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Herman TS, da Silva Goersch C, Bocca AL, Fernandes L. Resazurin to determine the minimum inhibitory concentration on antifungal susceptibility assays for Fonsecaea sp. using a modified EUCAST protocol. Braz J Microbiol 2024; 55:1349-1357. [PMID: 38438831 PMCID: PMC11153478 DOI: 10.1007/s42770-024-01293-2] [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: 11/07/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
Chromoblastomycosis is a fungal chronic disease, which affects humans, especially in cutaneous and subcutaneous tissues. There is no standard treatment for Chromoblastomycosis, and it is a therapeutic challenge, due natural resistance of their causative agents, inadequate response of patients and common cases of relapse. Protocols for determination of antifungal drugs susceptibility are not standardized for chromoblastomycosis agents and endpoint definition is usually based on visual inspection, which depends on the analyst, making it sometimes inaccurate. We presented a colorimetric and quantitative methodology based on resazurin reduction to resofurin to determine the metabolic status of viable cells of Fonsecaea sp. Performing antifungal susceptibility assay by a modified EUCAST protocol allied to resazurin, we validated the method to identify the minimum inhibitory concentrations of itraconazole, fluconazole, amphotericin B, and terbinafine for eight Fonsecaea clinical isolates. According to our data, resazurin is a good indicator of metabolic status of viable cells, including those exposed to antifungal drugs. This work aimed to test resazurin as an indicator of the metabolic activity of Fonsecaea species in susceptibility assays to antifungal drugs. Species of this genus are the main causative agents of Chromoblastomycosis, which affects humans.
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Affiliation(s)
- Tatiana Sobianski Herman
- Postgraduate Program in Molecular Pathology, Faculty of Medicine, University of Brasília, UnB, Brasília, DF, Brazil
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil
| | - Camila da Silva Goersch
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil
- Postgraduate Program in Microbial Biology, Institute of Biological Science, University of Brasília, UnB, Brasília, DF, Brazil
| | - Anamelia Lorenzetti Bocca
- Postgraduate Program in Molecular Pathology, Faculty of Medicine, University of Brasília, UnB, Brasília, DF, Brazil
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil
| | - Larissa Fernandes
- Laboratory of Applied Immunology, Department of Cell Biology, Institute of Biological Sciences, University of Brasília, UnB, Room J1 28/8, Brasília, DF, 70910-900, Brazil.
- Postgraduate Program in Microbial Biology, Institute of Biological Science, University of Brasília, UnB, Brasília, DF, Brazil.
- Faculty of Ceilândia, University of Brasília, UnB, Brasília, DF, Brazil.
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Ul Haq F, Yunus H, Mukhtiar R, Ahmad A, Akram R, Imran S. Diagnosis of Cutaneous Chromoblastomycosis and Its Response to Amphotericin B Therapy: A Case Report. Cureus 2022; 14:e28286. [PMID: 36158439 PMCID: PMC9494023 DOI: 10.7759/cureus.28286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/05/2022] Open
Abstract
Cutaneous chromoblastomycosis is a chronic subcutaneous fungal disease of the skin caused by Blastomyces dermatitidis, especially by Fonsecaea, Phialophora,and Cladophialophora species affecting the skin, lungs, intestines, stomach, and central nervous system. It is treated using itraconazole in mild cases and amphotericin B in severe cases. A six-year-old female child presented to the Dermatology Outpatient Department with pigmented brown to blackish tanned plaques and verrucous lesions on the face and extremities. These lesions were present for the past two and a half years and were slowly enlarging and involving other areas like the trunk. The lesions were proven on biopsy to be cutaneous blastomycosis. The patient was put on infusions of amphotericin B in a calculated pediatric dose. Her blood pressure and renal function tests were checked daily to avoid any electrolyte derangements, nephrotoxicity, and systemic infusion reactions caused by amphotericin B. Amphotericin B reduced the size of the cutaneous lesions, and treatment response was assessed on regular follow-ups. Chromoblastomycosis should be considered in the differential diagnosis to enable timely treatment and to prevent its lethal complications such as epidermoid carcinoma. Treatment should continue for two to three months until histopathology is negative to ensure complete eradication.
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3
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Li Z, Tang J, Zhu J, Xie M, Huang S, Li S, Zhan Y, Zeng W, Xu T, Ye F. The convoluted process of diagnosing pulmonary mycosis caused by Exophiala dermatitidis: a case report. BMC Infect Dis 2022; 22:433. [PMID: 35509001 PMCID: PMC9069750 DOI: 10.1186/s12879-022-07399-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/20/2022] [Indexed: 12/16/2022] Open
Abstract
Background Etiological diagnosis is a key step in the treatment of patients with rare pulmonary mycosis, and the lack of understanding of this disease and lack of specific markers for the detection of rare species, such as Exophiala dermatitidis, add to the difficulty in diagnosing the condition. Therefore, improving the diagnostic strategies for this disease is very important. Case presentation A 52-year-old man presented with cough, sputum production and hemoptysis; chest computed tomography (CT) revealed multiple bilateral lesions. The pathogen was unable to be identified after three biopsies. Subsequently, we performed combined tissue metagenomic next-generation sequencing (mNGS). The results of mNGS and a good therapeutic response helped to identify the causative pathogen as Exophiala dermatitidis. Finally, the patient was diagnosed with Exophiala dermatitidis pneumonia. Conclusions Combining molecular techniques, such as mNGS, with clinical microbiological tests will improve the rate of positivity in the diagnosis of rare fungal infections, and the importance of follow-up should be emphasized. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07399-y.
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Affiliation(s)
- Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Jianli Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Jinping Zhu
- Department of Respiratory and Critical Care Medicine, Songgang People's Hospital, Shenzhen, 518105, China
| | - Mingzhou Xie
- Vision Medicals Co. Ltd., Guangzhou, 510663, China
| | - Shaoqing Huang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Shaoqiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Yangqing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China
| | - Weiqi Zeng
- Vision Medicals Co. Ltd., Guangzhou, 510663, China
| | - Teng Xu
- Department of Respiratory and Critical Care Medicine, Songgang People's Hospital, Shenzhen, 518105, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China.
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4
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Ranawaka RR. Treatment of chromoblastomycosis with a combination of debulking surgery, intralesional amphotericin B, and oral terbinafine. Int J Dermatol 2021; 60:1040-1041. [PMID: 33826140 DOI: 10.1111/ijd.15567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
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5
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Ham RE, Temesvari LA. Joining forces: Leveraging novel combination therapies to combat infections with eukaryotic pathogens. PLoS Pathog 2021; 16:e1009081. [PMID: 33382854 PMCID: PMC7774843 DOI: 10.1371/journal.ppat.1009081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Rachel E. Ham
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, Unites States of America
- Eukaryotic Pathogens Innovation Center (EPIC), Clemson University, Clemson, South Carolina, Unites States of America
| | - Lesly A. Temesvari
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, Unites States of America
- Eukaryotic Pathogens Innovation Center (EPIC), Clemson University, Clemson, South Carolina, Unites States of America
- * E-mail:
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6
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Granato MQ, Sousa IS, Rosa TLSA, Gonçalves DS, Seabra SH, Alviano DS, Pessolani MCV, Santos ALS, Kneipp LF. Aspartic peptidase of Phialophora verrucosa as target of HIV peptidase inhibitors: blockage of its enzymatic activity and interference with fungal growth and macrophage interaction. J Enzyme Inhib Med Chem 2020; 35:629-638. [PMID: 32037904 PMCID: PMC7034032 DOI: 10.1080/14756366.2020.1724994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Phialophora verrucosa causes several fungal human diseases, mainly chromoblastomycosis, which is extremely difficult to treat. Several studies have shown that human immunodeficiency virus peptidase inhibitors (HIV-PIs) are attractive candidates for antifungal therapies. This work focused on studying the action of HIV-PIs on peptidase activity secreted by P. verrucosa and their effects on fungal proliferation and macrophage interaction. We detected a peptidase activity from P. verrucosa able to cleave albumin, sensitive to pepstatin A and HIV-PIs, especially lopinavir, ritonavir and amprenavir, showing for the first time that this fungus secretes aspartic-type peptidase. Furthermore, lopinavir, ritonavir and nelfinavir reduced the fungal growth, causing remarkable ultrastructural alterations. Lopinavir and ritonavir also affected the conidia-macrophage adhesion and macrophage killing. Interestingly, P. verrucosa had its growth inhibited by ritonavir combined with either itraconazole or ketoconazole. Collectively, our results support the antifungal action of HIV-PIs and their relevance as a possible alternative therapy for fungal infections.
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Affiliation(s)
- Marcela Q. Granato
- Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos (LTBBF), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ingrid S. Sousa
- Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos (LTBBF), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Diego S. Gonçalves
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes, Instituto de Microbiologia Paulo de Góes (IMPPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Bioquímica, Instituto de Química, UFRJ, Rio de Janeiro, Brazil
| | - Sergio H. Seabra
- Laboratório de Tecnologia em Cultura de Células, Centro Universitário Estadual da Zona Oeste (UEZO), Rio de Janeiro, Brazil
| | - Daniela S. Alviano
- Laboratório de Estrutura de Microrganismos, IMPPG, UFRJ, Rio de Janeiro, Brazil
| | | | - André L. S. Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes, Instituto de Microbiologia Paulo de Góes (IMPPG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Bioquímica, Instituto de Química, UFRJ, Rio de Janeiro, Brazil
| | - Lucimar F. Kneipp
- Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos (LTBBF), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
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7
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Zhang J, Wu X, Li M, Huang J, Yin S, Huang H, Lu C, Xi L. Synergistic effect of terbinafine and amphotericin B in killing Fonsecaea nubica in vitro and in vivo. Rev Inst Med Trop Sao Paulo 2019; 61:e31. [PMID: 31241660 PMCID: PMC6592013 DOI: 10.1590/s1678-9946201961031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022] Open
Abstract
Chromoblastomycosis is a chronic fungal infection. Itraconazole and terbinafine are the most recommended antifungal drugs for chromoblastomycosis, while amphotericin B is not usually recommended. A patient with chromoblastomycosis in our hospital showed poor clinical responses to itraconazole and terbinafine. The fungus isolated from the lesions of this patient was identified as Fonsecaea nubica and numbered zssy0803. In vitro antifungal susceptibilities of F. nubica zssy0803 to terbinafine, amphotericin B, itraconazole, voriconazole and caspofungin were evaluated, as well as the combinations of terbinafine with the other four antifungals. The combined effect of terbinafine and amphotericin B on other 20 clinical F. nubica strains was also evaluated. The minimal inhibitory concentrations of terbinafine, amphotericin B, itraconazole, voriconazole and caspofungin on F. nubica zssy0803 were 0.25 μg/mL, 2 μg/mL, 1 μg/mL, 4 μg/mL and 8 μg/mL, respectively. The combination of terbinafine and amphotericin B showed the lowest fractional inhibitory concentration index of 0.28 to F. nubica zssy0803 in comparison with combinations of terbinafine and the other four antifungal drugs. The combination of terbinafine and amphotericin B was also synergistic for all the other 20 F. nubica strains. Then, the combination of oral terbinafine (500 mg/day) and intralesional injections of amphotericin B (1 mg/mL) was used to treat this patient. After this combined therapy for 25 weeks and terbinafine monotherapy for additional 12 weeks, the patient was cured. These findings indicate for the first time that terbinafine and amphotericin B are synergistic in killing F. nubica both in vitro and in vivo.
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Affiliation(s)
- Jing Zhang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China.,Yat-sen University, Sun Yat-sen Memorial Hospital, Department of Dermatology and Venereology, Guangzhou, China.,Sun Yat-sen University, Sun Yat-sen Memorial Hospital, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Xiaoyan Wu
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Meirong Li
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Jiamin Huang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Songchao Yin
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Huaiqiu Huang
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Chun Lu
- Yat-sen University, Third Affiliated Hospital of Sun, Department of Dermatology and Venereology, Guangzhou, China
| | - Liyan Xi
- Yat-sen University, Sun Yat-sen Memorial Hospital, Department of Dermatology and Venereology, Guangzhou, China
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8
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Kirchhoff L, Olsowski M, Rath PM, Steinmann J. Exophiala dermatitidis: Key issues of an opportunistic fungal pathogen. Virulence 2019; 10:984-998. [PMID: 30887863 PMCID: PMC8647849 DOI: 10.1080/21505594.2019.1596504] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The black yeast Exophiala dermatitidis is an opportunistic pathogen, causing phaeohyphomycosis in immunosuppressed patients, chromoblastomycosis and fatal infections of the central nervous system in otherwise healthy Asian patients. In addition, it is also regularly isolated from respiratory samples from cystic fibrosis patients, with rates varying between 1% and 19%.Melanin, as part of the cell wall of black yeasts, is one major factor known contributing to the pathogenicity of E. dermatitidis and increased resistance against host defense and anti-infective therapeutics. Further virulence factors, e.g. the capability to adhere to surfaces and to form biofilm were reported. A better understanding of the pathogenicity of E. dermatitidis is essential for the development of novel preventive and therapeutic strategies. In this review, the current knowledge of E. dermatitidis prevalence, clinical importance, diagnosis, microbiological characteristics, virulence attributes, susceptibility, and resistances as well as therapeutically strategies are discussed.
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Affiliation(s)
- Lisa Kirchhoff
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Maike Olsowski
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Joerg Steinmann
- Institute of Medical Microbiology, Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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9
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Hoenigl M, Gangneux JP, Segal E, Alanio A, Chakrabarti A, Chen SCA, Govender N, Hagen F, Klimko N, Meis JF, Pasqualotto AC, Seidel D, Walsh TJ, Lagrou K, Lass-Flörl C, Cornely OA. Global guidelines and initiatives from the European Confederation of Medical Mycology to improve patient care and research worldwide: New leadership is about working together. Mycoses 2018; 61:885-894. [PMID: 30086186 DOI: 10.1111/myc.12836] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 12/21/2022]
Abstract
Invasive mycoses present a global challenge with expansion into new hosts, emergence of new pathogens, and development of multidrug resistance. In parallel, new antifungal agents and advanced laboratory diagnostic systems are being developed. In response to these evolving challenges, the European Confederation of Medical Mycology (ECMM) is committed to providing international expertise, guidance, and leadership with the key objectives of improving diagnosis, treatment, outcome, and survival of persons with invasive fungal diseases. Representing 25 affiliated National Medical Mycology Societies, the ECMM has developed several major ways to achieving these critical objectives: (a) tasking specific medical mycology working groups; (b) founding the ECMM Academy and Fellow program (FECMM); (c) expanding the goals of ECMM beyond the European region; (d) implementing the ECMM Excellence Centre Initiative in Europe; and (e) the ECMM Global Guidelines and Neglected Orphan Disease Guidance Initiatives focusing on mucormycosis, rare mould diseases, rare yeast diseases, and endemic mycoses. We believe that these important initiatives and other strategies of the ECMM will advance the field of medical mycology and improve the outcome of patients with invasive mycoses worldwide.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, Department of Medicine, University of California-San Diego, San Diego, California.,Section of Infectious Diseases and Tropical Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Jean-Pierre Gangneux
- CHU de Rennes, Univ Rennes, Inserm, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Esther Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, Groupe Hospitalier Lariboisière, Institut Pasteur, Molecular Mycology Unit, Département de Mycologie, CNRS UMR2000, Paris, France.,Fernand Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Department of Infectious Diseases, Westmead Hospital & School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Nelesh Govender
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses) & Division of the National Health Laboratory Service & School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Center, Utrecht, The Netherlands
| | - Nikolaj Klimko
- Department of Clinical Mycology, Allergy and Immunology, I. Mechnikov North-Western State Medical University, Saint-Petersburg, Russia
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ) and Center of Expertise in Mycology Radboudumc/CWZ (ECMM Diamond Excellence Center), Nijmegen, The Netherlands
| | - Alessandro C Pasqualotto
- Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil.,Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
| | - Danila Seidel
- CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.,Department of Internal Medicine, Infectious Diseases (ECMM Diamond Excellence Center), University Hospital Cologne, Cologne, Germany.,Clinical Trial Unit Cologne, University Hospital Cologne, Cologne, Germany
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York.,Departments of Pediatrics and Microbiology & Immunology, Weill Cornell Medicine of Cornell University, New York, New York
| | - Katrien Lagrou
- Department of Microbiology and Immunology, ECMM Diamond Excellence Center, KU Leuven, Leuven, Belgium.,Clinical Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, ECMM Diamond Excellence Center, Medical University of Innsbruck, Innsbruck, Austria
| | - Oliver A Cornely
- CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.,Department of Internal Medicine, Infectious Diseases (ECMM Diamond Excellence Center), University Hospital Cologne, Cologne, Germany.,Clinical Trial Unit Cologne, University Hospital Cologne, Cologne, Germany
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