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Gupta AK, Wang T, Cooper EA, Summerbell RC, Piguet V, Tosti A, Piraccini BM. A comprehensive review of nondermatophyte mould onychomycosis: Epidemiology, diagnosis and management. J Eur Acad Dermatol Venereol 2024; 38:480-495. [PMID: 38010049 DOI: 10.1111/jdv.19644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/09/2023] [Indexed: 11/29/2023]
Abstract
Nondermatophyte moulds (NDMs) are widely distributed and can be detected in association with mycotic nails; however, sometimes it can be challenging to establish the role of NDMs in the pathogenesis of onychomycosis (i.e. causative vs. contaminant). In studies where the ongoing invasive presence of NDMs is confirmed through repeat cultures, the global prevalence of NDMs in onychomycosis patients is estimated at 6.9% with the 3 most common genus being: Aspergillus, Scopulariopsis and Fusarium. NDM onychomycosis can, in many cases, appear clinically indistinguishable from dermatophyte onychomycosis. Clinical features suggestive of NDMs include proximal subungual onychomycosis with paronychia associated with Aspergillus spp., Fusarium spp. and Scopulariopsis brevicaulis, as well as superficial white onychomycosis in a deep and diffused pattern associated with Aspergillus and Fusarium. Longitudinal streaks seen in patients with distal and lateral onychomycosis may serve as an additional indicator. For diagnosis, light microscopic examination should demonstrate fungal filaments consistent with an NDM with at least two independent isolations in the absence of a dermatophyte; the advent of molecular testing combined with histological assessment may serve as an alternative with improved sensitivity and turnover time. In most instances, antifungal susceptibility testing has limited value. Information on effective treatments for NDM onychomycosis is relatively scarce, unlike the situation in the study of dermatophyte onychomycosis. Terbinafine and itraconazole therapy (continuous and pulsed) appear effective to varying extents for treating onychomycosis caused by Aspergillus, Fusarium or Scopulariopsis. There is scant literature on oral treatments for Neoscytalidium.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mediprobe Research Inc., London, Ontario, Canada
| | - Tong Wang
- Mediprobe Research Inc., London, Ontario, Canada
| | | | - Richard C Summerbell
- Sporometrics, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, Florida, USA
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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2
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Haghani I, Hedayati MT, Shokohi T, Kermani F, Ghazanfari M, Javidnia J, Khojasteh S, Roohi B, Badali H, Fathi M, Amirizad K, Yahyazadeh Z, Abastabar M, Al-Hatmi AMS. Onychomycosis due to Fusarium species in different continents, literature review on diagnosis and treatment. Mycoses 2024; 67:e13652. [PMID: 37605217 DOI: 10.1111/myc.13652] [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: 05/12/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
Fusarium species are an emerging cause of onychomycosis, and the number of cases has dramatically increased in recent decades worldwide. This review presents an overview of the onychomycosis cases caused by Fusarium species and diagnosis and treatment that have been reported in the literature. The most common causative agent of onychomycosis is F. solani species complex, which accounts for 11.68% of the cases of Fusarium onychomycosis, followed by the F. oxysporum species complex (164 out of 1669), which is accounted for 9.83% of the total. F. fujikuroi species complex (42 out of 1669) and F. dimerum species complex (7 out of 1669) are responsible for 2.52% and 0.42 cases, respectively. Fusarium nail infections were reported in patients aged range 1-98, accounting for 5.55% (1669 out of 30082) of all cases. Asia has the highest species diversity of Fusarium onychomycosis (31.51%). South America accounts for 21.09%, and the most common causative agent is F. solani (19.32%), followed by F. oxysporum species complex (15.63%). Europe accounts for 4.90% of cases caused by F. oxysporum, followed by F. solani. Africa accounts for 23.87% of the cases due to the F. solani species complex, followed by F. oxysporum and F. fujikuroi. Distal and lateral subungual onychomycosis was the most common clinical symptom accounting for 58.7% (135 out of 230) of the cases. Data analysis relieved that terbinafine and itraconazole are active treatments for Fusarium onychomycosis. For a definitive diagnosis, combining of direct examination, culture and sequencing of the elongation factor of translation 1α are recommended. Accurate identification of the causative agents of onychomycosis due to Fusarium species and antifungal susceptibility testing is essential in patient management.
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Affiliation(s)
- Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Department of Medical Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mona Ghazanfari
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shaghayegh Khojasteh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Behrad Roohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Maryam Fathi
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Kazem Amirizad
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zahra Yahyazadeh
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdullah M S Al-Hatmi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa, Oman
- Department of Biological Sciences & Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa, Oman
- Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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3
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Futatsuya T, Ogawa A, Anzawa K, Mochizuki T, Shimizu A. First Isolation of Neoscytalidium dimidiatum from Human Dermatomycosis in Japan. Med Mycol J 2022; 63:71-75. [PMID: 36047185 DOI: 10.3314/mmj.22-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neoscytalidium dimidiatum is a common fungus that causes non-dermatophyte dermatomycosis in tropical regions, but there have been no reports of infection with N. dimidiatum in Japan. Here, we report the first isolation of N. dimidiatum from human dermatomycosis in Japan. A 62-year-old healthy Japanese male had been treated with oral terbinafine for tinea pedis diagnosed from a microscopic examination in 2003 with a lesion that was intractable. In 2020, re-identification by sequencing the internal transcribed spacer regions and the D1/D2 domain of the large-subunit (LSU) ribosomal RNA gene revealed that the pathogen was N. dimidiatum. Antifungal susceptibility tests showed that the minimum inhibitory concentration of the drug luliconazole (LLCZ) against the pathogen was 0.00049 µg/mL. The patient's lesions were cured by topical LLCZ. The clinical course and drug susceptibility suggest that LLCZ is a suitable first-line drug for treatment.
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Affiliation(s)
| | | | | | | | - Akira Shimizu
- Department of Dermatology, Kanazawa Medical University
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4
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Haghani I, Shams-Ghahfarokhi M, Dalimi Asl A, Shokohi T, Hedayati MT. Prevalence, genetic diversity and antifungal susceptibility profiles of F. fujikuroi, F. solani, and Fusarium incarnatum-equiseti species complexes from onychomycosis in North of Iran. Mycoses 2022; 65:1030-1039. [PMID: 35775829 DOI: 10.1111/myc.13489] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/25/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022]
Abstract
Onychomycosis, a nail fungal infection, is normally caused by dermatophytes. However, yeasts and non-dermatophyte molds (NDM) are among pathogens that cause nail disease. Regarding, this study aimed to describe the molecular epidemiology of Fusarium onychomycosis in the North of Iran. 257 nail samples collected from the patients clinically suspected of onychomycosis were subjected to direct microscopy, calcofluor white staining, and culture. Fusarium isolates were identified at a species level through determination of multi-locus sequences for internal transcribed spacer and translation elongation factor 1 alpha. Based on the findings, Fusarium species were isolated from onychomycosis patients (n=27). According to a previous partial genes analysis, the species in the resent study belonged to the members of F. fujikuroi species complex (n=14), Fusarium incarnatum-equiseti species complex (n=1) and F. solani species complex (n=12). In rhis study, F. proliferatum was the dominant Fusarium species collected from the samples. The correct identification of Fusarium species is essential regarding the increased prevalence of Fusarium onychomycosis and the inherent resistance of these agents to a wide spectrum of antifungals. The obtained results indicated variation in the epidemiology of Fusarium species isolated from onychomycosis. Moreover, the minimum inhibitory concentration (MIC) of luliconazole and lanoconazole was in the range of 0.001-1 μg/mL, with the geometric mean of MICs obtained at 0.0103 and 0.0343 μg/mL against Fusarium species, respectively. These findings can increase researchers' knowledge regarding diversity of species, distribution of onychomycosis, and the choice of a proper treatment.
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Affiliation(s)
- Iman Haghani
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.,Department of Medical Mycology and Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Abdolhossein Dalimi Asl
- Department of Medical Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Tahereh Shokohi
- Department of Medical Mycology and Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Hedayati
- Department of Medical Mycology and Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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5
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Ribeiro TB, Lira JAC, Bezerra SMG, Oliveira RAOA, Machado RDS, Nogueira LT. USO DOS ÓLEOS ESSENCIAIS EM ONICOMICOSE: REVISÃO INTEGRATIVA. ESTIMA 2021. [DOI: 10.30886/estima.v19.1011_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:identificar na literatura como os óleos essenciais são utilizados em onicomicose. Métodos: revisão integrativa com buscas realizadas nas bases de dados MEDLINE/PubMed, Web of Science, Cochrane, SCOPUS e BVS, sendo 13 estudos analisados. Resultados: o uso de óleos essenciais Melaleucaalternifólia, Lavandulaangustifólia, Eucalyptuscitriodora e Foeniculumvulgare mostram-se eficazes e trazem benefícios no tratamento da onicomicose, por inibirem o crescimento micelial dos fungos infectantes das unhas. Sendo assim, os profissionais de saúde envolvidos nos cuidados em pessoas com onicomicose devem se manter atualizados sobre tais alternativas de tratamento e consequentemente da melhora da assistência prestada a esses pacientes. Conclusão: a eficácia antifúngica de uma variedade de óleos foi comprovada com diferentes formas de apresentação e possíveis associações. Entretanto, o nível da evidência apresentado foi baixo, o que justifica a necessidade de estudos mais robustos sobre a temática.
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Ribeiro TB, Lira JAC, Bezerra SMG, Oliveira RAOA, Machado RDS, Nogueira LT. USE OF ESSENTIAL OILS IN ONYCHOMYCOSIS: AN INTEGRATIVE REVIEW. ESTIMA 2021. [DOI: 10.30886/estima.v19.1011_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: identify in the literature how essential oils are used in onychomycosis. Methods: integrative review with searches performed in the MEDLINE/PubMed, Web of Science, Cochrane, SCOPUS and BVS databases, with 13 studies analyzed. Results: the use of essential oils Melaleuca alternifolia, Lavandula angustifolia, Eucalyptus citriodora and Foeniculum vulgare are effective and bring benefits in the treatment of onychomycosis, as they inhibit the mycelial growth of the nail fungus. Therefore, health professionals involved in the care of people with onychomycosis must keep themselves updated on such treatment alternatives and, consequently, on improving the care provided to these patients. Conclusion: the antifungal efficacy of a variety of oils has been proven with different forms of presentation and possible associations. However, the level of evidence presented was low, which justifies the need for more robust studies on the subject.
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Development and Validation of an In-House Library for Filamentous Fungi Identification by MALDI-TOF MS in a Clinical Laboratory in Medellin (Colombia). Microorganisms 2020; 8:microorganisms8091362. [PMID: 32899976 PMCID: PMC7563289 DOI: 10.3390/microorganisms8091362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Abstract
Identification of filamentous fungi by conventional phenotypic methods are time-consuming, and a correct identification at the species level is prone to errors. Therefore, a more accurate and faster time-to-results, and cost-effective technique, is required, such as the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). In this study, we describe the development of an in-house spectra library for the identification of filamentous fungi frequently isolated from patients with infections. An in-house spectra library was constructed using 14 reference strains grown in solid medium. Clinical isolates were identified either by the in-house spectra library or the Biotyper commercial library from Bruker Daltonics. Fungal identification was carried following the Biotyper’s established scores: ≤1.699: not reliably identified (NRI); 1.700–1.999: genus-level; ≥2.000: species-level. Clinical isolates were identified, with the in-house library, at species- and genus-level at 88.70% (55) and 3.22% (2), respectively. While 4.80% (3) was NRI and 3.22% (2) was discrepant concerning sequencing. On the contrary, identification up to species and genus-level with the commercial library was 44.44% (16) and 22.22% (8), respectively. NRI and the discrepancy was 30.55% (11) and 2.77% (1), respectively. For the reaming 26 isolates, 16 from Neoscytalidium dimidiatum and 10 from Sporothrix spp., respectively, the absence of spectrum and the specific spectra within the Sporothrix complex in the commercial library resulted in the inability to obtain an identification. In conclusion, the current results advocate the importance that each clinical microbiological laboratory needs to develop an ad hoc library associated with the MALDI-TOF MS fungal identification to overcome the limitations of the available commercial libraries.
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Shokoohi GR, Ansari S, Abolghazi A, Gramishoar M, Nouripour-Sisakht S, Mirhendi H, Makimura K. The first case of fingernail onychomycosis due to Neoscytalidium novaehollandiae, molecular identification and antifungal susceptibility. J Mycol Med 2019; 30:100920. [PMID: 31892498 DOI: 10.1016/j.mycmed.2019.100920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
Onychomycosis is considered a fungal nail infection caused mainly by dermatophytes, yeasts and non-dermatophyte molds including dematiaceous fungi. Onychomycosis caused by non-dermatophyte molds is a health problem in the medical environment as the patients frequently return to outpatient clinics seeking new therapeutic modalities. Here, we report the first case of onychomycosis caused by a black fungus, Neoscytalidium novaehollandiae, in the right hand finger nail of a 52-year-old Iranian female with no history of immunodeficiency and underlying disease. The pattern of nail involvement was recognized as total dystrophic onychomycosis. Examination of nail scrapings with potassium hydroxide revealed brown, septate and branching sub-hyaline to dark-colored hyphae. The black fungus isolated in culture was identified as Neoscytalidium novaehollandiae by molecular analysis. The patient received oral terbinafine plus ciclopirox nail lacquer twice a week and began responding to the treatment three months after initial antifungal therapy. Additional four weeks' use of terbinafine plus ciclopirox nail lacquer completely resolved the clinical manifestations of onychomycosis. After four months, both microscopy and culture were negative.
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Affiliation(s)
- G R Shokoohi
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - S Ansari
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Abolghazi
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - M Gramishoar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - S Nouripour-Sisakht
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - H Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - K Makimura
- Medical Mycology, Graduate School of Medicine, Teikyo University, Tokyo, Japan
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ITS rDNA Gene Analysis Versus MALDI-TOF MS For Identification of Neoscytalidium dimidiatum Isolated from Onychomycosis and Dermatomycosis Cases in Medellin (Colombia). Microorganisms 2019; 7:microorganisms7090306. [PMID: 31480602 PMCID: PMC6780217 DOI: 10.3390/microorganisms7090306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 12/30/2022] Open
Abstract
Within the Neoscytalidium genus, N. dimidiatum, N. oculus, N. orchidacearum, and N. novaehollandiae have been recognized. Although these species are frequently found in soil, N. dimidiatum has been identified as an etiologic agent of onychomycosis or dermatomycosis, and N. oculus has been identified as an etiologic agent of an ocular lesion. All these species can be cultured in vitro, but their morphological identification by macroscopic and microscopic traits is difficult and imprecise due to their similarity. In this study, 34 isolates of Neoscytalidium spp. from 32 onychomycosis and two dermatomycosis cases in Medellin (Colombia) were identified at the species level using sequencing of the ITS1+5.8S+ITS2 nuclear rDNA region and MALDI-TOF mass spectrometry (MS). Neoscytalidium dimidiatum strain MUM 17.21 was used to construct the reference spectrum in the in-house library to identify the clinical isolates by MALDI-TOF MS. Additionally, N. dimidiatum PPC-216 and PLAB-055 strains were used to validate the in-house constructed reference spectra. Although four groups were observed in the dendrogram obtained from the proteins of each isolate profile, MALDI-TOF MS and sequencing results are in accordance, since all isolates were identified as N. dimidiatum.
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[Evaluation of the usefulness of nail biopsy in the diagnosis of onychomycosis]. Rev Iberoam Micol 2019; 36:72-78. [PMID: 31153723 DOI: 10.1016/j.riam.2018.06.001] [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: 03/07/2017] [Revised: 05/07/2018] [Accepted: 06/08/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Onychomycosis affects between 2% to 30% of the world population. Nail biopsy may help in making a diagnosis and can distinguish between invasion and colonisation. AIMS To evaluate the diagnostic usefulness of nail biopsy with Periodic acid-Schiff (PAS) staining for onychomycosis, compared to direct KOH examination, culture and its combination in a reference laboratory in Colombia. METHODS The study included 66 patients in whom a blind and independent reading of the three tests was performed. The usefulness was defined based on the validity (sensitivity, specificity, Youden's index, likelihood ratios), performance (predictive values) efficiency (proportion of correctly diagnosed patients), and reproducibility (kappa coefficient). RESULTS The mean age of the patients was 55±16 years, and included 76% women. The direct tests with KOH were positive in 66.7% (n=44), 62.1% (n=41) were positive with culture, and 56.1% (n=37) with the biopsy. The main causal agents were non-dermatophytes moulds in 36.4% (n=24). The most frequent species were Neoscytalidium dimidiatum (n=11), Trichophyton rubrum (n=11), and Candida parapsilosis (n=13). The sensitivity of nail biopsy, when compared to the standard (KOH and/or culture), was 71%, specificity 83%, Youden's index 0.54, positive likelihood ratio 4.25, negative likelihood ratio 0.35, positive predictive value 92%, negative predictive value 52%, efficiency 74% and kappa coefficient 0.45. When biopsy was evaluated only in patients with onycholysis of the nail plate greater than 50%, all the parameters of diagnostic usefulness increased. CONCLUSIONS The overall usefulness of the biopsy was moderate for patients with more severe symptomatology, which makes its use advisable in cases of extensive onycholysis, and when discriminating colonisation from invasion is required.
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11
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Tsang CC, Tang JYM, Chan KF, Lee CY, Chan JFW, Ngan AHY, Cheung M, Lau ECL, Li X, Ng RHY, Lai CKC, Fung KSC, Lau SKP, Woo PCY. Diversity of phenotypically non-dermatophyte, non-Aspergillus filamentous fungi causing nail infections: importance of accurate identification and antifungal susceptibility testing. Emerg Microbes Infect 2019; 8:531-541. [PMID: 30938262 PMCID: PMC6455232 DOI: 10.1080/22221751.2019.1598781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/02/2022]
Abstract
Onychomycosis is most commonly caused by dermatophytes. In this study, we examined the spectrum of phenotypically non-dermatophyte and non-Aspergillus fungal isolates recovered over a 10-year period from nails of patients with onychomycosis in Hong Kong. A total of 24 non-duplicated isolates recovered from 24 patients were included. The median age of the patients was 51 years, and two-thirds of them were males. One-third and two-thirds had finger and toe nail infections respectively. Among these 24 nail isolates, 17 were confidently identified as 13 different known fungal species, using a polyphasic approach. These 13 species belonged to 11 genera and ≥9 families. For the remaining seven isolates, multilocus sequencing did not reveal their definite species identities. These seven potentially novel species belonged to four different known and three potentially novel genera of seven families. 33.3%, 41.7% and 95.8% of the 24 fungal isolates possessed minimum inhibitory concentrations of >1 µg/mL to terbinafine, itraconazole and fluconazole, respectively, the first line treatment of onychomycosis. A high diversity of moulds was associated with onychomycosis. A significant proportion of the isolates were potentially novel fungal species. To guide proper treatment, molecular identification and antifungal susceptibility testing should be performed for these uncommonly isolated fungal species.
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Affiliation(s)
- Chi-Ching Tsang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - James Y. M. Tang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ka-Fai Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chun-Yi Lee
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jasper F. W. Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong
| | - Antonio H. Y. Ngan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Mei Cheung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Pathology, Queen Elizabeth Hospital, Pokfulam, King's Park, Hong Kong
| | - Eunice C. L. Lau
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong
| | - Xin Li
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ricky H. Y. Ng
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong
| | | | - Kitty S. C. Fung
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong
| | - Susanna K. P. Lau
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong
| | - Patrick C. Y. Woo
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong
- Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong
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12
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Ekowati Y, Ferrero G, Kennedy MD, de Roda Husman AM, Schets FM. Potential transmission pathways of clinically relevant fungi in indoor swimming pool facilities. Int J Hyg Environ Health 2018; 221:1107-1115. [PMID: 30145117 DOI: 10.1016/j.ijheh.2018.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
Possible transmission pathways of fungi in indoor swimming pool facilities were assessed through fungal counting in different areas of the facilities and typing of the collected fungal isolates. Air, water and surface samples were collected from seven different indoor swimming pool facilities. Fungal species were identified based on their internal transcribed spacer (ITS) sequences. Maximum fungal concentrations of 6.2 CFU/cm2, 1.39 CFU/100 mL, and 202 CFU/m³ were found on surfaces, in water and air, respectively. In total, 458 isolates were obtained, belonging to 111 fungal species, of which 50 species were clinically relevant. Phialophora oxyspora (13.3%) and Trichosporon dohaense (5.0%) were the most frequently isolated species and were merely detected on floors, as were the dermatophytes, Trichophyton interdigitale and T. rubrum. Penicillium spp. and Aspergillus spp. were the dominant fungi in water and air. No typical patterns of fungal concentrations along the preferential pathways of pool visitors were observed, however, sites where pool visitors converge while moving from one room (e.g. dressing room) to another (e.g. shower room) and walking barefoot displayed the highest fungal concentrations thus posing the highest risk of contamination. The dispersal of fungi on floors is most likely facilitated by the pool visitors and cleaning tools. Clinically relevant fungi, including the ones rarely identified in nature, were widely detected on floors, in water and in air, as well as on cleaning tools and flexibeams. Preventive measures such as cleaning should minimize the prevalence of clinically relevant fungi in swimming pool facilities since these potentially pose health risks to those vulnerable for infections.
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Affiliation(s)
- Yuli Ekowati
- IHE Delft Institute for Water Education, Westvest 7, 2611 AX Delft, The Netherlands.
| | - Giuliana Ferrero
- IHE Delft Institute for Water Education, Westvest 7, 2611 AX Delft, The Netherlands
| | - Maria D Kennedy
- IHE Delft Institute for Water Education, Westvest 7, 2611 AX Delft, The Netherlands; Delft University of Technology, Stevinweg 1, 2628 CN Delft, The Netherlands
| | - Ana Maria de Roda Husman
- National Institute for Public Health and the Environment, Centre for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Utrecht University, Faculty of Veterinary Medicine, Institute for Risk Assessment Sciences, Domplein 29, 3512 JE, The Netherlands
| | - Franciska M Schets
- National Institute for Public Health and the Environment, Centre for Zoonoses and Environmental Microbiology, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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13
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Alvarado Z, Pereira C. Fungal diseases in children and adolescents in a referral centre in Bogota, Colombia. Mycoses 2018; 61:543-548. [DOI: 10.1111/myc.12774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 02/21/2018] [Accepted: 03/21/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Zulma Alvarado
- Mycology Unit; Centro Dermatológico Federico Lleras Acosta, E.S.E.; Bogotá Colombia
| | - Claudia Pereira
- Dermatology Resident; Fundación Universitaria Sanitas; Centro Dermatológico Federico Lleras Acosta, E.S.E.; Bogotá Colombia
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14
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Bongomin F, Batac CR, Richardson MD, Denning DW. A Review of Onychomycosis Due to Aspergillus Species. Mycopathologia 2018; 183:485-493. [PMID: 29147866 PMCID: PMC5958150 DOI: 10.1007/s11046-017-0222-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/02/2017] [Indexed: 01/22/2023]
Abstract
Aspergillus spp. are emerging causative agents of non-dermatophyte mould onychomycosis (NDMO). New Aspergillus spp. have recently been described to cause nail infections. The following criteria are required to diagnose onychomycosis due to Aspergillus spp.: (1) positive direct microscopy and (2) repeated culture or molecular detection of Aspergillus spp., provided no dermatophyte was isolated. A review of 42 epidemiological studies showed that onychomycosis due to Aspergillus spp. varies between < 1 and 35% of all cases of onychomycosis in the general population and higher among diabetic populations accounting for up to 71% and the elderly; it is very uncommon among children and adolescence. Aspergillus spp. constitutes 7.7-100% of the proportion of NDMO. The toenails are involved 25 times more frequently than fingernails. A. flavus, A. terreus and A. niger are the most common aetiologic species; other rare and emerging species described include A. tubingensis, A. sydowii, A. alliaceus, A. candidus, A. versicolor, A. unguis, A. persii, A. sclerotiorum, A. uvarum, A. melleus, A. tamarii and A. nomius. The clinical presentation of onychomycosis due to Aspergillus spp. is non-specific but commonly distal-lateral pattern of onychomycosis. A negative culture with a positive KOH may point to a NDM including Aspergillus spp., as the causative agent of onychomycosis. Treatment consists of systemic therapy with terbinafine or itraconazole.
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Affiliation(s)
- Felix Bongomin
- The National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - C R Batac
- Skin Study Group, Institute of Herbal Medicine, National Institutes of Health, University of the Philippines - Manila, Manila, Philippines
| | - Malcolm D Richardson
- The National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
- NHS Mycology Reference Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - David W Denning
- The National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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15
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Babayani M, Salari S, Hashemi SJ, Ghasemi Nejad Almani P, Fattahi A. Onychomycosis due to dermatophytes species in Iran: Prevalence rates, causative agents, predisposing factors and diagnosis based on microscopic morphometric findings. J Mycol Med 2018; 28:45-50. [PMID: 29449074 DOI: 10.1016/j.mycmed.2017.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/18/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Onychomycosis (OM) or fungal nail infection is one of the most common fungal infections, which is increasingly prevalent. OM is caused by dermatophytes spp, yeasts and non-dermatophyte moulds (NDMs). The purpose of this study was to identify and determine the prevalence rates, predisposing factors and causative agents of OM using clinical symptoms and microscopic morphometric findings. MATERIALS AND METHODS In the present study, 180 patients suspected of OM were evaluated by direct microscopy using KOH 20%, culturing in Mycosel and Sabouraud dextrose agar media and Olysia software for identifying the causative fungi of OM. RESULTS From 180 referred patients, 118 (65.56%) had OM, of whom 79 (66.94%) were positive for infection with dermatophytes spp. Of the 79 cases, the commonest age group was 61-70 years (21%) with males being 46 (58.23%) and females being 33 (41.77%). Both the fingernail and toenail infections were most prevalent in male patients. Sex, diabetes and age above 60 years were significant predisposing factors for OM development. DLSO was observed as the only clinical pattern of OM and T. rubrum was the commonest dermatophyte isolate (49.34%). CONCLUSION This study showed that T. rubrum was the most common dermatophyte agent of OM in Iran.
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Affiliation(s)
- M Babayani
- Department of Medical Parasitology and Mycology, Kerman University of Medical Sciences, Kerman, Iran
| | - S Salari
- Students Research Committee, Kerman University of Medical Sciences, Kerman, Iran; Department of Medical Parasitology and Mycology, Kerman University of Medical Sciences, Kerman, Iran; Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - S J Hashemi
- Department of Medical Mycology and Parasitology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - A Fattahi
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
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16
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Ekowati Y, van Diepeningen AD, Ferrero G, Kennedy MD, de Roda Husman AM, Schets FM. Clinically relevant fungi in water and on surfaces in an indoor swimming pool facility. Int J Hyg Environ Health 2017; 220:1152-1160. [DOI: 10.1016/j.ijheh.2017.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
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17
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Saldaña M, Férez-Blando K, Domínguez-Cherit J, Fierro-Arias L, Bonifaz A. Fungal Leukonychia and Melanonychia: a Review. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0289-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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18
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Lavorato FG, Guimarães DA, Premazzi MG, Piñeiro-Maceira JM, Bernardes-Engemann AR, Orofino-Costa R. Performance of mycology and histopathology tests for the diagnosis of toenail onychomycosis due to filamentous fungi: Dermatophyte and non-dermatophyte moulds. Mycoses 2017; 60:587-593. [DOI: 10.1111/myc.12633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/25/2017] [Accepted: 04/11/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Fernanda G. Lavorato
- Dermatology Departament; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
| | - Dávson A. Guimarães
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
| | - Mario G. Premazzi
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
| | | | - Andréa R. Bernardes-Engemann
- Dermatology Departament; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
| | - Rosane Orofino-Costa
- Dermatology Departament; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
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19
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Reduced Multidrug Susceptibility Profile Is a Common Feature of Opportunistic Fusarium Species: Fusarium Multi-Drug Resistant Pattern. J Fungi (Basel) 2017; 3:jof3020018. [PMID: 29371536 PMCID: PMC5715927 DOI: 10.3390/jof3020018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/27/2017] [Accepted: 04/07/2017] [Indexed: 01/26/2023] Open
Abstract
The resistance among various opportunistic Fusarium species to different antifungal agents has emerged as a cause of public health problems worldwide. Considering the significance of multi-drug resistant (MDR), this paper emphasizes the problems associated with MDR and the need to understand its clinical significance to combat microbial infections. The search platform PubMed/MEDLINE and a review of 32 cases revealed a common multidrug-resistant profile exists, and clinically relevant members of Fusarium are intrinsically resistant to most currently used antifungals. Dissemination occurs in patients with prolonged neutropenia, immune deficiency, and especially hematological malignancies. Amphotericin B displayed the lowest minimum inhibitory concentrarions (MICs) followed by voriconazole, and posaconazole. Itraconazole and fluconazole showed high MIC values, displaying in vitro resistance. Echinocandins showed the highest MIC values. Seven out of ten (70%) patients with neutropenia died, including those with fungemia that progressed to skin lesions. Clinical Fusarium isolates displayed a common MDR profile and high MIC values for the most available antifungal agents with species- and strain-specific differences in antifungal susceptibility. Species identification of Fusarium infections is important. While the use of natamycin resulted in a favorable outcome in keratitis, AmB and VRC are the most used agents for the treatment of fusariosis in clinical settings.
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20
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da Silva RT, Guimarães DA, Camargo ZP, Rodrigues AM, Maceira JP, Bernardes-Engemann AR, Orofino-Costa R. Cutaneous murine model of infection caused by Neoscytalidium dimidiatum: a preliminary study of an emerging human pathogen. Med Mycol 2016; 54:890-8. [PMID: 27250925 DOI: 10.1093/mmy/myw034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/11/2016] [Indexed: 12/27/2022] Open
Abstract
Neoscytalidium dimidiatum is an emerging fungus that causes a skin infection similar to dermatophytosis; it affects both immunocompetent and immunosuppressed individuals, and it may invade deeper tissues and organs and cause systemic disease. Little is known about the etiopathogenesis of the infection caused by this fungus, and no standard effective treatment is available. The aim of the present experimental study was to develop an animal model of skin infection with N. dimidiatum. BALB/c mice were inoculated with two fungal strains, and different routes of infection were tested. When challenged intradermally, N. dimidiatum strain HUPE164165 caused skin infection in 67% of the animals whereas strain HUPE115669 did it in 49%. Neoscytalidium dimidiatum was isolated from the skin of 25% of the animals inoculated via epidermal scarification and from 100% of the animals challenged via subcutaneous injection. Mice inoculated intradermally were followed-up during four weeks, and clinical samples were collected on days 3, 8, 15, and 29 after inoculation, corresponding to different stages of infection. The cutaneous infection rate, as measured by the recovery of N. dimidiatum strain HUPE164165 from skin biopsies of animals inoculated intradermally, revealed the presence of infection in 90% of the animals sacrificed at 3 days post-inoculation, 71% at 8, 85% at 15, and 33% at 29. Conidia and hyphae were observed in PAS-stained sections as well as a mild to moderate inflammatory infiltrate in haematoxylin-eosin, although it did not differ from animals inoculated either with T. quinckeanum or PBS. The intradermal route of inoculation was considered to be suitable for the study of skin infection with N. dimidiatum The animal model developed in this preliminary study is the first to allow the study of cutaneous infection with N. dimidiatum and may contribute to further investigations of the aetiology, immunology, pathogenesis and treatment targeting this emerging mycosis.
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Affiliation(s)
- Roberta Teixeira da Silva
- Dermatology Department, Medical Mycology Laboratory, Universidade do Estado do Rio de Janeiro (UERJ), Brazil
| | - Dávson A Guimarães
- Dermatology Department, Medical Mycology Laboratory, Universidade do Estado do Rio de Janeiro (UERJ), Brazil
| | - Zoilo P Camargo
- Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo, Brazil
| | - Anderson M Rodrigues
- Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo, Brazil
| | | | - Andréa R Bernardes-Engemann
- Dermatology Department, Medical Mycology Laboratory, Universidade do Estado do Rio de Janeiro (UERJ), Brazil
| | - Rosane Orofino-Costa
- Dermatology Department, Medical Mycology Laboratory, Universidade do Estado do Rio de Janeiro (UERJ), Brazil
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21
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Guevara-Suarez M, Cano-Lira JF, de García MCC, Sopo L, De Bedout C, Cano LE, García AM, Motta A, Amézquita A, Cárdenas M, Espinel-Ingroff A, Guarro J, Restrepo S, Celis A. Genotyping of Fusarium Isolates from Onychomycoses in Colombia: Detection of Two New Species Within the Fusarium solani Species Complex and In Vitro Antifungal Susceptibility Testing. Mycopathologia 2016; 181:165-74. [PMID: 26943726 DOI: 10.1007/s11046-016-9983-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/12/2016] [Indexed: 02/04/2023]
Abstract
Fusariosis have been increasing in Colombia in recent years, but its epidemiology is poorly known. We have morphologically and molecularly characterized 89 isolates of Fusarium obtained between 2010 and 2012 in the cities of Bogotá and Medellín. Using a multi-locus sequence analysis of rDNA internal transcribed spacer, a fragment of the translation elongation factor 1-alpha (Tef-1α) and of the RNA-dependent polymerase subunit II (Rpb2) genes, we identified the phylogenetic species and circulating haplotypes. Since most of the isolates studied were from onychomycoses (nearly 90 %), we carried out an epidemiological study to determine the risk factors associated with such infections. Five phylogenetic species of the Fusarium solani species complex (FSSC), i.e., F. falciforme, F. keratoplasticum, F. lichenicola, F. petroliphilum, and FSSC 6 as well as two of the Fusarium oxysporum species complex (FOSC), i.e., FOSC 3 and FOSC 4, were identified. The most prevalent species were FOSC 3 (38.2%) followed by F. keratoplasticum (33.7%). In addition, our isolates were distributed into 23 haplotypes (14 into FOSC and nine into FSSC). Two of the FSSC phylogenetic species and two haplotypes of FSSC were not described before. Our results demonstrate that recipients of pedicure treatments have a lower probability of acquiring onychomycosis than those not receiving such treatments. The antifungal susceptibility of all the isolates to five clinically available agents showed that amphotericin B was the most active drug, while the azoles exhibited lower in vitro activity.
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Affiliation(s)
- Marcela Guevara-Suarez
- Laboratorio de Micología y Fitopatología, Departamento de Ciencias Biológicas, Universidad de Los Andes, Carrera 1 No 18A-10, Bogotá, Colombia.,Unitat de Micología, Facultat de Medicina i Ciències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - José Francisco Cano-Lira
- Unitat de Micología, Facultat de Medicina i Ciències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - María Caridad Cepero de García
- Laboratorio de Micología y Fitopatología, Departamento de Ciencias Biológicas, Universidad de Los Andes, Carrera 1 No 18A-10, Bogotá, Colombia
| | - Leticia Sopo
- Laboratorio Especializado de Micología Médica (LEMM), Bogotá, Colombia
| | - Catalina De Bedout
- Grupo de Micología Médica y Experimental, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Luz Elena Cano
- Escuela de Microbiología, Universidad de Antioquia (UdeA), Medellín, Colombia
| | - Ana María García
- Unidad de Biología Celular y Molecular, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia
| | - Adriana Motta
- Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia.,Hospital Simón Bolívar, Bogotá, Colombia
| | - Adolfo Amézquita
- Grupo de Ecofisiología, Comportamiento y Herpetología (GECOH), Departamento de Ciencias Biológicas, Universidad de los Andes, Bogotá, Colombia
| | - Martha Cárdenas
- Laboratorio de Micología y Fitopatología, Departamento de Ciencias Biológicas, Universidad de Los Andes, Carrera 1 No 18A-10, Bogotá, Colombia
| | | | - Josep Guarro
- Unitat de Micología, Facultat de Medicina i Ciències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Silvia Restrepo
- Laboratorio de Micología y Fitopatología, Departamento de Ciencias Biológicas, Universidad de Los Andes, Carrera 1 No 18A-10, Bogotá, Colombia
| | - Adriana Celis
- Laboratorio de Micología y Fitopatología, Departamento de Ciencias Biológicas, Universidad de Los Andes, Carrera 1 No 18A-10, Bogotá, Colombia.
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22
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Ranawaka RR, Nagahawatte A, Gunasekara TA, Weerakoon HS, de Silva SHP. Randomized, double-blind, comparative study on efficacy and safety of itraconazole pulse therapy and terbinafine pulse therapy on nondermatophyte mold onychomycosis: A study with 90 patients. J DERMATOL TREAT 2015; 27:364-72. [PMID: 26651495 DOI: 10.3109/09546634.2015.1119781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nondermatophyte mold (NDM) onychomycosis shows poor response to current topical, oral or device-related antifungal therapies. This study was aimed to determine the efficacy and safety of itraconazole and terbinafine pulse therapy on NDM onychomycosis. METHODS Mycologically proven subjects were treated with itraconazole 400 mg daily or terbinafine 500 mg daily for 7 days/month; two pulses for fingernails and three pulses for toenails(SLCTR/2013/013). RESULTS One-hundred seventy-eight patients underwent mycological studies and 148 had positive fungal isolates. NDM were the prevailing fungi, 68.2%, followed by candida species 21.6%, and dermatophytes made up only 10.1%. Out of NDM Aspergillus spp (75.1%) predominated followed by 8.9% Fusarium spp and 4.95% Penicillium spp. The clinical cure at completion of pulse therapy was statistically significant 9.2% versus 2.0% (p < 0.05) in itraconazole group. But no statistically significant difference was detected between the two regimens at the end of 12 months; 65.1% versus 54.64%. Recurrences observed in both groups (6.5% vs. 4.1%) were not statistically significant. With itraconazole pulse 68.22% Aspergillus spp, 50.0% Fusarium spp and 84.6% Penicillium spp showed clinical cure, while terbinafine pulse cured 55.0% Aspergillus spp and 50.0% Fusarium spp. CONCLUSIONS NDM was the prevailing fungi in onychomycosis in Sri Lanka. Both itraconazole and terbinafine were partially effective on NDM onychomycosis showing a clinical cure of 54-65%. Future research should focus on searching more effective antifungal for NDM onychomycosis.
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Affiliation(s)
| | - Ajith Nagahawatte
- b Department of Microbiology , University of Ruhuna , Galle , Sri Lanka , and
| | | | - Hema S Weerakoon
- a Department of Dermatology , Base Hospital Homagama , Sri Lanka
| | - S H Padmal de Silva
- c Department of Evaluation and Research , National Institute of Health Sciences , Kalutara , Sri Lanka
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Machado Vila TV, Sousa Quintanilha N, Rozental S. Miltefosine is effective against Candida albicans and Fusarium oxysporum nail biofilms in vitro. J Med Microbiol 2015; 64:1436-1449. [DOI: 10.1099/jmm.0.000175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Taissa Vieira Machado Vila
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Natália Sousa Quintanilha
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sonia Rozental
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Abstract
Nail disorders are a common presenting complaint for both the primary care physician and the dermatologist. Nail diagnoses are broad in scope and include infectious, inflammatory, and neoplastic conditions. Onychomycosis is an especially common nail condition, and treatment should always be preceded by appropriate fungal studies for confirmation of diagnosis. Inflammatory conditions of the nail unit can mimic onychomycosis, and a dermatologist can assist with diagnosis and treatment recommendations. Likewise, subungual tumors often require biopsy, and should be evaluated by a dermatologist who is experienced in nail evaluation and treatment.
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Affiliation(s)
- Lauren K Biesbroeck
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street, BB-1353, Box 356524, Seattle, WA 98195-6524, USA.
| | - Philip Fleckman
- Division of Dermatology, University of Washington School of Medicine, 1959 Northeast Pacific Street, BB-1353, Box 356524, Seattle, WA 98195-6524, USA
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25
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Salah H, Al-Hatmi AMS, Theelen B, Abukamar M, Hashim S, van Diepeningen AD, Lass-Florl C, Boekhout T, Almaslamani M, Taj-Aldeen SJ. Phylogenetic diversity of human pathogenic Fusarium and emergence of uncommon virulent species. J Infect 2015; 71:658-66. [PMID: 26348828 DOI: 10.1016/j.jinf.2015.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Fusarium species cause a broad spectrum of infections. However, little is known about the etiological agents to the species level. We identified Fusarium species isolated from clinical specimens including those of high risk patients to better understand the species involved in the pathogenesis. METHODS A set of 44 Fusarium isolates were identified by two-locus sequence typing using partial sequences of the second largest subunit of RNA polymerase (RPB2) and translation elongation factor 1 alpha (TEF-1α). RESULTS The identified species belonged to four species complexes (SC); the most common SC was Fusarium solani (FSSC) (75%), followed by Fusarium oxysporum (FOSC) (4.5%), Fusarium fujikuroi (FFSC) (13.6%), and Fusarium dimerum (FDSC) (6.8%). Sites of infections were nails (n = 19, 43.2%), skin (n = 7, 15.9%), cornea (n = 6, 13.6%), blood (n = 3, 9%), wound (n = 4, 6.8%), burn (n = 2, 4.5%), tissue (n = 2, 4.5%), and urine (n = 1, 2.27%). Fusarium acutatum was rare and seem restricted to the Middle East. Comorbidities associated with invasive infections were hematological malignancy and autoimmune disorders. CONCLUSIONS Members of the FSSC predominantly caused cornea, nail and bloodstream infections. Less frequently encountered were the FOSC, FFSC and FDSC. More accurate molecular identification of Fusarium species is important to predict therapeutic outcome and the emergence of these species.
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Affiliation(s)
- Husam Salah
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar; CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Abdullah M S Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands; Directorate General of Health Services, Ministry of Health, Ibri Hospital, Ibri, Oman
| | - Bart Theelen
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - Mohammed Abukamar
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Samar Hashim
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | | | - Cornelia Lass-Florl
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
| | - Teun Boekhout
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands; Department of Dermatology, Shanghai Key Laboratory of Molecular Medical Mycology, Institute of Dermatology and Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China; Institute of Microbiology, Chinese Academy of Science, Beijing, People's Republic of China
| | - Muna Almaslamani
- Department of Medicine, Infectious Disease Division, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Saad J Taj-Aldeen
- Mycology Unit, Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar.
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Segal R, Shemer A, Hochberg M, Keness Y, Shvarzman R, Mandelblat M, Frenkel M, Segal E. Onychomycosis in Israel: epidemiological aspects. Mycoses 2015; 58:133-9. [DOI: 10.1111/myc.12287] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/27/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Rina Segal
- Outpatient Dermatology Clinic; Rabin Medical Center; Petah Tikva Israel
| | - Avner Shemer
- Outpatient Dermatology Clinic; Sheba Medical Center; Tel HaShomer Israel
| | - Malca Hochberg
- Outpatient Dermatology Clinic; Hadassa Medical Center; Jerusalem Israel
| | - Yoram Keness
- Clinical Microbiology Laboratory & Outpatient Dermatology Clinic; Emek Medical Center; Afula Israel
| | - Rima Shvarzman
- Central Laboratories Kupat Holim Leumit; Petah Tikva Israel
| | | | - Michael Frenkel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Esther Segal
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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Bunyaratavej S, Prasertworonun N, Leeyaphan C, Chaiwanon O, Muanprasat C, Matthapan L. Distinct characteristics of Scytalidium dimidiatum and non-dermatophyte onychomycosis as compared with dermatophyte onychomycosis. J Dermatol 2015; 42:258-62. [PMID: 25639524 DOI: 10.1111/1346-8138.12768] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/02/2014] [Indexed: 11/28/2022]
Abstract
Studies of demographic data, predisposing factors and clinical manifestations of non-dermatophyte mold (NDM) infection particularly in Scytalidium spp. have been limited. This study aimed to compare these data between dermatophytes (DMP) and NDM onychomycosis with statistical analysis. This was a retrospective chart review of outpatients with onychomycosis in the Nail Clinic of Department of Dermatology between January 2011 and December 2013. A total of 237 patients who had presented with onychomycosis were included. One hundred and eighty patients (75.9%) were infected with DMP: Trichophyton mentagrophytes, 46.8%; and Trichophyton rubrum, 28.3%. Of patients who had NDM onychomycosis, 17.3% were Scytalidium dimidiatum and 6.8% were Fusarium spp. Comparing the DMP and NDM groups, family history of superficial fungal infection was significantly demonstrated in the DMP group. Approximately 50% of patients in both groups had feet infections. However, no patients with NDM onychomycosis had fungal glabrous skin infection at other sites beyond the feet that was statistically different from cases with DMP onychomycosis. In conclusion, The distinct characteristic of patients with NDM onychomycosis was absence of fungal glabrous skin infection in areas other than the feet. This was statistically different from DMP.
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Affiliation(s)
- Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Khaled JM, Golah HA, Khalel AS, Alharbi NS, Mothana RA. Dermatophyte and non dermatophyte fungi in Riyadh City, Saudi Arabia. Saudi J Biol Sci 2015; 22:604-9. [PMID: 26288566 PMCID: PMC4537868 DOI: 10.1016/j.sjbs.2014.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/24/2014] [Accepted: 12/15/2014] [Indexed: 11/04/2022] Open
Abstract
Background Dermatophytes are a scientific label for a group of three genera (Microsporum, Epidermophyton and Trichophyton) of fungus that causes skin disease in animals and humans. Conventional methods for identification of these fungi are rapid and simple but are not accurate comparing to molecular methods. Objective This study aimed to isolate human pathogenic dermatophytes which cause dermatophytosis in Riyadh City, Saudi Arabia and to identify these fungi by using conventional and molecular methods. Methods The study was conducted in Medical Complex, Riyadh and King Saud University. Samples of infected skin, hairs and nails were collected from 112 patients. Diagnosis of skin infections, direct microscopic test, isolation and identification of dermatophytes by conventional and molecular methods were carried out. Results The results indicated that the tinea capitis infection had the highest prevalence among the patients (22.3%) while Tinea barbae had the lowest. In this study the identified dermatophyte isolates belong to nine species as Trichophyton violaceum, Trichophyton verrucosum, Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton schoenleinii, Trichophyton concentricum, Microsporum canis, Microsporum audouinii and Epidermophyton floccosum which cause skin infections were isolated during this study. Non dermatophyte isolates included 5 isolates from Aspergillus spp. 4 isolates from Acremonium potronii and 15 isolates from Candida spp. M. canis were the most common species (25% of isolated dermatophytes). Out of the 52 dermatophyte isolates identified by conventional methods, there were 45 isolates identified by the molecular method. Conclusions The results concluded that approximately M. canis caused a quarter of dermatophyte cases, tinea capitis infection was prevalent and the molecular method was more accurate than conventional methods.
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Affiliation(s)
- Jamal M Khaled
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia ; Department of Biotechnology and Food Technology, Thamar University, Yemen
| | - Hammed A Golah
- Agriculture and Veterinary Medicine, Department of Veterinary Medicine, Thamar University, Yemen
| | - Abdulla S Khalel
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Naiyf S Alharbi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Ramzi A Mothana
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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