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Spruijtenburg B, Melchior do Prado C, van Kempen M, Shawky SM, Meis JF, Aparecida Vicente V, Queiroz-Telles F, de Groot T, El-Kholy MA, Meijer EFJ. Genetic Epidemiology and Resistance Investigations of Clinical Yeasts in Alexandria, Egypt. Pathogens 2025; 14:486. [PMID: 40430806 PMCID: PMC12114656 DOI: 10.3390/pathogens14050486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2025] [Revised: 05/09/2025] [Accepted: 05/14/2025] [Indexed: 05/29/2025] Open
Abstract
Yeast bloodstream infections lead to high mortality and morbidity and are mostly observed in immunocompromised patients. In Africa, only a few studies have characterized clinical yeasts. To increase insight into yeast resistance and transmission in Africa, we identified various yeasts from Alexandria, Egypt and performed antifungal susceptibility testing (AFST) and genotyping. A total of 1307 single isolates from unique patients, recovered from different anatomical sites including the bloodstream, retrieved from a reference laboratory in Alexandria, Egypt were studied. All isolates were identified with MALDI-TOF MS, while some were initially identified with a Vitek 2 Compact system. Short tandem repeat (STR) genotyping was performed for the most common species, and AFST was performed with microbroth dilution. Among bloodstream isolates (n = 71), C. albicans was the most common etiological agent, followed by C. tropicalis and C. parapsilosis. Comparison of yeast identification methods demonstrated that 22% of isolates were incorrectly identified with the Vitek 2 Compact system compared to MALDI-TOF MS. Multiple rare yeasts showed reduced antifungal susceptibility. STR genotyping demonstrated potential events of nosocomial transmission with N. glabratus and C. parapsilosis. Moreover, an azole-resistant C. tropicalis clade identified earlier in Alexandria was still present. To conclude, clinical yeasts in Alexandria, Egypt, are overall susceptible common species.
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Affiliation(s)
- Bram Spruijtenburg
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands
- Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital (CWZ)/Dicoon, 6532 SZ Nijmegen, The Netherlands
| | - Carolina Melchior do Prado
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands
- Postgraduate Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology, Federal University of Paraná, Curitiba 82590-300, Brazil
| | - Mats van Kempen
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands
- Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital (CWZ)/Dicoon, 6532 SZ Nijmegen, The Netherlands
| | - Sherine M. Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria 5422021, Egypt
| | - Jacques F. Meis
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD) and Excellence Center for Medical Mycology, University of Cologne, 50931 Cologne, Germany
| | - Vânia Aparecida Vicente
- Postgraduate Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology, Federal University of Paraná, Curitiba 82590-300, Brazil
- Laboratory of Microbiology and Molecular Biology, Department of Basic Pathology, Federal University of Paraná, Curitiba 82590-300, Brazil
| | - Flavio Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba 80060-900, Brazil
| | - Theun de Groot
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands
- Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital (CWZ)/Dicoon, 6532 SZ Nijmegen, The Netherlands
| | - Mohammed A. El-Kholy
- Department of Microbiology and Biotechnology, Clinical and Biological Sciences Division, College of Pharmacy, Arab Academy of Science, Technology and Maritime Transport (AASTMT), Alexandria 1029, Egypt
| | - Eelco F. J. Meijer
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands
- Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital (CWZ)/Dicoon, 6532 SZ Nijmegen, The Netherlands
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Abdolrasouli A, Curtis CM, Spruijtenburg B, Flores A, Brown MN, Gandhi R, Bhat R, Meijer EFJ, Schelenz S. Cluster of clonal fluconazole-resistant Candida parapsilosis harbouring Y132F mutation in ERG11 gene in a neonatal ICU in the UK. J Antimicrob Chemother 2025; 80:887-890. [PMID: 39878027 DOI: 10.1093/jac/dkaf015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025] Open
Affiliation(s)
| | | | - Bram Spruijtenburg
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Ashley Flores
- Infection Prevention and Control, King's College Hospital, London, UK
| | | | - Rashmi Gandhi
- Neonatal Services, King's College Hospital, London, UK
| | - Ravindra Bhat
- Neonatal Services, King's College Hospital, London, UK
| | - Eelco F J Meijer
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Silke Schelenz
- School of Immunology and Microbial Sciences, Kings College London, London, UK
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Spruijtenburg B, De Carolis E, Magri C, Meis JF, Sanguinetti M, de Groot T, Meijer EFJ. Genotyping of Candida tropicalis isolates uncovers nosocomial transmission of two lineages in Italian tertiary care hospital. J Hosp Infect 2025; 155:115-122. [PMID: 39427771 DOI: 10.1016/j.jhin.2024.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/18/2024] [Accepted: 10/05/2024] [Indexed: 10/22/2024]
Abstract
OBJECTIVES Candida tropicalis is a medically important yeast with increasing antifungal resistance, but nosocomial transmission is rarely reported. This study genotyped C. tropicalis isolates from Italian hospitals to uncover potential nosocomial transmission and assess resistance. METHODS In total, 197 C. tropicalis isolates from 161 patients were collected from five centres from 2013 to 2023. Short tandem repeat (STR) genotyping was conducted on all isolates, and a selection of 24 isolates were typed with whole-genome sequencing (WGS) and the novel Fourier-transform infrared (FTIR) spectroscopy method. Antifungal resistance was investigated with microbroth dilution and WGS. RESULTS STR genotyping revealed seven clusters with isolates from multiple patients. WGS single nucleotide polymorphism (SNP) analysis on five groups of isolates with related STR genotypes also separated these isolates into five groups, of which two groups contained a cluster of isolates from different patients distinguished by ≤59 SNPs. In comparison, sequential isolates within three patients were differentiated by ≤141 SNPs. The two C. tropicalis WGS clusters also clustered based on FTIR genotyping, although this method did not separate the isolates into five groups. None of the 24 isolates were resistant to common antifungals. CONCLUSIONS WGS SNP analysis indicated nosocomial transmission of two lineages within the same hospital, highlighting the need for enforced infection prevention measures and routine genotyping on this common yeast in clinical settings. While both STR and FTIR genotyping also clustered these lineages, WGS SNP analysis is required to determine whether isolates were transmitted clonally.
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Affiliation(s)
- B Spruijtenburg
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Radboudumc-Canisius-Wilhelmina Hospital Centre of Expertise for Mycology, Nijmegen, The Netherlands; Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital/Dicoon, Nijmegen, The Netherlands
| | - E De Carolis
- Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Roma, Italy.
| | - C Magri
- Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Roma, Italy
| | - J F Meis
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Radboudumc-Canisius-Wilhelmina Hospital Centre of Expertise for Mycology, Nijmegen, The Netherlands; Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases and Excellence Centre for Medical Mycology, University of Cologne, Cologne, Germany
| | - M Sanguinetti
- Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Roma, Italy
| | - T de Groot
- Radboudumc-Canisius-Wilhelmina Hospital Centre of Expertise for Mycology, Nijmegen, The Netherlands; Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital/Dicoon, Nijmegen, The Netherlands
| | - E F J Meijer
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Radboudumc-Canisius-Wilhelmina Hospital Centre of Expertise for Mycology, Nijmegen, The Netherlands; Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital/Dicoon, Nijmegen, The Netherlands.
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Spruijtenburg B, Meis JF, Verweij PE, de Groot T, Meijer EFJ. Short Tandem Repeat Genotyping of Medically Important Fungi: A Comprehensive Review of a Powerful Tool with Extensive Future Potential. Mycopathologia 2024; 189:72. [PMID: 39096450 PMCID: PMC11297828 DOI: 10.1007/s11046-024-00877-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/11/2024] [Indexed: 08/05/2024]
Abstract
Fungal infections pose an increasing threat to public health. New pathogens and changing epidemiology are a pronounced risk for nosocomial outbreaks. To investigate clonal transmission between patients and trace the source, genotyping is required. In the last decades, various typing assays have been developed and applied to different medically important fungal species. While these different typing methods will be briefly discussed, this review will focus on the development and application of short tandem repeat (STR) genotyping. This method relies on the amplification and comparison of highly variable STR markers between isolates. For most common fungal pathogens, STR schemes were developed and compared to other methods, like multilocus sequence typing (MLST), amplified fragment length polymorphism (AFLP) and whole genome sequencing (WGS) single nucleotide polymorphism (SNP) analysis. The pros and cons of STR typing as compared to the other methods are discussed, as well as the requirements for the development of a solid STR typing assay. The resolution of STR typing, in general, is higher than MLST and AFLP, with WGS SNP analysis being the gold standard when it comes to resolution. Although most modern laboratories are capable to perform STR typing, little progress has been made to standardize typing schemes. Allelic ladders, as developed for Aspergillus fumigatus, facilitate the comparison of STR results between laboratories and develop global typing databases. Overall, STR genotyping is an extremely powerful tool, often complimentary to whole genome sequencing. Crucial details for STR assay development, its applications and merit are discussed in this review.
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Affiliation(s)
- Bram Spruijtenburg
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques F Meis
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD) and Excellence Center for Medical Mycology, Institute of Translational Research, University of Cologne, Cologne, Germany
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul E Verweij
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theun de Groot
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, Nijmegen, The Netherlands
| | - Eelco F J Meijer
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, The Netherlands.
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, Nijmegen, The Netherlands.
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Dolatabadi S, Najafzadeh MJ, Raeisabadi A, Zarrinfar H, Jalali M, Spruijtenburg B, Meijer EFJ, Meis JF, Lass-Flörl C, de Groot T. Epidemiology of Candidemia in Mashhad, Northeast Iran: A Prospective Multicenter Study (2019-2021). J Fungi (Basel) 2024; 10:481. [PMID: 39057366 PMCID: PMC11277834 DOI: 10.3390/jof10070481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Candidemia is a major cause of morbidity and mortality in health care settings, and its epidemiology is changing. In the last two decades, the proportion of non-albicans Candida (NAC) yeasts in candidemia has increased. These yeasts more often display resistance to common antifungals. In many western countries, candidemia is mainly caused by susceptible C. albicans, while in resource-limited countries, including Iran, the candidemia species distribution is studied less often. Here, we investigated the species distribution, resistance levels, and characteristics of patients with candidemia in five hospitals in Mashhad (northeast Iran) for two years (2019-2021). Yeast isolates from blood were identified with MALDI-TOF MS and subjected to antifungal susceptibility testing (AFST) using the broth microdilution method, while molecular genotyping was applied to Candida parapsilosis isolates. In total, 160 yeast isolates were recovered from 160 patients, of which the majority were adults (60%). Candidemia was almost equally detected in men (48%) and women (52%). Almost half of patients (n = 67, 49%) were from intensive care units (ICUs). C. parapsilosis (n = 58, 36%) was the most common causative agent, surpassing C. albicans (n = 52, 33%). The all-cause mortality rate was 53%, with C. albicans candidemia displaying the lowest mortality with 39%, in contrast to a mortality rate of 59% for NAC candidemia. With microbroth AFST, nearly all tested isolates were found to be susceptible, except for one C. albicans isolate that was resistant to anidulafungin. By applying short tandem repeat (STR) genotyping to C. parapsilosis, multiple clusters were found. To summarize, candidemia in Mashhad, Iran, from 2019 to 2021, is characterized by common yeast species, in particular C. parapsilosis, for which STR typing indicates potential nosocomial transmission. The overall mortality is high, while resistance rates were found to be low, suggesting that the high mortality is linked to limited diagnostic options and insufficient medical care, including the restricted use of echinocandins as the first treatment option.
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Affiliation(s)
- Somayeh Dolatabadi
- Department of Biology, Hakim Sabzevari University, Sabzevar 9617976487, Iran
| | - Mohammad Javad Najafzadeh
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91766-99199, Iran
| | - Abbas Raeisabadi
- Department of Medical Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 48471-91628, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad 91766-99199, Iran
| | - Mahsa Jalali
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91766-99199, Iran
| | - Bram Spruijtenburg
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands (E.F.J.M.)
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, 6532 SZ Nijmegen, The Netherlands
| | - Eelco F. J. Meijer
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands (E.F.J.M.)
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, 6532 SZ Nijmegen, The Netherlands
| | - Jacques F. Meis
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands (E.F.J.M.)
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, 50931 Cologne, Germany
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Excellence Center for Medical Mycology (ECMM), 6020 Innsbruck, Austria
| | - Theun de Groot
- Radboudumc-CWZ Center of Expertise for Mycology, 6532 SZ Nijmegen, The Netherlands (E.F.J.M.)
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, 6532 SZ Nijmegen, The Netherlands
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Amin Zadeh H, Zomorodkia AA, Hadi S, Mohammad Zadeh I, Sabetghadam SAA, Hadi V. Synthesis and evaluation of the antifungal activity of 5-hydroxy-3-phenyl-1H-pyrazole-1-carbothioamide for use in the oral environment. J Oral Biol Craniofac Res 2024; 14:211-215. [PMID: 38445048 PMCID: PMC10912861 DOI: 10.1016/j.jobcr.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Background and aim Candida albicans and Candida tropicalis, can cause superficial infections of the oral mucosa as well as disseminated bloodstream and deep-tissue infections. The most frequently employed class of antifungals used for Candida infection treatment are the azole antifungals. Their low price, low toxic qualities, and availability for oral use make fluconazole and similar azole antifungals the preferred treatment for various infections caused by Candida. Nevertheless, developed and intrinsic resistance to antifungals of the azole family has been widely documented in association with various species of Candida. Candida infection management requires synthesizing new compounds to improve azole class antifungals, as Candida isolates resistant to azole are increasingly encountered in the clinical setting. This study aimed to synthesize a new azole compound and investigate its antifungal activity. Methods In this experimental study, 5-hydroxy-3-phenyl-1H-pyrazole-1-carbothioamide was synthesized by the reaction between thiosemecarbazide and ethylbezoylacetate. The structure of the synthesized compound was characterized by different techniques such as Fourier transform infrared (FT-IR) and nuclear magnetic resonance (NMR) spectra and its antifungal activity against Candida albicans and Candida tropicalis was investigated by the Spread Plat method to determine its minimum fungicidal concentration (MFC) and minimum inhibitory concentration (MIC). Results and discussion The Spread Plat test demonstrated that with the increase in 5-hydroxy-3-phenyl-1H-pyrazole-1-carbothioamide concentration, colonies of fungi were increasingly eliminated at a significant level(p < 0.001). At a concentration of 1000 ppm, all Candida albicans and Candida tropicalis colonies were destroyed. Conclusions The results indicate that the synthesized compound showed a promising antifungal effect. On the other hand, it had a suitable spectrum of effect, because it showed antifungal effects on both Candida albicans and Candida tropicalis strains.
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Affiliation(s)
- Hossein Amin Zadeh
- Department of Chemistry, Shahid Bahonar University of Kerman, 76169, Iran
| | - Ali Asghar Zomorodkia
- Department of Chemical Engineering, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Saeid Hadi
- Department of Health and Nutriotion, Faculty of Medicine, AJA University of Medical Science, Tehran, Iran
| | - Iman Mohammad Zadeh
- Oral and Dental Disease Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Vahid Hadi
- Department of Health and Nutriotion, Faculty of Medicine, AJA University of Medical Science, Tehran, Iran
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Benjamin I, Benson CU, Adalikwu SA, Nduoma FA, Akor FO, Odey MO, Ezeani EC, Anyambula IA, Odume MA, Louis H. Investigating the potential of thiazolyl carbohydrazides derivatives as anti-Candida albicans agents: An intuition from molecular modelling, pharmacokinetic evaluation, and molecular docking analysis. CHEMICAL PHYSICS IMPACT 2023; 7:100275. [DOI: 10.1016/j.chphi.2023.100275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
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