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Dladla M, Gyzenhout M, Marias G, Ghosh S. Azole resistance in Aspergillus fumigatus- comprehensive review. Arch Microbiol 2024; 206:305. [PMID: 38878211 DOI: 10.1007/s00203-024-04026-z] [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: 05/02/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
Aspergillus fumigatus is a ubiquitous filamentous fungus commonly found in the environment. It is also an opportunistic human pathogen known to cause a range of respiratory infections, such as invasive aspergillosis, particularly in immunocompromised individuals. Azole antifungal agents are widely used for the treatment and prophylaxis of Aspergillus infections due to their efficacy and tolerability. However, the emergence of azole resistance in A. fumigatus has become a major concern in recent years due to their association with increased treatment failures and mortality rates. The development of azole resistance in A. fumigatus can occur through both acquired and intrinsic mechanisms. Acquired resistance typically arises from mutations in the target enzyme, lanosterol 14-α-demethylase (Cyp51A), reduces the affinity of azole antifungal agents for the enzyme, rendering them less effective, while intrinsic resistance refers to a natural resistance of certain A. fumigatus isolates to azole antifungals due to inherent genetic characteristics. The current review aims to provide a comprehensive overview of azole antifungal resistance in A. fumigatus, discusses underlying resistance mechanisms, including alterations in the target enzyme, Cyp51A, and the involvement of efflux pumps in drug efflux. Impact of azole fungicide uses in the environment and the spread of resistant strains is also explored.
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Affiliation(s)
- Mthokozisi Dladla
- Department of Genetics, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, 9301, South Africa
| | - Marieka Gyzenhout
- Department of Genetics, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, 9301, South Africa.
| | - Gert Marias
- Department of Plant Sciences, Division of Plant Pathology, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Soumya Ghosh
- Department of Genetics, Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, 9301, South Africa.
- Natural and Medical Sciences Research Center, University of Nizwa, Nizwa 616, Birkat Al Mawz, Oman.
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Vo AB, Thai TT, Pham DL, Pham HK. Manifestation and associated factors of systemic and local allergy among patients with allergic fungal rhinosinusitis: An observational study. Medicine (Baltimore) 2024; 103:e38084. [PMID: 38728514 PMCID: PMC11081618 DOI: 10.1097/md.0000000000038084] [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: 01/15/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis, characterized by excessive immune responses to environmental molds or fungi. The diagnosis and classification of AFRS into systemic and local types remain clinically challenging due to overlapping characteristics. This study investigated the prevalence of AFRS, its manifestation and associated factors in systemic and local AFRS. A total of 200 patients diagnosed with fungal rhinosinusitis underwent both skin provocation tests (SPT) and nasal provocation tests (NPT) to confirm AFRS and classify systemic and local types. Patients were considered to have AFRS if either the SPT or NPT was positive. Among these, patients with systemic AFRS were those who had a SPT positive. Local AFRS was when patients had a negative SPT and a positive NPT. Medical history, serum total IgE level, nasal endoscopy examinations, and CT scans were also recorded. Most patients were female (65.8%), with a mean age of 55.6 years (SD = 14.4). Based on the SPT and NPT results, 31% of patients (n = 62) were diagnosed with AFRS. Among these, 54.8% (n = 34) had systemic AFRS, while 45.2% (n = 28) had local AFRS. Patients with AFRS exhibited significantly higher levels of total IgE, eosinophils, and more pronounced signs and symptoms compared to those without AFRS. However, no statistically significant differences were observed between patients with systemic AFRS and those with local AFRS. AFRS was prevalent in our study. Among patients with AFRS, both systemic AFRS and local AFRS were also prevalent. While allergic indicators and clinical presentations can aid in AFRS diagnosis, minimal distinctions were observed between systemic and local AFRS. A comprehensive assessment incorporating both local and systemic allergic responses through provocation tests, such as a combination of skin and nasal tests, is imperative for optimizing AFRS diagnosis and management.
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Affiliation(s)
- An Binh Vo
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Truc Thanh Thai
- Department of Medical Statistics and Informatics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Duy Le Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Huu Kien Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Lambor S, Varughese KM, Naik A, Lambor DV, Tiwari M, De Sa CJA. A Retrospective Analysis of Clinicopathological Features in 117 Isolated Maxillary Sinus Pathologies in a Tertiary Care Hospital. Indian J Otolaryngol Head Neck Surg 2024; 76:1931-1940. [PMID: 38566682 PMCID: PMC10982275 DOI: 10.1007/s12070-023-04446-1] [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: 11/05/2023] [Accepted: 12/13/2023] [Indexed: 04/04/2024] Open
Abstract
Diagnosis of maxillary sinus pathologies is challenging. Herewith we describe the clinicopathological features in isolated maxillary sinus lesions in tertiary care hospital in Goa, India. The retrospective study included patients treated between 2017 and 2022, of all age groups and gender, who underwent either a biopsy or surgery, providing a histopathological diagnosis. Of the 117 pathologies, 88 (75.2%) were non-neoplastic. The overall frequency of pathologies were polyp in 40.2%, fungal lesions (18.8%), malignancy (13.7%), chronic rhinosinusitis (11.9%) and inverted papilloma (10.3%). There were 71 men (60.7%) and 46 women (39.3%). There were 10 patients (8.5%) below 20 years of age, of which 8 patients (80%) had non-neoplastic pathology. Common comorbidities were diabetes and hypertension, while symptoms were nasal blockage (75.2%), nasal discharge (47%) and ocular redness (16.2%). Each pathology was evaluated for demography, side of lesion, comorbidity, and symptoms. Most isolated maxillary sinus pathologies were benign lesions. However, a strong clinical suspicion and histopathological confirmation is needed for all lesions in all age groups due to a risk of malignancy.
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Affiliation(s)
- Swati Lambor
- Department of Otorhinolaryngology, Goa Medical College, Bambolim, Goa India
| | - Kevin Mathew Varughese
- Department of Otorhinolaryngology, North Goa District Hospital, Mapusa, Bardez, Goa India
| | - Archan Naik
- Department of Otorhinolaryngology, Goa Medical College, Bambolim, Goa India
| | - Dheeraj V. Lambor
- Department of Otorhinolaryngology, Goa Medical College & Hospital, Bambolim, Tiswadi, Goa 403202 India
| | - Markandeya Tiwari
- Department of Otorhinolaryngology, Goa Medical College, Bambolim, Goa India
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Zhou S, Ismail MAI, Buil JB, Gabr A, Verweij PE, Mahgoub ES, de Hoog S, Kang Y, Ahmed SA. Fungi involved in rhinosinusitis in arid regions: insights from molecular identification and antifungal susceptibility. Microbiol Spectr 2023; 11:e0183123. [PMID: 37772821 PMCID: PMC10580872 DOI: 10.1128/spectrum.01831-23] [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: 05/04/2023] [Accepted: 08/07/2023] [Indexed: 09/30/2023] Open
Abstract
Fungal rhinosinusitis (FRS) is a common problem worldwide, with an increasing burden in arid climate regions. Aspergillus species are the most common causative agents involved. In the present study, we investigated the prevalence, molecular characterization, and antifungal susceptibility of opportunists causing FRS in Sudan on the basis of strains collected over a period of 5 years. β-Tubulin and calmodulin sequencing were used for species identification, and antifungal susceptibility profiles were evaluated by the protocol of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Predominant species belonged to the Aspergillus flavus complex (n = 244), A. terreus complex (n = 16), A. fumigatus complex (n = 7), and other fungi (n = 17). Molecular identification of 94 strains of Aspergillus revealed the following species: A. flavus (n = 88), A. terreus (n = 1), A. citrinoterreus (n = 2), A. fumigatus (n = 1), A. caespitosus (n = 1), and A. sydowii (n = 1). Several A. flavus and an A. fumigatus isolates showed reduced susceptibility to azoles (minimum inhibitory concentrations above the clinical breakpoints or epidemiological cutoff values). Despite several mutations revealed in cyp51A of these isolates, none could be directly linked to azole resistance. Molecular identification of fungi causing FRS is useful to identify cryptic species and for epidemiologic studies. IMPORTANCE Fungal rhinosinusitis (FRS) is a significant clinical problem in arid regions. This study provides new insights into the prevalence, etiology, and antifungal susceptibility of FRS pathogens in Sudan, where the disease burden is high. Aspergillus species, particularly the A. flavus complex, were identified as the primary FRS pathogens in the region, with some evidence of antifungal resistance. The molecular identification of fungal species causing FRS is useful for detecting antifungal resistance, identifying cryptic species, and characterizing the epidemiology of the disease. The emergence of Azole resistance Aspergilli in Sudan highlights the need for continued surveillance and appropriate use of antifungal agents. These findings have important implications for clinical management, public health policy, and future research on FRS. Publishing this study in Microbiology Spectrum would enable other researchers and clinicians to build on these findings, ultimately improving the diagnosis, treatment, and prevention of FRS.
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Affiliation(s)
- Shaoqin Zhou
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, Guiyang, China
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| | | | - Jochem B. Buil
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| | - Aida Gabr
- Mycology Reference Laboratory, University of Khartoum, Khartoum, Sudan
| | - Paul E. Verweij
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
| | - El-Sheikh Mahgoub
- Mycology Reference Laboratory, University of Khartoum, Khartoum, Sudan
| | - Sybren de Hoog
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
| | - Yingqian Kang
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Basic Medical Science, Guizhou Medical University, Guiyang, China
| | - Sarah A. Ahmed
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
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Monga S, Malik JN, Sharma A, Agarwal D, Priya R, Naseeruddin K. Management of Fungal Rhinosinusitis: Experience From a Tertiary Care Centre in North India. Cureus 2022; 14:e23826. [PMID: 35530915 PMCID: PMC9068350 DOI: 10.7759/cureus.23826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Fungal rhinosinusitis (FRS) has increased over the past few decades due to the rampant use of antibiotics, steroids, immunosuppressive drugs, increased incidence of HIV and uncontrolled diabetes. The current study reviews the types, clinical presentation, microbiology, histopathology and outcomes related to FRS in a tertiary care center in North India. Methods We retrospectively reviewed the clinical and follow-up records of patients diagnosed with FRS over three years. The data reviewed included clinical workup, ophthalmological profile, comorbidities, immunological status, radiological investigations, intraoperative and histopathological findings, treatment and follow-up records. In addition, we performed a descriptive analysis of the reviewed data. Results The study consisted of 30 FRS patients (16 male, 14 female). In that, 77% of cases were of allergic FRS, while fungal ball, chronic invasive, chronic granulomatous and acute invasive FRS represented 3%, 10%, 3% and 7% cases, respectively. The most common presentation in non-invasive forms was nasal obstruction, nasal discharge, hyposmia and polyposis, while it was facial pain and headache in the invasive varieties. After appropriate medical and surgical management through endoscopic sinus surgery, the recurrence rate in non-invasive and invasive fungal sinusitis was 16.6% and 20.8%, respectively. There was nil mortality at a minimum of one year of follow-up. Conclusion The non-invasive forms of FRS are common and have a relatively mild course. Early medical and surgical intervention and management of the underlying comorbidities are the key factors in managing invasive FRS. Close follow-up after surgery is also necessary for the timely detection and management of recurrences.
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Prevalence of Positive Fungal Cultures in Patients with Chronic Sinusitis undergoing Functional Endoscopic Sinus Surgery in Yasuj, Iran. JOURNAL OF CLINICAL CARE AND SKILLS 2021. [DOI: 10.52547/jccs.2.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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A Cross-sectional Study on Chronic Fungal Rhinosinusitis in a Tertiary Care Hospital in Central Delhi, India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chronic Rhinosinusitis is a common disorder, and its prevalence vary from 1-20% globally. The incidence of fungal sinusitis has increased to such extent in recent years that fungal infection is a common diagnosis in patients with Chronic Rhinosinusitis. The objectives of this current research were objectives of estimating the prevalence of Fungal aetiology in chronic sinusitis patients and their drug sensitivity pattern with common antifungal drugs. A total of 61 Cases present with Chronic Rhinosinusitis (CRS), visited in a tertiary care hospital based in Central Delhi, were included in our study. Excision of sinus tissue, including polyps and masses, were collected in the operation theatre during Functional Endoscopic Sinus Surgery (FESS) procedure in a sterile manner. All the tissues brought in sterile normal saline were processed for bacteriological and mycological examination. Tissues, obtained in 10% formalin were processed for histopathological and cytological analysis. A total of 14 (22.9%) cases of Chronic Rhinosinusitis were affected by fungal etiologies. By E test, the MIC range for isolates of Rhizopus arrhizus after 24 hr of incubation was 1-2 μg/mL, and the mean was 1.5 μg/Ml. Similarly, the MIC range for isolates of Aspergillus flavus after 48 hr of incubation was 0.5-16 μg/mL, and the mean was 4.09μg/mL. By the M38-A broth dilution method, the MIC range for the isolates of Rhizopus arrhizus after 24 hr of incubation was 0.5-2 μg/mL, and the mean was 1.25 μg/ml. Similarly, the MIC range for isolates of Aspergillus flavus after 48 hr of incubation was 0.5-4 μg/mL, and the mean was 1.95 μg/mL.
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