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Francisco EC, Dieleman C, Hagen F, Colombo AL, Mendes AVA, de Oliveira Silva M, de Andrade Barberino MG, Neves RP, Botura MB, Hahn RC, de Almeida Junior JN, Ponzio V, de Tarso O e Castro P, Guimarães T, Santos DW, de Miranda BG, Silva ILAFE, Carlesse F, Ramos JF, Queiroz-Telles F, Aquino VR, Motta FA, Schwarzbold AV, Perozin JS. In vitro activity of isavuconazole against clinically relevant Trichosporon species: a comparative evaluation of EUCAST broth microdilution and MIC Test Strip methods. J Antimicrob Chemother 2023; 78:817-822. [PMID: 36702754 DOI: 10.1093/jac/dkad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To evaluate the in vitro activity of isavuconazole on 154 clinical and reference strains of Trichosporon asahii, Trichosporon asteroides, Trichosporon coremiiforme, Trichosporon faecale and Trichosporon inkin by using the EUCAST broth microdilution method (BMD) and Liofilchem MIC Test Strips (MTS). METHODS Antifungal susceptibility testing for isavuconazole, fluconazole, voriconazole and posaconazole was assessed by EUCAST E.DEF 7.3.2. MIC values of isavuconazole obtained by BMD after 48 h of incubation were compared with MTS MICs after 24 and 48 h of incubation. RESULTS T. asahii and T. asteroides showed the highest isavuconazole MIC90 values (0.5 mg/L). In clinical isolates, T. asahii exhibited the highest MIC90 values (0.5 mg/L) compared with non-T. asahii (0.06-0.25 mg/L). The five non-WT T. asahii isolates for fluconazole, voriconazole and posaconazole also exhibited high MICs of isavuconazole (≥0.5 mg/L). A better correlation between MTS and BMD MICs was observed after 24 h incubation for all species tested. MTS measurements performed at 48 h increased by at least 122% the number of isolates with >2 dilutions compared with the standard method. CONCLUSIONS Isavuconazole exhibited variable in vitro activity among the Trichosporon species tested, showing higher or equal MICs than the other azoles. The five non-WT T. asahii clinical isolates tested also exhibited high isavuconazole MICs, suggesting the occurrence of triazole cross-resistance. Our MTS data indicate that there is no advantage in extended reading time for MTS from 24 to 48 h for Trichosporon yeasts.
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Affiliation(s)
- Elaine Cristina Francisco
- Division of Infectious Diseases, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo 04024-002, Brazil.,Medical Mycology Group, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Chendo Dieleman
- Medical Mycology Group, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Ferry Hagen
- Medical Mycology Group, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
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Chen SC, Perfect J, Colombo AL, Cornely OA, Groll AH, Seidel D, Albus K, de Almedia JN Jr, Garcia-Effron G, Gilroy N, Lass-Flörl C, Ostrosky-Zeichner L, Pagano L, Papp T, Rautemaa-Richardson R, Salmanton-García J, Spec A, Steinmann J, Arikan-Akdagli S, Arenz DE, Sprute R, Duran-Graeff L, Freiberger T, Girmenia C, Harris M, Kanj SS, Roudbary M, Lortholary O, Meletiadis J, Segal E, Tuon FF, Wiederhold N, Bicanic T, Chander J, Chen YC, Hsueh PR, Ip M, Munoz P, Spriet I, Temfack E, Thompson L, Tortorano AM, Velegraki A, Govender NP. Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis 2021:S1473-3099(21)00203-6. [PMID: 34419208 DOI: 10.1016/S1473-3099(21)00203-6] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 01/10/2023]
Abstract
Uncommon, or rare, yeast infections are on the rise given increasing numbers of patients who are immunocompromised or seriously ill. The major pathogens include those of the genera Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon (ie, basidiomycetes) and Kodamaea, Malassezia, Pseudozyma (ie, now Moesziomyces or Dirkmeia), Rhodotorula, Saccharomyces, and Sporobolomyces (ie, ascomycetes). A considered approach to the complex, multidisciplinary management of infections that are caused by these pathogens is essential to optimising patient outcomes; however, management guidelines are either region-specific or require updating. In alignment with the One World-One Guideline initiative to incorporate regional differences, experts from diverse geographical regions analysed publications describing the epidemiology and management of the previously mentioned rare yeasts. This guideline summarises the consensus recommendations with regards to the diagnostic and therapeutic options for patients with these rare yeast infections, with the intent of providing practical assistance in clinical decision making. Because there is less clinical experience of patients with rare yeast infections and studies on these patients were not randomised, nor were groups compared, most recommendations are not robust in their validation but represent insights by use of expert opinions and in-vitro susceptibility results. In this Review, we report the key features of the epidemiology, diagnosis, antifungal susceptibility, and treatment outcomes of patients with Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon spp infections.
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de Almeida Júnior JN, Hennequin C. Invasive Trichosporon Infection: a Systematic Review on a Re-emerging Fungal Pathogen. Front Microbiol 2016; 7:1629. [PMID: 27799926 PMCID: PMC5065970 DOI: 10.3389/fmicb.2016.01629] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/29/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives: This review aimed to better depict the clinical features and address the issue of therapeutic management of Trichosporon deep-seated infections. Methods: We comprehensively reviewed the cases of invasive Trichosporon infection reported in the literature from 1994 (date of taxonomic modification) to 2015. Data from antifungal susceptibility testing (AST) studies were also analyzed. Results: Two hundred and three cases were retained and split into four groups: homeopathy (n = 79), other immunodeficiency conditions (n = 41), miscellaneous (n = 58) and newborns (n = 25). Trichosporon asahii was the main causative species (46.7%) and may exhibit cross-resistance to different antifungal classes. The unfavorable outcome rate was at 44.3%. By multivariate analysis, breakthrough infection (OR 2.45) was associated with unfavorable outcome, whilst the use of an azole-based therapy improved the prognosis (OR 0.16). Voriconazole-based treatment was associated with favorable outcome in hematological patients (73.6 vs. 41.8%; p = 0.016). Compiled data from AST demonstrated that (i) T. asahii exhibits the highest MICs to amphotericin B and (ii) voriconazole has the best in vitro efficacy against clinical isolates of Trichosporon spp. Conclusions:Trichosporon infection is not only restricted to hematological patients. Analysis of compiled data from AST and clinical outcome support the use of voriconazole as first line therapy.
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Affiliation(s)
- João N de Almeida Júnior
- Central Laboratory Division-LIM03, Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil; Laboratory of Medical Mycology-LIM53, Instituto de Medicina Tropical da Universidade de São PauloSão Paulo, Brazil
| | - Christophe Hennequin
- Service de Parasitologie-Mycologie-AP-HP, Hôpital St AntoineParis, France; Institut National de la Santé et de la Recherche Médicale UMR 1135, Centre National de la Recherche Scientifique ERL 8255, Sorbonne Universités, University Pierre and Marie Curie (UPMC)Paris, France; Centre d'Immunologie et des Maladies Infectieuses, Bd de l'hôpitalParis, France
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Rizzitelli G, Guanziroli E, Moschin A, Sangalli R, Veraldi S. Onychomycosis caused by Trichosporon mucoides. Int J Infect Dis 2016; 42:61-63. [DOI: 10.1016/j.ijid.2015.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 11/28/2022] Open
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Mariné M, Bom VLP, de Castro PA, Winkelstroter LK, Ramalho LN, Brown NA, Goldman GH. The development of animal infection models and antifungal efficacy assays against clinical isolates of Trichosporon asahii, T. asteroides and T. inkin. Virulence 2015; 6:476-86. [PMID: 25751127 DOI: 10.1080/21505594.2015.1020273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The present study developed Galleria mellonella and murine infection models for the study of Trichosporon infections. The utility of the developed animal models was demonstrated through the assessment of virulence and antifungal efficacy for 7 clinical isolates of Trichosporon asahii, T. asteroides and T. inkin. The susceptibility of the Trichosporon isolates to several common antifungal drugs was tested in vitro using the broth microdilution and the E-test methods. The E-test method depicted a lower minimal inhibitory concentration (MIC) for amphotericin and a slightly higher MIC for caspofungin, while MICs observed for the azoles were different but comparable between both methods. All three Trichosporon species established infection in both the G. mellonella and immunosuppressed murine models. Species and strain dependent differences were observed in both the G. mellonella and murine models. T. asahii was demonstrated to be more virulent than the other 2 species in both animal hosts. Significant differences in virulence were observed between strains for T. asteroides in the murine model. In both animal models, fluconazole and voriconazole were able to improve the survival of the animals compared to the untreated control groups infected with any of the 3 Trichosporon species. In G. mellonella, amphotericin was not able to reduce mortality in any of the 3 species. In contrast, amphotericin was able to reduce murine mortality in the T. asahii or T. inkin models, respectively. Hence, the developed animal infection models can be directly applicable to the future deeper investigation of the molecular determinants of Trichosporon virulence and antifungal resistance.
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Key Words
- AMB, Amphotericin B
- CFG, Caspofungin
- CLSI, Clinical Laboratory Standards Institute
- FLC, Fluconazole
- GMS, Gomori methenamine silver
- Galleria mellonella
- ITZ, Itraconazole
- MIC, Minimal Inhibitory Concentration
- PBS, Phosphate Buffered Saline
- PSC, Posaconazole
- SDA, Sabouraud Dextrose Agar
- Trichosporon
- VRC, Voriconazole
- antifungal
- experimental infection
- murine model
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Affiliation(s)
- Marçal Mariné
- a Faculdade de Ciências Farmacêuticas de Ribeirão Preto; Universidade de São Paulo ; São Paulo , Brazil
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Hazirolan G, Canton E, Sahin S, Arikan-Akdagli S. Head-to-head comparison of inhibitory and fungicidal activities of fluconazole, itraconazole, voriconazole, posaconazole, and isavuconazole against clinical isolates of Trichosporon asahii. Antimicrob Agents Chemother 2013; 57:4841-7. [PMID: 23877683 DOI: 10.1128/AAC.00850-13] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Treatment of disseminated Trichosporon infections still remains difficult. Amphotericin B frequently displays inadequate fungicidal activity and echinocandins have no meaningful antifungal effect against this genus. Triazoles are currently the drugs of choice for the treatment of Trichosporon infections. This study evaluates the inhibitory and fungicidal activities of five triazoles against 90 clinical isolates of Trichosporon asahii. MICs (μg/ml) were determined according to Clinical and Laboratory Standards Institute microdilution method M27-A3 at 24 and 48 h using two endpoints, MIC-2 and MIC-0 (the lowest concentrations that inhibited ∼50 and 100% of growth, respectively). Minimum fungicidal concentrations (MFCs; μg/ml) were determined by seeding 100 μl of all clear MIC wells (using an inoculum of 10(4) CFU/ml) onto Sabouraud dextrose agar. Time-kill curves were assayed against four clinical T. asahii isolates and the T. asahii ATCC 201110 strain. The MIC-2 (∼50% reduction in turbidity compared to the growth control well)/MIC-0 (complete inhibition of growth)/MFC values that inhibited 90% of isolates at 48 h were, respectively, 8/32/64 μg/ml for fluconazole, 1/2/8 μg/ml for itraconazole, 0.12/0.5/2 μg/ml for voriconazole, 0.5/2/4 μg/ml for posaconazole, and 0.25/1/4 μg/ml for isavuconazole. The MIC-0 endpoints yielded more consistent MIC results, which remained mostly unchanged when extending the incubation to 48 h (98 to 100% agreement with 24-h values) and are easier to interpret. Based on the time-kill experiments, none of the drugs reached the fungicidal endpoint (99.9% killing), killing activity being shown but at concentrations not reached in serum. Statistical analysis revealed that killing rates are dose and antifungal dependent. The lowest concentration at which killing activity begins was for voriconazole, and the highest was for fluconazole. These results suggest that azoles display fungistatic activity and lack fungicidal effect against T. asahii. By rank order, the most active triazole is voriconazole, followed by itraconazole ∼ posaconazole ∼ isavuconazole > fluconazole.
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Neyestani TR, Khalaji N, Gharavi A. Black and green teas may have selective synergistic or antagonistic effects on certain antibiotics againstStreptococcus pyogenesin vitro. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/13590840701703934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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de Oliveira Silva RB, Fusco-Almeida AM, Matsumoto MT, Baeza LC, Benaducci T, Mendes-Giannini MJS. Genetic diversity and antifungal susceptibility testing of Trichosporon asahii isolated of Intensive Care Units patients. Braz J Microbiol 2008; 39:585-92. [PMID: 24031270 PMCID: PMC3768427 DOI: 10.1590/s1517-838220080003000033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 02/08/2007] [Accepted: 07/05/2008] [Indexed: 11/21/2022] Open
Abstract
Trichosporon asahii is an opportunistic pathogen, associated with a high mortality rate in immunocompromised patients. In this study, ten isolates, recovered from oral cavity and urine of patients in Intensive Care Units (ICU) over six months, were identified by classical and molecular methods, typed by RAPD and tested in vitro for susceptibility to fluconazole, itraconazole, 5-flucytosine and amphotericin B. A total agreement between the identification of Trichosporon sp by PCR based on sequences of the Internal Transcribed Spacer Regions (ITS) and on the sequences of small-subunit (SSU) ribosomal DNA (rDNA) was found. Randomly amplified of polymorphic DNA (RAPD), with primers P6 and M13, was used to determine the genomic profiles. The dendogram analysis indicated that almost all strains showed similarity >0.9 among them and all strains were multidrug-resistant. This study brings new results on the identification and genotyping of T. asahii isolated from Brazilian ICU patients and information about their antifungal drugs susceptibility.
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Affiliation(s)
- Rosana Bellan de Oliveira Silva
- Instituto Adolfo Lutz , Rio Claro, SP , Brasil ; Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista , Araraquara, SP , Brasil
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Kalkanci A, Mekha N, Poonwan N, Makimura K, Sugita T. Comparative evaluation ofTrichosporon asahiisusceptibility using ASTY colorimetric microdilution and CLSI M27-A2 broth microdilution reference methods. Microbiol Immunol 2008; 52:435-9. [DOI: 10.1111/j.1348-0421.2008.00056.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Neyestani TR, Khalaji N, Gharavi A. Selective Microbiologic Effects of Tea Extract on Certain Antibiotics Against Escherichia coli In Vitro. J Altern Complement Med 2007; 13:1119-24. [DOI: 10.1089/acm.2007.7033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tirang R. Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Shaheed Beheshti Medical University, Tehran, Iran
| | - Niloufar Khalaji
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Shaheed Beheshti Medical University, Tehran, Iran
| | - A'Azam Gharavi
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute, Shaheed Beheshti Medical University, Tehran, Iran
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