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Chen TK, Batra JS, Michalik DE, Casillas J, Patel R, Ruiz ME, Hara H, Patel B, Kadapakkam M, Ch'Ng J, Small CB, Zagaliotis P, Ragsdale CE, Leal LO, Roilides E, Walsh TJ. Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor (rhu GM-CSF) as Adjuvant Therapy for Invasive Fungal Diseases. Open Forum Infect Dis 2022; 9:ofac535. [PMID: 36381625 PMCID: PMC9645583 DOI: 10.1093/ofid/ofac535] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/07/2022] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Sargramostim (yeast-derived, glycosylated recombinant human granulocyte-macrophage colony-stimulating factor [rhu GM-CSF]) augments innate and adaptive immune responses and accelerates hematopoietic recovery of chemotherapy-induced neutropenia. However, considerably less is known about its efficacy as adjunctive immunotherapy against invasive fungal diseases (IFDs). METHODS The clinical courses of 15 patients with pediatric malignancies and IFDs treated adjunctively with sargramostim at a single institution were analyzed in a retrospective cohort review. Further, a systematic review of published reports of rhu GM-CSF for IFDs was also conducted. RESULTS Among 65 cases, 15 were newly described pediatric patients and 50 were previously published cases of IFDs treated with rhu GM-CSF. Among the newly reported pediatric patients, IFDs were caused by Candida spp., Trichosporon sp., and molds (Aspergillus spp., Rhizopus sp., Lichtheimia sp., and Scedosporium sp). Twelve (80%) were neutropenic at baseline, and 12 (80%) were refractory to antifungal therapy. Among 12 evaluable patients, the overall response rate was 92% (8 [67%] complete responses, 3 [25%] partial responses, and 1 [8%] stable). Treatment is ongoing in the remaining 3 patients. Among 50 published cases (15 Candida spp., 13 Mucorales, 11 Aspergillus spp., 11 other organisms), 20 (40%) had baseline neutropenia and 36 (72%) were refractory to standard therapy before rhu GM-CSF administration. Consistent with responses in the newly reported patients, the overall response rate in the literature review was 82% (40 [80%] complete responses, 1 [2%] partial response, and 9 [18%] no response). CONCLUSIONS Sargramostim may be a potential adjunctive immunomodulator for selected patients with hematological malignancies and refractory IFDs.
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Affiliation(s)
- Tempe K Chen
- Department of Pediatric Infectious Diseases, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Department of Pediatrics, Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, USA
| | - Jagmohan S Batra
- Department of Pediatric Infectious Diseases, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Department of Pediatrics, Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, USA
| | - David E Michalik
- Department of Pediatric Infectious Diseases, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Department of Pediatrics, Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, USA
| | - Jacqueline Casillas
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Ramesh Patel
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Maritza E Ruiz
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Harneet Hara
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Bhavita Patel
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Meena Kadapakkam
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - James Ch'Ng
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Catherine B Small
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York, New York, USA
| | - Panagiotis Zagaliotis
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York, New York, USA
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Department of Pharmacology and Therapeutics, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Luis O Leal
- Partner Therapeutics, Inc., Lexington, Massachusetts, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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2
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Khalil N, Kasten JL, Marsh RA, Danziger-Isakov L. Multifocal Trichosporon asahii Infection in a Patient With Chronic Granulomatous Disease. J Pediatric Infect Dis Soc 2022; 11:467-470. [PMID: 35849130 DOI: 10.1093/jpids/piac064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Nadim Khalil
- Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Infectious Diseases, Department of Pediatrics, London Health Science Centre, London, Ontario, Canada
| | - Jennifer L Kasten
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lara Danziger-Isakov
- Division of Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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3
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Menu E, Kabtani J, Roubin J, Ranque S, L’Ollivier C. Pericardial Effusion Due to Trichosporon japonicum: A Case Report and Review of the Literature. Pathogens 2022; 11:pathogens11050598. [PMID: 35631119 PMCID: PMC9145057 DOI: 10.3390/pathogens11050598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Invasive infections due to Trichosporon spp. are life-threatening opportunistic fungal infections that may affect a wide array of organs. Here, we described a case of pericardial effusion due to Trichosporon japonicum in a 42-year-old female after a heart transplantation. T. japonicum was isolated from the pericardial fluid, pericardial drain hole and the swab of the sternal surgery scar wound. The late mycological diagnosis due to blood culture negative, the ineffective control of pulmonary bacterial infection and the late start antifungal therapy were the contributing factors in the patient’s death.
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Affiliation(s)
- Estelle Menu
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France; (S.R.); (C.L.)
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France;
- Correspondence:
| | - Jihane Kabtani
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France;
| | - Johanna Roubin
- Department of Cardiovascular Critical Care Medicine, La Timone Adult Hospital, AP-HM, Aix Marseille Université, 13385 Marseille, France;
| | - Stéphane Ranque
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France; (S.R.); (C.L.)
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France;
| | - Coralie L’Ollivier
- Laboratoire de Parasitologie-Mycologie, IHU Méditerranée Infection, 13385 Marseille, France; (S.R.); (C.L.)
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut de Recherche pour le Développement, Aix Marseille Université, 13385 Marseille, France;
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4
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Premamalini T, Rajyoganandh V, Vijayakumar R, Veena H, Kindo AJ, Marak RS. Strain Typing of Trichosporon asahii Clinical Isolates by Random Amplification of Polymorphic DNA (RAPD) Analysis. J Lab Physicians 2021; 13:245-251. [PMID: 34602789 PMCID: PMC8478501 DOI: 10.1055/s-0041-1731111] [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] [Indexed: 11/04/2022] Open
Abstract
Objective
The aim of this study was to identify and isolate
Trichosporon asahii
(
T. asahii
) from clinical samples and to assess the genetic relatedness of the most frequently isolated strains of
T. asahii
using random amplification of polymorphic DNA (RAPD) primers GAC-1 and M13.
Methods
All the clinical samples that grew
Trichosporon
species, identified and confirmed by polymerase chain reaction (PCR) using
Trichosporon
genus-specific primers, were considered for the study. Confirmation of the species
T. asahii
was carried out by
T. asahii-
specific PCR. Fingerprinting of the most frequently isolated
T. asahii
isolates was carried out by RAPD using random primers GAC-1 and M13.
Results
Among the 72 clinical isolates of
Trichosporon
sp. confirmed by
Trichosporon
-specific PCR, 65 were found to be
T. asahii
as identified by
T. asahii-
specific PCR. Fingerprinting of the 65 isolates confirmed as
T. asahii
using GAC-1 RAPD primer yielded 11 different patterns, whereas that of M13 primer produced only 5 patterns. The pattern I was found to be the most predominant type (29.2%) followed by pattern III (16.9%) by GAC-1 primer.
Conclusions
This study being the first of its kind in India on strain typing of
T. asahii
isolates by adopting RAPD analysis throws light on genetic diversity among the
T. asahii
isolates from clinical samples. Fingerprinting by RAPD primer GAC-1 identified more heterogeneity among the
T. asahii
isolates than M13.
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Affiliation(s)
- Thayanidhi Premamalini
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Vijayaraman Rajyoganandh
- Department of Microbiology, Vels Institute of Science, Technology and Advanced Studies, Vels Institute, Chennai, Tamil Nadu, India
| | - Ramaraj Vijayakumar
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Hemanth Veena
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Anupma Jyoti Kindo
- Department of Microbiology, Sri Ramachandra Medical College & Research Institute, SRIHER, Porur, Chennai, Tamil Nadu, India
| | - Rungmei Sk Marak
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Production of Secreted Carbohydrates that Present Immunologic Similarities with the Cryptococcus Glucuronoxylomannan by Members of the Trichosporonaceae Family: A Comparative Study Among Species of Clinical Interest. Mycopathologia 2021; 186:377-385. [PMID: 33956292 DOI: 10.1007/s11046-021-00558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/22/2021] [Indexed: 10/20/2022]
Abstract
Glucuronoxylomannan (GXM) participates in several immunoregulatory mechanisms, which makes it an important Cryptococcus virulence factor that is essential for the disease. Trichosporon asahii and Trichosporon mucoides share with Cryptococcus species the ability to produce GXM. To check whether other opportunistic species in the Trichosporonaceae family produce GXM-like polysaccharides, extracts from 28 strains were produced from solid cultures and their carbohydrate content evaluated by the sulfuric acid / phenol method. Moreover, extracts were assessed for cryptococcal GXM cross-reactivity through latex agglutination and lateral flow assay methods. Cryptococcus neoformans and Saccharomyces cerevisiae were used as positive and negative controls, respectively. In addition to T. asahii, the species Trichosporon inkin, Apiotrichum montevideense, Trichosporon japonicum, Trichosporon faecale, Trichosporon ovoides, Cutaneotrichosporon debeurmannianum, and Cutaneotrichosporon arboriformis are also producers of a polysaccharide immunologically similar to the GXM produced by human pathogenic Cryptococcus species. The carbohydrate concentration of the extracts presented a positive correlation with the GXM contents determined by titration of both methodologies. These results add several species to the list of fungal pathogens that produce glycans of the GXM type and bring information about the origin of potential false-positive results on immunological tests for diagnosis of cryptococcosis based on GXM detection.
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6
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A Novel, Inexpensive In-House Immunochromatographic Strip Test for Cryptococcosis Based on the Cryptococcal Glucuronoxylomannan Specific Monoclonal Antibody 18B7. Diagnostics (Basel) 2021; 11:diagnostics11050758. [PMID: 33922698 PMCID: PMC8145812 DOI: 10.3390/diagnostics11050758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to develop a novel lateral flow immunochromatoghaphic strip test (ICT) for detecting cryptococcal polysaccharide capsular antigens using only a single specific monoclonal antibody, mAb 18B7. The mAb 18B7 is a well characterized antibody that specifically binds repeating epitopes displayed on the cryptococcal polysaccharide glucuronoxylomannan (GXM). We validated the immunoreactivities of mAb 18B7 against capsular antigens of different cryptococcal serotypes. The mAb 18B7 ICT was constructed as a sandwich ICT strip and the antibody serving in the mobile phase (colloidal gold conjugated mAb 18B7) to bind one of the GXM epitopes while the stationary phase antibody (immobilized mAb18B7 on test line) binding to other remaining unoccupied epitopes to generate a positive visual readout. The lower limit of detection of capsular antigens for each of the Cryptococcus serotypes tested was 0.63 ng/mL. No cross-reaction was found against a panel of antigens isolated from cultures of other pathogenic fungal, except the crude antigen of Trichosporon sp. with the lower limit of detection of 500 ng/mL (~800 times higher than that for cryptococcal GXM). The performance of the mAb 18B7 ICT strip was studied using cerebrospinal fluid (CSF) and serum and compared to commercial diagnostic kits (latex agglutination CALAS and CrAg IMMY). The sensitivity, specificity and accuracy of the mAb18B7 ICT with CSF from patients with confirmed cryptococcal meningitis were 92.86%, 100% and 96.23%, respectively. No false positives were observed with samples from non-cryptococcosis patients. With serum samples, the mAb 18B7 ICT gave a sensitivity, specificity and accuracy of 96.15%, 97.78% and 96.91%, respectively. Our results show that the mAb 18B7 based ICT was reliable, reproducible, and cost-effective as a point-of-care immunodiagnostic test for cryptococcosis. The mAb 18B7 ICT may be particularly useful in countries where commercial kits are not available or affordable.
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7
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Karigane D, Sakurai M, Matsuyama E, Ide K, Yamamoto-Takeuchi S, Inazumi T, Kohashi S. Successful treatment of breakthrough disseminated Trichosporon asahii fungemia in a patient with acute myeloid leukemia receiving itraconazole prophylaxis. Med Mycol Case Rep 2017; 20:1-3. [PMID: 29264110 PMCID: PMC5726745 DOI: 10.1016/j.mmcr.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/26/2017] [Indexed: 11/15/2022] Open
Abstract
We encountered a case of a 73-year-old man with acute myeloid leukemia who developed Trichosporon asahii systemic infection while on itraconazole prophylaxis during severe neutropenia. Cryptococcal antigen was useful for diagnosis. Although itraconazole was ineffective in protecting against trichosporonosis, treatment was successful with voriconazole following liposomal amphotericin B.
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Affiliation(s)
- Daiki Karigane
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | | | - Emiko Matsuyama
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Kentaro Ide
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | | | - Toyoko Inazumi
- Department of Dermatology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Sumiko Kohashi
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
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8
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Duarte-Oliveira C, Rodrigues F, Gonçalves SM, Goldman GH, Carvalho A, Cunha C. The Cell Biology of the Trichosporon-Host Interaction. Front Cell Infect Microbiol 2017; 7:118. [PMID: 28439501 PMCID: PMC5383668 DOI: 10.3389/fcimb.2017.00118] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/23/2017] [Indexed: 11/13/2022] Open
Abstract
Fungi of the genus Trichosporon are increasingly recognized as causative agents of superficial and invasive fungal disease in humans. Although most species are considered commensals of the human skin and gastrointestinal tract, these basidiomycetes are an increasing cause of fungal disease among immunocompromised hosts, such as hematological patients and solid organ transplant recipients. The initiation of commensal or pathogenic programs by Trichosporon spp. involves the adaptation to the host microenvironment and its immune system. However, the exact virulence factors activated upon the transition to a pathogenic lifestyle, including the intricate biology of the cell wall, and how these interact with and subvert the host immune responses remain largely unknown. Here, we revisit our current understanding of the virulence attributes of Trichosporon spp., particularly T. asahii, and their interaction with the host immune system, and accommodate this knowledge within novel perspectives on fungal diagnostics and therapeutics.
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Affiliation(s)
- Cláudio Duarte-Oliveira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal.,ICVS/3B's - PT Government Associate LaboratoryBraga/Guimarães, Portugal
| | - Fernando Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal.,ICVS/3B's - PT Government Associate LaboratoryBraga/Guimarães, Portugal
| | - Samuel M Gonçalves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal.,ICVS/3B's - PT Government Associate LaboratoryBraga/Guimarães, Portugal
| | - Gustavo H Goldman
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São PauloSão Paulo, Brazil
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal.,ICVS/3B's - PT Government Associate LaboratoryBraga/Guimarães, Portugal
| | - Cristina Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of MinhoBraga, Portugal.,ICVS/3B's - PT Government Associate LaboratoryBraga/Guimarães, Portugal
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9
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Rivet-Dañon D, Guitard J, Grenouillet F, Gay F, Ait-Ammar N, Angoulvant A, Marinach C, Hennequin C. Rapid diagnosis of cryptococcosis using an antigen detection immunochromatographic test. J Infect 2015; 70:499-503. [PMID: 25597824 DOI: 10.1016/j.jinf.2014.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/13/2014] [Accepted: 12/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Current methods for cryptococcal antigen detection have some limitations. This study aimed at evaluating a lateral flow assay (LFA) for the diagnosis of cryptococcosis in a French University medical center. METHODS A retrospective study was performed on samples collected from patients with a definitive diagnosis of cryptococcosis (group I 66 samples; 28 patients) or with non-Cryptococcus invasive fungal infection (group II 18 samples; 17 patients). In addition, 274 samples from 205 consecutive patients, either suspected of cryptococcal infection or routinely screened during their follow-up, were prospectively tested (group III). Cryptococcal antigen was assayed using LFA and an EIA. A latex-based test was used for confirmation. RESULTS Sensitivity calculated on group I and specificity on group II, were respectively at 100% and 90.0%. Two false positives were related to Trichosporon fungemia. Per-sample analysis on group III revealed sensitivity, specificity, positive and negative predictive values all at 100% for CSF, and at 100%, 98.9%, 75% and 100%, respectively for serum samples. LFA enabled the diagnosis of two cases of asymptomatic cryptococcosis. CONCLUSION The excellent diagnostic value and practicality (visual reading results in 15 min) of LFA make it fully appropriate for the diagnosis of cryptococcosis in this particular setting.
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Affiliation(s)
- Diane Rivet-Dañon
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, F-75012, Paris, France
| | - Juliette Guitard
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, F-75012, Paris, France; Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France
| | - Frédéric Grenouillet
- Centre Hospitalier Régional Universitaire de Besançon, Service de Parasitologie-Mycologie, F-25030, Besançon, France
| | - Frédérick Gay
- Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, F-75013, Paris, France
| | - Nawel Ait-Ammar
- Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Service de Microbiologie, F-92100, Boulogne-Billancourt, France
| | - Adela Angoulvant
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Microbiologie, F-94270, Le Kremlin-Bicêtre, France
| | - Carine Marinach
- Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France
| | - Christophe Hennequin
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, F-75012, Paris, France; Inserm, U1135, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; CNRS, ERL 8255, CIMI-Paris, 91 Bd de l'hôpital, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Bd de l'hôpital, F-75013, Paris, France.
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10
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Arendrup M, Boekhout T, Akova M, Meis J, Cornely O, Lortholary O. ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect 2014; 20 Suppl 3:76-98. [DOI: 10.1111/1469-0691.12360] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/16/2013] [Accepted: 08/16/2013] [Indexed: 12/27/2022]
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11
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Liao Y, Hartmann T, Ao JH, Yang RY. Serum glucuronoxylomannan may be more appropriate for the diagnosis and therapeutic monitoring of Trichosporon fungemia than serum β-d-glucan. Int J Infect Dis 2012; 16:e638. [DOI: 10.1016/j.ijid.2012.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 03/10/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022] Open
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Abstract
Trichosporon spp. are basidiomycetous yeast-like fungi found widely in nature. Clinical isolates are generally related to superficial infections. However, this fungus has been recognized as an opportunistic agent of invasive infections, mostly in cancer patients and those exposed to invasive medical procedures. It is possible that the ability of Trichosporon strains to form biofilms on implanted devices, the presence of glucuronoxylomannan in their cell walls, and the ability to produce proteases and lipases are all factors likely related to the virulence of this genus and therefore may account for the progress of invasive trichosporonosis. Disseminated trichosporonosis has been increasingly reported worldwide and represents a challenge for both diagnosis and species identification. Phenotypic identification methods are useful for Trichosporon sp. screening, but only molecular methods, such as IGS region sequencing, allow the complete identification of Trichosporon isolates at the species level. Methods for the diagnosis of invasive trichosporonosis include PCR-based methods, Luminex xMAP technology, and, more recently, proteomics. Treating patients with trichosporonosis remains a challenge because of limited data on the in vitro and in vivo activities of antifungal drugs against clinically relevant species of the genus. Despite the mentioned limitations, the use of antifungal regimens containing triazoles appears to be the best therapeutic approach.
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Abstract
Fungal pneumonia is increasingly common, particularly in highly immunosuppressed patients, such as solid organ or hematopoietic stem cell transplant recipients, and the diagnosis is evolving. Although standard techniques such as microscopy and culture remain the mainstays of diagnosis, relatively recent advances in serological and molecular testing are important additions to the field. This article reviews the laboratory tools used to diagnose fungal respiratory disease.
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Affiliation(s)
- Erika D Lease
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina 27710, USA
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14
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Ueda Y, Yamashita H, Yoshida Y, Takahashi Y, Mimori A. [A case of rheumatoid arthritis involving disseminated torichosporonosis]. ACTA ACUST UNITED AC 2011; 85:532-6. [PMID: 22117385 DOI: 10.11150/kansenshogakuzasshi.85.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 75-year-old man who developed disseminated trichosporonosis had a long history of immunosuppressive therapy with weekly methotrexate and low-dose prednisolone for rheumatoid arthritis (RA). He had been administered 30 mg of prednisolone per day for organizing pneumonia, probably due to the RA, for about 3 months before admission for a lumbar compression fracture. He then developed bilateral aspiration pneumonia with pleural effusion, treated successfully with broad-spectrum antibiotics meropenem and ciprofloxacin, and fluid management. He then developed acute, progressive respiratory failure with changes in both lung lobes in chest computed tomography (CT). Meropenem, ciprofloxacin, micafungin, and pulsed steroid administration were ineffective. He died of respiratory failure, after which Trichosporon asahii was first detected in blood and urine culture. Disseminated trichosporonosis was determined based on positive blood culture, elevated serum glucuronoxylomannan antigen and beta-D glucan, and the man's lack of clinical progress. He had numerous risk factors for trichosporonosis, including neutrophilic dysfunction due to prolonged steroid therapy, administration of broad-spectrum antibiotics and micafungin, and central venous catheterization. Disseminated trichosporonosis is a chiefly hematological infection and case reports without hematological disorders are rare, so we report this instructive case.
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Affiliation(s)
- Yo Ueda
- Division of Rheumatic Disease, National Center for Global Health and Medicine
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15
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Obana Y, Sano M, Jike T, Homma T, Nemoto N. Differential diagnosis of trichosporonosis using conventional histopathological stains and electron microscopy. Histopathology 2010; 56:372-83. [PMID: 20459537 DOI: 10.1111/j.1365-2559.2010.03477.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Although Trichosporon is a causative pathogen of white piedra and summer-type hypersensitivity pneumonitis, fatal disseminated trichosporonosis cases have recently been increasing. However, Trichosporon is often confused with other fungi, especially Candida, in pathological specimens. The aim was to determine the utility of histopathological stains and electron microscopy for diagnosing trichosporonosis. METHODS AND RESULTS Autopsy cases of trichosporonosis, candidiasis, aspergillosis and cryptococcosis were investigated using histopathological stains and electron microscopy. Using Grocott's method, Trichosporon was weakly detected compared with other fungi. In contrast, diluted periodic acid methenamine silver (PAM) stain clearly enhanced the intensity of staining of Trichosporon compared with Candida. Furthermore, Alcian blue and colloidal iron stains predominantly detected Trichosporon. Electron microscopy after staining with diluted PAM demonstrated that Trichosporon has a variety of hyphal sizes and laminar deposition of rough silver granules, whereas Candida has uniform pseudohyphae and fine granules. The average diameter and population area of the granules were significantly higher in Trichosporon compared with Candida (P<0.01). Meanwhile, the laminar structure was preserved in the cell walls of Trichosporon without silver stains, whereas a low-density structure was observed in Candida. CONCLUSIONS Histopathological staining patterns and electron microscopic findings can facilitate the diagnosis of trichosporonosis.
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Affiliation(s)
- Yukari Obana
- Division of Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, and Nihon University Itabashi Hospital, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
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16
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Morrow CA, Fraser JA. Sexual reproduction and dimorphism in the pathogenic basidiomycetes. FEMS Yeast Res 2009; 9:161-77. [DOI: 10.1111/j.1567-1364.2008.00475.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Abstract
The incidence of invasive fungal infections has increased dramatically over the past two decades, mostly due to an increase in the number of immunocompromised patients.1–4 Patients who undergo chemotherapy for a variety of diseases, patients with organ transplants, and patients with the acquired immune deficiency syndrome have contributed most to the increase in fungal infections.5 The actual incidence of invasive fungal infections in transplant patients ranges from 15% to 25% in bone marrow transplant recipients to 5% to 42% in solid organ transplant recipients.6,7 The most frequently encountered are Aspergillus species, followed by Cryptococcus and Candida species. Fungal infections are also associated with a higher mortality than either bacterial or viral infections in these patient populations. This is because of the limited number of available therapies, dose-limiting toxicities of the antifungal drugs, fewer symptoms due to lack of inflammatory response, and the lack of sensitive tests to aid in the diagnosis of invasive fungal infections.1 A study of patients with fungal infections admitted to a university-affiliated hospital indicated that community-acquired infections are becoming a serious problem; 67% of the 140 patients had community-acquired fungal pneumonia.8
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18
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Pagano L, Caira M, Fianchi L. Pulmonary fungal infection with yeasts and pneumocystis in patients with hematological malignancy. Ann Med 2005; 37:259-69. [PMID: 16019724 DOI: 10.1080/07853890510037374] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Invasive fungal infections are an important cause of morbidity and mortality in patients with hematological malignancies, and in particular fungal pneumonia is the main clinical manifestation in this category of patients. The fungal agents responsible for this complication are various, but Aspergillus spp. and other molds such as Zygomycetes or Fusarium spp. represent the most frequently isolated micro-organisms. Less commonly, pneumonia could be due to other 'no-molds' fungal agents such as Candida spp, Cryptococcus spp, or Pneumocystis jirovecii . This review mainly focuses on practical aspects relevant to epidemiology, diagnosis and therapeutic management of the rare cases of pneumonia due to no-molds agents in patients affected by hematological malignancies.
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Affiliation(s)
- Livio Pagano
- Istituto di Ematologia, Università Cattolica S Cuore, Roma, Italy.
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20
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Abstract
More yeasts and molds are now recognized to cause more human disease than ever before. This development is not due to a change in the virulence of these fungi, but rather to changes in the human host. These changes include immunosuppression secondary to the pandemic of HIV, the use of life-saving advances in chemotherapy and organ transplantation, and the use of corticosteroids and other immunosuppressive agents to treat a variety of diseases. Fungi that were once considered common saprophytes are now recognized as potential pathogens in these patients. This situation necessitates better communication than ever between the clinician, pathologist, and clinical mycologist to ensure the prompt and accurate determination of the cause of fungal diseases.
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Affiliation(s)
- Gary W Procop
- Section of Clinical Microbiology, The Cleveland Clinic Foundation, L40, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Ichikawa T, Sugita T, Wang L, Yokoyama K, Nishimura K, Nishikawa A. Phenotypic switching and beta-N-acetylhexosaminidase activity of the pathogenic yeast Trichosporon asahii. Microbiol Immunol 2004; 48:237-42. [PMID: 15107533 DOI: 10.1111/j.1348-0421.2004.tb03519.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pathogenic yeast Trichosporon asahii is the major causative agent of deep-seated trichosporonosis in immunocompromised patients. Although infection by this microorganism is becoming increasingly frequent, information related to its pathogenicity and virulence factors is still limited. Therefore, we investigated phenotypic switching in colony morphology, and the production of extracellular enzymes as a virulence factor. Sixty-one clinical isolates of T. asahii produced four different morphological types on Sabouraud dextrose agar (SDA): 69% WF (white farinose), 18% WP (white pustular), 10% Y (yellowish white), and 3% WC (white cerebriform). Strains of the three major types (WF, WP, and Y) produced two to five colony types when cultured on SDA at 37 C. The frequency of switching between colony types was 10(-2) to 10(-4), as in Candida albicans and Cryptococcus neoformans. Notably, most of the colonies switched to the smooth (S) type irreversibly, at frequencies of 10(-2) to 10(-3). No secreted aspartic proteinase or phospholipase activity was detected in T. asahii, while beta-N-acetylhexosaminidase activity, which catalyzes the hydrolysis of terminal nonreducing N-acetyl-D-hexosamine residues in N-acetyl-beta-D-hexosaminides, was found. Furthermore, enzymatic activity of the S type was significantly greater than that of the parent type in all strains. No other clinically relevant Trichosporon species (T. mucoides, T. inkin, and T. ovoides ) produced this enzyme. These results provide basal information for understanding the pathogenic potential of T. asahii.
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Affiliation(s)
- Tomoe Ichikawa
- Department of Microbiology, Meiji Pharmaceutical University, Tokyo, Japan
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22
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Walsh TJ, Groll A, Hiemenz J, Fleming R, Roilides E, Anaissie E. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 2004; 10 Suppl 1:48-66. [PMID: 14748802 DOI: 10.1111/j.1470-9465.2004.00839.x] [Citation(s) in RCA: 374] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The emergence of less common but medically important fungal pathogens contributes to the rate of morbidity and mortality, especially in the increasingly expanding population of immunocompromised patients. These pathogens include septate filamentous fungi (e.g., Fusarium spp., Scedosporium spp., Trichoderma spp.), nonseptate Zygomycetes, the endemic dimorphic pathogen Penicillium marneffei, and non-Cryptococcus, non-Candida pathogenic yeast (e.g., Trichosporon spp.). The medical community is thus called upon to acquire an understanding of the microbiology, epidemiology and pathogenesis of these previously uncommon pathogens in order to become familiar with the options for prevention and treatment.
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Affiliation(s)
- T J Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, The National Cancer Institute, Bethesda, MD 20892-1928, USA.
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23
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Abstract
During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses and compromised host defenses. While Aspergillus and Candida spp. collectively account for the majority of these infections, recent epidemiological trends indicate a shift towards infections by Aspergillus spp., nonalbicans Candida spp., as well as previously uncommon opportunistic fungi. Apart from an expanding number of different Zygomycetes, previously uncommon hyaline filamentous fungi (such as Fusarium species, Acremonium species, Paecilomyces species, Pseudallescheria boydii, and Scedosporium prolificans), dematiaceous filamentous fungi (such as Bipolaris species, Cladophialophora bantiana, Dactylaria gallopava, Exophiala species, and Alternaria species) and yeast-like pathogens (such as Trichosporon species, Blastoschizomyces capitatus, Malassezia species, Rhodotorula rubra and others) are increasingly encountered as causing life threatening invasive infections that are often refractory to conventional therapies. On the basis of past and current trends, the spectrum of fungal pathogens will continue to evolve in the settings of an expanding population of immunocompromised hosts, selective antifungal pressures, and shifting conditions in hospitals and the environment. An expanded and refined drug arsenal, further elucidation of pathogenesis and resistance mechanisms, establishment of in vitro/in vivo correlations, incorporation of pharmacodynamics, combination- and immunotherapies offer hope for substantial progress in prevention and treatment.
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Affiliation(s)
- A H Groll
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
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Lo Passo C, Pernice I, Celeste A, Perdichizzi G, Todaro-Luck F. Transmission of Trichosporon asahii oesophagitis by a contaminated endoscope. Mycoses 2001; 44:13-21. [PMID: 11398636 DOI: 10.1046/j.1439-0507.2001.00614.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two cases of oesophageal trichosporonosis due to a suspected nosocomial infection are reported. Both the patients were immunocompetent and had undergone an endoscopic examination on the same day. Six strains of Trichosporon were isolated: three strains from the oesophageal biopsy of the first patient, one strain from the endoscopic forceps, one from the air in the endoscopy room, and one from the oesophageal biopsy of the second patient. The nosocomial nature of the infection and the role of the endoscopic forceps in transporting the micro-organism was suspected, but the morphology and physiology of the isolated strains did not confirm such hypothesis. To elucidate the nature of the infection and the genetic similarities of the strains isolated, all strains were typed with RFLPs of the rDNA fragment and with RAPD. The results of RAPD using primer (GTG)5 (GACA)4, M13 core sequence, and the 15-mer oligonucleotide GAGGGTGGXGGXTCT indicated the molecular identity of three strains supporting the hypothesis concerning a transport of the aetiological agent from the first patient to the second and that the carrier was the forceps of the endoscopic device.
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Affiliation(s)
- C Lo Passo
- Institute of Microbiology, University of Messina School of Science, salita Sperone, 31, 98166 Messina, Italy.
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25
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Sugita T, Ichikawa T, Matsukura M, Sueda M, Takashima M, Ikeda R, Nishikawa A, Shinoda T. Genetic diversity and biochemical characteristics of Trichosporon asahii isolated from clinical specimens, houses of patients with summer-type-hypersensitivity pneumonitis, and environmental materials. J Clin Microbiol 2001; 39:2405-11. [PMID: 11427546 PMCID: PMC88162 DOI: 10.1128/jcm.39.7.2405-2411.2001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trichosporon asahii, which is distributed in the environment, is the major causative agent of the opportunistic infection trichosporonosis, and it also causes summer-type hypersensitivity pneumonitis (SHP). Random amplification of polymorphic DNA analysis was used to determine the intraspecies diversity of 39 T. asahii isolates from clinical specimens, SHP patients' houses, and environmental materials. The three primers used revealed 46 polymorphic bands. A phenogram was generated by the unweighted pair-group method with arithmetic mean. Clinical isolates formed a cluster, characterized by a 90% matching coefficient, but they did not cluster with strains isolated from SHP patients' houses or environmental sources. In addition, the biochemical characteristics of 86 strains from three sources were examined with 31 compounds using an ID32C kit, and a phenogram was constructed. The phenogram consisted of three major clusters. Cluster I included most of the clinical SHP isolates, and cluster II included most of the environmental isolates. Cluster III contained only one strain. A remarkable difference was found in the abilities of the strains belonging to clusters I and II to utilize six compounds. These results suggest that the genetic diversity and biochemical characteristics of T. asahii seem to be related to the source of the isolate. We also found a specific DNA fragment for the clinical isolates and strains isolated from SHP patients' houses.
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Affiliation(s)
- T Sugita
- Department of Microbiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588 Japan.
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Yamagata E, Kamberi P, Yamakami Y, Hashimoto A, Nasu M. Experimental model of progressive disseminated trichosporonosis in mice with latent trichosporonemia. J Clin Microbiol 2000; 38:3260-6. [PMID: 10970368 PMCID: PMC87371 DOI: 10.1128/jcm.38.9.3260-3266.2000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trichosporon asahii and Trichosporon mucoides are the most common strains of fungi that cause disseminated trichosporonosis, a severe opportunistic infection in immunocompromised hosts. We have previously established a nested PCR assay using serum samples for detection of both strains. Here we describe a new experimental animal model for investigating the underlying mechanisms of disseminated trichosporonosis. T. asahii (OMU239, a clinical isolate from a patient with acute myelogenous leukemia) and 8-week-old ICR male mice were used in all experiments. A suspension of T. asahii (3 x 10(6) CFU/animal) was injected into the caudal vein of each mouse after immunosuppression with cyclophosphamide (200 mg/kg of body weight/day for 2 days) and prednisolone (30 mg/kg/day for 1 day). Mice were then divided into four subgroups (R0, R1, R2, and R3) based on the time of reimmunosuppression. The latter was performed using the same drugs 1 week (group R1), 2 weeks (group R2), and 3 weeks (group R3) after fungal infection. Reimmunosuppression was not performed in group R0. The 5-week-survival rates of mice after T. asahii infection were 0% for group R1, 50% for group R2, 80% for group R3, and 80% for group R0. There was a significant difference in the survival rates between group R1 and either group R0 or R3 (P < 0.05). Fungal clearance in peripheral blood and various organs of group R1 and R2 was delayed relative to that of group R0 but was similar to the control in group R3 in spite of reimmunosuppression. Our results suggest that the critical period for the development of disseminated trichosporonosis in our model is shorter than 3 weeks after T. asahii infection. We concluded that mice during this critical period were in a state of latent trichosporonemia. Comparison of the survival rates suggests that the nested PCR assay was more useful than blood culture and glucuronoxylomannan antigen assay in the detection of this latent trichosporonemia.
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Affiliation(s)
- E Yamagata
- The Second Department of Internal Medicine, Oita Medical University, Hasama-machi, Oita 879-5593, Japan.
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27
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Walsh TJ, Groll AH. Emerging fungal pathogens: evolving challenges to immunocompromised patients for the twenty-first century. Transpl Infect Dis 1999; 1:247-61. [PMID: 11428996 DOI: 10.1034/j.1399-3062.1999.010404.x] [Citation(s) in RCA: 223] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Opportunistic fungi have emerged during the past decade as important causes of morbidity and mortality in immunocompromised patients. Candida species constitute the third to fourth most common causes of nosocomial blood stream infections, and Aspergillus species have emerged as the most common infectious cause of pneumonic mortality in bone marrow/stem cell transplant recipients. Among HIV-infected patients, meningoencephalitis due to Cryptococcus neoformans ranks among the most common AIDS-defining infections. Hyaline septated filamentous fungi, such as Fusarium species, Acremonium species, Paecilomyces species, and Trichoderma species, are increasingly reported as causing invasive mycoses refractory to conventional therapy. Dematiaceous septated filamentous fungi, such as Pseudallescheria boydii, Bipolaris species, and Cladophialophora bantiana cause pneumonia, sinusitis, and CNS infection unresponsive to current therapy. An increasing number of different members of the class of Zygomycetes are reported as causing lethal infections, despite aggressive medical and surgical interventions. Yet the treatment for zygomycosis has not changed in approximately 40 years. The prevalence of the endemic mycoses, such as those due to Penicillium marneffei, Coccidioides immitis, and Histoplasma capsulatum, has been reported to expand rapidly in response to environmental exposures and increased numbers of vulnerable hosts in endemic regions of the world. Dermatophytoses are occurring with increasing prevalence and morbidity in elderly and immunocompromised patients. As we enter the next millennium, we may anticipate that emergent fungal infections will continue to develop in the settings of permissive environmental conditions, selective antifungal pressure, and an expanding population of immunocompromised hosts.
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Affiliation(s)
- T J Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
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28
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Cleare W, Cherniak R, Casadevall A. In vitro and in vivo stability of a Cryptococcus neoformans [corrected] glucuronoxylomannan epitope that elicits protective antibodies. Infect Immun 1999; 67:3096-107. [PMID: 10338526 PMCID: PMC96627 DOI: 10.1128/iai.67.6.3096-3107.1999] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The monoclonal antibody (MAb) 2H1 defines an epitope in Cryptococcus neoformans capsular glucuronoxylomannan (GXM) that can elicit protective antibodies. In murine models of cryptococcosis, MAb 2H1 administration prolongs survival and reduces fungal burden but seldom clears the infection. The mechanism by which C. neoformans persists and escape antibody-mediated clearance is not understood. One possibility is that variants that do not bind MAb 2H1 emerge in the course of infection. Using an agglutination-sedimentation protocol, we recovered a variant of strain 24067 that did not agglutinate, could not be serotyped, and had marked reduction in GXM O-acetyl groups. Binding of MAb 2H1 to 24067 variant cells produced a different immunofluorescence pattern and lower fluorescence intensity relative to the parent 24067 cells. Addition of MAb 2H1 to 24067 variant cells had no effect on cell charge. Phagocytic assays demonstrated that MAb 2H1 was not an effective opsonin for the 24067 variant. The 24067 variant was less virulent than the 24067 parent strain in mice, and MAb 2H1 administration did not prolong survival in animals infected with the variant strain. To investigate whether variants which do not bind MAb 2H1 are selected in experimental infection, three C. neoformans strains were serially passaged in mice given either MAb 2H1 or no antibody. Analysis of passaged isolates by agglutination assay, flow cytometry, and indirect immunofluorescence revealed changes in MAb 2H1 epitope expression but no clear trend with regards to gain or loss of MAb 2H1 epitope. C. neoformans variants with reduced MAb 2H1 epitope content can be isolated in vitro, but persistence of infection in mice given MAb 2H1 does not appear to be a result of selection of escape variants that lack the MAb 2H1 epitope.
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Affiliation(s)
- W Cleare
- Department of Microbiology and Immunology, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Nishiura Y, Nakagawa-Yoshida K, Suga M, Shinoda T, Guého E, Ando M. Assignment and serotyping of Trichosporon species: the causative agents of summer-type hypersensitivity pneumonitis. JOURNAL OF MEDICAL AND VETERINARY MYCOLOGY : BI-MONTHLY PUBLICATION OF THE INTERNATIONAL SOCIETY FOR HUMAN AND ANIMAL MYCOLOGY 1997; 35:45-52. [PMID: 9061585 DOI: 10.1080/02681219780000861] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We re-valued three antigenic types within the genus Trichosporon as the causative agents of summer-type hypersensitivity pneumonitis (SHP). Corresponding standard strains, TIMM 1573 (serotype I), TIMM 1318 (serotype II), and M9456 (serotype III) were assigned to species T. mucoides, T. asahii and T. montevideense, respectively, based on 95% or more DNA/DNA relatedness with each type of culture and other genetical, physiological and morphological characteristics. To confirm the significance of these serotypes, 98 other strains of Trichosporon isolated from patients' environments and 24 CBS strains, including type cultures of species described within the genus, were serotyped. Serum antibody analysis of 220 SHP patients against Trichosporon spp. were also examined to estimate the antigenic profile of SHP. The present results indicate that T. asahii and T. mucoides, which are the most common causes of trichosporonosis, appear to be the major causative agents of SHP. These observations suggest a common pathogenesis of Trichosporon inducing hypersensitivity and infection, depending on the immunological status of the host.
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Affiliation(s)
- Y Nishiura
- First Department of Internal Medicine, Kumamoto University School of Medicine, Japan
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