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Shah S, Nguyen MH. Potential role of broad-spectrum azoles as therapy for Malasezzia bloodstream infection. Med Mycol Case Rep 2023; 41:1-3. [PMID: 37251705 PMCID: PMC10220303 DOI: 10.1016/j.mmcr.2023.05.002] [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: 03/18/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Abstract
Amphotericin B is the currently recommended therapy for Malassezia invasive infection (MII), but this drug requires intravenous administration and is associated with significant toxicity. The role of broad-spectrum azoles in managing MII is not clear. We describe two cases of MII due to M. pachydermatis and M. furfur that were successfully treated with posaconazole and reviewed the literature to assess the position of posaconazole in treating MII.
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Affiliation(s)
- Sunish Shah
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - M. Hong Nguyen
- Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Ehemann K, Contreras A, Celis-Ramírez AM. In vitro sensitivity of Malassezia furfur isolates from HIV-positive and negative patients to antifungal agents. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:120-131. [PMID: 37721914 PMCID: PMC10599713 DOI: 10.7705/biomedica.6871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/02/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Malassezia is a lipophilic and lipid-dependent yeast genus belonging to the skin microbiota of humans and other animals. However, due to dysbiosis processes or other factors in the host, this yeast can cause different pathologies, ranging from skin diseases, such as seborrheic dermatitis, to fungemia. Isolation of Malassezia furfur has been reported in HIV-positive patients with or without skin lesions. Due to its opportunistic nature and its variable resistance to antifungal compounds, it is relevant to know the Malassezia sensitivity profiles. OBJECTIVE To determine the sensitivity to different antifungal agents, of clinical isolates of M. furfur obtained from HIV-positive or negative patients, with or without seborrheic dermatitis. MATERIALS AND METHODS Assessment of isolates sensitivity to itraconazole, voriconazole, fluconazole, and amphotericin B was performed by two techniques: (1) Broth microdilution using Clinical and Laboratory Standards Institute (CLSI) protocol M27-A3 with modifications; and (2) agar tests using Etest®. RESULTS Isolates obtained from HIV patients showed an increase in the minimum inhibitory concentration of fluconazole, voriconazole, and amphotericin B, compared with those of non-HIV patients. Itraconazole was the antifungal with the lowest minimum inhibitory concentration (MIC) in most isolates. CONCLUSION We observed differences in the sensitivity profiles of M. furfur isolates according to the context of the patient. High MIC of antifungals like fluconazole, commonly used for treating pathologies caused by Malassezia, were identified.
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Affiliation(s)
- Kevin Ehemann
- Grupo de Investigación Celular y Molecular de Microorganismos Patógenos, Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá, D. C., Colombia.
| | - Andrés Contreras
- Grupo de Investigación Celular y Molecular de Microorganismos Patógenos, Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá, D. C., Colombia.
| | - Adriana Marcela Celis-Ramírez
- Grupo de Investigación Celular y Molecular de Microorganismos Patógenos, Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá, D. C., Colombia.
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Zhang X, Jin F, Ni F, Xu Y, Lu Y, Xia W. Clinical data analysis of 86 patients with invasive infections caused by Malassezia furfur from a tertiary medical center and 37 studies. Front Cell Infect Microbiol 2023; 13:1079535. [PMID: 37457952 PMCID: PMC10340522 DOI: 10.3389/fcimb.2023.1079535] [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: 11/11/2022] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Malassezia furfur (M. furfur) is a lipophilic, conditionally pathogenic yeast that mainly causes skin infections, but the reports of related invasive infections are increasing. The aim of this study is to provide clinical data to assist physicians in the management of patients with invasive infections caused by M. furfur. Methods A case of pulmonary infection caused by M. furfur in a hematopoietic stem cell transplant patient for aplastic anemia was reported. In addition, the literature on invasive infection by M. furfur published in PubMed and Web of Science in English until 31 July 2022 was reviewed. Results Clinical data analysis of 86 patients (from 37 studies and our case) revealed that most of them were preterm (44.2%), followed by adults (31.4%). M. furfur fungemia occurred in 79.1% of the 86 patients, and 45 of them were clearly obtained from catheter blood. Other patients developed catheter-related infections, pneumonia, peripheral thromboembolism, endocarditis, meningitis, peritonitis and disseminated infections. Thirty-eight preterm infants had underlying diseases such as very low birth weight and/or multiple organ hypoplasia. The remaining patients had compromised immunity or severe gastrointestinal diseases. 97.7% of patients underwent invasive procedures and 80.2% received total parenteral nutrition (TPN). Fever, thrombocytopenia and leukocytosis accounted for 55.8%, 38.4% and 24.4% of patients with M. furfur invasive infections, respectively. 69.8% of the patients received antifungal therapy, mainly amphotericin B (AmB) or azoles. Of 84 patients with indwelling catheters, 58.3% underwent the removal of catheters. TPN were discontinued in 30 of 69 patients. The all-cause mortality of 86 patients was 27.9%. Conclusions M. furfur can cause a variety of invasive infections. These patients mostly occur in premature infants, low immunity and severe gastrointestinal diseases. Indwelling catheters and TPN infusion are major risk factors. AmB, l-AmB and azoles are the most commonly used agents, and simultaneous removal of the catheter and termination of TPN infusion are important for the treatment of M. furfur invasive infections.
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Affiliation(s)
- Xiaohui Zhang
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Fei Jin
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Fang Ni
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Yuqiao Xu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Yanfei Lu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Wenying Xia
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
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Proctor DM, Drummond RA, Lionakis MS, Segre JA. One population, multiple lifestyles: Commensalism and pathogenesis in the human mycobiome. Cell Host Microbe 2023; 31:539-553. [PMID: 37054674 PMCID: PMC10155287 DOI: 10.1016/j.chom.2023.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 04/15/2023]
Abstract
Candida auris and Candida albicans can result in invasive fungal diseases. And yet, these species can stably and asymptomatically colonize human skin and gastrointestinal tracts. To consider these disparate microbial lifestyles, we first review factors shown to influence the underlying microbiome. Structured by the damage response framework, we then consider the molecular mechanisms deployed by C. albicans to switch between commensal and pathogenic lifestyles. Next, we explore this framework with C. auris to highlight how host physiology, immunity, and/or antibiotic receipt are associated with progression from colonization to infection. While treatment with antibiotics increases the risk that an individual will succumb to invasive candidiasis, the underlying mechanisms remain unclear. Here, we describe several hypotheses that may explain this phenomenon. We conclude by highlighting future directions integrating genomics with immunology to advance our understanding of invasive candidiasis and human fungal disease.
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Affiliation(s)
- Diana M Proctor
- Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Rebecca A Drummond
- Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Julia A Segre
- Microbial Genomics Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Chebil W, Haouas N, Eskes E, Vandecruys P, Belgacem S, Belhadj Ali H, Babba H, Van Dijck P. In Vitro Assessment of Azole and Amphotericin B Susceptibilities of Malassezia spp. Isolated from Healthy and Lesioned Skin. J Fungi (Basel) 2022; 8:jof8090959. [PMID: 36135684 PMCID: PMC9502168 DOI: 10.3390/jof8090959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 12/11/2022] Open
Abstract
Malassezia yeasts have recently gained medical importance as emerging pathogens associated with a wide range of dermatological and systemic infections. Since standardized methods for in vitro antifungal susceptibility testing have not yet been established for Malassezia spp., related diseases are always treated empirically. As a result, a high rate of recurrence and decreased antifungal susceptibility have appeared. Thus, the aims of the study were to assess and analyze the in vitro susceptibility of Malassezia isolated from pityriasis versicolor (PV) lesions and healthy controls. A total of 58 Malassezia strains isolated from PV patients and healthy controls were tested. In vitro antifungal susceptibility testing was conducted using the CLSI broth microdilution with some modifications. Candida spp. criteria established in accordance with CLSI guidelines were used for data interpretation. Ketoconazole and posaconazole seemed to be the most effective molecules against Malassezia species. However, considerable percentages of itraconazole, fluconazole, and amphotericin B ‘‘resistant’’ strains (27.6%, 29.3%, and 43.1%, respectively) were revealed in this study. Malassezia furfur, M. sympodialis, and M. globosa showed different susceptibility profiles to the drugs tested. These results emphasize the importance of accurately identifying and evaluating the antifungal susceptibility of Malassezia species in order to guide a specific and effective treatment regimen.
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Affiliation(s)
- Wissal Chebil
- Laboratory of Medical and Molecular Parasitology-Mycology (LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia
| | - Najoua Haouas
- Laboratory of Medical and Molecular Parasitology-Mycology (LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia
| | - Elja Eskes
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, Department of Biology, Faculty of Sciences, KU Leuven, Heverlee, 3001 Leuven, Belgium
| | - Paul Vandecruys
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, Department of Biology, Faculty of Sciences, KU Leuven, Heverlee, 3001 Leuven, Belgium
| | - Sameh Belgacem
- Laboratory of Parasitology-Mycology, Fattouma Bourguiba University Hospital, Monastir 5000, Tunisia
| | - Hichem Belhadj Ali
- Dermatology Department, Fattouma Bourguiba University Hospital, Monastir 5000, Tunisia
| | - Hamouda Babba
- Laboratory of Medical and Molecular Parasitology-Mycology (LR12ES08), Department of Clinical Biology B, Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia
| | - Patrick Van Dijck
- Laboratory of Molecular Cell Biology, Institute of Botany and Microbiology, Department of Biology, Faculty of Sciences, KU Leuven, Heverlee, 3001 Leuven, Belgium
- Correspondence: ; Tel.: +32-16321512
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Chebil W, Rhimi W, Haouas N, Romano V, Belgacem S, Ali HB, Babba H, Cafarchia C. Virulence factors of Malassezia strains isolated from pityriasis versicolor patients and healthy individuals. Med Mycol 2022; 60:6652903. [PMID: 35913746 DOI: 10.1093/mmy/myac060] [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: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Over the last decade, Malassezia species have emerged as increasingly important pathogens associated with a wide range of dermatological disorders and bloodstream infections. The pathogenesis of Malassezia yeasts is not completely clear but it seems to be strictly related to Malassezia strains and hosts and need to be better investigated. This study aimed to assess the enzymatic activities, biofilm formation and in vitro antifungal profiles of Malassezia spp. from Pityriasis versicolor and heathy patients. The potential relationship between virulence attributes, the antifungal profiles and the origin of strains were also assessed. A total of 44 Malassezia strains isolated from patients with (n = 31) and without (n = 13) Pityriasis versicolor (PV) were employed to evaluate phospholipase (Pz), lipase (Lz), hemolytic (Hz) activities and biofilm formation. In addition, in vitro antifungal susceptibility testing was conducted using the CLSI broth microdilution with some modifications. A high percentage of strains produced phospholipase, lipase, hemolysins and biofilm regardless of their clinical origin. The highest number of strains producing high enzymatic activities came from PV patients. A correlation between the intensity of hydrolytic activities (lipase and phospholipase activities) and the hemolytic activity was detected. Positive associations between Lz and the low fluconazole susceptibility and Hz and biofilm formation were observed. These results suggest that enzyme patterns and biofilm formation together with antifungal profiles play a role in the pathogenicity of Malassezia spp. and might explain the implication of some Malassezia spp. in invasive fungal infections and in the development of inflammation.
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Affiliation(s)
- Wissal Chebil
- University of Monastir, Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology LP3M (code LR12ES08), Department of Clinical Biology B, 5000, Monastir, Tunisia
| | - Wafa Rhimi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari "Aldo Moro", 70010, Valenzano, Bari, Italy
| | - Najoua Haouas
- University of Monastir, Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology LP3M (code LR12ES08), Department of Clinical Biology B, 5000, Monastir, Tunisia
| | - Valentina Romano
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari "Aldo Moro", 70010, Valenzano, Bari, Italy
| | - Sameh Belgacem
- Laboratory of Parasitology-Mycology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hichem Belhadj Ali
- Dermatology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hamouda Babba
- University of Monastir, Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology LP3M (code LR12ES08), Department of Clinical Biology B, 5000, Monastir, Tunisia
| | - Claudia Cafarchia
- Dipartimento di Medicina Veterinaria, Università degli Studi di Bari "Aldo Moro", 70010, Valenzano, Bari, Italy
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Hobi S, Cafarchia C, Romano V, Barrs VR. Malassezia: Zoonotic Implications, Parallels and Differences in Colonization and Disease in Humans and Animals. J Fungi (Basel) 2022; 8:jof8070708. [PMID: 35887463 PMCID: PMC9324274 DOI: 10.3390/jof8070708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/13/2022] Open
Abstract
Malassezia spp. are commensals of the skin, oral/sinonasal cavity, lower respiratory and gastrointestinal tract. Eighteen species have been recovered from humans, other mammals and birds. They can also be isolated from diverse environments, suggesting an evolutionary trajectory of adaption from an ecological niche in plants and soil to the mucocutaneous ecosystem of warm-blooded vertebrates. In humans, dogs and cats, Malassezia-associated dermatological conditions share some commonalities. Otomycosis is common in companion animals but is rare in humans. Systemic infections, which are increasingly reported in humans, have yet to be recognized in animals. Malassezia species have also been identified as pathogenetic contributors to some chronic human diseases. While Malassezia species are host-adapted, some species are zoophilic and can cause fungemia, with outbreaks in neonatal intensive care wards associated with temporary colonization of healthcare worker’s hands from contact with their pets. Although standardization is lacking, susceptibility testing is usually performed using a modified broth microdilution method. Antifungal susceptibility can vary depending on Malassezia species, body location, infection type, disease duration, presence of co-morbidities and immunosuppression. Antifungal resistance mechanisms include biofilm formation, mutations or overexpression of ERG11, overexpression of efflux pumps and gene rearrangements or overexpression in chromosome 4.
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Affiliation(s)
- Stefan Hobi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University, Tat Chee Avenue, Kowloon, Hong Kong, China
- Correspondence: (S.H.); (V.R.B.)
| | - Claudia Cafarchia
- Department of Veterinary Medicine, University of Bari, Str. prov. per Casamassima Km 3, Valenzano, (Bari), 70010, Italy; (C.C.); (V.R.)
| | - Valentina Romano
- Department of Veterinary Medicine, University of Bari, Str. prov. per Casamassima Km 3, Valenzano, (Bari), 70010, Italy; (C.C.); (V.R.)
| | - Vanessa R. Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University, Tat Chee Avenue, Kowloon, Hong Kong, China
- Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, China
- Correspondence: (S.H.); (V.R.B.)
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Malassezia restricta Pneumonia in Solid Organ Transplant Recipients: First Report of Two Cases. J Fungi (Basel) 2021; 7:jof7121057. [PMID: 34947039 PMCID: PMC8706098 DOI: 10.3390/jof7121057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/04/2022] Open
Abstract
Emerging fungal infections are a major challenge in solid organ transplantation (SOT) and are associated with high morbidity and mortality. We report two cases of Malassezia restricta pneumonia in SOT recipients. Infections were diagnosed with molecular analysis and histology. Patients were treated with antifungal therapy and have fully recovered.
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da Silva GO, Farias BCS, da Silva RB, Teixeira EH, Cordeiro RDA, Hissa DC, Melo VMM. Effects of lipopeptide biosurfactants on clinical strains of Malassezia furfur growth and biofilm formation. Med Mycol 2021; 59:1191-1201. [PMID: 34424316 DOI: 10.1093/mmy/myab051] [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: 05/27/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 01/02/2023] Open
Abstract
Lipopeptide biosurfactants (LBs) are biological molecules with low toxicity that have aroused growing interest in the pharmaceutical industry. Their chemical structure confers antimicrobial and antibiofilm properties against different species. Despite their potential, few studies have demonstrated their capability against Malassezia spp., commensal yeasts which can cause dermatitis and serious infections. Thus, the aim of this study was to evaluate the antifungal activity of biosurfactants produced by new strains of Bacillus subtilis TIM10 and B. vallismortis TIM68 against M. furfur and their potential for removal and inhibition of yeast biofilms. Biosurfactants were classified as lipopeptides by FTIR, and their composition was characterized by ESI-Q-TOF/MS, showing ions for iturin, fengycin, and surfactin, with a greater abundance of surfactin. Through the broth microdilution method, both biosurfactants inhibited the growth of clinical M. furfur strains. Biosurfactant TIM10 showed greater capacity for growth inhibition, with no statistical difference compared to those obtained by the commercial antifungal fluconazole for M. furfur 153DR5 and 154DR8 strains. At minimal inhibitory concentrations (MIC-2), TIM10 and TIM68 were able to inhibit biofilm formation, especially TIM10, with an inhibition rate of approximately 90%. In addition, both biosurfactants were able to remove pre-formed biofilm. Both biosurfactants showed no toxicity against murine fibroblasts, even at concentrations above MIC-2. Our results show the effectiveness of LBs in controlling the growth and biofilm formation of M. furfur clinical strains and highlight the potential of these agents to compose new formulations for the treatment of these fungi.
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Affiliation(s)
- Gabrielly Oliveira da Silva
- Laboratório de Ecologia Microbiana e Biotecnologia (LEMBiotech). Departamento de Biologia, Federal University of Ceara, Avenida Humberto Monte 2977, Fortaleza - CE 60455-760, Brazil
| | - Bárbara Cibelle Soares Farias
- Laboratório de Ecologia Microbiana e Biotecnologia (LEMBiotech). Departamento de Biologia, Federal University of Ceara, Avenida Humberto Monte 2977, Fortaleza - CE 60455-760, Brazil
| | - Renally Barbosa da Silva
- Laboratório Integrado de Biomoléculas (LIBS). Departamento de Patologia e Medicina Legal, Federal University of Ceara, Rua Coronel Nunes de Melo, Fortaleza - CE 60430-275, Brazil
| | - Edson Holanda Teixeira
- Laboratório Integrado de Biomoléculas (LIBS). Departamento de Patologia e Medicina Legal, Federal University of Ceara, Rua Coronel Nunes de Melo, Fortaleza - CE 60430-275, Brazil
| | - Rossana de Aguiar Cordeiro
- Departamento de Patologia e Medicina Legal, Federal University of Ceara, Rua Coronel Nunes de Melo, Fortaleza - CE 60430-275, Brazil
| | - Denise Cavalcante Hissa
- Laboratório de Recursos Genéticos (LARGEN). Departamento de Biologia, Federal University of Ceara, Avenida Humberto Monte 2977, Fortaleza - CE 60455-760, Brazil
| | - Vânia Maria Maciel Melo
- Laboratório de Ecologia Microbiana e Biotecnologia (LEMBiotech). Departamento de Biologia, Federal University of Ceara, Avenida Humberto Monte 2977, Fortaleza - CE 60455-760, Brazil
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Rhimi W, Theelen B, Boekhout T, Aneke CI, Otranto D, Cafarchia C. Conventional therapy and new antifungal drugs against Malassezia infections. Med Mycol 2021; 59:215-234. [PMID: 33099634 DOI: 10.1093/mmy/myaa087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/14/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
Malassezia yeasts are commensal microorganisms occurring on the skin of humans and animals causing dermatological disorders or systemic infections in severely immunocompromised hosts. Despite attempts to control such yeast infections with topical and systemic antifungals, recurrence of clinical signs of skin infections as well as treatment failure in preventing or treating Malassezia furfur fungemia have been reported most likely due to wrong management of these infections (e.g., due to early termination of treatment) or due to the occurrence of resistant phenomena. Standardized methods for in vitro antifungal susceptibility tests of these yeasts are still lacking, thus resulting in variable susceptibility profiles to azoles among Malassezia spp. and a lack of clinical breakpoints. The inherent limitations to the current pharmacological treatments for Malassezia infections both in humans and animals, stimulated the interest of the scientific community to discover new, effective antifungal drugs or substances to treat these infections. In this review, data about the in vivo and in vitro antifungal activity of the most commonly employed drugs (i.e., azoles, polyenes, allylamines, and echinocandins) against Malassezia yeasts, with a focus on human bloodstream infections, are summarized and their clinical implications are discussed. In addition, the usefulness of alternative compounds is discussed.
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Affiliation(s)
- Wafa Rhimi
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", Bari, Italy
| | - Bart Theelen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, The Netherlands
| | - Chioma Inyang Aneke
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", Bari, Italy.,Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", Bari, Italy.,Faculty of Veterinary Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Claudia Cafarchia
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", Bari, Italy
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Wardlaw AJ, Rick EM, Pur Ozyigit L, Scadding A, Gaillard EA, Pashley CH. New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease. J Asthma Allergy 2021; 14:557-573. [PMID: 34079294 PMCID: PMC8164695 DOI: 10.2147/jaa.s251709] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/04/2021] [Indexed: 12/23/2022] Open
Abstract
Allergy to airway-colonising, thermotolerant, filamentous fungi represents a distinct eosinophilic endotype of often severe lung disease. This endotype, which particularly affects adult asthma, but also complicates other airway diseases and sometimes occurs de novo, has a heterogeneous presentation ranging from severe eosinophilic asthma to lobar collapse. Its hallmark is lung damage, characterised by fixed airflow obstruction (FAO), bronchiectasis and lung fibrosis. It has a number of monikers including severe asthma with fungal sensitisation (SAFS) and allergic bronchopulmonary aspergillosis/mycosis (ABPA/M), but these exclusive terms constitute only sub-sets of the condition. In order to capture the full extent of the syndrome we prefer the inclusive term allergic fungal airway disease (AFAD), the criteria for which are IgE sensitisation to relevant fungi in association with airway disease. The primary fungus involved is Aspergillus fumigatus, but a number of other thermotolerant species from several genera have been implicated. The unifying mechanism involves germination of inhaled fungal spores in the lung in the context of IgE sensitisation, leading to a persistent and vigorous eosinophilic inflammatory response in association with release of fungal proteases. Most allergenic fungi, including Alternaria and Cladosporium species, are not thermotolerant and cannot germinate in the airways so only act as aeroallergens and do not cause AFAD. Studies of the airway mycobiome have shown that A. fumigatus colonises the normal as much as the asthmatic airway, suggesting it is the tendency to become IgE-sensitised that is the critical triggering factor for AFAD rather than colonisation per se. Treatment is aimed at preventing exacerbations with glucocorticoids and increasingly by the use of anti-T2 biological therapies. Anti-fungal therapy has a limited place in management, but is an effective treatment for fungal bronchitis which complicates AFAD in about 10% of cases.
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Affiliation(s)
- Andrew J Wardlaw
- Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, and Allergy and Respiratory Medicine Service, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Eva-Maria Rick
- Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, and Allergy and Respiratory Medicine Service, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Leyla Pur Ozyigit
- Allergy and Respiratory Services University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alys Scadding
- Allergy and Respiratory Services University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Erol A Gaillard
- Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, Department of Paediatrics, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Catherine H Pashley
- Institute for Lung Health, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, and Allergy and Respiratory Medicine Service, NIHR Biomedical Research Centre: Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
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12
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Vijaya Chandra SH, Srinivas R, Dawson TL, Common JE. Cutaneous Malassezia: Commensal, Pathogen, or Protector? Front Cell Infect Microbiol 2021; 10:614446. [PMID: 33575223 PMCID: PMC7870721 DOI: 10.3389/fcimb.2020.614446] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
The skin microbial community is a multifunctional ecosystem aiding prevention of infections from transient pathogens, maintenance of host immune homeostasis, and skin health. A better understanding of the complex milieu of microbe-microbe and host-microbe interactions will be required to define the ecosystem's optimal function and enable rational design of microbiome targeted interventions. Malassezia, a fungal genus currently comprising 18 species and numerous functionally distinct strains, are lipid-dependent basidiomycetous yeasts and integral components of the skin microbiome. The high proportion of Malassezia in the skin microbiome makes understanding their role in healthy and diseased skin crucial to development of functional skin health knowledge and understanding of normal, healthy skin homeostasis. Over the last decade, new tools for Malassezia culture, detection, and genetic manipulation have revealed not only the ubiquity of Malassezia on skin but new pathogenic roles in seborrheic dermatitis, psoriasis, Crohn's disease, and pancreatic ductal carcinoma. Application of these tools continues to peel back the layers of Malassezia/skin interactions, including clear examples of pathogenicity, commensalism, and potential protective or beneficial activities creating mutualism. Our increased understanding of host- and microbe-specific interactions should lead to identification of key factors that maintain skin in a state of healthy mutualism or, in turn, initiate pathogenic changes. These approaches are leading toward development of new therapeutic targets and treatment options. This review discusses recent developments that have expanded our understanding of Malassezia's role in the skin microbiome, with a focus on its multiple roles in health and disease as commensal, pathogen, and protector.
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Affiliation(s)
| | - Ramasamy Srinivas
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Thomas L Dawson
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Drug Discovery, College of Pharmacy, Medical University of South Carolina, Charleston, SC, United States
| | - John E Common
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
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13
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Novel sulfamoylbenzoates as antifungal agents against Malassezia furfur. MENDELEEV COMMUNICATIONS 2020. [DOI: 10.1016/j.mencom.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Rhimi W, Theelen B, Boekhout T, Otranto D, Cafarchia C. Malassezia spp. Yeasts of Emerging Concern in Fungemia. Front Cell Infect Microbiol 2020; 10:370. [PMID: 32850475 PMCID: PMC7399178 DOI: 10.3389/fcimb.2020.00370] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/16/2020] [Indexed: 12/23/2022] Open
Abstract
Malassezia spp. are lipid-dependent yeasts, inhabiting the skin and mucosa of humans and animals. They are involved in a variety of skin disorders in humans and animals and may cause bloodstream infections in severely immunocompromised patients. Despite a tremendous increase in scientific knowledge of these yeasts during the last two decades, the epidemiology of Malassezia spp. related to fungemia remains largely underestimated most likely due to the difficulty in the isolation of these yeasts species due to their lipid-dependence. This review summarizes and discusses the most recent literature on Malassezia spp. infection and fungemia, its occurrence, pathogenicity mechanisms, diagnostic methods, in vitro susceptibility testing and therapeutic approaches.
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Affiliation(s)
- Wafa Rhimi
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", Bari, Italy
| | - Bart Theelen
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Teun Boekhout
- Yeast Research, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands.,The Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Amsterdam, Netherlands.,Shanghai Key Laboratory of Molecular Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", Bari, Italy.,Faculty of Veterinary Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Claudia Cafarchia
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", Bari, Italy
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15
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Rhimi W, Inyang Aneke C, Mosca A, Otranto D, Cafarchia C. In Vitro Azole and Amphotericin B Susceptibilities of Malassezia furfur from Bloodstream Infections Using E-Test and CLSI Broth Microdilution Methods. Antibiotics (Basel) 2020; 9:E361. [PMID: 32604712 PMCID: PMC7345317 DOI: 10.3390/antibiotics9060361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022] Open
Abstract
The number of reports of Malassezia furfur bloodstream infections is constantly increasing and there is a need for more simple antifungal susceptibility methods for their management. In this study, a total of 39 M. furfur isolates collected from hospitalized patients with fungemia were screened for antifungal susceptibility to azole and amphotericin B (AmB) using Clinical and Laboratory Standards Institute broth microdilution (CLSI BMD) and E-test in Sabouraud dextrose agar + 1% Tween80 (SDAt) and mDixon agar (DIX). Essential agreement (EA) and discrepancies between the two methods were evaluated after 48 h and 72 h reading times. Itraconazole (ITZ) and posaconazole (POS) displayed the lowest MIC values whereas fluconazole (FLZ) and AmB the highest, regardless of the methods and the reading time. The EA between BMD was >95% for FLZ and voriconazole (VOR) regardless of the media in the E-tests and reading time. The EA between BMD with E-test for AmB was >97% only when E-test in SDAt was used. The EA between BMD and E-test for ITZ and POS varied according to the media in E-test procedures and the reading time and was higher than 66.6% (POS) or 72% (ITZ) only when SABt was used. Substantial discrepancies for ITZ and POS were >5.1% regardless of the media and the reading time. This study suggests that the E-test in SABt represents an alternative method to CLSI BMD to evaluate the susceptibility of M. furfur to FLZ, VOR and AmB and not for ITZ and POS.
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Affiliation(s)
- Wafa Rhimi
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", 70010 Bari, Italy
| | - Chioma Inyang Aneke
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", 70010 Bari, Italy
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka 410001, Nigeria
| | - Adriana Mosca
- Dipartimento Interdisciplinare di Medicina, Università degli Studi di Bari, 70124 Bari, Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", 70010 Bari, Italy
- Faculty of Veterinary Sciences, Bu-Ali Sina University, Hamedan 65174, Iran
| | - Claudia Cafarchia
- Dipartimento di Medicina Veterinaria, Università degli Studi "Aldo Moro", 70010 Bari, Italy
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16
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Wang K, Cheng L, Li W, Jiang H, Zhang X, Liu S, Huang Y, Qiang M, Dong T, Li Y, Wang J, Feng S, Li H. Susceptibilities of Malassezia strains from pityriasis versicolor, Malassezia folliculitis and seborrheic dermatitis to antifungal drugs. Heliyon 2020; 6:e04203. [PMID: 32613106 PMCID: PMC7322256 DOI: 10.1016/j.heliyon.2020.e04203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
The human pathogenic yeast genus Malassezia may be an etiological agent of skin disorders and has received considerable attention from dermatologists in recent years. To investigate the different susceptibilities of Malassezia species to four antifungal drugs, we isolated a total of 244 Malassezia strains and identified six species of Malassezia from patients with clinical skin diseases. The minimum inhibitory concentration (MIC) of the four antifungal drugs was obtained by comparing the susceptibility of the isolated Malassezia strains to four antifungal drugs (ketoconazole (KTZ), itraconazole (ITZ), fluconazole (FLC) and amphotericin B (Am B)). We demonstrated that M. furfur, M. sympodialis, M. pachydermatis and M. globosa are the most common Malassezia species in the three skin diseases. The MICs of KTZ, ITZ, FLC and Am B against M. furfur, M. sympodialis, M. pachydermatis and M. globosa ranged from 0.03 - 16 mg/L, 0.03 - 2.0 mg/L, 0.03 - 8 mg/L, and 13 - 64 mg/L, respectively. The sensitivities of Malassezia to the four antifungal drugs from high to low were ITZ ≥ KTZ > Am B > FLC. The susceptibilities of the various Malassezia species to the four antifungal drugs were different, and the susceptibility of M. furfur to KTZ was significantly different from those of the three skin diseases (pityriasis versicolor, Malassezia folliculitis and seborrheic dermatitis). Our results suggested that the MIC analysis of the four antifungal drugs would be helpful in preventing drug resistance in the clinical screening of Malassezia and choosing better antifungal drugs to treat Malassezia-associated skin diseases.
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Affiliation(s)
- Kaiqin Wang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China.,Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, 2901, Caolang Road, Jinshan District, Shanghai, China.,Department of Dermatology, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Lu Cheng
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China
| | - Wenshuang Li
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China
| | - Hui Jiang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China.,Yantai Affiliated Hospital of Binzhou Medical University, Shandong, China
| | - Xiaofang Zhang
- Yantai Affiliated Hospital of Binzhou Medical University, Shandong, China
| | - Shanshan Liu
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, 2901, Caolang Road, Jinshan District, Shanghai, China
| | - Yunli Huang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China
| | - Mingyue Qiang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China
| | - Tianxiang Dong
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China
| | - Yuye Li
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China
| | - Jin Wang
- Scientific Research Center, Shanghai Public Health Clinical Center, Fudan University, 2901, Caolang Road, Jinshan District, Shanghai, China
| | - Shike Feng
- Department of Dermatology, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Hongbin Li
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032, Yunnan, China
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17
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Evaluation of a PCR-electrospray ionization mass spectrometry platform for detection and identification of fungal pathogens directly from prospectively collected bronchoalveolar lavage specimens. Diagn Microbiol Infect Dis 2020; 97:114988. [PMID: 32107092 PMCID: PMC7127232 DOI: 10.1016/j.diagmicrobio.2020.114988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/09/2019] [Accepted: 01/14/2020] [Indexed: 12/11/2022]
Abstract
The incidence of invasive fungal infections is on the rise worldwide due to the growth of the immunocompromised population. We report here the use of a diagnostic assay that utilizes a universal extraction method, broad spectrum PCR amplification and analysis via electrospray ionization mass spectrometry (PCR/ESI-MS) to detect and identify more than 200 pathogenic fungi directly from bronchoalveolar lavage (BAL) specimens in less than 8 hours. In this study, we describe both analytical and clinical performance of the assay, when run with prospectively collected clinical BAL specimens. In 146 patients with probable and possible fungal infections defined by EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group) criteria, the PCR/ESI-MS assay demonstrated a sensitivity of 90.9% (95% CI: 76.4–96.9%) and a specificity of 82.3% (95% CI: 74.2–88.2%). This data demonstrates the utility of a non-culture based broad fungal targets molecular diagnostic tool for rapid and accurate diagnosis of invasive fungal infections in patients at risk of developing fungal diseases.
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18
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Pedrosa AF, Lisboa C, Branco J, Almeida AC, Mendes C, Pellevoisin C, Leite-Moreira A, Miranda IM, Rodrigues AG. Malassezia colonisation on a reconstructed human epidermis: Imaging studies. Mycoses 2019; 62:1194-1201. [PMID: 31556177 DOI: 10.1111/myc.13011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Biofilm formation represents a major microbial virulence attribute especially at epithelial surfaces such as the skin. Malassezia biofilm formation at the skin surface has not yet been addressed. OBJECTIVE The present study aimed to evaluate Malassezia colonisation pattern on a reconstructed human epidermis (RhE) by imaging techniques. METHODS Malassezia clinical isolates were previously isolated from volunteers with pityriasis versicolor and seborrhoeic dermatitis. Yeast of two strains of M furfur and M sympodialis were inoculated onto the SkinEthic™ RHE. The tissues were processed for light microscopy, wide-field fluorescence microscopy and scanning electron microscopy. RESULTS Colonisation of the RhE surface with aggregates of Malassezia yeast entrapped in a multilayer sheet with variable amount of extracellular matrix was unveiled by imaging techniques following 24, 48, 72 and 96 hours of incubation. Whenever yeast were suspended in RPMI medium supplemented with lipids, the biofilm substantially increased with a dense extracellular matrix in which the yeast cells were embedded. Slight differences were found in the biofilm architectural structure between the two tested species with an apparently higher entrapment and viscosity in M furfur biofilm. CONCLUSION Skin isolates of M furfur and M sympodialis were capable of forming biofilm in vitro at the epidermal surface simulating in vivo conditions. Following 24 hours of incubation, without added lipids, rudimental matrix was barely visible, conversely to the reported at plastic surfaces. The amount of biofilm apparently increased progressively from 48 to 96 hours. A structural heterogeneity of biofilm between species was found.
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Affiliation(s)
- Ana Filipa Pedrosa
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Dermatology and Venereology, Centro Hospitalar Universitário S.João EPE, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Carmen Lisboa
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Dermatology and Venereology, Centro Hospitalar Universitário S.João EPE, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Joana Branco
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana C Almeida
- Chromosome Instability & Dynamics Laboratory, Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Graduate Program in Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Claudia Mendes
- Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Isabel M Miranda
- Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Acacio G Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Plastic and Reconstructive Surgery, Burn Unit, Centro Hospitalar Universitário S.João EPE, Porto, Portugal
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19
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Pedrosa AF, Lisboa C, Faria-Ramos I, Silva R, Ricardo E, Teixeira-Santos R, Miranda I, Rodrigues AG. Epidemiology and susceptibility profile to classic antifungals and over-the-counter products of Malassezia clinical isolates from a Portuguese University Hospital: a prospective study. J Med Microbiol 2019; 68:778-784. [PMID: 30907722 DOI: 10.1099/jmm.0.000966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Clinical epidemiological data about the distinct Malassezia species remain scarce. The recurrence of Malassezia-related skin diseases, despite long-term use of antifungals, raises concern about the hypothetical emergence of antifungal resistance. We aimed to assess the distribution of Malassezia species among patients from a University Hospital with pityriasis versicolor, seborrheic dermatitis and healthy volunteers, and to evaluate the susceptibility profile to classic antifungals and over-the-counter compounds, searching for clinical associations. METHODOLOGY The enrollment of volunteers was conducted at the Dermatology Department of a University Hospital over a 3 year period. Malassezia culture isolates were identified to the species-level by sequencing. The drug susceptibility profile was assessed according to a broth microdilution assay, as recommended by the Clinical Laboratory Standards Institute. RESULTS A total of 86 Malassezia isolates were recovered from 182 volunteers. Malassezia sympodialis was the most frequent isolated species. We found high MIC values and a wide MIC range in the case of tested azoles, and very low terbinafine MIC values against most isolates. Previous topical corticosteroid therapy was associated with a significant increase of MIC values of fluconazole and of terbinafine. CONCLUSION Conversely to other European studies, M. sympodialis was the most common isolated species, which might be related to geographic reasons. The impact of previous topical corticotherapy upon the antifungal susceptibility profile was hereby demonstrated. In vitro susceptibility test results suggest that terbinafine might be a valid alternative for Malassezia-related skin diseases nonresponsive to azoles.
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Affiliation(s)
- Ana Filipa Pedrosa
- Department of Dermatology and Venereology, Centro Hospitalar S. João EPE, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Portugal.,Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - Carmen Lisboa
- Department of Dermatology and Venereology, Centro Hospitalar S. João EPE, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Portugal.,Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - Isabel Faria-Ramos
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - Raquel Silva
- Department of Medical Sciences - iBiMED & IEETA, University of Aveiro, Aveiro, Portugal
| | - Elisabete Ricardo
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Portugal
| | - Rita Teixeira-Santos
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Portugal
| | - Isabel Miranda
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - Acácio Gonçalves Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine of the University of Porto, Portugal.,Burn Unit, Department of Plastic and Reconstructive Surgery, Centro Hospitalar S. João EPE, Porto, Portugal
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20
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Cam VT, Van TN, Hau KT, Huu DL, Minh PPT, Huu SN, Minh TN, Gandolfi M, Satolli F, Feliciani C, Tirant M, Vojvodic A, Lotti T. Distribution of Malassezia Species from Scales of Patient with Pityriasis Versicolor by Culture in Vietnam. Open Access Maced J Med Sci 2019; 7:184-186. [PMID: 30745953 PMCID: PMC6364713 DOI: 10.3889/oamjms.2019.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The detection of pathogenic fungus is an important step and key to assessing the sensitivity of the antifungal drugs, and therefore choosing an effective treatment method. AIM To identify Malassezia species from scales of a patient with pityriasis versicolor. METHODS Three hundred patients with pityriasis versicolor who were positive with direct examination, were isolated by culture. RESULTS Identification of Malassezia species by culture: the growth rate was 90.3%; the detection rate was 97.0%, including 11 species: M. globosa (42.4%), M. dermatitis (17.3%), M. furfur (14.4%). M. globosa was the most prevalent species in the 20-29 group 36.5%, in hyphae and yeast cells (42.2%). CONCLUSION M. globosa is the main cause of pityriasis versicolor in Vietnam.
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Affiliation(s)
- Van Tran Cam
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | | | - Khang Tran Hau
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Doanh Le Huu
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | | | - Sau Nguyen Huu
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Thu Nguyen Minh
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | | | | | | | - Michael Tirant
- University of Rome G. Marconi, Rome, Italy.,Psoriasis Eczema Clinic, Melbourne, Australia
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
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