non-HIV immunosuppressed, and 19 (20.2%) were non-immunosuppressed/non-HIV. A total of 288 isolates were identified, predominantly Cryptococcus neoformans (72/94, 76.6%), but Cryptococcus gattii (17/94, 18%) infection was non-neglectable. The mean time to culture positivity was 5 days (range 2–24 days) for aerobic cultures and 10 days (range 0–63 days) for fungal cultures.

Conclusions

This work reinforces the need for future studies to better represent non-HIV immunosuppressed patients, to address infections caused by C. gattii, and to consider the wide variability in culture growth time as a diagnostic limitation.

背景：隐球菌病的流行病学正在发生变化，越来越多的病例发生在非hiv免疫抑制的个体中。在这种疾病新的流行病学表现的背景下，需要进一步的研究来更好地描述与不同免疫状态相关的微生物谱。目的：根据免疫状态对隐球菌病病例进行特征描述，重点关注物种分布和培养阳性时间。方法：对巴西某三级医院2017 - 2022年间各种生物材料隐球菌培养阳性患者进行回顾性研究。提取临床和实验室数据，包括免疫状态、生物样品类型、隐球菌种类以及有氧和真菌培养的阳性时间。患者分为hiv阳性、非hiv免疫抑制、非免疫抑制/非hiv。进行描述性分析。结果：94例患者中hiv阳性29例（30.9%），非hiv免疫抑制39例（41.5%），非免疫抑制/非hiv 19例（20.2%）。共检出288株，以新型隐球菌感染为主（72/94,76.6%），而加蒂隐球菌感染不可忽视（17/94,18%）。有氧培养平均培养阳性时间为5天（2-24天），真菌培养平均培养阳性时间为10天（0-63天）。结论：这项工作加强了未来研究的需要，以更好地代表非hiv免疫抑制患者，解决由C. gatii引起的感染，并考虑培养生长时间的广泛变化作为诊断限制。

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引用次数: 0

Epidemiology of dermatophytes isolated from superficial dermatological samples taken during 2020–2023 in Zaragoza (Spain) 西班牙萨拉戈萨2020-2023年浅表皮肤样本分离的皮肤真菌流行病学

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-07-01 Epub Date: 2025-11-01 DOI: 10.1016/j.riam.2025.09.001

Eva Pablo-Hernando , Javier Alcón , María Riesgo , Rafael Benito

Background

Dermatophytoses are transmissible infections that affect one billion people worldwide and have a significant impact on public health. Dermatophytes distribution evolves geographically and over time. Consequently, local epidemiology should be periodically assessed to control infection.

Aims

To describe the local distribution of dermatophytes and types of dermatophytosis through the analysis of samples from patients with suspected superficial mycoses, and to identify areas of improvement.

Methods

A retrospective epidemiological analysis of mycological culture results from skin, hair and nail samples referred to the mycology lab in the Hospital Clínico Universitario Lozano Blesa, Zaragoza (Spain) between 2020 and 2023 was performed, and the results statistically analyzed.

Results

4371 specimens (skin: 41.4%; hair: 5.1%; nails: 53.5%) were cultured using standard procedures. The demand for testing increased by 53% over a 4-year time period and a dermatophyte positivity rate of 16.7% (n = 731) was found. The species distribution was the following: Trichophyton rubrum (56%), Trichophyton tonsurans (11.3%), Microsporum canis (11.8%), Trichophyton interdigitale (7%), Trichophyton. mentagrophytes (5.8%), Microsporum audouinii (3.8%) and other species (4.9%), with an anthropophilic to zoophilic ratio of 4:1. The dermatophytoses clinical forms found were tinea unguium (39.6%), associated to population over 45 years, tinea corporis (24.7%) and tinea capitis (10.6%), both associated to people with less than 16 years group, tinea pedis (17.5%), mainly observed in people aged 31–45 years; other forms accounted for 7.6%. Finally, the Emergency department requested 11.9% of the mycological tests.

Conclusions

Local epidemiology of dermatophytoses highlights the predominance of anthropophilic species, whereas 35 years ago zoophilic species represented 80% of the isolates. Interestingly, mild superficial lesions are frequently and inappropriately brought to the Emergency department.

背景：皮肤真菌病是一种传染性感染，影响全世界10亿人，并对公共卫生产生重大影响。皮癣菌的分布随着地理和时间的变化而变化。因此，应定期评估当地流行病学以控制感染。目的：通过分析疑似浅表真菌病患者的样本，描述皮肤真菌的局部分布和皮肤真菌病的类型，并确定改进的领域。方法：对西班牙萨拉戈萨Clínico Lozano Blesa大学医院真菌学实验室2020 - 2023年皮肤、头发和指甲样本的真菌学培养结果进行回顾性流行病学分析，并对结果进行统计分析。结果：4371例标本（皮肤：41.4%，毛发：5.1%，指甲：53.5%）按标准程序培养。在4年的时间里，检测需求增加了53%，发现皮肤真菌阳性率为16.7% （n=731）。种类分布依次为：红毛癣菌（56%）、毛癣菌（11.3%）、犬小孢子菌（11.8%）、趾间毛癣菌（7%）、毛癣菌（7%）。植物（5.8%）、audouinii Microsporum（3.8%）和其他物种（4.9%），亲人与亲动物的比例为4:1。皮肤真菌病的临床表现为45岁以上人群中有甲癣（39.6%），16岁以下人群中有体癣（24.7%）和头癣（10.6%），31-45岁人群中有足癣（17.5%）；其他形式占7.6%。最后，急诊科要求11.9%的真菌学测试。结论：当地流行病学研究表明，在35年前，80%的分离株为嗜兽种，而嗜人种占多数。有趣的是，轻微的表面病变经常被不适当地带到急诊科。

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引用次数: 0

Clinical insights into invasive aspergillosis among immunosuppressed patients: A single-centre experience from Argentina 侵袭性曲霉病在免疫抑制患者中的临床见解：来自阿根廷的单中心经验。

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 Epub Date: 2025-03-11 DOI: 10.1016/j.riam.2025.01.003

Fernando Riera , Julieta Carballo , Carlos Bergallo , Federico Romero , Belén Palacio , Lizet Luque-Aguada , Marcos Marino , Jon Salmanton-García

Background

Invasive aspergillosis poses a significant threat to immunocompromised individuals. Diagnostic criteria incorporating biomarkers and imaging have improved diagnosis, and treatment options have expanded. However, in Argentina, diverse patient demographics and environmental factors add complexity to managing this infection.

Aims

This study aims to explore the epidemiology, diagnostic methods, and treatment of invasive aspergillosis in an Argentine hospital setting.

Methods

We collected data from patients with suspected invasive aspergillosis at a tertiary care hospital in Central-Northern Argentina. Variables included demographics, underlying conditions, diagnostic criteria, treatment, and outcomes.

Results

With a median age of 44.5 years and a 51% of male patients, our institution conducted invasive aspergillosis screenings on 192 patients, many of whom were battling malignancies (90%). One third of them had the infection set as probable or possible. Imaging (31%) and positive microbiological results (16%) were examples of diagnostic evidence. With an overall mortality rate of 15%, half of the patients got antifungal treatment for a median of seven days. Mortality among the diagnosed patients was 22%. Patients without stem-cell transplantation had a high death rate (31%), although this difference was not statistically significant; in patients having pulmonary nodules (15%) the death rate was not statistically significant either. There were no discernible variations in mortality according to the type of treatment received.

Conclusions

Our study reveals that invasive aspergillosis remains a significant issue in high-risk patients, and has a notable mortality rate, particularly among those patients with pulmonary nodules. Computed tomography provides a high diagnostic yield.

背景：侵袭性曲霉病对免疫功能低下的个体构成重大威胁。结合生物标志物和影像的诊断标准改善了诊断，治疗选择也扩大了。然而，在阿根廷，不同的患者人口统计和环境因素增加了管理这种感染的复杂性。目的：本研究旨在探讨阿根廷医院侵袭性曲霉病的流行病学、诊断方法和治疗。方法：我们收集了阿根廷中北部一家三级医院疑似侵袭性曲霉病患者的资料。变量包括人口统计、基础条件、诊断标准、治疗和结果。结果：中位年龄为44.5岁，男性患者占51%，我院对192例患者进行了侵袭性曲霉病筛查，其中许多患者正在与恶性肿瘤作斗争（90%）。其中三分之一的人被定为可能感染。影像学（31%）和微生物学阳性结果（16%）是诊断证据的例子。总体死亡率为15%，一半的患者接受了抗真菌治疗，治疗时间中位数为7天。确诊患者的死亡率为22%。未进行干细胞移植的患者死亡率较高（31%），尽管这一差异无统计学意义；肺结节患者（15%）的死亡率也无统计学意义。根据所接受的治疗类型，死亡率没有明显的变化。结论：我们的研究表明，侵袭性曲霉病在高危患者中仍然是一个重要的问题，并且具有显著的死亡率，特别是在肺结节患者中。计算机断层扫描的诊断率很高。

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引用次数: 0

Fluconazole in combination with compounds of natural and pharmaceutical origin: A study on their antimicrobial activity against Candida auris 氟康唑与天然和药物来源的化合物联合使用对耳念珠菌的抑菌活性研究。

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 Epub Date: 2025-06-25 DOI: 10.1016/j.riam.2025.05.001

Iñigo de-la-Fuente , Andrea Guridi , Guillermo Quindós , Elena Eraso , Elena Sevillano

Background

Candidiasis is a prevalent and clinically significant fungal infection. Candida auris has emerged as an important etiological agent due to its high transmissibility, potential to cause severe infections, and resistance to multiple antifungal drugs. Combining fluconazole with other compounds to achieve additive or synergistic antifungal effects has been proposed as a promising strategy for managing these infections.

Aims

This study aimed to evaluate the antifungal effects of fluconazole in combination with seven natural compounds (berberine chloride, caffeic acid phenethyl ester, catechin monohydrate, epigallocatechin gallate, magnolol, osthole, and quercetin hydrate) and seven drugs (amiodarone, amlodipine, budesonide, doxycycline, ibuprofen, minocycline, and tigecycline) against C. auris.

Methods

The antifungal activity of fluconazole alone and in combination with selected compounds and drugs was analyzed to identify additive or synergistic interactions against 21 isolates of C. auris. Minimum inhibitory concentrations (MICs) of fluconazole were determined and compared across combinations.

Results

Fluconazole combined with magnolol, caffeic acid phenethyl ester, or quercetin hydrate showed additive effects against 38%, 9.5%, and 2% of isolates, respectively, and a synergistic effect with quercetin hydrate in 19% of isolates. Fluconazole MICs were reduced from >64 μg/mL to 1–16 μg/mL with magnolol in 19 isolates, to 1–32 μg/mL with caffeic acid phenethyl ester in 17 isolates, and to 1–2 μg/mL with quercetin hydrate in 8 isolates.

Conclusions

These findings highlight the potential of fluconazole combined with magnolol, caffeic acid phenethyl ester, or quercetin hydrate for managing C. auris infections. Further in vivo studies are warranted to assess their therapeutic applicability.

背景：念珠菌病是一种常见且具有临床意义的真菌感染。耳念珠菌因其高传播性、可能引起严重感染以及对多种抗真菌药物具有耐药性而成为一种重要的病原。将氟康唑与其他化合物联合使用以达到加性或协同抗真菌作用已被认为是治疗这些感染的一种有希望的策略。目的：评价氟康唑与7种天然化合物（氯化小檗碱、咖啡酸苯乙酯、一水儿茶素、表没食子儿茶素没食子酸酯、厚朴酚、蛇床子素、水合槲皮素）和7种药物（胺碘酮、氨氯地平、布地奈德、多西环素、布洛芬、米诺环素、替加环素）联用对金耳念珠菌的抑菌作用。方法：对氟康唑单用及与选定化合物和药物联用对21株金黄色葡萄球菌的抑菌活性进行分析，确定其加性或协同作用。测定氟康唑的最低抑菌浓度（mic）并比较不同组合的抑菌浓度。结果：氟康唑与厚朴酚、咖啡酸苯乙酯或水合槲皮素联用分别对38%、9.5%和2%的分离株有加性作用，与水合槲皮素联用对19%的分离株有协同作用。用厚朴酚处理19株氟康唑的mic值降至1 ~ 16μg/mL，用咖啡酸苯乙酯处理17株降至1 ~ 32μg/mL，用水合槲皮素处理8株降至1 ~ 2μg/mL。结论：这些发现突出了氟康唑联合厚朴酚、咖啡酸苯乙酯或槲皮素水合治疗耳球菌感染的潜力。需要进一步的体内研究来评估它们的治疗适用性。

{"title":"Fluconazole in combination with compounds of natural and pharmaceutical origin: A study on their antimicrobial activity against Candida auris","authors":"Iñigo de-la-Fuente , Andrea Guridi , Guillermo Quindós , Elena Eraso , Elena Sevillano","doi":"10.1016/j.riam.2025.05.001","DOIUrl":"10.1016/j.riam.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Candidiasis is a prevalent and clinically significant fungal infection. <em>Candida auris</em> has emerged as an important etiological agent due to its high transmissibility, potential to cause severe infections, and resistance to multiple antifungal drugs. Combining fluconazole with other compounds to achieve additive or synergistic antifungal effects has been proposed as a promising strategy for managing these infections.</div></div><div><h3>Aims</h3><div>This study aimed to evaluate the antifungal effects of fluconazole in combination with seven natural compounds (berberine chloride, caffeic acid phenethyl ester, catechin monohydrate, epigallocatechin gallate, magnolol, osthole, and quercetin hydrate) and seven drugs (amiodarone, amlodipine, budesonide, doxycycline, ibuprofen, minocycline, and tigecycline) against <em>C. auris</em>.</div></div><div><h3>Methods</h3><div>The antifungal activity of fluconazole alone and in combination with selected compounds and drugs was analyzed to identify additive or synergistic interactions against 21 isolates of <em>C. auris</em>. Minimum inhibitory concentrations (MICs) of fluconazole were determined and compared across combinations.</div></div><div><h3>Results</h3><div>Fluconazole combined with magnolol, caffeic acid phenethyl ester, or quercetin hydrate showed additive effects against 38%, 9.5%, and 2% of isolates, respectively, and a synergistic effect with quercetin hydrate in 19% of isolates. Fluconazole MICs were reduced from >64μg/mL to 1–16μg/mL with magnolol in 19 isolates, to 1–32μg/mL with caffeic acid phenethyl ester in 17 isolates, and to 1–2μg/mL with quercetin hydrate in 8 isolates.</div></div><div><h3>Conclusions</h3><div>These findings highlight the potential of fluconazole combined with magnolol, caffeic acid phenethyl ester, or quercetin hydrate for managing <em>C. auris</em> infections. Further in vivo studies are warranted to assess their therapeutic applicability.</div></div>","PeriodicalId":21291,"journal":{"name":"Revista Iberoamericana De Micologia","volume":"42 2","pages":"Pages 74-80"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative analysis of the nephrotoxicity of liposomal amphotericin B and amphotericin B lipid complex in hematological cancer patients: A multicenter retrospective study 两性霉素B脂质体和两性霉素B脂质复合物对血液病患者肾毒性的比较分析：一项多中心回顾性研究。

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 Epub Date: 2025-06-02 DOI: 10.1016/j.riam.2025.04.003

Susanne Edinger , Edson Abdala , Umran Şumeyse Ertürk , Serhat Çelik , Leylagül Kaynar , Ricardo Rabagliati , Hamid Badali , Ali Amanati , Alexis Manuel Holguin Ruiz , Joseph Meletiadis , Maria Stamouli , Jessica Fernandes Ramos , Alexandre Vargas Schwarzbold , Juan Pablo Caeiro , Guillermo N. Giordano , Maria N. Gamaletsou , Leonardo Filipetto Ferrari , Joao Paulo Telles , Felipe Francisco Tuon , Luiz Cesar Guarita-Souza

Background

The incidence rates of acute kidney injury (AKI) associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB) are inconsistent across studies.

Aims

This study aimed to assess the AKI incidence rates in the largest cohort of patients undergoing ABLC and L-AMB treatment for invasive fungal diseases (IFD) in individuals with hematological cancers.

Methods

This was a multicenter, international, retrospective cohort study involving patients treated with either L-AMB or ABLC for IFD. All patients had a diagnosed malignant hematological disease. Various clinical and epidemiological variables were examined, including the concurrent use of nephrotoxic drugs. The primary outcome was the incidence of AKI.

Results

A total of 637 patients were included in the study, with 294 patients in the ABLC group and 343 patients in the L-AMB group. The most common diagnosis was acute leukemia (56%), followed by lymphoma (22%). The predominant classification of IFD was probable (43%). ABLC was associated with an increased likelihood of inducing grade 1 and 2 nephrotoxicity compared to L-AMB (p < 0.001). Multivariate analysis identified age, vancomycin, and polymyxin use as independent risk factors for AKI. However, serum creatinine levels returned to baseline in 95.3% of patients.

Conclusion

Nephrotoxicity associated with L-AMB was lower than that associated with ABLC in patients with hematological cancer. Most AKI cases were mild to moderate and did not have significant short-term impact.

背景：与两性霉素B脂质复合物（ABLC）和两性霉素B脂质体（L-AMB）相关的急性肾损伤（AKI）发生率在研究中不一致。目的：本研究旨在评估血液病患者中接受ABLC和L-AMB治疗侵袭性真菌病（IFD）的最大队列患者的AKI发病率。方法：这是一项多中心、国际、回顾性队列研究，涉及使用L-AMB或ABLC治疗IFD的患者。所有患者均确诊为恶性血液病。检查了各种临床和流行病学变量，包括同时使用肾毒性药物。主要终点是AKI的发生率。结果：共纳入637例患者，其中ABLC组294例，L-AMB组343例。最常见的诊断是急性白血病（56%），其次是淋巴瘤（22%）。IFD的主要分类是可能的（43%）。与L-AMB相比，ABLC与诱导1级和2级肾毒性的可能性增加相关(结论：血液癌患者与L-AMB相关的肾毒性低于与ABLC相关的肾毒性。大多数AKI病例为轻度至中度，没有显著的短期影响。

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引用次数: 0

From 2012 ESCMID to global 2025 ECMM/ISHAM/ASM Candida guidelines: What are the key differences & practical implications? 从2012年ESCMID到2025年ECMM/ISHAM/ASM假丝达指南：主要差异和实际意义是什么？

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 Epub Date: 2025-06-20 DOI: 10.1016/j.riam.2025.05.002

Cornelia Lass-Flörl

The unity of the global 2025 ECMM/ISHAM/ASM Candida guideline (global Candida 2025 guideline) means a practitioner can find all important topics in one document, whereas in 2012 one had to consult multiple papers for each subgroup. The global Candida 2025 guideline retains echinocandins as the first-line treatment for invasive candidiasis while incorporating new agents – such as rezafungin for once-weekly dosing and novel oral options for resistant infections – to offer more personalized, susceptibility-guided therapy. They also recommend an earlier intravenous-to-oral step-down in stable non-neutropenic patients, and emphasize the need for prompt source control. Additionally, there is a stronger focus on managing emerging resistance (notably with Candida auris and azole-resistant Candida parapsilosis) and tailoring prophylaxis and treatment strategies to local epidemiology and special patient populations. It provides detailed, evidence-graded recommendations using the GRADE system, with explicit sections on emerging pathogens, resistance, antifungal stewardship, and infection control. The global Candida 2025 guideline incorporates broader public health considerations and guidance on resource-limited settings.

全球2025 ECMM/ISHAM/ASM念珠菌指南（全球念珠菌2025指南）的统一意味着从业者可以在一份文件中找到所有重要的主题，而在2012年，人们必须为每个子组查阅多篇论文。全球念珠菌2025指南保留了刺珠菌素作为侵袭性念珠菌病的一线治疗方法，同时纳入了新的药物——例如每周一次给药的rezafungin和治疗耐药感染的新型口服药物——以提供更加个性化的、以药物敏感性为导向的治疗。他们还建议在稳定的非中性粒细胞减少症患者中早期静脉到口服降压，并强调需要及时进行源头控制。此外，还更加注重管理新出现的耐药性（特别是耳念珠菌和耐唑假丝菌病），并根据当地流行病学和特殊患者群体制定预防和治疗策略。它使用GRADE系统提供了详细的证据分级建议，并明确介绍了新出现的病原体、耐药性、抗真菌管理和感染控制。《念珠菌2025》全球指南纳入了更广泛的公共卫生考虑和对资源有限环境的指导。

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引用次数: 0

Shift in Candida species causing candidemia: A seven-year study from a university hospital and evaluation of the rise of Candida parapsilosis sensu stricto 引起念珠菌病的念珠菌种类的转移：一项来自大学医院的7年研究和对严格意义上的假丝菌病兴起的评估。

IF 1.6 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-04-01 Epub Date: 2025-06-04 DOI: 10.1016/j.riam.2025.04.004

Elif Seren Tanriverdi, Yusuf Yakupogullari , Yucel Duman , Mehmet Sait Tekerekoglu , Baris Otlu

Background

Candidemia ranks the fourth most prevalent infection in healthcare settings. Notably, non-Candida albicans Candida species, particularly Candida parapsilosis, have experienced a worldwide increase as causative agents of candidemia in recent years.

Aims

This study aimed to assess shifts in prevalence and antifungal susceptibility of C. parapsilosis among candidemia-causing species over time, alongside investigating clonal relationships among isolates.

Methods

We analyzed Candida species in candidemia episodes from January 2016 to December 2022. MALDI-TOF MS identified Candida isolates at the species level, and the identification of the species within C. parapsilosis complex was achieved via the restriction fragment length polymorphism method. Fluconazole susceptibility testing followed EUCAST guidelines. Clonal relationships among C. parapsilosis isolates were assessed using three methods: AP-PCR, REA-PFGE, and electrophoretic karyotyping.

Results

Across a seven-year period, Candida prevalence among all blood cultures was 2.1% (679 cases). The most prevalent Candida species were C. parapsilosis (33.7%), C. albicans (32.7%), Nakaseomyces glabratus (formerly Candida glabrata) (14.4%), and Candida tropicalis (8%). Notably, C. parapsilosis isolation rates increased annually from 2016 to 2022. Fluconazole susceptibility of C. parapsilosis isolates declined over time, with rates decreasing from 100% in 2016 to 72.6% in 2022. Electrophoretic karyotyping exhibited superior discrimination in clonal relationship analysis (D = 0.9875).

Conclusions

Our findings highlight a concerning trend of increasing fluconazole resistance in C. parapsilosis sensu stricto over the study period. Electrophoretic karyotyping has emerged as a robust method for assessing clonal relationships. While no dominant outbreak isolate was identified, the high clustering rate suggests the potential of C. parapsilosis as a significant nosocomial infection agent in the future.

背景：念珠菌是卫生保健机构中第四大流行感染。值得注意的是，非白色念珠菌和念珠菌种类，特别是假丝酵母菌，近年来在世界范围内作为念珠菌的病原体有所增加。目的：本研究旨在评估假丝酵母菌引起的假丝酵母菌的患病率和抗真菌敏感性随时间的变化，同时调查分离株之间的克隆关系。方法：对2016年1月至2022年12月期间发生的念珠菌发作病例进行菌种分析。MALDI-TOF MS在种水平上对念珠菌分离物进行鉴定，并通过限制性片段长度多态性方法对C. parapsilosis复合体内的种进行鉴定。氟康唑药敏试验遵循EUCAST指南。采用AP-PCR、REA-PFGE和电泳核型分析三种方法，对拟裂菇分离株间的克隆关系进行了评价。结果：在7年的时间里，所有血培养中念珠菌的患病率为2.1%（679例）。最常见的念珠菌种为假丝酵母菌（33.7%）、白色念珠菌（32.7%）、光秃中丝酵母菌（14.4%）和热带假丝酵母菌（8%）。值得注意的是，从2016年到2022年，parapsilosis的分离率逐年上升。随着时间的推移，假僵菌对氟康唑的敏感性逐渐下降，从2016年的100%下降到2022年的72.6%。电泳核型在克隆亲缘分析中表现出较强的差异性（D=0.9875）。结论：我们的研究结果表明，在研究期间，严格意义上的假蝇对氟康唑的耐药性呈上升趋势。电泳核型已成为一种评估克隆关系的可靠方法。虽然没有发现显性暴发分离物，但高聚类率表明，在未来，副吸虫病有可能成为一种重要的医院感染因子。

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引用次数: 0

Real-life experience on the use of isavuconazole in solid organ transplantation 异戊康唑在实体器官移植中的应用体会。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 Epub Date: 2025-04-04 DOI: 10.1016/j.riam.2025.02.004

Jose Tiago Silva , Amparo Solé , José María Aguado

Solid organ transplant (SOT) recipients have a higher risk of developing invasive fungal infection (IFI). Isavuconazole is a novel broad-spectrum azole active against Aspergillus and Mucor. Isavuconazole is well tolerated, shows an excellent bioavailability and predictable pharmacokinetics, good diffusion to tissues, significantly reduced drug–drug interactions with immunosuppressive drugs in comparison with other broad-spectrum azoles, and few serious adverse effects, including hepatic toxicity. We have performed an extensive literature review concerning the clinical experience on the use of isavuconazole in SOT as prophylaxis and treatment of IFI, which included the SOTIS and the ISASOT studies, and fourteen published case reports. Clinical response, all-cause and invasive aspergillosis-attributable mortality in recipients treated with isavuconazole were similar to those described with voriconazole. Drug–drug interactions with immunosuppressive agents were manageable after the adjustment of tacrolimus and mTOR inhibitors. Isavuconazole showed fewer drug-related side effects and a smaller rate of premature discontinuation than voriconazole. In conclusion, isavuconazole appears to be a reasonable option for the treatment of IFI in SOT, and can be an alternative to voriconazole as antifungal prophylaxis in lung transplantation. Nonetheless, more clinical studies are needed.

实体器官移植（SOT）受者发生侵袭性真菌感染（IFI）的风险较高。异唑康唑是一种具有抗曲霉和毛霉菌活性的新型广谱唑类药物。Isavuconazole耐受性良好，具有良好的生物利用度和可预测的药代动力学，良好的组织扩散，与其他广谱唑类药物相比，与免疫抑制药物的药物相互作用显著减少，并且几乎没有严重的副作用，包括肝毒性。我们对isavuconazole在SOT中预防和治疗IFI的临床经验进行了广泛的文献回顾，其中包括SOTIS和ISASOT研究，以及14份已发表的病例报告。依唑康唑治疗的患者的临床反应、全因死亡率和侵袭性曲霉菌病死亡率与伏立康唑治疗的患者相似。调整他克莫司和mTOR抑制剂后，药物与免疫抑制剂的相互作用是可控的。与伏立康唑相比，依舒康唑的药物相关副作用较少，过早停药率也较低。综上所述，isavuconazole似乎是治疗SOT中IFI的合理选择，并且可以替代voriconazole作为肺移植中的抗真菌预防药物。尽管如此，还需要更多的临床研究。

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引用次数: 0

Real-world use of isavuconazole in adult oncohematology patients isavuconazole在成人血液病患者中的实际应用。

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 Epub Date: 2025-03-19 DOI: 10.1016/j.riam.2025.02.001

Mi Kwon

Isavuconazole has emerged as a significant antifungal agent in the treatment and prophylaxis of invasive fungal infections (IFIs) among immunocompromised patients, particularly those undergoing hematopoietic stem cell transplantation (HSCT) or receiving treatment for hematological malignancies. Real-world experience with the use of isavuconazole in oncohematological patients has increasingly been reported. Isavuconazole has demonstrated efficacy against a broad spectrum of fungal pathogens, with a favorable safety profile and lower rates of hepatotoxicity compared to other azoles. Isavuconazole is generally well-tolerated, making it suitable for long-term use in high-risk patients for both treatment and prophylaxis of IFIs. Isavuconazole can be considered a valuable treatment option for IFIs in patients with hematological malignancies and HSCT recipients. It may be a suitable alternative to other azoles, especially in patients with underlying liver dysfunction or those experiencing the effects of multiple drug interactions. Nevertheless, further research is needed to evaluate the long-term safety and efficacy of isavuconazole, particularly in specific patient populations and in combination with other antifungal agents. Overall, isavuconazole represents a promising addition to the antifungal armamentarium, offering a safer and more effective treatment option for patients at high risk of IFIs.

Isavuconazole已成为一种重要的抗真菌药物，用于治疗和预防免疫功能低下患者的侵袭性真菌感染（IFIs），特别是那些接受造血干细胞移植（HSCT）或接受血液恶性肿瘤治疗的患者。在血液病患者中使用异戊康唑的实际经验越来越多地被报道。与其他唑类药物相比，Isavuconazole具有良好的安全性和较低的肝毒性。Isavuconazole通常耐受性良好，因此适合高风险患者长期使用，用于治疗和预防ifi。Isavuconazole可以被认为是血液恶性肿瘤和造血干细胞移植患者ifi的有价值的治疗选择。它可能是其他唑类药物的合适替代品，特别是在有潜在肝功能障碍或经历多种药物相互作用的患者中。然而，需要进一步的研究来评估isavuconazole的长期安全性和有效性，特别是在特定患者群体和与其他抗真菌药物联合使用时。总体而言，isavuconazole是抗真菌药物的一个有希望的补充，为ifi高风险患者提供了更安全、更有效的治疗选择。

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引用次数: 0

Diagnosing invasive fungal infections in the laboratory today: It's all good news? 今天在实验室诊断侵袭性真菌感染：这都是好消息吗？

IF 1.5 4区生物学 Q4 MYCOLOGY

Revista Iberoamericana De Micologia

Pub Date : 2025-01-01 Epub Date: 2025-03-19 DOI: 10.1016/j.riam.2025.01.004

Javier Pemán , Alba Ruiz-Gaitán

Despite the advances in medical science, invasive fungal infections (IFI) remain a diagnostic challenge. The increasing prevalence of IFI, driven by immunosuppressive therapies, advances in intensive care and emerging pathogens, underscores the need for early and accurate diagnosis. This review evaluates current laboratory methods for the diagnosis of IFI, highlighting their strengths and limitations.

Conventional techniques, including fungal culture, direct microscopy, and histopathology, remain the gold standard for the diagnosis of proven IFIs. These methods allow pathogen isolation, species identification and antifungal susceptibility testing. However, these techniques have limitations in terms of sensitivity and turnaround times. Although microscopy is a rapid technique, its sensitivity and species discrimination profile are limited.

Modern serological assays, such as β-d-glucan and galactomannan detection, have improved the diagnostic accuracy of probable IFI cases. Integration of these assays with clinical and radiological findings, enables earlier intervention, although this is accompanied by an increased risk of false positives and necessitates careful clinical correlation. Molecular diagnostics, particularly polymerase chain reaction (PCR), allow rapid, species-specific identification directly from clinical samples. The advent of MALDI-TOF mass spectrometry has further improved diagnostic efficiency, particularly for yeast identification, although challenges remain for filamentous fungi.

Innovative techniques, such as metagenomic sequencing, lateral-flow assays, and loop-mediated isothermal amplification, offer the potential for rapid and precise detection, even in resource-limited settings. The combination of conventional and innovative methods provides a comprehensive diagnostic framework. The continuous refinement of these tools, in conjunction with multidisciplinary collaboration, is imperative to improve the early diagnostic and targeted treatment of patients with IFI.

尽管医学进步，侵袭性真菌感染（IFI）仍然是一个诊断挑战。免疫抑制疗法、重症监护技术的进步和新出现的病原体推动了IFI患病率的上升，这凸显了早期准确诊断的必要性。这篇综述评估了目前诊断IFI的实验室方法，强调了它们的优势和局限性。传统技术，包括真菌培养、直接显微镜和组织病理学，仍然是确诊ifi的金标准。这些方法允许病原分离、物种鉴定和抗真菌药敏试验。然而，这些技术在灵敏度和周转时间方面有局限性。虽然显微镜是一种快速的技术，但它的灵敏度和物种识别谱是有限的。现代血清学检测，如β-d-葡聚糖和半乳甘露聚糖检测，提高了可能的IFI病例的诊断准确性。将这些检测与临床和放射学结果相结合，可以进行早期干预，尽管这伴随着假阳性的风险增加，需要仔细的临床相关性。分子诊断，特别是聚合酶链反应（PCR），允许直接从临床样品中快速、物种特异性鉴定。MALDI-TOF质谱法的出现进一步提高了诊断效率，特别是在酵母鉴定方面，尽管丝状真菌仍然存在挑战。创新技术，如宏基因组测序、横向流动测定和环介导等温扩增，即使在资源有限的情况下，也有可能实现快速、精确的检测。传统和创新方法的结合提供了一个全面的诊断框架。结合多学科合作，不断完善这些工具对于改善IFI患者的早期诊断和靶向治疗至关重要。

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引用次数: 0