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Kharat AS, Makwana N, Nasser M, Gayen S, Yadav B, Kumar D, Veeraraghavan B, Mercier C. Dramatic increase in antimicrobial resistance in ESKAPE clinical isolates over the 2010-2020 decade in India. Int J Antimicrob Agents 2024; 63:107125. [PMID: 38431109 DOI: 10.1016/j.ijantimicag.2024.107125] [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: 03/01/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
RATIONALE AND OBJECTIVES ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) constitute a threat to humans worldwide. India is now the most populous country. The goal was to investigate the evolution of the rates of antimicrobial resistance in ESKAPE pathogens across India over the 2010-20 decade. METHODS The data (89 studies) were retrieved from the Medline PubMed repository using specific keywords. RESULTS The study of 20 177 ESKAPE isolates showed that A. baumannii isolates were the most represented (35.9%, n = 7238), followed by P. aeruginosa (25.3%, n = 5113), K. pneumoniae (19.5%, n = 3934), S. aureus (16.3%, n = 3286), E. faecium (2.6%, n = 517) and Enterobacter spp. (0.4%, n = 89). A notable increase in the resistance rates to antimicrobial agents occurred over the 2010-20 decade. The most important levels of resistance were observed in 2016-20 for A. baumannii (90% of resistance to the amoxicillin-clavulanate combination) and K. pneumoniae (81.6% of resistance to gentamycin). The rise in β-lactamase activities was correlated with an increase in the positivity of Gram-negative isolates for β-lactamase genes. CONCLUSIONS This review highlighted that, in contrast to developed countries that kept resistance levels under control, a considerable increase in resistance to various classes of antibiotics occurred in ESKAPE pathogens in India over the 2010-2020 decade.
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Affiliation(s)
- Arun S Kharat
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India.
| | - Nilesh Makwana
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Mahfouz Nasser
- Department of Biotechnology, Dr. Babasaheb Ambedkar Marathwada University, Subcampus Osmanbad, MS, Aurangabad, Maharashtra, India; National Center for Public Health Laboratories, Hodeidah, Yemen
| | - Samarpita Gayen
- Department of Biotechnology, Dr. Babasaheb Ambedkar Marathwada University, Subcampus Osmanbad, MS, Aurangabad, Maharashtra, India
| | - Bipin Yadav
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Durgesh Kumar
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore Tamil Nadu, India
| | - Corinne Mercier
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France.
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Sharma S, Devkota MD, Pokhrel BM, Banjara MR. Detection of bla NDM-1,mcr-1 and MexB in multidrug resistant Pseudomonas aeruginosa isolated from clinical specimens in a tertiary care hospital of Nepal. BMC Microbiol 2023; 23:153. [PMID: 37231387 DOI: 10.1186/s12866-023-02906-w] [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: 12/15/2022] [Accepted: 05/20/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Pseudomonas aeruginosa is an opportunistic pathogen, which causes healthcare-associated infections in immunosuppressed patients. They exhibit resistance to multiple classes of antibiotics via various mechanisms such as the over-expression of efflux pumps, decreased production of the outer membrane protein (D2 porin), over-expression of the chromosomally encoded AmpC cephalosporinase, modification of drugs, and mutation(s) at the target site of the drug. The bacteria also develop antibiotic resistance through the acquisition of resistance genes carried on mobile genetic elements. Limited data on phenotypic as well as genotypic characterization of MDR P. aeruginosa in Nepal infers the needs for this study. This study was carried out to determine the prevalence rate of metallo-β-lactamase (MBL-producer) as well as colistin resistant multidrug resistant (MDR) P. aeruginosa in Nepal and also to detect MBL, colistin resistance, and efflux pump encoding genes i.e. blaNDM-1, mcr-1 and MexB respectively in MDR P. aeruginosa isolated from clinical samples. METHODS/METHODOLOGY A total of 36 clinical isolates of P. aeruginosa were collected. All bacterial isolates were phenotypically screened for antibiotic susceptibility using Kirby Bauer Disc Diffusion method. All the multidrug resistant P. aeruginosa were phenotypically screened for MBL producer by Imipenem-EDTA combined disc diffusion test (CDDT). Similarly, MIC value for colistin was also determined by broth microdilution method. Genes encoding carbapenemase (blaNDM-1), colistin resistant (mcr-1) and efflux pump activity (MexB) were assayed by PCR. RESULTS Among 36 P. aeruginosa, 50% were found to be MDR among which 66.7% were found to be MBL producer and 11.2% were found to be colistin resistant. Among MDR P. aeruginosa, 16.7%, 11.2% and 94.4% were found to be harbouring blaNDM-1, mcr-1 and MexB genes respectively. CONCLUSION In our study, carbapenemase production (encoded by blaNDM-1), colistin resistant enzyme production (encoded by mcr-1), and expression of efflux pump (encoded by MexB) are found to be one of the major causes of antibiotic resistance in P. aeruginosa. Therefore, periodic phenotypic as well as genotypic study in Nepal on P. aeruginosa would provide the scenario of resistance pattern or mechanisms in P. aeruginosa. Furthermore, new policies or rules can be implemented in order to control the P. aeruginosa infections.
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Affiliation(s)
- Samikshya Sharma
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, 44613, Nepal
| | - Madhu Dixit Devkota
- Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, 44600, Nepal
| | - Bharat Mani Pokhrel
- Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, 44600, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, 44613, Nepal.
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Dawadi P, Khadka C, Shyaula M, Syangtan G, Joshi TP, Pepper SH, Kanel SR, Pokhrel LR. Prevalence of metallo-β-lactamases as a correlate of multidrug resistance among clinical Pseudomonas aeruginosa isolates in Nepal. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 850:157975. [PMID: 35964754 DOI: 10.1016/j.scitotenv.2022.157975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Pseudomonas aeruginosa is an opportunistic human pathogen that has developed antibiotic resistance (AR) and causes a range of illnesses, including respiratory pneumonia, gastrointestinal infections, keratitis, otitis media and bacteremia in patients with compromised immune system. The production of metallo-β-lactamases (MBLs) is one of the major mechanisms of AR in this bacterium with ensuing infections difficult to treat. The main goal of this study was to provide a quantitative estimate of MBLs producing clinical P. aeruginosa isolates among the Nepalese patients and determine if MBL correlates with multi-drug resistance (MDR). Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was followed for meta-analysis of relevant literature using PubMed, Research4Life, and Google Scholar. The prevalence of MBLs in P. aeruginosa from clinical samples was determined using R 4.1.2 for data pooled from studies published until 2021. The meta-analysis of a total of 19 studies selected (of 6038 studies for which titles and abstracts were reviewed) revealed the prevalence of MBLs producing P. aeruginosa (MBL-PA) was 14 % (95 % CI: 0.10-0.19) while MDR isolates among P. aeruginosa was 42 % (95 % CI: 0.30-0.55) in Nepal. Combined Disc Test was predominantly used phenotypic method for confirming MBLs phenotypes among the studies. Sputum was the most common specimen from which MBL-PA was recovered. A significant positive correlation was observed between MDR and MBL production in P. aeruginosa. We conclude that MBL producing strains are widespread among the clinical isolates of P. aeruginosa in Nepal and responsible for emerging MDR strains. It is paramount that antibiotics prescription against the bacterium should be monitored closely and alternative therapeutic modalities against MBL-PA explored.
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Affiliation(s)
- Prabin Dawadi
- Faculty of Science, Nepal Academy of Science and Technology, Khumaltar, Lalitpur 44700, Bagmati, Nepal; Central Department of Microbiology, Tribhuvan University, Kathmandu 44618, Bagmati, Nepal
| | - Christina Khadka
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44618, Bagmati, Nepal
| | - Manita Shyaula
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44618, Bagmati, Nepal
| | - Gopiram Syangtan
- Central Department of Microbiology, Tribhuvan University, Kathmandu 44618, Bagmati, Nepal
| | - Tista Prasai Joshi
- Faculty of Science, Nepal Academy of Science and Technology, Khumaltar, Lalitpur 44700, Bagmati, Nepal
| | - Samantha H Pepper
- Department of Heath Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA
| | - Sushil R Kanel
- Department of Chemistry, Wright State University, Dayton, OH 45435, USA
| | - Lok R Pokhrel
- Department of Public Health, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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Namaei MH, Yousefi M, Askari P, Roshanravan B, Hashemi A, Rezaei Y. High prevalence of multidrug-resistant non-fermentative Gram-negative bacilli harboring bla IMP-1 and bla VIM-1 metallo-beta-lactamase genes in Birjand, south-east Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:470-479. [PMID: 34557275 PMCID: PMC8421574 DOI: 10.18502/ijm.v13i4.6971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Non-fermentative Gram-negative Bacilli (NFGNB) is known as a major cause of healthcare-associated infections with high levels of antibiotic resistance. The aim of this study was to investigate the antibiotic resistance profiles and molecular characteristics of metallo-beta-lactamase (MBL)-producing NFGNB. Materials and Methods: In this cross-sectional study, the antibiotic resistance profile of 122 clinical NFGNB isolates was determined by the Kirby-Bauer disk diffusion and microdilution broth methods. Bacterial isolates were investigated for the detection of MBLs production using the combination disk diffusion Test (CDDT). The existence of blaIMP, blaVIM, and blaNDM genes in all carbapenem-resistant isolates was determined employing polymerase chain reaction (PCR) assays. Results: High resistance in Pseudomonas aeruginosa was reported to cefotaxime and minocycline, whereas Acinetobacter baumannii isolates were highly resistant to all antibiotics except colistin. Multidrug resistance (MDR)-NFGNB (66% vs. 12.5%, P=0.0004) and extensively drug resistant (XDR)-NFGNB (55.7% vs. 12.5%, P=0.001) isolates were significantly more common in hospitalized patients than in outpatients. The production of MBL was seen in 40% of P. aeruginosa and 93.3% of A. baumannii isolates. It was found that 33.3% and 46.7% of carbapenem-resistant P. aeruginosa isolates, and 13.3% and 28.9% of carbapenem-resistant A. baumannii isolates were harboring blaIMP-1 and blaVIM-1 genes, respectively. The incidence of MDR (98.2% vs. 28.3%, P<0.001) and XDR (96.4% vs. 11.7%, P<0.001) in MBL-producing NFGNB isolates was significantly higher than non-MBL-producing isolates. Conclusion: This study demonstrated a higher rate of resistance among NFGNB isolates with an additional burden of MBL production within them, warranting a need for robust microbiological surveillance and accurate detection of MBL producers among the NFGNB.
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Affiliation(s)
- Mohammad Hasan Namaei
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Masoud Yousefi
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Parvin Askari
- Department of Microbiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Rezaei
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
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Acharya M, Joshi PR, Thapa K, Aryal R, Kakshapati T, Sharma S. Detection of metallo-β-lactamases-encoding genes among clinical isolates of Pseudomonas aeruginosa in a tertiary care hospital, Kathmandu, Nepal. BMC Res Notes 2017; 10:718. [PMID: 29216906 PMCID: PMC5721655 DOI: 10.1186/s13104-017-3068-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/05/2017] [Indexed: 01/09/2023] Open
Abstract
Objectives This study was carried out to determine the prevalence of metallo-β-lactamases (MBLs) producing Pseudomonas aeruginosa in imipenem-nonsusceptible isolates and to detect MBL-encoding genes among MBLs-positive isolates. Results Metallo-β-lactamases production was detected in 68.6% isolates of P. aeruginosa with reduced susceptibility to imipenem. The blaVIM-2 gene was detected in 75% isolates and blaIMP-1 was detected in 25% isolates. All MBLs-positive isolates were multidrug resistant with a high level of resistance to imipenem (MIC 16 to ≥ 32 µg/ml), meropenem (MIC 16 to ≥ 32 µg/ml), and ceftazidime (MIC 64 to ≥ 512 µg/ml). All MBL-positive isolates were susceptible (MIC ≤ 2 µg/ml) to colistin. We found high prevalence of MBL-producing P. aeruginosa. To our knowledge this is the first report of detection of blaVIM-2 and blaIMP-1 in P. aeruginosa from Nepal. This indicates the need for awareness to prevent the spreading of these resistant isolates in hospital setting.
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Affiliation(s)
- Mahesh Acharya
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Prabhu R Joshi
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Kamal Thapa
- Kathmandu College of Science and Technology, Tribhuvan University, Kathmandu, Nepal
| | - Rajan Aryal
- Kantipur College of Medical Sciences, Tribhuvan University, Kathmandu, Nepal
| | | | - Supriya Sharma
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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Kazi M, Nikam C, Shetty A, Rodrigues C. Dual-tubed multiplex-PCR for molecular characterization of carbapenemases isolated among Acinetobacter spp. and Pseudomonas spp. J Appl Microbiol 2015; 118:1096-102. [PMID: 25647446 DOI: 10.1111/jam.12770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/21/2015] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
AIM To molecularly characterize clinical isolates of Acinetobacter spp. and Pseudomonas spp. from various clinical samples so as to identify the carbapenemases mechanisms harboured by them. MATERIALS AND RESULTS A total of 95 carbapenem-resistant, nonduplicate, multi-drug resistant Gram-negative clinical isolates (53 Acinetobacter spp. and 42 Pseudomonas spp.), were collected between July and December 2012. Modified Hodge test (MHT) for the detection of carbapenemases was performed. Inhibitor-based test, EDTA for the detection of metallo-β-lactamases (MBL) and phenyl boronic acid (PBA) for the detection of Klebsiella pneumoniae carbapenemase (KPC), were performed to distinguish between different classes of β-lactamases. Two-tubed multiplex-PCR was performed for genotypic characterization of different classes of carbapenemases ((blaNDM-1 , blaOXA-48 like , blaKPC , blaVIM , blaIMP ), (blaOXA-23 like , blaOXA-24 like , blaOXA-51 like , blaOXA-58 like )). Eighty-five per cent (81/95) isolates were carbapenemase producers. Among these, 56.7% (44) were multiple carbapenemase producers. Furthermore, 48.14% (39) were MBLs, 35.8% (29) were carbapenem hydrolyzing class D β-lactamases (CHDLs), 16% (13) had MBLs as well as CHDLs and 14.7% (14/95) had none of the targeted resistance mechanisms. The overall rate of concordance between phenotypic and genotypic test was 97% and 98% for the detection of carbapenemases and MBL, respectively. CONCLUSION This is the first study from Western India which highlights the presence of multiple carbapenemases in nonfermenters Gram-negative bacilli (NFGNB). Co-existence of multiple carbapenemases along with other resistance mechanisms might result in treatment failure. Molecular characterization of the resistance mechanisms of suspected pathogens would help provide appropriate antimicrobial treatment for good clinical outcome. SIGNIFICANCE AND IMPACT OF THE STUDY Dual-tubed multiplex PCR decreases the time of amplification and thus the turnaround time which is crucial in clinical microbiology; this would be helpful in rapid characterization of CHDLs and MBLs.
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Affiliation(s)
- M Kazi
- Department of Microbiology, P. D. Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, India
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Bloom of resident antibiotic-resistant bacteria in soil following manure fertilization. Proc Natl Acad Sci U S A 2014; 111:15202-7. [PMID: 25288759 DOI: 10.1073/pnas.1409836111] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The increasing prevalence of antibiotic-resistant bacteria is a global threat to public health. Agricultural use of antibiotics is believed to contribute to the spread of antibiotic resistance, but the mechanisms by which many agricultural practices influence resistance remain obscure. Although manure from dairy farms is a common soil amendment in crop production, its impact on the soil microbiome and resistome is not known. To gain insight into this impact, we cultured bacteria from soil before and at 10 time points after application of manure from cows that had not received antibiotic treatment. Soil treated with manure contained a higher abundance of β-lactam-resistant bacteria than soil treated with inorganic fertilizer. Functional metagenomics identified β-lactam-resistance genes in treated and untreated soil, and indicated that the higher frequency of resistant bacteria in manure-amended soil was attributable to enrichment of resident soil bacteria that harbor β-lactamases. Quantitative PCR indicated that manure treatment enriched the blaCEP-04 gene, which is highly similar (96%) to a gene found previously in a Pseudomonas sp. Analysis of 16S rRNA genes indicated that the abundance of Pseudomonas spp. increased in manure-amended soil. Populations of other soil bacteria that commonly harbor β-lactamases, including Janthinobacterium sp. and Psychrobacter pulmonis, also increased in response to manure treatment. These results indicate that manure amendment induced a bloom of certain antibiotic-resistant bacteria in soil that was independent of antibiotic exposure of the cows from which the manure was derived. Our data illustrate the unintended consequences that can result from agricultural practices, and demonstrate the need for empirical analysis of the agroecosystem.
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Tarumoto N, Kinjo Y, Kitano N, Sasai D, Ueno K, Okawara A, Izawa Y, Shinozaki M, Watarai H, Taniguchi M, Takeyama H, Maesaki S, Shibuya K, Miyazaki Y. Exacerbation of invasive Candida albicans infection by commensal bacteria or a glycolipid through IFN-γ produced in part by iNKT cells. J Infect Dis 2013; 209:799-810. [PMID: 24096333 DOI: 10.1093/infdis/jit534] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The commensal yeast Candida albicans is a major cause of invasive fungal infections. Despite treatment with antifungal agents, the mortality rate attributed to these types of infection is high. Although numerous cases have been reported regarding a poor outcome for patients with bacterial and C. albicans coinfection, the mechanisms by which the coinfecting bacteria exacerbate the C. albicans infection remain elusive. METHODS AND RESULTS We evaluated how glycolipid-mediated activation of invariant natural killer T (iNKT) cells affects the clearance of C. albicans. Surprisingly, C. albicans-infected, glycolipid-treated mice exhibited significantly lower survival rates, increased fungal burden, and higher interleukin (IL)-6 production in the kidneys compared with control mice. Glycolipid-induced exacerbation of C. albicans infection was not observed in interferon-gamma knockout (IFN-γKO) mice. In the C. albicans-infected, glycolipid-treated mice, the number of neutrophils in the blood and bone marrow dramatically decreased in an IFN-γ-dependent manner. Furthermore, mice that were coinfected with C. albicans and nonfermentative gram-negative commensal bacteria exhibited increased fungal burden and inflammatory cytokine production in the kidneys that were dependent on IFN-γ and iNKT cells. CONCLUSIONS Our results indicate that coinfecting commensal bacteria exacerbate C. albicans infection through IFN-γ produced, in part, by iNKT cells.
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Affiliation(s)
- Norihito Tarumoto
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo
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