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Belgacem S, Chebil W, Ben Salem S, Babba O, Mastouri M, Babba H. Identification and antifungal susceptibility profile of uncommon yeast species at Fattouma Bourguiba University Hospital in Tunisia. Med Mycol 2024; 62:myae070. [PMID: 38986508 DOI: 10.1093/mmy/myae070] [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: 04/04/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/12/2024] Open
Abstract
Despite the severe impact of uncommon yeast fungal infections and the pressing need for more research on the topic, there are still few studies available on the identification, epidemiology, and susceptibility profile of those pathogens. The aims of the current study were to define the profile of uncommon yeast species at Fattouma Bourguiba University Hospital using phenotypic, molecular, and proteomic methods and to study their antifungal susceptibility profile. Pre-identified uncommon yeast species were collected from 2018 to 2021. These isolates were further identified using phenotypic methods (ID32C® system and Vitek2® YST), matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and sequencing. The antifungal susceptibility profile was studied using the reference CLSI broth microdilution method. In total, 30 strains were collected during the study period. Referring to the sequencing, the most isolated uncommon species were Saprochaete capitata, Candida lusitaniae, Candida kefyr, Candida inconspicua, and Candida guilliermondii. A total of 90% of isolates were correctly identified by MALDI-TOF MS compared to 76.7% and 63.3% by ID32® C and VITEK® 2 YST, respectively. The isolated species showed variable responses to antifungals. Candida guilliermondii showed increased azole minimum inhibitory concentrations. Misidentification of uncommon yeast species was common using commercial phenotypic methods. The high percentage of concordance of MALDI-TOF results with sequencing highlights its high performance and usefulness as a routine diagnosis tool.
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Affiliation(s)
- Sameh Belgacem
- Unit of Parasitology-Mycology, Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Laboratory of Medical and Molecular Parasitology-Mycology (LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Wissal Chebil
- Laboratory of Medical and Molecular Parasitology-Mycology (LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Safa Ben Salem
- Unit of Parasitology-Mycology, Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Oussama Babba
- Laboratory of Medical and Molecular Parasitology-Mycology (LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Maha Mastouri
- Unit of Parasitology-Mycology, Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hamouda Babba
- Laboratory of Medical and Molecular Parasitology-Mycology (LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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Wongsuk T, Boonsilp S, Pumeesat P, Homkaew A, Sangsri T, Chongtrakool P. Genotyping, antifungal susceptibility testing, and biofilm formation of Trichosporon spp. isolated from urine samples in a University Hospital in Bangkok, Thailand. Acta Microbiol Immunol Hung 2022; 69:247-257. [PMID: 35976734 DOI: 10.1556/030.2022.01797] [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: 06/03/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022]
Abstract
The basidiomycetes yeast Trichosporon is widespread in the natural environment, but can cause disease, mainly in immunocompromised patients. However, there have been only few studies about this infection in Thailand. In this study, we characterized 53 Trichosporon spp. isolated from urine samples from patients admitted to a single hospital in Bangkok, Thailand over a one-year period from 2019 to 2020. The strains were identified using colony morphology, microscopy, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and nucleotide sequence analysis of intergenic spacer 1 (IGS1). Fifty-one isolates were Trichosporon asahii, and the remaining isolates were Trichosporon inkin and other Trichosporon species. Three genotypes of IGS1-1, 3, and 7 were observed among T. asahii. The sensitivity of the yeasts to the antifungal drugs amphotericin B, fluconazole, and voriconazole ranged from 0.25 to >16 μg ml-1, 0.5-8 μg ml-1, and 0.01-0.25 μg ml-1, respectively. We investigated biofilm formation by the isolates, and no biofilm production was found in one isolate, low biofilm production in forty-four isolates, and medium biofilm production in six isolates. T. inkin produced biofilms at low levels, and Trichosporon spp. produced biofilms at medium levels. This research increases our understanding of the molecular epidemiology of Trichosporon spp. isolated from one university hospital in Bangkok, Thailand, and reveals their genetic diversity, antifungal susceptibility profiles, and capacity for in vitro biofilm production.
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Affiliation(s)
- Thanwa Wongsuk
- 1 Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Siriphan Boonsilp
- 1 Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Potjaman Pumeesat
- 2 Department of Medical Technology, Faculty of Science and Technology, Bansomdejchaopraya Rajabhat University, Bangkok, Thailand
| | - Anchalee Homkaew
- 3 Microbiological Unit, Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tanes Sangsri
- 4 Department of Microbiology, Faculty of Medicine, Princess of Naradhiwas University, Narathiwat, Thailand
| | - Piriyaporn Chongtrakool
- 5 Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Premamalini T, Rajyoganandh V, Vijayakumar R, Veena H, Kindo AJ, Marak RS. Strain Typing of Trichosporon asahii Clinical Isolates by Random Amplification of Polymorphic DNA (RAPD) Analysis. J Lab Physicians 2021; 13:245-251. [PMID: 34602789 PMCID: PMC8478501 DOI: 10.1055/s-0041-1731111] [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] [Indexed: 11/04/2022] Open
Abstract
Objective
The aim of this study was to identify and isolate
Trichosporon asahii
(
T. asahii
) from clinical samples and to assess the genetic relatedness of the most frequently isolated strains of
T. asahii
using random amplification of polymorphic DNA (RAPD) primers GAC-1 and M13.
Methods
All the clinical samples that grew
Trichosporon
species, identified and confirmed by polymerase chain reaction (PCR) using
Trichosporon
genus-specific primers, were considered for the study. Confirmation of the species
T. asahii
was carried out by
T. asahii-
specific PCR. Fingerprinting of the most frequently isolated
T. asahii
isolates was carried out by RAPD using random primers GAC-1 and M13.
Results
Among the 72 clinical isolates of
Trichosporon
sp. confirmed by
Trichosporon
-specific PCR, 65 were found to be
T. asahii
as identified by
T. asahii-
specific PCR. Fingerprinting of the 65 isolates confirmed as
T. asahii
using GAC-1 RAPD primer yielded 11 different patterns, whereas that of M13 primer produced only 5 patterns. The pattern I was found to be the most predominant type (29.2%) followed by pattern III (16.9%) by GAC-1 primer.
Conclusions
This study being the first of its kind in India on strain typing of
T. asahii
isolates by adopting RAPD analysis throws light on genetic diversity among the
T. asahii
isolates from clinical samples. Fingerprinting by RAPD primer GAC-1 identified more heterogeneity among the
T. asahii
isolates than M13.
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Affiliation(s)
- Thayanidhi Premamalini
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Vijayaraman Rajyoganandh
- Department of Microbiology, Vels Institute of Science, Technology and Advanced Studies, Vels Institute, Chennai, Tamil Nadu, India
| | - Ramaraj Vijayakumar
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Hemanth Veena
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Anupma Jyoti Kindo
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Rungmei Sk Marak
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Arastehfar A, de Almeida Júnior JN, Perlin DS, Ilkit M, Boekhout T, Colombo AL. Multidrug-resistant Trichosporon species: underestimated fungal pathogens posing imminent threats in clinical settings. Crit Rev Microbiol 2021; 47:679-698. [PMID: 34115962 DOI: 10.1080/1040841x.2021.1921695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Species of Trichosporon and related genera are widely used in biotechnology and, hence, many species have their genome sequenced. Importantly, yeasts of the genus Trichosporon have been increasingly identified as a cause of life-threatening invasive trichosporonosis (IT) in humans and are associated with an exceptionally high mortality rate. Trichosporon spp. are intrinsically resistant to frontline antifungal agents, which accounts for numerous reports of therapeutic failure when echinocandins are used to treat IT. Moreover, these fungi have low sensitivity to polyenes and azoles and, therefore, are potentially regarded as multidrug-resistant pathogens. However, despite the clinical importance of Trichosporon spp., our understanding of their antifungal resistance mechanisms is quite limited. Furthermore, antifungal susceptibility testing is not standardized, and there is a lack of interpretive epidemiological cut-off values for minimal inhibitory concentrations to distinguish non-wild type Trichosporon isolates. The route of infection remains obscure and detailed clinical and environmental studies are required to determine whether the Trichosporon infections are endogenous or exogenous in nature. Although our knowledge on effective IT treatments is rather limited and future randomized clinical trials are required to identify the best antifungal agent, the current paradigm advocates the use of voriconazole, removal of central venous catheters and recovery from neutropenia.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - João N de Almeida Júnior
- Laboratorio de Micologia Medica (LIM 53), Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil.,Laboratório Central (LIM 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - David S Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Macit Ilkit
- Division of Mycology, University of Çukurova, Adana, Turkey
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Institute of Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Correlation of Trichosporon asahii Genotypes with Anatomical Sites and Antifungal Susceptibility Profiles: Data Analyses from 284 Isolates Collected in the Last 22 Years across 24 Medical Centers. Antimicrob Agents Chemother 2021; 65:AAC.01104-20. [PMID: 33318016 DOI: 10.1128/aac.01104-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
Trichosporon asahii is an opportunistic fungal pathogen that can cause severe infections with high mortality rates. Azole derivatives are the best-targeted therapy for T. asahii invasive infections, but azole-resistant isolates have been reported. To investigate peculiarities in the antifungal susceptibility profile (ASP) of T. asahii clinical isolates, we analyzed the genotype distribution, isolation sources, and ASP of 284 strains collected from 1997 to 2019 in different Brazilian medical centers. Species identification and genotype characterization were performed by analysis of the intergenic spacer (IGS1) region of the ribosomal DNA (rDNA). Antifungal susceptibility testing (AST) for amphotericin B and azoles was with the CLSI M27, 4th edition, microdilution broth method. Trends in the ASP of Brazilian T. asahii isolates were investigated using epidemiological cutoff values. Five different genotypes were found among the 284 isolates tested (G1, 76%; G3, 10%; G4, 3%; G5, 7%; and G7, 4%). The isolates were collected mainly from urine (55%) and blood/catheter tip samples (25%) where G1 was the most frequent genotype found (P < 0.05). The G7 isolates exhibited the highest MIC90 values for azoles compared to those for the other genotypes (P < 0.05). Genotype 7 isolates also contributed to the increasing rates of voriconazole non-wild-type isolates found in recent years (P = 0.02). No significant differences were found among the AST results generated by isolates cultured from different anatomical sites. Monitoring T. asahii genotype distributions and antifungal susceptibility profiles is warranted to prevent the spread of azole-resistant isolates.
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Padovan ACB, Rocha WPDS, Toti ACDM, Freitas de Jesus DF, Chaves GM, Colombo AL. Exploring the resistance mechanisms in Trichosporon asahii: Triazoles as the last defense for invasive trichosporonosis. Fungal Genet Biol 2019; 133:103267. [PMID: 31513917 DOI: 10.1016/j.fgb.2019.103267] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/22/2022]
Abstract
Trichosporon asahii has recently been recognized as an emergent fungal pathogen able to cause invasive infections in neutropenic cancer patients as well as in critically ill patients submitted to invasive medical procedures and broad-spectrum antibiotic therapy. T. asahii is the main pathogen associated with invasive trichosporonosis worldwide. Treatment of patients with invasive trichosporonosis remains a controversial issue, but triazoles are mentioned by most authors as the best first-line antifungal therapy. There is mounting evidence supporting the claim that fluconazole (FLC) resistance in T. asahii is emerging worldwide. Since 2000, 15 publications involving large collections of T. asahii isolates described non-wild type isolates for FLC and/or voriconazole. However, very few papers have addressed the epidemiology and molecular mechanism of antifungal resistance in Trichosporon spp. Data available suggest that continuous exposure to azoles can induce mutations in the ERG11 gene, resulting in resistance to this class of antifungal drugs. A recent report characterizing T. asahii azole-resistant strains found several genes differentially expressed and highly mutated, including genes related to the Target of Rapamycin (TOR) pathway, indicating that evolutionary modifications on this pathway induced by FLC stress may be involved in developing azole resistance. Finally, we provided new data suggesting that hyperactive efflux pumps may play a role as drug transporters in FLC resistant T. asahii strains.
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Affiliation(s)
| | - Walicyranison Plinio da Silva Rocha
- Laboratório de Micologia Médica e Molecular, Departamento de Análises Clínicas e Toxicológicas, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Ana Caroline de Moraes Toti
- Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Guilherme Maranhão Chaves
- Laboratório de Micologia Médica e Molecular, Departamento de Análises Clínicas e Toxicológicas, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Arnaldo Lopes Colombo
- Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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Epidemiology of antifungal susceptibility: Review of literature. J Mycol Med 2019; 28:574-584. [PMID: 29773435 DOI: 10.1016/j.mycmed.2018.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/24/2022]
Abstract
Fungal infections are a major cause of morbidity and mortality despite the latest developments of diagnostic tools and therapeutic options. Early initiation of the appropriate antifungal therapy has been demonstrated to have a direct impact on the patient's outcome. Antifungal susceptibility testing methods are available to detect antifungal resistance and to determine the best treatment for a specific fungus. American and European standards have been developed, as well as equivalent commercial systems, which are more appropriate for clinical laboratories. These studies have allowed the development of interpretative breakpoints against the most frequent agents of fungal infections in the world. Surveillance of antifungal susceptibility patterns can provide the local drug resistance data to the clinicians, which can further aid better management of patients. Antifungal susceptibility tests have become essential tools to identify resistance to antifungals, to know the local and global disease epidemiology and to guide the treatment of fungal diseases. The distribution of species and the prevalence of antifungal resistance in fungi isolates varied among different areas. Here we summarize the epidemiology of antifungal susceptibility pattern of different fungal species.
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Hazirolan G, Koçak N, Karagöz A. Sequence-based identification, genotyping and virulence factors of Trichosporon asahii strains isolated from urine samples of hospitalized patients (2011-2016). J Mycol Med 2018; 28:452-456. [PMID: 29983233 DOI: 10.1016/j.mycmed.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Trichosporon asahii is the most common species that causes trichosporonosis. MATERIALS AND METHODS In the present study, a collection of 68T. asahii strains recovered from hospitalized patients urine samples between 2011 and 2016 was examined. T. asahii strains were identified by sequencing the intergenic spacer 1 region (IGS1) and genotyped. In addition, proteinase, phospholipase, esterase, haemolytic activity, and biofilm formation of a total of T. asahii strains were investigated. RESULTS The predominant genotype was 1 (79.3%) and followed by 5 (8%), 3 (6.9%), 6 (3.4%), 4 (1.1%), 9 (1.1%). In none of the 68 strains, proteinase and phospholipase activities could be detected, while all were found to be esterase positive. Biofilm production and hemolytic activity were detected in 23.5 and 97% respectively. DISCUSSION Our results indicated that six genotypes were (1, 5, 3, 6, 4, 9) present among T. asahii strains and no property was found to associate with a genotype, in terms of virulence factors.
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Affiliation(s)
- G Hazirolan
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Hacettepe Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji ABD, Sıhhiye, 06100 Ankara, Turkey.
| | - N Koçak
- Selçuk Üniversity Medicine Faculty, Department of Medical Genetics, Selçuk Üniversitesi Tıp Fakültesi Tıbbi Genetik ABD Selçuklu/Konya, Ankara, Turkey
| | - A Karagöz
- Public Health Agency of Turkey, National Molecular Microbiology Reference Centers Laboratory, Türkiye Halk Sağlığı Kurumu, Moleküler Mikrobiyoloji Referans Laboratuvarları, Adnan Saygun Cad. No: 55 Sıhhiye, Ankara, Turkey
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