In a pilot study of 12 patients with chronic productive cough, we retrospectively compared sputum viscoelasticity before macrolide antibiotic administration and the clinical effects of macrolide antibiotic administration between two groups with and without sputum fungal culture. The fungal culture-positive group (n = 6) showed significantly higher sputum rheological parameters in the high-strain region, particularly critical strain (γC), and reduced response to macrolide treatment. In 5 patients with fungus-associated chronic cough, a decrease in high-strain sputum viscoelasticity and improvement in cough and laryngeal abnormal sensations were observed after administration of low-dose antifungals.
An adlescent girl was bitten on the right middle finger while attempting to intervene in a fight among her three pet guinea pigs. She was initially treated by a local physician without improvement and was subsequently referred to the Department of Dermatology at our hospital. Direct microscopic examination of scales and crusts with KOH was positive, and she was diagnosed with tinea corporis. The isolated fungus was morphologically identified as belonging to the Trichophyton mentagrophytes complex, and topical luliconazole cream was administered. Molecular analysis based on the DNA sequence of the nuclear ribosomal internal transcribed spacer (ITS) 1 region revealed that the isolate belonged to ITS type II, corresponding to T. mentagrophytes animal type 3. These findings strongly suggested zoonotic transmission from the pet guinea pigs. This appears to be one of the very few reported cases of T. mentagrophytes animal type 3 isolated from a human lesion.
We report a case series evaluating a novel oral care paste containing capric acid and a lysozyme-chitosan oligosaccharide conjugate (LYZOX). Ten patients with asymptomatic oral Candida colonization performed twice-daily self-care. Clinical eradication was achieved in 80% of cases, including polymicrobial infections involving Candida albicans, Candida glabrata, and Candida parapsilosis. This non-pharmacological approach effectively eliminated Candida species without adverse effects, suggesting a safe, daily preventive strategy for asymptomatic carriers in the maintenance phase of dental treatment.
Aspergillus fumigatus strains cause severe mycosis in humans. Strains belonging to the cryptic species of A. fumigatus, such as Aspergillus lentulus, are also pathogenic and tend to exhibit resistance to azole drugs. Although the contribution of cytochrome P450 14-α sterol demethylase (Cyp51A) to azole resistance in A. lentulus has been highlighted, the molecular mechanisms behind it remain unknown. In this study, we performed functional analysis of the CYP51 gene derived from A. lentulus (Al-cyp51A) to identify substitutions affecting azole susceptibility. We constructed a CRISPR/Cas9-based genome editing method that enabled one-step replacement of the cyp51A locus in A. fumigatus. Using this system showed that the expression of Al-cyp51A in the A. fumigatus strain increased its resistance to voriconazole (VRCZ) in comparison with the cyp51A of A. fumigatus (Af-cyp51A). By screening chimeric Al-cyp51A harboring partial sequences of Af-cyp51A, we successfully identified amino acid residues in Al-Cyp51A that contributed to VRCZ resistance. Molecular dynamics simulations showed that these substitutions may reduce the inhibitory effect of the drug. Our findings provide further insights into the molecular mechanisms of azole resistance in cryptic A. fumigatus and highlight the functional role of cyp51A mutations.
A male in his seventies presented with multiple erythematous follicular papules on the back, followed by lesions in the occipital region and posterior neck. Fungal examination revealed kerion celsi caused by Trichophyton rubrum. The patient was treated with fosravuconazole 100 mg/day for 8 weeks, and the brush method was negative 1 month later. The oral antifungal medicines approved for treatment of tinea capitis in Japan are limited to itraconazole and terbinafine hydrochloride. However, itraconazole has many contraindicated drugs, and antifungal resistance has recently become a major concern.As the challenge of drug-resistant fungi is expected to become more significant in the future, the clinical benefits of using fosravuconazole L-lysine ethanolate (F-RVCZ) for treating kerion celsi may increase. Our experience suggests that F-RVCZ could be a valuable therapeutic option.
