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Thu NTM, Borda H, Vitsupakorn S, Reddy KS, Kasmani N, Barwatt J, Schwartz IS, Giamberardino C, Perfect JR, Hoa NT, Le T. Development and validation of a colorimetric antifungal susceptibility testing method for the dimorphic fungus Talaromyces marneffei. Med Mycol 2023; 61:myad111. [PMID: 37994652 PMCID: PMC10681740 DOI: 10.1093/mmy/myad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023] Open
Abstract
Antifungal drug resistance is an emerging cause of treatment failure in invasive fungal infections, and antifungal susceptibility testing (AFST) may inform treatment decisions. Currently, there are no established AFST guidelines for Talaromyces marneffei (Tm) or other dimorphic fungi. We developed a colorimetric AFST method using a fluorescent redox indicator alamarBlue, which changes from blue to pink in proportion to cellular metabolic activity. We determined the optimal time for alamarBlue addition to be 24 h post-inoculation and for MIC reading to be 72 h post-inoculation. Our method allows three ways to determine minimum inhibitory concentration (MIC): visual inspection of color change, optical density, and fluorescence intensity. We validated the assay by determining the MICs for seven antifungals against 32 Tm clinical isolates and assessed the essential agreement (EA) and inter-rater reliability between our alamarBlue and the Clinical Laboratory Standard Institute (CLSI) broth microdilution methods. The MIC ranges (from low to high) were: 0.008-0.025 μg/ml for itraconazole, 0.004-0.13 μg/ml for voriconazole, 0.03-0.13 μg/ml for posaconazole, 0.06-0.5 µg/ml for flucytosine, 0.5-1 µg/ml for amphotericin B, 0.5-4 µg/ml for caspofungin, and 0.5-16 µg/ml for fluconazole. The EAs were 100% between all three MIC readouts of the alamarBlue method, and 94%-100% between the alamarBlue and CLSI methods. Our alamarBlue method had substantially higher inter-rater agreement and offers a more reliable method that can be standardized across laboratories in both high- and low-resource settings compared to the established CLSI methodology.
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Affiliation(s)
- Nguyen Thi Mai Thu
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Hannah Borda
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Shawin Vitsupakorn
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Kaushik Sreerama Reddy
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Navsin Kasmani
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Joseph Barwatt
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Charles Giamberardino
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - John R Perfect
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Ngo Thi Hoa
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Tropical Medicine Research Center for Talaromycosis, Biomedical Research Centre, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Tropical Medicine Research Center for Talaromycosis, Biomedical Research Centre, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Wong SYN, Wong KF. Penicillium marneffei Infection in AIDS. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:764293. [PMID: 21331327 PMCID: PMC3038620 DOI: 10.4061/2011/764293] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/06/2011] [Indexed: 11/20/2022]
Abstract
Penicillium marneffei is a dimorphic fungus which is endemic in Southeast Asia. It is an opportunistic pathogen which has emerged to become an AIDS-defining illness in the endemic areas. Early diagnosis with prompt initiation of treatment is crucial for its management. Prompt diagnosis can often be established through careful cytological and histological examination of clinical specimens although microbiological culture remains the gold standard for its diagnosis. Standard antifungal treatment for AIDS patients with penicilliosis is well established. Highly active antiretroviral therapy should be started early together with the antifungal treatment. Special attention should be paid to potential drug interaction between antiretroviral and antifungal treatments. Secondary prophylaxis may be discontinued with a low risk of relapse of the infection once the immune dysfunction has improved.
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Affiliation(s)
- Stephenie Y N Wong
- Department of Pathology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
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Tian J, Sun H, Cui X, Xian W, Li E, Liu X. Using Continuous Flow Peritoneal Dialysis with Double Tenckhoff Catheters to Treat Refractory Peritonitis — a Case Report. ARCH ESP UROL 2008. [DOI: 10.1177/089686080802800421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jun Tian
- Blood Purification Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Huaibin Sun
- Blood Purification Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Xianquan Cui
- Blood Purification Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Wanhua Xian
- Blood Purification Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Engang Li
- Blood Purification Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Xuemei Liu
- Department of General and Visceral Surgery University of Freiburg, Germany
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Abstract
During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses and compromised host defenses. While Aspergillus and Candida spp. collectively account for the majority of these infections, recent epidemiological trends indicate a shift towards infections by Aspergillus spp., nonalbicans Candida spp., as well as previously uncommon opportunistic fungi. Apart from an expanding number of different Zygomycetes, previously uncommon hyaline filamentous fungi (such as Fusarium species, Acremonium species, Paecilomyces species, Pseudallescheria boydii, and Scedosporium prolificans), dematiaceous filamentous fungi (such as Bipolaris species, Cladophialophora bantiana, Dactylaria gallopava, Exophiala species, and Alternaria species) and yeast-like pathogens (such as Trichosporon species, Blastoschizomyces capitatus, Malassezia species, Rhodotorula rubra and others) are increasingly encountered as causing life threatening invasive infections that are often refractory to conventional therapies. On the basis of past and current trends, the spectrum of fungal pathogens will continue to evolve in the settings of an expanding population of immunocompromised hosts, selective antifungal pressures, and shifting conditions in hospitals and the environment. An expanded and refined drug arsenal, further elucidation of pathogenesis and resistance mechanisms, establishment of in vitro/in vivo correlations, incorporation of pharmacodynamics, combination- and immunotherapies offer hope for substantial progress in prevention and treatment.
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Affiliation(s)
- A H Groll
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
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McGinnis MR, Nordoff NG, Ryder NS, Nunn GB. In vitro comparison of terbinafine and itraconazole against Penicillium marneffei. Antimicrob Agents Chemother 2000; 44:1407-8. [PMID: 10770792 PMCID: PMC89885 DOI: 10.1128/aac.44.5.1407-1408.2000] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated terbinafine and itraconazole against 30 isolates of Penicillium marneffei using a modification of the National Committee for Clinical Laboratory Standards broth macrodilution MIC testing protocol for yeasts. The minimal fungicidal concentration (MFC) was determined by plating 100 microl from each MIC drug dilution having no growth onto Sabouraud glucose agar incubated at 30 degrees C. The MFC was the dilution at which growth was absent at 72 h of incubation. The MICs, in micrograms per milliliter, were as follows: terbinafine, 0.03 to 1.0 (geometric mean titer, 0.09); itraconazole, 0.03 to 0.5 (geometric mean titer, 0.04). The MFCs, in micrograms per milliliter, were as follows: terbinafine, 0.03 to 8 (geometric mean titer, 2.60); itraconazole, 0.03 to 8 (geometric mean titer, 2. 45). Primary fungicidal activity (MFC within 2 dilutions of MIC) was observed with terbinafine in eight isolates and with itraconazole in four isolates. The data indicate that terbinafine is active against P. marneffei in vitro and may have a previously unrealized role in the management of infections caused by this fungus.
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Affiliation(s)
- M R McGinnis
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0609, USA.
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Myoken Y, Sugata T, Myoken Y, Kyo T, Fujihara M, Mikami Y. Antifungal susceptibility of Aspergillus species isolated from invasive oral infection in neutropenic patients with hematologic malignancies. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:174-9. [PMID: 10052372 DOI: 10.1016/s1079-2104(99)70269-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relevance of in vitro antifungal susceptibility to clinical response in neutropenic patients with invasive oral aspergillosis. STUDY DESIGN Nine isolates of Aspergillus species were obtained from invasive oral infections in 9 patients with hematologic malignancies and tested for their in vitro susceptibility to amphotericin B, fluconazole, miconazole, 5-fluorocytosine, and itraconazole. Minimal inhibitory concentration values of the 5 drugs were obtained for each fungus through use of a microdilution broth method. The patients were treated with intravenous amphotericin B (30-50 mg/day) in combination with oral 5-fluorocytosine (3000-6000 mg/day) and/or oral itraconazole (200 mg/day). RESULTS Amphotericin B and itraconazole were found to be very active, with minimal inhibitory concentration values of 0.861 and 0.194 microg/mL, respectively. Miconazole and 5-fluorocytosine showed minimal inhibitory concentration values of 1.72 and 3.56 microg/mL, respectively. On the other hand, fluconazole FCZ showed low activity, with a minimal inhibitory concentration value in excess of 64.0 microg/mL. During neutropenia, combined antifungal chemotherapy stabilized oral aspergillosis and prevented the spread of oral lesions in 8 patients in whom neutrophil counts eventually recovered. CONCLUSIONS The results imply that in vitro susceptibility testing may serve as an informative parameter with respect to the efficacy of these antifungals in the treatment of invasive oral aspergillosis, inducing fungal stasis until the neutrophils recover.
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Affiliation(s)
- Y Myoken
- Department of Dentistry and Oral Surgery, Hiroshima Red Cross-Atomic Bomb Survivors Hospital, Japan
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Yang HC, Mikami Y, Yazawa K, Taguchi H, Nishimura K, Miyaji M, Branchini ML, Aoki FH, Yamamoto K. Colorimetric MTT assessment of antifungal activity of D0870 against fluconazole-resistant Candida albicans. Mycoses 1998; 41:477-80. [PMID: 9919890 DOI: 10.1111/j.1439-0507.1998.tb00709.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The in vitro antifungal activity of D0870 against eight isolates of fluconazole-resistant Candida albicans was compared with that of itraconazole, ketoconazole and miconazole. The colorimetric MTT [3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide] assay was used to assess the antifungal activities. The 50% minimum inhibitory concentration (MIC50) of D0870 was below 0.031 microgram ml-1 for seven isolates and 0.25 microgram ml-1 for one isolate. The activity of D0870 was superior to that of the other azoles. Ketoconazole was the most effective azole next to D0870. Therefore, the new bis-triazole, D0870, is expected to be promising for the therapy of fluconazole-resistant candidosis. The present data also confirmed that the MTT assay may be useful for evaluation of resistance and detection of resistant C. albicans.
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Affiliation(s)
- H C Yang
- Research Center for Papthogenic Fungi and Microbial Foxicoses, Chiba University, Japan
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Poonwan N, Imai T, Mekha N, Yazawa K, Mikami Y, Ando A, Nagata Y. Genetic analysis of Histoplasma capsulatum strains isolated from clinical specimens in thailand by a PCR-based random amplified polymorphic DNA method. J Clin Microbiol 1998; 36:3073-6. [PMID: 9738073 PMCID: PMC105117 DOI: 10.1128/jcm.36.10.3073-3076.1998] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Thirteen strains of Histoplasma capsulatum were isolated from clinical specimens, including those from AIDS patients, in Thailand. Random amplified polymorphic DNA (RAPD) analysis with three different PCR primers showed that the DNA fingerprint patterns of the Thai isolates were very similar to each other and homogeneous, with only one exceptional strain, although the patterns were clearly different from those of a reference North American strain with all primers tested. Although the difference in the DNA fingerprinting patterns was minor, Thai isolates could be classified into two to four groups. A common PCR band (about 700 bp) in the patterns of all H. capsulatum strains was extracted, and its DNA sequence was determined. A new PCR primer set for the identification of H. capsulatum species was developed based on this sequence information. This primer set was 100% successful in the identification of the reference strain as well as all Thai isolates. The results of specificity tests of the primer set for the identification of the fungus are also discussed.
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Affiliation(s)
- N Poonwan
- Department of Medical Sciences, National Institute of Health, Nonthaburi, Thailand
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Mekha N, Poonwan N, Mikami Y, Yazawa K, Gonoi T, Hasegawa S, Nishimura K. Random amplified polymorphic DNA (RAPD) analysis of Penicillium marneffei strains isolated from AIDS patients in Thailand. MYCOSCIENCE 1997. [DOI: 10.1007/bf02460842] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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