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Martins-Santana L, Rezende CP, Rossi A, Martinez-Rossi NM, Almeida F. Addressing Microbial Resistance Worldwide: Challenges over Controlling Life-Threatening Fungal Infections. Pathogens 2023; 12:pathogens12020293. [PMID: 36839565 PMCID: PMC9961291 DOI: 10.3390/pathogens12020293] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
Fungal infections are a serious global concern because of their ability to spread and colonize host tissues in immunocompromised individuals. Such infections have been frequently reported worldwide and are currently gaining clinical research relevance owing to their resistant character, representing a bottleneck in treating affected people. Resistant fungi are an emergent public health threat. The upsurge of such pathogens has led to new research toward unraveling the destructive potential evoked by these species. Some fungi-grouped into Candida, Aspergillus, and Cryptococcus-are causative agents of severe and systemic infections. They are associated with high mortality rates and have recently been described as sources of coinfection in COVID-hospitalized patients. Despite the efforts to elucidate the challenges of colonization, dissemination, and infection severity, the immunopathogenesis of fungal diseases remains a pivotal characteristic in fungal burden elimination. The struggle between the host immune system and the physiological strategies of the fungi to maintain cellular viability is complex. In this brief review, we highlight the relevance of drug resistance phenotypes in fungi of clinical significance, taking into consideration their physiopathology and how the scientific community could orchestrate their efforts to avoid fungal infection dissemination and deaths.
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Affiliation(s)
- Leonardo Martins-Santana
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Caroline Patini Rezende
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Antonio Rossi
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Nilce Maria Martinez-Rossi
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
| | - Fausto Almeida
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-900, Brazil
- Correspondence:
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Martinez PS, Whitley RD, Plummer CE, Richardson RL, Hamor RE, Wellehan JFX. In vitro antifungal susceptibility of Fusarium species and Aspergillus fumigatus cultured from eleven horses with fungal keratitis. Vet Ophthalmol 2022; 25:376-384. [PMID: 35684950 DOI: 10.1111/vop.12995] [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: 10/21/2021] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the relationship between Minimum Inhibitory Concentration (MICs) and response to therapy of 6 Fusarium spp. and 5 Aspergillus fumigatus isolated from equine ulcerative keratitis cases. PROCEDURE Fungi were identified by morphology and Internal Transcribed Spacer (ITS) polymerase chain reaction (PCR) with sequencing and evaluated at the University of Texas Fungal Testing Laboratory for susceptibility to three azole antifungals (miconazole, voriconazole, posaconazole), natamycin, and two echinocandins (anidulafungin, caspofungin). A Mann-Whitney rank sum test was used for the comparison of time to heal between infections of different fungal genera and in vitro susceptibility to the drug administered. RESULTS Fusarium spp. were resistant to azole antifungals in 6/6 cases (100%). Fusarium spp. were susceptible to echinocandins and natamycin in all cases. A. fumigatus was resistant to anidulafungin in 1/5 cases (20%) and posaconazole in 1/5 cases (20%) The remainder of A. fumigatus isolates were susceptible to all antifungal agents tested. Fusarium isolates were treated with antifungals to which they were not susceptible; however, all cases of A. fumigatus were treated with antifungals to which they were susceptible. All Fusarium cases and A. fumigatus cases experienced clinical resolution, regardless of surgical intervention. There was no statistical correlation between fungal genus and time to heal (p < .082). CONCLUSIONS The in vitro susceptibility indicated that all cases of Fusarium spp. were resistant to azole antifungal drugs which were used as treatment. Clinical outcomes, however, showed that all cases healed despite resistance to antifungals.
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Affiliation(s)
- Paoul S Martinez
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - R David Whitley
- Department of Small Animal Clinical Sciences, Professor Emeritus, University of Florida, Gainesville, Florida, USA
| | - Caryn E Plummer
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA.,Department of Large Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - Rebecca L Richardson
- Clinical Microbiology, Parasitology and Serology, University of Florida, Gainesville, Florida, USA
| | - Ralph E Hamor
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, USA
| | - James F X Wellehan
- Department of Comparative, Diagnostic & Population Medicine, University of Florida, Gainesville, Florida, USA
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Schrecker J, Seitz B, Berger T, Daas L, Behrens-Baumann W, Auw-Hädrich C, Schütt S, Kerl S, Rentner-Andres S, Hof H. Malignant Keratitis Caused by a Highly-Resistant Strain of Fusarium Tonkinense from the Fusarium Solani Complex. J Fungi (Basel) 2021; 7:jof7121093. [PMID: 34947075 PMCID: PMC8707679 DOI: 10.3390/jof7121093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 12/28/2022] Open
Abstract
Fusarium spp. are moulds ubiquitously distributed in nature and only occasionally pathogenic for humans. Species of the Fusarium solani complex are the predominant keratitis-inducing pathogens, because they are endowed with proper virulence factors. These fungi can adhere to the cornea creating a biofilm and, with the help of enzymes and cytotoxins, penetrate the cornea. Whereas an intact cornea is hardly able to be invaded by Fusarium spp. in spite of appropriate virulence factors, these opportunistic fungi may profit from predisposing conditions, for example mechanical injuries. This can lead to a progressive course of corneal infection and may finally affect the whole eye up to the need for enucleation. Here, we present and discuss the clinical, microbiological and histopathological aspects of a particular case due to Fusarium tonkinense of the Fusarium solani complex with severe consequences in a patient without any obvious predisposing factors. A broad portfolio of antifungal agents was applied, both topically and systemically as well as two penetrating keratoplasties were performed. The exact determination of the etiologic agent of the fungal infection proved likewise to be very challenging.
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Affiliation(s)
- Jens Schrecker
- Department of Ophthalmology, Rudolf Virchow Klinikum Glauchau, Virchowstraße 18, D-08371 Glauchau, Germany;
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Kirrbergstr. 100, D-66424 Homburg, Germany; (B.S.); (T.B.); (L.D.)
| | - Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Kirrbergstr. 100, D-66424 Homburg, Germany; (B.S.); (T.B.); (L.D.)
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Kirrbergstr. 100, D-66424 Homburg, Germany; (B.S.); (T.B.); (L.D.)
| | - Wolfgang Behrens-Baumann
- Emeritus, Department of Ophthalmology, Otto-von-Guericke-University Magdeburg, Eckenbornweg 5j, D-37075 Göttingen, Germany;
| | - Claudia Auw-Hädrich
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Kilianstr. 5, D-79106 Freiburg im Breisgau, Germany;
| | - Sabine Schütt
- MVZ Labor Limbach and Colleagues, Im Breitspiel 16, D-69126 Heidelberg, Germany; (S.S.); (S.K.)
| | - Sabine Kerl
- MVZ Labor Limbach and Colleagues, Im Breitspiel 16, D-69126 Heidelberg, Germany; (S.S.); (S.K.)
| | - Sascha Rentner-Andres
- Limbach Analytics GmbH, Arotop Laboratories, Dekan-Laiststr. 9, D-55129 Mainz, Germany;
| | - Herbert Hof
- MVZ Labor Limbach and Colleagues, Im Breitspiel 16, D-69126 Heidelberg, Germany; (S.S.); (S.K.)
- Correspondence: ; Tel.: +49-6221-34-32-342
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Szaliński M, Zgryźniak A, Rubisz I, Gajdzis M, Kaczmarek R, Przeździecka-Dołyk J. Fusarium Keratitis-Review of Current Treatment Possibilities. J Clin Med 2021; 10:jcm10235468. [PMID: 34884170 PMCID: PMC8658515 DOI: 10.3390/jcm10235468] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
In many parts of the world, fungi are the predominant cause of infectious keratitis; among which, Fusarium is the most commonly isolated pathogen. The clinical management of this ophthalmic emergency is challenging. Due to the retardation of the first symptoms from an injury and the inability to differentiate fungal from bacterial infections based on clinical symptoms and difficult microbial diagnostics, proper treatment, in many cases, is postponed. Moreover, therapeutical options of Fusarium keratitis remain limited. This paper summarizes the available treatment modalities of Fusarium keratitis, including antifungals and their routes of administration, antiseptics, and surgical interventions.
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Affiliation(s)
- Marek Szaliński
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Aleksandra Zgryźniak
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
- Correspondence:
| | - Izabela Rubisz
- Okulus Ophthalmology Clinic, ul. Śródmiejska 34, 62-800 Kalisz, Poland;
| | - Małgorzata Gajdzis
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
| | - Radosław Kaczmarek
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
- Clinic of Ophthalmology, University Teaching Hospital, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Joanna Przeździecka-Dołyk
- Department of Ophthalmology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (M.S.); (M.G.); (R.K.); (J.P.-D.)
- Department of Optics and Photonics, Wroclaw University of Science and Technology, Wyb. Stanisława Wyspiańskiego 27, 50-370 Wrocław, Poland
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He D, Feng Z, Gao S, Wei Y, Han S, Wang L. Contribution of NADPH-cytochrome P450 Reductase to Azole Resistance in Fusarium oxysporum. Front Microbiol 2021; 12:709942. [PMID: 34594311 PMCID: PMC8476996 DOI: 10.3389/fmicb.2021.709942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Fusarium species exhibit significant intrinsic resistance to most antifungal agents and fungicides, resulting in high mortality rates among immunocompromised patients. Consequently, a thorough characterization of the antifungal resistance mechanism is required for effective treatments and for preventing fungal infections and reducing antifungal resistance. In this study, an isolate of Fusarium oxysporum (wild-type) with broadly resistant to commonly antifungal agents was used to generate 1,450 T-DNA random insertion mutants via Agrobacterium tumefaciens-mediated transformation. Antifungal susceptibility test results revealed one mutant with increased sensitivity to azoles. Compared with the resistant wild-type, the mutant exhibited low MICs to KTZ, ITC, VRC, POS, and PCZ (0.125, 1, 0.06, 0.5, and 0.125μg/ml, respectively). The T-DNA insertion site of this mutant was characterized as involving two adjacent genes, one encoding a hypothetical protein with unknown function and the other encoding the NADPH-cytochrome P450 reductase, referred as CPR1. To confirm the involvement of these genes in the altered azole susceptibility, the independent deletion mutants were generated and the Cpr1 deletion mutant displayed the same phenotypes as the T-DNA random mutant. The deletion of Cpr1 significantly decreased ergosterol levels. Additionally, the expression of the downstream Cyp51 gene was affected, which likely contributed to the observed increased susceptibility to azoles. These findings verified the association between Cpr1 and azole susceptibility in F. oxysporum. Furthermore, this gene may be targeted to improve antifungal treatments.
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Affiliation(s)
- Dan He
- Department of Pathogenobiology, Jilin University Mycology Research Center, Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Zeqing Feng
- Department of Pathogenobiology, Jilin University Mycology Research Center, Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Song Gao
- Department of Pathogenobiology, Jilin University Mycology Research Center, Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, China.,Beijing ZhongKaiTianCheng Bio-technonogy Co. Ltd., Beijing, China
| | - Yunyun Wei
- Department of Pathogenobiology, Jilin University Mycology Research Center, Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Shuaishuai Han
- Department of Pathogenobiology, Jilin University Mycology Research Center, Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, China.,Beijing ZhongKaiTianCheng Bio-technonogy Co. Ltd., Beijing, China
| | - Li Wang
- Department of Pathogenobiology, Jilin University Mycology Research Center, Key Laboratory of Zoonosis Research, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, China
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Morris AJ, McKinney WP, Rogers K, Freeman JT, Roberts SA. Antifungal susceptibility of clinical mould isolates in New Zealand, 2001-2019. Pathology 2021; 53:639-644. [PMID: 33518383 DOI: 10.1016/j.pathol.2020.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
The objective of this study was to review the antifungal susceptibility of clinical mould isolates performed by the New Zealand Mycology Reference Laboratory. Isolates were either local or referred for testing from other New Zealand laboratories. All isolates were tested by the broth colorimetric microdilution method, Sensititre YeastOne (SYO). Epidemiological cut-off values (ECVs) derived from either the Clinical and Laboratory Standards Institute (CLSI) method or SYO were used to determine the proportion of non-wild type (non-WT) isolates, i.e., those with an increased likelihood to harbour acquired mechanisms of resistance. A total of 614 isolates were tested. Most isolates (55%) were from the respiratory tract followed by musculoskeletal tissue (17%), eye (10%) and abdomen (5%). The azoles had similar activity except for voriconazole which was less active against the Mucorales. The echinocandins had good activity against Aspergillus spp., other hyaline moulds and dematiaceous isolates but were inactive against Fusarium spp., Lomentospora prolificans and the Mucorales. Amphotericin B had best activity against the Mucorales. The two least susceptible groups were Fusarium spp. and L. prolificans isolates. Three Aspergillus isolates were non-WT for amphotericin B, and four non-WT for azoles. Non-WT were not encountered for caspofungin. Non-Aspergillus isolates in New Zealand have susceptibility patterns similar to those reported elsewhere. In contrast to a growing number of other countries, azole resistance was rare in A. fumigatus sensu stricto. Non-WT isolates were uncommon. The results provide a baseline for monitoring emerging antifungal resistance in New Zealand and support current Australasian treatment guidelines for invasive fungal infections.
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Affiliation(s)
- Arthur J Morris
- New Zealand Mycology Reference Laboratory, LabPlus, Auckland City Hospital, Auckland, New Zealand.
| | - Wendy P McKinney
- New Zealand Mycology Reference Laboratory, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Karen Rogers
- New Zealand Mycology Reference Laboratory, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Joshua T Freeman
- Microbiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Sally A Roberts
- New Zealand Mycology Reference Laboratory, LabPlus, Auckland City Hospital, Auckland, New Zealand
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Castillo-Castañeda A, Cañas-Duarte SJ, Guevara-Suarez M, Guarro J, Restrepo S, Celis Ramírez AM. Transcriptional response of Fusarium oxysporum and Neocosmospora solani challenged with amphotericin B or posaconazole. MICROBIOLOGY (READING, ENGLAND) 2020; 166:936-946. [PMID: 32644917 PMCID: PMC7660915 DOI: 10.1099/mic.0.000927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/27/2020] [Indexed: 01/09/2023]
Abstract
Some species of fusaria are well-known pathogens of humans, animals and plants. Fusarium oxysporum and Neocosmospora solani (formerly Fusarium solani) cause human infections that range from onychomycosis or keratitis to severe disseminated infections. In general, these infections are difficult to treat due to poor therapeutic responses in immunocompromised patients. Despite that, little is known about the molecular mechanisms and transcriptional changes responsible for the antifungal resistance in fusaria. To shed light on the transcriptional response to antifungals, we carried out the first reported high-throughput RNA-seq analysis for F. oxysporum and N. solani that had been exposed to amphotericin B (AMB) and posaconazole (PSC). We detected significant differences between the transcriptional profiles of the two species and we found that some oxidation-reduction, metabolic, cellular and transport processes were regulated differentially by both fungi. The same was found with several genes from the ergosterol synthesis, efflux pumps, oxidative stress response and membrane biosynthesis pathways. A significant up-regulation of the C-22 sterol desaturase (ERG5), the sterol 24-C-methyltransferase (ERG6) gene, the glutathione S-transferase (GST) gene and of several members of the major facilitator superfamily (MSF) was demonstrated in this study after treating F. oxysporum with AMB. These results offer a good overview of transcriptional changes after exposure to commonly used antifungals, highlights the genes that are related to resistance mechanisms of these fungi, which will be a valuable tool for identifying causes of failure of treatments.
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Affiliation(s)
- A. Castillo-Castañeda
- Grupo de Investigación Celular y Molecular de Microorganismos Patógenos (CeMoP), Departamento de Ciencias Biológicas, Universidad de Los Andes, Bogotá, Colombia
- Laboratorio de Micología y Fitopatología (LAMFU), Facultad de Ingeniería, Universidad de Los Andes, Bogotá, Colombia
| | - S. J. Cañas-Duarte
- Department of Systems Biology, Blavatnik Institute at Harvard Medical School, Harvard University, Boston, MA, USA
| | - M. Guevara-Suarez
- Grupo de Investigación Celular y Molecular de Microorganismos Patógenos (CeMoP), Departamento de Ciencias Biológicas, Universidad de Los Andes, Bogotá, Colombia
- Laboratorio de Micología y Fitopatología (LAMFU), Facultad de Ingeniería, Universidad de Los Andes, Bogotá, Colombia
| | - J. Guarro
- Facultat de Medicina I Ciéncies de la Salut, Departament de Ciéncies Médiques Básiques, Unitat de Microbiología. Universitat de Rovira I Virgili, Reus, España
| | - S. Restrepo
- Laboratorio de Micología y Fitopatología (LAMFU), Facultad de Ingeniería, Universidad de Los Andes, Bogotá, Colombia
| | - A. M. Celis Ramírez
- Grupo de Investigación Celular y Molecular de Microorganismos Patógenos (CeMoP), Departamento de Ciencias Biológicas, Universidad de Los Andes, Bogotá, Colombia
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Ocular Fungi: Molecular Identification and Antifungal Susceptibility Pattern to Azoles. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.99922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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The genome of opportunistic fungal pathogen Fusarium oxysporum carries a unique set of lineage-specific chromosomes. Commun Biol 2020; 3:50. [PMID: 32005944 PMCID: PMC6994591 DOI: 10.1038/s42003-020-0770-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
Fusarium oxysporum is a cross-kingdom fungal pathogen that infects plants and humans. Horizontally transferred lineage-specific (LS) chromosomes were reported to determine host-specific pathogenicity among phytopathogenic F. oxysporum. However, the existence and functional importance of LS chromosomes among human pathogenic isolates are unknown. Here we report four unique LS chromosomes in a human pathogenic strain NRRL 32931, isolated from a leukemia patient. These LS chromosomes were devoid of housekeeping genes, but were significantly enriched in genes encoding metal ion transporters and cation transporters. Homologs of NRRL 32931 LS genes, including a homolog of ceruloplasmin and the genes that contribute to the expansion of the alkaline pH-responsive transcription factor PacC/Rim1p, were also present in the genome of NRRL 47514, a strain associated with Fusarium keratitis outbreak. This study provides the first evidence, to our knowledge, for genomic compartmentalization in two human pathogenic fungal genomes and suggests an important role of LS chromosomes in niche adaptation. Zhang, Yang et al. compare a Fusarium oxysporum isolate obtained clinically to a phytopathogenic strain to examine transfer of lineage-specific chromosomes in determining host specificity. They find four unique lineage-specific chromosomes that seem to contribute to fungal adaptation to human hosts.
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Nematollahi S, Shoham S. Updates on the Treatment of Non-Aspergillus Hyaline Mold Infections. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Clinical impact of molecular identification of rare yeasts and nonsporulating molds recovered in culture from clinical specimens. Diagn Microbiol Infect Dis 2019; 96:114945. [PMID: 31948697 DOI: 10.1016/j.diagmicrobio.2019.114945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 11/22/2022]
Abstract
Uncommon fungi can cause opportunistic infections and are often unidentifiable using phenotypic methods. Molecular techniques, like DNA sequencing, may permit species-level identification but results may be challenging to interpret. To determine the clinical impact of molecular identification in this setting, we performed a retrospective review of fungal isolates referred for molecular identification. Seventy-five distinct fungal species were identified from 93 referred isolates, 31 (41%) of which are not known to be human pathogens. DNA sequencing prompted change in anti-infective therapy in only 3 (3.5%) cases but significantly delayed culture turnaround time (40 ± 31 vs. 30 ± 13 days, P < 0.001). Patient immune status and concurrent histologic or serologic testing significantly correlated with the proportion of pathogenic isolates recovered and patients treated (χ2, P < 0.05). Molecular identification of uncommon fungal isolates should be limited to specialized clinical settings such as patients with immunosuppression and/or concurrent positive histology or fungal serology.
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Yu J, Chen Y, Fang J, Zhang K. Successful treatment of disseminated fusariosis in a patient with acute lymphoblastic leukemia: A case report and literature review. Medicine (Baltimore) 2019; 98:e16246. [PMID: 31261588 PMCID: PMC6617023 DOI: 10.1097/md.0000000000016246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Fusarium is the second most common cause of fungi infections in the immunocompromised patients with the mortality rate over 80%. Early identification and appropriate selection of antifungal drugs is the key to successful treatment. PATIENT CONCERNS A 31-year-old female was diagnosed with acute lymphocytic leukemia (pro-B ALL). She developed a high fever and presented with typical painful purple nodules with central necrosis formed on the upper and lower limbs during the induction chemotherapy. DIAGNOSIS Combining clinical manifestations with results of blood culture testing and sequencing methods, it was consistent with the diagnosis of disseminated fusariosis. INTERVENTIONS The patient was treated with the combination of tigecycline and antifungal agents (Liposomal Amphotericin B and Voriconazole), OUTCOMES:: The skin lesions generally healed with some scar left after treating with antifungal agents for 6 weeks. The final date of follow-up was 1.5 years later, and the patient was alive with no diseases. LESSONS This case highlights the importance of the typical cutaneous lesions for early diagnosis and proper treatment to decrease the mortality rate of this severe infection. This patient was successfully treated with the combination of tigecycline and antifungal agents, which may be the first clinical confirmation of tigecycline that improved the effectiveness of antifungal agents against fusariosis, but it requires more studies to verify. We reviewed 62 cases from literature and analyzed using logistic regression and recognized the high-risk factor for fusariosis mortality in patients with acute leukemia was non-remission of underlying disease.
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Affiliation(s)
| | | | - Jiabin Fang
- Laboratory, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
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Sandoval-Denis M, Crous P. Removing chaos from confusion: assigning names to common human and animal pathogens in Neocosmospora. PERSOONIA 2018; 41:109-129. [PMID: 30728601 PMCID: PMC6344815 DOI: 10.3767/persoonia.2018.41.06] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/30/2017] [Indexed: 12/24/2022]
Abstract
The genus Neocosmospora encompasses highly prevalent and aggressive human and animal fungal pathogens. Here we assign formal descriptions and Latin binomials to some of the most clinically relevant phylogenetic species of the genus. Three new species, named Neocosmospora catenata, N. gamsii and N. suttoniana (previously assigned to the informal names 'Fusarium' solani species complex (FSSC) lineages, FSSC 43, FSSC 7 and FSSC 20, respectively) are described on the basis of multilocus phylogenetic analyses (using EF-1α, ITS, LSU and RPB2 loci) and morphological characters. Lineage FSSC 9 is conspecific with the ex-type strain of Cylindrocarpon tonkinense, thus the new combination Neocosmospora tonkinensis is proposed. In addition, and based on the latest taxonomy for this generic complex, new combinations are introduced for four medically important taxa: Neocosmospora keratoplastica, N. lichenicola, N. metavorans and N. petroliphila. The most significant distinctive features for all the clinically relevant species treated here are compared and illustrated.
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Affiliation(s)
- M. Sandoval-Denis
- Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
- Faculty of Natural and Agricultural Sciences, Department of Plant Sciences, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
| | - P.W. Crous
- Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
- Faculty of Natural and Agricultural Sciences, Department of Plant Sciences, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
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14
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Fusarium Infection in a Kidney Transplant Recipient Successfully Treated with Voriconazole. Case Rep Infect Dis 2018; 2018:3128081. [PMID: 30159184 PMCID: PMC6109559 DOI: 10.1155/2018/3128081] [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] [Received: 02/03/2018] [Accepted: 07/15/2018] [Indexed: 11/18/2022] Open
Abstract
Fusarium infections in solid-organ transplant recipients are rare and carry high mortality. We report a case of a kidney transplant recipient who developed infection with Fusarium species. The patient received treatment with oral voriconazole for five months with good response.
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15
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Clark HL, Minns MS, Sun Y, de Jesus T, Ghannoum MG, Pearlman E. Atovaquone Impairs Growth of Aspergillus and Fusarium Keratitis Isolates by Modulating Mitochondrial Function and Zinc Homeostasis. Invest Ophthalmol Vis Sci 2018; 59:1589-1598. [PMID: 29625485 PMCID: PMC5863689 DOI: 10.1167/iovs.17-22585] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Aspergillus and Fusarium molds cause blinding corneal infections as a consequence of ocular trauma and in association with contact lens wear. As these fungi require zinc for fungal growth, we examined the effect of atovaquone, a ubiquinone analog that disrupts zinc homeostasis, on fungal growth in vitro and in vivo. Methods In vitro: Aspergillus and Fusarium germinating conidia were incubated overnight with atovaquone, and hyphal growth was measured by fluorimetry. In vivo: C57BL/6 mouse corneas were infected with Aspergillus or Fusarium conidia. Atovaquone was added topically and corneal opacification and fungal growth were quantified. Results Atovaquone has antifungal activity against Aspergillus and Fusarium clinical isolates, with Fusarium species being more sensitive to atovaquone than Aspergillus species. Atovaquone also reduced labile intracellular zinc levels and increased the sensitivity of Aspergillus to metal shock. Atovaquone reduced vacuolar acidification, which regulates storage of intracellular free zinc, and also acted synergistically with voriconazole and itraconazole to kill hyphae. Furthermore, mitochondrial potential and ATP production were reduced in both Aspergillus and Fusarium following atovaquone treatment. Finally, topical application of atovaquone to the ocular surface significantly inhibited fungal growth and corneal opacification in murine models of fungal keratitis. Conclusions These studies demonstrate that atovaquone has pronounced in vitro and in vivo antifungal activity against filamentous fungi by disrupting both metal homeostasis and mitochondrial function, and therefore has potential as a novel antifungal agent.
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Affiliation(s)
- Heather L Clark
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States.,Department of Ophthalmology, University of California Irvine, Irvine, California, United States.,Department of Physiology and Biophysics, University of California Irvine, Irvine, California, United States
| | - Martin S Minns
- Department of Ophthalmology, University of California Irvine, Irvine, California, United States.,Department of Physiology and Biophysics, University of California Irvine, Irvine, California, United States
| | - Yan Sun
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Tristan de Jesus
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Mahmoud G Ghannoum
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Eric Pearlman
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States.,Department of Ophthalmology, University of California Irvine, Irvine, California, United States.,Department of Physiology and Biophysics, University of California Irvine, Irvine, California, United States
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16
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D'Agostino M, Lemmet T, Dufay C, Luc A, Frippiat JP, Machouart M, Debourgogne A. Overinduction of CYP51A Gene After Exposure to Azole Antifungals Provides a First Clue to Resistance Mechanism in Fusarium solani Species Complex. Microb Drug Resist 2018; 24:768-773. [DOI: 10.1089/mdr.2017.0311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maurine D'Agostino
- Laboratoire Stress Immunité Pathogènes, EA7300, Faculté de Médecine, Vandoeuvre-les-Nancy, France
| | - Thomas Lemmet
- Laboratoire Stress Immunité Pathogènes, EA7300, Faculté de Médecine, Vandoeuvre-les-Nancy, France
| | - Claire Dufay
- Laboratoire Stress Immunité Pathogènes, EA7300, Faculté de Médecine, Vandoeuvre-les-Nancy, France
| | - Amandine Luc
- Unité de Méthodologie, Data Management et Statistique, PARC, CHRU de Nancy, Hôpitaux de Brabois, Vandoeuvre-les-Nancy, France
| | - Jean Pol Frippiat
- Laboratoire Stress Immunité Pathogènes, EA7300, Faculté de Médecine, Vandoeuvre-les-Nancy, France
| | - Marie Machouart
- Laboratoire Stress Immunité Pathogènes, EA7300, Faculté de Médecine, Vandoeuvre-les-Nancy, France
- Service de Parasitologie-Mycologie, CHRU de Nancy, Hôpitaux de Brabois, Vandoeuvre-les-Nancy, France
| | - Anne Debourgogne
- Laboratoire Stress Immunité Pathogènes, EA7300, Faculté de Médecine, Vandoeuvre-les-Nancy, France
- Service de Parasitologie-Mycologie, CHRU de Nancy, Hôpitaux de Brabois, Vandoeuvre-les-Nancy, France
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17
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Homa M, Galgóczy L, Manikandan P, Narendran V, Sinka R, Csernetics Á, Vágvölgyi C, Kredics L, Papp T. South Indian Isolates of the Fusarium solani Species Complex From Clinical and Environmental Samples: Identification, Antifungal Susceptibilities, and Virulence. Front Microbiol 2018; 9:1052. [PMID: 29875757 PMCID: PMC5974209 DOI: 10.3389/fmicb.2018.01052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/03/2018] [Indexed: 11/13/2022] Open
Abstract
Members of the Fusarium solani species complex (FSSC) are the most frequently isolated fusaria from soil. Moreover, this complex solely affects more than 100 plant genera, and is also one of the major opportunistic human pathogenic filamentous fungi, being responsible for approximately two-third of fusariosis cases. Mycotic keratitis due to Fusarium species is among the leading causes of visual impairment and blindness in South India, but its management is still challenging due to the poor susceptibility of the isolates to conventional antifungal drugs. Aims of the present study were to isolate South Indian clinical and environmental FSSC strains and identify them to species level, to determine the actual trends in their susceptibilities to antifungal therapeutic drugs and to compare the virulence of clinical and environmental FSSC members. Based on the partial sequences of the translation elongation factor 1α gene, the majority of the isolates-both from keratomycosis and environment-were confirmed as F. falciforme, followed by F. keratoplasticum and F. solani sensu stricto. In vitro antifungal susceptibilities to commonly used azole, allylamine and polyene antifungals were determined by the CLSI M38-A2 broth microdilution method. The first generation triazoles, fluconazole and itraconazole proved to be ineffective against all isolates tested. This phenomenon has already been described before, as fusaria are intrinsically resistant to them. However, our results indicated that despite the intensive agricultural use of azole compounds, fusaria have not developed resistance against the imidazole class of antifungals. In order to compare the virulence of different FSSC species from clinical and environmental sources, a Drosophila melanogaster model was used. MyD88 mutant flies having impaired immune responses were highly susceptible to all the examined fusaria. In wild-type flies, one F. falciforme and two F. keratoplasticum strains also reduced the survival significantly. Pathogenicity seemed to be independent from the origin of the isolates.
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Affiliation(s)
- Mónika Homa
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Szeged, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - László Galgóczy
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.,Division of Molecular Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Palanisamy Manikandan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India.,Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia.,Greenlink Analytical and Research Laboratory India Private Limited, Coimbatore, India
| | | | - Rita Sinka
- Department of Genetics, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Árpád Csernetics
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Csaba Vágvölgyi
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - László Kredics
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Tamás Papp
- MTA-SZTE "Lendület" Fungal Pathogenicity Mechanisms Research Group, Szeged, Hungary.,Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
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18
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Geddes-McAlister J, Shapiro RS. New pathogens, new tricks: emerging, drug-resistant fungal pathogens and future prospects for antifungal therapeutics. Ann N Y Acad Sci 2018; 1435:57-78. [DOI: 10.1111/nyas.13739] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/19/2018] [Accepted: 03/28/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Jennifer Geddes-McAlister
- Department of Molecular and Cellular Biology; University of Guelph; Guelph Ontario Canada
- Department of Proteomics and Signal Transduction; Max Planck Institute of Biochemistry; Munich Germany
| | - Rebecca S. Shapiro
- Department of Molecular and Cellular Biology; University of Guelph; Guelph Ontario Canada
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19
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Endophthalmitis caused by Fusarium: An emerging problem in patients with corneal trauma. A case series. Rev Iberoam Micol 2018; 35:92-96. [PMID: 29724456 DOI: 10.1016/j.riam.2017.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/14/2017] [Accepted: 09/08/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. AIMS The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. METHODS Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. RESULTS Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. CONCLUSIONS It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection.
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20
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In vitro Antifungal Susceptibility Testing of Clinical and Environmental Fusarium Isolates in Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.58976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Gaviria-Rivera AM, Giraldo-López AD, Cano Restrepo LE. In vitro antifungal susceptibility of clinical isolates of Fusarium from Colombia. Rev Salud Publica (Bogota) 2017; 19:800-805. [DOI: 10.15446/rsap.v19n6.54654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/07/2017] [Indexed: 11/09/2022] Open
Abstract
Objetivo Evaluar la susceptibilidad antifúngica in vitro de aislamientos de Fusarium a los antimicóticos amfotericina B, itraconazol y voriconazol.Métodos La susceptibilidad de 44 aislamientos clínicos de Fusarium fue evaluada por el método de difusión en disco, E-test.Resultados Todos los aislamientos fueron resistentes al itraconazol, y 89 % y 54,5 % fueron resistentes a la amfotericina B y al voriconazol, respectivamente.Discusión Los resultados confirman el alto nivel de resistencia reportado, independiente de la especie o la cepa de Fusarium involucrada. Los valores tan altos de MICs son preocupantes y sugieren la necesidad de evaluar nuevos medicamentos.
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22
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Sharma C, Chowdhary A. Molecular bases of antifungal resistance in filamentous fungi. Int J Antimicrob Agents 2017; 50:607-616. [DOI: 10.1016/j.ijantimicag.2017.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 06/16/2017] [Accepted: 06/24/2017] [Indexed: 01/15/2023]
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23
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Mixão V, Gabaldón T. Hybridization and emergence of virulence in opportunistic human yeast pathogens. Yeast 2017; 35:5-20. [PMID: 28681409 PMCID: PMC5813172 DOI: 10.1002/yea.3242] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 02/06/2023] Open
Abstract
Hybridization between different species can result in the emergence of new lineages and adaptive phenotypes. Occasionally, hybridization in fungal organisms can drive the appearance of opportunistic lifestyles or shifts to new hosts, resulting in the emergence of novel pathogens. In recent years, an increasing number of studies have documented the existence of hybrids in diverse yeast clades, including some comprising human pathogens. Comparative and population genomics studies performed on these clades are enabling us to understand what roles hybridization may play in the evolution and emergence of a virulence potential towards humans. Here we survey recent genomic studies on several yeast pathogenic clades where hybrids have been identified, and discuss the broader implications of hybridization in the evolution and emergence of pathogenic lineages. © 2017 The Authors. Yeast published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Verónica Mixão
- Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Dr. Aiguader 88, Barcelona, 08003, Spain.,Universitat Pompeu Fabra, 08003, Barcelona, Spain
| | - Toni Gabaldón
- Centre for Genomic Regulation, The Barcelona Institute of Science and Technology, Dr. Aiguader 88, Barcelona, 08003, Spain.,Universitat Pompeu Fabra, 08003, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Pg. Lluís Companys 23, 08010, Barcelona, Spain
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24
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Abstract
Immunocompromised patients are at high risk for invasive fungal infections (IFIs); although Aspergillus remains the most common IFI caused by molds, other fungi, such as Mucorales, dematiaceous molds, and Fusarium spp, are being seen with increasing frequency. Presentations can vary, but sinopulmonary and disseminated infections are common. Our understanding of the pathogenesis of these infections is rudimentary. Fungal cultures and histopathology remain the backbone of diagnostics, as no good serologic markers are available. Polymerase chain reaction tests are being developed but currently remain investigational. Management of these infections is usually multidisciplinary, requiring surgical debridement along with antifungal therapy.
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25
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An Assessment of In Vitro Antifungal Activities of Efinaconazole and Itraconazole against Common Non-Dermatophyte Fungi Causing Onychomycosis. J Fungi (Basel) 2017; 3:jof3020020. [PMID: 29371538 PMCID: PMC5715924 DOI: 10.3390/jof3020020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022] Open
Abstract
Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. Drug toxicities, prolonged regimens, lack of patient compliance, and high keratin affinity of drugs are all contributive factors. Efinaconazole is a novel topical triazole antifungal agent that has shown excellent in vitro activity against both dermatophyte and non-dermatophyte fungi causing onychomycosis. This study presents the in vitro susceptibility profiles of 44 common non-dermatophyte fungi against efinaconazole and itraconazole, another azole drug used in the treatment of onychomycosis.
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26
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Al-Hatmi AMS, Curfs-Breuker I, de Hoog GS, Meis JF, Verweij PE. Antifungal Susceptibility Testing of Fusarium: A Practical Approach. J Fungi (Basel) 2017; 3:jof3020019. [PMID: 29371537 PMCID: PMC5715922 DOI: 10.3390/jof3020019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/14/2017] [Accepted: 04/19/2017] [Indexed: 12/12/2022] Open
Abstract
In vitro susceptibility testing of Fusarium is becoming increasingly important because of frequency and diversity of infections and because resistance profiles are species-specific. Reference methods for antifungal susceptibility testing (AFST) are those of Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility (EUCAST), but breakpoints (BPs) have not yet been established. One of the problems is that phylogenetic distances between Fusarium species are much smaller than between species of, e.g., Candida. Epidemiological cutoff values (ECVs) for some Fusarium species have been determined in order to differentiate wild-type from non-wild-type isolates. In clinical routine, commercially available assays such as Etest, Sensititre or others provide essential agreement with reference methods. Our objective is to summarize antifungal susceptibility testing of Fusarium genus in the clinical laboratory: how to do it, when to do it, and how to interpret it.
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Affiliation(s)
- Abdullah M S Al-Hatmi
- Westerdijk Fungal Biodiversity Institute, PO Box 85167, 3508 AD Utrecht, The Netherlands.
- Centre of Expertise in Mycology Radboud University Medical Centre, Canisius Wilhelmina Hospital, 6500HB Nijmegen, The Netherlands.
- Ministry of Health, Directorate General of Health Services, PO Box 393, 100 Muscat, Oman.
| | - Ilse Curfs-Breuker
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6500HB Nijmegen, The Netherlands.
| | - G Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, PO Box 85167, 3508 AD Utrecht, The Netherlands.
- Basic Pathology Department, Federal University of Paraná State, Curitiba, 81540-970 Paraná, Brazil.
- Biological Sciences Department, Faculty of Science, King Abdulaziz University, PO Box 80203 Jeddah, Saudi Arabia.
| | - Jacques F Meis
- Centre of Expertise in Mycology Radboud University Medical Centre, Canisius Wilhelmina Hospital, 6500HB Nijmegen, The Netherlands.
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, 6500HB Nijmegen, The Netherlands.
| | - Paul E Verweij
- Centre of Expertise in Mycology Radboud University Medical Centre, Canisius Wilhelmina Hospital, 6500HB Nijmegen, The Netherlands.
- Department of Medical Microbiology, Radboud University, Nijmegen Medical Centre, 6500GS Nijmegen, The Netherlands.
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27
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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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28
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Zhang J, Jin K, Xia Y. Contributions of β-tubulin to cellular morphology, sporulation and virulence in the insect-fungal pathogen, Metarhizium acridum. Fungal Genet Biol 2017; 103:16-24. [PMID: 28336393 DOI: 10.1016/j.fgb.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/28/2017] [Accepted: 03/18/2017] [Indexed: 11/25/2022]
Abstract
β-tubulin is an elementary subunit of microtubules that form the cytoskeleton, participating in a wide range of cellular processes. The contributions of the single β-tubulin gene in affecting cell morphology, sporulation and virulence were examined in the entomopathogenic fungus Metarhizium acridum. Targeted gene knockout of β-tubulin resulted in resistance to benomyl but impaired proper nuclear segregation, lipid droplet transport, and deposition of chitin to the cell wall. M. acridum β-tubulin mutants displayed wavy hyphal growth and densely packed, wrinkled colonies. Decreases in the rate of phialides formation and conidial yield were observed for the β-tubulin mutant, which was also impaired in virulence towards locust hosts as compared to wild type and complemented strains. Morphological analyses of infection structures revealed development of bifurcated germ tubes, with reduced appressoria formation seen in the β-tubulin mutant. M. acridum β-tubulin mutant appressoria were aberrant in morphology and displayed decreased turgor pressure. The ability of the M. acridum β-tubulin mutant to proliferate in the insect hemolymph both in vitro and in vivo was also significantly reduced. Our results indicate that in M. acridum, β-tubulin is not essential for survival but that it contributes to cellular transport of organelles and cell wall materials, impacting growth, appressorial differentiation, virulence, and sporulation.
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Affiliation(s)
- Jie Zhang
- Genetic Engineering Research Center, School of Life Science, Chongqing University, Chongqing 400030, PR China; Chongqing Engineering Research Center for Fungal Insecticide, Chongqing 400030, PR China; Key Laboratory of Gene Function and Regulation Technologies under Chongqing Municipal Education Commission, Chongqing 400030, PR China.
| | - Kai Jin
- Genetic Engineering Research Center, School of Life Science, Chongqing University, Chongqing 400030, PR China; Chongqing Engineering Research Center for Fungal Insecticide, Chongqing 400030, PR China; Key Laboratory of Gene Function and Regulation Technologies under Chongqing Municipal Education Commission, Chongqing 400030, PR China.
| | - Yuxian Xia
- Genetic Engineering Research Center, School of Life Science, Chongqing University, Chongqing 400030, PR China; Chongqing Engineering Research Center for Fungal Insecticide, Chongqing 400030, PR China; Key Laboratory of Gene Function and Regulation Technologies under Chongqing Municipal Education Commission, Chongqing 400030, PR China.
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29
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Al-Hatmi AMS, Normand AC, Ranque S, Piarroux R, de Hoog GS, Meletiadis J, Meis JF. Comparative Evaluation of Etest, EUCAST, and CLSI Methods for Amphotericin B, Voriconazole, and Posaconazole against Clinically Relevant Fusarium Species. Antimicrob Agents Chemother 2017; 61:e01671-16. [PMID: 27795379 PMCID: PMC5192122 DOI: 10.1128/aac.01671-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/20/2016] [Indexed: 11/20/2022] Open
Abstract
We compared EUCAST and CLSI methods versus Etest for antifungal susceptibility testing of 20 clinically relevant Fusarium species against amphotericin B, posaconazole, and voriconazole. The median Etest amphotericin B and posaconazole MICs were 1 dilution higher than the median EUCAST and the CLSI MICs. The essential agreement (within ±1/±2 dilutions) was 60/90%, 80/95%, and 70/85% between the Etest and EUCAST methods and 80/95%, 75/95%, and 45/100% between the Etest and CLSI methods for amphotericin B, voriconazole, and posaconazole, respectively. The categorical agreement was >85%. Etest can be used for antifungal susceptibility testing of Fusarium species.
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Affiliation(s)
- 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
| | - Anne-Cécile Normand
- Aix-Marseille University, APHM, CHU Timone, IP-TPT, Parasitology-Mycology, Marseille, France
| | - Stephane Ranque
- Aix-Marseille University, APHM, CHU Timone, IP-TPT, Parasitology-Mycology, Marseille, France
| | - Renaud Piarroux
- Aix-Marseille University, APHM, CHU Timone, IP-TPT, Parasitology-Mycology, Marseille, France
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Halliday CL, Chen SCA, Kidd SE, van Hal S, Chapman B, Heath CH, Lee A, Kennedy KJ, Daveson K, Sorrell TC, Morrissey CO, Marriott DJ, Slavin MA. Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations. Int J Antimicrob Agents 2016; 48:453-8. [PMID: 27562696 DOI: 10.1016/j.ijantimicag.2016.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/27/2016] [Accepted: 07/02/2016] [Indexed: 01/29/2023]
Abstract
Antifungal susceptibilities of non-Aspergillus filamentous fungal pathogens cannot always be inferred from their identification. Here we determined, using the Sensititre(®) YeastOne(®) YO10 panel, the in vitro activities of nine antifungal agents against 52 clinical isolates of emergent non-Aspergillus moulds representing 17 fungal groups in Australia. Isolates comprised Mucorales (n = 14), Scedosporium/Lomentospora spp. (n = 18) and a range of hyaline hyphomycetes (n = 9) and other dematiaceous fungi (n = 11). Excluding Verruconis gallopava, echinocandins demonstrated poor activity (MICs generally >8 mg/L) against these moulds. Lomentospora prolificans (n = 4) and Fusarium spp. (n = 6) demonstrated raised MICs to all antifungal drugs tested, with the lowest being to voriconazole and amphotericin B (AmB), respectively (geometric mean MICs of 3.4 mg/L and 2.2 mg/L, respectively). All Scedosporium apiospermum complex isolates (n = 14) were inhibited by voriconazole concentrations of ≤0.25 mg/L, followed by posaconazole and itraconazole at ≤1 mg/L. Posaconazole and AmB were the most active agents against the Mucorales, with MIC90 values of 1 mg/L and 2 mg/L, respectively, for Rhizopus spp. For dematiaceous fungi, all isolates were inhibited by itraconazole and posaconazole concentrations of ≤0.5 mg/L (MIC90, 0.12 mg/L and 0.25 mg/L, respectively), but voriconazole and AmB also had in vitro activity (MIC90, 0.5 mg/L and 1 mg/L, respectively). Differences in antifungal susceptibility within species and between species within genera support the need for testing individual patient isolates to guide therapy. The Sensititre(®) YeastOne(®) offers a practical alternative to the reference methodology for susceptibility testing of moulds.
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Affiliation(s)
- Catriona L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Westmead, NSW, Australia.
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Westmead, NSW, Australia; Marie Bashir Institute, University of Sydney, Westmead, NSW, Australia
| | - Sarah E Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, South Australia, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Belinda Chapman
- The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Infectious Diseases, Fiona Stanley Hospital, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Andie Lee
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Karina J Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - Kathryn Daveson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - Tania C Sorrell
- Marie Bashir Institute, University of Sydney, Westmead, NSW, Australia; The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, VIC, Australia
| | - Deborah J Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service, Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
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Taj-Aldeen SJ, Salah H, Al-Hatmi AMS, Hamed M, Theelen B, van Diepeningen AD, Boekhout T, Lass-Flörl C. In vitro resistance of clinical Fusarium species to amphotericin B and voriconazole using the EUCAST antifungal susceptibility method. Diagn Microbiol Infect Dis 2016; 85:438-43. [PMID: 27312690 DOI: 10.1016/j.diagmicrobio.2016.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 12/22/2022]
Abstract
Susceptibility testing using the EUCAST-AFST method against 39 clinical Fusarium strains consecutively collected from local and invasive infections during the last 10years assessed the in vitro activities of amphotericin B (AmB) and triazole antifungal agents. In addition, the susceptibility pattern of 12 reference strains from the CBS-KNAW Fungal Biodiversity Centre (CBS) was evaluated. In particular Fusarium petroliphilum and F. solani sensu lato were involved in disseminated infections and known for treatment failure. AmB displayed the lowest MICs followed by voriconazole VRC, posaconazole (POC). Itraconazole (ITC) showed high MIC values, displaying in vitro resistance. Clinical isolates were significantly (P <0.05) more resistant to AmB, VRC, and POC, than the CBS reference isolates probably due to previous exposure to antifungal therapy. Resistant profiles to AmB and VRC, which are the currently recommended agents in the guidelines for treatments, and a late diagnosis may be associated with high mortality rate in immunocompromised patients. The present antifungal susceptibility profiles showed that species- and strain-specific differences in antifungal susceptibility exist within Fusarium and that susceptibility testing is important and may improve the prognosis of these infections.
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Affiliation(s)
- Saad J Taj-Aldeen
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar; Weill Cornell Medical College, Doha, Qatar.
| | - Husam Salah
- 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
| | - Manal Hamed
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Bart Theelen
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | | | - 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
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria
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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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Pushing the Limits of MALDI-TOF Mass Spectrometry: Beyond Fungal Species Identification. J Fungi (Basel) 2015; 1:367-383. [PMID: 29376916 PMCID: PMC5753130 DOI: 10.3390/jof1030367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 12/12/2022] Open
Abstract
Matrix assisted laser desorption ionization time of flight (MALDI-TOF) is a powerful analytical tool that has revolutionized microbial identification. Routinely used for bacterial identification, MALDI-TOF has recently been applied to both yeast and filamentous fungi, confirming its pivotal role in the rapid and reliable diagnosis of infections. Subspecies-level identification holds an important role in epidemiological investigations aimed at tracing virulent or drug resistant clones. This review focuses on present and future applications of this versatile tool in the clinical mycology laboratory.
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Stempel JM, Hammond SP, Sutton DA, Weiser LM, Marty FM. Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience. Open Forum Infect Dis 2015; 2:ofv099. [PMID: 26258156 PMCID: PMC4525012 DOI: 10.1093/ofid/ofv099] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/26/2015] [Indexed: 11/12/2022] Open
Abstract
Invasive fusariosis is an aggressive fungal disease among immunocompromised patients. Mortality remains high in the voriconazole era. Combination therapy should be studied systematically for fusariosis. Background. Invasive fusariosis remains an aggressive, albeit infrequent infection in immunocompromised patients. Methods. We identified all cases of invasive fusariosis between January 2002 and December 2014. We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities. Results. Fifteen patients were diagnosed with proven (12, 80%) or probable (3, 20%) fusariosis. Median age was 60 years (range, 26–78), and 10 patients were male. Underlying conditions included hematological malignancies (13, 87%), juvenile idiopathic arthritis (1, 7%), and third-degree burns (1, 7%). Five patients underwent hematopoietic stem-cell transplantation before diagnosis. Six patients (40%) received systemic glucocorticoids, and 11 patients (73%) had prolonged neutropenia at the time of diagnosis. Clinical presentations included the following: skin/soft tissue infection (8, 53%), febrile neutropenia (4, 27%), respiratory tract infection (2, 13%), and septic arthritis (1, 7%). Twelve patients were treated with voriconazole: 6 (40%) with voriconazole alone, 4 (27%) with voriconazole and terbinafine, and 2 (13%) with voriconazole, terbinafine, and amphotericin. One patient (7%) was treated with terbinafine alone, and another with micafungin alone. Four patients underwent surgical debridement (4, 27%). Susceptibility testing was performed on 9 isolates; 8 demonstrated voriconazole minimum inhibitory concentrations ≥4 µg/mL. The cumulative probability of survival was 66.7% and 53.3% at 6 and 12 weeks after diagnosis. Conclusions. Mortality associated with invasive fusariosis remains high. Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations. Combination therapy should be studied systematically for fusariosis.
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Affiliation(s)
| | - Sarah P Hammond
- Brigham and Women's Hospital ; Harvard Medical School ; Dana-Farber Cancer Institute , Boston, Massachusetts
| | - Deanna A Sutton
- Fungus Testing Laboratory , University of Texas Health Science Center , San Antonio, Texas
| | | | - Francisco M Marty
- Brigham and Women's Hospital ; Harvard Medical School ; Dana-Farber Cancer Institute , Boston, Massachusetts
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Emergence of fusarioses in a university hospital in Turkey during a 20-year period. Eur J Clin Microbiol Infect Dis 2015; 34:1683-91. [DOI: 10.1007/s10096-015-2405-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/05/2015] [Indexed: 12/22/2022]
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Al-Hatmi AMS, van Diepeningen AD, Curfs-Breuker I, de Hoog GS, Meis JF. Specific antifungal susceptibility profiles of opportunists in the Fusarium fujikuroi complex. J Antimicrob Chemother 2014; 70:1068-71. [PMID: 25538167 DOI: 10.1093/jac/dku505] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of the present study was to evaluate and assess the in vitro activity of eight drugs, including the new azole isavuconazole, against 81 strains representing 13 species of the Fusarium fujikuroi species complex. METHODS A total of 81 Fusarium spp. isolates, within the F. fujikuroi species complex, were identified by molecular methods and tested according to CLSI M38-A2. Eight antifungal compounds, including the new azole isavuconazole, were tested. Isolates were selected to represent the widest variety of geographical regions and to include clinical as well as environmental strains. RESULTS Susceptibility profiles differed between and within species, with Fusarium verticillioides showing the lowest MICs and Fusarium nygamai the highest MICs. Amphotericin B was the most active drug, followed by voriconazole, posaconazole, isavuconazole and natamycin. The remaining antifungals (fluconazole, itraconazole and micafungin) showed poor activity with MIC/minimum effective concentration values of ≥ 32, ≥ 16 and >8 mg/L, respectively. CONCLUSIONS Resistance patterns in the F. fujikuroi species complex are species specific and therefore identification down to species level is important for the choice of antifungal treatment.
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Affiliation(s)
- Abdullah M S Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, PO Box 85167, 3508 AD Utrecht, The Netherlands Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands Directorate General of Health Services, Ibri Hospital, Ministry of Health, Muscat, Oman
| | | | - Ilse Curfs-Breuker
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - G Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, PO Box 85167, 3508 AD Utrecht, The Netherlands Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Use of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of molds of the Fusarium genus. J Clin Microbiol 2014; 53:465-76. [PMID: 25411180 DOI: 10.1128/jcm.02213-14] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The rates of infection with Fusarium molds are increasing, and a diverse number of Fusarium spp. belonging to different species complexes can cause infection. Conventional species identification in the clinical laboratory is time-consuming and prone to errors. We therefore evaluated whether matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a useful alternative. The 289 Fusarium strains from the Belgian Coordinated Collections of Microorganisms (BCCM)/Institute of Hygiene and Epidemiology Mycology (IHEM) culture collection with validated sequence-based identities and comprising 40 species were used in this study. An identification strategy was developed, applying a standardized MALDI-TOF MS assay and an in-house reference spectrum database. In vitro antifungal testing was performed to assess important differences in susceptibility between clinically relevant species/species complexes. We observed that no incorrect species complex identifications were made by MALDI-TOF MS, and 82.8% of the identifications were correct to the species level. This success rate was increased to 91% by lowering the cutoff for identification. Although the identification of the correct species complex member was not always guaranteed, antifungal susceptibility testing showed that discriminating between Fusarium species complexes can be important for treatment but is not necessarily required between members of a species complex. With this perspective, some Fusarium species complexes with closely related members can be considered as a whole, increasing the success rate of correct identifications to 97%. The application of our user-friendly MALDI-TOF MS identification approach resulted in a dramatic improvement in both time and accuracy compared to identification with the conventional method. A proof of principle of our MALDI-TOF MS approach in the clinical setting using recently isolated Fusarium strains demonstrated its validity.
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Ersal T, Al-Hatmi ASM, Cilo BD, Curfs-Breuker I, Meis JF, Özkalemkaş F, Ener B, van Diepeningen AD. Fatal disseminated infection with Fusarium petroliphilum. Mycopathologia 2014; 179:119-24. [PMID: 25234793 DOI: 10.1007/s11046-014-9813-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/10/2014] [Indexed: 12/12/2022]
Abstract
Members of the Fusarium solani species complex (FSSC) are causing the majority of the fusariosis in humans. Disseminated fusariosis has a high mortality and is predominantly observed in patients with leukemia. Here, we present the case of a fatal infection by a Fusarium strain with a degenerated phenotype, in a patient with acute lymphatic leukemia. Multiple nasal and skin biopsies as well as blood cultures yielded fungal growth, while in direct and histopathological examination of biopsy material septate hyphae were visible. Initial colonies were white with slimy masses with microconidia reminiscent of Fusarium/Acremonium, but with conidiospore production directly on the hyphae. Multi-locus sequence typing discerned a pionnotal-morphologically degenerated-colony of the recently recognized F. petroliphilum as etiological agent. The culture returned to a typical F. solani species complex morphology only after several weeks of growth in culture. Antifungal susceptibility tests indicate amphotericin B as best drug for this FSSC member rather than any of the azoles or echinocandins.
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Affiliation(s)
- Tuba Ersal
- Department of Haematology, Faculty of Medicine, Uludağ University, Bursa, Turkey
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Tortorano AM, Prigitano A, Esposto MC, Arsic Arsenijevic V, Kolarovic J, Ivanovic D, Paripovic L, Klingspor L, Nordøy I, Hamal P, Arikan Akdagli S, Ossi C, Grancini A, Cavanna C, Lo Cascio G, Scarparo C, Candoni A, Caira M, Drogari Apiranthitou M. European Confederation of Medical Mycology (ECMM) epidemiological survey on invasive infections due to Fusarium species in Europe. Eur J Clin Microbiol Infect Dis 2014; 33:1623-30. [DOI: 10.1007/s10096-014-2111-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
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Masaphy S. A novel echinocandin MIG0310 with anticandida activity from newly isolated Fusarium
sp. strain MS-R1. J Appl Microbiol 2014; 116:1458-64. [DOI: 10.1111/jam.12493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/27/2014] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S. Masaphy
- Applied Mycology and Microbiology Department; MIGAL - Galilee Research Center and Tel Hai College; Kiryat Shmona Israel
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Microscopic evaluation, molecular identification, antifungal susceptibility, and clinical outcomes in fusarium, Aspergillus and, dematiaceous keratitis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:605308. [PMID: 24260740 PMCID: PMC3821891 DOI: 10.1155/2013/605308] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/22/2013] [Accepted: 08/16/2013] [Indexed: 11/25/2022]
Abstract
Purpose. Fusarium, Aspergillus, and Dematiaceous are the most common fungal species causing keratitis in tropical countries. Herein we report a prospective study on fungal keratitis caused by these three fungal species. Methodology. A prospective investigation was undertaken to evaluate eyes with presumed fungal keratitis. All the fungal isolates (n = 73) obtained from keratitis infections were identified using morphological and microscopic characters. Molecular identification using sequencing of the ITS region and antifungal susceptibility tests using microdilution method were done. The final clinical outcome was evaluated in terms of the time taken for resolution of keratitis and the final visual outcome. The results were analyzed after segregating the cases into three groups, namely, Fusarium, Aspergillus, and Dematiaceous keratitis. Results. Diagnosis of fungal keratitis was established in 73 (35.9%) cases out of 208 cases. The spectra of fungi isolated were Fusarium spp. (26.6%), Aspergillus spp. (21.6%), and Dematiaceous fungi (11.6%). The sequence of the ITS region could identify the Fusarium and Aspergillus species at the species complex level, and the Dematiaceous isolates were accurately identified. Using antifungal agents such as fluconazole, natamycin, amphotericin B, and itraconazole, the minimum inhibitory concentrations (MICs) for Fusarium spp. were >32 μg/mL, 4–8 μg/mL, 0.5–1 μg/mL, and >32 μg/mL, respectively. Antifungal susceptibility data showed that Curvularia spp. was highly resistant to all the antifungal agents. Overall, natamycin and amphotericin B were found to be the most effective antifungal agents. The comparative clinical outcomes in all cases showed that the healing response in terms of visual acuity of the Dematiaceous group was significantly good when compared with the Fusarium and Aspergillus groups (P < 0.05). The time required for healing in the Fusarium group was statistically significantly less when compared with the Aspergillus and Dematiaceous groups. Conclusion. This study demonstrates important differences in microscopic features of scraping material and antifungal susceptibility between the three groups. Early and accurate identification coupled with the MIC data, and thereby appropriate treatment is crucial for complete recovery.
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Homa M, Shobana CS, Singh YRB, Manikandan P, Selvam KP, Kredics L, Narendran V, Vágvölgyi C, Galgóczy L. Fusarium keratitis in South India: causative agents, their antifungal susceptibilities and a rapid identification method for the Fusarium solani species complex. Mycoses 2013; 56:501-511. [PMID: 23437826 DOI: 10.1111/myc.12062] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/23/2013] [Accepted: 01/23/2013] [Indexed: 09/07/2023]
Abstract
Seventy Fusarium isolates derived from human keratomycosis were identified based on partial sequences of the β-tubulin (β-TUB) and translation elongation factor 1α (EF-1α) genes. Most of the isolates were confirmed as members of the F. solani species complex (75.71%), followed by the F. dimerum species complex (8.57%), the F. fujikuroi species complex (8.57%), the F. oxysporum species complex (4.29%) and the F. incarnatum-equiseti species complex (2.86%). A combined phylogenetic tree was estimated including all the 70 isolates. Isolates belonging to different species complexes formed separate clades. In this study, we also report the first isolation of F. napiforme from human keratomycosis. A new method based on a specific EcoRI restriction site in the EF-1α gene was developed for the rapid identification of F. solani. In vitro antifungal susceptibilities of the isolates to seven antifungals were determined by broth microdilution method. Terbinafine, natamycin and amphotericin B proved to be the most effective drugs, followed by voriconazole. The minimal inhibitory concentrations of clotrimazole, econazole and itraconazole were generally high (≥64 μg ml(-1) ). The interactions between the two most effective antifungals (natamycin and terbinafine) were determined by checkerboard microdilution method. Synergism (71.8%) or no interaction (28.2%) was revealed between the two compounds.
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Affiliation(s)
- Mónika Homa
- Faculty of Science and Informatics, Department of Microbiology, University of Szeged, H-6726 Szeged, Hungary
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Murine Model of Disseminated Fusariosis: Evaluation of the Fungal Burden by Traditional CFU and Quantitative PCR. Mycopathologia 2013; 176:219-24. [DOI: 10.1007/s11046-013-9687-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
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Guarro J. Fusariosis, a complex infection caused by a high diversity of fungal species refractory to treatment. Eur J Clin Microbiol Infect Dis 2013; 32:1491-500. [DOI: 10.1007/s10096-013-1924-7] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/03/2013] [Indexed: 11/30/2022]
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Abstract
PURPOSE To determine differences in the clinical characteristics and antifungal susceptibility patterns among molecularly characterized ocular Fusarium sp isolates. METHODS Fifty-eight isolates of Fusarium sp obtained from 52 eyes of 52 patients were retrieved from the Ocular Microbiology Laboratory of the Bascom Palmer Eye Institute and grown in pure culture. These isolates were characterized based on DNA sequence analysis of the ITS1/2 and ribosomal deoxyribonucleic acid regions. Antifungal susceptibilities were determined for each isolate using broth microdilution methods, and the corresponding medical records were reviewed to determine the clinical outcomes. RESULTS Fusarium solani isolates had significantly higher values of minimum inhibitory concentration for 90% isolates (MIC90) with voriconazole than F. non-solani organisms (16 and 4 μg/mL, respectively). Isolates of F. solani also exhibited a significantly longer time to cure (65 vs. 40.5 days), a worse follow-up best-corrected visual acuity (20/118 vs. 20/36), and an increased need for urgent surgical management (7 vs. 0 penetrating keratoplasties) when compared with those of F. non-solani. CONCLUSIONS This is the first report to examine the correlation between ocular genotyped Fusarium sp and clinical outcomes. It supports the overall worse prognosis of F. solani versus F. non-solani isolates, including higher voriconazole resistance by the former. The clinical implementation of molecular-based diagnostics and antifungal efficacy testing may yield important prognostic and therapeutic information that could improve the management of fungal ocular infections.
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Short DPG, O'Donnell K, Thrane U, Nielsen KF, Zhang N, Juba JH, Geiser DM. Phylogenetic relationships among members of the Fusarium solani species complex in human infections and the descriptions of F. keratoplasticum sp. nov. and F. petroliphilum stat. nov. Fungal Genet Biol 2013; 53:59-70. [PMID: 23396261 DOI: 10.1016/j.fgb.2013.01.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/16/2013] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
Fusarium species are frequently associated with mycotic keratitis and, to a lesser extent, cases of localized and disseminated infections. The Fusarium solani species complex (FSSC) is the most common group of fusaria associated with human infectious diseases. Several studies to date have revealed dozens of strongly supported phylogenetic species within this important evolutionary clade, though little work has been done to improve the taxonomy and understanding of the reproductive mode and phenotypes of the predominant clinically relevant species. Here we described Fusarium keratoplasticum sp. nov., and Fusarium petroliphilum stat. nov., two phylogenetic species that are among the most frequently isolated fusaria in plumbing drain biofilms and outbreaks of contact lens-associated mycotic keratitis. F. keratoplasticum isolates were highly variable and showed a range of morphological characteristics typical for most classical concepts of 'F. solani.' Many isolates failed to produce sporodochia and macroconidia. Although most attempts to sexually cross F. keratoplasticum isolates failed, a heterothallic sexual stage typical for the FSSC was discovered by pairing isolates of opposite mating type on V-8 agar, the ascospores of which showed molecular evidence of recombination. Secondary metabolite profiles of FSSC species defined through molecular data were compared for the first time and revealed the production of bioactive compounds including cyclosporines and several novel compounds of unknown function. We speculate that the inferred phenotypic variability in these species is the result of the almost entirely anthropogenic sources from which they are derived, including biofilms on plumbing systems.
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Affiliation(s)
- Dylan P G Short
- Department of Plant Pathology, Penn State University, University Park, PA, United States.
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Salter CE, O'Donnell K, Sutton DA, Marancik DP, Knowles S, Clauss TM, Berliner AL, Camus AC. Dermatitis and systemic mycosis in lined seahorses Hippocampus erectus associated with a marine-adapted Fusarium solani species complex pathogen. DISEASES OF AQUATIC ORGANISMS 2012; 101:23-31. [PMID: 23047188 DOI: 10.3354/dao02506] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
During a 4 mo epizootic, 100% of 152 lined seahorses Hippocampus erectus in 3 separate groups died while in quarantine following shipment to a public aquarium. Twelve animals with skin depigmentation and ulceration were received by the Aquatic Pathology Service, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA, for diagnostic evaluation. Microscopically, lesions in 11 seahorses included multifocal epithelial necrosis and ulceration associated with 2 to 7 µm diameter, branching, septate fungal hyphae, typically accompanied by deeper infiltration into underlying skeletal muscle. Angioinvasion, with vascular thrombosis and tissue infarction, was a prominent feature in multiple animals. Fungal invasion of one or more internal organs was observed in 4 animals. Hyphae appeared to course freely through tissues and elicited little or no inflammatory response. Fusariosis has been reported sporadically in fish and other aquatic organisms, but identification has often been limited to the genus level based solely on morphologic features. Morphologic characteristics of the fungus isolated from this case were consistent with the Fusarium solani species complex (FSSC), which includes over 50 members that can only be identified definitively using DNA sequence data. A 3-locus typing scheme identified the isolate as a distinct species/haplotype, designated FSSC 12-a, belonging to a specific lineage that appears adapted to aquatic environments and disease in marine animals. Empirical treatment with itraconazole failed to stop mortalities, and subsequent in vitro antifungal susceptibility data explained a lack of clinical efficacy for this agent. Effective treatment in human medicine has similarly been limited by poor susceptibility to several classes of antifungal compounds.
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Affiliation(s)
- Caroline E Salter
- Department of Pathology, The University of Georgia College of Veterinary Medicine, Athens, Georgia 30602, USA
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The efficacy of voriconazole in 24 ocular Fusarium infections. Infection 2012; 41:15-20. [PMID: 22718362 DOI: 10.1007/s15010-012-0273-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We examined, retrospectively, the efficacy of voriconazole in Fusarium eye infections. METHODS Voriconazole-treated patients with proven or probable keratitis or endophthalmitis from the voriconazole database (9 patients) and six French ophthalmology departments (15 patients) were included. Sociodemographic features, predisposing factors, history of corneal trauma, associated ocular conditions, other diseases and prior therapies were analysed. Investigator-determined success was defined as infection resolution with medical treatment. Failure was no response or persistent infection and required surgery. RESULTS Most patients were Caucasian (83 %) and male (71 %). The infection was keratitis (63 %) or endophthalmitis (37 %) and proven in 23 (96 %). Prior therapy included topical and/or systemic amphotericin (46 %), fluconazole (17 %) or others (33 %), often in combination. Causative fungi were Fusarium solani (14, 58 %), Fusarium moniliforme (1), Fusarium oxysporum (1) and Fusarium spp. (8). Voriconazole was administered systemically, topically and/or by intraocular injection, and 16 patients (67 %) received salvage and eight primary therapy. The overall response was 67 % (73 % keratitis and 56 % endophthalmitis) but seven patients required adjunctive surgery. However, response was 63 % for eight primary therapy patients and 69 % for 16 salvage therapy patients. Response by species was Fusarium solani 64 % (9/14) and all others 80 % (8/10). In 13 patients (77 %), voriconazole was used in combination (response 69 vs. 64 % alone) with topical [amphotericin B 10/24 (42 %), caspofungin 5 (21 %), natamycin 1 (4 %)] and systemic agents [caspofungin 3 (13 %), amphotericin 2 (8 %)]. CONCLUSIONS Topical and systemic voriconazole appears to be effective alone or in combination with other agents for treating severe Fusarium keratitis or endophthalmitis.
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Bernal-Martínez L, Buitrago MJ, Castelli MV, Rodríguez-Tudela JL, Cuenca-Estrella M. Detection of invasive infection caused byFusarium solaniand non-Fusarium solanispecies using a duplex quantitative PCR-based assay in a murine model of fusariosis. Med Mycol 2012; 50:270-5. [DOI: 10.3109/13693786.2011.604047] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Caira M, Trecarichi EM, Mancinelli M, Leone G, Pagano L. Uncommon mold infections in hematological patients: epidemiology, diagnosis and treatment. Expert Rev Anti Infect Ther 2012; 9:881-92. [PMID: 21810058 DOI: 10.1586/eri.11.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Invasive fungal diseases continue to be an important cause of morbidity and mortality in immunosuppressed patients. This is of particular interest, since the progress we made in the treatment of underlying malignancies has led to an increase of the number of persons 'at high risk'. During the last few years, several changes in clinical practice in hematology (new immunosuppressants, hematopoietic stem cell transplants) have influenced the epidemiology of invasive fungal diseases; in particular, cases due to some uncommon etiologic agents are being increasingly reported, making it even more urgent to reconsider differential diagnoses in high-risk patients. A better understanding of epidemiology, risk factors and prognosis appears to be crucial to analyze prevention and diagnostic strategies, as well as to guarantee an early and adequate treatment.
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Affiliation(s)
- Morena Caira
- Hematology Division, Università Cattolica S. Cuore, Rome, Italy.
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