台湾新出现的曲霉菌感染:临床和环境监测。

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-08-29 eCollection Date: 2024-08-01 DOI:10.1093/jacamr/dlae138
Pao-Yu Chen, Chien-Ming Chao, Chwan-Yau Luo, Yau-Lin Tseng, Po-Lin Chen, Jun-Neng Roan, Wei-Lun Liu, Chien Chu, Chi-Jung Wu, Hsuan-Chen Wang, Ming-I Hsieh, Pui-Ching Choi, Yee-Chun Chen
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引用次数: 0

摘要

研究目的本研究旨在调查台湾曲霉临床和环境分离株的流行率和特征:方法:筛选了从台湾三家医院的病人和 530 份土壤样本中分离出的曲霉菌。对经钙调素测序确认的齿曲霉进行抗真菌药敏试验和 cyp51A 分析。分析了土壤样本中的 25 种唑类杀真菌剂的残留量:结果:从 601 株 Fumigati 曲霉临床分离株中鉴定出 9 株 A. lentulus 分离株,其中 7 株(1.2%,7/601)来自 3 位抗真菌无效的患者;从 659 株土壤曲霉分离株中鉴定出 2 株(0.3%,2/659)。所有分离株都长出白色菌落,在 48°C 温度下无法生长。它们对阿尼芬灵敏感,但对两性霉素 B(AmB)、伏立康唑和唑类杀菌剂的敏感性降低。一名已证实患有侵袭性肺曲霉菌病(IPA)的心脏移植受者最初对伏立康唑单一疗法的反应不佳,但在接受了伏立康唑-卡泊芬净、脂质体AmB(LAmB)-卡泊芬净联合疗法以及手术治疗后,又接受了伏立康唑维持疗法,最终治愈了该患者。在两名疑似 IPA 的重症患者中,一名患者在使用米卡芬净后存活了下来,而另一名患者在连续使用异武唑和 LAmB 单药治疗后死于曲霉菌病。临床和环境分离物具有相同的 Cyp51A 序列,与 A. lentulus NIID0096 的 Cyp51A 序列相匹配。在一份土壤样本中检测到氟硅唑(0.0009 mg/kg):这项研究引起了人们对源于自然环境的人类致病性齿孔菌所造成的健康威胁的关注,并强调了提高临床和实验室对齿孔菌感染警惕的必要性。
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Emerging Aspergillus lentulus infections in Taiwan: clinical and environmental surveillance.

Objectives: This study aimed to investigate the prevalence and characteristics of Aspergillus lentulus clinical and environmental isolates in Taiwan.

Methods: Aspergillus isolates obtained from patients at three hospitals and from 530 soil samples across Taiwan were screened. A. lentulus, confirmed by calmodulin sequencing, was subjected to antifungal susceptibility testing and cyp51A analyses. Soil samples yielding A. lentulus were analysed for residues of 25 azole fungicides.

Results: Nine A. lentulus isolates were identified, which included seven (1.2%, 7/601) isolates from three antifungal-naïve patients out of 601 Aspergillus section Fumigati clinical isolates and two (0.3%, 2/659) isolates out of 659 Aspergillus soil isolates. All isolates developed white colonies and failed to grow at 48°C. They were susceptible to anidulafungin but showed reduced susceptibility to amphotericin B (AmB), voriconazole and azole fungicides. One heart transplant recipient with proven invasive pulmonary aspergillosis (IPA) initially showed suboptimal response to voriconazole monotherapy but was cured with a combination of voriconazole-caspofungin, liposomal AmB (LAmB)-caspofungin, along with surgery, followed by voriconazole maintenance therapy. Among two critically ill patients with probable IPA, one survived with micafungin, while the other died of aspergillosis despite sequential isavuconazole and LAmB monotherapy. Clinical and environmental isolates sharing identical Cyp51A sequence are identified, matching the Cyp51A sequence of A. lentulus NIID0096. Flusilazole (0.0009 mg/kg) was detected in one soil sample.

Conclusions: This study raises concerns about health threat posed by human pathogenic A. lentulus originating from natural environments and underscores the need for increased clinical and laboratory vigilance regarding A. lentulus infections.

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