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Liu R, Xing Y, Shen J. Establishment and methodological evaluation of a rapid detection method for Cryptococcus neoformans and Cryptococcus gattii species complexes based on CRISPR-Cas12a technology. J Microbiol Methods 2024; 225:107026. [PMID: 39182694 DOI: 10.1016/j.mimet.2024.107026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE The opportunistic pathogens causing Cryptococcal meningitis are Cryptococcus neoformans and Cryptococcus gattii species complexes. At present, clinical detection methods for this condition include culture, ink staining, and cryptococcal antigen detection. In addition, enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR), and real-time quantitative PCR (qPCR) can be applied for the detection of Cryptococcus. Nevertheless, these methods cannot achieve point-of-care detection (POCT); thus, there is a pressing need to establish a fast, sensitive, and effective detection method. METHODS Recombinase polymerase amplification (RPA) and clustered regularly spaced short palindromic repeat (CRISPR) techniques are effective tools for achieving rapid POCT. In this study, RPA was combined with CRISPR-Cas12a to establish a fast, sensitive, and specific detection method for cryptococcal meningitis. RESULTS This study included RPA-Cas12a fluorescence detection and RPA-Cas12a immunochromatographic detection, which can be performed within 50 min. Moreover, the detection limit was as low as 102 copies/μL. Interestingly, the developed method demonstrated satisfactory specificity and no cross-reactivity with other fungi and bacteria. 36 clinical samples were tested, and the consistency between the test results and those obtained using the commonly used clinical culture method was 100 %. CONCLUSION In this study, a rapid detection method for Cryptococcus neoformans and Cryptococcus gattii species complexes was developed based on CRISPR-Cas12a technology, characterized by its high sensitivity and specificity, ease of use, and cost-effectiveness, making it suitable for on-site detection.
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Affiliation(s)
- Runde Liu
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China; Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Yuqing Xing
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China; Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Jilu Shen
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China; Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China.
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2
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Hoffmann LC, Reinholz M, French LE, Sárdy M, Wollenberg A, Kerschnitzki A, Horváth ON. Epidemiological overview of mucocutaneous fungal infections in Munich. J Dtsch Dermatol Ges 2024; 22:1371-1381. [PMID: 39097945 DOI: 10.1111/ddg.15484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/07/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Knowledge about the current spectrum of dermatomycoses is important for diagnosis and therapy. PATIENTS AND METHODS A retrospective, monocentric analysis of mucocutaneous fungal infections diagnosed at a large European academic dermatology department in Munich was conducted; 87,229 samples from 48,916 patients from January 1, 2011, to August 30, 2020, were included. RESULTS Fungi were detected in 11,513 samples from 48,916 (23.54%), and 36 different species were identified. Candida (C.) albicans was the most common pathogen (5,055 detections; 43.91% of all positive samples), followed by Trichophyton (T.) rubrum (3,076 detections; 26.72% of all positive samples) and Candida parapsilosis (923 detections; 8.02% of all positive samples). Rare pathogens such as Trichophyton raubitschekii were also detected. Coinfections with multiple species were detected in 44 cases. CONCLUSIONS Even though C. albicans, T. rubrum, and C. parapsilosis were confirmed as the most common pathogens, rare pathogens should also be considered in clinical practice. The predominant spectrum of fungi differed from that reported in other countries. Furthermore, a difference in the pathogen spectrum could be observed depending on the age group and body site.
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Affiliation(s)
- Liv C Hoffmann
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
| | - Markus Reinholz
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Miklós Sárdy
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
- Department of Dermatology and Allergy, University Hospital Augsburg (UKA), Augsburg, Germany
| | | | - Orsolya N Horváth
- Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
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Dai C, Bai D, Lin C, Li KY, Zhu W, Lin J, Lu F, Chen Q, Luo W, Zhu B, Lin Y. The relationship between lung CT features and serum cryptococcal antigen titers in localized pulmonary cryptococcosis patients. BMC Pulm Med 2024; 24:441. [PMID: 39251951 PMCID: PMC11386080 DOI: 10.1186/s12890-024-03259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 08/30/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND To explore the associations of computed tomography (CT) image features with the serum cryptococcal antigen (CrAg) titers measured by the lateral flow assay (LFA) in localized pulmonary cryptococcosis patients. METHODS A retrospective analysis of patients with pathologically confirmed pulmonary cryptococcosis admitted to the First Affiliated Hospital of Xiamen University from January 2016 to December 2022 was performed. Clinical data, CT results, serum CrAg-LFA test results, and follow-up data were collected and analyzed. RESULTS A total of 107 patients with localized pulmonary cryptococcosis were included, of which 31 had a single lesion in chest CT and the other 76 had multiple lesions. The positivity rate was (94.74% vs 64.52%) and titers of serum CrAg-LFA (1.77 ± 0.87 vs 0.91 ± 0.98) in the multiple lesion group were higher than those in the single lesion group, respectively. Multivariate linear regression analysis showed that the serum CrAg titers were positively associated with the number of lesions (β, 0.08; 95% CI, 0.05 to 0.12) and the lesion size (β, 0.40; 95% CI, 0.31 to 0.50) after adjusting other covariates. The serum CrAg-LFA titers of 60 pulmonary cryptococcosis patients showed a decreasing trend with the reduction in pulmonary lesion size after effective therapy. CONCLUSION In pulmonary cryptococcosis patients, the number and size of lung lesions are positively correlated with the titers of the serum CrAg-LFA test. The CrAg-LFA test could be a useful tool for the diagnosis, severity assessment, and therapeutic monitoring of localized pulmonary cryptococcosis patients.
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Affiliation(s)
- Chunmei Dai
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China
- Clinical Medicine Department of Fujian Medical University, Fujian, China
| | - Dongyu Bai
- Department of Pathology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Chunbei Lin
- Department of Internal Medicine, the First Hospital of Zhangzhou China Merchants Economic and Technological Development Zone, Zhangzhou, Fujian, China
- Department of Internal Medicine, Zhangzhou Development Zone Branch of the First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ke-Yi Li
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China
| | - Wenliang Zhu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China
| | - Juan Lin
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China
- Clinical Medicine Department of Fujian Medical University, Fujian, China
| | - Fang Lu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China
- Clinical Medicine Department of Fujian Medical University, Fujian, China
| | - Qiujuan Chen
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China
- Clinical Medicine Department of Fujian Medical University, Fujian, China
| | - Wen Luo
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China
- Clinical Medicine Department of Fujian Medical University, Fujian, China
| | - Bo Zhu
- Xiamen Key Laboratory of Genetic Testing, Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Xiamen, 361003, China.
| | - Yihua Lin
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China.
- Clinical Medicine Department of Fujian Medical University, Fujian, China.
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Zhang R, Song Z, Su X, Li T, Xu J, He X, Yang Y, Chang B, Kang Y. Molecular epidemiology and antifungal susceptibility of dermatophytes and Candida isolates in superficial fungal infections at a grade A tertiary hospital in Northern China. Med Mycol 2024; 62:myae087. [PMID: 39174486 DOI: 10.1093/mmy/myae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 08/24/2024] Open
Abstract
This study analyzed the prevalence and antifungal susceptibility of superficial fungal infections in 295 cases from 2019 to 2020 at a dermatology clinic. Dermatophytes were the predominant pathogens (69.5%), including Trichophytonrubrum, T. interdigitale, Microsporum canis, et al., followed by Candida spp. (29.5%), including Candidaalbicans, Ca. parapsilosis, and Ca. glabrata. The most common infections were onychomycosis (36.3%), tinea cruris (30.5%), and tinea corporis (18.6%). The distribution of SFI types showed variations based on gender, age, and season. Common antifungal agents, including terbinafine, voriconazole, ciclopiroxamine, amphotericin B, itraconazole, and ketoconazole have exhibited low minimum inhibitory concentrations against dermatophytes, especially terbinafine, which has been potent against superficial fungal infections caused by dermatophytes in the local area. Candida spp. strains were generally susceptible or classified as wild-type to 5-flucytosine and amphotericin B, with 92.0% being wild-type for itraconazole. However, resistance to fluconazole and voriconazole was observed in a small percentage of Ca. albicans and Ca. parapsilosis strains. The emergence of drug-resistant Candida underscores the importance of prudent antifungal use and continuous surveillance.
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Affiliation(s)
- Ruijun Zhang
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ziping Song
- Department of Dermatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Xiaorui Su
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ting Li
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Juan Xu
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Xiao He
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yuanwen Yang
- Department of Dermatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Bingmei Chang
- Department of Biochemistry and Molecular Biology, Shanxi Medical University, Taiyuan 030000, China
| | - Yuying Kang
- Department of Dermatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences Tongji Shanxi Hospital, Taiyuan 030032, China
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Wang L, He Z, Guo Y, Ran X, Cheng Y, He Z. A novel quantitative double antigen sandwich ELISA for detecting total antibodies against Candida albicans enolase 1. Eur J Clin Microbiol Infect Dis 2024; 43:1815-1823. [PMID: 39012550 DOI: 10.1007/s10096-024-04899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE This study aimed to develop a double antigen sandwich ELISA (DAgS-ELISA) method for more efficient, accurate, and quantitative detection of total antibodies against Candida albicans enolase1 (CaEno1) for diagnosing invasive candidiasis (IC). METHODS DAgS-ELISA was developed using recombinant CaEno1 and a monoclonal antibody as the standard. Performance evaluation included limit of detection, accuracy, and repeatability. Dynamic changes in antibody levels against CaEno1 in serum from systemic candidiasis mice were analyzed using DAgS-ELISA. Patient serum samples from IC, Candida colonization, bacterial infections, and healthy controls were analyzed with DAgS-ELISA and indirect ELISA. RESULTS DAgS-ELISA outperformed indirect ELISA in terms of linear range and test background. In systemic candidiasis mice, a distinctive 'double-peak' pattern in dynamic antibody levels was observed. Additionally, there was a high level of consistency in the positive rates of CaEno1 antibodies detected by both DAgS-ELISA and indirect ELISA. While the positivity rates differed among patient groups, no significant variations in antibody levels were detected among the various positive patient groups. CONCLUSIONS DAgS-ELISA offers a reliable novel approach for IC diagnosis, enabling rapid, accurate, and quantitative detection of CaEno1 antibodies. Further validation and optimization are needed for its clinical application and effectiveness.
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Affiliation(s)
- Lihui Wang
- Department of Nephrology, Bethune International Peace Hospital, No.398 West Zhongshan Road, Shijiazhuang, Hebei, 050082, P.R. China
| | - Zongzhong He
- Blood Transfusion, Southern Theater General Hospital, No.111 Liuhua Road, Guangzhou, 510180, P.R. China
| | - Yiyang Guo
- Laboratory Medicine, Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Shijiazhuang, Hebei, 050011, P.R. China
| | - Xiangyang Ran
- Laboratory Medicine, Bethune International Peace Hospital, No.398 West Zhongshan Road, Shijiazhuang, Hebei, 050082, P.R. China
| | - Yan Cheng
- Basic Medicine Laboratory, Bethune International Peace Hospital, No.398 West Zhongshan Road, Shijiazhuang, Hebei, 050082, P.R. China
| | - Zhengxin He
- Basic Medicine Laboratory, Bethune International Peace Hospital, No.398 West Zhongshan Road, Shijiazhuang, Hebei, 050082, P.R. China.
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Zhang WF, Zhao XY, Chen H, Meng LH, Chen YX. Endogenous Endophthalmitis at a Tertiary Referral Center in China: A Retrospective Study Over Three Decades. Ocul Immunol Inflamm 2024; 32:803-812. [PMID: 37094073 DOI: 10.1080/09273948.2023.2198001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/19/2023] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To investigate the etiology, pathogens, treatment, and prognosis of endogenous endophthalmitis (EE). METHODS Patients diagnosed with EE over three decades at Peking Union Medical College Hospital were retrospectively reviewed and analyzed. RESULTS A total of 97 eyes from 81 patients were included. Diabetes was the most common predisposing medical condition (34.6%). Klebsiella pneumoniae (31.3%) and Candida albicans (32.8%) were the most common pathogens. Liver abscess (20.6%) was the predominant cause EE due to liver abscess had a worse initial visual acuity (P < 0.05). Patients who initially underwent pars plana vitrectomy (PPV)+silicone oil tamponade underwent fewer total treatments (P < 0.05). In the past 10 years, the proportion of Gram-positive cocci, Gram-negative bacilli, and Candida showed an upward trend. Over the past 15 years, EE after liver abscess and immunosuppression has increased, while EE from genitourinary systems has decreased. CONCLUSION EE was a devastating intraocular disease with a poor visual prognosis. The initial condition and prognosis of EE after liver abscess were the worst. PPV+silicone oil tamponade as an initial treatment may reduce additional therapy.
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Affiliation(s)
- Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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7
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Elalouf A, Maoz H, Rosenfeld AY. Bioinformatics-Driven mRNA-Based Vaccine Design for Controlling Tinea Cruris Induced by Trichophyton rubrum. Pharmaceutics 2024; 16:983. [PMID: 39204328 PMCID: PMC11357599 DOI: 10.3390/pharmaceutics16080983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Tinea cruris, a dermatophyte fungal infection predominantly caused by Trichophyton rubrum and Epidermophyton floccosum, primarily affects the groin, pubic region, and adjacent thigh. Its recurrence is frequent, attributable to repeated fungal infections in susceptible individuals, especially those with onychomycosis or tinea pedis, which act as reservoirs for dermatophytes. Given the persistent nature of tinea cruris, vaccination emerges as a promising strategy for fungal infection management, offering targeted, durable protection against various fungal species. Vaccines stimulate both humoral and cell-mediated immunity and are administered prophylactically to prevent infections while minimizing the risk of antifungal resistance development. Developing fungal vaccines is challenging due to the thick fungal cell wall, similarities between fungal and human cells, antigenic variation, and evolutionary resemblance to animals, complicating non-toxic target identification and T-cell response variability. No prior research has shown an mRNA vaccine for T. rubrum. Hence, this study proposes a novel mRNA-based vaccine for tinea cruris, potentially offering long-term immunity and reducing reliance on antifungal medications. This study explores the complete proteome of T. rubrum, identifying potential protein candidates for vaccine development through reverse vaccinology. Immunogenic epitopes from these candidates were mapped and integrated into multitope vaccines and reverse translated to construct mRNA vaccines. Then, the mRNA was translated and computationally assessed for physicochemical, chemical, and immunological attributes. Notably, 1,3-beta-glucanosyltransferase, CFEM domain-containing protein, cell wall galactomannoprotein, and LysM domain-containing protein emerged as promising vaccine targets. Antigenic, immunogenic, non-toxic, and non-allergenic cytotoxic T lymphocyte, helper T lymphocyte, and B lymphocyte epitopes were selected and linked with appropriate linkers and Toll-like receptor (TLR) agonist adjuvants to formulate vaccine candidates targeting T. rubrum. The protein-based vaccines underwent reverse translation to construct the mRNA vaccines, which, after inoculation, were translated again by host ribosomes to work as potential components for triggering the immune response. After that, molecular docking, normal mode analysis, and molecular dynamic simulation confirmed strong binding affinities and stable complexes between vaccines and TLR receptors. Furthermore, immune simulations of vaccines with and without adjuvant demonstrated activation of immune responses, evidenced by elevated levels of IgG1, IgG2, IgM antibodies, cytokines, and interleukins. There was no significant change in antibody production between vaccines with and without adjuvants, but adjuvants are crucial for activating the innate immune response via TLRs. Although mRNA vaccines hold promise against fungal infections, further research is essential to assess their safety and efficacy. Experimental validation is crucial for evaluating their immunogenicity, effectiveness, and safety.
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Affiliation(s)
- Amir Elalouf
- Department of Management, Bar-Ilan University, Ramat Gan 5290002, Israel; (H.M.); (A.Y.R.)
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Liao M, Xia X, Meng Q, Zhu C, Liao B, Wang J, Gou L, Zhou X, Yuan W, Cheng L, Ren B. Holotoxin A 1 from Apostichopus japonicus inhibited oropharyngeal and intra-abdominal candidiasis by inducing oxidative damage in Candida albicans. Br J Pharmacol 2024; 181:1857-1873. [PMID: 38382564 DOI: 10.1111/bph.16333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/26/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND PURPOSE The holotoxin A1, isolated from Apostichopus japonicus, exhibits potent antifungal activities, but the mechanism and efficacy against candidiasis are unclear. In this study we have studied the antifungal effects and mechanism of holotoxin A1 against Candida albicans and in murine oropharyngeal and intra-abdominal candidiasis. EXPERIMENTAL APPROACH The antifungal effect of holotoxin A1 against C. albicans was tested in vitro. To explore the antifungal mechanism of holotoxin A1, the transcriptome, ROS levels, and mitochondrial function of C. albicans was evaluated. Effectiveness and systematic toxicity of holotoxin A1 in vivo was assessed in the oropharyngeal and intra-abdominal candidiasis models in mice. KEY RESULTS Holotoxin A1 was a potent fungicide against C. albicans SC5314, clinical strains and drug-resistant strains. Holotoxin A1 inhibited oxidative phosphorylation and induced oxidative damage by increasing intracellular accumulation of ROS in C. albicans. Holotoxin A1 induced dysfunction of mitochondria by depolarizing the mitochondrial membrane potential and reducing the production of ATP. Holotoxin A1 directly inhibited the enzymatic activity of mitochondrial complex I and antagonized with the rotenone, an inhibitor of complex I, against C. albicans. Meanwhile, the complex I subunit NDH51 null mutants showed a decreased susceptibility to holotoxin A1. Furthermore, holotoxin A1 significantly reduced fungal burden and infections with no significant systemic toxicity in oropharyngeal and intra-abdominal candidiasis in murine models. CONCLUSION AND IMPLICATIONS Holotoxin A1 is a promising candidate for the development of novel antifungal agents against both oropharyngeal and intra-abdominal candidiasis, especially when caused by drug-resistant strains.
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Affiliation(s)
- Min Liao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuekui Xia
- Biology Institute, Key Laboratory of Bio-manufacturing of Shandong Province, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Qingzhou Meng
- Biology Institute, Key Laboratory of Bio-manufacturing of Shandong Province, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Chengguang Zhu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Binyou Liao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Jiannan Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Lichen Gou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wenpeng Yuan
- Biology Institute, Key Laboratory of Bio-manufacturing of Shandong Province, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
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Chen X, Lin S, Jin Q, Zhang L, Jiang W, Lu X, Wang G, Ge Y. Prevalence, Risk Factors, and Mortality of Invasive Pulmonary Aspergillosis in Patients with Anti-MDA5+ Dermatomyositis: A Retrospective Study in China. J Inflamm Res 2024; 17:3247-3257. [PMID: 38800596 PMCID: PMC11122320 DOI: 10.2147/jir.s460702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To investigate the prevalence, risk factors and prognosis of invasive pulmonary aspergillosis (IPA) in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM). Methods A retrospective analysis was conducted in anti-MDA5+ DM patients diagnosed between January 2016 and March 2023. Patients with lower respiratory tract specimens were categorized into IPA+ and IPA- groups based on the presence of IPA and their clinical characteristics and prognoses then compared. Results Of the 415 patients diagnosed with anti-MDA5+ DM, 28 cases had IPA (prevalence rate of 6.7%) with Aspergillus fumigatus being the most common species. The patients were categorized into IPA+ (n=28) and IPA- (n=98) groups, with no significant age or gender-related differences (P>0.05). The IPA+ group had a lower lymphocyte count, particularly the CD4+ T-cell count, and reduced serum albumin and higher serum ferritin levels (P all<0.05). An elevated bronchoalveolar lavage fluid (BALF) galactomannan level was found to be the sole independent risk factor for the occurrence of IPA (adjusted OR=2.191, P=0.029) with a cut-off value of 0.585 and area under the curve of 0.779. The mortality rate in the IPA+ group was 25%. Compared to survivors, non-survivors in this group exhibited a higher incidence of rapidly progressive interstitial lung disease, lower lymphocyte counts, and increased co-infection with Pneumocystis jirovecii (P all<0.05). Conclusion IPA was not rare in patients with anti-MDA5+ DM, with elevated BALF galactomannan levels being an independent risk factor for IPA occurrence. Clinicians must exercise vigilance to identify patients exhibiting the aforementioned risk factors.
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Affiliation(s)
- Xixia Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Sang Lin
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qiwen Jin
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Lu Zhang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Wei Jiang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Xin Lu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Yongpeng Ge
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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10
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Frota HF, Lorentino CMA, Barbosa PF, Ramos LS, Barcellos IC, Giovanini L, Souza LOP, Oliveira SSC, Abosede OO, Ogunlaja AS, Pereira MM, Branquinha MH, Santos ALS. Antifungal potential of the new copper(II)-theophylline/1,10-phenanthroline complex against drug-resistant Candida species. Biometals 2024; 37:321-336. [PMID: 37917351 DOI: 10.1007/s10534-023-00549-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023]
Abstract
Candida spp. are the commonest fungal pathogens worldwide. Antifungal resistance is a problem that has prompted the discovery of novel anti-Candida drugs. Herein, 25 compounds, some of them containing copper(II), cobalt(II) and manganese(II) ions, were initially evaluated for inhibiting the growth of reference strains of Candida albicans and Candida tropicalis. Eight (32%) of the compounds inhibited the proliferation of these yeasts, displaying minimum inhibitory concentrations (MICs) ranging from 31.25 to 250 μg/mL and minimum fungicidal concentration (MFCs) from 62.5 to 250 μg/mL. Drug-likeness/pharmacokinetic calculated by SwissADME indicated that the 8 selected compounds were suitable for use as topical drugs. The complex CTP, Cu(theo)2phen(H2O).5H2O (theo = theophylline; phen = 1,10-phenanthroline), was chosen for further testing against 10 medically relevant Candida species that were resistant to fluconazole/amphotericin B. CTP demonstrated a broad spectrum of action, inhibiting the growth of all 20 clinical fungal isolates, with MICs from 7.81 to 62.5 μg/mL and MFCs from 15.62 to 62.5 μg/mL. Conversely, CTP did not cause lysis in erythrocytes. The toxicity of CTP was evaluated in vivo using Galleria mellonella and Tenebrio molitor. CTP had no or low levels of toxicity at doses ranging from 31.25 to 250 μg/mL for 5 days. After 24 h of treatment, G. mellonella larvae exhibited high survival rates even when exposed to high doses of CTP (600 μg/mL), with the 50% cytotoxic concentration calculated as 776.2 μg/mL, generating selectivity indexes varying from 12.4 to 99.4 depending on each Candida species. These findings suggest that CTP could serve as a potential drug to treat infections caused by Candida species resistant to clinically available antifungals.
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Affiliation(s)
- Heloisa F Frota
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
- Programa de Pós-Graduação Em Bioquímica (PPGBq), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-909, Brazil
| | - Carolline M A Lorentino
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
| | - Pedro F Barbosa
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
| | - Lívia S Ramos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
| | - Iuri C Barcellos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, 20270-220, Brazil
| | - Lucas Giovanini
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
| | - Lucieri O P Souza
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
| | - Simone S C Oliveira
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
| | - Olufunso O Abosede
- Department of Chemistry, Federal University Otuoke, P.M.B 126, Yenagoa, Bayelsa State, Nigeria
- Department of Chemistry, Nelson Mandela University, PO Box 77000, Port Elizabeth, 6031, South Africa
| | - Adeniyi S Ogunlaja
- Department of Chemistry, Nelson Mandela University, PO Box 77000, Port Elizabeth, 6031, South Africa
| | - Matheus M Pereira
- Chemical Engineering Processes and Forest Products Research Centre (CIEPQPF), Department of Chemical Engineering, University of Coimbra, 3030-790, Coimbra, Portugal
| | - Marta H Branquinha
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil
- Rede Micologia RJ - Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, 21941-901, Brazil
| | - André L S Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-901, Brazil.
- Programa de Pós-Graduação Em Bioquímica (PPGBq), Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, 21941-909, Brazil.
- Rede Micologia RJ - Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, 21941-901, Brazil.
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11
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Lin C, Zhou J, Gao N, Liu R, Li G, Wang J, Lu G, Shen J. Establishing a pulmonary aspergillus fumigatus infection diagnostic platform based on RPA-CRISPR-Cas12a. World J Microbiol Biotechnol 2024; 40:116. [PMID: 38418617 DOI: 10.1007/s11274-024-03940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
In this study, we devised a diagnostic platform harnessing a combination of recombinase polymerase amplification (RPA) and the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12a system. Notably, this platform obviates the need for intricate equipment and finds utility in diverse settings. Two result display methods were incorporated in this investigation: the RPA-Cas12a-fluorescence method and the RPA-Cas12a-LFS (lateral flow strip). Upon validation, both display platforms exhibited no instances of cross-reactivity, with seven additional types of fungal pathogens responsible for respiratory infections. The established detection limit was ascertained to be as low as 102 copies/µL. In comparison to fluorescence quantitative PCR, the platform demonstrated a sensitivity of 96.7%, a specificity of 100%, and a consistency rate of 98.0%.This platform provides expeditious, precise, and on-site detection capabilities, thereby rendering it a pivotal diagnostic instrument amenable for deployment in primary healthcare facilities and point-of-care settings.
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Affiliation(s)
- Chunhui Lin
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Jing Zhou
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Nana Gao
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Runde Liu
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Ge Li
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Jinyu Wang
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Guoping Lu
- Department of Laboratory Medicine, Fuyang Hospital of Anhui Medical University, Fuyang, People's Republic of China
| | - Jilu Shen
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China.
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12
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Wang P, Li Y, Gao L, Tang X, Zheng D, Wu K, Wang L, Guo P, Ye F. In vitro characterization and molecular epidemiology of Cryptococcus spp. isolates from non-HIV patients in Guangdong, China. Front Microbiol 2024; 14:1295363. [PMID: 38287960 PMCID: PMC10823435 DOI: 10.3389/fmicb.2023.1295363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
Background The burden of cryptococcosis in mainland China is enormous. However, the in vitro characterization and molecular epidemiology in Guangdong, a key region with a high incidence of fungal infection in China, are not clear. Methods From January 1, 2010, to March 31, 2019, clinical strains of Cryptococcus were collected from six medical centres in Guangdong. The clinical information and characteristics of the strains were analysed. Furthermore, molecular types were determined. Results A total of 84 strains were collected, mostly from male and young or middle-aged adult patients. Pulmonary and cerebral infections (82.1%) were most common. All strains were Cryptococcus neoformans, grew well at 37°C and had capsules around their cells. One melanin- and urea- and one melanin+ and urea- variants were found. Although most strains exhibited a low minimum inhibitory concentration (MIC) value for voriconazole (mean: 0.04 μg/mL) and posaconazole (mean: 0.12 μg/mL), the results for these isolates showed a high degree of variation in the MIC values of fluconazole and 5-fluorocytosine, and resistance was observed for 4 out of 6 drugs. A significant proportion of these strains had MIC values near the ECV values, particularly in the case of amphotericin B. The proportion of strains near the clinical breakpoints was as follows: fluconazole: 3.66%; voriconazole: 3.66%; itraconazole: 6.10%; posaconazole: 13.41%; amphotericin B: 84.15%; 5-fluorocytosine: 2.44%. These strains were highly homogeneous and were dominated by the Grubii variant (95.2%), VNI (94.0%), α mating (100%), and ST5 (89.3%) genotypes. Other rare types, including ST4, 31, 278, 7, 57 and 106, were also found. Conclusion Phenotypically variant and non-wild-type strains were found in Guangdong, and a significant proportion of these strains had MIC values near the ECV values towards the 6 antifungal drugs, and resistance was observed for 4 out of 6 drugs. The molecular type was highly homogeneous but compositionally diverse, with rare types found. Enhanced surveillance of the aetiology and evolution and continuous monitoring of antifungal susceptibility are needed to provide references for decision-making in the health sector and optimization of disease prevention and control.
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Affiliation(s)
- Penglei Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, China
- Department of Respiratory Medicine, Longgang Central Hospital, Shenzhen, China
| | - Yongming Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, China
| | - Lei Gao
- Microscopy Core Facility, Biomedical Research Core Facilities, Westlake University, Hangzhou, China
| | - Xiang Tang
- Intensive Care Unit, Guangzhou First People's Hospital, Guangzhou, China
| | - Dandian Zheng
- Department of Hematology Oncology, Jieyang City People's Hospital, Jieyang, China
| | - Kuihai Wu
- Clinical Medicine Laboratory, Foshan City First People's Hospital, Foshan, China
| | - Luxia Wang
- Clinical Medicine Laboratory, Southern Military Region General Hospital, Guangzhou, China
| | - Penghao Guo
- Clinical Medicine Laboratory, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, China
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13
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Baomo L, Guofen Z, Jie D, Liu X, Shuru C, Jing L. Disseminated cryptococcosis in a patient with idiopathic CD4 + T lymphocytopenia presenting as prostate and adrenal nodules: diagnosis from pathology and mNGS, a case report. BMC Infect Dis 2024; 24:26. [PMID: 38166809 PMCID: PMC10763445 DOI: 10.1186/s12879-023-08926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Disseminated Cryptococcosis infection typically occurs in immunocompromised patients, often manifested as pneumonia or meningoencephalitis. Cases with involvement of either prostate or adrenal glands are less frequent. We describe a case of an immunocompromised 62-year-old man with new-found Idiopathic CD4 + T lymphocytopenia who presented with urinary irritation symptoms followed by headache. The patient was finally diagnosed as disseminated cryptococcosis of prostate, adrenal gland involvement with the help of combining histopathology of formalin-fixed, paraffin-embedded tissue with metagenomic next-generation sequencing technique to identify C neoformans sensu stricto in prostate, adrenal gland tissues. Clinicians should be aware of atypical presentations of cryptococcal disease. In this case of cryptococcosis in immunocompromised patients, we find that cryptococcosis can affect varied organs simultaneously and should be considered in the differential of infectious diseases. And mNGS technology helps to confirm the diagnosis.
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Affiliation(s)
- Liu Baomo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zeng Guofen
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, 510630, Guangzhou, China
| | - Dong Jie
- Department of Infectious Diseases, Zhuhai People's Hospital(Zhuhai Hospital affiliated with Jinan University), 519000, Zhuhai, China
| | - Xie Liu
- Department of Infectious Diseases, Shenzhen Longhua District People's Hospital, 518110, Shenzhen, China
| | - Chen Shuru
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, 510630, Guangzhou, China.
| | - Liu Jing
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, 510630, Guangzhou, China.
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14
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Wang M, Zhang C, Li Z, Ji B, Man S, Yi M, Li R, Hao M, Wang S. Epidemiology and antifungal susceptibility of fungal infections from 2018 to 2021 in Shandong, eastern China: A report from the SPARSS program. Indian J Med Microbiol 2024; 47:100518. [PMID: 38016503 DOI: 10.1016/j.ijmmb.2023.100518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE We analyzed the pathogenic fungal epidemiology and antifungal susceptibility from 2018 to 2021 in Shandong Province, China, to provide the basis for empiric antifungal therapy. METHODS Fungal isolates were collected from 54 hospitals in Shandong province from 2018 to 2021 through the Shandong Province Pediatric bacterial & fungal Antimicrobial Resistance Surveillance System (SPARSS), WHONET v5.6 and SPSS software v20.0 were used for statistical analysis. RESULTS A total of 15,348 strains of fungi were collected, with Candida accounting for 78.25 %, followed by Aspergillus at 15.45 %, and other species at 6.27 %. Candida albicans was the predominant Candida species, but more than half of the Candida isolates were non-albicans species, with C. tropicalis being the most dominant (22.74 %), followed by C. glabrata (17.50 %) and C. parapsilosis (11.02 %). The composition of fungi varied significantly among different age groups. Children had a higher proportion of C. albicans (47.30 %) compared to non-children (32.06 %). The non-wild-type phenotype rate of Candida for Amphotericin B was less than 3 %, while Cryptococcus neoformans was 16.67 %. In addition, less than 6 % of C. albicans and C. parapsilosis were resistant to fluconazole and voriconazole, and 96.30 % of C. glabrata were SDD to fluconazole. We also found that 80.56 % of C. glabrata and 83.70 % of C. krusei were voriconazole WT/susceptibility phenotype. However, the susceptibility rates of C. tropicalis to fluconazole/voriconazole decreased from 70.40 %/46.40 % in 2018 to 62.30 %/35.20 % in 2021. The comprehensive susceptibility rate to fluconazole of C. albicans, C. tropicalis, C. parapsilosis and C. glabrata isolated from the blood has decreased from 69.36 % to 56.62 %. CONCLUSIONS The study reveals that the composition and antifungal susceptibility of pathogenic fungi in Shandong Province differ from other regions. Moreover, the resistance to azoles is more severe, especially in C. tropicalis. These findings indicate the need for region-specific antifungal treatment strategies to combat fungal infections effectively.
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Affiliation(s)
- Mengyuan Wang
- Clinical Microbiology Department, Children's Hospital Affiliated to Shandong University, Jinan, 250022, China; Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China.
| | - Chunyan Zhang
- Clinical Microbiology Department, Children's Hospital Affiliated to Shandong University, Jinan, 250022, China; Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China.
| | - Zheng Li
- Clinical Microbiology Department, Children's Hospital Affiliated to Shandong University, Jinan, 250022, China; Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China.
| | - Bing Ji
- Laboratory Medicine, Hospital Affiliated to Binzhou Medical University, Binzhou, 256603, China.
| | - Sijin Man
- Laboratory Medicine, Central People's Hospital of Tengzhou, Tengzhou, 277500, China.
| | - Maoli Yi
- Laboratory Medicine, Yantai Yuhuangding Hospital, YanTai, 264000, China.
| | - Renzhe Li
- Laboratory Medicine, Jining First People's Hospital, Jining, 272111, China.
| | - Mingju Hao
- Laboratory Medicine, Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China.
| | - Shifu Wang
- Clinical Microbiology Department, Children's Hospital Affiliated to Shandong University, Jinan, 250022, China; Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China.
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15
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Khan S, Bilal H, Shafiq M, Zhang D, Awais M, Chen C, Khan MN, Wang Q, Cai L, Islam R, Zeng Y. Distribution of Aspergillus species and risk factors for aspergillosis in mainland China: a systematic review. Ther Adv Infect Dis 2024; 11:20499361241252537. [PMID: 38835831 PMCID: PMC11149451 DOI: 10.1177/20499361241252537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/17/2024] [Indexed: 06/06/2024] Open
Abstract
Background Aspergillus, a widespread fungus in the natural environment, poses a significant threat to human health by entering the human body via the airways and causing a disease called aspergillosis. This study comprehensively analyzed data on aspergillosis in published articles from mainland China to investigate the prevalence of Aspergillus, and risk factors, mortality rate, and underlying condition associated with aspergillosis. Methods Published articles were retrieved from Google Scholar, PubMed, and Science Direct online search engines. In the 101 analyzed studies, 3558 Aspergillus isolates were meticulously collected and classified. GraphPad Prism 8 was used to statistically examine the epidemiology and clinical characteristics of aspergillosis. Results Aspergillus fumigatus was prominently reported (n = 2679, 75.14%), followed by A. flavus (n = 437, 12.25%), A. niger (n = 219, 6.14%), and A. terreus (n = 119, 3.33%). Of a total of 9810 patients, 7513 probable cases accounted for the highest number, followed by confirmed cases (n = 1956) and possible cases (n = 341). In patients, cough emerged as the most common complaint (n = 1819, 18.54%), followed by asthma (n = 1029, 10.48%) and fever (1024, 10.44%). Of total studies, invasive pulmonary aspergillosis (IPA) was reported in 47 (45.53%) studies, exhibiting an increased prevalence in Beijing (n = 12, 25.53%), Guangdong (n = 7, 14.89%), and Shanghai (n = 6, 12.76%). Chronic pulmonary aspergillosis (CPA) was reported in 14 (13.86%) studies. Among the total of 14 studies, the occurrence of CPA was 5 (35.71%) in Beijing and 3 (21.42%) in Shanghai. Allergic bronchopulmonary aspergillosis (ABPA), was reported at a lower frequency (n = 8, 7.92%), Guangdong recorded a relatively high number (n = 3, 37.5%), followed by Beijing (n = 2, 25.0%), and Shanghai (n = 1, 12.5%). Percentage of death reported: IPA had the highest rate (n = 447, 68.87%), followed by CPA (n = 181, 27.88%) and ABPA (n = 14, 2.15%). Among the aspergillosis patients, 6220 had underlying conditions, including chronic lung disease (n = 3765, 60.53%), previous tuberculosis (n = 416, 6.68%), and organ transplant or organ failure (n = 648, 10.41%). Aspergillosis was also found in patients using corticosteroid therapy (n = 622, 10.0%). Conclusion This review sheds light on the prevalence patterns of Aspergillus species, risk factors of aspergillosis, and gaps in surveillance that could be helpful for the control and treatment of aspergillosis and guide the researchers in future studies. Registration This systematic review was prospectively registered on PROSPERO: Registration ID CRD42023476870.
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Affiliation(s)
- Sabir Khan
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hazrat Bilal
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Muhammad Shafiq
- Department of Pharmacology, Shantou University Medical College, Shantou, China
| | - Dongxing Zhang
- Department of Dermatology, Meizhou Dongshan Hospital, Meizhou, Guangdong, China
- Department of Dermatology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Muhammad Awais
- Department of Environmental Science, Kunming University of Science and Technology, Yunnan, China
| | - Canhua Chen
- Clinical Laboratory, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Muhammad Nadeem Khan
- Faculty of Biological Sciences, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Qian Wang
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical-Surgical and Experimental Sciences, University of Sassari - Neurology Unit, Azienza Ospedaliera Universitaria (AOU) Sassari, Sassari, Italy
| | - Lin Cai
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Rehmat Islam
- Key Laboratory of Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Yuebin Zeng
- Department of Dermatology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610021, China
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16
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Han G, Xu Q, Lv Q, Li X, Shi X. Pharmacoeconomic evaluation of isavuconazole, posaconazole, and voriconazole for the treatment of invasive mold diseases in hematological patients: initial therapy prior to pathogen differential diagnosis in China. Front Public Health 2023; 11:1292162. [PMID: 38179563 PMCID: PMC10766362 DOI: 10.3389/fpubh.2023.1292162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background Invasive mold diseases (IMD) is associated with high mortality and a substantial economic burden. For high-risk patients, fever drive or diagnostic drive therapy is usually initiated prior to the differential diagnosis of the pathogen. This study evaluated the cost-effectiveness of isavuconazole, posaconazole, vs. voriconazole in the treatment of IMD from the perspective of the Chinese healthcare system, informing healthcare decision-making and resource allocation. Methods A decision analytic model was constructed using TreeAge Pro 2011 software to evaluate the cost-effectiveness of the entire disease course. We assumed that the prevalence of mucormycosis in the patients entering the model was 7.8%. Efficacy, cost, adverse events, and other data included in the model were mainly derived from clinical studies, published literature, and publicly available databases. The primary outcomes of the model output were total cost, quality-adjusted life years (QALYs), life years (Lys), and incremental cost-effectiveness ratio (ICER). The willing-to-pay (WTP) threshold was defined as one to three times China's GDP per capita in 2022. One-way sensitivity analysis and probability sensitivity analysis were used to determine the robustness of the model. At the same time, the cost-effectiveness of three triazole antifungal agents under a broader range of mucormycosis prevalence, when voriconazole was covered by medical insurance reimbursement, and after the price reduction of posaconazole was discussed. Results Compared with voriconazole, isavuconazole provided an additional 0.38 Lys (9.29 vs. 8.91 LYs) and 0.31 QALYs (7.62 vs. 7.31 QALYs); ICER was $15,702.46/QALY, well-below the WTP threshold ($38,223/QALY). However, posaconazole did not provide a significant economic advantage over voriconazole (9.40 vs. 9.36 Lys; 7.71 vs. 7.68 QALYs; ICER $64,466.57/QALY). One-way sensitivity analysis found that ICER was highly sensitive to the mortality of patients with invasive aspergillus infection. In the probabilistic sensitivity analysis, when the WTP threshold was $38,223/QALY, the probability of isavuconazole being cost-effective was 72.9%. The scenario analysis results indicated that posaconazole would become cost-effective when the price was reduced by 15% or the prevalence of mucormycosis was 14%. Conclusions Isavuconazole represents a cost-effective initial option for treating IMD in high-risk hematological patients prior to the differential diagnosis of pathogens. It will also be economical when a 15% reduction in posaconazole cost is achieved.
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Affiliation(s)
- Guangxin Han
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Qing Xu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoping Shi
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
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Zhang L, Wang S, Hong N, Li M, Liu Y, Zhou T, Peng Y, Hu C, Li X, Zhang Z, Guo M, Cogliati M, Hitchcock M, Xu J, Chen M, Liao G. Genotypic diversity and antifungal susceptibility of Cryptococcus neoformans species complex from China, including the diploid VNIII isolates from HIV-infected patients in Chongqing region. Med Mycol 2023; 61:myad119. [PMID: 37985734 DOI: 10.1093/mmy/myad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023] Open
Abstract
Although previous studies on the genotypic diversity and antifungal susceptibility of the Cryptococcus neoformans species complex (CNSC) isolates from China revealed ST5 genotype isolates being dominant, the information about the CNSC isolates from Chinese HIV-infected patients is limited. In this study, 171 CNSC isolates from HIV-infected patients in the Chongqing region of Southwest China were genotyped using the International Society for Human and Animal Mycology-multilocus sequence typing consensus scheme, and their antifungal drug susceptibilities were determined following CLSI M27-A3 guidelines. Among 171 isolates, six sequence types (STs) were identified, including the dominant ST5 isolates, the newly reported ST15, and four diploid VNIII isolates (ST632/ST636). Moreover, a total of 1019 CNSC isolates with STs and HIV-status information were collected and analyzed from Mainland China in the present study. A minimum spanning analysis grouped these 1019 isolates into three main subgroups, which were dominated by the ST5 clonal complex (CC5), followed by the ST31 clonal complex (CC31) and ST93 clonal complex (CC93). The trend of resistance or decreasing susceptibility of clinical CNSC isolates to azole agents within HIV-infected patients from the Chongqing region is increasing, especially resistance to fluconazole.
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Affiliation(s)
- Lanyu Zhang
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Saisai Wang
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Nan Hong
- Department of Dermatology, Jinling Hospital, School of Medicine of Nanjing University, Nanjing, China
| | - Muyuan Li
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Yiting Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tao Zhou
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Yan Peng
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Changhua Hu
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Xiaoxu Li
- The Medical Research Institute (MRI), Southwest University, Chongqing, China
| | - Zhen Zhang
- Department of Clinical Laboratory, Chongqing General Hospital, Chongqing, China
| | - Mengzhu Guo
- Department of Dermatology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Massimo Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Megan Hitchcock
- Department of Biology, McMaster University, Hamilton, Canada
| | - Jianping Xu
- Department of Biology, McMaster University, Hamilton, Canada
| | - Min Chen
- Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Changzheng Hospital, Shanghai, China
| | - Guojian Liao
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
- The Medical Research Institute (MRI), Southwest University, Chongqing, China
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18
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Li F, He J, Yang T, Li S, Liu L, Huang Q, Duan X. 5-aminolevulinic acid-photodynamic therapy for a refractory severe kerion: A case report. Photodiagnosis Photodyn Ther 2023; 44:103888. [PMID: 37949388 DOI: 10.1016/j.pdpdt.2023.103888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
Kerion is a subtype of tinea capitis with a severe inflammatory response, requiring early diagnosis to prevent secondary bacterial infection, folliculitis and permanent alopecia. Oral antifungal drugs are considered the first-line treatment for tinea capitis; however, drugs therapy is challenged by the long treatment duration, side effects, and drug resistance. Photodynamic therapy (PDT) has been widely used to treat dermatomycosis and has shown significant efficacy in recent years. We report the case of a girl who presented with refractory severe kerion following unregulated treatment and insensitivity to itraconazole; however,she was cured with 5-aminolevulinic acid-PDT. The case showed that PDT is a potentially promising alternative treatment for cutaneous fungal infections.
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Affiliation(s)
- Feng Li
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Jia He
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Ting Yang
- Department of Dermatology,Nanchong Central Hospital, Nanchong 637000, China
| | - Si Li
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Li Liu
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Qing Huang
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xi Duan
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
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19
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Jing Y, Wei Q, Zeng H, Cheng R, Tian P, Li Y. The clinical features and prognosis of fungal pleural infection: A case series and literature review. Medicine (Baltimore) 2023; 102:e36411. [PMID: 38050212 PMCID: PMC10695481 DOI: 10.1097/md.0000000000036411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Fungal pleural infections are infrequent and insidious, for which there are neither large clinical studies nor targeted guidelines to provide standardized treatment options. We reported 4 cases of fungal pleural infection and reviewed the cases of fungal pleural infections in previous studies to provide a basis for the diagnosis and treatment of fungal pleural infections. There were 2 females and 2 males with a mean age of 58.5 years in our data. The average time from onset to diagnosis was 30.25 days. Risk factors most frequently included pulmonary diseases (n = 4) and malignancy (n = 1). Two patients underwent pleural biopsy through a thoracoscope, and no pathogens were detected. Pleural fluid culture was positive in 2 out of 3 cases. The diagnoses were "possible" (n = 1), "probable" (n = 1), and "proven" (n = 2). All patients received systemic antifungal therapy, and 3 received combined thoracic drainage. The outcomes were cured (n = 1), improved (n = 2) and lost to follow-up (n = 1). We reviewed 12 cases of fungal pleural infection in previous studies. The diagnosis was confirmed via culture in 7 cases and via biopsy in 8 cases. The pathogen was Aspergillus in 7 cases. After a combination of systemic antifungal (n = 12) and local treatment (n = 11), 10 patients improved and 2 patients died. Diagnosis of fungal pleural infection should incorporate risk factors, clinical presentation and fungal evidence, with pleural fluid culture being an important and feasible mean of confirming the diagnosis; and treatment should be based on systemic antifungal therapy supplemented by topical therapy.
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Affiliation(s)
- Yawan Jing
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gerontology and Geriatrics, Tibet Autonomous Region People’s Hospital, Lhasa, Tibet Autonomous Region, China
| | - Qi Wei
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Zeng
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruixin Cheng
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Panwen Tian
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yalun Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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20
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Bouazzi D, Andersen PL, Jacobsen EW, Arendrup MC, Jemec GBE, Saunte DML. Nationwide epidemiology and treatment pattern of superficial fungal infections in the Faroe Islands: a retrospective study from 2003 to 2019. APMIS 2023; 131:564-566. [PMID: 37186327 DOI: 10.1111/apm.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Lindsø Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ester Weihe Jacobsen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Cavling Arendrup
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Medical Health and Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
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21
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Lu YA, Lin CH, Chang CJ, Shu KH, Chung MC, Chou CC. Non-meningeal, non-pulmonary cryptococcosis with limited posterior uveitis in a kidney organ transplant recipient with antibody-mediated rejection: a case report. BMC Ophthalmol 2023; 23:409. [PMID: 37817150 PMCID: PMC10565975 DOI: 10.1186/s12886-023-03130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Cryptococcosis is one of the most frequent fungal eye infections in patients with immunosuppression. Currently, treatment approaches for non-meningeal, non-pulmonary cryptococcosis are based on those used for cryptococcal meningitis or pneumonia. CASE PRESENTATION We present a rare case of non-meningeal, non-pulmonary cryptococcosis with clinical manifestations limited to one eye of a cadaveric kidney transplant recipient with chronic-active antibody-mediated rejection. Typical manifestations, diagnosis, and treatments, including antifungal therapies, adjunctive therapies, and immunosuppression reduction, are discussed. After timely diagnosis and treatment, her visual acuity recovered to baseline without recurrence or sequelae of cryptococcosis. CONCLUSIONS Clinicians should be aware of rare presentations of fungal infections, especially when a kidney transplant recipient with rejection has been treated with intensive immunosuppressants. Early diagnosis with individualized therapies may have a favorable prognosis.
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Affiliation(s)
- Yi-An Lu
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan
| | - Chun-Hsien Lin
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan
| | - Chia-Jen Chang
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan
| | - Kuo-Hsiung Shu
- Division of Nephrology, Department of Internal Medicine, Lin Shin Hospital, No.36, Sec. 3, Huizhong Rd., Nantun District, Taichung City, 40867, Taiwan
| | - Mu-Chi Chung
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan.
- PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan.
| | - Chien-Chih Chou
- Department of Ophthalmology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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22
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Wang Y, Guo X, Zhang X, Chen P, Wang W, Hu S, Ma T, Zhou X, Li D, Yang Y. In Vivo Microevolutionary Analysis of a Fatal Case of Rhinofacial and Disseminated Mycosis Due to Azole-Drug-Resistant Candida Species. J Fungi (Basel) 2023; 9:815. [PMID: 37623586 PMCID: PMC10455694 DOI: 10.3390/jof9080815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
Ten Candida species strains were isolated from the first known fatal case of rhinofacial and rhino-orbital-cerebral candidiasis. Among them, five strains of Candida parapsilosis complex were isolated during the early stage of hospitalization, while five strains of Candida tropicalis were isolated in the later stages of the disease. Using whole-genome sequencing, we distinguished the five strains of C. parapsilosis complex as four Candida metapsilosis strains and one Candida parapsilosis strain. Antifungal susceptibility testing showed that the five strains of C. parapsilosis complex were susceptible to all antifungal drugs, while five C. tropicalis strains had high minimum inhibitory concentrations to azoles, whereas antifungal-drug resistance gene analysis revealed the causes of azole resistance in such strains. For the first time, we analyzed the microevolutionary characteristics of pathogenic fungi in human hosts and inferred the infection time and parallel evolution of C. tropicalis strains. Molecular clock analysis revealed that azole-resistant C. tropicalis infection occurred during the first round of therapy, followed by divergence via parallel evolution in vivo. The presence/absence variations indicated a potential decrease in the virulence of genomes in strains isolated following antifungal drug treatment, despite the absence of observed clinical improvement in the conditions of the patient. These results suggest that genomic analysis could serve as an auxiliary tool in guiding clinical diagnosis and treatment.
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Affiliation(s)
- Yuchen Wang
- Bioinformatics Center of AMMS, Beijing Key Laboratory of New Molecular Diagnosis Technologies for Infectious Diseases, Beijing Institute of Microbiology and Epidemiology, Beijing 100850, China; (Y.W.); (X.Z.)
| | - Xi Guo
- TEDA Institute of Biological Sciences and Biotechnology, Nankai University, Tianjing 300457, China;
| | - Xinran Zhang
- Bioinformatics Center of AMMS, Beijing Key Laboratory of New Molecular Diagnosis Technologies for Infectious Diseases, Beijing Institute of Microbiology and Epidemiology, Beijing 100850, China; (Y.W.); (X.Z.)
| | - Ping Chen
- Division of Dermatology and Mycological Lab, Peking University Third Hospital, Beijing 100191, China
| | - Wenhui Wang
- Division of Dermatology and Mycological Lab, Peking University Third Hospital, Beijing 100191, China
| | - Shan Hu
- Bioinformatics Center of AMMS, Beijing Key Laboratory of New Molecular Diagnosis Technologies for Infectious Diseases, Beijing Institute of Microbiology and Epidemiology, Beijing 100850, China; (Y.W.); (X.Z.)
| | - Teng Ma
- Bioinformatics Center of AMMS, Beijing Key Laboratory of New Molecular Diagnosis Technologies for Infectious Diseases, Beijing Institute of Microbiology and Epidemiology, Beijing 100850, China; (Y.W.); (X.Z.)
| | - Xingchen Zhou
- Bioinformatics Center of AMMS, Beijing Key Laboratory of New Molecular Diagnosis Technologies for Infectious Diseases, Beijing Institute of Microbiology and Epidemiology, Beijing 100850, China; (Y.W.); (X.Z.)
- School of Life Science & Technology, China Pharmaceutical University, Nanjing 210009, China
| | - Dongming Li
- Division of Dermatology and Mycological Lab, Peking University Third Hospital, Beijing 100191, China
| | - Ying Yang
- Bioinformatics Center of AMMS, Beijing Key Laboratory of New Molecular Diagnosis Technologies for Infectious Diseases, Beijing Institute of Microbiology and Epidemiology, Beijing 100850, China; (Y.W.); (X.Z.)
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23
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Cai W, Ruan Q, Li J, Lin L, Xi L, Sun J, Lu S. Fungal Spectrum and Susceptibility Against Nine Antifungal Agents in 525 Deep Fungal Infected Cases. Infect Drug Resist 2023; 16:4687-4696. [PMID: 37484904 PMCID: PMC10362860 DOI: 10.2147/idr.s403863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Deep fungal infection has become an important cause of infection and death in hospitalized patients, and this has worsened with increasing antifungal drug resistance. Objective A 3-year retrospective study was conducted to investigate the clinical characteristics, pathogen spectrum, and drug resistance of deep fungal infection in a regional hospital of Guangzhou, China. Methods Non-duplicate fungi isolates recovered from blood and other sterile body fluids of in-patients of the clinical department were identified using biochemical tests of pure culture with the API20C AUX and CHROMagar medium. Antifungal susceptibilities were determined by Sensititre YeastOne® panel trays. Results In this study, 525 patients (283 female, 242 male) with deep fungal infection were included, half of them were elderly patients (≥60 years) (54.67%, n=286). A total of 605 non-repetitive fungi were finally isolated from sterile samples, of which urine specimens accounted for 66.12% (n=400). Surgery, ICU, and internal medicine were the top three departments that fungi were frequently detected. The mainly isolated fungal species were Candida albicans (43.97%, n=266), Candida glabrata (20.00%, n=121), and Candida tropicalis (17.02%, n=103), which contributed to over 80% of fungal infection. The susceptibility of the Candida spp. to echinocandins, 5-fluorocytosine, and amphotericin B remained above 95%, while C. glabrata and C. tropicalis to itraconazole were about 95%, and the dose-dependent susceptibility of C. glabrata to fluconazole was more than 90%. The echinocandins had no antifungal activity against Trichosporon asahi in vitro (MIC90>8 μg/mL), but azole drugs were good, especially voriconazole and itraconazole (MIC90 = 0.25 μg/mL). Conclusion The main causative agents of fungal infection were still the genus of Candida. Echinocandins were the first choice for clinical therapy of Candida infection, followed with 5-fluorocytosine and amphotericin B. Azole antifungal agents should be used with caution in Candida glabrata and Candida tropicalis infections.
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Affiliation(s)
- Wenying Cai
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Qianqian Ruan
- Guangdong Provincial Institute of Public Health, Guangzhou, People’s Republic of China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People’s Republic of China
- School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jiahao Li
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Li Lin
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Liyan Xi
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Dermatology Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jiufeng Sun
- Guangdong Provincial Institute of Public Health, Guangzhou, People’s Republic of China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People’s Republic of China
| | - Sha Lu
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
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Bilal H, Zhang D, Shafiq M, Khan MN, Chen C, Khan S, Wang Q, Cai L, Awais M, Hu H, Zeng Y. Cryptococcosis in Southern China: Insights from a Six-Year Retrospective Study in Eastern Guangdong. Infect Drug Resist 2023; 16:4409-4419. [PMID: 37435235 PMCID: PMC10332366 DOI: 10.2147/idr.s417968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Cryptococcosis is a fatal infection that can affect both immunocompetent and immunocompromised patients, and it is little understood in China's various regions. This research aimed to look at the epidemiology, risk factors, and antifungal susceptibility pattern of Cryptococcus neoformans in eastern Guangdong, China. Methods A six-year (2016-2022) retrospective study was conducted at Meizhou People's Hospital, China. Demographical, clinical, and laboratory data of cryptococcal patients were collected from hospital records and statistically analyzed using the chi-square and ANOVA tests. Results Overall, 170 cryptococcal infections were recorded, of which meningitis accounted for 78 (45.88%), cryptococcemia for 50 (29.41%), and pneumonia for 42 (24.7%). The number of cases increased 8-fold during the study duration. The median age of patients was 58 years (Inter quartile range: 47-66), and the high proportion of cases was from the male population (n = 121, 71.17%). The underlying diseases were identified only in 60 (35.29%) patients, of which 26 (15.29%) were severely immunocompromised, and 26 (15.29%) others were mildly immunocompromised. A statistically significant difference was reported for chronic renal failure, and anemia (p < 0.05) persisted in cases of three infection types. A high number of non-wild type (NWT) isolates were found against amphotericin B (n=13/145, 8.96%), followed by itraconazole (n=7/136, 5.15%) and voriconazole (n=4/158, 2.53%). Only six isolates (3.79%) were multidrug-resistant, four of which were from cryptococcemia patients. Compared to meningitis and pneumonia, cryptococcemia revealed a higher percentage of NWT isolates (p < 0.05). Conclusion In high-risk populations, cryptococcal infections require ongoing monitoring and management.
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Affiliation(s)
- Hazrat Bilal
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, People’s Republic of China
| | - Dongxing Zhang
- Department of Dermatology, Meizhou Dongshan Hospital, Meizhou, Guangdong Province, 514023, People’s Republic of China
- Department of Dermatology, Meizhou People’s Hospital, Meizhou, Guangdong Province, 514023, People’s Republic of China
| | - Muhammad Shafiq
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, People’s Republic of China
| | - Muhammad Nadeem Khan
- Faculty of Biological Sciences, Department of Microbiology, Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | - Canhua Chen
- Clinical Laboratory, Meizhou People’s Hospital, Meizhou, Guangdong Province, 514023, People’s Republic of China
| | - Sabir Khan
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, People’s Republic of China
| | - Qian Wang
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, People’s Republic of China
- Department of Medical-Surgical and Experimental Sciences University of Sassari Neurology Unit, Azienda Ospedaliera Universitaria (AOU), Sassari, Italy
| | - Lin Cai
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, People’s Republic of China
| | - Muhammad Awais
- Department of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, People’s Republic of China
| | - Haibin Hu
- The First Clinical Medical college, Guangdong Medical University, Zhanjiang, 523808, People’s Republic of China
| | - Yuebin Zeng
- Department of Dermatology, Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, People’s Republic of China
- Department of Dermatology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610021, People’s Republic of China
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Hua Y, Hu F, Ren X, Xiong Y, Hu J, Su F, Tang X, Wen Y. A novel aptamer-G-quadruplex/hemin self-assembling color system: rapid visual diagnosis of invasive fungal infections. Ann Clin Microbiol Antimicrob 2023; 22:35. [PMID: 37170137 PMCID: PMC10176924 DOI: 10.1186/s12941-023-00570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/24/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The clinical symptoms of invasive fungal infections (IFI) are nonspecific, and early clinical diagnosis is challenging, resulting in high mortality rates. This study reports the development of a novel aptamer-G-quadruplex/hemin self-assembling color system (AGSCS) based on (1 → 3)-β-D-glucans' detection for rapid, specific and visual diagnosis of IFI. METHODS We screened high affinity and specificity ssDNA aptamers binding to (1 → 3)-β-D-glucans, the main components of cell wall from Candida albicans via Systematic Evolution of Ligands by EXponential enrichment. Next, a comparison of diagnostic efficiency of AGSCS and the (1 → 3)-β-D-glucans assay ("G test") with regard to predicting IFI in 198 clinical serum samples was done. RESULTS Water-soluble (1 → 3)-β-D-glucans were successfully isolated from C. albicans ATCC 10,231 strain, and these low degree of polymerization glucans (< 1.7 kD) were targeted for aptamer screening with the complementary sequences of G-quadruplex. Six high affinity single stranded DNA aptamers (A1, A2, A3, A4, A5 and A6) were found. The linear detection range for (1 → 3)-β-D-glucans stretched from 1.6 pg/mL to 400 pg/mL on a microplate reader, and the detection limit was 3.125 pg/mL using naked eye observation. Using a microplate reader, the sensitivity and specificity of AGSCS for the diagnosis of IFI were 92.68% and 89.65%, respectively, which was higher than that of the G test. CONCLUSION This newly developed visual diagnostic method for detecting IFI showed promising results and is expected to be developed as a point-of-care testing kit to enable quick and cost effective diagnosis of IFI in the future.
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Affiliation(s)
- Ying Hua
- School of Nursing, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Feng Hu
- Department of Blood Transfusion, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241000, Anhui, China
| | - Xia Ren
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China
| | - Yueling Xiong
- Centre of Translational Medicine and Vascular Disease Research Center, The Second Affiliated Hospital of Wannan Medical College, Kangfu Road 10#, Jinghu District, Wuhu, 241000, Anhui, China
| | - Jian Hu
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China
| | - Fan Su
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China
| | - Xiaolei Tang
- Centre of Translational Medicine and Vascular Disease Research Center, The Second Affiliated Hospital of Wannan Medical College, Kangfu Road 10#, Jinghu District, Wuhu, 241000, Anhui, China.
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, No.22, Wenchang Xi Road, Wuhu, 241002, Anhui, China.
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Si Z, Bai J, Wei L, Zhao H, Wang S, Liu B, Xu J, Fang H, Ling Z, Qiao J. Clinical Features and Skin Microbiome of Tinea Scrotum: An Observational Study of 113 Cases in China. Mycopathologia 2023:10.1007/s11046-023-00712-6. [PMID: 37072674 DOI: 10.1007/s11046-023-00712-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/04/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The scrotum is considered as an uncommon site for tinea, hence there is a lack of knowledge about the clinical characteristics, pathogenic agents and the skin microbiome changes of tinea scrotum. OBJECTIVE We sought to analyze the clinical features, pathogenic agents and skin microbiome of tinea scrotum. METHODS A two-center prospective observational study was carried out in outpatient dermatology clinics in Zhejiang, China, from September 2017 to September 2019. The diagnosis of tinea scrotum was confirmed by direct microscopy. Clinical and mycological data were collected. The composition of microbial communities of patients with tinea scrotum was analyzed and compared with healthy controls. RESULTS A total of 113 patients with tinea scrotum were included. Tinea scrotum was either presented with isolated lesions (9/113, 8.0%) or accompanied by tinea of other sites (104/113, 92.0%). Tinea cruris was detected in 101 cases (89.38%). Fungal culture was positive in 63 cases, among which Trichophyton rubrum was grown in 60 cases (95.2%) and Nannizzia gypsea was cultured in 3 cases (4.8%). The skin microbiome in scrotum lesions from 18 patients showed increased abundance of Trichophyton compared with 18 healthy individuals, while Malassezia was decreased. No significant difference in bacterial diversity was found. CONCLUSIONS Tinea scrotum was often companied by superficial fungal infections of other skin sites, with tinea cruris being the most common condition. Instead of N. gypsea, T. rubrum was the most frequently identified pathogen for tinea scrotum. In general, tinea scrotum exhibited changes in the fungal communities of the skin with increased Trichophyton and decreased Malassezia abundance.
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Affiliation(s)
- Zixiang Si
- Department of Dermatology, Beilun Branch of The First Affiliated Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Juan Bai
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China
| | - Linwei Wei
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China
| | - Honglei Zhao
- Department of Dermatology, Beilun Branch of The First Affiliated Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Songting Wang
- Department of Dermatology, Beilun Branch of The First Affiliated Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Bin Liu
- Department of Dermatology, Beilun Traditional Chinese Medicine Hospital, NingBo, China
| | - Jingjing Xu
- Department of Dermatology, Beilun Branch of The First Affiliated Hospital, Zhejiang University School of Medicine, Ningbo, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.
| | - Zongxin Ling
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, School of Medicine, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
- Institute of Microbe & Host Health, Linyi University, Linyi, China.
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou, China.
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Liu S, Chen W, Cheng F, Ye X, Pan N, Lu H. Clinical characteristics and prognostic factors of 60 patients with acquired immune deficiency syndrome combined with Cryptococcus neoformans. BMC Infect Dis 2023; 23:204. [PMID: 37024795 PMCID: PMC10080839 DOI: 10.1186/s12879-023-08137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE Cryptococcal meningitis (CM) threatens people's health and is the main cause of opportunistic fungus-related death in acquired immune deficiency syndrome (AIDS) patients. Herein, we investigate the clinical characteristics and prognostic factors of AIDS patients with Cryptococcus neoformans in Wenzhou, Zhejiang Province, China. METHODS Our study enrolled AIDS patients diagnosed with Cryptococcus neoformans infection who were hospitalised in our hospital. They were divided into Group A (32 patients with CM) and Group B (28 patients without CM) according to their diagnosis. The differences between the two groups of patients' clinical symptoms, imaging examinations and laboratory examinations were observed. Statistical methods were used to analyse the difference in prognosis between the two groups. RESULTS Headache and fever were the most common clinical characteristics for patients with CM, while respiratory symptoms and fever were the most common clinical characteristics for patients without CM. The positive rate of cryptococcal capsular antigen, India ink staining and culture in the cerebrospinal fluid examination was higher in the CM patients than in the non-CM patients. The overall morbidity and mortality rate after systemic antifungal therapy was higher in the CM patients than in the non-CM patients. A higher incidence of headache, impaired consciousness, nuchal rigidity, first intracranial pressure > 200 mmH2O and mortality was observed in the CM patients than in the non-CM patients. Multifactorial logistic regression analysis showed that headache risk factors affecting the patient's prognosis at 12 weeks. CONCLUSION Patients with AIDS diagnosed with Cryptococcus neoformans infection have insidious clinical symptoms in the early stage, and their manifestation is often non-specific, resulting in poor prognosis and high mortality among CM patients compared to patients without CM. Therefore, early identification and timely antifungal therapy before the disease progresses to meningitis are of great value in improving the survival rate of patients.
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Affiliation(s)
- Saiduo Liu
- Departments of Infectious Disease, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Wei Chen
- Department of Radiology, The 2ed Affiliated Hospital of Wenzhou Medical University, Fuxue Lane, No. 2, Wenzhou, Zhejiang, 325000, China
| | - Fang Cheng
- Departments of Infectious Disease, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Xinchun Ye
- Departments of Infectious Disease, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Ning Pan
- Departments of Infectious Disease, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Hongzhou Lu
- Department of Infectious Disease, The 1st School of Medicine,School of Information and Engineering,The1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
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Huang C, Dong D, Yu F, Ren X, Wu Y, Wang Z, Wang Y. Evaluation of Pharmacokinetics and Safety With Bioequivalence of Voriconazole Injection of 2 Formulations in Chinese Healthy Volunteers: Bioequivalence Study. Clin Pharmacol Drug Dev 2023; 12:542-547. [PMID: 36785899 DOI: 10.1002/cpdd.1218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/13/2022] [Indexed: 02/15/2023]
Abstract
Voriconazole is a first-line medicine for treating invasive aspergillosis. We aimed to evaluate the bioequivalence (BE) of voriconazole injection in Chinese healthy volunteers (HVs). In this single-center, randomized, single-dose, 2-cycle, fasting-dose BE study, HVs (n = 24) were 1:1 divided into 2 groups (test [T]-reference [R] and R-T) and received 6 mg/kg of voriconazole intravenously with a 7-day washout. The plasma was collected for up to 72 hours at the time point after dosing on day 1/day 8. The plasma concentration of voriconazole was measured by liquid chromatography-tandem mass spectrometry. Pharmacokinetic parameters were ascertained on the basis of a noncompartmental model. In the BE study, the geometric mean ratios of the maximum concentration, area under the concentration-time curve from time 0 to the last measurable plasma concentration, and area under the concentration-time curve from time 0 to infinity were 101.1%, 105.6%, and 105.5%, respectively, and the 90%CI fell within 80%-125%. Adverse events were observed in 26.1% of subjects in the T formulation stage and 17.4% in the R formulation stage. Under the BE study, voriconazole values from T and R formulations were bioequivalent.
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Affiliation(s)
- Chunqi Huang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Danqing Dong
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Fei Yu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xueying Ren
- Department of Laboratory Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yi Wu
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhuoyan Wang
- Medical Examination Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ying Wang
- Phase I Clinical Research Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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Salah H, Houbraken J, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Molecular epidemiology of clinical filamentous fungi in Qatar beyond Aspergillus and Fusarium with notes on the rare species. Med Mycol 2023; 61:6967136. [PMID: 36592959 PMCID: PMC9874029 DOI: 10.1093/mmy/myac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Due to an increasing number of patients at risk (i.e., those with a highly compromised immune system and/or receiving aggressive chemotherapy treatment), invasive fungal infections (IFI) are increasingly being reported and associated with high mortality rates. Aspergillus spp., particularly A. fumigatus, is the major cause of IFI caused by filamentous fungi around the world followed by Fusarium spp., however, other fungi are emerging as human pathogens. The aim of this study was to explore the epidemiology and prevalence of the non-Aspergillus and non-Fusarium filamentous fungi in human clinical samples over an 11-year period in Qatar using molecular techniques. We recovered 53 filamentous fungal isolates from patients with various clinical conditions. Most patients were males (75.5%), 9.4% were immunocompromised, 20.7% had IFI, and 11.3% died within 30 days of diagnosis. The fungal isolates were recovered from a variety of clinical samples, including the nasal cavity, wounds, respiratory samples, body fluids, eye, ear, tissue, abscess, and blood specimens. Among the fungi isolated, 49% were dematiaceous fungi, followed by Mucorales (30%), with the latter group Mucorales being the major cause of IFI (5/11, 45.5%). The current study highlights the epidemiology and spectrum of filamentous fungal genera, other than Aspergillus and Fusarium, recovered from human clinical samples in Qatar, excluding superficial infections, which can aid in the surveillance of uncommon and emerging mycoses.
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Affiliation(s)
- Husam Salah
- To whom correspondence should be addressed. Husam Salah, M.Sc. Division
of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical
Corporation, Doha, Qatar, PO Box 3050. Tel: +97-444-391-047. E-mail: ;
| | - Jos Houbraken
- Applied and Industrial Mycology, Westerdijk Fungal Biodiversity
Institute, Utrecht, Netherlands
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute,
Utrecht, Netherlands,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of
Amsterdam, Amsterdam, The
Netherlands
| | | | - Saad J Taj-Aldeen
- Division of Microbiology, Department of Laboratory Medicine and
Pathology, Hamad Medical Corporation, Doha,
Qatar,Department of Biology, College of Science, University of
Babylon, Hilla, Iraq
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30
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Xie P, Wang W, Dong M. A Predictive Model for 30-Day Mortality of Fungemia in ICUs. Infect Drug Resist 2022; 15:7841-7852. [PMID: 36605852 PMCID: PMC9809363 DOI: 10.2147/idr.s389161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/23/2022] [Indexed: 12/31/2022] Open
Abstract
Background Few predictive models have been established to predict the risk of 30-day mortality from fungemia. This study aims to create a nomogram to predict the 30-day mortality of fungemia in ICUs. Methods Data of ICU patients with fungemia from both the Medical Information Mart for Intensive Care (MIMIC-III) database and the Grade-III Class-A hospital in China were collected. The data extracted from the MIMIC-III database functioned as the training dataset, which was used to construct a predictive model for 30-day mortality risk in ICU patients with fungemia; the data from the hospital functioned as the validation dataset, which was used to validate the model. A predictive model for 30-day mortality risk in ICU patients with fungemia was then built based on R software. Such indicators as C-index and calibration curve were utilized to evaluate the prediction ability of the model. Data of ICU patients with fungemia from the hospital were used as a validation dataset to validate the model. Results Predictive models were constructed by age, international normalized ratio (INR), renal failure, liver disease, respiratory rate (RR), glucocorticoid therapy, antifungal therapy, and platelets. The C-index value of the models was 0.838 (95% CI: 0.79096-0.88504). Attested by external validation results, the model has satisfactory predictive ability. Conclusion The 30-day mortality risk predictive model for ICU patients with fungemia constructed in this study has good predictive ability and may hopefully provide a 30-day mortality risk screening tool for ICU patients with fungemia.
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Affiliation(s)
- Peng Xie
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China,Department of Critical Care Medicine, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Wenqiang Wang
- Department of Nursing, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, People’s Republic of China
| | - Maolong Dong
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China,Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China,Correspondence: Maolong Dong, No. 1838, Guangzhou Avenue North Road, Guangzhou, 510515, Guangdong, People’s Republic of China, Tel +86-020-61641888, Fax +86-020-61641888, Email
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Zhong H, Han L, Lu RY, Wang Y. Antifungal and Immunomodulatory Ingredients from Traditional Chinese Medicine. Antibiotics (Basel) 2022; 12:antibiotics12010048. [PMID: 36671249 PMCID: PMC9855100 DOI: 10.3390/antibiotics12010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Fungal infections have become a growing public health challenge due to the clinical transmission of pathogenic fungi. The currently available antifungal drugs leave very limited choices for clinical physicians to deal with such situation, not to mention the long-standing problems of emerging drug resistance, side effects and heavy economic burdens imposed to patients. Therefore, new antifungal drugs are urgently needed. Screening drugs from natural products and using synthetic biology strategies are very promising for antifungal drug development. Chinese medicine is a vast library of natural products of biologically active molecules. According to traditional Chinese medicine (TCM) theory, preparations used to treat fungal diseases usually have antifungal and immunomodulatory functions. This suggests that if antifungal drugs are used in combination with immunomodulatory drugs, better results may be achieved. Studies have shown that the active components of TCM have strong antifungal or immunomodulatory effects and have broad application prospects. In this paper, the latest research progress of antifungal and immunomodulatory components of TCM is reviewed and discussed, hoping to provide inspiration for the design of novel antifungal compounds and to open up new horizons for antifungal treatment strategies.
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Affiliation(s)
- Hua Zhong
- School of Pharmacy, Second Military Medical University, Shanghai 200433, China
| | - Lei Han
- School of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Ren-Yi Lu
- School of Pharmacy, Second Military Medical University, Shanghai 200433, China
| | - Yan Wang
- School of Pharmacy, Second Military Medical University, Shanghai 200433, China
- Correspondence:
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32
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Sha M, Shen C, Tong Y, Xia Q. Cluster of Donor-Derived Cryptococcosis after Liver and Kidney Transplantation. Emerg Infect Dis 2022; 28:2112-2114. [PMID: 36148992 PMCID: PMC9514340 DOI: 10.3201/eid2810.220522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cryptococcosis infection after transplantation is easily overlooked or misdiagnosed. We report a cluster of donor-derived cryptococcosis infection in liver and kidney transplant recipients from the same donor in China. Infections occurred within 1 month after transplantation, and were confirmed by using biopsies and blood tests.
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Li Z, Wang M, Xu T, Zhan Y, Chen F, Lin Y, Li S, Cheng J, Ye F. Development and clinical implications of a novel CRISPR-based diagnostic test for pulmonary Aspergillus fumigatus infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:749-756. [PMID: 34969623 DOI: 10.1016/j.jmii.2021.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Rapid and reliable diagnostic methods for Aspergillus fumigatus infection are urgently needed. Clustered regularly interspaced short palindromic repeat (CRISPR)-associated protein 13a (Cas13a) has high sensitivity and specificity in the diagnosis of viral infection. However, its potential use in detecting A. fumigatus remains unexplored. A highly sensitive and specific method using the CRISPR/Cas13a system was developed for the reliable and rapid detection of A. fumigatus. METHODS The conserved internal transcribed spacer (ITS) region of A. fumigatus was used to design CRISPR-derived RNA (crRNA) and the corresponding recombinase polymerase amplification (RPA) primer sequence with the T7 promoter for the CRISPR assay. Twenty-five clinical isolates and 43 bronchoalveolar lavage fluid (BALF) remaining from routine examinations of patients with confirmed pulmonary aspergillosis were collected to further validate the CRISPR assay. RESULTS No amplification signal was observed when genomic DNA from closely clinically related Aspergillus species, such as Aspergillus flavus, Aspergillus niger, and Aspergillus terreus, as well as Monascus purpureus Went and Escherichia coli, was tested by this assay, and the detection limit for A. fumigatus was 3 copies in a single reaction system. Validation experiments using the 25 clinical isolates demonstrated 91.7% specificity for the A. fumigatus section, and the sensitivity was 100% when first-generation sequencing was used as the standard. There was no significant difference between the PCR and CRISPR methods (P = 1.0), and the diagnosis results of the two methods were consistent (Kappa = 0.459, P = 0.003). CONCLUSION The study offers a new validated CRISPR/Cas13a technique for A. fumigatus detection, providing a simple, rapid and affordable test that is ready for application in the diagnosis of A. fumigatus infection.
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Affiliation(s)
- Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou 510120, China
| | - Mingdie Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou 510120, China
| | - Teng Xu
- Vision Medicals Co. Ltd., Guangzhou 510663, China
| | - Yangqing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou 510120, China
| | - Fengyi Chen
- Vision Medicals Co. Ltd., Guangzhou 510663, China
| | - Ye Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou 510120, China
| | - Shaoqiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou 510120, China
| | - Jing Cheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou 510120, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou 510120, China.
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Song G, Zhang M, Liu W, Liang G. Epidemiology of Onychomycosis in Chinese Mainland: A 30-year Retrospective Study. Mycopathologia 2022; 187:323-331. [PMID: 35819711 DOI: 10.1007/s11046-022-00647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis was a common nail disease caused by dermatophytes, yeasts or molds. The prevalence of onychomycosis varied in different counties and it was necessary to understand the epidemiology in China. OBJECTIVES This study was conducted to investigate the epidemiology of onychomycosis in Chinese mainland in the past 30 years. METHODS A 30-year systemic review was carried out by searching publications investigating the prevalence of onychomycosis in Chinese mainland from 1991 to 2020. RESULTS A total of 90 articles involving more than 40,000 onychomycosis patients were enrolled in this study. The ratio of males to females was 1:1.32. Fingernail onychomycosis was found in 36.12% cases, toenail onychomycosis in 48.31%, and both fingernail and toenail onychomycosis in 15.57%. The most common clinical type of onychomycosis was distal lateral subungual onychomycosis (60.99%), followed by total dystrophic onychomycosis (18.91%), proximal subungual onychomycosis (10.19%) and superficial white onychomycosis (9.92%). Dermatophytes (60.59%) were the most frequently isolated pathogens, followed by yeasts (30.09%), molds (7.91%) and mixed infection (1.41%). The primary pathogens in dermatophytes, yeasts and molds were Trichophyton rubrum (49.93%), Candida albicans (10.99%) and Aspergillus (3.11%), respectively. Additionally, dermatophytes were more commonly affected males than females (63.69% vs. 51.57%), and mostly involved in toenail onychomycosis (75.63%). The infection of yeasts was higher in females than males (40.97% vs. 29.52%), often causing onychomycosis in fingernail than toenail (41.03% vs. 17.08%), and it was more common in warm and humid southern regions than northern area (34.07% vs. 24.41%). CONCLUSION The proportion of the causative agents changed over time, dermatophytes, especially T. rubrum had always been the predominant pathogen, followed by yeasts and molds. The distribution of fungal pathogens varied among clinical types, gender, infection sites and geography gender.
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Affiliation(s)
- Ge Song
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Meijie Zhang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China. .,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China. .,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China. .,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China. .,CAMS Collection Center of Pathogen Microorganisms-D (CAMS-CCPM-D), Nanjing, 210042, China. .,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
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Clinical Diagnosis, Treatment, and Laboratory Detection of 50 Cases of Pulmonary Cryptococcosis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7981472. [PMID: 35924106 PMCID: PMC9343196 DOI: 10.1155/2022/7981472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022]
Abstract
Objective This study retrospectively analyzed the clinical diagnosis, treatment process, and laboratory test data of patients with pulmonary cryptococcosis to improve the understanding and diagnosis and treatment ability of the disease. Methods Patients with pulmonary cryptococcosis diagnosed in the First Affiliated Hospital of Dalian Medical University from October 2003 to July 2021 were selected, and their medical records were consulted. The general data, clinical manifestations, laboratory examinations, imaging characteristics, diagnosis, and treatment methods were studied. The software SPSS 22 was used for statistical analysis. Results A total of 50 patients with pulmonary cryptococcosis were included in the study. The ratio of male to female was 1 : 1. The average age was 53.56 ± 11.99 years with a range of 27-82 years. Grouping the patients by age, with 10 years as an age group, we found that 40-60 years was the high-incidence age group. Two patients (4%) had a history of bird contact, and 18 patients (36%) had at least one underlying conditions. Hypertension and cough were the most common underlying condition and clinical manifestation, respectively. The main admission diagnoses were lung shadow (19/50, 38%) and chest/lung mass (15/50, 30%). In the imaging findings, the most common type of lesions was nodule/nodule shadow (29/69, 42.03%). Lesion distribution in the lower lobe, single lobe, and right lung was more frequent than that in the upper lobe, multilobes, and left lung, respectively. Burr sign (12/43, 27.91%) was the most common concomitant sign. Pulmonary ventilatory defect was found in 7 cases. Laboratory test results were largely nonspecific. The pathological examination showed granuloma, with 47 cases (94%) confirmed by postoperative biopsy. Two cases (4%) were confirmed by serology. One case (2%) was diagnosed with Cryptococcus smear. 43 cases (86%) were treated with simple surgical resection, 6 cases (12%) were treated with antifungal drugs, and 1 case (2%) was transferred to another hospital for suspicion of pulmonary tuberculosis. Conclusions Pulmonary cryptococcosis is more common in the middle-aged and elderly, and the clinical specificity is low. It can occur in people with normal or impaired immune function. The main clinical and imaging manifestation is cough and pulmonary nodules, which are very easy 5to be misdiagnosed. Surgical resection is the primary treatment.
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Zhou Z, Zhu C, Ip M, Liu M, Zhu Z, Liu R, Li X, Zeng L, Wu W. Molecular Epidemiology and Antifungal Resistance of Cryptococcus neoformans From Human Immunodeficiency Virus-Negative and Human Immunodeficiency Virus-Positive Patients in Eastern China. Front Microbiol 2022; 13:942940. [PMID: 35865921 PMCID: PMC9294546 DOI: 10.3389/fmicb.2022.942940] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Cryptococcosis is an opportunistic and potentially lethal infection caused by Cryptococcus neoformans and Cryptococcus gattii complex, which affects both immunocompromised and immunocompetent people, and it has become a major public health concern worldwide. In this study, we characterized the molecular epidemiology and antifungal susceptibility of 133 C. neoformans isolates from East China Invasive Fungal Infection Group (ECIFIG), 2017–2020. Isolates were identified to species level by matrix-assisted laser desorption ionization-time of flight mass spectrometry and confirmed by IGS1 sequencing. Whole-genome sequencing (WGS) was conducted on three multidrug-resistant isolates. Among the 133 strains, 61 (45.86%) were isolated from HIV-positive patients and 72 (54.16%) were isolated from HIV-negative patients. In total, C. neoformans var. grubii accounted for 97.74% (130/133), while C. neoformans var. neoformans was rare (2.06%, 3/133). The strains were further classified into nine sequence types (STs) dominated by ST5 (90.23%, 120/133) with low genetic diversity. No association was observed between STs and HIV status. All strains were wild type to voriconazole, while high antifungal minimal inhibitory concentrations (MICs) above the epidemiological cutoff values (ECVs) were observed in C. neoformans strains, and more than half of isolates were non-wild-type to amphotericin B (89.15%, 109/133). Eight isolates were resistant to fluconazole, and eight isolates were non-wild type to 5-fluorocytosine. Furthermore, WGS has verified the novel mutations of FUR1 in 5-fluorocytosine-resistant strains. In one isolate, aneuploidy of chromosome 1 with G484S mutation of ERG11 was observed, inducing high-level resistance (MIC: 32 μg/ml) to fluconazole. In general, our data showed that there was no significant difference between HIV-positive and HIV-negative patients on STs, and we elucidate the resistant mechanisms of C. neoformans from different perspectives. It is important for clinical therapy and drug usage in the future.
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Affiliation(s)
- Ziyi Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chendi Zhu
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Manjiao Liu
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Zhaoqin Zhu
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Ryon Liu
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Xiaomin Li
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Lingbing Zeng
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Lingbing Zeng,
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Wenjuan Wu,
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Guo X, Mao X, Tian D, Liao Y, Su B, Ye C, Shi D, Liu TF, Ling Y, Hao Y. Cryptococcus neoformans Infection Induces IL-17 Production by Promoting STAT3 Phosphorylation in CD4 + T Cells. Front Immunol 2022; 13:872286. [PMID: 35720334 PMCID: PMC9197778 DOI: 10.3389/fimmu.2022.872286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/14/2022] [Indexed: 12/02/2022] Open
Abstract
Cryptococcus neoformans infection in the central nervous system is a severe infectious disease with poor outcomes and high mortality. It has been estimated that there are 220,000 new cases each year. Over 90% of C. neoformans meningitis cases were diagnosed in AIDS patients with CD4+ T cell count <100 cells/μl; however, the mechanism of cryptococcal meningitis in patients with normal immune functions remains unclear. IL-17 is a pro-inflammatory cytokine and plays an important role in anti-fungal immunity. Here we report that significantly high levels of IL-17 were predominantly detected in the cerebrospinal fluid of patients with either AIDS- or non-AIDS-associated C. neoformans meningitis but not in patients with tuberculous meningitis or non-neurosyphilis. Antifungal therapy minimized the IL-17 level in the cerebrospinal fluid. An in vitro mechanistic study showed that C. neoformans stimulation of healthy peripheral blood mononuclear cells prompted IL-17 production, and CD4+ T cells were the predominant IL-17-producing cells. IL-17 production by C. neoformans stimulation was STAT3 signaling dependent. Inhibition of STAT3 phosphorylation attenuated the C. neoformans-mediated IL-17 expression. Our data highlighted the significance of CD4+ T cells in antifungal immunity and suggested IL-17 as a diagnostic biomarker of C. neoformans infection and STAT3 as a checkpoint for antifungal targeted therapies.
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Affiliation(s)
- Xiaoman Guo
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinru Mao
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Tian
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yixin Liao
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Bintao Su
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Laboratory Medicine, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaoliang Ye
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongling Shi
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Tie Fu Liu
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yun Ling
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yi Hao
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen M, Al-Hatmi AMS, Xu J, De Hoog GS. Editorial: Molecular Epidemiology of Fungal Infections. Front Cell Infect Microbiol 2022; 12:939140. [PMID: 35711661 PMCID: PMC9195173 DOI: 10.3389/fcimb.2022.939140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Min Chen
- Department of Dermatology, Shanghai Key Laboratory of Medical Mycology, Changzheng Hospital, Shanghai, China
| | - Abdullah M. S. Al-Hatmi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
- Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Jianping Xu
- Department of Biology, McMaster University, Hamilton, ON, Canada
- *Correspondence: G. Sybren De Hoog, ; Jianping Xu,
| | - G. Sybren De Hoog
- Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
- *Correspondence: G. Sybren De Hoog, ; Jianping Xu,
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Wu HN, Yuan EY, Li WB, Peng M, Zhang QY, Xie KL. Microbiological and Clinical Characteristics of Bloodstream Infections in General Intensive Care Unit: A Retrospective Study. Front Med (Lausanne) 2022; 9:876207. [PMID: 35573022 PMCID: PMC9097869 DOI: 10.3389/fmed.2022.876207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 12/29/2022] Open
Abstract
Background Bloodstream infections (BSI) are one of the common causes of morbidity and mortality in hospitals; however, the pathogenic spectrum and bacterial antibiotic resistance vary across the world. Therefore, identifying the pathogenic spectrum and changes in bacterial antibiotic resistance is critical in controlling BSI and preventing the irrational use of antibiotics. This study evaluated the microbiological and clinical data of BSI patients in the intensive care unit (ICU) of Tianjin Medical University General Hospital in Tianjin, China, to guide the selection of empirical antibiotic therapy. Methods This study retrospectively analyzed the distribution and antibiotic resistance of pathogens based on the clinical data of BSI patients presented in the ICU of a tertiary teaching hospital from 2018 to 2020. Test performance for the prediction of pathogen species was assessed by receiver operating characteristic (ROC) analysis. Results The analysis of the data of 382 BSI cases (10.40 cases per thousand patient day) revealed the most frequently isolated microorganisms to be Klebsiella pneumonia (11.52%), followed by Escherichia coli (9.95%), Staphylococcus epidermidis (9.95%), Candida parapsilosis (8.12%), and Enterococcus faecium (8.12%). Out of the isolated E. coli and K. pneumonia strains, 52.63, and 36.36%, respectively, were extended-spectrum β-lactamase (ESBL) positive. The antibiotic-resistance rate of the ESBL-positive strains was 30.56% for piperacillin/tazobactam, 5.56% for imipenem, and 11.11% for tigecycline. In addition, most A. baumannii belonged to the group of multidrug-resistant (MDR) strains, with an antibiotic-resistance rate of 90.48% for meropenem and 16.00% for amikacin. However, polymyxin-resistant A. baumannii strains were not detected. Four strains of methicillin-resistant S. aureus (MRSA) (4/21, 19.05%) and one strain of vancomycin-resistant enterococci (VRE) were detected, with a resistance rate of 4.76 and 2.32%, respectively. Among the isolated 55 fungal strains, C. parapsilosis was the most common one (30/55, 56.36%), with an antibiotic-resistance rate of 5.77% for voriconazole, fluconazole, and itraconazole. The presence of amphotericin B-or flucytosine-resistant strains was not observed. Compared with the patients with Gram-positive and fungal pathogens, patients with Gram-negative bacteria exhibited the highest sequential organ failure assessment (SOFA) score (P < 0.001), lowest Glasgow Coma Scale (GCS) (P = 0.010), lowest platelet (PLT) value (P < 0.001), highest plasma creatinine (Cr) value (P = 0.016), and the highest procalcitonin (PCT) value (P < 0.001). The AUC in the ROC curve was 0.698 for the differentiation of Gram-negative BSI from Gram-positive BSI. A cutoff value of 8.47 ng/mL for PCT indicated a sensitivity of 56.9% and a specificity of 75.5%. The AUC in the ROC curve was 0.612 for the differentiation of bacteremia from fungemia. A cutoff value of 4.19 ng/mL for PCT indicated a sensitivity of 56.8% and a specificity of 62.7%. Conclusion Among the bloodstream infection strains in ICU, Gram-negative bacteria have the highest drug resistance rate, and will cause more serious brain damage, renal function damage and thrombocytopenia. So clinician should pay more attention to the treatment of Gram-negative bacteria in patients with bloodstream infection in ICU. The test index of PCT can be used to distinguish Gram-negative bacteremia from Gram-positive and bacteremia from fungemia but not as an effective indicator, thereby indicating the need for further large-scale research.
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Affiliation(s)
- He-Ning Wu
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Er-Yan Yuan
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Wen-Bin Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.,Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Peng
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing-Yu Zhang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin, China
| | - Ke-Liang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China.,Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
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Mo Z, Li C, Liang Z, Cui J, Yu L, Chen L. Clinical analysis of non-AIDS patients with pulmonary cryptococcosis and the change in their clinical features over 30 years in a tertiary hospital in Beijing, China. Jpn J Infect Dis 2022; 75:476-483. [PMID: 35491232 DOI: 10.7883/yoken.jjid.2022.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Chunsun Li
- Department of Pulmonary and Critical Care Medicine, the Eighth Medical Centre, Chinese PLA General Hospital, China
| | - Zhixin Liang
- Department of Pulmonary and Critical Care Medicine, the Eighth Medical Centre, Chinese PLA General Hospital, China
| | - Jiewei Cui
- Department of Pulmonary and Critical Care Medicine, the Eighth Medical Centre, Chinese PLA General Hospital, China
| | - Ling Yu
- Department of Pulmonary and Critical Care Medicine, the Eighth Medical Centre, Chinese PLA General Hospital, China
| | - Liangan Chen
- Department of Pulmonary and Critical Care Medicine, the Eighth Medical Centre, Chinese PLA General Hospital, China
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Wang Y, Zhang L, Zhou L, Zhang M, Xu Y. Epidemiology, Drug Susceptibility, and Clinical Risk Factors in Patients With Invasive Aspergillosis. Front Public Health 2022; 10:835092. [PMID: 35493371 PMCID: PMC9051236 DOI: 10.3389/fpubh.2022.835092] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study aimed to investigate the Aspergillus species distribution, antifungal sensitivities, clinical characteristics, and risk factors of patients with invasive aspergillosis (IA) in a tertiary teaching hospital in Anhui Province.MethodsIn the present study, 156 Aspergillus isolates were collected from patients admitted to a 2,800-bed comprehensive hospital between January 2019 and April 2021. The epidemiology of Aspergillus species was well-examined, and its antifungal susceptibility was specifically measured by the microbroth dilution method. The risk factors of patients with IA were documented and analyzed intensively. In addition, gene sequencing was employed to determine gene mutations of cytochrome P450 14-α sterol demethylase-Aspergillus (cyp51A) associated with azole resistance among Aspergillus fumigatus.ResultsThe Aspergillus species distribution was dominated by A. fumigatus (56.41%), Aspergillus flavus (20.51%), and Aspergillus niger (15.38%) locally. In particular, all Aspergillus species showed very low minimum inhibitory concentrations (MICs, ≤ 0.5 μg/ml) for azoles and echinocandins, slightly high MICs (1.66–2.91 μg/ml) for amphotericin B, and exceptionally high MICs (>64 μg/ml) for flucytosine. Azole-resistant rate of Aspergillus species in this local region reached up to 5.79%. Correlation analyses of multiple antifungals indicate a significant MIC relevance between isavuconazole and voriconazole (Pearson correlation coefficient was 0.81, P < 0.0001). The clinical risk factors for patients with IA were found primarily to be pulmonary diseases (P = 0.007) and patients' age (P < 0.001). Notably, three mutant loci (TR46/Y121F/T289A) of the cyp51A gene were identified in azole-resistant A. fumigatus.ConclusionsThe Aspergillus species emerged increasingly, of which A. fumigatus and A. flavus remained the main pathogens for invasive Aspergillus infections in the local region. The vast majority of Aspergillus species exhibited good susceptibility to all the antifungals, except flucytosine. The local occurrence of azole-resistant Aspergillus species grew gradually and needed monitoring in time. Pulmonary diseases and age were likely considered as highly associated risk factors for IA. To our knowledge, the clinically isolated azole-resistant A. fumigatus with TR46/Y121F/T289A mutations identified here were rarely reported in the area of China.
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Chen Y, Wu Y, Lulou K, Yao D, Ying C. Multilocus Sequence Typing and Antifungal Susceptibility of Vaginal and Non-vaginal Candida glabrata Isolates From China. Front Microbiol 2022; 13:808890. [PMID: 35369470 PMCID: PMC8969424 DOI: 10.3389/fmicb.2022.808890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022] Open
Abstract
Candida glabrata is a common cause of Candida infections. In our present study, we investigated the antifungal susceptibility and molecular epidemiology of vaginal and non-vaginal C. glabrata isolates. Seventy-six vaginal C. glabrata strains isolated from patients with vulvovaginal candidiasis and 57 non-vaginal C. glabrata isolates were collected at two hospitals in Shanghai, China. Antifungal susceptibility was examined using a broth microdilution method. Multilocus sequence typing was used for genotyping. Overall, 28 (21.1%), 28 (21.1%), and 29 (21.8%) C. glabrata isolates were resistant to fluconazole, itraconazole, and voriconazole, respectively. Briefly, 18 (23.7%), 18 (23.7%), and 19 (25%) vaginal strains were resistant to fluconazole, itraconazole, and voriconazole. While the resistance to these antifungals were all 17.5% (10/57) in non-vaginal strains. All isolates retained susceptibility to amphotericin B, and only four non-vaginal isolates were caspofungin resistant. Genotyping identified 17 ST patterns. In non-vaginal samples, the same genotypes appear as in the vaginal samples, except for one genotype (ST-182), while in the vaginal samples more genotypes appear (ST8, ST19, ST45, ST55, ST66, ST80, ST138, and ST17). The most common genotype was ST7 (81 strains), followed by ST10 (14 strains) and ST15 (11 strains). The majority of resistant phenotype strains (25/30, 83.3%) correlated to the predominant genotype (ST7), and the rest belonged to ST3 (2/30, 6.7%), ST10 (1/30, 3.3%), ST19 (1/30, 3.3%), and ST45 (1/30, 3.3%). Our survey revealed cross-resistance in vaginal and non-vaginal C. glabrata isolates. Moreover, there is no genotype associated with the resistance phenotype.
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Affiliation(s)
- Yisheng Chen
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yongqin Wu
- Division of Life Sciences and Medicine, Department of Clinical Laboratory, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Kaiyi Lulou
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Dongting Yao
- Department of Laboratory Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chunmei Ying
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Qiu S, Chen C, Li Y, Li C, Tang Z, Liao Y, Deng D, Zhong L. Pulmonary cryptococcosis misdiagnosed as lung cancer in a man with normal immune function: A case report. Radiol Case Rep 2022; 17:1185-1189. [PMID: 35169425 PMCID: PMC8829501 DOI: 10.1016/j.radcr.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 11/22/2022] Open
Abstract
Pulmonary cryptococcosis is an opportunistic infection of cryptococcus both in immunocompetent and immunocompromised patients, who suffered from HIV infection, organ transplantation, diabetes mellitus, corticosteroid or immunosuppressive therapy, and malignancy. Pulmonary cryptococcosis is the commonest location of non-central nervous system cryptococcosis and usually presents with nonspecific symptoms. It often shows shadows on the lung, which makes it difficult to distinguish it from lung cancer. Here we report a case of a 52-year-old man with pulmonary cryptococcosis, who was misdiagnosed as lung cancer. Clinicians need to consider the possibility of pulmonary cryptococcosis and the importance of lung biopsy when treating a patient with a normal immune function that has isolated pulmonary nodules. This case also indirectly illustrates the importance of percutaneous lung biopsy in patients with isolated pulmonary nodules.
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Wei S, Wang H, Li A, Yuan C. Kerion Celsi caused by Microsporum gypseum in a Chinese child, a case report. Medicine (Baltimore) 2022; 101:e28936. [PMID: 35421059 PMCID: PMC9276258 DOI: 10.1097/md.0000000000028936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Kerion Celsi, a severe form of tinea capitis, is generally caused by zoophilic and geophilic fungi. This is the first report of an unusual case of kerion Celsi caused by Microsporum gypseum in a 6-year-old boy. PATIENT CONCERNS A 6-year-old boy presented to the dermatology clinic with the complaint of multiple pustules, edematous plaques over the scalp with hair loss for 1 month. DIAGNOSIS Clinical and laboratory investigations, including reverse transcriptase-quantitative polymerase chain reaction, confirmed M gypseum causing kerion Celsi. INTERVENTIONS Upon combination therapy using oral itraconazole and oral prednisolone along with the topical terbinafine, kerion Celsi remitted in the patient. OUTCOME New hair growth was noted during the 4-month follow-up. LESSON We presented the first case of kerion Celsi infection secondary to M gypseum that was probably transmitted from a guinea pig.
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Prasong W, Matthapan L, Lertrujiwanit K, Supcharoenkul S, Ongsri P, Kiratiwongwan R, Leeyaphan C, Bunyaratavej S. In Vitro Antifungal Activity of Plain Socks and Zinc Oxide Nanoparticle-Coated Socks. J Am Podiatr Med Assoc 2022; 112:20-134. [PMID: 36459108 DOI: 10.7547/20-134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fungal foot infection is a common superficial fungal infection and is recognized as an important public health problem. Related to the wearing of occlusive footwear, foot infection is usually caused by dermatophytes and nondermatophyte molds. Previous in vitro studies have demonstrated that zinc oxide nanoparticles (ZnO-NPs) have antimicrobial activity against fungi. This study, therefore, evaluated the ability of socks coated with ZnO-NPs to inhibit fungal growth in an in vitro model mimicking real-life situations. METHODS Scale from patients with fungal foot infections was equally divided into three groups: control, plain socks, and ZnO-NP socks. The specimens in the control group were routinely fungal cultured, whereas in the plain sock and ZnO-NP sock groups, scale was incubated with plain socks and ZnO-NP socks, respectively, for 24 hours. After incubation, each piece of sock was cultured. The fungal culture results of the three groups were progressively evaluated for 4 weeks. RESULTS From 31 specimens, the positive fungal culture results of the control, plain sock, and ZnO-NP sock groups were 100%, 64.5%, and 54.8%, respectively. Specimens incubated with plain socks (P = .001) or with ZnO-NP socks (P < .001) had a significant reduction in the number of positive fungal cultures compared with the control. CONCLUSIONS Plain socks and ZnO-NP socks significantly inhibited fungal growth relative to the control. The wearing of either plain socks or ZnO-NP socks can prevent fungal foot infection because these socks act as a barrier to the insoles of shoes.
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Affiliation(s)
- Waranyoo Prasong
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lalita Matthapan
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kamonpan Lertrujiwanit
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Salisa Supcharoenkul
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Punyawee Ongsri
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungsima Kiratiwongwan
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charussri Leeyaphan
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sumanas Bunyaratavej
- *Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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46
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Song G, Zhang M, Liu W, Liang G. The Changing Face of Epidemiology of Dermatophytoses in Chinese Mainland: A 30 years Nationwide Retrospective Study from 1991 to 2020. Mycoses 2022; 65:440-448. [PMID: 35102623 DOI: 10.1111/myc.13425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatophytoses are the most common infectious skin disease. Its epidemiology varies in different countries and regions, and its prevalence in China is still unknown. OBJECTIVES We aimed to reveal the epidemiological features of dermatophytoses in Chinese mainland in the past thirty years. METHODS From 1991 to 2020, a 30-year retrospective epidemiological study was carried out. All published literatures containing dermatophytoses and dermatophytes were collected and analyzed. RESULTS A total of more than 180,000 cases in 124 articles from more than 100 hospitals were included and analyzed. Among dermatophytoses, tinea cruris (24.92%) was the predominant clinical type, followed by tinea pedis (22.97%) and tinea corporis (18.12%). In recent 10 years, tinea pedis (25.40%) was more common than tinea cruris (22.39%) and became the most common infection. Among dermatophytes, T. rubrum (69.48%) has always been the most common isolates, followed by T. mentagrophytes (16.45%) and M. canis (8.09%). Other species were found below 3%. In superficial mycoses, dermatophytes accounted for 75.52%, higher than that of yeasts/yeast-like (21.83%) and molds (2.65%). The prevalence of tinea capitis was lower in economically developed eastern region than that in central and western regions. Tinea cruris was more common in warm zones than cold zones. CONCLUSIONS The top three dermatophytoses are tinea cruris, tinea pedis and tinea corporis, while the top three dermatophytes are T. rubrum, T. mentagrophytes and M. canis. The distribution of dermatophytoses may be influenced by socioeconomic status and geographical-meteorological conditions.
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Affiliation(s)
- Ge Song
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Meijie Zhang
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, 210042, China.,Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
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47
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Xing XW, Yu SF, Zhang JT, Tan RS, Ma YB, Tian X, Wang RF, Yao GE, Cui F, Gui QP, Yu SY. Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid for the Diagnosis of Cerebral Aspergillosis. Front Microbiol 2022; 12:787863. [PMID: 35003020 PMCID: PMC8740169 DOI: 10.3389/fmicb.2021.787863] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose: Cerebral aspergillosis (CA) is a rare but often fatal, difficult-to-diagnose, opportunistic infection. The utility of metagenomic next-generation sequencing (mNGS) for diagnosis of CA is unclear. We evaluated the usefulness of mNGS of the cerebrospinal fluid (CSF) for the diagnosis of CA. Methods: This prospective study involved seven consecutive patients with confirmed CA in whom CSF mNGS was performed. Serum (1→3)-β-D-glucan and galactomannan levels were determined, and histopathological examination and mNGS of the CSF were conducted. CSF specimens from three non-infected patients were used as positive controls. Results: mNGS of the CSF was positive in six of the seven confirmed CA cases (85.71% sensitivity). In the cryptococcal meningitis group (control), mNGS of the CSF was positive for Aspergillus in two patients (84.62% specificity). The positive likelihood ratio, negative likelihood ratio, and Youden's index of mNGS for CA in the CSF were 5.565, 0.169, and 0.7, respectively. Among the six mNGS-positive cases, more than two Aspergillus species were found in four (4/6, 66.67%). In the positive controls, the addition of one A. fumigatus spore yielded a standardised species-specific read number (SDSSRN) of 25.45 by mNGS; the detection rate would be 0.98 if SDSSRN was 2. Conclusion: mNGS facilitates the diagnosis of CA and may reduce the need for cerebral biopsy in patients with suspected CA. Trial Registration Number: Chinese Clinical Trial Registry, ChiCTR1800020442.
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Affiliation(s)
- Xiao-Wei Xing
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Su-Fei Yu
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Jia-Tang Zhang
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
| | | | - Yu-Bao Ma
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xia Tian
- Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rong-Fei Wang
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guo-En Yao
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fang Cui
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Qiu-Ping Gui
- Department of Pathology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Sheng-Yuan Yu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
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48
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Tong X, Liu T, Jiang K, Wang D, Liu S, Wang Y, Fan H. Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study. Front Med (Lausanne) 2022; 8:756237. [PMID: 35004724 PMCID: PMC8733578 DOI: 10.3389/fmed.2021.756237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023] Open
Abstract
Background: The mortality and burden of medical costs associated with invasive pulmonary aspergillosis (IPA) is very high. Currently, the clinical features and prognostic factors of patients with proven IPA are not very clear, especially in the Chinese population. In this retrospective analysis, we aimed to identify the clinical features and prognostic factors of patients with proven IPA. Methods: The diagnostic criteria for proven IPA were based on the international consensus of the EORTC/MSG. Data of patients with proven IPA at the West China Hospital of Sichuan University between January 2012 and December 2018 were collected. The optimal cut-off value of continuous variables was determined by Receiver Operating Characteristic curve and maximum Youden's index. Finally, using the Cox regression analysis to identify correlations between the clinical parameters associated with morbidity. Results: A total of 117 patients with proven IPA were included in the study, and 32 (27.4%) patients died during the follow-up period. Compared with the survivor group, elderly, patients with comorbidities, and patients undergoing chemotherapy and the level of inflammatory biomarkers [erythrocyte sedimentation rate, platelet count, interleukin-6, C-reactive protein (CRP)] in the non-survivor group were higher, while the albumin level was lower (P = 0.018). The imaging features were consolidation, nodules, cavities, pleural effusion, ground-glass shadows, and halo signs in order. Overall, 41.0% patients had mixed imaging features. The results suggested the most appropriate cut-off value of age and CRP were 60 years and 14.1 mg/L, respectively. The multivariate Cox regression analysis suggested that advanced age (>60 years) [hazard ratio (HR): 10.7, confidence interval (CI): 2.5-44.9, P < 0.001), undergoing chemotherapy (HR: 9.5, CI: 2.7-32.9, P < 0.001), presence of pleural effusion (HR: 5.74, CI: 1.6-20.8, P = 0.008), and increased CRP levels (>14.1 mg/L) (HR: 6.3, CI: 1.2-34.3, P = 0.033) were risk factors for all-cause mortality in patients with proven aspergillosis. Conclusions: This study showed that the prognosis of proven IPA is poor, and the age >60 years, undergoing chemotherapy, pleural effusion on CT image, and CRP levels >14.1 mg/L may be as risk factors for mortality in patients with proven IPA. large samples and real-world studies are needed to confirm these results in the future.
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Affiliation(s)
- Xiang Tong
- Department of Respiratory Medicine and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Tao Liu
- Department of Respiratory Medicine and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Kexin Jiang
- Clinical Medicine of Eight-Year Program, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Dongguang Wang
- Department of Respiratory Medicine and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Sitong Liu
- Department of Respiratory Medicine and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Ye Wang
- Department of Respiratory Medicine and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Hong Fan
- Department of Respiratory Medicine and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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49
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Zhang M, Zhou Z, Wang D, Zhou A, Song G, Chen X, Guo J, Wu W. OUP accepted manuscript. Med Mycol 2022; 60:6517704. [PMID: 35099022 DOI: 10.1093/mmy/myac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Min Zhang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Ziyi Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Dongjiang Wang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Aiping Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Guobin Song
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Xingchun Chen
- Department of Clinical Laboratory, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 530021, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jian Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
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50
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Liu X, Zhang F, Lou H, Luo H, Peng C, Zhu S, Zhou B. Guanidinium‐Based Ionic Covalent Organic Porous Polymer as Natamycin Delivery Agents for
Anti‐Candida albicans. ChemistrySelect 2021. [DOI: 10.1002/slct.202102517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Xia Liu
- Department of Ophthalmology Affiliated Hospital of Weifang Medical College Weifang 261053 Shandong P. R. China
- School of Pharmacy Weifang Medical University Weifang 261053 Shandong P. R. China
| | - Fang Zhang
- School of Pharmacy Weifang Medical University Weifang 261053 Shandong P. R. China
| | - Han Lou
- School of Clinical Medicine Weifang Medical University Weifang 261053 Shandong P. R. China
| | - Haotian Luo
- School of Pharmacy Weifang Medical University Weifang 261053 Shandong P. R. China
| | - Cheng Peng
- Department of Ophthalmology Affiliated Hospital of Weifang Medical College Weifang 261053 Shandong P. R. China
| | - Shourong Zhu
- Department of Ophthalmology Affiliated Hospital of Weifang Medical College Weifang 261053 Shandong P. R. China
| | - Baolong Zhou
- School of Pharmacy Weifang Medical University Weifang 261053 Shandong P. R. China
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