1
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Max A, Glasgow HL, Santiago TCB, Holland A, Inaba H, Cañete-Gibas CF, Wiederhold NP, Hayden RT, Adderson EE. Choanephora infundibulifera Rhinosinusitis in Man with Acute Lymphoblastic Leukemia, Tennessee, USA. Emerg Infect Dis 2024; 30:1245-1248. [PMID: 38782142 DOI: 10.3201/eid3006.230794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Choanephora infundibulifera is a member of the Mucorales order of fungi. The species is associated with plants as a saprophyte or parasite and may be responsible for spoilage or disease but is an uncommon cause of human infection. We describe C. infundibulifera rhinosinusitis in a young man with leukemia in Tennessee, USA.
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2
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Espinel-Ingroff A, Wiederhold NP. A Mini-Review of In Vitro Data for Candida Species, Including C. auris, Isolated during Clinical Trials of Three New Antifungals: Fosmanogepix, Ibrexafungerp, and Rezafungin. J Fungi (Basel) 2024; 10:362. [PMID: 38786717 DOI: 10.3390/jof10050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
This mini-review summarizes the clinical outcomes and antifungal susceptibility results, where available, for three new antifungals, including fosmanogepix, ibrexafungerp, and rezafungin, against Candida isolates cultured from patients in clinical trials. When reported, most of the data were generated by the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method or by both the CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodologies. For fosmanogepix, we summarize the in vitro data for C. auris isolates from 9 patients and for Candida spp. cultured from 20 patients in two clinical trials. Ibrexafungerp has also been evaluated in several clinical trials. From conference proceedings, a total of 176 Candida isolates were evaluated in the FURI and CARES studies, including 18 C. auris isolates (CARES study). However, MIC data are not available for all clinical isolates. Results from the ReSTORE rezafungin phase 3 clinical study also included in vitro results against Candida spp., but no patients with C. auris infections were included. In conclusion, this mini-review summarizes insights regarding clinical outcomes and the in vitro activity of three new antifungals against Candida spp. cultured from patients in clinical trials.
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Affiliation(s)
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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3
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Gebremariam T, Alkhazraji S, Gu Y, Najvar LK, Borroto-Esoda K, Patterson TF, Filler SG, Wiederhold NP, Ibrahim AS. Ibrexafungerp is efficacious in a neutropenic murine model of pulmonary mucormycosis as monotherapy and combined with liposomal amphotericin B. Antimicrob Agents Chemother 2024; 68:e0154523. [PMID: 38557112 PMCID: PMC11064560 DOI: 10.1128/aac.01545-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Ibrexafungerp (formerly SCY-078) is the first member of the triterpenoid class that prevents the synthesis of the fungal cell wall polymer β-(1,3)-D-glucan by inhibiting the enzyme glucan synthase. We evaluated the in vivo efficacy of ibrexafungerp against pulmonary mucormycosis using an established murine model. Neutropenic mice were intratracheally infected with either Rhizopus delemar or Mucor circinelloides. Treatment with placebo (diluent control), ibrexafungerp (30 mg/kg, PO BID), liposomal amphotericin B (LAMB 10 mg/kg IV QD), posaconazole (PSC 30 mg/kg PO QD), or a combination of ibrexafungerp plus LAMB or ibrexafungerp plus PSC began 16 h post-infection and continued for 7 days for ibrexafungerp or PSC and through day 4 for LAMB. Ibrexafungerp was as effective as LAMB or PSC in prolonging median survival (range: 15 days to >21 days) and enhancing overall survival (30%-65%) vs placebo (9 days and 0%; P < 0.001) in mice infected with R. delemar. Furthermore, median survival and overall percent survival resulting from the combination of ibrexafungerp plus LAMB were significantly greater compared to all monotherapies (P ≤ 0.03). Similar survival results were observed in mice infected with M. circinelloides. Monotherapies also reduce the lung and brain fungal burden by ~0.5-1.0log10 conidial equivalents (CE)/g of tissue vs placebo in mice infected with R. delemar (P < 0.05), while a combination of ibrexafungerp plus LAMB lowered the fungal burden by ~0.5-1.5log10 CE/g compared to placebo or any of the monotherapy groups (P < 0.03). These results are promising and warrant continued investigation of ibrexafungerp as a novel treatment option against mucormycosis.
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Affiliation(s)
- Teclegiorgis Gebremariam
- The Lundquist Institute at Harbor—University of California at Los Angeles (UCLA) Medical Center, Torrance, California, USA
| | - Sondus Alkhazraji
- The Lundquist Institute at Harbor—University of California at Los Angeles (UCLA) Medical Center, Torrance, California, USA
| | - Yiyou Gu
- The Lundquist Institute at Harbor—University of California at Los Angeles (UCLA) Medical Center, Torrance, California, USA
| | - Laura K. Najvar
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Thomas F. Patterson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Scott G. Filler
- The Lundquist Institute at Harbor—University of California at Los Angeles (UCLA) Medical Center, Torrance, California, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nathan P. Wiederhold
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ashraf S. Ibrahim
- The Lundquist Institute at Harbor—University of California at Los Angeles (UCLA) Medical Center, Torrance, California, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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4
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Hoenigl M, Arastehfar A, Arendrup MC, Brüggemann R, Carvalho A, Chiller T, Chen S, Egger M, Feys S, Gangneux JP, Gold JAW, Groll AH, Heylen J, Jenks JD, Krause R, Lagrou K, Lamoth F, Prattes J, Sedik S, Wauters J, Wiederhold NP, Thompson GR. Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease. Clin Microbiol Rev 2024:e0007423. [PMID: 38602408 DOI: 10.1128/cmr.00074-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
SUMMARYFungal infections are on the rise, driven by a growing population at risk and climate change. Currently available antifungals include only five classes, and their utility and efficacy in antifungal treatment are limited by one or more of innate or acquired resistance in some fungi, poor penetration into "sequestered" sites, and agent-specific side effect which require frequent patient reassessment and monitoring. Agents with novel mechanisms, favorable pharmacokinetic (PK) profiles including good oral bioavailability, and fungicidal mechanism(s) are urgently needed. Here, we provide a comprehensive review of novel antifungal agents, with both improved known mechanisms of actions and new antifungal classes, currently in clinical development for treating invasive yeast, mold (filamentous fungi), Pneumocystis jirovecii infections, and dimorphic fungi (endemic mycoses). We further focus on inhaled antifungals and the role of immunotherapy in tackling fungal infections, and the specific PK/pharmacodynamic profiles, tissue distributions as well as drug-drug interactions of novel antifungals. Finally, we review antifungal resistance mechanisms, the role of use of antifungal pesticides in agriculture as drivers of drug resistance, and detail detection methods for antifungal resistance.
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Affiliation(s)
- Martin Hoenigl
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Amir Arastehfar
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Roger Brüggemann
- Department of Pharmacy and Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc-CWZ Center of Expertise in Mycology, Nijmegen, The Netherlands
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW South Wales Health Pathology, Westmead Hospital, Westmead, Australia
- The University of Sydney, Sydney, Australia
| | - Matthias Egger
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Simon Feys
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jean-Pierre Gangneux
- Centre National de Référence des Mycoses et Antifongiques LA-AspC Aspergilloses chroniques, European Excellence Center for Medical Mycology (ECMM EC), Centre hospitalier Universitaire de Rennes, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S 1085, Rennes, France
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology and Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
| | - Jannes Heylen
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jeffrey D Jenks
- Department of Public Health, Durham County, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Robert Krause
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Juergen Prattes
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Sarah Sedik
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Joost Wauters
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
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5
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Campuzano A, Pentakota KD, Liao YR, Zhang H, Wiederhold NP, Ostroff GR, Hung CY. A Recombinant Multivalent Vaccine (rCpa1) Induces Protection for C57BL/6 and HLA Transgenic Mice against Pulmonary Infection with Both Species of Coccidioides. Vaccines (Basel) 2024; 12:67. [PMID: 38250880 PMCID: PMC10819930 DOI: 10.3390/vaccines12010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Coccidioidomycosis is caused by Coccidioides posadasii (Cp) and Coccidioides immitis (Ci), which have a 4-5% difference in their genomic sequences. There is an urgent need to develop a human vaccine against both species. A previously created recombinant antigen (rCpa1) that contains multiple peptides derived from Cp isolate C735 is protective against the autologous isolate. The focus of this study is to evaluate cross-protective efficacy and immune correlates by the rCpa1-based vaccine against both species of Coccidioides. DNA sequence analyses of the homologous genes for the rCpa1 antigen were conducted for 39 and 17 clinical isolates of Cp and Ci, respectively. Protective efficacy and vaccine-induced immunity were evaluated for both C57BL/6 and human HLA-DR4 transgenic mice against five highly virulent isolates of Cp and Ci. There are total of seven amino acid substitutions in the rCpa1 antigen between Cp and Ci. Both C57BL/6 and HLA-DR4 mice that were vaccinated with an rCpa1 vaccine had a significant reduction of fungal burden and increased numbers of IFN-γ- and IL-17-producing CD4+ T cells in the first 2 weeks post challenge. These data suggest that rCpa1 has cross-protection activity against Cp and Ci pulmonary infection through activation of early Th1 and Th17 responses.
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Affiliation(s)
- Althea Campuzano
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Komali Devi Pentakota
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Yu-Rou Liao
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Hao Zhang
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
| | - Nathan P. Wiederhold
- Department of Pathology, Graduate School of Biomedical Sciences, UT Health, San Antonio, TX 78229, USA;
| | - Gary R. Ostroff
- Program in Molecular Medicine, UMass Chan Medical School, Worcester, MA 01655, USA;
| | - Chiung-Yu Hung
- Department of Molecular Microbiology and Immunology, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (A.C.); (H.Z.)
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6
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Ajetunmobi OH, Chaturvedi AK, Badali H, Vaccaro A, Najvar L, Wormley FL, Wiederhold NP, Patterson TF, Lopez-Ribot JL. Screening the medicine for malaria venture's Pandemic Response Box to identify novel inhibitors of Candida albicans and Candida auris biofilm formation. APMIS 2023; 131:613-625. [PMID: 37337909 PMCID: PMC10592529 DOI: 10.1111/apm.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
Candida spp. are opportunistic yeasts capable of forming biofilms, which contribute to resistance, increasing the urgency for new effective antifungal therapies. Repurposing existing drugs could significantly accelerate the development of novel therapies against candidiasis. We screened the Pandemic Response Box containing 400 diverse drug-like molecules active against bacteria, viruses or fungi, for inhibitors of Candida albicans and Candida auris biofilm formation. Initial hits were identified based on the demonstration of >70% inhibitory activity. Dose-response assays were used to confirm the antifungal activity of initial hits and establish their potency. The spectrum of antifungal activity of the leading compounds was determined against a panel of medically important fungi, and the in vivo activity of the leading repositionable agent was evaluated in murine models of C. albicans and C. auris systemic candidiasis. The primary screening identified 20 hit compounds, and their antifungal activity and potency against C. albicans and C. auris were validated using dose-response measurements. From these experiments, the rapalog everolimus, emerged as the leading repositionable candidate. Everolimus displayed potent antifungal activity against different Candida spp., but more moderate levels of activity against filamentous fungi. Treatment with everolimus increased survival of mice infected with C. albicans, but not those with C. auris. The screening of the Pandemic Response Box resulted in the identification of several drugs with novel antifungal activity, with everolimus emerging as the main repositionable candidate. Further in vitro and in vivo studies are needed to confirm its potential therapeutic use.
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Affiliation(s)
- Olabayo H. Ajetunmobi
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Ashok K. Chaturvedi
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Hamid Badali
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Alessandra Vaccaro
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Laura Najvar
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Floyd L. Wormley
- Department of Biology, Texas Christian University, Fort Worth, Texas, USA
| | - Nathan P. Wiederhold
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jose L. Lopez-Ribot
- Department of Molecular Microbiology & Immunology, and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, Texas, USA
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7
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Maji A, Soutar CP, Zhang J, Lewandowska A, Uno BE, Yan S, Shelke Y, Murhade G, Nimerovsky E, Borcik CG, Arango AS, Lange JD, Marin-Toledo JP, Lyu Y, Bailey KL, Roady PJ, Holler JT, Khandelwal A, SantaMaria AM, Sanchez H, Juvvadi PR, Johns G, Hageman MJ, Krise J, Gebremariam T, Youssef EG, Bartizal K, Marr KA, Steinbach WJ, Ibrahim AS, Patterson TF, Wiederhold NP, Andes DR, Pogorelov TV, Schwieters CD, Fan TM, Rienstra CM, Burke MD. Tuning sterol extraction kinetics yields a renal-sparing polyene antifungal. Nature 2023; 623:1079-1085. [PMID: 37938782 PMCID: PMC10883201 DOI: 10.1038/s41586-023-06710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 10/04/2023] [Indexed: 11/09/2023]
Abstract
Decades of previous efforts to develop renal-sparing polyene antifungals were misguided by the classic membrane permeabilization model1. Recently, the clinically vital but also highly renal-toxic small-molecule natural product amphotericin B was instead found to kill fungi primarily by forming extramembraneous sponge-like aggregates that extract ergosterol from lipid bilayers2-6. Here we show that rapid and selective extraction of fungal ergosterol can yield potent and renal-sparing polyene antifungals. Cholesterol extraction was found to drive the toxicity of amphotericin B to human renal cells. Our examination of high-resolution structures of amphotericin B sponges in sterol-free and sterol-bound states guided us to a promising structural derivative that does not bind cholesterol and is thus renal sparing. This derivative was also less potent because it extracts ergosterol more slowly. Selective acceleration of ergosterol extraction with a second structural modification yielded a new polyene, AM-2-19, that is renal sparing in mice and primary human renal cells, potent against hundreds of pathogenic fungal strains, resistance evasive following serial passage in vitro and highly efficacious in animal models of invasive fungal infections. Thus, rational tuning of the dynamics of interactions between small molecules may lead to better treatments for fungal infections that still kill millions of people annually7,8 and potentially other resistance-evasive antimicrobials, including those that have recently been shown to operate through supramolecular structures that target specific lipids9.
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Affiliation(s)
- Arun Maji
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Molecule Maker Lab, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Corinne P Soutar
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA
| | - Jiabao Zhang
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Agnieszka Lewandowska
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA
| | - Brice E Uno
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Su Yan
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Yogesh Shelke
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Ganesh Murhade
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Evgeny Nimerovsky
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department for NMR-Based Structural Biology, Max-Planck-Institute for Biophysical Chemistry, Göttingen, Germany
| | - Collin G Borcik
- Molecule Maker Lab, Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- National Magnetic Resonance Facility at Madison, University of Wisconsin-Madison, Madison, WI, USA
| | - Andres S Arango
- Center for Biophysics and Quantitative Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Justin D Lange
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | | | - Yinghuan Lyu
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Pathology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Keith L Bailey
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Patrick J Roady
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jordan T Holler
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Anuj Khandelwal
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Anna M SantaMaria
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Hiram Sanchez
- Department of Medicine, Section of Infectious Disease, University of Wisconsin-Madison, Madison, WI, USA
| | - Praveen R Juvvadi
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Michael J Hageman
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, KS, USA
| | - Joanna Krise
- Department of Pharmaceutical Chemistry, The University of Kansas, Lawrence, KS, USA
| | | | - Eman G Youssef
- Division of Infectious Diseases, The Lundquist Institute, Torrance, CA, USA
| | | | | | - William J Steinbach
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, The Lundquist Institute, Torrance, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Thomas F Patterson
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - David R Andes
- Department of Medicine, Section of Infectious Disease, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, USA
| | - Taras V Pogorelov
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Center for Biophysics and Quantitative Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- School of Chemical Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Charles D Schwieters
- Computational Biomolecular Magnetic Resonance Core, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Timothy M Fan
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Chad M Rienstra
- Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA.
- National Magnetic Resonance Facility at Madison, University of Wisconsin-Madison, Madison, WI, USA.
- Morgridge Institute for Research, University of Wisconsin-Madison, Madison, WI, USA.
| | - Martin D Burke
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, Urbana, IL, USA.
- Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Biochemistry, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Carle-Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
- Molecule Maker Lab Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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8
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Zangeneh TT, Lainhart WD, Wiederhold NP, Al-Obaidi MM. Coccidioides species antifungal susceptibility testing: Experience from a large healthcare system in the endemic region. Med Mycol 2023; 61:myad104. [PMID: 37804176 DOI: 10.1093/mmy/myad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023] Open
Abstract
The clinical utility of Coccidioides species antifungal susceptibility testing (AST) remains unclear. This study describes the clinical course of eight patients with severe or chronic coccidioidomycosis and subsequent Coccidioides AST. We present the clinical manifestations, antifungal treatment regimens, and clinical outcomes for these patients.
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Affiliation(s)
- Tirdad T Zangeneh
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Valley Fever Center for Excellence, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - William D Lainhart
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Mohanad M Al-Obaidi
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Valley Fever Center for Excellence, University of Arizona College of Medicine, Tucson, Arizona, USA
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9
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McCreary EK, Davis MR, Narayanan N, Andes DR, Cattaneo D, Christian R, Lewis RE, Watt KM, Wiederhold NP, Johnson MD. Utility of triazole antifungal therapeutic drug monitoring: Insights from the Society of Infectious Diseases Pharmacists: Endorsed by the Mycoses Study Group Education and Research Consortium. Pharmacotherapy 2023; 43:1043-1050. [PMID: 37459118 DOI: 10.1002/phar.2850] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 08/15/2023]
Abstract
Triazole antifungals (i.e., fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole) are commonly used in clinical practice to prevent or treat invasive fungal infections. Most triazole antifungals require therapeutic drug monitoring (TDM) due to highly variable pharmacokinetics, known drug interactions, and established relationships between exposure and response. On behalf of the Society of Infectious Diseases Pharmacists (SIDP), this insight describes the pharmacokinetic principles and pharmacodynamic targets of commonly used triazole antifungals and provides the rationale for utility of TDM within each agent.
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Affiliation(s)
- Erin K McCreary
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew R Davis
- Infectious Disease Connect, Inc., Pittsburgh, Pennsylvania, USA
| | - Navaneeth Narayanan
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - David R Andes
- Departments of Medicine and Medical Microbiology & Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Department of Laboratory Medicine, Luigi Sacco University Hospital, Milan, Italy
| | - Robbie Christian
- Department of Pharmacy, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Russell E Lewis
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Kevin M Watt
- Division of Pediatric Clinical Pharmacology and Division of Critical Care, University of Utah, Salt Lake City, Utah, USA
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Melissa D Johnson
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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10
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Smith DJ, Gold JAW, Chiller T, Bustamante ND, Marinissen MJ, Rodriquez GG, Cortes VBG, Molina CD, Williams S, Vazquez Deida AA, Byrd K, Pappas PG, Patterson TF, Wiederhold NP, Thompson Iii GR, Ostrosky-Zeichner L. Update on Outbreak of Fungal Meningitis among U.S. Residents who Received Epidural Anesthesia at Two Clinics in Matamoros, Mexico. Clin Infect Dis 2023:ciad570. [PMID: 37739479 PMCID: PMC10957502 DOI: 10.1093/cid/ciad570] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/28/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Public health officials are responding to an outbreak of fungal meningitis among patients who received procedures under epidural anesthesia at two clinics (River Side Surgical Center and Clinica K-3) in Matamoros, Mexico, during January 1-May 13, 2023. This report describes outbreak epidemiology and outlines interim diagnostic and treatment recommendations. METHODS Interim recommendations for diagnosis and management were developed by the Mycoses Study Group Research Education and Consortium (MSGERC) based on the clinical experience of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States. RESULTS As of July 7, 2023, the situation has evolved into a multistate and multinational fungal meningitis outbreak. A total of 185 residents in 22 U.S. states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 11 suspected, 10 probable, and 10 confirmed U.S. cases have been diagnosed, with severe vascular complications and eight deaths occurring. Fusarium solani species complex has been identified as the causative agent, with antifungal susceptibility testing of a single isolate demonstrating poor in vitro activity for most available antifungals. Currently, triple therapy with intravenous voriconazole, liposomal amphotericin B, and fosmanogepix is recommended. CONCLUSIONS Efforts to understand the source of this outbreak and optimal treatment approaches are ongoing, but infectious diseases physicians should be aware of available treatment recommendations. New information will be available on CDC's website.
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Affiliation(s)
- Dallas J Smith
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Nirma D Bustamante
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Maria Julia Marinissen
- Health Attaché, U.S. Embassy | Mexico City; Acting Director, U.S. Section - U.S-Mexico Border Health Commission, U.S. Department of Health and Human Services, Washington, DC., United States
| | | | - Vladimir Brian Gonzalez Cortes
- Medical Supervisor in the Regulatory Area of the General Director of Epidemiology, Ministry of Health Mexico, México City, México
| | - Celida Duque Molina
- Director of Medical Services, Mexican Social Security Institute, México City, México
| | - Samantha Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Axel A Vazquez Deida
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Katrina Byrd
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Peter G Pappas
- Division of Infectious Diseases, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Thomas F Patterson
- Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, San Antonio, Texas, United States
| | - George R Thompson Iii
- Division of Infectious Diseases, Department of Internal Medicine, University of California-Davis Medical Center, Sacramento, California, United States
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, United States
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11
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Ituarte BE, Cañete-Gibas C, Wiederhold NP, Olarte L. Kneiffiella palmae: A non- Aspergillus fungal infection isolated from a pulmonary nodule in a child with chronic granulomatous disease. Med Mycol Case Rep 2023; 41:36-40. [PMID: 37706048 PMCID: PMC10495388 DOI: 10.1016/j.mmcr.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
We report the first known human case of Kneiffiella palmae in the medical literature. K. palmae was isolated from a pulmonary nodule in a 7-year-old male with chronic granulomatous disease. The mold was identified as K. palmae at a national reference laboratory, where 17 other human respiratory samples tested positive for K. palmae from 2013 to 2021. Optimal antimicrobial treatment is unknown, but azoles and amphotericin B demonstrated in vitro activity against each tested isolate.
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Affiliation(s)
- Bianca E. Ituarte
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, 64108, USA
| | - Connie Cañete-Gibas
- University of Texas Health Science Center at San Antonio Texas, 7703 Floyd Curl Drive, San Antonio, 78229, USA
| | - Nathan P. Wiederhold
- University of Texas Health Science Center at San Antonio Texas, 7703 Floyd Curl Drive, San Antonio, 78229, USA
| | - Liset Olarte
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, 64108, USA
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, 64108, USA
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12
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Ajetunmobi OH, Wall G, Vidal Bonifacio B, Martinez Delgado LA, Chaturvedi AK, Najvar LK, Wormley FL, Patterson HP, Wiederhold NP, Patterson TF, Lopez-Ribot JL. High-Throughput Screening of the Repurposing Hub Library to Identify Drugs with Novel Inhibitory Activity against Candida albicans and Candida auris Biofilms. J Fungi (Basel) 2023; 9:879. [PMID: 37754987 PMCID: PMC10532723 DOI: 10.3390/jof9090879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Candidiasis is one of the most frequent nosocomial infections affecting an increasing number of at-risk patients. Candida albicans remains the most frequent causative agent of candidiasis, but, in the last decade, C. auris has emerged as a formidable multi-drug-resistant pathogen. Both species are fully capable of forming biofilms, which contribute to resistance, increasing the urgency for new effective antifungal therapies. Repurposing existing drugs could significantly accelerate the development of novel therapies against candidiasis. Here, we have screened the Repurposing Hub library from the Broad Institute, containing over 6000 compounds, in search for inhibitors of C. albicans and C. auris biofilm formation. The primary screen identified 57 initial hits against C. albicans and 33 against C. auris. Confirmatory concentration-dependent assays were used to validate the activity of the initial hits and, at the same time, establish their anti-biofilm potency. Based on these results, ebselen, temsirolimus, and compound BAY 11-7082 emerged as the leading repositionable compounds. Subsequent experiments established their spectrum of antifungal activity against yeasts and filamentous fungi. In addition, their in vivo activity was examined in the murine models of hematogenously disseminated C. albicans and C. auris infections. Although promising, further in vitro and in vivo studies are needed to confirm their potential use for the therapy of candidiasis and possibly other fungal infections.
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Affiliation(s)
- Olabayo H. Ajetunmobi
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (O.H.A.); (A.K.C.)
| | - Gina Wall
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (O.H.A.); (A.K.C.)
| | - Bruna Vidal Bonifacio
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (O.H.A.); (A.K.C.)
| | | | - Ashok K. Chaturvedi
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (O.H.A.); (A.K.C.)
| | - Laura K. Najvar
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (L.K.N.); (T.F.P.)
| | - Floyd L. Wormley
- Department of Biology, Texas Christian University, Fort Worth, TX 76129, USA;
| | - Hoja P. Patterson
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (H.P.P.); (N.P.W.)
| | - Nathan P. Wiederhold
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (H.P.P.); (N.P.W.)
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (L.K.N.); (T.F.P.)
| | - Jose L. Lopez-Ribot
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA; (O.H.A.); (A.K.C.)
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13
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Cañete-Gibas CF, Mele J, Patterson HP, Sanders CJ, Ferrer D, Garcia V, Fan H, David M, Wiederhold NP. Terbinafine-Resistant Dermatophytes and the Presence of Trichophyton indotineae in North America. J Clin Microbiol 2023; 61:e0056223. [PMID: 37432126 PMCID: PMC10446870 DOI: 10.1128/jcm.00562-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023] Open
Abstract
Dermatophytes are common causes of skin, hair, and nail infections in humans. The most common species causing infections in humans are Trichophyton rubrum, Trichophyton mentagrophytes, and Trichophyton interdigitale. Outbreaks of recalcitrant dermatophytosis have been reported in parts of South Asia, including those caused by a hypervirulent and resistant species, Trichophyton indotineae. We evaluated the antifungal susceptibility profiles of dermatophytes received by our laboratory from institutions across North America between 2021 and 2022 and performed species identification for isolates deemed to demonstrate in vitro resistance. Susceptibility testing was performed by CLSI broth microdilution methods, and species identification was performed by DNA sequence analysis. During this 2-year period, 271 dermatophyte isolates were included, the majority of which demonstrated low MIC values for terbinafine (geometric mean [GM] and modal MIC, 0.031 μg/mL and 0.008 μg/mL, respectively) and the azoles itraconazole, posaconazole, and voriconazole (0.035 to 0.049 μg/mL and ≤0.03 μg/mL). However, 18.6% of the isolates tested were resistant to terbinafine (MIC ≥ 0.5 μg/mL), including 21 T. rubrum and 21 T. indotineae isolates. These isolates were received from several different states in the United States and two provinces in Canada. In contrast, resistance to itraconazole was relatively rare. We also searched our laboratory database for earlier isolates that were resistant to terbinafine and identified 3 additional T. indotineae isolates, the earliest of which was from 2017. These results demonstrate that terbinafine resistance in dermatophytes was relatively common over this 2-year period and that T. indotineae is present in multiple areas in North America. Continued surveillance is warranted.
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Affiliation(s)
- Connie F. Cañete-Gibas
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - James Mele
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hoja P. Patterson
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Carmita J. Sanders
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Dora Ferrer
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Victor Garcia
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hongxin Fan
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Marjorie David
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Nathan P. Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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14
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Benedict K, Gold JAW, Toda M, Thompson GR, Wiederhold NP, Smith DJ. Low Rates of Antifungal Therapeutic Drug Monitoring Among Inpatients Who Received Itraconazole, Posaconazole, or Voriconazole, United States, 2019-2021. Open Forum Infect Dis 2023; 10:ofad389. [PMID: 37539059 PMCID: PMC10394719 DOI: 10.1093/ofid/ofad389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
Antifungal therapeutic drug monitoring (TDM) is recommended for hospitalized patients receiving itraconazole, posaconazole, or voriconazole for treatment or prophylaxis. In this analysis of hospital-based data, TDM was uncommonly performed (15.8%) in a large cohort of eligible patients, suggesting missed opportunities to avoid subtherapeutic drug levels and minimize toxicity.
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Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mitsuru Toda
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California, Davis, California, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Dallas J Smith
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Souza ACO, Ge W, Wiederhold NP, Rybak JM, Fortwendel JR, Rogers PD. hapE and hmg1 Mutations Are Drivers of cyp51A-Independent Pan-Triazole Resistance in an Aspergillus fumigatus Clinical Isolate. Microbiol Spectr 2023; 11:e0518822. [PMID: 37140376 PMCID: PMC10269825 DOI: 10.1128/spectrum.05188-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/05/2023] [Indexed: 05/05/2023] Open
Abstract
Aspergillus fumigatus is a ubiquitous environmental mold that can cause severe disease in immunocompromised patients and chronic disease in individuals with underlying lung conditions. Triazoles are the most widely used class of antifungal drugs to treat A. fumigatus infections, but their use in the clinic is threatened by the emergence of triazole-resistant isolates worldwide, reinforcing the need for a better understanding of resistance mechanisms. The predominant mechanisms of A. fumigatus triazole resistance involve mutations affecting the promoter region or coding sequence of the target enzyme of the triazoles, Cyp51A. However, triazole-resistant isolates without cyp51A-associated mutations are frequently identified. In this study, we investigate a pan-triazole-resistant clinical isolate, DI15-105, that simultaneously carries the mutations hapEP88L and hmg1F262del, with no mutations in cyp51A. Using a Cas9-mediated gene-editing system, hapEP88L and hmg1F262del mutations were reverted in DI15-105. Here, we show that the combination of these mutations accounts for pan-triazole resistance in DI15-105. To our knowledge, DI15-105 is the first clinical isolate reported to simultaneously carry mutations in hapE and hmg1 and only the second with the hapEP88L mutation. IMPORTANCE Triazole resistance is an important cause of treatment failure and high mortality rates for A. fumigatus human infections. Although Cyp51A-associated mutations are frequently identified as the cause of A. fumigatus triazole resistance, they do not explain the resistance phenotypes for several isolates. In this study, we demonstrate that hapE and hmg1 mutations additively contribute to pan-triazole resistance in an A. fumigatus clinical isolate lacking cyp51-associated mutations. Our results exemplify the importance of and the need for a better understanding of cyp51A-independent triazole resistance mechanisms.
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Affiliation(s)
- Ana C. O. Souza
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Wenbo Ge
- Department of Clinical Pharmacy and Translational Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nathan P. Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jeffrey M. Rybak
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jarrod R. Fortwendel
- Department of Clinical Pharmacy and Translational Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - P. David Rogers
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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16
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Barrantes Murillo DF, Anderson S, Capobianco C, Lewbart GA, Wiederhold NP, Cañete-Gibas CF, Negrão Watanabe TT. Systemic Exophiala equina infection in an Eastern box turtle ( Terrapene carolina carolina): a case report and literature review. Front Vet Sci 2023; 10:1158393. [PMID: 37252397 PMCID: PMC10213272 DOI: 10.3389/fvets.2023.1158393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Phaeohyphomycosis is an infection caused by melanized fungi. This disease has been reported in several animal species including invertebrates, cold-blooded vertebrates, mammals, and humans. Melanized fungi have similar phenotypical features and confirmation requires culture and molecular diagnostics. To exemplify this we present a case of a 333 g adult of unknown age, free-ranging, male Eastern box turtle (Terrapene carolina carolina) that was referred to the Turtle Rescue Team at North Carolina State University for evaluation of multilobulated masses occupying the entire left orbit and at the right forelimb on the plantarolateral aspect of the foot. A fine needle aspirate cytologic examination of the mass on the right forelimb revealed large numbers of inflammatory cells and fungal organisms. Histopathology of the skin biopsies from the right forefoot was consistent with phaeohyphomycosis. A course of antifungal medication was started (Fluconazole 21 mg/kg loading dose IV then 5 mg/kg PO SID q 30 days). Due to concern for the patient's quality of life and the lack of a curative treatment plan, humane euthanasia was elected. Gross and histological postmortem examination confirmed the presence of multiple coelomic masses similar in appearance to those observed in the left orbit and right forefoot indicating disseminated phaeohyphomycosis. A swab of the periocular mass was submitted for fungal culture and phenotypic identification. The isolate was later identified as Exophiala equina through a combination of phenotypic characterization and sequencing of the ITS region of the nuclear rDNA. Exophiala is a genus in the family Herpotrichiellaceae, order Chaetothyriales and is considered an opportunistic "black yeast" causing infection in aquatic invertebrates, fish, amphibians, reptiles, and mammals including humans. Exophiala equina is infrequently reported in animals, with only three cases in the literature including the herein report.
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Affiliation(s)
| | - Stephanie Anderson
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Christian Capobianco
- Department of Clinical Science, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Gregory A. Lewbart
- Department of Clinical Science, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Nathan P. Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Connie F. Cañete-Gibas
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Tatiane Terumi Negrão Watanabe
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Antech Diagnostics, Los Angeles, CA, United States
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17
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Cañete-Gibas CF, Patterson HP, Sanders CJ, Mele J, Fan H, David M, Wiederhold NP. Species Distribution and Antifungal Susceptibilities of Aspergillus Section Terrei Isolates in Clinical Samples from the United States and Description of Aspergillus pseudoalabamensis sp. nov. Pathogens 2023; 12:pathogens12040579. [PMID: 37111465 PMCID: PMC10142542 DOI: 10.3390/pathogens12040579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Aspergillus section Terrei consists of numerous cryptic species in addition to A. terreus sensu stricto. The treatment of invasive infections caused by these fungi may pose a unique challenge prior to diagnosis and species identification, in that they are often clinically resistant to amphotericin B, with poor outcomes and low survival rates in patients treated with this polyene. Data on the species distributions and susceptibility profiles of isolates within section Terrei from the United States (U.S.) are limited. Here, we report the species distributions and susceptibility profiles for amphotericin B, isavuconazole, itraconazole, posaconazole, voriconazole, and micafungin against 278 clinical isolates of this section from institutions across the U.S. collected over a 52-month period. Species identification was performed by DNA sequence analysis and phenotypic characterization. Susceptibility testing was performed using the CLSI broth microdilution method. The majority of isolates were identified as Aspergillus terreus sensu stricto (69.8%), although several other cryptic species were also identified. Most were cultured from specimens collected from the respiratory tract. Posaconazole demonstrated the most potent activity of the azoles (MIC range ≤ 0.03-1 mg/L), followed by itraconazole (≤0.03-2 mg/L), voriconazole, and isavuconazole (0.125-8 mg/L for each). Amphotericin B demonstrated reduced in vitro susceptibility against this section (MIC range 0.25-8 mg/L), although this appeared to be species-dependent. A new species within this section, A. pseudoalabamensis, is also described. Our results, which are specific to the U.S., are similar to previous surveillance studies of the Aspergillus section Terrei.
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Affiliation(s)
- Connie F Cañete-Gibas
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Fungus Testing Laboratory UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Hoja P Patterson
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Fungus Testing Laboratory UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Carmita J Sanders
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Fungus Testing Laboratory UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - James Mele
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Hongxin Fan
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Marjorie David
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Fungus Testing Laboratory UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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Wiederhold NP, Patterson HP, Sanders CJ, Cañete-Gibas C. Dihydroorotate dehydrogenase inhibitor olorofim has potent in vitro activity against Microascus/Scopulariopsis, Rasamsonia, Penicillium and Talaromyces species. Mycoses 2023; 66:242-248. [PMID: 36435987 DOI: 10.1111/myc.13548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment options against infections caused by rare but emerging moulds may be limited by their reduced susceptibility or resistance to clinically available antifungals. The investigational antifungal olorofim, which targets the biosynthesis of pyrimidines within fungi, has activity against different species of filamentous fungi, including Aspergillus and Scedosporium/Lomentospora prolificans isolates that are resistant to available antifungals. OBJECTIVE We evaluated the in vitro activity of olorofim against 160 isolates within the genera Microascus/Scopulariopsis, Penicillium, Talaromyces and the Rasamsonia argillacea species complex. METHODS One hundred sixty clinical isolates that had previously been identified to the species level by DNA sequence analysis were included. Antifungal susceptibility testing was performed by CLSI M38 broth microdilution for olorofim, amphotericin B, caspofungin, posaconazole and voriconazole. RESULTS Olorofim demonstrated in vitro activity against each of the genera tested. Overall, olorofim MICs ranged from ≤0.008 to 0.5 mg/L against all isolates tested, with MIC90 and modal MIC values ranging from ≤0.008 to 0.25 mg/L and ≤0.008 to 0.03 mg/L, respectively. This activity was also maintained against individual isolates that had reduced susceptibility to or in vitro resistance against amphotericin B, posaconazole and/or voriconazole. CONCLUSIONS The investigational agent olorofim demonstrated good in vitro activity against clinical isolates of emerging mould pathogens, including those with reduced susceptibility or resistance to clinically available antifungals. Further studies are warranted to determine how well this in vitro activity translates into in vivo efficacy against infections caused by these fungi.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hoja P Patterson
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Carmita J Sanders
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Connie Cañete-Gibas
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Oremosu J, Ung L, Chodosh J, Cañete-Gibas C, Wiederhold NP, Davies EC, Bispo PJ. Fungal keratitis caused by Coniochaeta mutabilis – a case report. J Mycol Med 2023; 33:101384. [PMID: 37012189 DOI: 10.1016/j.mycmed.2023.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/29/2023] [Indexed: 03/31/2023]
Abstract
We present a rare case of recalcitrant fungal keratitis caused by Coniochaeta mutabilis, successfully managed with a course of oral, topical, intrastromal, and intracameral antifungals. A 57-year-old male on their fourth week of treatment for presumed left herpes simplex keratitis presented to clinic with severe left-sided foreign body sensation after gardening in his yard. On examination, a white corneal plaque was observed at 8 o'clock, shown to be a dense collection of fungal hyphae on confocal microscopy. Corneal cultures revealed yeast-like cells, initially identified as Kabatiella zeae by matching 100% identity with K. zeae strains CBS 767.71 and CBS 265.32 in BLASTn search using the internal transcribed spacer (ITS) sequence. Treated for over four months with topical amphotericin B and oral voriconazole without improvement, recourse to intrastromal and intracameral amphotericin B injections, coupled with the application of cyanoacrylate glue to the lesion and a bandage contact lens, led to eventual resolution. The patient subsequently underwent cataract surgery, achieving a BCVA of 20/20 in the eye. Surprisingly, upon further sequence analyses of combined ITS and large subunit ribosomal ribonucleic acid (LSU) and investigation of the K. zeae German strain CBS 767.71, the organism was revealed to be Coniochaeta mutabilis (formerly Lecythospora mutabilis). This means that the correct name for CBS 767.71 and CBS 265.32 is C. mutabilis and should be corrected in the GenBank record to avoid misleading identification in the future. This case also underscores the urgent unmet need for improved molecular diagnostic modalities in the care of corneal infections.
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Wiederhold NP, Patterson TF, Rebholz S, Brennan J, Patton T, Barrett J, Boal CWC, Ehrensberger M, Boyle R, Cushion MT. Erratum for Wiederhold et al., "The Antifungal and Anti-Pneumocystis Activities of the Novel Compound A3IS (Mycosinate)". Antimicrob Agents Chemother 2023; 67:e0147522. [PMID: 36645296 PMCID: PMC9933700 DOI: 10.1128/aac.01475-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Nathan P. Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Thomas F. Patterson
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Sandra Rebholz
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Medical Research Service, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - James Brennan
- Atlantic Technological University Sligo, Sligo, Ireland
| | - Thomas Patton
- Atlantic Technological University Sligo, Sligo, Ireland
| | - John Barrett
- Atlantic Technological University Sligo, Sligo, Ireland
| | | | | | | | - Melanie T. Cushion
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Medical Research Service, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
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Wiederhold NP. Antifungal Susceptibility of Yeasts and Filamentous Fungi by CLSI Broth Microdilution Testing. Methods Mol Biol 2023; 2658:3-16. [PMID: 37024691 DOI: 10.1007/978-1-0716-3155-3_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Antifungal susceptibility testing is performed against yeasts and filamentous fungi (molds) for various purposes. In clinical settings, the results of these in vitro assays may be used to help guide therapy for individual patients. Surveillance studies use susceptibility testing to monitor for the development of resistance to different agents. These assays are also frequently used in preclinical drug development to determine the spectrum of activity and assess the in vitro potency of investigational agents. Broth microdilution is a form of antifungal susceptibility testing that is frequently used for each of these purposes. The Clinical and Laboratory Standards Institute (CLSI) has developed standardized methods for broth microdilution antifungal susceptibility testing of both yeasts and molds. These methods are useful in the clinical diagnostics arena for determining if a particular fungal isolate may be resistant to clinically available antifungals, and they are also amendable for research purposes, as the microtiter trays can be prepared in different formats with different antifungal and investigational agent concentration ranges and with different growth media if necessary. This chapter describes the CLSI methods for antifungal susceptibility testing by broth microdilution for both yeasts and molds, how endpoints are read for different classes of antifungal agents, and how the results may be interpreted.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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22
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Dukes J, Sosa N, Cañete-Gibas CF, Wiederhold NP, Ryan KL. Pseudocanariomyces americanus, gen. nov., sp. nov.: Update to the Management of a Periprosthetic Hip Infection. Mycopathologia 2022; 187:603-604. [PMID: 36271310 DOI: 10.1007/s11046-022-00674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Joanna Dukes
- Pharmacy Department, The University of New Mexico Hospital, Albuquerque, NM, USA
| | - Nestor Sosa
- Division of Infectious Diseases, Department of Internal Medicine, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Connie F Cañete-Gibas
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Keenan L Ryan
- Pharmacy Department, The University of New Mexico Hospital, Albuquerque, NM, USA.
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23
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Weiss ZF, DiCarlo JE, Basta DW, Kent S, Liakos A, Baden L, Brigl M, Kanjilal S, Cañete-Gibas C, Wiederhold NP, Basu SS. Hidden in plain sight: urinary Cryptococcus neoformans missed by routine diagnostics in a patient with acute leukemia. Ann Clin Microbiol Antimicrob 2022; 21:49. [PMID: 36371203 PMCID: PMC9655867 DOI: 10.1186/s12941-022-00540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/20/2022] [Indexed: 11/15/2022] Open
Abstract
Cryptococcuria is a rare manifestation of localized cryptococcal disease. We present a case of Cryptococcus neoformans urinary tract infection in an immunocompromised host missed by routine laboratory workup. The patient had negative blood cultures, a negative serum cryptococcal antigen (CrAg), and “non-Candida yeast” growing in urine culture that was initially dismissed as non-pathogenic. The diagnosis was ultimately made by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) from a repeat urine culture after transfer to a tertiary care center. Cryptococcus should be considered in the differential of refractory urinary tract infections growing non-Candida yeast.
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Wiederhold NP. Pharmacodynamics, Mechanisms of Action and Resistance, and Spectrum of Activity of New Antifungal Agents. J Fungi (Basel) 2022; 8:jof8080857. [PMID: 36012845 PMCID: PMC9410397 DOI: 10.3390/jof8080857] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 12/21/2022] Open
Abstract
Several new antifungals are currently in late-stage development, including those with novel pharmacodynamics/mechanisms of action that represent new antifungal classes (manogepix, olorofim, ATI-2307, GR-2397). Others include new agents within established classes or with mechanisms of action similar to clinically available antifungals (ibrexafungerp, rezafungin, oteseconazole, opelconazole, MAT2203) that have been modified in order to improve certain characteristics, including enhanced pharmacokinetics and greater specificity for fungal targets. Many of the antifungals under development also have activity against Candida and Aspergillus strains that have reduced susceptibility or acquired resistance to azoles and echinocandins, whereas others demonstrate activity against species that are intrinsically resistant to most clinically available antifungals. The tolerability and drug–drug interaction profiles of these new agents also appear to be promising, although the number of human subjects that have been exposed to many of these agents remains relatively small. Overall, these agents have the potential for expanding our antifungal armamentarium and improving clinical outcomes in patients with invasive mycoses.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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25
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Hoenigl M, Sprute R, Arastehfar A, Perfect JR, Lass-Flörl C, Bellmann R, Prattes J, Thompson GR, Wiederhold NP, Al Obaidi MM, Willinger B, Arendrup MC, Koehler P, Oliverio M, Egger M, Schwartz IS, Cornely OA, Pappas PG, Krause R. Invasive candidiasis: Investigational drugs in the clinical development pipeline and mechanisms of action. Expert Opin Investig Drugs 2022; 31:795-812. [PMID: 35657026 PMCID: PMC9339492 DOI: 10.1080/13543784.2022.2086120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The epidemiology of invasive Candida infections is evolving. Infections caused by non-albicans Candida spp. are increasing; however, the antifungal pipeline is more promising than ever and is enriched with repurposed drugs and agents that have new mechanisms of action. Despite progress, unmet needs in the treatment of invasive candidiasis remain and there are still too few antifungals that can be administered orally or that have CNS penetration. AREAS COVERED The authors shed light on those antifungal agents active against Candida that are in late-stage clinical development. Mechanisms of action and key pharmacokinetic and pharmacodynamic properties are discussed. Insights are offered on the potential future roles of the investigational agents MAT-2203, oteseconazole, ATI-2307, VL-2397, NP-339, and the repurposed drug miltefosine. EXPERT OPINION Ibrexafungerp and fosmanogepix have novel mechanisms of action and will provide effective options for the treatment of Candida infections (including those caused by multiresistant Candida spp). Rezafungin, an echinocandin with an extended half-life allowing for once weekly administration, will be particularly valuable for outpatient treatment and prophylaxis. Despite this, there is an urgent need to garner clinical data on investigational drugs, especially in the current rise of azole-resistant and multi-drug resistant Candida spp.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA.,Clinical and Translational Fungal - Working Group, University of California San Diego, La Jolla, CA
| | - Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - John R Perfect
- Division of Infectious Diseases and Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Excellence Center for Medical Mycology (ECMM), Medical University of Innsbruck, Innsbruck, Austria
| | - Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Juergen Prattes
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, University of California Davis Medical Center
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mohanad M Al Obaidi
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Maiken C Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Matteo Oliverio
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Matthias Egger
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Krause
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria
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Laga AC, Crothers JW, Cañete-Gibas CF, Wiederhold NP, Solomon IH. Rigidoporus corticola Colonization and Invasive Fungal Disease in Immunocompromised Patients, United States. Emerg Infect Dis 2022; 28:856-859. [PMID: 35318923 PMCID: PMC8962884 DOI: 10.3201/eid2804.211987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report 2 cases of Rigidoporus corticola (Oxyporus corticola) infection in humans in the United States. Clinical manifestations consisted of angioinvasive fungal sinusitis in 1 patient and pulmonary intracavitary fungus ball in the other patient. These cases illustrate previously undescribed clinicopathologic manifestations of infection by this filamentous basidiomycete in humans.
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Abstract
Background Infections caused by fungi can be important causes of morbidity and mortality in certain patient populations, including those who are highly immunocompromised or critically ill. Invasive mycoses can be caused by well-known species, as well as emerging pathogens, including those that are resistant to clinically available antifungals. Content This review highlights emerging fungal infections, including newly described species, such as Candida auris, and those that having undergone taxonomic classification and were previously known by other names, including Blastomyces and Emergomyces species, members of the Rasamsonia argillacea species complex, Sporothrix brasiliensis, and Trichophyton indotinae. Antifungal resistance also is highlighted in several of these emerging species, as well as in the well-known opportunistic pathogen Aspergillus fumigatus. Finally, the increased recognition and importance of fungal co-infections with respiratory pathogens, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is discussed. Summary Both clinicians and clinical microbiology laboratories should remain vigilant regarding emerging fungal infections. These may be difficult both to diagnose and treat due to the lack of experience of clinicians and laboratory personnel with these organisms and the infections they may cause. Many of these fungal infections have been associated with poor clinical outcomes, either due to inappropriate therapy or the development of antifungal resistance.
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Affiliation(s)
- Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Abstract
Clinicians treating patients with fungal infections may turn to susceptibility testing to obtain information regarding the activity of different antifungals against a specific fungus that has been cultured. These results may then be used to make decisions regarding a patient's therapy. However, for many fungal species that are capable of causing invasive infections, clinical breakpoints have not been established. Thus, interpretations of susceptible or resistant cannot be provided by clinical laboratories, and this is especially true for many molds capable of causing severe mycoses. The purpose of this review is to provide an overview of susceptibility testing for clinicians, including the methods used to perform these assays, their limitations, how clinical breakpoints are established, and how the results may be put into context in the absence of interpretive criteria. Examples of when susceptibility testing is not warranted are also provided.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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29
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Armwood AR, Cañete-Gibas CF, Dill-Okubo JA, Wiederhold NP, Camus AC. Retrospective study of phaeohyphomycosis in aquarium-housed fish, with first descriptions of Exophiala lecanii-corni and Neodevriesia cladophorae in fish. J Fish Dis 2021; 44:1563-1577. [PMID: 34148252 DOI: 10.1111/jfd.13477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
A broadening fish host range is affected by novel and known pigmented fungal pathogens. A review of 2,250 piscine submissions received by the Aquatic Pathology Service, University of Georgia, revealed 47 phaeohyphomycosis cases (2.1%), representing 34 bony and cartilaginous fish species. The majority involved bony fish (45/47, 95.7%) and were predominantly marine (41/47, 87.2%), with only a few freshwater species (4/47, 8.5%). Cartilaginous fish cases included two zebra sharks (Stegostoma fasciatum) (2/47, 4.3%). Northern seahorses (Hippocampus erectus) had the highest incidence overall (7/47, 14.9%). Culture and sequencing of the internal-transcribed spacer region of the rDNA (ITS), large ribosomal subunit gene D1/D2 domains (LSU) and the DNA polymerase II gene (RPB2) were performed for fungal identification when fresh tissue was obtainable. Exophiala, Ochroconis and Neodevriesia spp. were identified, with Exophiala as the most common fungal genus (8/11, 72.7%). Exophiala lecanii-corni and Neodevriesia cladophorae were described for the first time from fish. Microscopically, lesions were characterized by necrosis, granulomatous inflammation and angioinvasion most frequently affecting the skin/fin, skeletal muscle and kidneys. In this study of diverse aquarium-housed fish species, phaeohyphomycosis cases occurred sporadically and in rare outbreaks with variable pathologic presentations, tissue distributions and severities.
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Affiliation(s)
- Abigail R Armwood
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Connie F Cañete-Gibas
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Nathan P Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Alvin C Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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Tisdale-Macioce N, Green J, Perl AKT, Ashbaugh A, Wiederhold NP, Patterson TF, Cushion MT. The Promise of Lung Organoids for Growth and Investigation of Pneumocystis Species. Front Fungal Biol 2021; 2:740845. [PMID: 37744131 PMCID: PMC10512221 DOI: 10.3389/ffunb.2021.740845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 09/26/2023]
Abstract
Pneumocystis species (spp.) are host-obligate fungal parasites that colonize and propagate almost exclusively in the alveolar lumen within the lungs of mammals where they can cause a lethal pneumonia. The emergence of this pneumonia in non-HIV infected persons caused by Pneumocystis jirovecii (PjP), illustrates the continued importance of and the need to understand its associated pathologies and to develop new therapies and preventative strategies. In the proposed life cycle, Pneumocystis spp. attach to alveolar type 1 epithelial cells (AEC1) and prevent gas exchange. This process among other mechanisms of Pneumocystis spp. pathogenesis is challenging to observe in real time due to the absence of a continuous ex vivo or in vitro culture system. The study presented here provides a proof-of-concept for the development of murine lung organoids that mimic the lung alveolar sacs expressing alveolar epithelial type 1 cells (AEC1) and alveolar type 2 epithelial cells (AEC2). Use of these 3-dimensional organoids should facilitate studies of a multitude of unanswered questions and serve as an improved means to screen new anti- PjP agents.
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Affiliation(s)
- Nikeya Tisdale-Macioce
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Medical Research Service, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, United States
| | - Jenna Green
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anne-Karina T. Perl
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, The Perinatal Institute and Section of Neonatology, Cincinnati, OH, United States
| | - Alan Ashbaugh
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Medical Research Service, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, United States
| | - Nathan P. Wiederhold
- Department of Pathology, The University of Texas Health Science Center, San Antonio, TX, United States
| | - Thomas F. Patterson
- Department of Medicine, The University of Texas Health Science Center, San Antonio, TX, United States
- Section of Infectious Diseases, South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Melanie T. Cushion
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Medical Research Service, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, United States
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31
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Badali H, Cañete-Gibas C, McCarthy D, Patterson H, Sanders C, David MP, Mele J, Fan H, Wiederhold NP. Epidemiology and Antifungal Susceptibilities of Mucoralean Fungi in Clinical Samples from the United States. J Clin Microbiol 2021; 59:e0123021. [PMID: 34232068 PMCID: PMC8373021 DOI: 10.1128/jcm.01230-21] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/01/2021] [Indexed: 01/12/2023] Open
Abstract
The global incidence of mucormycosis has increased in recent years owing to higher numbers of individuals at risk for these infections. The diagnosis and treatment of this aggressive fungal infection are of clinical concern due to differences in species distribution in different geographic areas and susceptibility profiles between different species that are capable of causing highly aggressive infections. The purpose of this study was to evaluate the epidemiology and susceptibility profiles of Mucorales isolates in the United States over a 52-month period. Species identification was performed by combined phenotypic characteristics and DNA sequence analysis, and antifungal susceptibility testing was performed by CLSI M38 broth microdilution for amphotericin B, isavuconazole, itraconazole, and posaconazole. During this time frame, 854 isolates were included, representing 11 different genera and over 26 species, of which Rhizopus (58.6%) was the predominant genus, followed by Mucor (19.6%). The majority of isolates were cultured from the upper and lower respiratory tracts (55%). Amphotericin B demonstrated the most potent in vitro activity, with geometric mean (GM) MICs of ≤0.25 μg/ml against all genera with the exception of Cunninghamella species (GM MIC of 1.30 μg/ml). In head-to-head comparisons, the most active azole was posaconazole, followed by isavuconazole. Differences in azole and amphotericin B susceptibility patterns were observed between the genera with the greatest variability observed with isavuconazole. Awareness of the epidemiology of Mucorales isolates and differences in antifungal susceptibility patterns in the United States may aide clinicians in choosing antifungal treatment regimens. Further studies are warranted to correlate these findings with clinical outcomes.
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Affiliation(s)
- Hamid Badali
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Connie Cañete-Gibas
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Dora McCarthy
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hoja Patterson
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Carmita Sanders
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Marjorie P. David
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - James Mele
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hongxin Fan
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Nathan P. Wiederhold
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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32
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Geiser DM, Al-Hatmi AMS, Aoki T, Arie T, Balmas V, Barnes I, Bergstrom GC, Bhattacharyya MK, Blomquist CL, Bowden RL, Brankovics B, Brown DW, Burgess LW, Bushley K, Busman M, Cano-Lira JF, Carrillo JD, Chang HX, Chen CY, Chen W, Chilvers M, Chulze S, Coleman JJ, Cuomo CA, de Beer ZW, de Hoog GS, Del Castillo-Múnera J, Del Ponte EM, Diéguez-Uribeondo J, Di Pietro A, Edel-Hermann V, Elmer WH, Epstein L, Eskalen A, Esposto MC, Everts KL, Fernández-Pavía SP, da Silva GF, Foroud NA, Fourie G, Frandsen RJN, Freeman S, Freitag M, Frenkel O, Fuller KK, Gagkaeva T, Gardiner DM, Glenn AE, Gold SE, Gordon TR, Gregory NF, Gryzenhout M, Guarro J, Gugino BK, Gutierrez S, Hammond-Kosack KE, Harris LJ, Homa M, Hong CF, Hornok L, Huang JW, Ilkit M, Jacobs A, Jacobs K, Jiang C, Jiménez-Gasco MDM, Kang S, Kasson MT, Kazan K, Kennell JC, Kim HS, Kistler HC, Kuldau GA, Kulik T, Kurzai O, Laraba I, Laurence MH, Lee T, Lee YW, Lee YH, Leslie JF, Liew ECY, Lofton LW, Logrieco AF, López-Berges MS, Luque AG, Lysøe E, Ma LJ, Marra RE, Martin FN, May SR, McCormick SP, McGee C, Meis JF, Migheli Q, Mohamed Nor NMI, Monod M, Moretti A, Mostert D, Mulè G, Munaut F, Munkvold GP, Nicholson P, Nucci M, O'Donnell K, Pasquali M, Pfenning LH, Prigitano A, Proctor RH, Ranque S, Rehner SA, Rep M, Rodríguez-Alvarado G, Rose LJ, Roth MG, Ruiz-Roldán C, Saleh AA, Salleh B, Sang H, Scandiani MM, Scauflaire J, Schmale DG, Short DPG, Šišić A, Smith JA, Smyth CW, Son H, Spahr E, Stajich JE, Steenkamp E, Steinberg C, Subramaniam R, Suga H, Summerell BA, Susca A, Swett CL, Toomajian C, Torres-Cruz TJ, Tortorano AM, Urban M, Vaillancourt LJ, Vallad GE, van der Lee TAJ, Vanderpool D, van Diepeningen AD, Vaughan MM, Venter E, Vermeulen M, Verweij PE, Viljoen A, Waalwijk C, Wallace EC, Walther G, Wang J, Ward TJ, Wickes BL, Wiederhold NP, Wingfield MJ, Wood AKM, Xu JR, Yang XB, Yli-Mattila T, Yun SH, Zakaria L, Zhang H, Zhang N, Zhang SX, Zhang X. Phylogenomic Analysis of a 55.1-kb 19-Gene Dataset Resolves a Monophyletic Fusarium that Includes the Fusarium solani Species Complex. Phytopathology 2021; 111:1064-1079. [PMID: 33200960 DOI: 10.1094/phyto-08-20-0330-le] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Scientific communication is facilitated by a data-driven, scientifically sound taxonomy that considers the end-user's needs and established successful practice. In 2013, the Fusarium community voiced near unanimous support for a concept of Fusarium that represented a clade comprising all agriculturally and clinically important Fusarium species, including the F. solani species complex (FSSC). Subsequently, this concept was challenged in 2015 by one research group who proposed dividing the genus Fusarium into seven genera, including the FSSC described as members of the genus Neocosmospora, with subsequent justification in 2018 based on claims that the 2013 concept of Fusarium is polyphyletic. Here, we test this claim and provide a phylogeny based on exonic nucleotide sequences of 19 orthologous protein-coding genes that strongly support the monophyly of Fusarium including the FSSC. We reassert the practical and scientific argument in support of a genus Fusarium that includes the FSSC and several other basal lineages, consistent with the longstanding use of this name among plant pathologists, medical mycologists, quarantine officials, regulatory agencies, students, and researchers with a stake in its taxonomy. In recognition of this monophyly, 40 species described as genus Neocosmospora were recombined in genus Fusarium, and nine others were renamed Fusarium. Here the global Fusarium community voices strong support for the inclusion of the FSSC in Fusarium, as it remains the best scientific, nomenclatural, and practical taxonomic option available.
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Affiliation(s)
- David M Geiser
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | | | - Takayuki Aoki
- Genetic Resources Center, National Agriculture and Food Research Organization, Tsukuba, Japan
| | - Tsutomu Arie
- Tokyo University of Agriculture and Technology, Fuchu, Japan
| | - Virgilio Balmas
- Dipartimento di Agraria, Università degli Studi di Sassari, Sassari, Italy
| | - Irene Barnes
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, South Africa
| | - Gary C Bergstrom
- Plant Pathology and Plant-Microbe Biology Section, Cornell University, Ithaca, NY 14853, U.S.A
| | | | - Cheryl L Blomquist
- Plant Pest Diagnostics Branch, California Department of Food and Agriculture, Sacramento, CA 95832, U.S.A
| | - Robert L Bowden
- Hard Winter Wheat Genetics Research Unit, U.S. Department of Agriculture Agricultural Research Service (USDA-ARS), Manhattan, KS 66506, U.S.A
| | - Balázs Brankovics
- Wageningen Plant Research, Wageningen University and Research, Wageningen, The Netherlands
| | - Daren W Brown
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - Lester W Burgess
- Sydney Institute of Agriculture, Faculty of Science, University of Sydney, Sydney, Australia
| | - Kathryn Bushley
- Department of Plant and Microbial Biology, University of Minnesota, St. Paul, MN 55108, U.S.A
| | - Mark Busman
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - José F Cano-Lira
- Mycology Unit and IISPV, Universitat Rovira i Virgili Medical School, Reus, Spain
| | - Joseph D Carrillo
- Gulf Coast Research and Education Center, University of Florida, Wimauma, FL 33598, U.S.A
| | - Hao-Xun Chang
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, Taiwan
| | - Chi-Yu Chen
- Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan
| | - Wanquan Chen
- State Key Laboratory for Biology of Plant Diseases and Insect Pests, Institute of Plant Protection, Chinese Academy of Agriculture Sciences, Beijing, People's Republic of China
| | - Martin Chilvers
- Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824, U.S.A
| | - Sofia Chulze
- Research Institute on Mycology and Mycotoxicology, National Scientific and Technical Research Council, National University of Rio Cuarto, Rio Cuarto, Córdoba, Argentina
| | - Jeffrey J Coleman
- Department of Entomology and Plant Pathology, Auburn University, Auburn, AL 36849, U.S.A
| | | | - Z Wilhelm de Beer
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, South Africa
| | - G Sybren de Hoog
- Department of Medical Mycology and Infectious Diseases, Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Emerson M Del Ponte
- Departamento de Fitopatologia, Universidade Federal de Viçosa, Viçosa, Brazil
| | | | - Antonio Di Pietro
- Departamento de Genética, Campus de Excelencia Internacional Agroalimentario, Universidad de Córdoba, Córdoba, Spain
| | | | - Wade H Elmer
- Department of Plant Pathology and Ecology, Connecticut Agricultural Experiment Station, New Haven, CT 06504, U.S.A
| | - Lynn Epstein
- Department of Plant Pathology, University of California, Davis, CA 95616, U.S.A
| | - Akif Eskalen
- Department of Plant Pathology, University of California, Davis, CA 95616, U.S.A
| | | | - Kathryne L Everts
- Wye Research and Education Center, University of Maryland, Queenstown, MD 21658, U.S.A
| | - Sylvia P Fernández-Pavía
- Laboratorio de Patología Vegetal, Instituto de Investigaciones Agropecuarias y Forestales, Universidad Michoacana de San Nicolás de Hidalgo, Tarímbaro, Michoacán 58880, México
| | | | - Nora A Foroud
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada, Lethbridge, Alberta T1J 4B1, Canada
| | - Gerda Fourie
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, South Africa
| | - Rasmus J N Frandsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Stanley Freeman
- Department of Plant Pathology and Weed Research, Agricultural Research Organization, Volcani Center, Rishon LeZion, Israel
| | - Michael Freitag
- Department of Biochemistry and Biophysics, Oregon State University, Corvallis, OR 97331, U.S.A
| | - Omer Frenkel
- Department of Plant Pathology and Weed Research, Agricultural Research Organization, Volcani Center, Rishon LeZion, Israel
| | - Kevin K Fuller
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, U.S.A
| | - Tatiana Gagkaeva
- Laboratory of Mycology and Phytopathology, All-Russian Institute of Plant Protection, St. Petersburg-Pushkin, Russia
| | | | - Anthony E Glenn
- Toxicology and Mycotoxin Research Unit, USDA-ARS, Athens, GA 30605, U.S.A
| | - Scott E Gold
- Toxicology and Mycotoxin Research Unit, USDA-ARS, Athens, GA 30605, U.S.A
| | - Thomas R Gordon
- Department of Plant Pathology, University of California, Davis, CA 95616, U.S.A
| | - Nancy F Gregory
- Department of Plant and Soil Sciences, University of Delaware, DE 19716, U.S.A
| | - Marieka Gryzenhout
- Department of Genetics, University of the Free State, Bloemfontein, South Africa
| | - Josep Guarro
- Unitat de Microbiologia, Departament de Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, Reus, Spain
| | - Beth K Gugino
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | | | - Kim E Hammond-Kosack
- Department of Biointeractions and Crop Protection, Rothamsted Research, Harpenden, United Kingdom
| | - Linda J Harris
- Ottawa Research and Development Centre, Agriculture and Agri-Food Canada, Ottawa, Ontario K1A 0C6, Canada
| | - Mónika Homa
- MTA-SZTE Fungal Pathogenicity Mechanisms Research Group, Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - Cheng-Fang Hong
- Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan
| | - László Hornok
- Institute of Plant Protection, Szent István University, Gödöllő, Hungary
| | - Jenn-Wen Huang
- Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan
| | - Macit Ilkit
- Division of Mycology, Faculty of Medicine, University of Çukurova, Sarıçam, Adana, Turkey
| | - Adriaana Jacobs
- Biosystematics Unit, Plant Health and Protection, Agricultural Research Council, Pretoria, South Africa
| | - Karin Jacobs
- Department of Microbiology, Stellenbosch University, Matieland, South Africa
| | - Cong Jiang
- College of Plant Protection, Northwest Agriculture and Forestry University, Xianyang, People's Republic of China
| | - María Del Mar Jiménez-Gasco
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - Seogchan Kang
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - Matthew T Kasson
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV 26506, U.S.A
| | - Kemal Kazan
- CSIRO Agriculture and Food, St. Lucia, Australia
| | - John C Kennell
- Biology Department, St. Louis University, St. Louis, MO 63101, U.S.A
| | - Hye-Seon Kim
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - H Corby Kistler
- USDA-ARS Cereal Disease Laboratory, University of Minnesota, St. Paul, MN 55108, U.S.A
| | - Gretchen A Kuldau
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - Tomasz Kulik
- Department of Botany and Nature Protection, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Oliver Kurzai
- German National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
| | - Imane Laraba
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - Matthew H Laurence
- Australian Institute of Botanical Science, Royal Botanic Garden and Domain Trust, Sydney, Australia
| | - Theresa Lee
- Microbial Safety Team, National Institute of Agricultural Sciences, Rural Development Administration, Wanju, Republic of Korea
| | - Yin-Won Lee
- Department of Agricultural Biotechnology, Seoul National University, Seoul, Republic of Korea
| | - Yong-Hwan Lee
- Department of Agricultural Biotechnology, Seoul National University, Seoul, Republic of Korea
| | - John F Leslie
- Department of Plant Pathology, Kansas State University, Manhattan, KS 66506, U.S.A
| | - Edward C Y Liew
- Australian Institute of Botanical Science, Royal Botanic Garden and Domain Trust, Sydney, Australia
| | - Lily W Lofton
- Toxicology and Mycotoxin Research Unit, USDA-ARS, Athens, GA 30605, U.S.A
| | - Antonio F Logrieco
- Institute of Sciences of Food Production, Research National Council, Bari, Italy
| | - Manuel S López-Berges
- Departamento de Genética, Campus de Excelencia Internacional Agroalimentario, Universidad de Córdoba, Córdoba, Spain
| | - Alicia G Luque
- Facultad de Ciencias Bioquímicas y Farmacéuticas, Centro de Referencia de Micología, Universidad Nacional de Rosario, Rosario, Argentina
| | - Erik Lysøe
- Division of Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research, Høgskoleveien, Ås, Norway
| | - Li-Jun Ma
- Department of Biochemistry and Molecular Biology, University of Massachusetts, Amherst, MA 01003, U.S.A
| | - Robert E Marra
- Department of Plant Pathology and Ecology, Connecticut Agricultural Experiment Station, New Haven, CT 06504, U.S.A
| | - Frank N Martin
- Crop Improvement and Protection Research Unit, ARS-USDA, Salinas, CA 93905, U.S.A
| | - Sara R May
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - Susan P McCormick
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - Chyanna McGee
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - Jacques F Meis
- Department of Medical Mycology and Infectious Diseases, Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Quirico Migheli
- Dipartimento di Agraria and Nucleo Ricerca Desertificazione, Università degli Studi di Sassari, Sassari, Italy
| | - N M I Mohamed Nor
- School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Michel Monod
- Laboratoire de Mycologie, Service de Dermatologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Antonio Moretti
- Institute of Sciences of Food Production, Research National Council, Bari, Italy
| | - Diane Mostert
- Department of Plant Pathology, Stellenbosch University, Matieland, South Africa
| | - Giuseppina Mulè
- Institute of Sciences of Food Production, Research National Council, Bari, Italy
| | | | - Gary P Munkvold
- Department of Plant Pathology and Microbiology, Iowa State University, Ames, IA 50011, U.S.A
| | - Paul Nicholson
- Department of Crop Genetics, John Innes Centre, Norwich Research Park, Norwich, United Kingdom
| | - Marcio Nucci
- Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kerry O'Donnell
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - Matias Pasquali
- Department of Food, Environmental and Nutritional Sciences, University of Milano, Milan, Italy
| | - Ludwig H Pfenning
- Departamento de Fitopatologia, Universidade Federal de Lavras, Lavras, Minas Gerais State, Brazil
| | - Anna Prigitano
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Robert H Proctor
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - Stéphane Ranque
- Institut Hospitalier Universitaire Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Stephen A Rehner
- Mycology and Nematology Genetic Diversity and Biology Laboratory, USDA-ARS, Beltsville, MD 20705, U.S.A
| | - Martijn Rep
- Swammerdam Institute for Life Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerardo Rodríguez-Alvarado
- Laboratorio de Patología Vegetal, Instituto de Investigaciones Agropecuarias y Forestales, Universidad Michoacana de San Nicolás de Hidalgo, Tarímbaro, Michoacán 58880, México
| | - Lindy Joy Rose
- Department of Plant Pathology, Stellenbosch University, Matieland, South Africa
| | - Mitchell G Roth
- Department of Plant Pathology, University of Wisconsin, Madison, WI 53706, U.S.A
| | - Carmen Ruiz-Roldán
- Departamento de Genética, Campus de Excelencia Internacional Agroalimentario, Universidad de Córdoba, Córdoba, Spain
| | - Amgad A Saleh
- Department of Plant Protection, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Baharuddin Salleh
- School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hyunkyu Sang
- Department of Integrative Food, Bioscience and Biotechnology, Chonnam National University, Gwangju, Republic of Korea
| | - María Mercedes Scandiani
- Facultad de Ciencias Bioquímicas y Farmacéuticas, Centro de Referencia de Micología, Universidad Nacional de Rosario, Rosario, Argentina
| | - Jonathan Scauflaire
- Centre de Recherche et de Formation Agronomie, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium
| | - David G Schmale
- School of Plant and Environmental Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, U.S.A
| | | | - Adnan Šišić
- Department of Ecological Plant Protection, University of Kassel, Witzenhausen, Germany
| | - Jason A Smith
- School of Forest Resources and Conservation, University of Florida, Gainesville, FL 32611, U.S.A
| | - Christopher W Smyth
- Department of Biological Sciences, Binghamton University, State University of New York, Binghamton, NY 13902, U.S.A
| | - Hokyoung Son
- Department of Agricultural Biotechnology, Seoul National University, Seoul, Republic of Korea
| | - Ellie Spahr
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV 26506, U.S.A
| | - Jason E Stajich
- Department of Microbiology and Plant Pathology, University of California, Riverside, CA 92521, U.S.A
| | - Emma Steenkamp
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, South Africa
| | - Christian Steinberg
- Agroécologie, AgroSup Dijon, INRAE, University of Bourgogne Franche-Comté, Dijon, France
| | - Rajagopal Subramaniam
- Ottawa Research and Development Centre, Agriculture and Agri-Food Canada, Ottawa, Ontario K1A 0C6, Canada
| | - Haruhisa Suga
- Life Science Research Center, Gifu University, Gifu, Japan
| | - Brett A Summerell
- Australian Institute of Botanical Science, Royal Botanic Garden and Domain Trust, Sydney, Australia
| | - Antonella Susca
- Institute of Sciences of Food Production, Research National Council, Bari, Italy
| | - Cassandra L Swett
- Department of Plant Pathology, University of California, Davis, CA 95616, U.S.A
| | | | - Terry J Torres-Cruz
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - Anna M Tortorano
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Martin Urban
- Department of Biointeractions and Crop Protection, Rothamsted Research, Harpenden, United Kingdom
| | - Lisa J Vaillancourt
- Department of Plant Pathology, University of Kentucky, Lexington, KY 40546, U.S.A
| | - Gary E Vallad
- Gulf Coast Research and Education Center, University of Florida, Wimauma, FL 33598, U.S.A
| | - Theo A J van der Lee
- Wageningen Plant Research, Wageningen University and Research, Wageningen, The Netherlands
| | - Dan Vanderpool
- Department of Biology, Indiana University, Bloomington, IN 47405, U.S.A
| | - Anne D van Diepeningen
- Wageningen Plant Research, Wageningen University and Research, Wageningen, The Netherlands
| | - Martha M Vaughan
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - Eduard Venter
- Department of Botany and Plant Biotechnology, University of Johannesburg, Auckland Park, South Africa
| | - Marcele Vermeulen
- Department of Microbial Biochemical and Food Biotechnology, University of the Free State, Bloemfontein, South Africa
| | - Paul E Verweij
- Department of Medical Mycology and Infectious Diseases, Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Altus Viljoen
- Department of Plant Pathology, Stellenbosch University, Matieland, South Africa
| | - Cees Waalwijk
- Wageningen Plant Research, Wageningen University and Research, Wageningen, The Netherlands
| | - Emma C Wallace
- Department of Plant Pathology and Environmental Microbiology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - Grit Walther
- German National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
| | - Jie Wang
- DOE Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA 94702
| | - Todd J Ward
- Mycotoxin Prevention and Applied Microbiology Research Unit, USDA-ARS, Peoria, IL 61604, U.S.A
| | - Brian L Wickes
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center, San Antonio, TX 78229, U.S.A
| | - Nathan P Wiederhold
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX 78229, U.S.A
| | - Michael J Wingfield
- Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Pretoria, South Africa
| | - Ana K M Wood
- Department of Biointeractions and Crop Protection, Rothamsted Research, Harpenden, United Kingdom
| | - Jin-Rong Xu
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX 78229, U.S.A
| | - Xiao-Bing Yang
- Department of Crop Genetics, John Innes Centre, Norwich Research Park, Norwich, United Kingdom
| | | | - Sung-Hwan Yun
- Department of Medical Biotechnology, Soonchunhyang University, Asan, Republic of Korea
| | - Latiffah Zakaria
- School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hao Zhang
- State Key Laboratory for Biology of Plant Diseases and Insect Pests, Institute of Plant Protection, Chinese Academy of Agriculture Sciences, Beijing, People's Republic of China
| | - Ning Zhang
- Department of Plant Biology, Rutgers University, New Brunswick, NJ 08901, U.S.A
| | - Sean X Zhang
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, U.S.A
| | - Xue Zhang
- College of Plant Protection, Northwest Agriculture and Forestry University, Xianyang, People's Republic of China
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Rothacker T, Jaffey JA, Rogers ER, Fales WH, Gibas CFC, Wiederhold NP, Sanders C, Mele J, Fan H, Cohn LA, Royal A. Novel Penicillium species causing disseminated disease in a Labrador Retriever dog. Med Mycol 2021; 58:1053-1063. [PMID: 32242628 DOI: 10.1093/mmy/myaa016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023] Open
Abstract
This report describes the phenotypic characteristics of a novel Penicillium species, Penicillium labradorum, isolated from a 3-year-old male, castrated, Labrador retriever with disseminated fungal disease. The dog's presenting clinical signs included lethargy, lymphadenopathy, tachypnea, moderate pitting edema, and nonweight bearing lameness associated with the right hind limb. Fine-needle aspirate biopsies from the sublumbar and prescapular lymph nodes were initially examined. The cytologic findings were consistent with pyogranulomatous inflammation with abundant extracellular and phagocytized fungal fragments and hyphae. Based on the morphology of the organisms and lack of endogenous pigment, hyalohyphomycosis was considered most likely, with Fusarium, Penicillium, and Paecilomyces species being considerations. Fungal isolates were obtained via culture of samples from the lymph nodes, and molecular identification testing originally identified an undescribed Penicillium species belonging to the Penicillium section Exilicaulis. BLAST searches and phylogenetic analyses performed approximately 1 year and 9 months after the isolation date revealed an isolate within the Penicillium parvum clade in the Penicillium section Exilicaulis but phylogenetically distant from the other species in the section, thus representing a new species, Penicillium labradorum. Antifungal susceptibility testing was also performed on the isolate and low minimum inhibitory concentrations were observed with terbinafine, voriconazole, and posaconazole, while in vitro resistance was observed with fluconazole. The dog had been previously treated with fluconazole, itraconazole, amphotericin B lipid complex, voriconazole, and terbinafine. Approximately 587 days after the initial diagnosis, the dog was euthanized due to worsening of clinical signs and concerns for quality of life.
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Affiliation(s)
- Tatiana Rothacker
- University of Missouri, A345 Clydesdale Hall, Columbia, Missouri, USA
| | - Jared A Jaffey
- Midwestern University, 19555 N 59th Ave, Phoenix, Arizona, USA
| | - Erin R Rogers
- University of Missouri, 2308 Houma Blvd 522, Metairie, Louisiana, USA
| | - William H Fales
- (Emeritus), University of Missouri, 2328 Hamilton Drive, Ames, Iowa, USA
| | - Connie F C Gibas
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Carmita Sanders
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - James Mele
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Hongxin Fan
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Leah A Cohn
- University of Missouri, A344 Clydesdale Hall, Columbia, Missouri, USA
| | - Angela Royal
- University of Missouri, A344 Clydesdale Hall, Columbia, Missouri, USA
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Ryan K, Cañete-Gibas C, Sanders C, Sosa N, Wiederhold NP. Pseudocanariomyces americanus, gen. nov., sp. nov., A New Thielavia-Like Species in the Chaetomiaceae: Identification and Management of a Prosthetic Hip Infection. Mycopathologia 2021; 186:441-447. [PMID: 34013385 DOI: 10.1007/s11046-021-00555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
This report describes the phenotypic characteristics of a novel fungal species, isolated from a prosthetic hip infection. The patient, who had undergone multiple total hip arthroplasties due to Legg-Calvé-Perthes disease, presented with continued fever and wound dehiscence. Findings upon incision and draining were notable for necrotic tissue and a sinus tract from the fluid collection. Intraoperative cultures were positive for a sterile filamentous fungus. BLASTn results following DNA sequencing placed the isolate within the family Chaetomiaceae close to the genera Madurella, Canariomyces, Stolonocarpus, Stellatospora, Ovatospora, Carteria and Melanocarpus. Phylogenetic analysis demonstrated that the isolate was a new thielavia-like species, Pseudocanariomyces americanus. Antifungal susceptibility was performed, and low minimum inhibitory concentrations were observed with amphotericin B, itraconazole, posaconazole, and voriconazole. The patient was initially treated with voriconazole but was switched to posaconazole secondary to a photosensitivity reaction. Acceptable posaconazole trough concentrations were achieved, and the patient remained stable without pain or drainage from her surgical incision.
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Affiliation(s)
- Keenan Ryan
- Pharmacy Department, The University of New Mexico Hospital, Albuquerque, NM, USA
| | - Connie Cañete-Gibas
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center At San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78228, USA
| | - Carmita Sanders
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center At San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78228, USA
| | - Nestor Sosa
- Division of Infectious Diseases, Department of Internal Medicine, The University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center At San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78228, USA.
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Gebremariam T, Alkhazraji S, Alqarihi A, Wiederhold NP, Najvar LK, Patterson TF, Filler SG, Ibrahim AS. Evaluation of Sex Differences in Murine Diabetic Ketoacidosis and Neutropenic Models of Invasive Mucormycosis. J Fungi (Basel) 2021; 7:jof7040313. [PMID: 33919611 PMCID: PMC8072604 DOI: 10.3390/jof7040313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
There is increased concern that the quality, generalizability and reproducibility of biomedical research can be influenced by the sex of animals used. We studied the differences between male and female mice in response to invasive pulmonary mucormycosis including susceptibility to infection, host immune reaction and responses to antifungal therapy. We used diabetic ketoacidotic (DKA) or neutropenic mice infected with either Rhizopus delemar or Mucor circinelloides. The only difference detected was that when DKA mice were infected with M. circinelloides, female mice were more resistant to infection than male mice (median survival time of 5 vs. 2 days for female and male mice, respectively). However, a 100% lethality was detected among infected animals of both sexes. Treatment with either liposomal amphotericin B (L-AMB) or posaconazole (POSA) protected mice from infection and eliminated the difference seen between infected but untreated female and male mice. Treatment with L-AMB consistently outperformed POSA in prolonging survival and reducing tissue fungal burden of DKA and neutropenic mice infected with R. delemar or M. circinelloides, in both mouse sexes. While little difference was detected in cytokine levels among both sexes, mucormycosis infection in the DKA mouse model induced more inflammatory cytokines/chemokines involved in neutrophil (CXCL1) and macrophage (CXCL2) recruitment vs. uninfected mice. As expected, this inflammatory response was reduced in the neutropenic mouse model. Our studies show that there are few differences between female and male DKA or neutropenic mice infected with mucormycosis with no effect on the outcome of treatment or host immune response.
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Affiliation(s)
- Teclegiorgis Gebremariam
- The Division of Infectious Diseases, The Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA 90502, USA; (T.G.); (S.A.); (A.A.); (S.G.F.)
| | - Sondus Alkhazraji
- The Division of Infectious Diseases, The Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA 90502, USA; (T.G.); (S.A.); (A.A.); (S.G.F.)
| | - Abdullah Alqarihi
- The Division of Infectious Diseases, The Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA 90502, USA; (T.G.); (S.A.); (A.A.); (S.G.F.)
| | - Nathan P. Wiederhold
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (N.P.W.); (L.K.N.); (T.F.P.)
| | - Laura K. Najvar
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (N.P.W.); (L.K.N.); (T.F.P.)
- South Texas Veterans Health Care System, San Antonio, TX 78229, USA
| | - Thomas F. Patterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; (N.P.W.); (L.K.N.); (T.F.P.)
- South Texas Veterans Health Care System, San Antonio, TX 78229, USA
| | - Scott G. Filler
- The Division of Infectious Diseases, The Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA 90502, USA; (T.G.); (S.A.); (A.A.); (S.G.F.)
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Ashraf S. Ibrahim
- The Division of Infectious Diseases, The Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA 90502, USA; (T.G.); (S.A.); (A.A.); (S.G.F.)
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-310-222-6424
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Badali H, Cañete-Gibas C, Patterson H, Sanders C, Mermella B, Garcia V, Mele J, Fan H, Wiederhold NP. In vitro activity of olorofim against clinical isolates of the Fusarium oxysporum and Fusarium solani species complexes. Mycoses 2021; 64:748-752. [PMID: 33755988 DOI: 10.1111/myc.13273] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Invasive fusariosis is associated with marked morbidity and mortality in immunocompromised hosts, and clinical outcomes are poor with conventional therapy. Olorofim (F901318) is an investigational antifungal in the orotomide class that selectively targets fungal dihydroorotate dehydrogenase (DHODH) causing inhibition of pyrimidine biosynthesis. OBJECTIVE We evaluated the in vitro activity of olorofim against 61 clinical isolates of the Fusarium oxysporum and F solani species complexes (FOSC and FSSC, respectively), the most prevalent causes of invasive fusariosis. METHODS Clinical isolates of FOSC (n = 45) and FSSC (n = 16) were identified using DNA sequence analysis of the translation elongation factor 1-alpha (TEF1α) and RNA polymerase II second largest subunit (RPB2). Antifungal susceptibility testing was performed by CLSI M38 broth microdilution for olorofim, amphotericin B, isavuconazole, posaconazole, voriconazole and micafungin. RESULTS Olorofim demonstrated good in vitro activity against both FOSC and FSSC. Against the 45 FOSC isolates, olorofim MICs ranged between 0.03-0.5 mg/L and 0.06->4 mg/L at the 50% and 100% inhibition endpoints, respectively. Against FSSC isolates, olorofim MIC ranged between 0.25-1 mg/L and 1->4 mg/L at 50% and 100% inhibition, respectively. While amphotericin B also demonstrated similar in vitro activity (MIC ranges 1-4 and 0.25-4 mg/L against FOSC and FSSC, respectively), neither the triazoles nor micafungin demonstrated consistent in vitro activity against Fusarium isolates at clinically relevant concentrations. CONCLUSIONS The investigational agent olorofim demonstrated good in vitro activity against FOSC and FSSC clinical isolates. Further studies are warranted to determine how well this in vitro activity translates into in vivo efficacy.
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Affiliation(s)
- Hamid Badali
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Connie Cañete-Gibas
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hoja Patterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Carmita Sanders
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Barbara Mermella
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Victor Garcia
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - James Mele
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hongxin Fan
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nathan P Wiederhold
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Al-Obaidi M, Badali H, Cañete-Gibas C, Patterson HP, Wiederhold NP. Pulmonary infection secondary to Blastobotrys raffinosifermentans in a cystic fibrosis patient: Review of the literature. Mycoses 2021; 64:616-623. [PMID: 33555073 DOI: 10.1111/myc.13252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The genus Blastobotrys consists of at least 20 species. Disease in humans has been reported with B adeninivorans, B raffinosifermentans, B proliferans and B serpentis, mostly in immunocompromised patients and those with cystic fibrosis. OBJECTIVE We report a lung infection secondary to B raffinosifermentans in a cystic fibrosis patient successfully treated with isavuconazole and review the literature of invasive infections caused this genus. We also evaluated clinical isolates in our laboratory for species identification and antifungal susceptibility. METHODS Phylogenetic analysis was performed on a collection of 22 Blastobotrys isolates in our reference laboratory, and antifungal susceptibility patterns were determined for nine clinically available antifungals against 19 of these isolates. RESULTS By phylogenetic analysis, 21 of the 22 isolates in our collection were identified as B raffinosifermentans and only 1 as B adeninivorans. Most were cultured from the respiratory tract, although others were recovered from other sources, including CSF and blood. Isavuconazole, caspofungin and micafungin demonstrated the most potent in vitro activity, followed by amphotericin B. In contrast, fluconazole demonstrated poor activity. The patient in this case responded to isavuconazole treatment for breakthrough infection due to B raffinosifermentans that was cultured from pleural fluid while on posaconazole prophylaxis post-bilateral lung transplantation for cystic fibrosis. CONCLUSIONS Blastobotrys species are rare causes of infections in humans and primarily occur in immunocompromised hosts. In our collection, the majority of isolates were identified as B raffinosifermentans. To our knowledge, this is the first report of successful treatment of such an infection with isavuconazole.
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Affiliation(s)
| | - Hamid Badali
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Connie Cañete-Gibas
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Hoja P Patterson
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Jaffey JA, Hostnik ET, Hoffman AR, Jay M, Ferguson SH, Wiederhold NP. Case Report: Successful Management of Conidiobolus Lamprauges Rhinitis in a Dog. Front Vet Sci 2021; 8:633695. [PMID: 33614770 PMCID: PMC7892434 DOI: 10.3389/fvets.2021.633695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
This is a case of Conidiobolus lamprauges rhinitis in a Goldendoodle, that was presented for evaluation of sneezing, coughing, lethargy, as well as right-sided epistaxis and clear ocular discharge. Computed tomography revealed a large amount of soft tissue within the right nasal passage that obscured the osseous turbinates from the right maxillary canine tooth to the right side of the choanae. Biopsies revealed eosinophilic granulomas with variable number of basophilic to negatively staining, septate, fungal hyphae with non-parallel walls and irregular branching that were subsequently determined to be Conidiobolus lamprauges via panfungal PCR and sequencing. Complete and sustained resolution of clinical disease was achieved after 75 days of systemic antifungal therapy. This report describes for the first time, important clinical features of a dog with nasal conidiobolomycosis that will facilitate its recognition, prognostication, and treatment in clinical practice.
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Affiliation(s)
- Jared A. Jaffey
- Department of Specialty Medicine, Midwestern University College of Veterinary Medicine, Glendale, AZ, United States
| | - Eric T. Hostnik
- Department of Veterinary Clinical Sciences, Veterinary Medical Center, Ohio State University, Columbus, OH, United States
| | - Aline Rodrigues Hoffman
- Department of Veterinary Pathobiology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Maureen Jay
- Department of Surgery, Animal Medical & Surgical Center, Scottsdale, AZ, United States
| | - Sylvia H. Ferguson
- Department of Pathology and Population Medicine, Midwestern University College of Veterinary Medicine, Glendale, AZ, United States
| | - Nathan P. Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, San Antonio, TX, United States
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Badali H, Patterson H, Sanders C, Mermella B, Gibas C, Mele J, Fan H, Ibrahim AS, Shaw KJ, Wiederhold NP. 1282. Manogepix, the Active Moiety of the Investigational Agent Fosmanogepix, Demonstrates In vitro Activity Against Members of the Fusarium oxysporum and Fusarium solani Species Complexes. Open Forum Infect Dis 2020. [PMCID: PMC7776725 DOI: 10.1093/ofid/ofaa439.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Invasive fusariosis is associated with marked morbidity and mortality in immunocompromised hosts, and treatment options are limited. Common etiologic agents include members of the F. oxysporum and F. solani species complexes (FOSC and FSSC, respectively). Manogepix (MGX), the active moiety of fosmanogepix, is a novel GWT1 inhibitor with broad antifungal activity. Fosmanogepix has previously shown in vivo efficacy in an immunocompromised murine model of invasive fusariosis. Our objective was to evaluate the in vitro activity of MGX against FOSC and FSSC isolates.
Methods
Clinical isolates of FOSC (n=49) and FSSC (19) were identified by combined phenotypic characteristics and DNA sequence analysis of the translation elongation factor 1-alpha (TEF1α) and RNA polymerase II second largest subunit (RPB2). Antifungal susceptibility testing was performed by CLSI M38 broth microdilution. Minimum effective concentrations (MEC) and minimum inhibitory concentrations (MIC) were read after 48 hours of incubation at 50% and 100% inhibition of growth for MGX, and MIC values were read for amphotericin B, posaconazole, isavuconazole, and voriconazole at 100% inhibition of growth.
Results
MGX demonstrated potent in vitro activity against both FOSC and FSSC isolates. Against the 49 FOSC isolates, the MGX MECs ranged from <0.015-0.03 mg/mL, and MICs at the 50% inhibition of growth endpoint ranged from <0.015-0.12 mg/mL (Table). MIC values were higher when read at 100% inhibition of growth. Similar results were observed against FSSC isolates (MEC and MIC ranges <0.015 and <0.015-0.25 mg/mL, respectively). MGX MEC and MIC 50% inhibition values were in close agreement for both FOSC and FSSC isolates. Of the other antifungals tested, amphotericin B demonstrated in vitro good activity (MIC ranges 1-4 and 0.25-4 mg/mL against FOSC and FSSC, respectively). In contrast, the azoles demonstrated reduced susceptibility (MIC range 1- >16 mg/mL).
MIC/MEC values (mcg/mL) for manogepix and other antifungals against FOSC and FSSC isolates
Conclusion
MGX demonstrated in vitro activity against FOSC and FSSC clinical isolates. Both changes in fungal morphology (MEC) and reductions in growth (MIC 50% inhibition) were observed. Clinical studies are ongoing to determine the efficacy of fosmanogepix in patients with invasive fungal infections.
Disclosures
Ashraf S. Ibrahim, PhD, Astellas Pharma (Research Grant or Support) Karen J. Shaw, PhD, Amplyx (Consultant)Forge Therapeutics (Consultant) Nathan P. Wiederhold, PharmD, Astellas (Grant/Research Support)BioMerieux (Grant/Research Support)Cepheid (Grant/Research Support)Covance (Grant/Research Support)F2G (Grant/Research Support)Gilead (Speaker’s Bureau)Mayne Pharma (Advisor or Review Panel member)Sfunga (Grant/Research Support)
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Affiliation(s)
| | | | | | | | | | - James Mele
- UT Health San Antonio, San Antonio, Texas
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40
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Mead HL, Hamm PS, Shaffer IN, Teixeira MDM, Wendel CS, Wiederhold NP, Thompson GR, Muñiz-Salazar R, Castañón-Olivares LR, Keim P, Plude C, Terriquez J, Galgiani JN, Orbach MJ, Barker BM. Differential Thermotolerance Adaptation between Species of Coccidioides. J Fungi (Basel) 2020; 6:E366. [PMID: 33327629 PMCID: PMC7765126 DOI: 10.3390/jof6040366] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 12/18/2022] Open
Abstract
Coccidioidomycosis, or Valley fever, is caused by two species of dimorphic fungi. Based on molecular phylogenetic evidence, the genus Coccidioides contains two reciprocally monophyletic species: C. immitis and C. posadasii. However, phenotypic variation between species has not been deeply investigated. We therefore explored differences in growth rate under various conditions. A collection of 39 C. posadasii and 46 C. immitis isolates, representing the full geographical range of the two species, was screened for mycelial growth rate at 37 °C and 28 °C on solid media. The radial growth rate was measured for 16 days on yeast extract agar. A linear mixed effect model was used to compare the growth rate of C. posadasii and C. immitis at 37 °C and 28 °C, respectively. C. posadasii grew significantly faster at 37 °C, when compared to C. immitis; whereas both species had similar growth rates at 28 °C. These results indicate thermotolerance differs between these two species. As the ecological niche has not been well-described for Coccidioides spp., and disease variability between species has not been shown, the evolutionary pressure underlying the adaptation is unclear. However, this research reveals the first significant phenotypic difference between the two species that directly applies to ecological research.
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Affiliation(s)
- Heather L. Mead
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA; (H.L.M.); (P.K.)
| | - Paris S. Hamm
- Department of Biology, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Isaac N. Shaffer
- School of Informatics, Computers, and Cyber Systems, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | | | | | - Nathan P. Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 77030, USA;
| | - George R. Thompson
- Departments of Internal Medicine Division of Infectious Diseases, and Medical Microbiology and Immunology, University of California-Davis, Sacramento, CA 95616, USA;
| | - Raquel Muñiz-Salazar
- Laboratorio de Epidemiología y Ecología Molecular, Escuela Ciencias de la Salud, Universidad Autónoma de Baja California, Unidad Valle Dorado, Ensenada 22890, Mexico;
| | - Laura Rosio Castañón-Olivares
- Department of Microbiology and Parasitology, Universidad Nacional Autónoma de Mexico, Ciudad de México 04510, Mexico;
| | - Paul Keim
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA; (H.L.M.); (P.K.)
| | - Carmel Plude
- Northern Arizona Healthcare, Flagstaff, AZ 86001, USA; (C.P.); (J.T.)
| | - Joel Terriquez
- Northern Arizona Healthcare, Flagstaff, AZ 86001, USA; (C.P.); (J.T.)
| | - John N. Galgiani
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ 85721, USA; (J.N.G.); (M.J.O.)
| | - Marc J. Orbach
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ 85721, USA; (J.N.G.); (M.J.O.)
- School of Plant Sciences, University of Arizona, Tucson, AZ 85721, USA
| | - Bridget M. Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ 86011, USA; (H.L.M.); (P.K.)
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ 85721, USA; (J.N.G.); (M.J.O.)
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41
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Salazar J, Hardin KA, Wiederhold NP, Thompson GR. Trichosporonosis Presenting as an Exophytic Cutaneous Mass Lesion. Mycopathologia 2020; 185:705-708. [PMID: 32705416 DOI: 10.1007/s11046-020-00477-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
Opportunistic fungal pathogens have increased in frequency with the growing immunosuppressed population. New and emerging pathogens, including the rare yeasts, continue to cause significant morbidity and mortality and frequently develop despite prophylaxis with antifungal agents. We report a previously unreported manifestation of disseminated trichosporonosis. Our patient with underlying acute myeloid leukemia presented with as an exophytic toe lesion found secondary to Trichosporon asahii. We highlight the need for a high index of suspicion to diagnose breakthrough infections and the need for aggressive treatment.
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Affiliation(s)
- Jorge Salazar
- Department of Internal Medicine, University of California-Davis Health, Sacramento, CA, USA
| | - Kaitlyn A Hardin
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Health, 4150 V Street, Suite G500, Sacramento, CA, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center At San Antonio, San Antonio, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Health, 4150 V Street, Suite G500, Sacramento, CA, USA. .,Department of Medical Microbiology and Immunology, University of California-Davis, Sacramento, CA, USA.
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42
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Bose P, McCue D, Wurster S, Wiederhold NP, Konopleva M, Kadia TM, Borthakur G, Ravandi F, Masarova L, Takahashi K, Estrov Z, Yilmaz M, Daver N, Pemmaraju N, Naqvi K, Rausch CR, Marx KR, Qiao W, Huang X, Bivins CA, Pierce SA, Kantarjian HM, Kontoyiannis DP. Isavuconazole as Primary Antifungal Prophylaxis in Patients With Acute Myeloid Leukemia or Myelodysplastic Syndrome: An Open-label, Prospective, Phase 2 Study. Clin Infect Dis 2020; 72:1755-1763. [PMID: 32236406 PMCID: PMC8130026 DOI: 10.1093/cid/ciaa358] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/30/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Mold-active primary antifungal prophylaxis (PAP) is routinely recommended in neutropenic patients with newly diagnosed acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS) undergoing remission-induction chemotherapy (RIC). Isavuconazole (ISAV) is an extended spectrum mold-active triazole and has superior tolerability and fewer significant drug-drug interactions compared with other triazoles. METHODS In our investigator-initiated, phase 2 trial, treatment-naive adult patients with AML or MDS starting RIC received ISAV per the dosing recommendations in the US label until neutrophil recovery (absolute neutrophil count [ANC] ≥ 0.5 × 109/L) and attainment of complete remission, occurrence of invasive fungal infection (IFI), or for a maximum of 12 weeks. The primary endpoint was the incidence of proven/probable IFI during ISAV PAP and up to 30 days after the last dose. RESULTS Sixty-five of 75 enrolled patients received ISAV PAP (median age, 67 years, median ANC at enrollment, 0.72 × 109/L). Thirty-two patients (49%) received oral targeted leukemia treatments (venetoclax, FTL3 inhibitors). Including the 30-day follow-up period, probable/proven and possible IFIs were encountered in 4 (6%) and 8 patients (12%), respectively. ISAV trough serum concentrations were consistently > 1 µg/mL, showed low intraindividual variation, and were not significantly influenced by chemotherapy regimen. Tolerability of ISAV was excellent, with only 3 cases (5%) of mild to moderate elevations of liver function tests and no QTc prolongations. CONCLUSIONS ISAV is a safe and effective alternative for PAP in patients with newly diagnosed AML/MDS undergoing RIC in the era of recently approved or emerging small-molecule antileukemia therapies. CLINICAL TRIALS REGISTRATION NCT03019939.
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Affiliation(s)
- Prithviraj Bose
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David McCue
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sebastian Wurster
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Marina Konopleva
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tapan M Kadia
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gautam Borthakur
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lucia Masarova
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Koichi Takahashi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zeev Estrov
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Musa Yilmaz
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naval Daver
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Pemmaraju
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kiran Naqvi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caitlin R Rausch
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kayleigh R Marx
- Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei Qiao
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xuelin Huang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carol A Bivins
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherry A Pierce
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hagop M Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, Texas, USA,Correspondence: D. P. Kontoyiannis, Division of Internal Medicine, Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1460, Houston, TX 77030 ()
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43
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Vaezi A, Fakhim H, Ilkit M, Faeli L, Fakhar M, Alinejad V, Wiederhold NP, Badali H. Rapid and Low-Cost Culture-Based Method for Diagnosis of Mucormycosis Using a Mouse Model. Front Microbiol 2020; 11:440. [PMID: 32265876 PMCID: PMC7099612 DOI: 10.3389/fmicb.2020.00440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/02/2020] [Indexed: 11/13/2022] Open
Abstract
Prompt and targeted antifungal treatment has a positive impact on the clinical outcome of mucormycosis; however, current diagnostic tools used in histopathology laboratories often fail to provide rapid results. Rapid culture-based strategies for early diagnosis of Mucorales infections, which may influence treatment decisions, are urgently needed. Herein, we evaluated a microculture assay for the early diagnosis of mucormycosis in an immunocompetent murine model of disseminated infection, by comparing it with traditional diagnostic methods. The assay specificity was assessed using blood (n = 90) and tissue (n = 90) specimens obtained from mice infected with Rhizopus arrhizus using different inoculum sizes [1 × 104, 1 × 105, and 1 × 106 colony forming units (CFUs)/mouse] and blood (n = 15) and tissue specimens (n = 15) from uninfected mice. Surprisingly, 26 of 90 (28.9%) blood samples revealed positive results by microculture, whereas all blood samples were negative when assayed by conventional culture. The overall positive conventional culture rate for the mouse tissue (kidney) samples was 31.1% (28/90). The calculated sensitivity for kidney microculture was 98.8% [95% confidence interval (CI) 96.6–100], with an assay specificity of 100%. Hence, the microculture assay may be useful for rapid culturing and diagnosis of mucormycosis caused by R. arrhizus directly in blood and tissue samples. Hence, this method may allow for the timely administration of an appropriate treatment.
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Affiliation(s)
- Afsane Vaezi
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamed Fakhim
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.,Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Leila Faeli
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vahid Alinejad
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Hamid Badali
- Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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44
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Hopf C, Graham EA, Gibas CFC, Sanders C, Mele J, Fan H, Garner MM, Wiederhold NP, Ossiboff R, Abou-Madi N. A Novel Exophiala Species Associated With Disseminated Granulomatous Inflammation in a Captive Eastern Hellbender ( Cryptobranchus alleganiensis alleganiensis). Front Vet Sci 2020; 7:25. [PMID: 32083105 PMCID: PMC7004953 DOI: 10.3389/fvets.2020.00025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
The genus Exophiala is composed of ubiquitous, pigmented, saprotrophic fungi and includes both terrestrial and waterborne species. Though Exophiala species are generally considered opportunistic pathogens, exophialosis can be an important cause of morbidity and mortality in aquatic and semi-aquatic species. Over a 6-year period, a captive 32-year-old male eastern hellbender (Cryptobranchus alleganiensis alleganiensis), was treated for recurring, slow growing, ventral midline cutaneous masses. Excisional biopsies were characterized histologically by granulomatous dermatitis with low numbers of intralesional, pigmented fungal conidia and hyphae. Bacterial and fungal cultures of the masses and skin were negative on two separate submissions. Polymerase chain reaction amplification of a short fragment of the fungal 28S large subunit (LSU) ribosomal RNA was positive with 100% nucleotide sequence identity to several species of Exophiala. Following recurrence after successive rounds of antifungal therapy, euthanasia was elected. At necropsy, similar dermal granulomatous inflammation and intralesional pigmented fungal elements as observed in excisional biopsies formed a thick band in the dermis and extended through the coelomic body wall. Visceral dissemination was noted in the lung and kidney. Postmortem DNA sequence analysis of a large portion of the fungal LSU as well as the internal transcribed spacer (ITS) from a portion of frozen affected dermis identified the fungus as a novel species, Exophiala sp. 1 (UTHSCSA R-5437).
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Affiliation(s)
- Cynthia Hopf
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Erin A. Graham
- Department of Comparative Diagnostic and Population Medicine, University of Florida College of Veterinary Medicine, Gainesville, FL, United States
| | - Connie F. C. Gibas
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Carmita Sanders
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - James Mele
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Hongxin Fan
- Department of Comparative Diagnostic and Population Medicine, University of Florida College of Veterinary Medicine, Gainesville, FL, United States
| | | | - Nathan P. Wiederhold
- Fungus Testing Laboratory & Molecular Diagnostics Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Robert Ossiboff
- Department of Comparative Diagnostic and Population Medicine, University of Florida College of Veterinary Medicine, Gainesville, FL, United States
- Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
| | - Noha Abou-Madi
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, United States
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45
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Schwartz IS, Wiederhold NP, Hanson KE, Patterson TF, Sigler L. Blastomyces helicus, a New Dimorphic Fungus Causing Fatal Pulmonary and Systemic Disease in Humans and Animals in Western Canada and the United States. Clin Infect Dis 2020; 68:188-195. [PMID: 29878145 PMCID: PMC6321858 DOI: 10.1093/cid/ciy483] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background Blastomyces helicus (formerly Emmonsia helica) is a dimorphic fungus first isolated from a man with fungal encephalitis in Alberta, Canada. The geographic range, epidemiology, and clinical features of disease are unknown. Methods We reviewed human and veterinary isolates of B. helicus identified among Blastomyces and Emmonsia isolates at the University of Alberta Microfungus Collection and Herbarium, University of Texas Health San Antonio’s Fungus Testing Laboratory, and Associated Regional and University Pathologists Laboratories. Isolates were selected based on low Blastomyces dermatitidis DNA probe values and/or atypical morphology. Species identification was confirmed for most isolates by DNA sequence analysis of the internal transcribed spacer with or without D1/D2 ribosomal RNA regions. Epidemiological and clinical data were analyzed. Results We identified isolates from 10 human and 5 veterinary cases of B. helicus infection; all were referred from western regions of Canada and the United States. Isolates remained sterile in culture, producing neither conidia nor sexual spores in the mycelial phase, but often producing coiled hyphae. Isolates were most frequently cultured from blood and bronchoalveolar lavage in humans and lungs in animals. Most infected persons were immunocompromised. Histopathological findings included pleomorphic, small or variably sized yeast-like cells, with single or multiple budding, sometimes proliferating to form short, branching, hyphal-like elements. Disease carried a high case-fatality rate. Conclusions Blastomyces helicus causes fatal pulmonary and systemic disease in humans and companion animals. It differs from B. dermatitidis in morphological presentation in culture and in histopathology, by primarily affecting immunocompromised persons, and in a geographic range that includes western regions of North America.
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.,San Antonio Center for Medical Mycology
| | - Nathan P Wiederhold
- San Antonio Center for Medical Mycology.,Fungus Testing Laboratory, University of Texas Health San Antonio
| | - Kimberly E Hanson
- Division of Infectious Diseases, Department of Medicine.,Clinical Microbiology Division, Department of Pathology, University of Utah, Salt Lake City
| | - Thomas F Patterson
- San Antonio Center for Medical Mycology.,South Texas Veterans Health Care System, San Antonio
| | - Lynne Sigler
- Department of Biological Sciences, University of Alberta, Edmonton, Canada
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46
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Patterson JE, McElmeel L, Wiederhold NP. In Vitro Activity of Essential Oils Against Gram-Positive and Gram-Negative Clinical Isolates, Including Carbapenem-Resistant Enterobacteriaceae. Open Forum Infect Dis 2019; 6:ofz502. [PMID: 31844638 PMCID: PMC6902000 DOI: 10.1093/ofid/ofz502] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background There is increasing demand for compounds to treat antimicrobial-resistant pathogens, and essential oils have gained interest. Moreover, previous studies have demonstrated antimicrobial activity of these nonpharmaceutical products. We investigated the activity of essential oils against multiresistant bacteria and other clinical isolates to evaluate the potential of their use topically and/or internally for treatment of bacterial infections. Methods We studied the in vitro activity of 10 essential oils and 1 essential oil blend against clinical isolates including extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus. Results Essential oils of oregano, thyme, cinnamon bark, and lemongrass had the largest zones of inhibition against Gram-positive organisms, whereas cinnamon bark had the largest zone of inhibition against P aeruginosa. Oregano, thyme, and cinnamon bark had the largest zones of inhibition against Enterobacteriaceae. Conclusions Essential oils have promising in vitro activity that warrants further study of their activity and use in the clinical setting.
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Affiliation(s)
- Jan E Patterson
- Departments of Medicine/Infectious Diseases and Pathology, Department of Pathology, University of Texas Health San Antonio, Long School of Medicine, San Antonio, Texas, USA
| | - Leticia McElmeel
- Departments of Medicine/Infectious Diseases and Pathology, Department of Pathology, University of Texas Health San Antonio, Long School of Medicine, San Antonio, Texas, USA
| | - Nathan P Wiederhold
- Departments of Medicine/Infectious Diseases and Pathology, Department of Pathology, University of Texas Health San Antonio, Long School of Medicine, San Antonio, Texas, USA
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47
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Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, Mellinghoff SC, Mer M, Pana ZD, Seidel D, Sheppard DC, Wahba R, Akova M, Alanio A, Al-Hatmi AMS, Arikan-Akdagli S, Badali H, Ben-Ami R, Bonifaz A, Bretagne S, Castagnola E, Chayakulkeeree M, Colombo AL, Corzo-León DE, Drgona L, Groll AH, Guinea J, Heussel CP, Ibrahim AS, Kanj SS, Klimko N, Lackner M, Lamoth F, Lanternier F, Lass-Floerl C, Lee DG, Lehrnbecher T, Lmimouni BE, Mares M, Maschmeyer G, Meis JF, Meletiadis J, Morrissey CO, Nucci M, Oladele R, Pagano L, Pasqualotto A, Patel A, Racil Z, Richardson M, Roilides E, Ruhnke M, Seyedmousavi S, Sidharthan N, Singh N, Sinko J, Skiada A, Slavin M, Soman R, Spellberg B, Steinbach W, Tan BH, Ullmann AJ, Vehreschild JJ, Vehreschild MJGT, Walsh TJ, White PL, Wiederhold NP, Zaoutis T, Chakrabarti A. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19:e405-e421. [PMID: 31699664 PMCID: PMC8559573 DOI: 10.1016/s1473-3099(19)30312-3] [Citation(s) in RCA: 804] [Impact Index Per Article: 160.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/10/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Abstract
Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
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Affiliation(s)
- Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany.
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Dorothee Arenz
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, and the Department of Infectious Diseases, Westmead Hospital, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Eric Dannaoui
- Université Paris-Descartes, Faculté de Médecine, APHP, Hôpital Européen Georges Pompidou, Unité de Parasitologie-Mycologie, Service de Microbiologie, Paris, France
| | - Bruno Hochhegger
- Radiology, Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, Brazil; Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven and Clinical Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Russell E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Mervyn Mer
- Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Zoi D Pana
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Danila Seidel
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Donald C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Roger Wahba
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alexandre Alanio
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Abdullah M S Al-Hatmi
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands; Centre of Expertise in Mycology RadboudUMC/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; Ministry of Health, Directorate General of Health Services, Ibri, Oman
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University School of Medicine, Sıhhiye Ankara, Turkey
| | - Hamid Badali
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ronen Ben-Ami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Medical Center, Tel- Aviv, Israel
| | - Alexandro Bonifaz
- Dermatology Service & Mycology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Stéphane Bretagne
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Methee Chayakulkeeree
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arnaldo L Colombo
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dora E Corzo-León
- Department of Epidemiology and Infectious Diseases, Hospital General Dr Manuel Gea González, Mexico City, Mexico; Medical Mycology and Fungal Immunology/Wellcome Trust Strategic Award Program, Aberdeen Fungal Group, University of Aberdeen, King's College, Aberdeen, UK
| | - Lubos Drgona
- Oncohematology Clinic, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Andreas H Groll
- InfectiousDisease Research Program, Department of Paediatric Hematology/Oncology and Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany
| | - Jesus Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación v Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Claus-Peter Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nikolay Klimko
- Department of Clinical Mycology, Allergology and Immunology, North Western State Medical University, St Petersburg, Russia
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Fanny Lanternier
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Cornelia Lass-Floerl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Korea
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Badre E Lmimouni
- School of Medicine and Pharmacy, University Mohammed the fifth, Hay Riad, Rabat, Morocco
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iaşi, Romania
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rita Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Yaba, Lagos, Nigeria; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Livio Pagano
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli -IRCCS- Universita Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Pasqualotto
- Federal University of Health Sciences of Porto Alegre, Hospital Dom Vicente Scherer, Porto Alegre, Brazil
| | - Atul Patel
- Infectious Diseases Clinic, Vedanta Institute of Medical Sciences, Navarangpura, Ahmeddabad, India
| | - Zdenek Racil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Malcolm Richardson
- UK NHS Mycology Reference Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Markus Ruhnke
- Hämatologie & Internistische Onkologie, Lukas-Krankenhaus Bünde, Onkologische Ambulanz, Bünde, Germany
| | - Seyedmojtaba Seyedmousavi
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran; Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Neeraj Sidharthan
- Department of Hemato Oncology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham University, Kochi, India
| | - Nina Singh
- Division of Infectious Diseases, University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System, Infectious Diseases Section, University of Pittsburgh, Pittsburgh, PA, USA
| | - János Sinko
- Infectious Diseases Unit, Szent Istvan and Szent Laszlo Hospital, Budapest, Hungary
| | - Anna Skiada
- Department of Infectious Diseases, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Monica Slavin
- University of Melbourne, Melbourne, VIC, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Melbourne, VIC, Australia
| | - Rajeev Soman
- P D Hinduja Hospital & Medical Research Centre, Department of Medicine, Veer Sarvarkar Marg, Mumbai, India
| | - Brad Spellberg
- Los Angeles County and University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - William Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapur, Singapore
| | - Andrew J Ullmann
- Department for Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Jörg J Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas J Walsh
- Departments of Medicine, Pediatrics, Microbiology & Immunology, Weill Cornell Medicine, and New York Presbyterian Hospital, New York City, NY, USA
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, UHW, Heath Park, Cardiff, UK
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Bose P, McCue D, Wurster S, Wiederhold NP, Kadia TM, Borthakur G, Ravandi-Kashani F, Masarova L, Konopleva M, Estrov Z, Takahashi K, Yilmaz M, Rausch CR, Marx K, Qiao W, Huang X, Bivins CA, Pierce SA, Kantarjian HM, Kontoyiannis DP. 2121. Isavuconazole (ISAV) as Primary Anti-Fungal Prophylaxis (PAP) in Patients with Acute Myeloid Leukemia (AML) or Myelodysplastic Syndrome (MDS): An Open-Label, Prospective Study. Open Forum Infect Dis 2019. [PMCID: PMC6811325 DOI: 10.1093/ofid/ofz360.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Mold-active antifungal prophylaxis (ppx) is recommended in neutropenic patients with newly diagnosed AML or MDS. ISAV is an extended spectrum triazole with superior tolerability, reliability of absorption, fewer drug–drug interactions, lack of QTc prolongation or need for therapeutic drug monitoring, approved for the treatment of invasive aspergillosis (IA) and mucormycosis. NCT03019939 is an investigator-initiated, phase 2 trial of PAP with ISAV in patients with AML/MDS. Methods Treatment-naïve adult patients with AML or MDS initiating remission-induction chemotherapy (RIC) received ISAV per the dosing recommendations in the United States label until recovery from neutropenia (neutrophils (ANC) ≥ 0.5 × 109/L) and attainment of complete remission (CR), occurrence of proven or probable invasive fungal infection (IFI, EORTC/MSG criteria), or for a maximum of 12 weeks. The primary endpoint was incidence of proven/probable IFI during the study period (up to 30 days from the last dose of ISAV). Results 67 patients were enrolled (April 28, 2017 to February 14, 2019) and 60 patients were eligible for assessment (median age 67 years, 57 patients with AML, median ANC on enrollment was 660). Reasons for study completion were achievement of CR with ANC recovery (n = 35), completion of 12 weeks of PAP (n = 9), possible IFI (n = 7), investigator decision (n = 3), death (n = 2, 1 disease progression, 1 cardiac arrest), proven/probable IFI (n = 3), and mild transaminitis, possibly ISAV-related (n = 2). The median durations of neutropenia and ISAV ppx were 33 (7–86) and 31 (7–86) days, respectively. One microbiologically-proven (gluteal abscess due to Candida glabrata) and 2 cases of probable breakthrough IFIs (probable IA with positive galactomannan) occurred (IFI incidence 5%). ISAV trough serum concentrations were available in 31 patients on both day 8 (median 3.74 µg/mL, 2.03–7.65) and day 15 (median 4.10 µg/mL, 2.17–9.25), and were not significantly different. Conclusion ISAV is a safe and effective alternative for PAP in patients with newly diagnosed AML/MDS undergoing RIC, with a breakthrough (proven/probable) IFI rate of 5%. ISAV serum levels were adequate in patients with AML/MDS undergoing RIC. Pharmacological features make ISAV attractive for PAP in the era of recently approved or emerging small-molecule AML therapies. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Prithviraj Bose
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David McCue
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Nathan P Wiederhold
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Tapan M Kadia
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gautam Borthakur
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Lucia Masarova
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marina Konopleva
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeev Estrov
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Koichi Takahashi
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Musa Yilmaz
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caitlin R Rausch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kayleigh Marx
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Qiao
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xuelin Huang
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carol A Bivins
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherry A Pierce
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Wiederhold NP, Locke JB, Daruwala P, Bartizal K. Rezafungin (CD101) demonstrates potent in vitro activity against Aspergillus, including azole-resistant Aspergillus fumigatus isolates and cryptic species. J Antimicrob Chemother 2019; 73:3063-3067. [PMID: 30032217 DOI: 10.1093/jac/dky280] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/18/2018] [Indexed: 11/12/2022] Open
Abstract
Background Rezafungin is an investigational echinocandin under development for the treatment and prevention of invasive fungal infections, with a long half-life in humans (∼130 h) and potent in vitro activity against Aspergillus spp. Our objective was to further evaluate its activity against Aspergillus fumigatus isolates, including azole-resistant isolates and cryptic Aspergillus spp. Methods Clinical isolates of Aspergillus were used, including 15 WT and 31 azole-resistant A. fumigatus, 11 Aspergillus lentulus, 5 each of Aspergillus thermomutatus and Aspergillus udagawae and 11 Aspergillus calidoustus. Minimum effective concentrations (MECs) and MICs of rezafungin, caspofungin, micafungin, posaconazole and voriconazole were determined by CLSI M38-A2 broth microdilution. Differences in geometric mean (GM) MEC/MIC values were assessed for significance by ANOVA. Results Rezafungin GM MECs for A. fumigatus were 0.024 and 0.043 mg/L for WT and azole-resistant isolates, respectively. Rezafungin was also active against cryptic species, including A. lentulus (0.016 mg/L), A. calidoustus (0.044 mg/L), A. thermomutatus (MEC range ≤0.015-0.25 mg/L) and A. udagawae (≤0.015-0.03 mg/L). This activity was similar to that of caspofungin and micafungin with the exception of A. calidoustus, against which rezafungin was more potent than caspofungin (GM MEC 0.044 versus 0.468 mg/L; P < 0.0001). Conclusions Rezafungin demonstrated potent in vitro activity against Aspergillus spp., including azole-resistant A. fumigatus isolates and cryptic species with elevated posaconazole and voriconazole MICs. Additional studies are warranted to determine whether the in vitro activity translates into in vivo efficacy against infections caused by resistant Aspergillus isolates.
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Affiliation(s)
- Nathan P Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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50
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van Duijkeren E, Hope R, Wiederhold NP. Preface. J Antimicrob Chemother 2019. [DOI: 10.1093/jac/dkz373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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