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Shankar J, Thakur R, Clemons KV, Stevens DA. Interplay of Cytokines and Chemokines in Aspergillosis. J Fungi (Basel) 2024; 10:251. [PMID: 38667922 PMCID: PMC11051073 DOI: 10.3390/jof10040251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Aspergillosis is a fungal infection caused by various species of Aspergillus, most notably A. fumigatus. This fungus causes a spectrum of diseases, including allergic bronchopulmonary aspergillosis, aspergilloma, chronic pulmonary aspergillosis, and invasive aspergillosis. The clinical manifestations and severity of aspergillosis can vary depending on individual immune status and the specific species of Aspergillus involved. The recognition of Aspergillus involves pathogen-associated molecular patterns (PAMPs) such as glucan, galactomannan, mannose, and conidial surface proteins. These are recognized by the pathogen recognition receptors present on immune cells such as Toll-like receptors (TLR-1,2,3,4, etc.) and C-type lectins (Dectin-1 and Dectin-2). We discuss the roles of cytokines and pathogen recognition in aspergillosis from both the perspective of human and experimental infection. Several cytokines and chemokines have been implicated in the immune response to Aspergillus infection, including interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), CCR4, CCR17, and other interleukins. For example, allergic bronchopulmonary aspergillosis (ABPA) is characterized by Th2 and Th9 cell-type immunity and involves interleukin (IL)-4, IL-5, IL-13, and IL-10. In contrast, it has been observed that invasive aspergillosis involves Th1 and Th17 cell-type immunity via IFN-γ, IL-1, IL-6, and IL-17. These cytokines activate various immune cells and stimulate the production of other immune molecules, such as antimicrobial peptides and reactive oxygen species, which aid in the clearance of the fungal pathogen. Moreover, they help to initiate and coordinate the immune response, recruit immune cells to the site of infection, and promote clearance of the fungus. Insight into the host response from both human and animal studies may aid in understanding the immune response in aspergillosis, possibly leading to harnessing the power of cytokines or cytokine (receptor) antagonists and transforming them into precise immunotherapeutic strategies. This could advance personalized medicine.
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Affiliation(s)
- Jata Shankar
- Genomic Laboratory, Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Waknaghat Solan 173234, Himachal Pradesh, India
| | - Raman Thakur
- Department of Medical Laboratory Science, Lovely Professional University, Jalandhar 144001, Punjab, India;
| | - Karl V. Clemons
- California Institute for Medical Research, San Jose, CA 95128, USA; (K.V.C.); (D.A.S.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA; (K.V.C.); (D.A.S.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
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Sass G, Larwood DJ, Stevens DA. Synergy In Vitro of Nikkomycin Z with Azole Against the Invasive Form of Candida albicans. Mycopathologia 2023; 188:949-956. [PMID: 37713047 DOI: 10.1007/s11046-023-00788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
In a previous study, therapeutic activity of nikkomycin Z (NZ) in a model of invasive candidiasis did not appear to correlate with lesser activity in vitro (using classical MIC methods) with planktonic organisms. However, NZ potency was much greater assaying activity in vitro against germ tubes, the initiator of the invasive mycelial form of the fungus, as occurs in infected tissues. Synergy has been demonstrated for NZ and other drugs, notably fluconazole (the most commonly used drug against candidiasis), in planktonic testing, which correlated with results in vivo. This raised the question whether activity shown by NZ alone against germ tubes would be reflected in drug combinations, and even whether synergy testing against germ tubes might be a better correlate of synergy in future in vivo studies. We show in this study significant NZ synergy with fluconazole against germ tubes, for several C. albicans isolates, with testing in many drug ratios. This observation opens the way for further explorations of this method of susceptibility testing for synergy, and correlation with combination therapy against candidiasis.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA, USA.
| | - David J Larwood
- California Institute for Medical Research, San Jose, CA, USA
- Valley Fever Solutions, Tucson, AZ, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
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Trápaga MR, Poester VR, Mousquer MA, de Souza RP, Rafael LA, Bonel J, Melo AM, Reis AG, de Faria RO, Stevens DA, Nogueira CEW, Xavier MO. Systemic aspergillosis associated with acute enterocolitis in foals. J Mycol Med 2023; 33:101433. [PMID: 37708695 DOI: 10.1016/j.mycmed.2023.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/12/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
Aspergillosis is an uncommon disease in horses, but it can be fatal. We report two cases of systemic aspergillosis in foals that occurred in a short period in the same region of southern Brazil. In addition, a literature review of similar cases was also performed. Risk factors were attributed to an immunodepression by primary enterocolitis and corticosteroid treatment, the damage in the epithelium, and multiple antibacterial treatments, which allowed local fungal proliferation, tissue invasion and spread of infection, leading to death. Since the antemortem diagnosis of aspergillosis in foals is difficult, our report alerts equine veterinarians regarding the importance of suspecting and investigating fungal co-infections in complicated cases of enterocolitis.
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Affiliation(s)
- Mariana Rodrigues Trápaga
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, 96200-400 Rio Grande, RS, Brazil; Post-graduate Program in Health Sciences, Federal University of Rio Grande 96200-400 Rio Grande, RS, Brazil
| | - Vanice Rodrigues Poester
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, 96200-400 Rio Grande, RS, Brazil; Post-graduate Program in Health Sciences, Federal University of Rio Grande 96200-400 Rio Grande, RS, Brazil
| | - Mariana Andrade Mousquer
- Hospital of Veterinary Clinics, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Rafaela Pinto de Souza
- Hospital of Veterinary Clinics, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Leandro Américo Rafael
- Hospital of Veterinary Clinics, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Josiane Bonel
- Hospital of Veterinary Clinics, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Angelita Gomes Reis
- Hospital of Veterinary Clinics, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Renata Osorio de Faria
- Hospital of Veterinary Clinics, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, California, United States; Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, United States
| | | | - Melissa Orzechowski Xavier
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, 96200-400 Rio Grande, RS, Brazil; Post-graduate Program in Health Sciences, Federal University of Rio Grande 96200-400 Rio Grande, RS, Brazil.
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Sass G, Groleau MC, Déziel E, Stevens DA. Simple method for quantification of anionic biosurfactants in aqueous solutions. Front Bioeng Biotechnol 2023; 11:1253652. [PMID: 37885452 PMCID: PMC10598384 DOI: 10.3389/fbioe.2023.1253652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/13/2023] [Indexed: 10/28/2023] Open
Abstract
Biosurfactants are microbial products that have applications as cleaning agents, emulsifiers, and dispersants. Detection and quantification of biosurfactants can be done by various methods, including colorimetric tests, high performance liquid chromatography (HPLC) coupled to several types of detectors, and tests that take advantage of biosurfactants reducing surface tension of aqueous liquids, allowing for spreading and droplet formation of oils. We present a new and simple method for quantifying biosurfactants by their ability, on paper, to reduce surface tension of aqueous solutions, causing droplet dispersion on an oiled surface in correlation with biosurfactant content. We validated this method with rhamnolipids, surfactin, sophorolipids, and ananatoside B; all are anionic microbial surfactants. Linear ranges for quantification in aqueous solutions for all tested biosurfactants were between 10 and 500 µM. Our method showed time-dependent biosurfactant accumulation in cultures of Pseudomonas aeruginosa strains PA14 and PAO1, and Burkholderia thailandensis E264. Mutants in genes responsible for surfactant production showed negligible activity on oiled paper. In summary, our simple assay provides the opportunity to quantify biosurfactant contents of aqueous solutions, for a diversity of surfactants, by means readily available in any laboratory.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA, United States
| | - Marie-Christine Groleau
- Institut National de la Recherche Scientific-Centre Armand-Frappier Santé Biotechnologie, Laval, QC, Canada
| | - Eric Déziel
- Institut National de la Recherche Scientific-Centre Armand-Frappier Santé Biotechnologie, Laval, QC, Canada
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA, United States
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Poester VR, Munhoz LS, Stevens DA, Melo AM, Trápaga MR, Flores MM, Larwood DJ, Xavier MO. Nikkomycin Z for the treatment of experimental sporotrichosis caused by Sporothrix brasiliensis. Mycoses 2023; 66:898-905. [PMID: 37434420 DOI: 10.1111/myc.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
Sporotrichosis caused by Sporothrix brasiliensis is a global emergent infectious disease. Due to the scarcity of therapeutic options for fungal diseases, new antifungals are urgently needed. Nikkomycin Z (NikZ) is a future option as an agent against dimorphic fungi. We evaluated NikZ monotherapy and in combination with itraconazole (ITZ; the conventional therapy) in the treatment of experimental sporotrichosis caused by S. brasiliensis in a murine model. Animals were subcutaneously infected, and treated orally for 30 days. The study groups were as follows control (untreated), ITZ group (50 mg/kg/day), and three groups treated with NikZ, two by monotherapy (200 or 400 mg/kg/day), and one combining NikZ (400 mg/kg/day) and ITZ. Efficacy of treatments was evaluated via body weight gain, mortality and fungal burden in tissues. Efficacy was noted in all treatment groups, and the group receiving the drug combination showed even better results than those with monotherapy. Our study shows for the first time the high potential of NikZ to be used in the treatment of sporotrichosis caused by S. brasiliensis.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Brazil
- Mycology Laboratory of FAMED-FURG, Rio Grande, Brazil
| | | | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA
| | - Aryse Martins Melo
- Department of Infectious Diseases, National Institute of Health Doutor Ricardo Joge, Lisbon, Portugal
| | - Mariana Rodrigues Trápaga
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Brazil
- Mycology Laboratory of FAMED-FURG, Rio Grande, Brazil
| | | | - David J Larwood
- California Institute for Medical Research, San Jose, California, USA
- Valley Fever Solutions, Tucson, Arizona, USA
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, Brazil
- Mycology Laboratory of FAMED-FURG, Rio Grande, Brazil
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Xavier MO, Poester VR, Trápaga MR, Stevens DA. Sporothrix brasiliensis: Epidemiology, Therapy, and Recent Developments. J Fungi (Basel) 2023; 9:921. [PMID: 37755029 PMCID: PMC10532502 DOI: 10.3390/jof9090921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
Sporotrichosis caused by Sporothrix brasiliensis is an emergent mycosis that is now a worldwide concern. One important step to sporotrichosis control is its correct treatment. However, limitations abound; thus, new antifungals, mainly focused on S. brasiliensis, are urgently needed. We performed a systematic review (following the PRISMA guideline) focused on (1) the global distribution of human and animal sporotrichosis by S. brasiliensis, especially outside of Brazil; (2) appraising therapies tested against this pathogen. We identified sporotrichosis caused by S. brasiliensis reported in five countries (Paraguay, Chile, Argentina, the United Kingdom, and the United States) in addition to Brazil, occurring on three continents, highlighting the epidemiological scenario in Argentina with an important increase in reported cases in recent years. Regarding the antifungal activity of drugs, 25 articles described the in vitro action of 20 unique chemicals and eight repurposed drugs against S. brasiliensis. Only five studies reported in vivo activity against S. brasiliensis (five drugs) using invertebrate and vertebrate models. Sporotrichosis caused by S. brasiliensis has a global impact and it is no longer specifically a Brazilian problem. We review the need for understanding the disease epidemiology, education of clinicians and of the populace, organization of health care delivery to respond to a spreading epidemic, and research on therapy for sporotrichosis.
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Affiliation(s)
- Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (M.O.X.); (V.R.P.); (M.R.T.)
- Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil
| | - Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (M.O.X.); (V.R.P.); (M.R.T.)
- Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil
| | - Mariana Rodrigues Trápaga
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (M.O.X.); (V.R.P.); (M.R.T.)
- Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
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Illek B, Fischer H, Machen TE, Hari G, Clemons KV, Sass G, Ferreira JAG, Stevens DA. Protective role of CFTR during fungal infection of cystic fibrosis bronchial epithelial cells with Aspergillus fumigatus. Front Cell Infect Microbiol 2023; 13:1196581. [PMID: 37680748 PMCID: PMC10482090 DOI: 10.3389/fcimb.2023.1196581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 09/09/2023] Open
Abstract
Lung infection with the fungus Aspergillus fumigatus (Af) is a common complication in cystic fibrosis (CF) and is associated with loss of pulmonary function. We established a fungal epithelial co-culture model to examine the impact of Af infection on CF bronchial epithelial barrier function using Af strains 10AF and AF293-GFP, and the CFBE41o- cell line homozygous for the F508del mutation with (CF+CFTR) and without (CF) normal CFTR expression. Following exposure of the epithelial surface to Af conidia, formation of germlings (early stages of fungal growth) was detected after 9-12 hours and hyphae (mature fungal growth) after 12-24 hours. During fungal morphogenesis, bronchial epithelial cells showed signs of damage including rounding, and partial detachment after 24 hours. Fluorescently labeled conidia were internalized after 6 hours and more internalized conidia were observed in CF compared to CF+CFTR cells. Infection of the apical surface with 10AF conidia, germlings, or hyphae was performed to determine growth stage-specific effects on tight junction protein zona occludens protein 1 (ZO-1) expression and transepithelial electrical resistance (TER). In response to infection with conidia or germlings, epithelial barrier function degraded time-dependently (based on ZO-1 immunofluorescence and TER) with a delayed onset in CF+CFTR cell monolayers and required viable fungi and apical application. Infection with hyphae caused an earlier onset and faster rate of decline in TER compared to conidia and germlings. Gliotoxin, a major Af virulence factor, caused a rapid decline in TER and induced a transient chloride secretory response in CF+CFTR but not CF cells. Our findings suggest growth and internalization of Af result in deleterious effects on bronchial epithelial barrier function that occurred more rapidly in the absence of CFTR. Bronchial epithelial barrier breakdown was time-dependent and morphotype-specific and mimicked by acute administration of gliotoxin. Our study also suggests a protective role for CFTR by turning on CFTR-dependent chloride transport in response to gliotoxin, a mechanism that will support mucociliary clearance, and could delay the loss of epithelial integrity during fungal development in vivo.
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Affiliation(s)
- Beate Illek
- UCSF Benioff Children's Hospital Oakland, Children's Hospital Oakland Research Institute, Oakland, CA, United States
| | - Horst Fischer
- UCSF Benioff Children's Hospital Oakland, Children's Hospital Oakland Research Institute, Oakland, CA, United States
| | - Terry E. Machen
- Department of Molecular and Cell Biology, University of California, Berkeley, Berkeley, CA, United States
| | - Gopika Hari
- UCSF Benioff Children's Hospital Oakland, Children's Hospital Oakland Research Institute, Oakland, CA, United States
| | - Karl V. Clemons
- California Institute for Medical Research, San Jose, CA, United States
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, United States
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, CA, United States
| | - Jose A. G. Ferreira
- California Institute for Medical Research, San Jose, CA, United States
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, United States
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA, United States
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, United States
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Beltrame A, Stevens DA, Haiduven D. Mortality in ICU Patients with COVID-19-Associated Pulmonary Aspergillosis. J Fungi (Basel) 2023; 9:689. [PMID: 37367625 DOI: 10.3390/jof9060689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
A review of 38 studies involving 1437 COVID-19 patients admitted to intensive care units (ICUs) with pulmonary aspergillosis (CAPA) was conducted to investigate whether mortality has improved since the pandemic's onset. The study found that the median ICU mortality was 56.8%, ranging from 30% to 91.8%. These rates were higher for patients admitted during 2020-2021 (61.4%) compared to 2020 (52.3%), and prospective studies found higher ICU mortality (64.7%) than retrospective ones (56.4%). The studies were conducted in various countries and used different criteria to define CAPA. The percentage of patients who received antifungal therapy varied across studies. These results indicate that the mortality rate among CAPA patients is a growing concern, mainly since there has been an overall reduction in mortality among COVID-19 patients. Urgent action is needed to improve prevention and management strategies for CAPA, and additional research is needed to identify optimal treatment strategies to reduce mortality rates among these patients. This study serves as a call to action for healthcare professionals and policymakers to prioritize CAPA, a serious and potentially life-threatening complication of COVID-19.
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Affiliation(s)
- Anna Beltrame
- College of Public Health, University of South Florida, Tampa, FL 33622, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
| | - Donna Haiduven
- College of Public Health, University of South Florida, Tampa, FL 33622, USA
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Munhoz LS, Poester VR, Benelli JL, Melo AM, Trápaga MR, Nogueira CW, Zeni G, Flores MM, Stevens DA, Xavier MO. Effectiveness of diphenyl diselenide against experimental sporotrichosis caused by Sporothrix brasiliensis. Med Mycol 2023; 61:myad035. [PMID: 36977574 DOI: 10.1093/mmy/myad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Diphenyl diselenide (PhSe)2 is a stable organoselenium compound with promising in vitro antifungal activity against several fungi, including Sporothrix brasiliensis. This species is associated with feline and zoonotic sporotrichosis, an emergent mycosis in Latin America. We evaluated the activity of (PhSe)2, alone and in association with itraconazole, in the treatment of sporotrichosis caused by S. brasiliensis, in a murine model. Sixty mice were subcutaneously infected with S. brasiliensis in the footpad and treated by gavage for 30 consecutive days. The six treatment groups received: no active treatment, itraconazole (50 mg/kg), (PhSe)2 at 1, 5, and 10 mg/kg dosages, or itraconazole (50 mg/kg) + (PhSe)2 1 mg/kg, once a day, starting seven days post-inoculation. A significant reduction in the fungal burden of internal organs was achieved in the groups treated with (PhSe)2 1 mg/kg or itraconazole alone in comparison with the untreated group. Higher dosages (5 and 10 mg/kg) of (PhSe)2 increased the clinical manifestation of sporotrichosis and mortality rate. Treatment with both itraconazole and (PhSe)2 1 mg/kg was better than their activities alone (P < .001). This is the first demonstration of the potential use of (PhSe)2, alone or with the present drug of choice, in the treatment of sporotrichosis.
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Affiliation(s)
- Lívia Silveira Munhoz
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
| | - Vanice Rodrigues Poester
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - Jéssica Louise Benelli
- Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande city, Rio Grande do Sul state, 96200-190, Brazil
| | - Aryse Martins Melo
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, 1600-609, Portugal
| | - Mariana Rodrigues Trápaga
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
| | - Cristina Wayne Nogueira
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - Gilson Zeni
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - Mariana Martins Flores
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, California 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California 94305, USA
| | - Melissa Orzechowski Xavier
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
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Stevens DA, Kotta-Loizou I, Martinez M, Coutts RHA, Sass G. Virus Infection Impairs Fungal Response to Stress: Effect of Salt. Viruses 2023; 15:718. [PMID: 36992427 PMCID: PMC10056142 DOI: 10.3390/v15030718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Infection with Aspergillus fumigatus polymycovirus 1 (AfuPmV-1) weakens the resistance of biofilms of common A. fumigatus reference strain Af293 in intermicrobial competition with Pseudomonas aeruginosa, and sensitizes A. fumigatus for antifungal effects of nikkomycin Z. We compared the sensitivity of two virus-infected (VI) and one virus-free (VF) Af293 strains to hypertonic salt. Salt stress impairs the growth of VI and VF at all times; VF control growth always exceeds VI, and VF growth in salt always exceeds VI. Since VF growth exceeds VI in the presence and absence of salt, we also examined growth in salt as a percentage of control growth. Initially, as a percentage of control, VI exceeded VF, but at 120 h VF began to exceed VI consistently even by this measure; thus, at that time the growth of VF in salt surges in relation to control growth, or, alternatively, its growth in salt persists compared to the relative inhibition of VI. In summary, virus infection impairs the response of A. fumigatus to several different stresses, including hypertonic salt.
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Affiliation(s)
- David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA 94305, USA
| | - Ioly Kotta-Loizou
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK
| | - Marife Martinez
- California Institute for Medical Research, San Jose, CA 95128, USA
| | - Robert H. A. Coutts
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA
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11
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Melo AM, Poester VR, Trápaga MR, Stevens DA, Canabarro PL, Adornes AC, da Silva AP, Estima SC, Frere E, Sabino R, Xavier MO. Aspergillosis in free-ranging Magellanic penguins. Med Mycol 2023; 61:7034336. [PMID: 36764673 DOI: 10.1093/mmy/myad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
We evaluated the mortality due to aspergillosis in free-ranging Magellanic penguins during their migration and the reproductive season. A total of 98 carcasses of penguins were collected along 370 km of coastline in Southern Brazil, between June 2017 and October 2019, and from reproductive colonies in Patagonian Argentina, in January 2019. All animals were necropsied, and only proven cases were computed. Aspergillosis was diagnosed in 2.5% of the penguins evaluated during their migration route. Our study, of the Southern coast of Brazil, is the first to demonstrate that aspergillosis is an important cause of mortality in free-ranging penguins. The implications of these findings in the One Health context are discussed.
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Affiliation(s)
- Aryse Martins Melo
- Microbiology and Parasitology Post-Graduate Program, Institute of Biology, Universidade Federal de Pelotas (UFPEL), Pelotas, Rio Grande do Sul (RS), Brazil.,Department of Infectious Diseases, National Institute of Health, Dr. Ricardo Jorge, Lisbon, Portugal
| | - Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brazil
| | - Mariana Rodrigues Trápaga
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Div. of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | | | | | | | - Sérgio Curi Estima
- Center for Environmental Education and Monitoring (NEMA), Rio Grande - RS, Brazil
| | - Esteban Frere
- Centro De Investigaciones Puerto Deseado -Unidad Academica Caleta Olivia - (UNPA) Universidad Nacional De La Patagonia Austral, Puerto Deseado, Argentina
| | - Raquel Sabino
- Department of Infectious Diseases, National Institute of Health, Dr. Ricardo Jorge, Lisbon, Portugal.,Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028, Lisboa, Portugal
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande, RS, Brazil
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12
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Luptáková D, Patil RH, Dobiáš R, Stevens DA, Pluháček T, Palyzová A, Káňová M, Navrátil M, Vrba Z, Hubáček P, Havlíček V. Siderophore-Based Noninvasive Differentiation of Aspergillus fumigatus Colonization and Invasion in Pulmonary Aspergillosis. Microbiol Spectr 2023; 11:e0406822. [PMID: 36719229 PMCID: PMC10100950 DOI: 10.1128/spectrum.04068-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
Germination from conidia to hyphae and hyphal propagation of Aspergillus fumigatus are the key pathogenic steps in the development of invasive pulmonary aspergillosis (IPA). By applying in vitro observations in a clinical study of 13 patients diagnosed with probable IPA, here, we show that the transition from colonization to the A. fumigatus invasive stage is accompanied by the secretion of triacetylfusarinine C (TafC), triacetylfusarinine B (TafB), and ferricrocin (Fc) siderophores into urine, with strikingly better sensitivity performance than serum sampling. The best-performing index, the TafC/creatinine index, with a median value of 17.2, provided 92.3% detection sensitivity (95% confidence interval [CI], 64.0 to 99.8%) and 100% specificity (95% CI, 84.6 to 100%), i.e., substantially better than the corresponding indications provided by galactomannan (GM) and β-d-glucan (BDG) serology. For the same patient cohort, the serum GM and BDG sensitivities were 46.2 and 76.9%, respectively, and their specificities were 86.4 and 63.6%, respectively. The time-dependent specific appearance of siderophores in the host's urine represents an impactful clinical diagnostic advantage in the early discrimination of invasive aspergillosis from colonization. A favorable concentration of TafC in a clinical specimen distant from a deep infection site enables the noninvasive sampling of patients suffering from IPA. IMPORTANCE The importance of this research lies in the demonstration that siderophore analysis can distinguish between asymptomatic colonization and invasive pulmonary aspergillosis. We found clear associations between phases of fungal development, from conidial germination to the proliferative stage of invasive aspergillosis, and changes in secondary metabolite secretion. The critical extracellular fungal metabolites triacetylfusarinines C and B are produced during the polarized germination or postpolarized growth phase and reflect the morphological status of the proliferating pathogen. False positivity in Aspergillus diagnostics is minimized as mammalian cells do not synthesize Aspergillus siderophore or mycotoxin molecules.
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Affiliation(s)
- Dominika Luptáková
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czechia
| | - Rutuja H. Patil
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czechia
- Department of Analytical Chemistry, Palacký University, Olomouc, Czechia
| | - Radim Dobiáš
- Department of Bacteriology and Mycology, Public Health Institute in Ostrava, Ostrava, Czechia
- Institute of Laboratory Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - David A. Stevens
- California Institute for Medical Research, San Jose, California, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Tomáš Pluháček
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czechia
- Department of Analytical Chemistry, Palacký University, Olomouc, Czechia
| | - Andrea Palyzová
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czechia
| | - Marcela Káňová
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czechia
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, Ostrava, Czechia
| | - Milan Navrátil
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czechia
| | - Zbyněk Vrba
- Lung Department, Krnov Combined Medical Facility, Krnov, Czechia
| | - Petr Hubáček
- Department of Medical Microbiology, Charles University, Prague, Czechia
- Motol University Hospital, Prague, Czechia
| | - Vladimír Havlíček
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czechia
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13
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Sass G, Larwood DJ, Martinez M, Stevens DA. Continuous dosing of nikkomycin Z against systemic candidiasis, in vivo and in vitro correlates. Mycoses 2023; 66:378-386. [PMID: 36680371 DOI: 10.1111/myc.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Candidiasis is the most common cause of fungal sepsis, and new agents are of interest to ameliorate current deficiencies in therapy. Nikkomycin Z (NIKZ) is an inhibitor of chitin synthase, interfering with fungal cell wall development. OBJECTIVES/METHODS We studied NIKZ therapy of disseminated murine candidiasis, via continuous drug exposure, in drinking water, to compensate for rapid clearance of the drug. RESULTS Drinking, and thus drug intake in the NIKZ groups, as well as body weight, was affected by the degree of illness. NIKZ effect on survival, despite reduced drinking initially after infection, was highly efficacious and dose-related, and comparable to fluconazole, though neither were curative with the regimens employed. The challenge was rapidly lethal to all untreated animals, whereas NIKZ groups achieved >50% survival. Assays of residual fungal infection were consistent with impressions of efficacy based on survival. Although NIKZ MIC for Candida albicans appeared unpromising, mycelial formation assays more closely correlated with in vivo observations. CONCLUSIONS In vitro-in vivo disparity may be explained by NIKZ tissue concentration in the target tissue and/or by enhanced NIKZ action on mycelial formation, a morphological change in vivo wherein chitin synthesis is more critical, compared to NIKZ activity in inhibiting planktonic growth. A sustained release oral form of NIKZ in drug development for humans could hold promise, possibly also in future exploring previously demonstrated synergy in vitro with other antifungals.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - David J Larwood
- California Institute for Medical Research, San Jose, California, USA.,Valley Fever Solutions, Tucson, Arizona, USA
| | - Marife Martinez
- California Institute for Medical Research, San Jose, California, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA.,Div. of Infectious Diseases and Geographic Medicine, Stanford Univ. Medical School, Stanford, California, USA
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14
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Sass G, Kotta-Loizou I, Martinez M, Larwood DJ, Stevens DA. Polymycovirus Infection Sensitizes Aspergillus fumigatus for Antifungal Effects of Nikkomycin Z. Viruses 2023; 15:197. [PMID: 36680240 PMCID: PMC9864188 DOI: 10.3390/v15010197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Infection with Aspergillus fumigatus polymycovirus 1 (AfuPmV-1) weakens resistance of Aspergillus fumigatus common reference strain Af293 biofilms in intermicrobial competition with Pseudomonas aeruginosa. We compared the sensitivity of two infected and one virus-free Af293 strains to antifungal drugs. All three were comparably sensitive to drugs affecting fungal membranes (voriconazole, amphotericin) or cell wall glucan synthesis (micafungin, caspofungin). In contrast, forming biofilms of virus-free Af293 were much more resistant than AfuPmV-1-infected Af293 to nikkomycin Z (NikZ), a drug inhibiting chitin synthase. The IC50 for NikZ on biofilms was between 3.8 and 7.5 µg/mL for virus-free Af293 and 0.94-1.88 µg/mL for infected strains. The IC50 for the virus-free A. fumigatus strain 10AF was ~2 µg/mL in most experiments. NikZ also modestly affected the planktonic growth of infected Af293 more than the virus-free strain (MIC 50%, 2 and 4 µg/mL, respectively). Virus-free Af293 biofilm showed increased metabolism, and fungus growing as biofilm or planktonically showed increased growth compared to infected; these differences do not explain the resistance of the virus-free fungus to NikZ. In summary, AfuPmV-1 infection sensitized A. fumigatus to NikZ, but did not affect response to drugs commonly used against A. fumigatus infection. Virus infection had a greater effect on NikZ inhibition of biofilm than planktonic growth.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA
| | - Ioly Kotta-Loizou
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Department of Clinical, Pharmaceutical and Biological Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK
| | - Marife Martinez
- California Institute for Medical Research, San Jose, CA 95128, USA
| | | | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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15
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Poester VR, Severo CB, da Silva CAE, Stevens DA, Trápaga MR, Xavier MO. Tattooing as a gateway to Sporothrix brasiliensis infection. Med Mycol Case Rep 2022; 37:23-25. [PMID: 35800068 PMCID: PMC9253035 DOI: 10.1016/j.mmcr.2022.06.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
Recently, sporotrichosis caused by Sporothrix brasiliensis transmitted during tattooing process was described in the epicenter of the Brazilian epidemic sporotrichosis. We report a similar case of this mycosis in a patient recently tattooed, but probably infected by a sick cat instead of via a contaminated procedure. Clinical cure was attained after two months of oral itraconazole. In the hyperendemic S. brasiliensis regions of sporotrichosis, health professionals must be aware of atypical transmissions of this fungus.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande do Sul, RS, Brazil
- Corresponding author.
| | - Cecília Bittencourt Severo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
- Irmandade Santa Casa de Porto Alegre, Hospital Santa Rita, Laboratório de Micologia, RS, Brazil
| | | | - David A. Stevens
- California Institute for Medical Research, San Jose, CA, USA
- Div. of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Mariana Rodrigues Trápaga
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande do Sul, RS, Brazil
| | - Melissa Orzechowski Xavier
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande do Sul, RS, Brazil
- Corresponding author. Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Campus Saúde, Visconde de Paranaguá 102, Centro, 96201-900, Rio Grande, RS, Brazil.
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16
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Munhoz LS, Poester VR, Severo CB, Trápaga MR, Madrid IM, Benelli JL, Stevens DA, Xavier MO. Update of the Epidemiology of the Sporotrichosis Epidemic in the state of Rio Grande do Sul, Brazil. Mycoses 2022; 65:1112-1118. [PMID: 35833311 DOI: 10.1111/myc.13497] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sporotrichosis is a disease not requiring jurisdictional notification, and consequently is underreported in Brazil. Therefore, the epidemiological picture even in hyperendemic states is unknown. Thus we evaluated the occurrence of sporotrichosis throughout the territory of the southern state of Brazil, Rio Grande do Sul (RS). METHODS We update the epidemiological situation of sporotrichosis in the southern region of this state and describe the emergence of this disease in the Metropolitan region. We engaged professionals from RS enrolled in animal health care in answering a questionnaire regarding sporotrichosis. RESULTS The occurrence of local cases of feline sporotrichosis was reported by 83% of the participants from 40 cities, distributed through the seven health districts of RS. Human sporotrichosis cases, transmitted by cats, were also reported by professionals from four regions of the state. The frequency of the disease in both the South and Metropolitan regions showed a marked increase in recent years. CONCLUSION Feline and cat-transmitted human sporotrichosis is an underreported mycosis in RS, widely distributed in the territory of this state and increasing. Aggressive public health policies are urgently necessary to control the geographical expansion of this spreading mycosis.
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Affiliation(s)
- Lívia Silveira Munhoz
- Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), RS, Brazil
| | | | | | - Mariana Rodrigues Trápaga
- Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), RS, Brazil
| | | | - Jéssica Louise Benelli
- Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH)
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Melissa Orzechowski Xavier
- Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), RS, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH)
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17
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Thompson GR, Ampel NM, Blair JE, Donovan F, Fierer J, Galgiani JN, Heidari A, Johnson R, Shatsky SA, Uchiyama CM, Stevens DA. Controversies in the Management of Central Nervous System Coccidioidomycosis. Clin Infect Dis 2022; 75:555-559. [PMID: 35717645 DOI: 10.1093/cid/ciac478] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 11/12/2022] Open
Abstract
Central nervous system infection with Coccidioides spp is fatal if untreated, and complications occur even when therapy is directed by experienced clinicians. We convened a panel of clinicians experienced in the management of coccidioidal meningitis to summarize current controversies and provide consensus for the management of this difficult infection.
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Affiliation(s)
- George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and the Department of Medical Microbiology and Immunology, University of California-Davis Medical Center; Sacramento, CA USA.,University of California - Davis Center for Valley Fever, Sacramento, CA USA
| | - Neil M Ampel
- Division of Infectious Diseases, Mayo Clinic in Arizona, Phoenix, AZ, USA.,University of Arizona College of Medicine, Tucson, AZ, USA
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic in Arizona, Phoenix, AZ, USA
| | - Fariba Donovan
- University of Arizona College of Medicine, Tucson, AZ, USA.,Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Joshua Fierer
- Division of Infectious Disease, Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, USA.,Infectious Diseases Section, VA Healthcare San Diego, San Diego, CA, USA
| | - John N Galgiani
- University of Arizona College of Medicine, Tucson, AZ, USA.,Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
| | - Arash Heidari
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute, Kern Medical Center, Bakersfield, CA, USA
| | - Royce Johnson
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Kern Medical, Bakersfield, CA, USA.,Valley Fever Institute, Kern Medical Center, Bakersfield, CA, USA
| | | | - Christopher M Uchiyama
- Department of Neurosurgery, Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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18
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Benelli JL, Basso RP, Grafulha TW, Poester VR, Munhoz LS, Martins KB, Zogbi HE, Von Groll A, Severo CB, Stevens DA, Xavier MO. Fungal Bloodstream Co-infection by Trichosporon asahii in a COVID-19 Critical Patient: Case Report and Literature Review. Mycopathologia 2022; 187:397-404. [PMID: 35661958 PMCID: PMC9166219 DOI: 10.1007/s11046-022-00637-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Opportunistic infections are serious complications in critically ill COVID-19 patients, especially co-infections with bacterial and fungal agents. Here we report a rare case of bloodstream co-infection by Trichosporon asahii, an emerging yeast, and Acinetobacterbaumannii, an opportunistic nosocomial pathogen, both multidrug resistant, in a tertiary hospital from southern Brazil. A review of the literature regarding similar cases is also included. Treatment with multiple antimicrobials failed, and the patient progressed to death four days after the diagnosis of bacteremia and fungemia.
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Affiliation(s)
- Jéssica Louise Benelli
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
- Dr. Miguel Riet Correa University Hospital (HU-FURG/EBSERH), Rio Grande, Rio Grande Do Sul, 96200-190, Brazil
| | - Rossana Patrícia Basso
- Dr. Miguel Riet Correa University Hospital (HU-FURG/EBSERH), Rio Grande, Rio Grande Do Sul, 96200-190, Brazil
| | - Talita Werner Grafulha
- Dr. Miguel Riet Correa University Hospital (HU-FURG/EBSERH), Rio Grande, Rio Grande Do Sul, 96200-190, Brazil
| | - Vanice Rodrigues Poester
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
| | - Lívia Silveira Munhoz
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
| | - Katheryne Benine Martins
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
- Medical Microbiology Research Nucleus - NUPEMM, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
| | - Heruza Einsfeld Zogbi
- Dr. Miguel Riet Correa University Hospital (HU-FURG/EBSERH), Rio Grande, Rio Grande Do Sul, 96200-190, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
- Medical Microbiology Research Nucleus - NUPEMM, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
| | - Andrea Von Groll
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
- Medical Microbiology Research Nucleus - NUPEMM, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil
| | - Cecília Bittencourt Severo
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande Do Sul, 90050-170, Brazil
- Hospital Complex Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande Do Sul, 90035-074, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, and Div. of Infectious Diseases and Geographic Medicine, Stanford Univ. Medical School, Stanford, CA, USA
| | - Melissa Orzechowski Xavier
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil.
- Postgraduate Program in Health Sciences, Federal University of Rio Grande, Rio Grande, Rio Grande Do Sul, 96200-400, Brazil.
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19
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Sass G, Marsh JJ, Shrestha P, Sabino R, Stevens DA. Synergy Between Pseudomonas aeruginosa Filtrates And Voriconazole Against Aspergillus fumigatus Biofilm Is Less for Mucoid Isolates From Persons With Cystic Fibrosis. Front Cell Infect Microbiol 2022; 12:817315. [PMID: 35493738 PMCID: PMC9047052 DOI: 10.3389/fcimb.2022.817315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Persons with cystic fibrosis (CF) frequently suffer from Pseudomonas aeruginosa and Aspergillus fumigatus co-infections. There is evidence that co-infections with these interacting pathogens cause airway inflammation and aggravate deterioration of lung function. We recently showed that P. aeruginosa laboratory isolates synergistically interact with the anti-fungal azole voriconazole (VCZ), inhibiting biofilm metabolism of several A. fumigatus laboratory strains. Interaction was usually mediated via pyoverdine, but also via pyocyanin or pyochelin. Here we used planktonic filtrates of 7 mucoid and 9 non-mucoid P. aeruginosa isolates from CF patients, as well as 8 isolates without CF origin, and found that all of these isolates interacted with VCZ synergistically at their IC50 as well as higher dilutions. CF mucoid isolates showed the weakest interactive effects. Four non-mucoid P. aeruginosa CF isolates produced no or very low levels of pyoverdine and did not reach an IC50 against forming A. fumigatus biofilm; interaction with VCZ still was synergistic. A VCZ-resistant A. fumigatus strain showed the same level of susceptibility for P. aeruginosa anti-fungal activity as a VCZ-susceptible reference strain. Filtrates of most Pseudomonas isolates were able to increase anti-fungal activity of VCZ on a susceptible A. fumigatus strain. This was also possible for the VCZ-resistant strain. In summary these data show that clinical P. aeruginosa isolates, at varying degrees, synergistically interact with VCZ, and that pyoverdine is not the only molecule responsible. These data also strengthen the idea that during co-infections of A. fumigatus and P. aeruginosa lower concentrations of VCZ might be sufficient to control fungal growth.
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Affiliation(s)
- Gabriele Sass
- Infectious Disease Research Laboratory, California Institute for Medical Research, San Jose, CA, United States
- *Correspondence: Gabriele Sass,
| | - Julianne J. Marsh
- Infectious Disease Research Laboratory, California Institute for Medical Research, San Jose, CA, United States
| | - Pallabi Shrestha
- Infectious Disease Research Laboratory, California Institute for Medical Research, San Jose, CA, United States
| | - Raquel Sabino
- Department of Infectious Diseases, National Institute of Health, ‘Dr. Ricardo Jorge’, Lisbon, Portugal
- Institute of Environmental Health, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - David A. Stevens
- Infectious Disease Research Laboratory, California Institute for Medical Research, San Jose, CA, United States
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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20
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Abstract
We evaluated disseminated histoplasmosis (DH) in HIV patients over 10 years in southern Brazil. The incidence was 12 cases/1,000 hospitalizations (2010–2019); the mortality rate was 35%. Tuberculosis frequently obscured the diagnosis of DH. We emphasize the need in our region to suspect and investigate DH using more sensitive methods.
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Sass G, Scherpe L, Martinez M, Marsh JJ, Stevens DA. Metrics of Antifungal Effects of Ciprofloxacin on Aspergillus fumigatus Planktonic Growth and Biofilm Metabolism; Effects of Iron and Siderophores. J Fungi (Basel) 2022; 8:jof8030240. [PMID: 35330242 PMCID: PMC8950033 DOI: 10.3390/jof8030240] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/27/2023] Open
Abstract
Pseudomonas aeruginosa and Aspergillus fumigatus frequently coexist in the airways of immunocompromised patients or individuals with cystic fibrosis. Ciprofloxacin (CIP) is a synthetic quinolone antibiotic commonly used to treat bacterial infections, such as those produced by Pseudomonas aeruginosa. CIP binds iron, and it is unclear what effect this complex would have on the mycobiome. The effects of CIP on Aspergillus were dependent on the iron levels present, and on the presence of Aspergillus siderophores. We found that CIP alone stimulated wildtype planktonic growth, but not biofilm metabolism. At high concentrations, CIP antagonized a profungal effect of iron on wildtype Aspergillus metabolism, presumably owing to iron chelation. CIP interfered with the metabolism and growth of an Aspergillus siderophore mutant, with the effect on metabolism being antagonized by iron. CIP acted synergistically with iron on the growth of the mutant, and, to a lesser extent, the wildtype. In summary, CIP can increase fungal growth or affect fungal metabolism, depending on the local iron concentration and available siderophores. Therefore, high local CIP concentrations during treatment of Pseudomonas–Aspergillus co-infections may increase the fungal burden.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA; (L.S.); (M.M.); (J.J.M.); (D.A.S.)
- Correspondence: ; Tel.: +1-408-998-4557
| | - Lynn Scherpe
- California Institute for Medical Research, San Jose, CA 95128, USA; (L.S.); (M.M.); (J.J.M.); (D.A.S.)
- Faculty of Science and Engineering, Maastricht University, 6229 EN Maastricht, The Netherlands
| | - Marife Martinez
- California Institute for Medical Research, San Jose, CA 95128, USA; (L.S.); (M.M.); (J.J.M.); (D.A.S.)
| | - Julianne J. Marsh
- California Institute for Medical Research, San Jose, CA 95128, USA; (L.S.); (M.M.); (J.J.M.); (D.A.S.)
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA; (L.S.); (M.M.); (J.J.M.); (D.A.S.)
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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Poester VR, Basso RP, Stevens DA, Munhoz LS, de Souza Rabello VB, Almeida-Paes R, Zancopé-Oliveira RM, Zanchi M, Benelli JL, Xavier MO. Treatment of Human Sporotrichosis Caused by Sporothrix brasiliensis. J Fungi (Basel) 2022; 8:jof8010070. [PMID: 35050010 PMCID: PMC8779703 DOI: 10.3390/jof8010070] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 01/19/2023] Open
Abstract
We describe the successful treatment of a series of 30 zoonotic sporotrichosis cases from southern Brazil. Sporothrix brasiliensis was the species genotypically identified in all 25 confirmed cases. Five other cases were classified as probable, without laboratory confirmation, but with clinical and epidemiological data of cat-transmitted sporotrichosis. Two isolates were sequenced by translation elongation factor-1 alpha (EF1α) loci in order to compare their sequences, and both of them showed distinct genotypes from S. brasiliensis strains from other Brazilian states. Itraconazole (ITZ) or potassium iodide (KI) were the first choice treatment in 28 and 2 cases, respectively. Microdilution assay showed a wild-type profile of S. brasiliensis isolates to ITZ. However, a lack of clinical response occurred in 42% of cases, especially those treated with ITZ 100 mg/day, and treatment needed modifications, by either increased doses or antifungal combinations. Clinical cure required a mean of 187 days of treatment, which was dependent on the clinical form of the disease and age of patients. Therapy, including dosages and durations, for cutaneous forms of sporotrichosis requires re-evaluation, since cases caused by S. brasiliensis may influence treatment efficacy.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (R.P.B.); (L.S.M.); (M.O.X.)
- Programa de Pós Graduação em Bioquímica Toxicológica, Universidade Federal de Santa Maria (UFSM), Santa Maria 97105-900, RS, Brazil
- Laboratório de Micologia, FAMED, FURG, Rio Grande 96200-190, RS, Brazil
- Correspondence: (V.R.P.); (J.L.B.)
| | - Rossana Patricia Basso
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (R.P.B.); (L.S.M.); (M.O.X.)
- Laboratório de Micologia, FAMED, FURG, Rio Grande 96200-190, RS, Brazil
- Hospital Universitário-UH-FURG/Empresa Brasileira de Serviços Hospitalares—Ebserh, Rio Grande 96200-190, RS, Brazil;
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA;
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
| | - Lívia Silveira Munhoz
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (R.P.B.); (L.S.M.); (M.O.X.)
- Laboratório de Micologia, FAMED, FURG, Rio Grande 96200-190, RS, Brazil
| | - Vanessa Brito de Souza Rabello
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, RJ, Brazil; (V.B.d.S.R.); (R.A.-P.); (R.M.Z.-O.)
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, RJ, Brazil; (V.B.d.S.R.); (R.A.-P.); (R.M.Z.-O.)
| | - Rosely Maria Zancopé-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, RJ, Brazil; (V.B.d.S.R.); (R.A.-P.); (R.M.Z.-O.)
| | - Mariza Zanchi
- Hospital Universitário-UH-FURG/Empresa Brasileira de Serviços Hospitalares—Ebserh, Rio Grande 96200-190, RS, Brazil;
| | - Jéssica Louise Benelli
- Laboratório de Micologia, FAMED, FURG, Rio Grande 96200-190, RS, Brazil
- Hospital Universitário-UH-FURG/Empresa Brasileira de Serviços Hospitalares—Ebserh, Rio Grande 96200-190, RS, Brazil;
- Correspondence: (V.R.P.); (J.L.B.)
| | - Melissa Orzechowski Xavier
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande 96200-190, RS, Brazil; (R.P.B.); (L.S.M.); (M.O.X.)
- Laboratório de Micologia, FAMED, FURG, Rio Grande 96200-190, RS, Brazil
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Benelli JL, Basso RP, Rodrigues MDL, Poester VR, Munhoz LS, Aquino VR, Stevens DA, Xavier MO. Coinfection of disseminated cryptococcosis and BK Virus, a casualty of missed diagnosis during the COVID-19 Pandemic: A case report and review of the literature. Curr Med Mycol 2021. [DOI: 10.18502/cmm.7.3.7802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: The COVID-19 pandemic resulted in an overload of health services and healthcare professionals. The result is a setback in health promotion and prevention, delays in diagnosis, and deaths from other diseases that are currently receiving inadequate attention. This article illustrates the risk of this negligence.
Case report: This study aimed to report a case of coinfection of disseminated cryptococcosis and BK virus in a patient without a previous diagnosis of human immunodeficiency virus infection and COVID-19 negative in the context of the COVID-19 pandemic. Despite receiving antifungal therapy, the patient died.
Conclusion: This fatal case is a warning regarding delay of diagnosis and neglect ofother serious illnesses owing to the current pandemic, including fungal diseases and neglected diagnoses.
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24
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Sass G, Nazik H, Chatterjee P, Shrestha P, Groleau MC, Déziel E, Stevens DA. Altered Pseudomonas Strategies to Inhibit Surface Aspergillus Colonies. Front Cell Infect Microbiol 2021; 11:734296. [PMID: 34746024 PMCID: PMC8570168 DOI: 10.3389/fcimb.2021.734296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/30/2021] [Accepted: 08/17/2021] [Indexed: 01/23/2023] Open
Abstract
Pseudomonas aeruginosa and Aspergillus fumigatus infections frequently co-localize in lungs of immunocompromised patients and individuals with cystic fibrosis (CF). The antifungal activity of P. aeruginosa has been described for its filtrates. Pyoverdine and pyocyanin are the principal antifungal P. aeruginosa molecules active against A. fumigatus biofilm metabolism present in iron-limited or iron-replete planktonic P. aeruginosa culture filtrates, respectively. Using various P. aeruginosa laboratory wild-type strains (PA14, PAO1, PAK), we found antifungal activity against Aspergillus colonies on agar. Comparing 36 PA14 and 7 PAO1 mutants, we found that mutants lacking both major siderophores, pyoverdine and pyochelin, display higher antifungal activity on agar than their wild types, while quorum sensing mutants lost antifungal activity. Addition of ferric iron, but not calcium or magnesium, reduced the antifungal effects of P. aeruginosa on agar, whereas iron-poor agar enhanced antifungal effects. Antifungal activity on agar was mediated by PQS and HHQ, via MvfR. Among the MvfR downstream factors, rhamnolipids and elastase were produced in larger quantities by pyoverdine–pyochelin double mutants and showed antifungal activity on agar. In summary, antifungal factors produced by P. aeruginosa on agar differ from those produced by bacteria grown in liquid cultures, are dependent on quorum sensing, and are downregulated by the availability of ferric iron. Rhamnolipids and elastase seem to be major mediators of Pseudomonas’ antifungal activity on a solid surface.
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Affiliation(s)
- Gabriele Sass
- Infectious Disease Research Laboratory, San Jose, CA, United States
| | - Hasan Nazik
- Infectious Disease Research Laboratory, San Jose, CA, United States
| | | | - Pallabi Shrestha
- Infectious Disease Research Laboratory, San Jose, CA, United States
| | - Marie-Christine Groleau
- Centre Armand-Frappier Santé Biotechnologie, Institute National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - Eric Déziel
- Centre Armand-Frappier Santé Biotechnologie, Institute National de la Recherche Scientifique (INRS), Laval, QC, Canada
| | - David A Stevens
- Infectious Disease Research Laboratory, San Jose, CA, United States.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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O'Shaughnessy E, Yasinskaya Y, Dixon C, Higgins K, Moore J, Reynolds K, Ampel NM, Angulo D, Blair JE, Catanzaro A, Galgiani JN, Garvey E, Johnson R, Larwood DJ, Lewis G, Purdie R, Rex JH, Shubitz LF, Stevens DA, Page SJ, Shukla SJ, Farley JJ, Nambiar S. FDA Public Workshop Summary-Coccidioidomycosis (Valley Fever): Considerations for Development of Antifungal Drugs. Clin Infect Dis 2021; 74:2061-2066. [PMID: 34651656 DOI: 10.1093/cid/ciab904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Coccidioidomycosis is a fungal disease endemic to the southwestern United States, Mexico, and Central and South America. Prevalence rates are increasing steadily and new endemic areas of Coccidioides are emerging. Standard treatment is often administered for months to decades, and intolerance to medications and treatment failures are common. No new treatments for coccidioidomycosis have been approved in the U.S. in nearly 40 years. On August 5, 2020, the U.S. Food and Drug Administration convened experts in coccidioidomycosis from academia, industry, patient groups and other government agencies to discuss the disease landscape and strategies to facilitate product development for treatment of coccidioidomycosis. This paper summarizes the key topics concerning drug development for coccidioidomycosis presented by speakers and panelists during the workshop, such as unmet need, trial designs, endpoints, incentives, research and development support, and collaborations to facilitate antifungal drug development.
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Affiliation(s)
- Elizabeth O'Shaughnessy
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Yuliya Yasinskaya
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Cheryl Dixon
- Division of Biometrics IV, Office of Translational Sciences, CDER, FDA, Silver Spring, MD, USA
| | - Karen Higgins
- Division of Biometrics IV, Office of Translational Sciences, CDER, FDA, Silver Spring, MD, USA
| | - Jason Moore
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, CDER, FDA, Silver Spring, MD, USA
| | - Kellie Reynolds
- Division of Infectious Disease Pharmacology, Office of Clinical Pharmacology, CDER, FDA, Silver Spring, MD, USA
| | - Neil M Ampel
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ, USA
| | | | | | | | - John N Galgiani
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ, USA
| | | | - Royce Johnson
- Valley Fever Institute, Kern Medical, Bakersfield, CA, USA
| | | | | | - Rob Purdie
- Valley Fever Institute, Kern Medical, Bakersfield, CA, USA
| | | | - Lisa F Shubitz
- Valley Fever Center for Excellence, University of Arizona, Tucson, AZ, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, and Div. of Infectious Diseases and Geographic Medicine, Dept. of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sunita J Shukla
- Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - John J Farley
- Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Sumathi Nambiar
- Division of Anti-Infectives, Office of Infectious Diseases, Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
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Sass G, Larwood DJ, Martinez M, Chatterjee P, Xavier MO, Stevens DA. Nikkomycin Z against Disseminated Coccidioidomycosis in a Murine Model of Sustained-Release Dosing. Antimicrob Agents Chemother 2021; 65:e0028521. [PMID: 34252303 PMCID: PMC8448119 DOI: 10.1128/aac.00285-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/03/2021] [Indexed: 11/20/2022] Open
Abstract
Nikkomycin Z (nikZ) is a chitin synthase inhibitor. Efficacy against Coccidioides has been demonstrated in animal models of pulmonary or brain infection. Its short half-life in mice and in humans would necessitate divided daily dosing. We assayed nikZ efficacy in disseminated coccidioidomycosis (in a reduction of CFU design) and whether sustained release might be useful. Mice were challenged intravenously with low or high arthroconidial inocula. Fluconazole, clinically the most commonly used anticoccidioidal drug, was compared (gavage) at high dose to a dose range of nikZ administered intraperitoneally or, to mimic sustained release, administered continuously in drinking water. Therapy was given for 5 days. In vitro, both fluconazole and nikZ inhibited the isolate studied; nikZ was fungicidal. Oral nikZ therapy gave similar results to intraperitoneal nikZ and sterilized infection in most animals after low-inoculum challenge. In both challenges, oral nikZ produced greater reduction of CFU in organs (lung, liver, and spleen) than fluconazole. Oral nikZ doses of ≥200 mg/kg of body weight/day were particularly effective in all organs and were well tolerated. This efficacy occurred even though, after severe challenge, mice had reduced water intake, resulting in ingesting less than the desired dose, particularly initially after infection. This study shows, for the first time, efficacy of nikZ against disseminated coccidioidomycosis. Efficacy was shown after challenges producing different levels of severity of disease. This study also suggests the likely benefits of developing an extended release formulation supplying continuous systemic concentrations of nikZ.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - David J. Larwood
- California Institute for Medical Research, San Jose, California, USA
- Valley Fever Solutions, Tucson, Arizona, USA
| | - Marife Martinez
- California Institute for Medical Research, San Jose, California, USA
| | | | - Melissa O. Xavier
- California Institute for Medical Research, San Jose, California, USA
- Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - David A. Stevens
- California Institute for Medical Research, San Jose, California, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA
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Dobiáš R, Škríba A, Pluháček T, Petřík M, Palyzová A, Káňová M, Čubová E, Houšť J, Novák J, Stevens DA, Mitulovič G, Krejčí E, Hubáček P, Havlíček V. Noninvasive Combined Diagnosis and Monitoring of Aspergillus and Pseudomonas Infections: Proof of Concept. J Fungi (Basel) 2021; 7:jof7090730. [PMID: 34575768 PMCID: PMC8471143 DOI: 10.3390/jof7090730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/20/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022] Open
Abstract
In acutely ill patients, particularly in intensive care units or in mixed infections, time to a microbe-specific diagnosis is critical to a successful outcome of therapy. We report the application of evolving technologies involving mass spectrometry to diagnose and monitor a patient’s course. As proof of this concept, we studied five patients and used two rat models of mono-infection and coinfection. We report the noninvasive combined monitoring of Aspergillus fumigatus and Pseudomonas aeruginosa infection. The invasive coinfection was detected by monitoring the fungal triacetylfusarinine C and ferricrocin siderophore levels and the bacterial metabolites pyoverdin E, pyochelin, and 2-heptyl-4-quinolone, studied in the urine, endotracheal aspirate, or breath condensate. The coinfection was monitored by mass spectrometry followed by isotopic data filtering. In the rat infection model, detection indicated 100-fold more siderophores in urine compared to sera, indicating the diagnostic potential of urine sampling. The tools utilized in our studies can now be examined in large clinical series, where we could expect the accuracy and speed of diagnosis to be competitive with conventional methods and provide advantages in unraveling the complexities of mixed infections.
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Affiliation(s)
- Radim Dobiáš
- Department of Bacteriology and Mycology, Public Health Institute in Ostrava, 702 00 Ostrava, Czech Republic; (R.D.); (E.K.)
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic
| | - Anton Škríba
- Institute of Microbiology of the Czech Academy of Sciences, 142 20 Prague, Czech Republic; (A.Š.); (T.P.); (A.P.); (J.H.); (J.N.)
| | - Tomáš Pluháček
- Institute of Microbiology of the Czech Academy of Sciences, 142 20 Prague, Czech Republic; (A.Š.); (T.P.); (A.P.); (J.H.); (J.N.)
- Department of Analytical Chemistry, Faculty of Science, Palacký University, 771 46 Olomouc, Czech Republic
| | - Miloš Petřík
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, 779 00 Olomouc, Czech Republic;
| | - Andrea Palyzová
- Institute of Microbiology of the Czech Academy of Sciences, 142 20 Prague, Czech Republic; (A.Š.); (T.P.); (A.P.); (J.H.); (J.N.)
| | - Marcela Káňová
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 708 00 Ostrava, Czech Republic;
- Institute of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, 701 03 Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, University of Ostrava, 701 03 Ostrava, Czech Republic
| | - Eva Čubová
- Department of Internal Medicine, Ostrava City Hospital, 728 80 Ostrava, Czech Republic;
| | - Jiří Houšť
- Institute of Microbiology of the Czech Academy of Sciences, 142 20 Prague, Czech Republic; (A.Š.); (T.P.); (A.P.); (J.H.); (J.N.)
- Department of Analytical Chemistry, Faculty of Science, Palacký University, 771 46 Olomouc, Czech Republic
| | - Jiří Novák
- Institute of Microbiology of the Czech Academy of Sciences, 142 20 Prague, Czech Republic; (A.Š.); (T.P.); (A.P.); (J.H.); (J.N.)
| | - David A. Stevens
- Infectious Disease Research Laboratory, California Institute for Medical Research, San Jose, CA 95128, USA;
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 95128, USA
| | - Goran Mitulovič
- Clinical Department of Laboratory Medicine Proteomics Core Facility, Medical University of Vienna, A-1090 Wien, Austria;
| | - Eva Krejčí
- Department of Bacteriology and Mycology, Public Health Institute in Ostrava, 702 00 Ostrava, Czech Republic; (R.D.); (E.K.)
- Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic
| | - Petr Hubáček
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 150 06 Prague, Czech Republic;
| | - Vladimír Havlíček
- Institute of Microbiology of the Czech Academy of Sciences, 142 20 Prague, Czech Republic; (A.Š.); (T.P.); (A.P.); (J.H.); (J.N.)
- Department of Analytical Chemistry, Faculty of Science, Palacký University, 771 46 Olomouc, Czech Republic
- Correspondence:
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Louise Benelli J, Basso RP, Rodrigues MDL, Poester VR, Munhoz LS, Aquino VR, Stevens DA, Xavier MO. Coinfection of disseminated cryptococcosis and BK Virus, a casualty of missed diagnosis during the COVID-19 Pandemic: A case report and review of the literature. Curr Med Mycol 2021; 7:44-49. [PMID: 35528625 PMCID: PMC9006733 DOI: 10.18502/cmm.7.2.7802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/27/2021] [Revised: 09/14/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose The COVID-19 pandemic resulted in an overload of health services and healthcare professionals. The result is a setback in health promotion and prevention, delays in diagnosis, and deaths from other diseases that are currently receiving inadequate attention. This article illustrates the risk of this negligence. Case report This study aimed to report a case of coinfection of disseminated cryptococcosis and BK virus in a patient without a previous diagnosis of human immunodeficiency virus infection and COVID-19 negative in the context of the COVID-19 pandemic. Despite receiving antifungal therapy, the patient died. Conclusion This fatal case is a warning regarding delay of diagnosis and neglect of other serious illnesses owing to the current pandemic, including fungal diseases and neglected diagnoses.
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Affiliation(s)
- Jéssica Louise Benelli
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, Rio Grande (FURG), Brazil,
Postgraduate Program in Health Science, Federal University of Rio Grande (PPGCS-FURG), Rio Grande, Brazil,
Clinical Analysis Laboratory, Dr. Miguel Riet Correa University Hospital, Rio Grande (HU-FURG/EBSERH), Brazil
| | - Rossana Patrícia Basso
- Postgraduate Program in Health Science, Federal University of Rio Grande (PPGCS-FURG), Rio Grande, Brazil,
Specialized Care Service in Infectious Diseases, Dr. Miguel Riet Correa University Hospital, Rio Grande, Brazil
| | - Márcia de Lima Rodrigues
- Specialized Care Service in Infectious Diseases, Dr. Miguel Riet Correa University Hospital, Rio Grande, Brazil
| | - Vanice Rodrigues Poester
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, Rio Grande (FURG), Brazil,
Postgraduate Program in Health Science, Federal University of Rio Grande (PPGCS-FURG), Rio Grande, Brazil
| | - Lívia Silveira Munhoz
- Postgraduate Program in Health Science, Federal University of Rio Grande (PPGCS-FURG), Rio Grande, Brazil
| | - Valerio Rodrigues Aquino
- Laboratory Diagnostic Service, Microbiology Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - David A. Stevens
- California Institute for Medical Research, San Jose, and Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Melissa Orzechowski Xavier
- Laboratory of Mycology, Faculty of Medicine, Federal University of Rio Grande, Rio Grande (FURG), Brazil,
Postgraduate Program in Health Science, Federal University of Rio Grande (PPGCS-FURG), Rio Grande, Brazil
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Poester VR, Stevens DA, Basso RP, Munhoz LS, Zanchi M, Benelli JL, Klafke GB, Cardone S, Xavier MO. CATastrophe: response to the challenges of zoonotic sporotrichosis in southern Brazil. Mycoses 2021; 65:30-34. [PMID: 34390588 DOI: 10.1111/myc.13363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Brazil, zoonotic sporotrichosis became a national public health problem, with thousands of cases in the last decade in several regions of the country. In this context, health education activities are critical, especially in promoting early diagnosis and access to proper health care in sporotrichosis hyperendemic areas. Therefore, we report the implementation of a public specialized reference service (SRS) for diagnosis and treatment of sporotrichosis in southern Brazil We evaluated the impact of the SRS on diagnostic confirmation and speed of diagnosis. METHODS The SRS was implemented in Rio Grande city. We implemented a public service to promote the correct diagnosis, treatment and follow-up of human sporotrichosis cases. To study the impact of implementing SRS, the annual number of cases, and the period between the appearance of lesions until diagnosis were compared, using prior data and that post-implementation. RESULTS The implementation of the SRS directly benefited almost 50 patients in only four years, with the collaboration of almost 50% of the local health groups, together with an increase of more than 200% in diagnosis confirmation and speed of diagnosis, showing the reach, impact and importance of the SRS. CONCLUSION The impact on the individual and collective health of the local population highlights the value of this public health approach in facing the epidemiological threat of zoonotic sporotrichosis.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), FURG, RS, Brazil.,Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), RS, Brazil
| | - David A Stevens
- Div. of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA.,California Institute for Medical Research, San Jose, California, USA
| | - Rossana Patricia Basso
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), FURG, RS, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. - HU-Universidade Federal do Rio Grande - FURG/Empresa brasileira de serviços hospitalares - EBSERH, Brazil
| | - Lívia Silveira Munhoz
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), FURG, RS, Brazil.,Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), RS, Brazil
| | - Mariza Zanchi
- Hospital Universitário Dr. Miguel Riet Corrêa Jr. - HU-Universidade Federal do Rio Grande - FURG/Empresa brasileira de serviços hospitalares - EBSERH, Brazil
| | - Jéssica Louise Benelli
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), FURG, RS, Brazil.,Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), RS, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. - HU-Universidade Federal do Rio Grande - FURG/Empresa brasileira de serviços hospitalares - EBSERH, Brazil
| | - Gabriel Baracy Klafke
- Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), RS, Brazil
| | | | - Melissa Orzechowski Xavier
- Programa de Pós Graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), FURG, RS, Brazil.,Laboratório de Micologia, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), RS, Brazil
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Villar-Prados A, Chang JJ, Stevens DA, Schoolnik GK, Wang SXY. Severe Posaconazole-Induced Glucocorticoid Deficiency with Concurrent Pseudohyperaldosteronism: An Unfortunate Two-for-One Special. J Fungi (Basel) 2021; 7:jof7080620. [PMID: 34436160 PMCID: PMC8397024 DOI: 10.3390/jof7080620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/29/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was diagnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohyperaldosteronism and severe glucocorticoid deficiency due to posaconazole’s mechanism of action on the adrenal steroid synthesis pathway. Transitioning to fluconazole and starting hydrocortisone resolved the hypokalemia but not his glucocorticoid deficiency. This case highlights the importance of recognizing iatrogenic glucocorticoid deficiency with azole antifungal agents and potential long term sequalae.
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Affiliation(s)
| | - Julia J. Chang
- Division of Endocrinology, Metabolism, and Gerontology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - David A. Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.A.S.); (G.K.S.)
- California Institute of Medical Research, San Jose, CA 95128, USA
| | - Gary K. Schoolnik
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (D.A.S.); (G.K.S.)
| | - Samantha X. Y. Wang
- Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-650-721-8900
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Melo AM, Poester VR, Canabarro PL, Sampaio DA, Stevens DA, Veríssimo C, Sabino R, Xavier MO. Molecular epidemiology of aspergillosis in Magellanic penguins and susceptibility patterns of clinical isolates. Med Mycol 2021; 59:1076-1084. [PMID: 34320182 DOI: 10.1093/mmy/myab040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
Aspergillus section Fumigati is reported in up to 99% of aspergillosis cases in penguins. So far, no data regarding molecular epidemiology and azole resistance are available for A. fumigatus isolates collected from Magellanic penguins. The aim of this work was to perform molecular identification of Aspergillus section Fumigati at species level, to genotype those isolates using microsatellite markers, to evaluate the in vitro susceptibility patterns of A. fumigatus sensu stricto, and to characterize the cyp51A gene in clinical A. fumigatus strains isolated from Magellanic penguins with proven aspergillosis. All 34 isolates included in the study were identified as A. fumigatus sensu stricto. Analyzing the genetic diversity of the isolates of A. fumigatus sensu stricto, we identified two possible outbreaks in the rehabilitation center and we also observed the maintenance of clonal strains through the years. One A. fumigatus sensu stricto isolate was resistant to posaconazole, but the mutations found in the cyp51A gene of this isolate have not been described as conferring phenotypic resistance, suggesting that other mechanisms of resistance could be involved in the resistance of this isolate. With this study we were able to understand the molecular diversity of Aspergillus fumigatus isolates collected from Magellanic penguins, to characterize them and to associate them with the described global population of Aspergillus fumigatus.
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Affiliation(s)
- Aryse Martins Melo
- Microbiology and Parasitology Post-Graduate Program, Institute of Biology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.,National Institute of Health, Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal
| | - Vanice Rodrigues Poester
- Health Sciences Post-Graduation Program, Medical College, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Paula Lima Canabarro
- Rehabilitation Center for Marine Animals, Federal University of Rio Grande (CRAM-FURG), Rio Grande, Rio Grande do Sul, Brazil
| | - Daniel Ataíde Sampaio
- Technology and Innovation Unit, Department of Human Genetics, National Institute of Health, Lisbon, Portugal
| | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA.,California Institute for Medical Research, San Jose, California, USA
| | - Cristina Veríssimo
- National Institute of Health, Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal
| | - Raquel Sabino
- National Institute of Health, Dr. Ricardo Jorge, Av. Padre Cruz, 1649-016, Lisbon, Portugal.,Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Melissa Orzechowski Xavier
- Microbiology and Parasitology Post-Graduate Program, Institute of Biology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.,Health Sciences Post-Graduation Program, Medical College, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
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32
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Wurster S, Sass G, Albert ND, Nazik H, Déziel E, Stevens DA, Kontoyiannis DP. Live imaging and quantitative analysis of Aspergillus fumigatus growth and morphology during inter-microbial interaction with Pseudomonas aeruginosa. Virulence 2021; 11:1329-1336. [PMID: 33017225 PMCID: PMC7549912 DOI: 10.1080/21505594.2020.1827885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 12/31/2022] Open
Abstract
Pseudomonas aeruginosa (PA) and Aspergillus fumigatus (AF) chronically colonize the airways of patients with cystic fibrosis or chronic immunosuppression and mutually affect each other’s pathogenesis. Here, we evaluated IncuCyte time-lapse imaging and NeuroTrackTM (NT) analysis (Wurster et al., 2019, mBio) as a toolbox to study mycelial expansion and morphogenesis of AF during interaction with PA. Co-incubation of AF with supernatant filtrates of wild-type (WT) PA strains strongly inhibited hyphal growth and branching. Consonant with prior metabolic studies, pyoverdine-deficient PA mutants had significantly attenuated inhibitory capacity. Accordingly, purified PA products pyoverdine and pyocyanin suppressed mycelial expansion of AF in a concentration-dependent way. Using fluorescence-guided tracking of GFP-AF293 mycelia during co-culture with live WT PA cells, we found significant inoculum-dependent mycelial growth inhibition and robust precision of the NT algorithm. Collectively, our experiments position IncuCyte NT as an efficient platform for longitudinal analysis of fungal growth and morphogenesis during bacterial co-infection.
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Affiliation(s)
- Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, TX, USA
| | - Gabriele Sass
- California Institute for Medical Research , San Jose, CA, USA
| | - Nathaniel D Albert
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, TX, USA
| | - Hasan Nazik
- California Institute for Medical Research , San Jose, CA, USA
| | - Eric Déziel
- INRS-Centre Armand-Frappier Santé Biotechnologie , Laval, Quebec, Canada
| | - David A Stevens
- California Institute for Medical Research , San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine , Stanford, CA, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center , Houston, TX, USA
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33
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Sass G, Larwood DJ, Martinez M, Shrestha P, Stevens DA. Efficacy of nikkomycin Z in murine CNS coccidioidomycosis: modelling sustained-release dosing. J Antimicrob Chemother 2021; 76:2629-2635. [PMID: 34269392 DOI: 10.1093/jac/dkab223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Meningitis is the most feared coccidioidomycosis complication. Nikkomycin Z (nikZ) is a chitin synthase inhibitor. A concern is short half-life, necessitating multiple dose/day regimens. We simulated extended release, providing nikZ in drinking water. Extended release would enhance convenience, and adherence, for patients. METHODS Coccidioides posadasii was injected intracerebrally into mice. Twelve day treatments began on Day 3. Fluconazole was given 100 mg/kg once daily (gavage); designed doses of nikZ 30, 100 or 300 mg/kg/day in drinking water. On Day 30 post-treatment, survivors were euthanized, brain cfu quantitated and cfu in other organs assessed. RESULTS nikZ was stable in drinking water. Survival was 11%, 50%, 70%, 90% and 100% in untreated controls, fluconazole and nikZ 30, 100 and 300 mg/kg/day, respectively ; nikZ 300 mg/kg/day was superior (P ≤ 0.01) to fluconazole. Brains were sterilized in 0%, 20%, 86%, 89% and 80% of mice, respectively; nikZ 100 or 300 mg/kg/day was superior (P ≤ 0.01) to fluconazole. Clearance of infection in other organs was similar. All decreased drinking after infection, causing nikZ mice to ingest less than the desired dose in early therapy; despite this, they recovered sufficiently to resume pre-infection drinking and designed drug intakes. Thus, when sickest, even less than the designed dose was sufficient to enable recovery. CONCLUSIONS This efficacy supports the development of sustained-release nikZ. Decreased intake wouldn't be a factor in humans, receiving drug via extended-release pill or continuous IV infusion. In prior studies (twice daily nikZ) of murine coccidioidal meningitis, results were inferior, suggesting sustained release may provide both convenience and superior outcomes.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA, USA
| | - David J Larwood
- California Institute for Medical Research, San Jose, CA, USA.,Valley Fever Solutions, Tucson, AZ, USA
| | - Marife Martinez
- California Institute for Medical Research, San Jose, CA, USA
| | | | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
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Benelli JL, Poester VR, Munhoz LS, Klafke GB, Stevens DA, Xavier MO. In vitro anti-Cryptococcus activity of diphenyl diselenide alone and in combination with amphotericin B and fluconazole. Braz J Microbiol 2021; 52:1719-1723. [PMID: 34195915 DOI: 10.1007/s42770-021-00552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Cryptococcus is an encapsulated yeast that causes fungal meningitis, most commonly in HIV patients, with high mortality rates. Thus, the study of new treatment options is relevant. Antifungal activity of organoselenium compounds attributed to their pro-oxidative effect in fungal cells has been shown given that few data regarding its anti-Cryptococcus activity are available, this in vitro study was conducted with 40 clinical isolates of Cryptococcus neoformans. Diphenyl diselenide (DD) alone, and its interaction with amphotericin B or fluconazole, was tested by microdilution and checkerboard assays. All Cryptococcus neoformans were inhibited by DD in concentrations ≤ 32 μg/mL, and fungicidal concentrations were ≤ 64 μg/mL. Advantageous interaction between fluconazole occurred in 40% of the isolates, respectively. This study contributes with data of DD alone and in combination with classical drugs of choice for cryptococcosis treatment. Further studies focused on DD antifungal mechanism of action, and in vivo experiments are necessary.
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Affiliation(s)
- Jéssica Louise Benelli
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, Rio Grande do Sul, 96201-900, Brazil
- Health Science Post-Graduation Program, College of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
- Biomedical, Clinical Analysis Laboratory (LAC) of the University Hospital Dr. Miguel Riet Correa (HU-FURG/EBSERH), Rio Grande, Rio Grande do Sul, Brazil
| | - Vanice Rodrigues Poester
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, Rio Grande do Sul, 96201-900, Brazil
- Health Science Post-Graduation Program, College of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Lívia Silveira Munhoz
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, Rio Grande do Sul, 96201-900, Brazil
- Health Science Post-Graduation Program, College of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil
| | - Gabriel Baracy Klafke
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, Rio Grande do Sul, 96201-900, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, and Div. of Infectious Diseases and Geographic Medicine, Stanford Univ. Medical School, Stanford, CA, USA
| | - Melissa Orzechowski Xavier
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, Rio Grande do Sul, 96201-900, Brazil.
- Health Science Post-Graduation Program, College of Medicine, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil.
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35
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Poester VR, Munhoz LS, Benelli JL, Klafke GB, Nogueira CW, Zeni GR, Stevens DA, Larwood D, Xavier MO. Synergism of Nikkomycin Z in Combination with Diphenyl Diselenide Against Sporothrix spp. Curr Microbiol 2021; 78:2905-2909. [PMID: 34181049 DOI: 10.1007/s00284-021-02581-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
We evaluated the in vitro activity of nikkomycin Z (NikZ) in combination with diphenyl diselenide (PhSe)2, two compounds previously shown to have anti-Sporothrix spp. activity. Eighteen isolates of Sporothrix spp. were tested in checkerboard assays. Synergism for inhibition and killing Sporothrix spp. occurred in 100% and 89% of the isolates, respectively. The anti-Sporothrix spp. activity of this combination provides a rationale for in vivo studies to evaluate the application of both compounds in sporotrichosis treatment.
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Affiliation(s)
- Vanice Rodrigues Poester
- Programa de Pós Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, RS, Brazil
- Laboratório de Micologia, FAMED, FURG, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil
| | - Lívia Silveira Munhoz
- Programa de Pós Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, RS, Brazil
- Laboratório de Micologia, FAMED, FURG, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil
| | - Jéssica Louise Benelli
- Programa de Pós Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, RS, Brazil
- Hospital Universitário Dr. Miguel Riet Corrêa Jr. - HU- FURG/Empresa brasileira de serviços hospitalares - Ebserh, Rio Grande, RS, Brazil
| | - Gabriel Baracy Klafke
- Laboratório de Micologia, FAMED, FURG, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil
| | - Cristina Wayne Nogueira
- Programa de Pós Graduação Em Bioquímica Toxicológica, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Gilson Rogério Zeni
- Programa de Pós Graduação Em Bioquímica Toxicológica, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - David Larwood
- California Institute for Medical Research, San Jose, CA, USA
- Valley Fever Solutions, Tucson, AZ, USA
| | - Melissa Orzechowski Xavier
- Programa de Pós Graduação Em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal Do Rio Grande (FURG), Rio Grande, RS, Brazil.
- Laboratório de Micologia, FAMED, FURG, Campus Saúde. Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil.
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Sass G, Miller Conrad LC, Nguyen TTH, Stevens DA. The Pseudomonas aeruginosa product pyochelin interferes with Trypanosoma cruzi infection and multiplication in vitro. Trans R Soc Trop Med Hyg 2021; 114:492-498. [PMID: 32193540 DOI: 10.1093/trstmh/trz136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 09/09/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bacteria are sources of numerous molecules used in treatment of infectious diseases. We investigated effects of molecules produced by 26 Pseudomonas aeruginosa strains against infection of mammalian cell cultures with Trypanosoma cruzi, the aetiological agent of Chagas disease. METHODS Vero cells were infected with T. cruzi in the presence of wild-type P. aeruginosa supernatants or supernatants of mutants with defects in the production of various virulence, quorum sensing and iron acquisition factors. Quantification of T. cruzi infection (percentage of infected cells) and multiplication (number of amastigotes per infected cell) was performed and cell viability was determined. RESULTS Wild-type P. aeruginosa products negatively affected T. cruzi infection and multiplication in a dose-dependent manner, without evident toxicity for mammalian cells. PvdD/pchE mutation (loss of the P. aeruginosa siderophores pyoverdine and pyochelin) had the greatest impact on anti-T. cruzi activity. Negative effects on T. cruzi infection by pure pyochelin, but not pyoverdine, or other P. aeruginosa exoproducts studied, were quantitatively similar to the effects of benznidazole, the current standard therapy against T. cruzi. CONCLUSIONS The P. aeruginosa product pyochelin showed promising activity against T. cruzi and might become a new lead molecule for therapy development.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA
| | | | | | - David A Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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Melo AM, Silva Filho RPD, Poester VR, Fernandes CG, von Groll A, Stevens DA, Sabino R, Xavier MO. Aspergillosis in albatrosses. Med Mycol 2021; 58:852-855. [PMID: 31782484 DOI: 10.1093/mmy/myz122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/29/2019] [Accepted: 11/12/2019] [Indexed: 11/14/2022] Open
Abstract
Aspergillosis is a respiratory fungal disease of importance in captive marine birds. The aim of this study was to describe the occurrence of aspergillosis in Thalassarche melanophris during rehabilitation events and to identify the etiological agent. All the albatrosses that were received for rehabilitation and died within a 2-year period were included in the study. The proportionate mortality rate caused by aspergillosis was 21.4% (3/14). One of the etiological agents was Aspergillus flavus/oryzae lineage, and the other was A. fumigatus sensu stricto. Our study suggests that aspergillosis can act as a limiting factor in the rehabilitation of albatrosses.
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Affiliation(s)
- Aryse Martins Melo
- Programa de Pós-Graduação em Parasitologia, Instituto de Biologia, Universidade Federal de Pelotas, Avenida Eliseu Maciel, s/n, Pelotas, RS, Brazil
| | | | - Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rua General Osório, 1109, Rio Grande, RS, Brazil
| | - Cristina Gevehr Fernandes
- Departamento de Patologia Animal, Faculdade de Veterinária, Universidade Federal de Pelotas Avenida Eliseu Maciel, s/n, Pelotas, RS, Brazil
| | - Andrea von Groll
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rua General Osório, 1109, Rio Grande, RS, Brazil
| | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA.,California Institute for Medical Research, San Jose, California, USA
| | - Raquel Sabino
- National Institute of Health, Dr. Ricardo Jorge, Lisbon, Portugal
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Parasitologia, Instituto de Biologia, Universidade Federal de Pelotas, Avenida Eliseu Maciel, s/n, Pelotas, RS, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rua General Osório, 1109, Rio Grande, RS, Brazil
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Kovanda LL, Sass G, Martinez M, Clemons KV, Nazik H, Kitt TM, Wiederhold N, Hope WW, Stevens DA. Efficacy and Associated Drug Exposures of Isavuconazole and Fluconazole in an Experimental Model of Coccidioidomycosis. Antimicrob Agents Chemother 2021; 65:e02344-20. [PMID: 33782009 PMCID: PMC8316117 DOI: 10.1128/aac.02344-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/14/2021] [Indexed: 12/19/2022] Open
Abstract
Coccidioides spp. are important pathogens in regions where they are endemic, and new treatment options are needed. Here, isavuconazonium sulfate (ISAVUSULF) and fluconazole (FLU) were evaluated in experimental disseminated coccidioidomycosis to characterize drug exposures associated with efficacy. Broth macrodilution was performed on Coccidioides isolates to measure minimal effective concentrations (MEC) and minimal fungicidal concentrations (MFC). Mice were inoculated with Coccidioides posadasii (Silveira strain). Treatment started 4 days postinoculation. In model 1, mice were treated for 19 days, followed by 30 days of off-therapy observation, measuring survival through day 49 and residual fungal burden. Treatments included ISAVUSULF (prodrug; 186, 279, or 372 mg/kg twice daily), FLU (20 or 100 mg/kg once daily), and no treatment. Model 2 included 7-day treatment with ISAVUSULF (prodrug; 74.4, 111.6, or 148.8 mg/kg twice daily), FLU (20 or 100 mg/kg once daily), and no treatment. Serial plasma and tissues samples were obtained for pharmacokinetics (PK) and fungal burden measurement, respectively. Fifty percent minimal effective concentration (MEC50) values were 0.39 mg/liter (isavuconazole [ISAV]) and 12.5 mg/liter (FLU). Treatment with ISAVUSULF186 or with either FLU dose resulted in higher survival compared to that in the untreated group. Treatment with ISAVUSULF186 or ISAVUSULF279 twice daily or FLU100 reduced fungal burden in all organs (model 1). In model 2, a >1 log10 CFU/organ reduction was demonstrated, with ISAV area under the concentration-time curve (AUC) values achieved with 111.6 mg/kg twice daily (56.8 mg · h/liter) in the spleen and liver. FLU AUC values of 100 and 500 mg·h/liter for 20 and 100 mg/kg doses, respectively, resulted in a >1 log10 CFU/organ mean reduction in all organs. ISAVUSULF and FLU improved survival and reduced fungal burden. Increasing plasma drug exposures resulted in decreases in fungal burden.
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Affiliation(s)
- Laura L Kovanda
- Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - Marife Martinez
- California Institute for Medical Research, San Jose, California, USA
| | - Karl V Clemons
- California Institute for Medical Research, San Jose, California, USA
| | - Hasan Nazik
- California Institute for Medical Research, San Jose, California, USA
| | - Therese M Kitt
- Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA
| | - Nathan Wiederhold
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - William W Hope
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool Health Partners, Liverpool, United Kingdom
- Royal Liverpool and Broadgreen University Hospital Trust, Liverpool Health Partners, Liverpool, United Kingdom
| | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA
- Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, USA
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Chang JJ, Villar-Prados A, Stevens DA, Wang XY, Chen J. Concurrent Pseudohyperaldosteronism and Primary Glucocorticoid Deficiency From Posaconazole. J Endocr Soc 2021. [DOI: 10.1210/jendso/bvab048.250] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Posaconazole can cause pseudohyperaldosteronism via inhibition of 11-beta hydroxylase and 11-beta-hydroxysteroid dehydrogenase type 2 (1). The accumulation of 11-deoxycorticosterone and increased cortisol-to-cortisone ratio in the kidney causes apparent mineralocorticoid excess. The effect of posaconazole on the glucocorticoid axis is less established.
Clinical Case: A 56-year-old Hispanic man with a history of chronic septic arthritis of the left ankle from Coccidioides presented with 3 months of malaise, nausea, weight loss of 30 pounds, and recurrent hypokalemia. He was recently switched from long-term fluconazole therapy to posaconazole around the time his symptoms began. His initial labs at our hospital were notable for low potassium (2.9 mmol/L, nl 3.5–5.5 mmol/L) and a random cortisol of 5.8 mcg/dL (nl ≥2.0 mcg/dL). A Cosyntropin stimulation test revealed elevated ACTH (168 pg/mL, nl 7.2–63.3 pg/mL) with minimal rise of cortisol from 4.6 to 7.2 mcg/dL at 1 hour after Cosyntropin administration (nl ≥18 mcg/dL at 1-hour post-Cosyntropin). His plasma renin activity was below detection (<0.6 ng/ml/h, nl 0.6–3.0 ng/mL/h), consistent with renin suppression from apparent mineralocorticoid excess. Hydrocortisone for glucocorticoid deficiency was started. A posaconazole determination indicated elevation (5240 ng/mL, usual therapeutic range ≥1000 ng/mL). His posaconazole was stopped, and he was switched back to fluconazole. Three months later, his symptoms were improved with regain of lost weight. Repeat Cosyntropin stimulation test showed ongoing primary glucocorticoid deficiency (ACTH 123 pg/mL, cortisol 4.1 mcg/dL at 1-hour post-Cosyntropin) but normal levels of plasma renin activity (1.2 ng/mL/h), aldosterone (8.6 ng/dL, nl ≤21 ng/dL), and potassium. Quantiferon TB and 21-hydroxylase antibody tests were negative. Hydrocortisone has been continued with plans to repeat Cosyntropin testing in 3 months to reassess.
Conclusion: Pseudohyperaldosteronism with glucocorticoid deficiency requiring hydrocortisone treatment has thus far not been reported with posaconazole. Our case shows that posaconazole may lead to true primary glucocorticoid deficiency that can persist after discontinuation of posaconazole and reversal of pseudohyperaldosteronism.
Reference: (1) Sanchez-Niño MD, Ortiz A. Unravelling drug-induced hypertension: Molecular mechanisms of aldosterone-independent mineralocorticoid receptor activation by posaconazole. Clin Kidney J 2018;11(5):688–90.
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Affiliation(s)
- Julia J Chang
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Xiao-Yan Wang
- Stanford University School of Medicine, Stanford, CA, USA
| | - Julie Chen
- Stanford University School of Medicine, Stanford, CA, USA
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40
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Nazik H, Sass G, Williams P, Déziel E, Stevens DA. Molecular Modifications of the Pseudomonas Quinolone Signal in the Intermicrobial Competition with Aspergillus. J Fungi (Basel) 2021; 7:jof7050343. [PMID: 33925067 PMCID: PMC8146305 DOI: 10.3390/jof7050343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/16/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023] Open
Abstract
The Pseudomonas quinolone signal (PQS) is an important quorum-sensing molecule for Pseudomonas aeruginosa that regulates virulence factors, chelates iron, and is an important factor in interactions with eukaryotes, including fungi and mammalian hosts. It was previously shown to inhibit or boost Aspergillus, depending on the milieu iron concentration. We studied several molecular modifications of the PQS molecule, and their effects on Aspergillus biofilm metabolism and growth in vitro, and the effects of iron supplementation. We found that most molecules inhibited Aspergillus at concentrations similar to that of PQS, but with relatively flat dose-responses, and all were less potent than PQS. The inhibition was reversible by iron, suggesting interference with fungal iron metabolism. Stimulation of Aspergillus was not noted. We conclude that the critical Aspergillus-inhibiting moeities of the PQS molecule were partially, but not completely, interfered with by molecular modifications at several sites on the PQS molecule. The mechanism, as with PQS, appears to relate to fungal iron metabolism.
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Affiliation(s)
- Hasan Nazik
- Infectious Diseases Research Laboratory, California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Gabriele Sass
- Infectious Diseases Research Laboratory, California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Paul Williams
- Biodiscovery Institute and School of Life Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Eric Déziel
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Laval, QC H7V 1B7, Canada;
| | - David A. Stevens
- Infectious Diseases Research Laboratory, California Institute for Medical Research, San Jose, CA 95128, USA; (H.N.); (G.S.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-408-998-4554
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Sass G, Shrestha P, Stevens DA. Pseudomonas aeruginosa Virulence Factors Support Voriconazole Effects on Aspergillus fumigatus. Pathogens 2021; 10:pathogens10050519. [PMID: 33925818 PMCID: PMC8146861 DOI: 10.3390/pathogens10050519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/19/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 12/20/2022] Open
Abstract
Pseudomonas aeruginosa and Aspergillus fumigatus are pathogens that are associated with deterioration of lung function, e.g., in persons with cystic fibrosis (CF). There is evidence that co-infections with these pathogens cause airway inflammation and aggravate pathology in CF lungs. Intermicrobial competition of P. aeruginosa and A. fumigatus has been described, but it is unknown how anti-fungal therapy is affected. The anti-fungal azole voriconazole (VCZ), supernatants of P. aeruginosa laboratory isolates PA14 or PAO1, or clinical isolate Pa10 independently inhibited biofilm metabolism of A. fumigatus isolates 10AF and AF13073. When VCZ and supernatants were combined at their IC50s, synergistic effects on A. fumigatus were found. Synergistic effects were no longer observed when P. aeruginosa supernatants were prepared in the presence of iron, or when P. aeruginosa mutants were lacking the ability to produce pyoverdine and pyochelin. Combination of pure P. aeruginosa products pyoverdine, pyochelin, and pyocyanin with VCZ showed synergistic anti-fungal effects. Combining VCZ with P. aeruginosa supernatants also improved its MIC and MFC against planktonic A. fumigatus. In summary, in the case of P. aeruginosa–A. fumigatus co-infections, it appeared that the P. aeruginosa co-infection facilitated therapy of the Aspergillus; lower concentrations of VCZ might be sufficient to control fungal growth.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, CA 95128, USA; (G.S.); (P.S.)
| | - Pallabi Shrestha
- California Institute for Medical Research, San Jose, CA 95128, USA; (G.S.); (P.S.)
| | - David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA; (G.S.); (P.S.)
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence:
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Nazik H, Kotta-Loizou I, Sass G, Coutts RHA, Stevens DA. Virus Infection of Aspergillus fumigatus Compromises the Fungus in Intermicrobial Competition. Viruses 2021; 13:v13040686. [PMID: 33923408 PMCID: PMC8073786 DOI: 10.3390/v13040686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
Aspergillus and Pseudomonas compete in nature, and are the commonest bacterial and fungal pathogens in some clinical settings, such as the cystic fibrosis lung. Virus infections of fungi occur naturally. Effects on fungal physiology need delineation. A common reference Aspergillus fumigatus strain, long studied in two (of many) laboratories, was found infected with the AfuPmV-1 virus. One isolate was cured of virus, producing a virus-free strain. Virus from the infected strain was purified and used to re-infect three subcultures of the virus-free fungus, producing six fungal strains, otherwise isogenic. They were studied in intermicrobial competition with Pseudomonasaeruginosa. Pseudomonas culture filtrates inhibited forming or preformed Aspergillus biofilm from infected strains to a greater extent, also seen when Pseudomonas volatiles were assayed on Aspergillus. Purified iron-chelating Pseudomonas molecules, known inhibitors of Aspergillus biofilm, reproduced these differences. Iron, a stimulus of Aspergillus, enhanced the virus-free fungus, compared to infected. All infected fungal strains behaved similarly in assays. We show an important consequence of virus infection, a weakening in intermicrobial competition. Viral infection may affect the outcome of bacterial–fungal competition in nature and patients. We suggest that this occurs via alteration in fungal stress responses, the mechanism best delineated here is a result of virus-induced altered Aspergillus iron metabolism.
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Affiliation(s)
- Hasan Nazik
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Ioly Kotta-Loizou
- Department of Life Sciences, Imperial College London, London SW7 2AZ, UK;
| | - Gabriele Sass
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA 95128, USA; (H.N.); (G.S.)
| | - Robert H. A. Coutts
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK;
| | - David A. Stevens
- California Institute for Medical Research, 2260 Clove Dr., San Jose, CA 95128, USA; (H.N.); (G.S.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 95128, USA
- Correspondence: ; Tel.: +1-408-998-4554
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Abstract
Filamentous basidiomycetes are uncommon agents of human diseases, despite their ubiquitous presence in the environment. We present a case of symptomatic pulmonary infection in a 38-year-old male with cough and fever; a thin-walled cyst in the posterior left upper pulmonary lobe was revealed by radiography. A non-sporulating fungus was isolated from sputum and biopsy material from the cyst. ITS and LSU sequences placed the fungus phylogenetically in Agaricales, family Cyphellaceae, and identified it as a member of shelf fungi in Gloeostereum, but without identity to any known species. The new species is described as Gloeostereum cimri. The clinical strain showed high MIC to voriconazole (>8 µg/ml) but had low MIC to amphotericin B (0.5 µg/ml).
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Affiliation(s)
- Sarah A Ahmed
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands.,Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands.,Expertise Center in Mycology Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Janet Kim
- Santa Clara Valley Medical Center, San Jose, CA, USA
| | | | | | | | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
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Benelli JL, Poester VR, Munhoz LS, Melo AM, Trápaga MR, Stevens DA, Xavier MO. Ebselen and diphenyl diselenide against fungal pathogens: A systematic review. Med Mycol 2021; 59:409-421. [PMID: 33421963 DOI: 10.1093/mmy/myaa115] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/16/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022] Open
Abstract
Fungal infections are one of the most prevalent diseases in the world and there is a lack of new antifungal drug development for these diseases. We conducted a systematic review of the literature regarding the in vitro antifungal activity of the organoselenium compounds ebselen (Eb) and diphenyl diselenide [(PhSe)2]. A systematic review was carried out based on the search for articles with data concerning Minimal Inhibitory Concentration (MIC) values, indexed in international databases and published until August 2020. A total of 2337 articles were found, and, according to the inclusion and exclusion criteria used, 22 articles were included in the study. Inhibitory activity against 96% (200/208) and 95% (312/328) of the pathogenic fungi tested was described for Eb and [(PhSe)2], respectively. Including in these 536 fungal isolates tested, organoselenium activity was highlighted against Candida spp., Cryptococcus ssp., Trichosporon spp., Aspergillus spp., Fusarium spp., Pythium spp., and Sporothrix spp., with MIC values lower than 64 μg/mL. In conclusion, Eb and [(PhSe)2] have a broad spectrum of in vitro inhibitory antifungal activity. These data added with other pharmacological properties of these organoselenium compounds suggest that both compounds are potential future antifungal drugs. Whether MICs toward the upper end of the ranges described here are compatible with efficacious therapy, and whether they may achieve such end as a result of the favorable non-antimicrobial effects of selenium on the host, requires more in vivo testing.
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Affiliation(s)
- Jéssica Louise Benelli
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil.,Health Science Post-graduation program, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
| | - Vanice Rodrigues Poester
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil.,Health Science Post-graduation program, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
| | - Lívia Silveira Munhoz
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil.,Health Science Post-graduation program, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
| | - Aryse Martins Melo
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil.,Microbiology and Parasitology Post-graduation program, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA
| | - Melissa Orzechowski Xavier
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil.,Health Science Post-graduation program, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil.,Microbiology and Parasitology Post-graduation program, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil
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45
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Basso RP, Poester VR, Benelli JL, Stevens DA, Zogbi HE, Vasconcellos ICDS, Pasqualotto AC, Xavier MO. COVID-19-Associated Histoplasmosis in an AIDS Patient. Mycopathologia 2020; 186:109-112. [PMID: 33156463 PMCID: PMC7644795 DOI: 10.1007/s11046-020-00505-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 09/26/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022]
Abstract
Most reports associating fungal infections with COVID-19 have been cases of invasive aspergillosis. Here, we report a case of severe histoplasmosis and COVID-19 infections in an HIV patient in Rio Grande, Southern Brazil. Histoplasmosis must be included as a diagnostic possibility in opportunistic fungal co-infections in COVID-19 patients with AIDS, mainly in endemic areas.
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Affiliation(s)
- Rossana Patricia Basso
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande, RS, Brazil
| | - Vanice Rodrigues Poester
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil
| | - Jéssica Louise Benelli
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA.,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Heruza Einsfeld Zogbi
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil.,Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande, RS, Brazil
| | - Izadora Clezar da S Vasconcellos
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Alessandro Comarú Pasqualotto
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Melissa Orzechowski Xavier
- Pós-Graduação em Ciências da Saúde, Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande (FAMED-FURG), Campus Saúde, Visconde de Paranaguá 102, Centro, Rio Grande, RS, 96201-900, Brazil. .,California Institute for Medical Research, San Jose, CA, USA. .,Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA.
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da Silva LB, Bock D, Klafke GB, Sanchotene KO, Basso RP, Benelli JL, Poester VR, da Silva FA, Trilles L, Severo CB, Stevens DA, Xavier MO. Cryptococcosis in HIV-AIDS patients from Southern Brazil: Still a major problem. J Mycol Med 2020; 30:101044. [PMID: 33046394 DOI: 10.1016/j.mycmed.2020.101044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/23/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Cryptococcus neoformans is an opportunistic pathogen that causes ∼15% mortality in AIDS patients. Rio Grande City, Rio Grande do Sul (RS), Brazil, has the highest national rate of HIV/AIDS, considering cities with population more than 100,000 habitants. OBJECTIVE We aimed to evaluate the clinical and epidemiological profile of cryptococcosis in a reference service for HIV-AIDS patients in the South region of Brazil, over seven years. Material and methods A retrospective study was performed including all cryptococcosis cases diagnosed at the University Hospital, Federal University of Rio Grande (UH-FURG) between January 2010 and December 2016. RESULTS Seventy cases of cryptococcosis were diagnosis from 2010 to 2016 in the UH-FURG in the seven years of the study. These numbers were responsible for 2.1% to 8.1% of the hospitalizations/year for HIV patients. All were caused by C. neoformans infection (95% C. neoformans var. grubii VNI and 5% C. neoformans var. grubii VNII). Neurocryptococcosis was the major clinical manifestation and cryptococcosis was the HIV- defining condition in 40% of patients. The period of hospitalization was an average of 39.3 days (SD=31.3), and more than half of patients (53%; 37/70) died after a mean of 82 days. DISCUSSION The present study showed the importance of cryptococcosis as an AIDS-defining disease in HIV-AIDS patients in a tertiary hospital from Southern Brazil. More investment is necessary to reduce the impact of this opportunistic mycosis in HIV-AIDS patients from southern Brazil.
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Affiliation(s)
- L B da Silva
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - D Bock
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil
| | - G B Klafke
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil
| | - K O Sanchotene
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - R P Basso
- Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - J L Benelli
- Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - V R Poester
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil
| | - F A da Silva
- Mycology Laboratory of National Institute of Infectology, Foundation Oswaldo Cruz (INI-FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - L Trilles
- Mycology Laboratory of National Institute of Infectology, Foundation Oswaldo Cruz (INI-FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - C B Severo
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - D A Stevens
- California Institute for Medical Research, San Jose, California, USA and Div. of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA
| | - M O Xavier
- Mycology Laboratory of Faculty of Medicine (FAMED), Federal University of Rio Grande (FURG), Rio Grande do Sul, Brazil; Program Post-Graduation in Health Sciences (PPGCS - FAMED-FURG), Rio Grande do Sul, Brazil.
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Donnelly JP, Chen SC, Kauffman CA, Steinbach WJ, Baddley JW, Verweij PE, Clancy CJ, Wingard JR, Lockhart SR, Groll AH, Sorrell TC, Bassetti M, Akan H, Alexander BD, Andes D, Azoulay E, Bialek R, Bradsher RW, Bretagne S, Calandra T, Caliendo AM, Castagnola E, Cruciani M, Cuenca-Estrella M, Decker CF, Desai SR, Fisher B, Harrison T, Heussel CP, Jensen HE, Kibbler CC, Kontoyiannis DP, Kullberg BJ, Lagrou K, Lamoth F, Lehrnbecher T, Loeffler J, Lortholary O, Maertens J, Marchetti O, Marr KA, Masur H, Meis JF, Morrisey CO, Nucci M, Ostrosky-Zeichner L, Pagano L, Patterson TF, Perfect JR, Racil Z, Roilides E, Ruhnke M, Prokop CS, Shoham S, Slavin MA, Stevens DA, Thompson GR, Vazquez JA, Viscoli C, Walsh TJ, Warris A, Wheat LJ, White PL, Zaoutis TE, Pappas PG. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020; 71:1367-1376. [PMID: 31802125 PMCID: PMC7486838 DOI: 10.1093/cid/ciz1008] [Citation(s) in RCA: 1286] [Impact Index Per Article: 321.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.
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Affiliation(s)
| | - Sharon C Chen
- Centre for Infectious Diseases and Microbiology, Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Carol A Kauffman
- Division of Infectious Diseases, University of Michigan, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - William J Steinbach
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - John W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul E Verweij
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | | | - John R Wingard
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology University Children’s Hospital, Münster, Germany
| | - Tania C Sorrell
- University of Sydney, Marie Bashir Institute for Infectious Diseases & Biosecurity, University of Sydney School of Medicine Faculty of Medicine and Health, Westmead Institute for Centre for Infectious Diseases and Microbiology, Western Sydney Local Health District, Sydney, Australia
| | - Matteo Bassetti
- Infectious Disease Clinic, Department of Medicine University of Udine and Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy
| | - Hamdi Akan
- Ankara University, Faculty of Medicine, Cebeci Campus, Hematology Clinical Research Unit, Ankara, Turkey
| | - Barbara D Alexander
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - David Andes
- Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology School of Medicine and Public Health and School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Elie Azoulay
- Médicine Intensive et Réanimation Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Ralf Bialek
- Molecular Diagnostics of Infectious Diseases, Microbiology, LADR Zentrallabor Dr. Kramer & Kollegen, Geesthacht, Germany
| | - Robert W Bradsher
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stephane Bretagne
- Institut Pasteur, Molecular Mycology Unit, CNRS UMR2000, Mycology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Angela M Caliendo
- Department of Medicine, Alpert Warren Medical School of Brown University, Providence, Rhode Island, USA
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mario Cruciani
- Infectious Diseases Unit, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | | | - Catherine F Decker
- Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sujal R Desai
- National Heart & Lung Institute, Imperial College London, the Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Brian Fisher
- Pediatric Infectious Diseases Division at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thomas Harrison
- Centre for Global Health, Institute for Infection and Immunity, St Georges University of London, London, UK
| | - Claus Peter Heussel
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center and Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Bart-Jan Kullberg
- Radboud Center for Infectious Diseases and Department of Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation and Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University of Frankfurt, Frankfurt, Germany
| | - Jurgen Loeffler
- Molecular Biology and Infection, Medical Hospital II, WÜ4i, University Hospital Würzburg, Würzburg, Germany
| | - Olivier Lortholary
- Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine & Institut Pasteur, Molecular Mycology Unit, CNRS UMR 2000, Paris, France
| | - Johan Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, K.U. Leuven, Leuven, Belgium
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kieren A Marr
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Henry Masur
- Critical Care Medicine Department NIH-Clinical Center, Bethesda, Maryland, USA
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases and Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Livio Pagano
- Istituto di Ematologia, Università Cattolica S. Cuore, Rome, Italy
| | - Thomas F Patterson
- UT Health San Antonio and South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - John R Perfect
- Department of Medicine and Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Zdenek Racil
- Department of Internal Medicine–Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Marcus Ruhnke
- Department of Hematology & Oncology, Lukas Hospital, Buende, Germany
| | - Cornelia Schaefer Prokop
- Meander Medical Center Amersfoort and Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shmuel Shoham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Center and the National Centre for Infections in Cancer, The University of Melbourne, Melbourne, Victoria, Australia
| | - David A Stevens
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California
- California Institute for Medical Research, San Jose, California, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, USA
| | - Jose A Vazquez
- Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA
| | - Claudio Viscoli
- Division of Infectious Disease, University of Genova and San Martino University Hospital, Genova, Italy
| | - Thomas J Walsh
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, Microbiology & Immunology, New York, New York, USA
| | - Adilia Warris
- MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen, UK
| | | | - P Lewis White
- Public Health Wales Mycology Reference Laboratory, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Theoklis E Zaoutis
- Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia and Roberts Center for Pediatric Research, Philadelphia, Pennsylvania, USA
| | - Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Melo AM, Poester VR, Trapaga M, Nogueira CW, Zeni G, Martinez M, Sass G, Stevens DA, Xavier MO. Diphenyl diselenide and its interaction with antifungals against Aspergillus spp. Med Mycol 2020; 59:myaa072. [PMID: 32844203 DOI: 10.1093/mmy/myaa072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/16/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
Given the few antifungal classes available to treat aspergillosis, this study aimed to evaluate the in vitro antifungal activity of diphenyl diselenide (PhSe)2 alone and in combination with classical antifungals against Aspergillus spp., and its in vivo activity in a systemic experimental aspergillosis model. We performed in vitro broth microdilution assay of (PhSe)2 against 32 Aspergillus isolates; and a checkboard assay to test the interaction of this compound with itraconazole (ITC), voriconazole (VRC), amphotericin B (AMB), and caspofungin (CAS), against nine Aspergillus isolates. An experimental model of invasive aspergillosis in mice was studied, and survival curves were compared between an untreated group and groups treated with 100 mg/kg ITC, or (PhSe)2 in different dosages (10 mg/kg, 50 mg/kg and 100 mg/kg). All Aspergillus non-fumigatus and 50% of A. fumigatus were inhibited by (PhSe)2 in concentrations ≤ 64 µg/ml, with significant differences in MICs between the sections. Synergism or additive effect in the in vitro (PhSe)2 interaction with VRC and CAS was observed against the majority of isolates, and with ITC against the non-fumigatus strains. In addition to the inhibitory interaction, (PhSe)2 was able to add a fungicidal effect to CAS. Survival curves from the systemic experimental aspergillosis model demonstrated that the inoculum caused an acute and lethal infection in mice, and no treatment applied significantly prolonged survival over that of the control group. The results highlight the promising activity of (PhSe)2 against Aspergillus species, but more in vivo studies are needed to determine its potential applicability in aspergillosis treatment. LAY SUMMARY The activity of diphenyl diselenide (PhSe)2 alone and in combination with itraconazole, voriconazole, and caspofungin, is described against three of the most pathogenic Aspergillus sections. (PhSe)2 may prove useful in therapy of infection in future; further study is required.
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Affiliation(s)
- Aryse Martins Melo
- Microbiology and Parasitology Post-graduation program, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil
- Department of Infectious Diseases/Reference Unit for Parasitic and Fungal Infections, National Institute of Health, Dr. Ricardo Jorge, Lisbon, Portugal
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
| | - Vanice Rodrigues Poester
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
- Health Science Post-graduation program, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
| | - Mariana Trapaga
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
| | - Cristina Wayne Nogueira
- Biological Sciences Post-graduation program, Department of Biochemistry and Molecular Biology, Center for Natural and Exact Sciences, Federal University of Santa Maria. RS, Brazil
| | - Gilson Zeni
- Biological Sciences Post-graduation program, Department of Biochemistry and Molecular Biology, Center for Natural and Exact Sciences, Federal University of Santa Maria. RS, Brazil
| | - Marife Martinez
- California Institute for Medical Research, San Jose, California, USA
| | - Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California, USA
| | - Melissa Orzechowski Xavier
- Microbiology and Parasitology Post-graduation program, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil
- Mycology Laboratory, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
- Health Science Post-graduation program, College of Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil
- California Institute for Medical Research, San Jose, California, USA
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Sass G, Nazik H, Chatterjee P, Stevens DA. Under nonlimiting iron conditions pyocyanin is a major antifungal molecule, and differences between prototypic Pseudomonas aeruginosa strains. Med Mycol 2020; 59:453-464. [PMID: 32827431 DOI: 10.1093/mmy/myaa066] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 01/09/2023] Open
Abstract
Airways of immunocompromised patients, or individuals with cystic fibrosis (CF), are common ground for Pseudomonas aeruginosa and Aspergillus fumigatus infections. Hence, in such a microenvironment both pathogens compete for resources. While under limiting iron conditions the siderophore pyoverdine is the most effective antifungal P. aeruginosa product, we now provide evidence that under nonlimiting iron conditions P. aeruginosa supernatants lack pyoverdine but still possess considerable antifungal activity. Spectrometric analyses of P. aeruginosa supernatants revealed the presence of phenazines, such as pyocyanin, only under nonlimiting iron conditions. Supernatants of quorum sensing mutants of strain PA14, defective in phenazine production, as well as supernatants of the P. aeruginosa strain PAO1, lacked pyocyanin, and were less inhibitory toward A. fumigatus biofilms under nonlimiting iron conditions. When blood as a natural source of iron was present during P. aeruginosa supernatant production, pyoverdine was absent, and phenazines, including pyocyanin, appeared, resulting in an antifungal effect on A. fumigatus biofilms. Pure pyocyanin reduced A. fumigatus biofilm metabolism. In summary, P. aeruginosa has mechanisms to compete with A. fumigatus under limiting and non-limiting iron conditions, and can switch from iron-denial-based to toxin-based antifungal activity. This has implications for the evolution of the microbiome in clinical settings where the two pathogens co-exist. Important differences in the iron response of P. aeruginosa laboratory strains PA14 and PAO1 were also uncovered.
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Affiliation(s)
- Gabriele Sass
- California Institute for Medical Research, San Jose, California, USA
| | - Hasan Nazik
- California Institute for Medical Research, San Jose, California, USA
| | | | - David A Stevens
- California Institute for Medical Research, San Jose, California, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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50
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Stevens DA, Martinez M, Sass G, Pappagianis D, Doherty B, Kutsche H, McGuire M. Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis. J Fungi (Basel) 2020; 6:jof6030125. [PMID: 32759879 PMCID: PMC7558155 DOI: 10.3390/jof6030125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
Meningitis is the most devastating form of coccidioidomycosis. A convenient, rapid diagnostic method could result in early treatment and avoid many meningitis complications. We studied cerebrospinal fluid (CSF) samples in patients with documented coccidioidal meningitis, and controls, with complement fixation (CF), immunodiffusion (ID) (the “classical” assays), lateral flow assays (LFA; one-strip and two-strip), and two enzyme immunoassays (EIA). The two-strip LFA and EIAs not only enabled separate testing for IgG and IgM antibodies separately, but also could aggregate results for each method. CF with ID or the aggregate use of IgG and IgM tests were considered optimal test uses. LFAs and EIAs were evaluated at 1:21 and 1:441 dilutions of specimens. All assays were compared to true patient status. With 49 patient specimens and 40 controls, this is the largest comparative study of CSF coccidioidal diagnostics. Sensitivity of these tests ranged from 71–95% and specificity 90–100%. IgM assays were less sensitive. Assays at 1:441 were similarly specific but less sensitive, suggesting that serial dilutions of samples could result in assays yielding titers. Agreement of positive results on cases was 87–100%. When kits are available, hospital laboratories in endemic areas can perform testing. LFA assays do not require a laboratory, are simple to use, and give rapid results, potentially even at the bedside.
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Affiliation(s)
- David A. Stevens
- California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA; (M.M.); (G.S.)
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-408-998-4554
| | - Marife Martinez
- California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA; (M.M.); (G.S.)
| | - Gabriele Sass
- California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA; (M.M.); (G.S.)
| | - Demosthenes Pappagianis
- Department of Medical Microbiology, University of California School of Medicine, Davis, CA 95616, USA;
| | - Brian Doherty
- IMMY, Inc., 2701 Corporate Center Drive, Norman, OK 73069, USA; (B.D.); (H.K.); (M.M.)
| | - Hannah Kutsche
- IMMY, Inc., 2701 Corporate Center Drive, Norman, OK 73069, USA; (B.D.); (H.K.); (M.M.)
| | - Meredith McGuire
- IMMY, Inc., 2701 Corporate Center Drive, Norman, OK 73069, USA; (B.D.); (H.K.); (M.M.)
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