BACKGROUND:Chronic and recalcitrant dermatophytosis has become increasingly problematic in dermatology practice, largely due to emerging antifungal resistance, affecting not only terbinafine but also azoles. Among the causative agents, Trichophyton indotineae has emerged as a key pathogen associated with treatment failure, extensive disease, and frequent relapse, even in immunocompetent patients. OBJECTIVE:This study aimed to evaluate and compare two rapid molecular diagnostic approaches: A commercial multiplex qPCR assay (DermaGenius Resistance Multiplex PCR, DermaGenius RMP) and a T. indotineae-specific in-house qPCR assay, focusing on their practical value for early detection of recalcitrant dermatophyte infections and terbinafine resistance in routine dermatology practice. METHODS:Sixty-four dermatophyte isolates obtained from patients with chronic or treatment-resistant dermatophytosis in Türkiye wereanalysed. Species identification and detection of squalene epoxidase (SQLE) gene mutations associated with terbinafine resistance were performed using DermaGenius RMP and the in-house T. indotineae-specific qPCR assay, with confirmatory ITS/SQLE sequencing and CLSI microbroth dilution antifungal susceptibility testing. RESULTS:Overall concordance between the two qPCR methods was 93.8% (κ = 0.74, z = 5.99, p < 0.001) for T. indotineae identification. Most recalcitrant cases were caused by T. indotineae, and SQLE mutations were detected in > 90% of these isolates, consistent with the observed clinical resistance. DermaGenius RMP enabled rapid, standardised detection of terbinafine resistance-associated mutations suitable for routine diagnostics, whereas the in-house qPCR provided highly specific identification of T. indotineae. Notably, 10 T. indotineae isolates harboured the SQLE F397L substitution despite terbinafine susceptibility. CONCLUSIONS:Rapid molecular diagnostics, particularly qPCR-based assays, provide actionable information early in the course of infection. In this study, both assays showed comparable performance for T. indotineae detection. Prompt identification of T. indotineae and associated resistance mutations may help avoid ineffective antifungal therapy, reduce chronicity, and support rational treatment decisions in routine clinical practice.
BACKGROUND:Dermatophytosis is a common superficial fungal infection that is increasingly complicated by terbinafine (TRB)-resistant strains, especially Trichophyton indotineae. Conventional antifungals often show limited efficacy against resistant isolates, highlighting the need for novel treatments. This study evaluated the efficacy and safety of nanostructured lipid carrier-loaded luliconazole (NLC-LCZ) gel in TRB-resistant dermatophytosis. MATERIALS AND METHODS:In a randomized, clinical trial conducted at Touba Specialty Clinic, Sari, Iran, forty-eight adults with confirmed TRB-resistant dermatophytosis were assigned to oral itraconazole (ITZ), topical luliconazole, NLC-LCZ gel, or ITZ + NLC-LCZ gel for 4 weeks (n = 12 each). The primary endpoint was complete recovery (clinical and mycological), while secondary endpoints included lesion size, itch, inflammation, Dermatology Life Quality Index (DLQI), and safety. RESULTS:Complete recovery occurred in 83.3% of ITZ + NLC-LCZ, 75% of NLC-LCZ, 58.3% of LCZ, and 0% of ITZ alone. LCZ and NLC-LCZ had lower MIC50/ MIC90 values (0.016 μg/mL) compared with ITZ (MIC90: 8 μg/mL) and TRB (MIC90: 4 μg/mL). DLQI improved most in NLC-LCZ (score: 2) and ITZ + NLC-LCZ (score: 3) groups (p < 0.001). Adverse events were mild and did not require discontinuation. CONCLUSIONS:These findings indicate that NLC-LCZ enhanced antifungal efficacy and quality of life in TRB-resistant dermatophytosis, and that combination therapy with ITZ + NLC-LCZ yielded the highest recovery, representing a promising strategy against resistant infections.
BACKGROUND:The emergence of Trichophyton indotineae as a multidrug-resistant dermatophyte has challenged conventional therapeutic approaches for dermatophytosis, leading to a significant therapeutic dilemma. The absence of formal epidemiological cutoff values (ECVs) under the Clinical and Laboratory Standards Institute (CLSI) framework has led to inconsistent interpretation of antifungal susceptibility testing (AFST) data, highlighting the urgent need for standardised susceptibility interpretation criteria and effective therapeutic strategies. OBJECTIVES:This study aimed to (1) establish CLSI-based estimated tentative ECVs (ET-ECVs) to facilitate reliable minimum inhibitory concentration (MIC) interpretation; (2) analyse resistance rates of T. indotineae to terbinafine, itraconazole and voriconazole using a large-scale global dataset and (3) explore and identify effective therapeutic options following first-line treatment failure. METHODS:This systematic review compiled global susceptibility data for T. indotineae through comprehensive literature searches, including only studies that performed CLSI- or European Committee on Antimicrobial Susceptibility Testing (EUCAST)-standardised AFST. Furthermore, the clinical efficacy of voriconazole was specifically evaluated by summarising and analysing reported treatment cases. RESULTS:A total of 67 studies from 14 countries, comprising 981 isolates, were included. The proposed CLSI ET-ECVs for terbinafine, itraconazole and voriconazole were 0.125, 0.25 and 1 mg/L, respectively, showing full alignment with EUCAST tentative epidemiological cutoff values (TECOFFs). Integrated resistance rates were 77.6% for terbinafine, 17.0% for itraconazole and 1.4% for voriconazole. Cross-resistance analysis revealed that terbinafine resistance predominated, with 14.3% of isolates co-resistant to itraconazole. In vitro susceptibility data demonstrated high activity of voriconazole and clinical case summaries further confirmed its favourable therapeutic efficacy, with complete remission reported in all evaluated cases. CONCLUSION:This study defined the CLSI ET-ECVs for interpreting T. indotineae MICs, highlighted the resistance burden to first-line agents and provided in vitro evidence supporting further evaluation of voriconazole as a potential effective alternative therapy. These findings may provide critical warnings regarding the high-resistance landscape and help guide antifungal susceptibility interpretation for this emerging multidrug-resistant pathogen.
BACKGROUND:Tinea capitis (TC) presents with diverse clinical manifestations that may complicate diagnosis. Dermoscopy is a useful adjunctive tool, but data correlating dermoscopic findings with clinical and mycological characteristics in Korean patients remain limited. OBJECTIVE:To characterize dermoscopic features of TC in Korean patients and evaluate their associations with clinical subtypes, age distributions and causative dermatophytes. METHODS:We retrospectively analysed 71 patients with mycologically confirmed TC diagnosed between 2011 and 2025. Dermoscopic patterns were compared across clinical subtypes, fungal species and age groups. Representative dystrophic hairs were further examined using super-resolution confocal laser scanning microscopy. RESULTS:The cohort demonstrated a bimodal age distribution, with peaks in children (≤ 10 years) and elderly adults (≥ 61 years). Microsporum canis was the predominant pathogen (71.8%). The most frequent dermoscopic findings were scaling (83.1%), black dots (78.9%), follicular hyperkeratosis (78.9%) and broken hairs (78.9%). Empty follicles were significantly associated with Trichophyton infections (p = 0.001), whereas zigzag hairs, Morse code-like hairs, bent hairs and scaling were significantly more frequent in Microsporum infections (p < 0.05). Comma hairs were commonly observed in diffuse pustular and black dot subtypes. Children more often exhibited Morse code-like hairs, whereas elderly patients showed higher rates of empty follicles and perifollicular erythema. Confocal microscopy confirmed distinct structural shaft damage corresponding to characteristic dermoscopic patterns. CONCLUSION:Dermoscopy provides valuable diagnostic and aetiological clues in TC, enabling differentiation between clinical subtypes and prediction of causative fungal species. These findings are especially relevant in adult-predominant, Microsporum-endemic settings and support dermoscopy as an important adjunct to routine clinical evaluation.
Aim Metamizole is an analgesic drug with moderate cytochrome P450 (CYP) inductive properties. The antifungal triazoles are metabolized by several CYP enzymes, but the interaction with metamizole remains poorly described. We investigated the influence of metamizole on the exposure of voriconazole, isavuconazole, and posaconazole.Methods Patients from UZ Leuven (Belgium) and Ljubljana University Medical Centre (Slovenia) receiving voriconazole, isavuconazole, or posaconazole concomitantly with metamizole were included in the study. Routine therapeutic drug monitoring (TDM) measurements collected between January 2019 and December 2024 were retrieved retrospectively. TDM concentrations outside of concomitant therapy were collected as controls. The influence of metamizole and other clinically relevant covariates was analysed using generalized estimating equations (GEE).Results A total of 126 distinct treatments with a triazole from 115 patients, accounting for 392 measurements, were included in the study. GEE analysis revealed a significant negative association between the 7-day cumulative metamizole dose and lower voriconazole and posaconazole concentrations. Additionally, C-reactive protein had a positive association with voriconazole concentrations. Only ICU admission and patient characteristics, that is, sex and weight, had a significant influence on isavuconazole concentrations.Conclusion Concomitant therapy with metamizole led to lower voriconazole and posaconazole concentrations, presumably through induction of CYP enzymes and possibly UDP-glucuronyltransferase. We recommend avoiding concomitant use of metamizole with the antifungal triazoles to prevent underexposure and treatment failure or frequent TDM if the combination cannot be avoided. Further studies are needed to confirm our findings and investigate the influence of metamizole on other triazoles.
BACKGROUND:Invasive fungal infections (IFIs) represent a major complication after intestine transplantation, with reported incidence rates between 40% and 49%. These infections are associated with high morbidity and allograft loss. This study evaluates the impact of post-transplant IFIs on graft outcomes in intestine transplant recipients. METHODS:We conducted a retrospective cohort study of 152 patients who underwent intestine transplantation from 2008 to 2022. The primary outcome was IFI, defined as proven or probable by EORTC/MSGERC criteria. The secondary outcome was a composite of allograft failure or death. Analyses were conducted using multivariable Cox proportional hazards models, with non-baseline variables incorporated as time-dependent exposures. RESULTS:Among 152 intestine transplant recipients, 56 (36.8%) developed post-transplant IFI. Median time to IFI was 83.5 days (IQR 19.5-444.2), with Candida infections occurring early and non-Candida infections occurring later. Candida species accounted for 73% of IFIs, most commonly C. glabrata, C. albicans, and C. parapsilosis, with 29.3% showing fluconazole resistance. Most infections were intra-abdominal and bloodstream. Redo transplantation (HR 2.44, 95% CI 1.20-4.95; p = 0.014), anastomotic leak (HR 2.23, 95% CI 1.02-4.90; p = 0.045), and augmented immunosuppression (HR 4.73, 95% CI 1.94-11.53; p < 0.001) were independent predictors of Candida IFI. IFI was associated with a markedly increased risk of allograft loss or death (HR 3.67, 95% CI 2.30-5.83; p < 0.001). CONCLUSIONS:Post-transplant IFIs are common and associated with allograft loss or mortality in intestine transplant recipients. Early recognition and aggressive management of IFIs remain critical to improving transplant outcomes.
BACKGROUND:Histoplasmosis is an endemic mycosis in the Americas. While urinary Histoplasma antigen enzyme immunoassay testing (HAET) has been validated mainly in HIV-infected patients with disseminated disease, its performance in HIV-negative populations with heterogeneous clinical presentations is unclear. OBJECTIVES:To describe the performance of urinary HAET for the diagnosis of histoplasmosis in a cohort of Brazilian HIV-negative patients. MATERIAL AND METHODS:We conducted a retrospective study at Einstein Hospital Israelita (Brazil) including HIV-negative patients whose urine samples were analysed by Histoplasma antigen enzyme immunoassay test (HAET) from January 2022 to October 2025. Factors associated with positive urinary HAET were analysed using univariable and multivariable models. Among 346 patients, histoplasmosis was diagnosed in 43 (12%); 16 (37%) were immunocompromised and 14 (33%) had disseminated disease. Urinary HAET was positive in eight patients (19%), with antigen levels from 0.3 to > 15 ng/mL. Sensitivity and specificity were 19% and 100%, respectively; positive and negative predictive values were 100% and 90%. Sensitivity increased to 45% in immunocompromised patients with multiorgan involvement, and immunocompromised status independently predicted HAET positivity (p = 0.008). In HIV-negative patients, HAET demonstrates excellent specificity but low sensitivity, performing best in immunocompromised individuals with disseminated histoplasmosis.
BACKGROUND:Aspergillus fumigatus resistance to triazole antifungals poses an increasing global health concern. Moreover, the cross-resistance between azole antifungal agents used in clinical settings and those applied in agriculture has become an important emerging issue. OBJECTIVES:In this study, we investigated the five environmental A. fumigatus strains showing reduced susceptibility to tebuconazole. METHODS:Fungal strains were recovered from air samples collected around the homes of two patients with suspected aspergillosis caused by resistant isolates. Species identification was performed by sequencing the β-tubulin gene, and minimum inhibitory concentrations were determined by broth microdilution. The cyp51A gene was sequenced to detect mutations, and CRISPR-Cas9 genome editing was employed to investigate their influence on susceptibility patterns. Microsatellite genotyping was performed to assess genetic variability, followed by whole genome sequencing and single nucleotide polymorphism analysis. RESULTS:The environmental strains presented the same cyp51A genotype characterised by the M172V substitution and silent mutations. Microsatellite genotyping and whole genome sequencing confirmed that the strains were clonal. Functional validation demonstrated that the M172V and silent mutations partially contribute to reduced susceptibility to tebuconazole but are not the main mechanism of resistance involved. Analysis of polymorphisms in genes other than cyp51A revealed no resistance-conferring mutations. CONCLUSIONS:The findings described herein suggest the possibility of local clonal dissemination of environmental strains under selective pressure from agricultural azoles in a major agribusiness region of the Midwest of Brazil. This study highlights the silent spread of potentially resistant genotypes in urban areas and reinforces the need for environmental surveillance and expanded genomic monitoring in South America.
Background Filamentous fungi cause a wide range of superficial and invasive infections, and antifungal susceptibility assay is essential for guiding effective therapy. Standard broth microdilution methods rely on microconidia-based inocula; however, many clinically important moulds produce insufficient microconidia due to intrinsic characteristics or culture conditions, limiting the applicability of conventional testing and often necessitating empirical treatment.Objectives To overcome this limitation, we developed an alternative method using precisely quantified mycelial cell suspensions for MIC determination.Methods The method was evaluated using 115 fungal strains and compared with traditional microconidia-based testing.Results High concordance was observed between the two approaches, with agreement rates of 90% or higher across three common dermatophytes causing tinea infections and three representative fungi responsible for invasive infections.Conclusions This mycelial-based approach provides a reliable and practical alternative for antifungal susceptibility testing of poorly sporulating moulds and may improve the efficiency and accessibility of MIC testing in clinical laboratories.
Background The incidence of Candida tropicalis isolation is increasing in hospital settings. High azole resistance and mortality rates make it a pathogen that requires further analysis.Methods Fourteen azole resistant Candida glabrata clinical isolates were collected from a Lebanese hospital and analysed through whole genome sequencing for single nucleotide polymorphisms in key resistance and virulence genes, and for phylogenetic relatedness. Isolates were then characterised for pathogenicity related attributes.Results All isolates had Lys314Glu mutation in ERG20 with multiple isolates displaying numerous shared mutations, such as Glu291Lys in CDR2 and Ala16Thr in CDR3. With the exception of two isolates that clustered together, most isolates were over 99.6% identical based on a genomic heatmap, implying high relatedness consistent with localised clonal expansion, although SNP differences appeared too high to support this. However, the isolates exhibited increased ergosterol and chitin content, as well as upregulation of drug efflux pumps resulting in drug resistance.Conclusion Our hospital isolates showed convergent resistant pathways, with many isolates having both shared and unique mutations and a high degree of genomic similarities.
Background Candida auris is a globally emerging multidrug-resistant fungus. Its dissemination is driven by patient movement and asymptomatic carriers. However, molecular epidemiological studies linking imported cases to local strains in large metropolitan areas remain limited.Objectives To analyse the molecular epidemiology and resistance mechanisms of 33 clinical isolates in Shanghai and propose an integrated infection control strategy tailored to metropolitan healthcare settings.Methods Isolates from 19 patients were identified via MALDI-TOF MS and sequencing. Antifungal susceptibility and biofilm formation were assessed. Environmental contamination was evaluated using PCR. Whole-genome sequencing (WGS) was employed to identify resistance mutations and perform phylogenetic analysis.Results All 33 isolates were fluconazole-resistant. Resistance to amphotericin B and echinocandins was observed in 9 and 4 isolates, respectively. All echinocandin-resistant strains harboured the Fks1-S639F mutation. Phylogenetic analysis revealed that Clade III (South African clade) was the dominant lineage. Colonisation was concentrated in the urinary tract and inguinal regions, while bedside tables were identified as key environmental reservoirs. All strains exhibited strong biofilm-forming capacity.Conclusions ICU patients serve as primary reservoirs, with transmission driven by interregional movement. The distinct colonisation patterns and environmental hotspots provide specific targets for screening. Integrating PCR-based environmental monitoring with culture methods constitutes an effective strategy. These findings underscore the need for a standardised protocol integrating molecular diagnostics to optimise infection control in urban hospitals.
BACKGROUND:Malassezia spp. are part of the microbiota of many animals, including humans. However, under certain conditions, they can become pathogenic. Diseases associated with Malassezia include pityriasis versicolor (PV), seborrheic dermatitis (SD), Malassezia folliculitis, atopic dermatitis, psoriasis and fungemia. OBJECTIVE:The present study aimed to describe the distribution of Malassezia species among Brazilian patients with PV and SD and to evaluate their susceptibility profiles to common antifungals. METHODS:In this study, 102 clinical samples from patients with PV or SD were analysed. Clinical isolates of Malassezia were identified at the species level by sequencing the D1/D2 variable domains of the large subunit rRNA gene. Antifungal susceptibility was assessed using a modified microbroth dilution method adapted for the growth of Malassezia species. RESULTS:Among the 40 cultures obtained, six Malassezia species were identified. M. furfur was the most prevalent species (40.0%), followed by M. sympodialis (27.5%), M. globosa (15.0%), M. japonica (7.5%) and both M. yamatoensis and M. slooffiae (5.0% each). All isolates exhibited high MICs to caspofungin (> s16 μg/mL) and to isoconazole (MIC₅₀ = 8 μg/mL). Miconazole and clotrimazole showed MIC₅₀ values of 4 μg/mL, while itraconazole and ketoconazole were more active, with an MIC₅₀ of 0.125 μg/mL. CONCLUSION:This study showed the diversity of Malassezia species causing PV and SD in Brazil, including the rare species M. yamatoensis and M. japonica. These findings highlight the importance of antifungal susceptibility testing for these species to guide appropriate therapy.
BACKGROUND:Dermatophytosis remains one of the most prevalent superficial fungal infections worldwide, increasingly complicated by the emergence of terbinafine-resistant Trichophyton indotineae. Despite its global spread, molecular and clinical data from the United Arab Emirates (UAE) remain limited. OBJECTIVES:We conducted the first comprehensive molecular and phenotypic characterization of dermatophyte infections in the UAE to define the local epidemiology, antifungal resistance patterns and clinical outcomes. METHODS:Between September 2024 and March 2025, 33 consecutive clinical dermatophyte isolates associated with tinea infections were collected through passive laboratory-based surveillance across the Abu Dhabi Emirate. Isolates underwent macroscopic and microscopic examination, urease testing, internal transcribed spacer (ITS) genotyping for species identification and sequencing of the squalene epoxidase (SQLE) gene to detect mutations associated with terbinafine resistance. Phylogenetic analyses were conducted using reference ITS genotypes. Antifungal susceptibility testing was conducted on 28 isolates following CLSI M38 guidelines. RESULTS:Among the 33 isolates, 26 (78.8%) were confirmed as T. indotineae, with SQLE mutations detected in 88.5% of isolates, most frequently Phe397Leu and Ala448Thr. Terbinafine demonstrated high non-wild-type rates (63.6%; MIC₅₀/MIC₉₀: 2/> 2 μg/mL), while itraconazole and griseofulvin retained activity. Significant inter-laboratory discordance was observed (6.1% agreement), with conventional methods failing to detect any T. indotineae cases. Most patients (84.8%) reported no travel history, indicating autochthonous transmission. Clinical outcomes were poor despite prolonged combination therapy: only 30.8% achieved improvement while 69.2% experienced recurrence. CONCLUSIONS:This study provides baseline evidence of endemic terbinafine-resistant T. indotineae in the UAE, underscoring urgent needs for molecular diagnostics, routine susceptibility testing and antifungal stewardship programs to guide effective management strategies.
OBJECTIVES:Sputum is a commonly collected specimen for suspected respiratory fungal infections due to its non-invasive nature and diagnostic value. However, conventional culture at 29°C (CC29) often fails to detect filamentous moulds. To improve recovery, we applied a high-volume culture incubated at 37°C (HVC37) and compared its diagnostic performance with CC29, with particular focus on Aspergillus species and azole-resistant isolates. METHODS:Between October 2022 and June 2025, a total of 1546 sputum samples from 793 patients, including 219 samples from 67 patients with chronic pulmonary aspergillosis (CPA), were cultured in parallel using HVC37 (0.5-1 mL inoculum) and CC29 (1-10 μL inoculum) on Sabouraud agar for 7 days. Positivity rates for moulds and Aspergillus species were calculated with 95% confidence intervals. Antifungal susceptibility testing followed EUCAST standards. RESULTS:High-volume culture incubated at 37°C (HVC37) markedly outperformed CC29 for detection of both moulds and Aspergillus species. Across all sputum samples, HVC37 achieved a mould positivity rate of 41.6% (95% CI 39.2%-44.1%) versus 27.7% (95% CI 25.5%-30.0%) with CC29. The improvement was most evident for Aspergillus detection: 37.0% (95% CI 34.7%-39.5%) for HVC37 compared with 11.5% (95% CI 10.0%-13.2%) for CC29, an absolute increase of 25.5%. Both methods together yielded the highest overall detection rates for moulds (54.0%) and Aspergillus species (42.1%). In patients with CPA, HVC37 detected moulds in 53.0% of samples and Aspergillus species in 45.2%, compared with 30.6% and 15.5%, respectively, for CC29. Importantly, of 46 azole-resistant A. fumigatus isolates recovered, HVC37 detected 42 (91.3%), whereas CC29 detected only 20 (43.5%). CC29 mainly identified environmental moulds such as Penicillium species, not detected by HVC37. CONCLUSIONS:High-volume culture at 37°C substantially improves the detection of filamentous moulds in sputum, especially Aspergillus species and clinically relevant azole-resistant A. fumigatus. Incorporating HVC37 into routine mycology workflows can significantly enhance fungal diagnosis and antifungal resistance surveillance.
BACKGROUND:Although Aspergillus fumigatus remains the primary cause of invasive aspergillosis, other species-including emerging cryptic ones-are increasingly identified in clinical settings. These species often exhibit distinct antifungal susceptibility profiles, emphasising the importance of species-level identification for effective patient management. Galactomannan, once considered specific to A. fumigatus, is now widely used for aspergillosis diagnosis regardless of species. However, its performance in detecting non-fumigatus infections remains insufficiently characterised. OBJECTIVE:To evaluate the diagnostic performance of the Sōna GM LFA (IMMY) in BAL samples from patients with pulmonary infections attributed to different Aspergillus spp., including cryptic species. METHODS:We evaluated the diagnostic performance of the Sōna galactomannan LFA (IMMY) in bronchoalveolar lavage samples from 49 patients (15% paediatric) with probable invasive aspergillosis or COVID-associated pulmonary aspergillosis, confirmed by microscopy and culture. RESULTS:The etiologic agents comprised A. fumigatus sensu stricto (46.9%), A. terreus ss. (16.3%), A. flavus ss. (16.3%), A. niger ss. (6.1%), A. nidulans (4.1%) and five cryptic species (10.2%). Galactomannan index values varied across species and clinical group, with particularly low readings (0.09-0.31) in six cases (five involving cryptic species), suggesting reduced assay sensitivity for cryptic taxa. Paediatric samples also showed lower galactomannan levels compared to adults. CONCLUSIONS:This study highlights the limitations of galactomannan assays in detecting cryptic Aspergillus infections, showing consistently low galactomannan levels in BAL. Multicenter studies are needed to validate findings and refine clinical algorithms.
Background Candida species are common causes of nosocomial infections. Candida parapsilosis has emerged as an important pathogen. Mortality rates associated with invasive C. parapsilosis infections range from 14.5% to 47%, with azole resistance estimated between 4% and 15%. Resistance mechanisms include mutations in ERG11 that diminish azole binding, upregulation of ergosterol biosynthesis genes due to mutations in regulatory factors like UPC2 and NDT80, and increased efflux pump activity.Methods Thirty clinical strains of the C. parapsilosis complex were isolated from bloodstream cultures, biopsies and catheter tips from hospitalised patients from a major rehabilitation centre in Mexico between June 2011 and August 2016. Minimum inhibitory concentrations for fluconazole, voriconazole, itraconazole, caspofungin, micafungin, anidulafungin and amphotericin B were determined using the broth microdilution method. Whole genome sequencing was conducted using Illumina technology, with subsequent assembly and annotation. Analyses included antifungal resistance variant screening, SNP distance, average nucleotide identity and phylogenetic comparisons with publicly available genomes.Results Most strains (96.7%, 29/30) were identified as C. parapsilosis sensu stricto, predominantly isolated from blood. Thirty-three percent of isolates showed phenotypic resistance to fluconazole. The SNP-distance and maximum-likelihood phylogenetic analyses revealed two distinct haplotypes and the genotype 1: ERG11WT/Y132F, CDR1I1287V/I1287V and UPC2WT/N455D was the most represented (8/10 isolates).Conclusions C. parapsilosis sensu stricto was the predominant species isolated, with a notable proportion exhibiting resistance to FLU and VOR. The Y132F variant in the ERG11 gene was present in most sequenced isolates.
BACKGROUND:Fluconazole-resistant Candida parapsilosis is a matter of concern. OBJECTIVES:To investigate fluconazole resistance among Candida parapsilosis complex isolates from patients admitted to three Brazilian hospitals, and to characterise resistance mechanisms and clonal relatedness. PATIENTS/METHODS:A total of 76 C. parapsilosis complex isolates were collected from 60 patients hospitalised at three medical centres (H1-H3) located in Vitória, Espírito Santo state (2017-2023). Of these, 38 isolates were obtained from bloodstream cultures, four from catheter tips and 34 from an ICU surveillance study conducted at H1. In vitro susceptibility testing was performed according to the E.Def 7.4 EUCAST method. C. parapsilosis sensu stricto isolates were genotyped using microsatellite markers, and the ERG11 gene was sequenced in resistant isolates. RESULTS:Candida parapsilosis sensu stricto was the most common species (65/76 isolates; 85.5%), followed by C. orthopsilosis (n = 8, 10.5%), and C. metapsilosis (n = 3, 4%). Among the C. parapsilosis sensu stricto isolates, 5/65 (7.7%) were fluconazole-resistant, harboured the G458S ERG11p substitution, and were detected in 2019 and 2020. Only one fluconazole-resistant isolate was also voriconazole-resistant; all isolates were susceptible to the remaining agents. Fluconazole-resistant isolates sourced from H2 were grouped into two unrelated genotypes, and recovered from patients with haematological malignancies, tumours and central nervous system disorders. Only two patients had a history of azole exposure. CONCLUSIONS:This is the first report of fluconazole-resistant C. parapsilosis sensu stricto isolates harbouring the G458S ERG11p substitution in Brazil. Here reported isolates showed resistance to fluconazole alone, which is an unusual pattern among C. parapsilosis sensu stricto isolates harbouring the G458S substitution.
BACKGROUND:Superficial fungal infections (SFIs) are common dermatological conditions, and both domestic and international reports indicate an increasing incidence in recent years. Their prevalence is strongly affected by climate, temperature, humidity and lifestyle, resulting in significant regional variations. OBJECTIVE:To describe the epidemiological characteristics of superficial fungal infections in Shanghai, East China, from 2022 to 2024. METHODS:This single-centre retrospective observational study was conducted at Shanghai Skin Disease Hospital. Clinical specimens, including skin scales, hair and nails, were examined using KOH microscopy, followed by culture on Sabouraud dextrose agar. Fungal identification was primarily based on colony morphology and microscopic features. RESULTS:A total of 12,976 cases of superficial fungal infections were recorded during the study period. Onychomycosis was the most common infection (33.75%), followed by tinea cruris (20.05%) and tinea pedis (18.63%). Significant gender differences were identified: females showed higher rates of onychomycosis and tinea pedis, while males more frequently presented with tinea cruris, tinea corporis and other SFIs. The highest number of infections occurred in individuals aged 31-40 years, with onychomycosis, tinea pedis and tinea versicolor being most prevalent in this group. Among culture-positive samples, dermatophytes accounted for the majority (52.54%), with Trichophyton rubrum being the most frequently isolated species (44.27%). Dermatophyte infections were more common in males, whereas yeast infections were more frequent in females. Dermatophyte infections peaked in the 31-40 and 61-70 age groups, while yeast infections were most common among individuals aged 21-40. CONCLUSION:This study provides valuable epidemiological insights into superficial fungal infections in Shanghai, offering necessary guidance for clinical diagnosis, treatment decision-making and prevention strategies.
BACKGROUND:There is a lack of contemporary studies addressing the prevalence rates and antifungal susceptibility of bloodstream infections (BSI) caused by rare yeasts (RY) from the Saccharomycotina subphylum. OBJECTIVES:This 16-year multicentre study (2007-2023) aimed to assess the prevalence and antifungal susceptibility of rare yeasts isolated from BSIs in 28 Brazilian tertiary care hospitals. METHODS:Yeasts from the Saccharomycotina subphylum, excluding common Candida species and Basidiomycota, were selected from BSI episodes. Species were identified using proteomics and molecular methods. Antifungal susceptibility testing was performed by EUCAST broth microdilution. RESULTS:Among 2655 BSI episodes, 100 (3.76%) involved rare yeasts. Prevalence showed a slight, non-significant increase from 3.16% (2007-2015) to 4.17% (2016-2023; p = 0.183). A total of 11 genera and 20 species were identified, with Clavispora lusitaniae (20%), Wickerhamomyces anomalus (16%), Candida haemulonii (14%) and Candida duobushaemulonii (12%) being the most frequent species. Eight species, including Pichia kluyveri and Kodamaea ohmeri, appeared only in the latter period. Most rare yeasts showed low MICs to amphotericin B and anidulafungin, except for Clavispora lusitaniae, Candida haemulonii and Candida duobushaemulonii, which were less susceptible to amphotericin B. Wickerhamomyces anomalus and Candida duobushaemulonii also showed reduced susceptibility to fluconazole. CONCLUSIONS:This study provides valuable insights into the prevalence rates, species distribution and antifungal susceptibility of rare yeasts causing BSIs in tertiary care hospitals. Our findings highlight the need for continuous surveillance, incorporation of new diagnostic and tailored therapeutic strategies to mitigate morbidity and mortality due to invasive infections caused by emerging fungal pathogens.
BACKGROUND:Intra-abdominal candidiasis (IAC) is a severe and heterogeneous infection associated with significant morbidity and mortality. OBJECTIVES:To evaluate outcomes of IAC according to initial antifungal therapy and to identify predictors of persistent infection and 30-day mortality. METHODS:A retrospective non-randomised single-centre study (January 2020-February 2025) evaluated adult IAC according to the initial antifungal (azoles vs. echinocandins), assessing demographics, type, location, and persistent positive cultures, re-intervention, antifungal reintroduction, and 3- and 90-day mortality. Multivariate logistic regression identified predictors of persistent cultures and 30-day mortality, and inverse probability of treatment weighting (IPTW) addressed confounding in mortality analyses. RESULTS:Among 154 patients (median age 64.5 years, 66.9% male), 102 received azoles and 52 echinocandins, with greater severity in the latter group. Persistent positive cultures occurred in 51.7% (46/89), without difference between groups. Factors associated with persistent positive cultures included concomitant candidemia, septic shock, previous antibiotic usage, and peritonitis. The 30-day mortality was 28.1% (higher with echinocandins, 38.5% vs. 22.8% in azole group, p = 0.041). Multivariate logistic regression and IPTW indicated that the initial antifungal therapy did not affect 30-day mortality, while septic shock (OR:2.2, 95% CI:1.0-4.9; p = 0.047) and age ≥ 60 years (OR:2.6, 95% CI:1.1-6.3; p = 0.032) were significantly associated with it. CONCLUSIONS:IAC remains a complex infection with substantial morbidity and mortality. Echinocandins are preferred in critically ill patients, but mortality did not differ significantly between initial echinocandin and azole treatment. Persistent positive cultures were linked to severe presentation, including peritonitis, candidemia, and septic shock, which required more frequent re-intervention, and consequently carried higher mortality.
