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Viegas C, Peixoto C, Gomes B, Dias M, Cervantes R, Pena P, Slezakova K, Pereira MDC, Morais S, Carolino E, Twarużek M, Viegas S, Caetano LA. Assessment of Portuguese fitness centers: Bridging the knowledge gap on harmful microbial contamination with focus on fungi. Environ Pollut 2024; 350:123976. [PMID: 38657893 DOI: 10.1016/j.envpol.2024.123976] [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] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/24/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
The lack of knowledge regarding the extent of microbial contamination in Portuguese fitness centers (FC) puts attendees and athletes at risk for bioaerosol exposure. This study intends to characterize microbial contamination in Portuguese FC by passive sampling methods: electrostatic dust collectors (EDC) (N = 39), settled dust (N = 8), vacuum filters (N = 8), and used cleaning mops (N = 12). The obtained extracts were plated in selective culture media for fungi and bacteria. Filters, EDC, and mop samples' extracts were also screened for antifungal resistance and used for the molecular detection of the selected Aspergillus sections. The detection of mycotoxins was conducted using a high-performance liquid chromatograph (HPLC) system and to determine the cytotoxicity of microbial contaminants recovered by passive sampling, HepG2 (human liver carcinoma) and A549 (human alveolar epithelial) cells were employed. The results reinforce the use of passive sampling methods to identify the most critical areas and identify environmental factors that influence microbial contamination, namely having a swimming pool. The cardio fitness area presented the highest median value of total bacteria (TSA: 9.69 × 102 CFU m-2.day-1) and Gram-negative bacteria (VRBA: 1.23 CFU m-2.day-1), while for fungi it was the open space area, with 1.86 × 101 CFU m-2.day-1. Aspergillus sp. was present in EDC and in filters used to collect settled dust. Reduced azole susceptibility was observed in filters and EDC (on ICZ and VCZ), and in mops (on ICZ). Fumonisin B2 was the only mycotoxin detected and it was present in all sampling matrixes except settled dust. High and moderate cytotoxicity was obtained, suggesting that A549 cells were more sensitive to samples' contaminants. The observed widespread of critical toxigenic fungal species with clinical relevance, such as Aspergillus section Fumigati, as well as Fumonisin B2 emphasizes the importance of frequent and effective cleaning procedures while using shared mops appeared as a vehicle of cross-contamination.
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Affiliation(s)
- Carla Viegas
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, 1600-560, Lisbon, Portugal.
| | - Cátia Peixoto
- REQUIMTE-LAQV, Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida 431, 4200-072, Porto, Portugal; LEPABE-ALiCE, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Bianca Gomes
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal; CE3C-Center for Ecology, Evolution and Environmental Change, Faculdade de Ciências, Universidade de Lisboa, 1749-016, Lisbon, Portugal
| | - Marta Dias
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, 1600-560, Lisbon, Portugal
| | - Renata Cervantes
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, 1600-560, Lisbon, Portugal
| | - Pedro Pena
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, 1600-560, Lisbon, Portugal
| | - Klara Slezakova
- LEPABE-ALiCE, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Maria do Carmo Pereira
- LEPABE-ALiCE, Faculdade de Engenharia da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Simone Morais
- REQUIMTE-LAQV, Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida 431, 4200-072, Porto, Portugal
| | - Elisabete Carolino
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal
| | - Magdalena Twarużek
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Susana Viegas
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, 1600-560, Lisbon, Portugal
| | - Liliana Aranha Caetano
- H&TRC-Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal; Research Institute for Medicines (iMed.uLisboa), Faculty of Pharmacy, University of Lisbon, 1649-003, Lisbon, Portugal
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Gupta AK, Polla Ravi S, Wang T, Bakotic WL, Shemer A. Mapping the Global Spread of T. indotineae: An Update on Antifungal Resistance, Mutations, and Strategies for Effective Management. Mycopathologia 2024; 189:45. [PMID: 38734753 DOI: 10.1007/s11046-024-00856-z] [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: 01/09/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The global spread of Trichophyton indotineae presents a pressing challenge in dermatophytosis management. This systematic review explores the current landscape of T. indotineae infections, emphasizing resistance patterns, susceptibility testing, mutational analysis, and management strategies. METHODS A literature search was conducted in November 2023 using Embase, PubMed, Scopus, and Web of Science databases. Inclusion criteria covered clinical trials, observational studies, case series, or case reports with T. indotineae diagnosis through molecular methods. Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction. RESULTS AND DISCUSSION A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing. CONCLUSION Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. The absence of established clinical breakpoints for dermatophytes underscores the need for further research in this challenging field.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada.
| | - Shruthi Polla Ravi
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
| | - Tong Wang
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
| | | | - Avner Shemer
- Department of Dermatology, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
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Ghazanfari M, Abastabar M, Haghani I, Kermani F, Keikha N, Kholoujini M, Minooeianhaghighi MH, Jeddi SA, Shokri A, Ghojoghi A, Amirizad K, Azish M, Nasirzadeh Y, Roohi B, Nosratabadi M, Hedayati S, Ghanbari S, Valadan R, Hedayati MT. Electronic equipment and appliances in special wards of hospitals as a source of azole-resistant Aspergillus fumigatus: a multi-centre study from Iran. J Hosp Infect 2024; 145:65-76. [PMID: 38199436 DOI: 10.1016/j.jhin.2023.12.011] [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: 09/01/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Azole-resistant Aspergillus fumigatus (ARAf), reported as a global public health concern, has been unexpectedly observed in different countries. AIM To identify ARAf and detect azole resistance related to the CYP51A mutation in different hospital environmental samples. METHODS In this multi-centre study from Iran, surfaces of electronic equipment and appliances from different hospitals in Iran were sampled using cotton swabs. All samples were cultured using azole-containing agar plates (ACAPs). Recovered Aspergillus isolates were identified at the species level using partial DNA sequencing of the β-tubulin gene. The azole susceptibility testing of A. fumigatus isolates was performed using the Clinical and Laboratory Standards Institute M38-A3 guideline. The sequencing of the CYP51A gene was also performed to detect mutations related to resistance. FINDINGS Out of the 693 collected samples, 89 (12.8%) Aspergillus species were recovered from ACAPs. Aspergillus fumigatus (41.6%) was the most prevalent, followed by A. tubingensis (23.6%) and A. niger (15.6%). Among 37 isolates of A. fumigatus, 19 (51.3%) showed high minimum inhibitory concentration (MIC) values to at least one of the three azoles, voriconazole, itraconazole, and posaconazole. CYP51A polymorphisms were detected in all 19 isolates, of which 52.6% showed the TR34/L98H mutation. Other detected mutations were G432C, G448S, G54E/G138C, F46Y, and Y121F/M220I/D255E. T289F and G432C were the first reported mutations in ARAf. CONCLUSION There was a considerable level of azole resistance in hospital environmental samples, a serious warning for patients vulnerable to aspergillosis. Our findings have also revealed a different mutation pattern in the CYP51A gene.
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Affiliation(s)
- M Ghazanfari
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - I Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - F Kermani
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - N Keikha
- Infectious Disease and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - M Kholoujini
- Beheshti Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - M H Minooeianhaghighi
- Department of Medical Microbiology, Faculty of Medicine, Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - S A Jeddi
- Department of Laboratory Sciences, School of Allied Sciences, Abadan University of Medical Sciences, Abadan, Iran
| | - A Shokri
- Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - A Ghojoghi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - K Amirizad
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - M Azish
- Department of Medical Parasitology and Mycology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Y Nasirzadeh
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - B Roohi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Nosratabadi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Laboratory Sciences, Sirjan Faculty of Medical Sciences, Sirjan, Iran
| | - S Hedayati
- Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - S Ghanbari
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - R Valadan
- Department of Immunology/Molecular and Cell Biology Research Center (MCBRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - M T Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran; Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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El-Kholy MA, Helaly GF, El Ghazzawi EF, El-Sawaf G, Shawky SM. Analysis of CDR1 and MDR1 Gene Expression and ERG11 Substitutions in Clinical Candida tropicalis Isolates from Alexandria, Egypt. Braz J Microbiol 2023; 54:2609-2615. [PMID: 37606863 PMCID: PMC10689625 DOI: 10.1007/s42770-023-01106-y] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Candida tropicalis is a common non-albicans Candida (NAC) species that causes numerous fungal infections. Increasing antifungal resistance to azoles in NAC is becoming a major health problem worldwide; however, in Egypt, almost no data is available regarding fluconazole resistance mechanisms in C. tropicalis. The current study aims to investigate two possible important molecular mechanisms involved in fluconazole resistance in C. tropicalis isolates. MATERIALS Fifty-four clinical C. tropicalis isolates were included. Identification and antifungal susceptibility profiles of the isolates were carried out using the VITEK 2 compact system. The molecular investigation of fluconazole resistance included the expression of the CDR1 and MDR1 genes by quantitative real-time RT-PCR as well as the sequence analysis of the ERG11 gene. RESULTS Antifungal susceptibility testing identified 30 fluconazole-non-susceptible isolates. Statistically, CDR1 gene expression in fluconazole-non-susceptible isolates was significantly higher than that in fluconazole-susceptible isolates, with MDR1 gene expression levels that were similar in both non-susceptible and susceptible isolates. Sequence analysis of the ERG11 gene of 26 fluconazole-resistant isolates identified two missense mutations: A395T (Y132F) and G1390A (G464S). CONCLUSIONS This study has highlighted the role of overexpression of the CDR1 gene and ERG11 gene mutations in fluconazole non-susceptibility. Further studies in Egypt are required to investigate other possible molecular mechanisms involved in azole resistance.
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Affiliation(s)
- Mohammed A El-Kholy
- Department of Microbiology and Biotechnology, Division of Clinical and Biological Sciences, College of Pharmacy, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Alexandria, Egypt.
| | - Ghada F Helaly
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ebtisam F El Ghazzawi
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Gamal El-Sawaf
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sherine M Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Álvarez-Pérez S, García ME, Martínez-Nevado E, Blanco JL. Presence of Aspergillus fumigatus with the TR 34/L98H Cyp51A mutation and other azole-resistant aspergilli in the air of a zoological park. Res Vet Sci 2023; 164:104993. [PMID: 37657393 DOI: 10.1016/j.rvsc.2023.104993] [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: 04/14/2023] [Revised: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
Antifungal-resistant fungi, including Aspergillus fumigatus and other Aspergillus species, pose an urgent threat to human and animal health. Furthermore, the environmental route of azole resistance selection due to the widespread use of azole fungicides in crop protection and other applications is a major public health issue. Although environmental surveillance of fungi is frequently performed in many zoological parks and wildlife rehabilitation centers, the antifungal susceptibility of recovered isolates is only rarely analyzed, which precludes a clear assessment of the threat posed by these fungi to captive animals. In this study, we assessed the presence of airborne azole-resistant Aspergillus spp., including the so-called 'cryptic species' (i.e., species which are phenotypically similar to more well-known aspergilli but clearly constitute different phylogenetic lineages) in a zoological park located in the city of Madrid, Spain. In general, our results revealed a low prevalence A. fumigatus and cryptic aspergilli with decreased susceptibility to azoles. However, we detected an A. fumigatus isolate with the TR34/L98H mutation in the gene encoding the lanosterol 14α-demethylase (Cyp51A), consisting of a tandem repeat of 34 base pairs in the promoter region and a lysine to histidine substitution at codon 98. Notably, this TR34/L98H mutation has been linked to the environmental route of azole resistance selection, thus highlighting the 'One Health' dimension of the emerging problem of antifungal resistance. In this context, continuous environmental surveillance of azole-resistant aspergilli in zoological parks and other similar animal facilities is recommended.
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Affiliation(s)
- Sergio Álvarez-Pérez
- Department of Animal Health, Faculty of Veterinary Medicine, Complutense University of Madrid, Avenida Puerta de Hierro s/n, Madrid 28040, Spain.
| | - Marta E García
- Department of Animal Health, Faculty of Veterinary Medicine, Complutense University of Madrid, Avenida Puerta de Hierro s/n, Madrid 28040, Spain
| | | | - José L Blanco
- Department of Animal Health, Faculty of Veterinary Medicine, Complutense University of Madrid, Avenida Puerta de Hierro s/n, Madrid 28040, Spain
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Salama EA, Eldesouky HE, Elgammal Y, Abutaleb NS, Seleem MN. Lopinavir and ritonavir act synergistically with azoles against Candida auris in vitro and in a mouse model of disseminated candidiasis. Int J Antimicrob Agents 2023; 62:106906. [PMID: 37392947 PMCID: PMC10528984 DOI: 10.1016/j.ijantimicag.2023.106906] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/06/2022] [Revised: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES The emergence of Candida auris has created a global health challenge. Azole antifungals are the most affected antifungal class because of the extraordinary capability of C. auris to develop resistance against these drugs. Here, we used a combinatorial therapeutic approach to sensitize C. auris to azole antifungals. METHODS AND RESULTS We have demonstrated the capability of the HIV protease inhibitors lopinavir and ritonavir, at clinically relevant concentrations, to be used with azole antifungals to treat C. auris infections both in vitro and in vivo. Both lopinavir and ritonavir exhibited potent synergistic interactions with the azole antifungals, particularly with itraconazole against 24/24 (100%) and 31/34 (91%) of tested C. auris isolates, respectively. Furthermore, ritonavir significantly interfered with the fungal efflux pump, resulting in a significant increase in Nile red fluorescence by 44%. In a mouse model of C. auris systemic infection, ritonavir boosted the activity of lopinavir to work synergistically with fluconazole and itraconazole and significantly reduced the kidney fungal burden by a 1.2 log (∼94%) and 1.6 log (∼97%) CFU, respectively. CONCLUSION Our results urge further comprehensive assessment of azoles and HIV protease inhibitors as a novel drug regimen for the treatment of serious invasive C. auris infections.
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Affiliation(s)
- Ehab A Salama
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia; Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Hassan E Eldesouky
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia; Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Yehia Elgammal
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia; Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Nader S Abutaleb
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia; Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Mohamed N Seleem
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia; Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia.
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Spruijtenburg B, Meijer EFJ, Xiao M, Shawky SM, Meis JF, de Groot T, El-Kholy MA. Genotyping and susceptibility testing uncovers large azole-resistant Candida tropicalis clade in Alexandria, Egypt. J Glob Antimicrob Resist 2023; 34:99-105. [PMID: 37419181 DOI: 10.1016/j.jgar.2023.06.012] [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: 04/25/2023] [Revised: 06/09/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Candida tropicalis is an emerging medically relevant Candida species. The yeast primarily causes opportunistic infections in intensive care units and is highly prevalent in tropical countries. The genetic diversity within this species is high, and nosocomial transmission has been reported. C. tropicalis genotyping of isolates from low- and middle-income countries is underrepresented when compared with that from high-income countries. Also, in Egypt, only limited genotyping has been conducted for C. tropicalis isolates, while antifungal resistance seems to increase, especially against azoles. METHODS Antifungal susceptibility testing was performed on 64 C. tropicalis isolates from ICU patients collected from multiple hospitals in Alexandria, Egypt. Genotyping by means of short tandem repeat (STR) and whole genome sequencing (WGS) single nucleotide polymorphism (SNP) analysis was performed. RESULTS Using antifungal susceptibility testing, fluconazole resistance was observed in 24 isolates (38%), of which 23 harboured an ERG11 G464S substitution, previously shown to cause resistance in Candida albicans. STR genotyping showed that these 23 isolates were related, forming a distinct resistant clade. WGS SNP analysis subsequently confirmed this genetic relationship, although isolates within this clade differed in at least 429 SNPs, suggesting that these were independently introduced. CONCLUSION Overall, STR and WGS SNP analysis of this collection indicates limited C. tropicalis nosocomial transmission in Alexandria, while the presence of this large azole-resistant C. tropicalis clade within this city hampers the treatment of intensive care unit patients.
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Affiliation(s)
- Bram Spruijtenburg
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Eelco F J Meijer
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Meng Xiao
- Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, People's Republic of China
| | - Sherine M Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands; Center of Expertise in Mycology Radboud University Medical Center/Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Mohammed A El-Kholy
- Department of Microbiology and Biotechnology, Division of Clinical and Biological Sciences, College of Pharmacy, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Alexandria, Egypt.
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Hemmings SJ, Rhodes JL, Fisher MC. Long-read Sequencing and de novo Genome Assembly of Three Aspergillus fumigatus Genomes. Mycopathologia 2023; 188:409-412. [PMID: 37227556 PMCID: PMC10386934 DOI: 10.1007/s11046-023-00740-2] [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: 03/24/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023]
Abstract
Aspergillus fumigatus is a genetically diverse fungal species, which is near ubiquitous in its global distribution and is the major cause of the life-threatening disease invasive aspergillosis. We present 3 de novo genome assemblies that were selected to be representative of the genetic diversity of clinical and environmental A. fumigatus. Sequencing using long-read Oxford Nanopore and subsequent assembly of the genomes yielded 10-23 contigs with an N50 of 4.05 Mbp to 4.93 Mbp.
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Affiliation(s)
- Samuel J Hemmings
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Johanna L Rhodes
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Matthew C Fisher
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Kong X, Song G, Mei H, Zheng H, Tang C, de Hoog S, Li X, She X, Liu W, Liang G. The Domestic Isolation of Terbinafine- and Itraconazole-Resistant Trichophyton indotineae in Chinese Mainland. Mycopathologia 2023; 188:383-393. [PMID: 37335400 DOI: 10.1007/s11046-023-00761-x] [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: 03/13/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Trichophyton indotineae, a new species of dermatophytes, has become a significant concern in treating dermatophytosis due to the high level of terbinafine resistance reported in India and even worldwide. OBJECTIVES This study aimed to report the terbinafine- and itraconazole-resistant T. indotineae in Chinese mainland, by identifying the phylogenetic classification of the isolate strain, and detecting the drug resistance, gene mutation and expression. PATIENTS/METHODS The skin scales of the patient were cultured on SDA and the isolate was authenticated by DNA sequencing and MALDI-TOF MS. Antifungal susceptibility testing was performed following the M38-A2 CLSI protocol to examine the MICs values of terbinafine, itraconazole, fluconazole, etc. The strain was screened for mutations in the squalene epoxidase (SQLE) gene by Sanger sequencing and detected the expression of CYP51A and CYP51B by qRT-PCR. RESULTS A multi-resistant ITS genotype VIII sibling of the T. mentagrophytes complex (T. indotineae) was isolated in Chinese mainland. The strain harbored high terbinafine MIC of > 32 μg/mL and itraconazole MIC of 1.0 μg/mL, which was identified a mutation in the squalene epoxidase gene with amino acid substitution (Phe397Leu, mutation 1191C > A). In addition, overexpression of CYP51A and CYP51B was observed. With multiple relapses, the patient finally achieved clinical cure by itraconazole pulse therapy and topical clotrimazole cream for 5 weeks. CONCLUSIONS The first domestic strain of terbinafine- and itraconazole-resistant T. indotineae from a patient in Chinese mainland was isolated. Itraconazole pulse therapy can be an effective method for the treatment of T. indotineae.
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Affiliation(s)
- Xue Kong
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Ge Song
- Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Huan Mei
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, China
| | - Hailin Zheng
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, China
| | - Chao Tang
- Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Sybren de Hoog
- Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Xiaofang Li
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Xiaodong She
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China
| | - Weida Liu
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 21166, China.
| | - Guanzhao Liang
- Department of Medical Mycology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, China.
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, 210042, China.
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Viegas C, Gomes B, Cervantes R, Moreira S, Dias M, Pena P, Carolino E, Twarużek M, Kosicki R, Soszczyńska E, Caetano LA, Cañas L, Pozdniakova S, Borràs S, Viegas S. Microbial contamination in grocery stores from Portugal and Spain - The neglected indoor environment to be tackled in the scope of the One Health approach. Sci Total Environ 2023; 875:162602. [PMID: 36878289 DOI: 10.1016/j.scitotenv.2023.162602] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Microbial contamination in grocery shops (GS) should be evaluated since food commodities are commonly handled by workers and customers increasing the risk of food contamination and disease transmission. The aim of this study was to evaluate the microbial contamination in Portuguese and Spanish GS with a multi-approach protocol using passive (electrostatic dust cloths and surface swabs) sampling methods. The molecular detection of Aspergillus sections, mycotoxin analysis, screening of azole resistance as well as cytotoxicity measurement were conducted to better estimate the potential health risks of exposure and to identify possible relations between the risk factors studied. Fruits/vegetables sampling location was the one identified has being the most contaminated (bacteria and fungi) area in GS from both countries. Aspergillus section Fumigati and Fusarium species were observed in samples from Portuguese groceries with reduced susceptibilities to azoles commonly used in the clinical treatment of fungal infections. Fumonisin B2 was detected in Portuguese GS possible unveiling this emergent threat concerning occupational exposure and food safety. Overall, the results obtained raise concerns regarding human health and food safety and must be surveilled applying a One Health approach.
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Affiliation(s)
- Carla Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
| | - Bianca Gomes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Renata Cervantes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Sílvia Moreira
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Marta Dias
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Pedro Pena
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Elisabete Carolino
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Magdalena Twarużek
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Robert Kosicki
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Ewelina Soszczyńska
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Liliana Aranha Caetano
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal; Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064 Bydgoszcz, Poland
| | - Lídia Cañas
- AIRLAB, Climate and Health Program, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Sofya Pozdniakova
- AIRLAB, Climate and Health Program, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Sílvia Borràs
- AIRLAB, Climate and Health Program, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Susana Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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11
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Stewart AG, Isler B, Simos P, Farquhar D, George N, Golmayo M, Heney C. Aspergillus Species Causing Invasive Fungal Disease in Queensland, Australia. Mycopathologia 2023:10.1007/s11046-023-00713-5. [PMID: 37067664 DOI: 10.1007/s11046-023-00713-5] [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: 05/24/2022] [Accepted: 02/05/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Aspergillus species are important causes of invasive fungal disease, particularly among those with an impaired immune system. Increasing reports have revealed a rising incidence of antifungal drug resistance among Aspergillus spp., particularly among cryptic species. Understanding local antifungal susceptibility patterns is paramount to delivering optimal clinical care. METHODS Aspergillus spp. recovered from clinical specimens between 2000 and 2021 from Pathology Queensland were collected. Aspergillus spp. were identified routinely morphologically, and where there was ambiguity or a lack of sporulation, by sequencing of the internal transcribed spacer (ITS) region. All Aspergillus spp. that underwent antifungal susceptibility testing according to the CLSI M38-A3 method and were recorded and included in the study. Amphotericin B, voriconazole, posaconazole, isavuconazole, micafungin, caspofungin, and anidulafungin were tested. Pathology Queensland services all public healthcare facilities in Queensland, Australia. RESULTS 236 Aspergillus spp. were identified from clinical specimens during the study period. The most frequent species identified were Aspergillus section Fumigati (n = 119), Aspergillus section Flavi (n = 35), Aspergillus terreus (n = 32) and Aspergillus niger (n = 29). Overall, MIC50/90 values for voriconazole, posaconazole, itraconazole, and isavuconazole were 0.25/1, 0.25/0.5, 0.25/0.5, and 0.5/2 mg/L respectively. Echinocandins demonstrated low MIC values overall with micafungin and anidulafungin both having an MIC50/90 of 0.015/0.03 mg/L. A total of 15 cryptic species were identified; high triazole MIC values were observed with a voriconazole MIC50/90 of 2/8 mg/L. From 2017 to 2021 we observed an increase in incidence of isolates with high voriconazole MIC values. There was no difference in voriconazole MIC values between Aspergillus spp. acquired in North Queensland when compared to Southeast Queensland, Australia. CONCLUSION Increasing reports of antifungal resistance among Aspergillus spp. is concerning and warrants further investigation both locally and worldwide. Active surveillance of both the emergence of different Aspergillus spp. and changes in antifungal susceptibility patterns over time is crucial to informing clinicians and treatment guidelines.
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Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Central Microbiology, Pathology Queensland, Brisbane, Australia.
| | - Burcu Isler
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Peter Simos
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Drew Farquhar
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Narelle George
- Central Microbiology, Pathology Queensland, Brisbane, Australia
| | - Mila Golmayo
- Central Microbiology, Pathology Queensland, Brisbane, Australia
| | - Claire Heney
- Central Microbiology, Pathology Queensland, Brisbane, Australia
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12
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Simonicova L, Moye-Rowley WS. Characterizing Candida glabrata Pdr1, a Hyperactive Transcription Factor Involved in Azole Resistance. Methods Mol Biol 2023; 2658:169-179. [PMID: 37024701 DOI: 10.1007/978-1-0716-3155-3_11] [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] [Indexed: 04/08/2023]
Abstract
This chapter illustrates how to prepare isogenic strains carrying gain-of-function forms of transcription factor Pdr1 in the human pathogen Candida glabrata. Simple steps are described that lead from a characterized plasmid-borne PDR1-GOF allele to its integration into the yeast genome in a markerless manner. Pdr1-GOF strains constructed by this approach are suitable for virulence studies in an animal host.
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Affiliation(s)
- Lucia Simonicova
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - W Scott Moye-Rowley
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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13
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Prajapati J, Goswami D, Dabhi M, Acharya D, Rawal RM. Potential dual inhibition of SE and CYP51 by eugenol conferring inhibition of Candida albicans: Computationally curated study with experimental validation. Comput Biol Med 2022; 151:106237. [PMID: 36327880 DOI: 10.1016/j.compbiomed.2022.106237] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/05/2022] [Accepted: 10/22/2022] [Indexed: 12/27/2022]
Abstract
Ergosterol is the key sterol component in the cell membrane of fungi including moulds and yeasts. Any decrease in the levels of ergosterol in the cell membrane of fungi render them venerable to cell membrane damage and even its death. Majority of antifungal drug targets the key enzymes involved in ergosterol biosynthesis pathway. The biochemical pathway for the synthesis of Ergosterol is a complex one, though the reactions carried by Squalene Epoxidase (SE) and 14α-demethylase (CYP51- a member of Cytochrome P450 family) serves to the key rate limiting reactions that can impact the overall production of Ergosterol. Allylamines class of antifungal drug target SE while Azoles target the CYP51. Currently advancement in the drug development is focused to introduce newer drugs that can simultaneously inhibit both this rate limiting enzymes. However, natural compounds established to possess antifungal activity but the major loophole about their understanding lies in the fact that their mode of action are severely unstudied. One such well-established antifungal natural phytochemical is Eugenol, and in current manuscript we investigated its efficacy to interact with both, SE and CYP51 of Candida albicans using molecular Docking, Free energy change calculations and Molecular Dynamics (MD) simulation, showing promising outcomes. For experimental studies, terbinafine, clotrimazole and eugenol showed 4 μg/ml, 2 μg/ml, and 512 μg/ml MIC90 values, respectively against C. albicans and also showed reduction in Ergosterol production at sub-MIC levels. The obtained result indicates the involvement of eugenol in the inhibition of enzymes require in the ergosterol biosynthesis pathway.
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Affiliation(s)
- Jignesh Prajapati
- Department of Biochemistry & Forensic Science, University School of Sciences, Gujarat University, Ahmedabad, 380009, Gujarat, India
| | - Dweipayan Goswami
- Department of Microbiology & Biotechnology, University School of Sciences, Gujarat University, Ahmedabad, 380009, Gujarat, India.
| | - Milan Dabhi
- Department of Microbiology & Biotechnology, University School of Sciences, Gujarat University, Ahmedabad, 380009, Gujarat, India
| | - Dhaval Acharya
- Department of Microbiology, B N Patel Institute of Paramedical and Sciences, Anand, 388001, Gujarat, India
| | - Rakesh M Rawal
- Department of Biochemistry & Forensic Science, University School of Sciences, Gujarat University, Ahmedabad, 380009, Gujarat, India; Department of Life Science, University School of Sciences, Gujarat University, Ahmedabad, 380009, Gujarat, India.
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14
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Branco J, Ryan AP, Silva AP, Butler G, Miranda IM, Rodrigues AG. Clinical azole cross-resistance in Candida parapsilosis is related to a novel MRR1 gain-of-function mutation. Clin Microbiol Infect 2022; 28:1655.e5-1655.e8. [PMID: 36028086 DOI: 10.1016/j.cmi.2022.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/27/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Hereby is described the molecular mechanisms underlying the acquisition of azole resistance by a C. parapsilosis isolate following fluconazole treatment due to candiduria. METHODS A set of three consecutive C. parapsilosis isolates were recovered from urine samples of a patient with candiduria. Whole-genome sequencing (WGS) and antifungal susceptibility assays were performed. Expression of MRR1, MDR1, ERG11 and CDR1B (CPAR2_304370) was quantified by RT-qPCR. RESULTS The initial isolate CPS-A, was susceptible to all three azoles tested (fluconazole, voriconazole and posaconazole); isolate CPS-B, collected after the 2nd cycle of treatment, exhibited a susceptible-dose dependent phenotype to fluconazole, while isolate CPS-C, recovered after the 3rd cycle, exhibited a cross-resistance profile to fluconazole and voriconazole. WGS revealed a putative resistance mechanism in isolate CPS-C, associated with a G1810A nucleotide substitution, leading to a G604R change in the Mrr1p transcription factor. Introducing this mutation into the susceptible CPS-A isolate (MRR1RI) resulted in resistance to fluconazole and voriconazole, as well as upregulation of MRR1 and MDR1. Interestingly, the susceptible-dose dependent phenotype exhibited by isolate CPS-B is associated with an increased copy number of the CDR1B gene. Expression of CDR1B is increased in both isolates CPS-B and CPS-C, and in the MRR1RI strain, harboring the gain-of-function (GOF) mutation. CONCLUSIONS Our results describe clinical azole cross-resistance acquisition in C. parapsilosis due to a G1810A (G604R) GOF mutation resulting in MRR1 hyperactivation and consequently, MDR1 efflux pump overexpression. We also associated amplification of CDR1B gene with decreased fluconazole susceptibility and showed that it is a putative target of the MRR1 GOF mutation.
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Affiliation(s)
- Joana Branco
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research - CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Adam P Ryan
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Ana Pinto Silva
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research - CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Geraldine Butler
- School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Isabel M Miranda
- Cardiovascular Research & Development Centre - UnIC@RISE, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Acácio Gonçalves Rodrigues
- Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal; Center for Health Technology and Services Research - CINTESIS@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
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15
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Dovo EE, Zohoncon TM, Tovo SF, Soubeiga ST, Kiendrebeogo IT, Yonli AT, Ouedraogo RA, Dabire AM, Djigma FW, Nadembega CW, Belemgnegre M, Ouedraogo P, Obiri-Yeboah D, Simpore J. First detection of mutated ERG11 gene in vulvovaginal Candida albicans isolates at Ouagadougou/Burkina Faso. BMC Infect Dis 2022; 22:678. [PMID: 35941587 PMCID: PMC9361531 DOI: 10.1186/s12879-022-07619-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Vulvovaginal candidiasis is an important cause of morbidity among women due to Candida species. In the last decades, resistance to azoles, first-line antifungals has increased. One molecular mechanism of azole resistance by Candida involves mutations in the ERG11 gene encoding lanosterol 14-α-demethylase, the target enzyme. This study was conducted to identify the clinical Candida species associated in vulvovaginal candidiasis; to determine the rate of antifungal resistance among Candida albicans isolates and to determine mutated ERG11 gene at Saint Camille Hospital in Ouagadougou, Burkina Faso. Methods Antifungals susceptibility were performed using Kirby–Bauer disk diffusion method. ERG11 gene was detected using conventional PCR in C. albicans isolates resistant to at least one azole. Results Out of 262 clinical strains isolated, C. albicans accounted for 59.90%, followed by Candida glabrata 27.86%, Candida famata 7.25%, Candida tropicalis 3.05% and Saccharomyces cerevisiae 1.91%. Resistance rate of fluconazole to C. albicans was 59.54%. ERG11 gene was found in 9.79% of 92 C. albicans strains resistant to azoles. Conclusions This detection of mutated ERG11 gene in C. albicans is the first in Burkina Faso and may be a cause of azole resistance in recurrent Candida vulvovaginitis. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07619-5.
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Affiliation(s)
- Essi Etonam Dovo
- Molecular Biology and Genetics Laboratory (LABIOGENE), University of Joseph Ki ZERBO, BP 7021, Ouagadougou 03, Burkina Faso
| | - Théodora Mahoukèdè Zohoncon
- Molecular Biology and Genetics Laboratory (LABIOGENE), University of Joseph Ki ZERBO, BP 7021, Ouagadougou 03, Burkina Faso.
| | - Sessi Frida Tovo
- Molecular Biology and Genetics Laboratory (LABIOGENE), University of Joseph Ki ZERBO, BP 7021, Ouagadougou 03, Burkina Faso
| | | | | | - Albert Théophane Yonli
- Biomolecular Research Center Pietro Annigoni (CERBA), 01 BP 364, Ouagadougou 01, Burkina Faso
| | - Rogomenona Alice Ouedraogo
- Molecular Biology and Genetics Laboratory (LABIOGENE), University of Joseph Ki ZERBO, BP 7021, Ouagadougou 03, Burkina Faso
| | | | - Florencia Wendkuuni Djigma
- Molecular Biology and Genetics Laboratory (LABIOGENE), University of Joseph Ki ZERBO, BP 7021, Ouagadougou 03, Burkina Faso
| | - Christelle Wendyam Nadembega
- Molecular Biology and Genetics Laboratory (LABIOGENE), University of Joseph Ki ZERBO, BP 7021, Ouagadougou 03, Burkina Faso
| | - Marius Belemgnegre
- Saint Camille Hospital of Ouagadougou (HOSCO), 01 BP 444, Ouagadougou 01, Burkina Faso
| | - Paul Ouedraogo
- Saint Camille Hospital of Ouagadougou (HOSCO), 01 BP 444, Ouagadougou 01, Burkina Faso
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
| | - Jacques Simpore
- Molecular Biology and Genetics Laboratory (LABIOGENE), University of Joseph Ki ZERBO, BP 7021, Ouagadougou 03, Burkina Faso
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16
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Viegas C, Pena P, Dias M, Gomes B, Cervantes R, Carolino E, Twarużek M, Soszczyńska E, Kosicki R, Caetano LA, Viegas S. Microbial contamination in waste collection: Unveiling this Portuguese occupational exposure scenario. J Environ Manage 2022; 314:115086. [PMID: 35483278 DOI: 10.1016/j.buildenv.2022.108862] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 05/22/2023]
Abstract
Previous studies anticipated that microorganisms and their metabolites in waste will increase as a consequence of a decreased collection frequency and due to differences in what kind of waste is bagged before collection leading to an increased exposure of workers handling the waste. This study aim was to investigate the microbial contamination present in the waste collection trucks (WCT) and in the support facilities (waste collection station - WCS). It was applied a multi-approach protocol using active (air sampling by impingement and impaction) and passive (surface swabs, electrostatic dust cloths and settled dust) sampling methods. The screening of azole-resistance, the investigation of mycotoxins and the assessment of the elicited biological responses in vitro were also carried out aiming recognizing the possible health effects of waste collection drivers. SARS-CoV-2 detection was also performed. In WCS only air samples had contamination in all the four sampling sites (canteen, operational removal core, operational removal center, and administrative service). Among all the analyzed matrices from the WCT a higher percentage of total bacterial counts and Gram-was detected in swabs (66.93%; 99.36%). In WCS the most common species were Penicillium sp. (43.98%) and Cladosporium sp. (24.68%), while on WCT Aspergillus sp. (4.18%) was also one of the most found. In the azole resistance screening Aspergillus genera was not observed in the azole-supplemented media. SARS-CoV-2 was not detected in any of the environmental samples collected, but Aspergillus section Fumigati was detected in 5 samples. Mycotoxins were not detected in EDC from WCS, while in WCT they were detected in filters (N = 1) and in settled dust samples (N = 16). In conclusion, our study reveals that a comprehensive sampling approach using active and passive sampling (e.g. settled dust sampling for a representative mycotoxin evaluation) and combined analytic methods (i.e., culture-based and molecular) is an important asset in microbial exposure assessments. Concerning the waste collection exposure scenario, the results of this study unveiled a complex exposure, particularly to fungi and their metabolites. Aspergillus section Fumigati highlight the significance of targeting this section in the waste management industry as an indicator of occupational health risk.
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Affiliation(s)
- Carla Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal.
| | - Pedro Pena
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Marta Dias
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
| | - Bianca Gomes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Renata Cervantes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Elisabete Carolino
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Magdalena Twarużek
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Ewelina Soszczyńska
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Robert Kosicki
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Liliana Aranha Caetano
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Susana Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
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Viegas C, Pena P, Dias M, Gomes B, Cervantes R, Carolino E, Twarużek M, Soszczyńska E, Kosicki R, Caetano LA, Viegas S. Microbial contamination in waste collection: Unveiling this Portuguese occupational exposure scenario. J Environ Manage 2022; 314:115086. [PMID: 35483278 DOI: 10.1016/j.jenvman.2022.115086] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 05/22/2023]
Abstract
Previous studies anticipated that microorganisms and their metabolites in waste will increase as a consequence of a decreased collection frequency and due to differences in what kind of waste is bagged before collection leading to an increased exposure of workers handling the waste. This study aim was to investigate the microbial contamination present in the waste collection trucks (WCT) and in the support facilities (waste collection station - WCS). It was applied a multi-approach protocol using active (air sampling by impingement and impaction) and passive (surface swabs, electrostatic dust cloths and settled dust) sampling methods. The screening of azole-resistance, the investigation of mycotoxins and the assessment of the elicited biological responses in vitro were also carried out aiming recognizing the possible health effects of waste collection drivers. SARS-CoV-2 detection was also performed. In WCS only air samples had contamination in all the four sampling sites (canteen, operational removal core, operational removal center, and administrative service). Among all the analyzed matrices from the WCT a higher percentage of total bacterial counts and Gram-was detected in swabs (66.93%; 99.36%). In WCS the most common species were Penicillium sp. (43.98%) and Cladosporium sp. (24.68%), while on WCT Aspergillus sp. (4.18%) was also one of the most found. In the azole resistance screening Aspergillus genera was not observed in the azole-supplemented media. SARS-CoV-2 was not detected in any of the environmental samples collected, but Aspergillus section Fumigati was detected in 5 samples. Mycotoxins were not detected in EDC from WCS, while in WCT they were detected in filters (N = 1) and in settled dust samples (N = 16). In conclusion, our study reveals that a comprehensive sampling approach using active and passive sampling (e.g. settled dust sampling for a representative mycotoxin evaluation) and combined analytic methods (i.e., culture-based and molecular) is an important asset in microbial exposure assessments. Concerning the waste collection exposure scenario, the results of this study unveiled a complex exposure, particularly to fungi and their metabolites. Aspergillus section Fumigati highlight the significance of targeting this section in the waste management industry as an indicator of occupational health risk.
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Affiliation(s)
- Carla Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal.
| | - Pedro Pena
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Marta Dias
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
| | - Bianca Gomes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Renata Cervantes
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Elisabete Carolino
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Magdalena Twarużek
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Ewelina Soszczyńska
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Robert Kosicki
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Liliana Aranha Caetano
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Susana Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
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18
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Mello TP, Oliveira SSC, Branquinha MH, Santos ALS. Decoding the antifungal resistance mechanisms in biofilms of emerging, ubiquitous and multidrug-resistant species belonging to the Scedosporium/Lomentospora genera. Med Mycol 2022; 60:6596289. [PMID: 35641191 DOI: 10.1093/mmy/myac036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
The opportunistic filamentous fungi belonging to the Scedosporium and Lomentospora genera are highly tolerant to all classes of available antifungal drugs. Moreover, the mature biofilm formed by these fungi presents higher antifungal resistance when compared to planktonic cells. Nevertheless, the resistance mechanisms developed by the biofilm lifestyle are not completely elucidated. In the current study, we have investigated the mainly known resistance mechanisms to azoles (voriconazole and fluconazole) and polyenes (amphotericin B - AMB) in S. apiospermum, S. minutisporum, S. aurantiacum, and L. prolificans (formerly S. prolificans) biofilms. Both classes of antifungals can physically bind to the extracellular matrix of mature biofilms, preventing the drugs from reaching their targets on biofilm-forming cells, which precludes their activity and toxicity. In addition, the activity of efflux pumps, measured by Rhodamine 6 G, was increased along the maturation of the biofilm. The efflux pump's inhibition by L-Phe-L-Arg-β-naphthylamide culminated in a 2- to 16-fold increase in azole susceptibility in conidial cells, but not in mature biofilms. Finally, we demonstrated by using specific inhibitors that in conidia, but not in biofilms, AMB induced the production of reactive oxygen species through the activity of the oxidative phosphorylation system (complex I to IV and alternative oxidases). However, the cellular redox imbalance caused by AMB was well coped with the high activity of antioxidative enzymes, such as superoxide dismutase and catalase. Altogether, our results revealed that Scedosporium/Lomentospora biofilm resistance occurs through various mechanisms that operate concomitantly, which could explain the huge challenge in the clinical treatment of scedosporiosis/lomentosporiosis.
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Affiliation(s)
- Thaís P Mello
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Simone S C Oliveira
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marta H Branquinha
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Rede Micologia RJ - Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)
| | - André L S Santos
- Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes (IMPG), Centro de Ciências da Saúde (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Rede Micologia RJ - Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ).,Programa de Pós-Graduação em Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
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Escribano P, Gómez A, Reigadas E, Muñoz P, Guinea J; ASPEIN Study Group. In vitro activity of olorofim against Aspergillus fumigatus sensu lato clinical isolates: activity is retained against isolates showing resistance to azoles and/or amphotericin B. Clin Microbiol Infect 2022:S1198-743X(22)00269-5. [PMID: 35597509 DOI: 10.1016/j.cmi.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES New antifungal drugs, such as olorofim, may overcome the problem of resistance in Aspergillus fumigatus. We here report the activity of olorofim against a set of A. fumigatus sensu lato recently collected in Spain. METHODS A total of 332 A. fumigatus sensu lato clinical isolates collected in a multicentre study conducted in Spain in 2019 and comprising susceptible and resistant isolates to azoles and/or amphotericin B were tested. Isolates distributed among the following species: A. fumigatus sensu stricto (n = 312), Aspergillus lentulus (n = 6), Aspergillus fumigatiaffinis (n = 5), Neosartorya tsurutae (n = 3), Neosartorya udagawae (n = 3), Aspergillus novofumigatus (n = 2), and Aspergillus thermomutatus (n = 1). Azole resistance was found in 44 A. fumigatus sensu stricto isolates that harboured the following cyp51A gene substitutions: TR34-L98H (n = 24), G54 (n = 5), TR46/Y121F/T289A (n = 1), other mutations (n = 4), and gene wild type (n = 10). Isolates were tested for antifungal susceptibility to olorofim using European Committee on Antimicrobial Susceptibility Testing (EUCAST) E.Def. 9.4 methodology. RESULTS Olorofim minimum inhibitory concentrations against A. fumigatus sensu stricto isolates ranged from 0.008 to 0.125 mg/L and in vitro activity of the drug was not impacted by the presence of azole/amphotericin B resistance. Azole resistance and amphotericin B resistance was found in 18 and 13 cryptic species isolates, respectively. Olorofim showed high in vitro activity against cryptic species isolates and minimum inhibitory concentrations ranged from 0.004 to 0.016 mg/L, regardless of the presence of resistance to other drugs. DISCUSSION Olorofim showed in vitro activity against both A. fumigatus sensu stricto and cryptic species clinical isolates and was active against isolates showing resistance to azoles and/or amphotericin B.
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Zhou D, Wang R, Li X, Peng B, Yang G, Zhang KQ, Zhang Y, Xu J. Genetic Diversity and Azole Resistance Among Natural Aspergillus fumigatus Populations in Yunnan, China. Microb Ecol 2022; 83:869-885. [PMID: 34279697 DOI: 10.1007/s00248-021-01804-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
The emergence and spread of azole resistance alleles in clinical and environmental isolates of Aspergillus fumigatus is a global human health concern and endangers the "One Health" approach in our fight against antifungal resistance (AFR) in this pathogen. A major challenge to combat AFR in A. fumigatus is the massive aerial dispersal ability of its asexual spores. Our recent fine-scale survey of greenhouse populations of A. fumigatus near Kunming, Yunnan, China, suggested that the use of azole fungicides for plant protection was likely a major driver of the high-frequency azole-resistant A. fumigatus (ARAF) in greenhouses. Here, we investigated the potential spread of those ARAF and the structure of geographic populations of A. fumigatus by analyzing 452 isolates from 19 geographic locations across Yunnan. We found lower frequencies of ARAF in these outdoor populations than those in greenhouses near Kunming, but there were abundant new alleles and new genotypes, including those associated with azole resistance, consistent with multiple independent origins of ARAF across Yunnan. Interestingly, among the four ecological niches, the sediments of a large lake near Kunming were found to have the highest frequency of ARAF (~ 43%). While most genetic variations were observed within the 19 local populations, statistically significant genetic differentiations were found between many subpopulations within Yunnan. Furthermore, similar to greenhouse populations, these outdoor populations of A. fumigatus in Yunnan were significantly different from those in other parts of the world. Our results call for increased attention to local and regional studies of this fungal pathogen to help develop targeted control strategies against ARAF.
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Affiliation(s)
- Duanyong Zhou
- State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, and Key Laboratory for Southwest Microbial Diversity of the Ministry of Education, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
- College of Life Science, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
- School of Biology and Chemistry, Xingyi Normal University for Nationalities, Xingyi, 562400, Guizhou, People's Republic of China
| | - Ruirui Wang
- State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, and Key Laboratory for Southwest Microbial Diversity of the Ministry of Education, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
- College of Life Science, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
| | - Xiao Li
- State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, and Key Laboratory for Southwest Microbial Diversity of the Ministry of Education, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
- College of Life Science, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
| | - Bin Peng
- College of Life Science, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
| | - Guangzhu Yang
- State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, and Key Laboratory for Southwest Microbial Diversity of the Ministry of Education, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
- College of Life Science, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
| | - Ke-Qin Zhang
- State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, and Key Laboratory for Southwest Microbial Diversity of the Ministry of Education, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China
| | - Ying Zhang
- State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, and Key Laboratory for Southwest Microbial Diversity of the Ministry of Education, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China.
| | - Jianping Xu
- State Key Laboratory for Conservation and Utilization of Bio-Resources in Yunnan, and Key Laboratory for Southwest Microbial Diversity of the Ministry of Education, Yunnan University, Kunming, 650032, Yunnan, People's Republic of China.
- Department of Biology, McMaster University, Hamilton, Ontario, L8S 4K1, Canada.
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Khalife S, Resendiz-Sharpe A, Lagrou K, Fréalle E. Molecular identification and azole susceptibility testing of Aspergillus section Fumigati isolated from soil samples in Lebanon. J Mycol Med 2021; 32:101242. [PMID: 35030518 DOI: 10.1016/j.mycmed.2021.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/27/2021] [Accepted: 12/24/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Sara Khalife
- Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Tripoli, Lebanon.
| | - Agustin Resendiz-Sharpe
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine and National Reference Center for Mycosis, Excellence Center for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium
| | - Emilie Fréalle
- Center for Infection and Immunity of Lille, University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL, Lille F-59000, France; CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille F-59000, France
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22
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Chen WC, Chen PY, Yang SC, Yen TY, Lu CY, Chen JM, Lee PI, Chang LY, Chen YC, Huang LM. Comparisons of the clinical and mycological characteristics of pediatric candidemia. J Formos Med Assoc 2021; 121:1668-1679. [PMID: 34876342 DOI: 10.1016/j.jfma.2021.11.009] [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: 06/07/2021] [Revised: 09/17/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/PURPOSE Invasive candidiasis is a severe infectious disease that could lead to mortality in critically ill children. METHODS We collected data regarding demographics, underlying diseases, predisposing factors, outcomes for pediatric patients with candidemia at a medical centre in Taiwan from 2011 to 2017. RESULTS Fifty-eight patients with 60 candidemia episodes were diagnosed. The 3 most common species were Candida albicans (42%), Candida parapsilosis (25%) and Candida tropicalis (23%). C. parapsilosis predominantly infected infants and neonates (median age: 0.8 years, range: 0.1-14.5). Cases with C. tropicalis had significantly higher rates of multidrug resistance (p = 0.011) and disseminated candidiasis (p = 0.025) compared with other cases. The all-cause mortality rate was 43%, and the candidemia-related mortality rate was 29%. Pediatric sequential organ failure assessment score >8 [adjusted odds ratio (aOR) 66.2, 95% CI 4.03-1088.5] and posaconazole resistance (aOR 33.57, 95% CI 1.61-700.3) were the most significant risk factors associated with candidemia-related mortality, whereas treatment with effective antifungal agents within 48 h (aOR 0.07, 95% CI 0.01-0.9) was the only significant protective factor. CONCLUSIONS Candidemia-related mortality was related to azole resistance; therefore, empirical therapy with echinocandin or amphotericin B is recommended pending species and susceptibility results.
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Affiliation(s)
- Wan-Chen Chen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, Changhua Christian Children's Hospital, Changhua City, Taiwan
| | - Pao-Yu Chen
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shun-Chen Yang
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua City, Taiwan
| | - Ting-Yu Yen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jong-Min Chen
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Ying Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yee-Chun Chen
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Khalifa HO, Watanabe A, Kamei K. Azole and echinocandin resistance mechanisms and genotyping of Candida tropicalis in Japan: cross-boundary dissemination and animal-human transmission of C. tropicalis infection. Clin Microbiol Infect 2021; 28:302.e5-302.e8. [PMID: 34687855 DOI: 10.1016/j.cmi.2021.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/24/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To assess the prevalence and genetic basis of antifungal resistance mechanisms as well as the genotyping of Candida tropicalis from clinical and non-clinical sources in Japan. METHODS Eighty C. tropicalis isolates, including 32 clinical isolates recovered from 29 patients and 48 non-clinical isolates recovered from 24 different sources (animals and the environment) were evaluated. All isolates were tested phenotypically for resistance to a wide range of antifungals and genotypically for resistance mechanisms to azole and echinocandin. Furthermore, all the isolates were genotyped by multilocus sequence typing (MLST). RESULTS Phenotypically, 30.2% (16/53) of the isolates were azole-resistant, with high levels of azole resistance among clinical isolates (51.7%; 15/29) and low levels (4.2%; 1/24) among non-clinical isolates. None of the isolates were reported as echinocandin resistant, with 60.4% (32/53) of the isolates intermediate to caspofungin. Azole resistance was basically attributed to high expression levels of drug efflux transporter genes (CDR2 and CDR3), transcription factors (TAC1 and UPC2) and ergosterol biosynthesis pathway HMG gene. No FKS1 hot spot 1 (HS1) or HS2 missense mutations were detected in any of the isolates. MLST analysis revealed 36 different sequence types (STs), with the first identification of 23 new STs. Phylogenetic analysis confirmed the close relationship between the clinical and non-clinical isolates, with identifications of ST232 and ST933 among patients and marine mammals. CONCLUSION Our results confirmed the emergence of azole resistance in C. tropicalis in Japan. Furthermore, phylogenetic analysis confirmed the transboundary dissemination and cross-transmission of C. tropicalis between humans and animals.
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Affiliation(s)
- Hazim O Khalifa
- Division of Clinical Research, Medical Mycology Research Centre, Chiba University, Chiba, Japan; Department of Pharmacology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Akira Watanabe
- Division of Clinical Research, Medical Mycology Research Centre, Chiba University, Chiba, Japan.
| | - Katsuhiko Kamei
- Division of Clinical Research, Medical Mycology Research Centre, Chiba University, Chiba, Japan
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Simon L, Déméautis T, Dupont D, Kramer R, Garnier H, Durieu I, Sénéchal A, Reix P, Couraud S, Devouassoux G, Lina B, Rabodonirina M, Wallon M, Dannaoui E, Persat F, Menotti J. Azole resistance in Aspergillus fumigatus isolates from respiratory specimens in Lyon University Hospitals, France: prevalence and mechanisms involved. Int J Antimicrob Agents 2021; 58:106447. [PMID: 34619334 DOI: 10.1016/j.ijantimicag.2021.106447] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/05/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022]
Abstract
Resistance of Aspergillus fumigatus to triazoles has been reported increasingly in Europe. As few data are available from Southern France, the objectives of this study were to assess the burden of A. fumigatus isolates with azole resistance from clinical specimens in Lyon, and explore the resistance mechanisms involved. In this retrospective cross-sectional study, 221 consecutive A. fumigatus isolates from respiratory samples were identified from an 8-month period from 195 patients attending the Pulmonary Medicine Departments of Lyon University Hospitals. Morphological identification was confirmed by sequence analysis of the β-tubulin gene. All samples were tested for susceptibilities to itraconazole, voriconazole, posaconazole and isavuconazole using concentration gradient strips, and the results were confirmed using the EUCAST broth microdilution method. Resistance mechanisms were investigated by sequencing the cyp51A gene and its promoter, and by expression analysis of cyp51 and genes encoding several efflux transporters. Four isolates exhibited azole resistance. Three isolates presented with polymorphisms in an intronic region of cyp51A, and one isolate had F46Y, M172V and E427K polymorphisms. No mutations were identified in the cyp51A promoter, but significant induction of cyp51A and cyp51B gene expression was observed for all four and three isolates, respectively. Significant induction of atrF and cdr1B gene expression was observed for two and three isolates, respectively. No significant induction of MDR1/2/3/4, MFS56 and M85 gene expression was observed. To conclude, the observed prevalence of azole resistance was 2.1%. Significant induction of expression of the cyp51 genes and two genes encoding efflux transporters was evidenced, underlying the diversity of resistance mechanisms to be explored.
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Affiliation(s)
- Loïc Simon
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Centre Hospitalier Universitaire de Nice, Service de Parasitologie-Mycologie, Université Côte d'Azur, Nice, France
| | - Tanguy Déméautis
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France
| | - Damien Dupont
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Inserm U1028, CNRS UMR5292, équipe WAKING, Lyon, France
| | - Rolf Kramer
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; European Public Health Microbiology Training Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Héloïse Garnier
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France
| | - Isabelle Durieu
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Médecine Interne et Vasculaire, Centre de Ressources et de Compétences de la Mucoviscidose Adultes, Pierre-Bénite, France
| | - Agathe Sénéchal
- Hospices Civils de Lyon, Hôpital Louis Pradel, Département de Pneumologie et de Transplantation Pulmonaire, Hospices Civils de Lyon, Bron, France
| | - Philippe Reix
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressources et de Compétences de la Mucoviscidose Enfants, Bron, France
| | - Sébastien Couraud
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Pneumologie Aiguë Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Gilles Devouassoux
- Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France; Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Pneumologie, Lyon, France
| | - Bruno Lina
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Virologie, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France
| | - Meja Rabodonirina
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France
| | - Martine Wallon
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Inserm U1028, CNRS UMR5292, équipe WAKING, Lyon, France
| | - Eric Dannaoui
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Microbiologie, Unité de Parasitologie-Mycologie, Paris, France; Université Paris-Est Créteil, Équipe Dynamyc, EA 7380, Créteil, France
| | - Florence Persat
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France
| | - Jean Menotti
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France.
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Sasani E, Yadegari MH, Khodavaisy S, Rezaie S, Salehi M, Getso MI. Virulence Factors and Azole-Resistant Mechanism of Candida Tropicalis Isolated from Candidemia. Mycopathologia 2021; 186:847-856. [PMID: 34410566 DOI: 10.1007/s11046-021-00580-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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/14/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Limited knowledge exists on the virulence factors of Candida tropicalis and the mechanisms of azole resistance that lead to an intensified pathogenicity and treatment failure. We aimed to evaluate the virulence factors and molecular mechanisms of azole resistance among C. tropicalis isolated from patients with candidemia. MATERIALS AND METHODS Several virulence factors, including extracellular enzymatic activities, cell surface hydrophobicity (CSH), and biofilm formation, were evaluated. Antifungal susceptibility pattern and expression level of ERG11, UPC2, MDR1, and CDR1 genes of eight (4 fluconazole resistance and 4 fluconazole susceptible) clinical C. tropicalis isolates were assessed. The correlation between the virulence factors and antifungal susceptibility patterns was analyzed. RESULTS During a 4 year study, forty-five C. tropicalis isolates were recovered from candidemia patients. The isolates expressed different frequencies of virulence determinants as follows: coagulase 4 (8.9%), phospholipase 5 (11.1%), proteinase 31 (68.9%), esterase 43 (95.6%), hemolysin 44 (97.8%), biofilm formation 45 (100%) and CSH 45(100%). All the isolates were susceptible to amphotericin B and showed the highest resistance to voriconazole. There was a significant positive correlation between micafungin minimum inhibitory concentrations (MICs) and hemolysin production (rs = 0.316). However, we found a negative correlation between fluconazole MICs and esterase production (rs = -0.383). We observed the high expression of ERG11 and UPC2 genes in fluconazole-resistant C. tropicalis isolates. CONCLUSION C. tropicalis isolated from candidemia patients extensively displayed capacities for biofilm formation, hemolysis, esterase activity, and hydrophobicity. In addition, the overexpression of ERG11 and UPC2 genes was considered one of the possible mechanisms of azole resistance.
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Affiliation(s)
- Elahe Sasani
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Hossein Yadegari
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sassan Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University, Kano, Nigeria
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Umamaheshwari S, Neelambike SM, Shankarnarayan SA, Kumarswamy KS, Gopal S, Prakash H, Rudramurthy SM. Clinical profile, antifungal susceptibility, and molecular characterization of Candida auris isolated from patients in a South Indian surgical ICU. J Mycol Med 2021; 31:101176. [PMID: 34340186 DOI: 10.1016/j.mycmed.2021.101176] [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: 04/16/2021] [Revised: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Candida auris is an emerging multidrug resistant yeast which causes blood stream infection especially among critically ill patients. This yeast can also colonize patients and are isolated from hospital environment causing outbreaks in hospital settings. OBJECTIVE To describe possible outbreak of C. auris infection in surgical ICU and characterize the isolates by molecular typing and azole resistance mechanism. METHODS After isolation of Candida auris from cluster of patients from surgical ICU, environment survey was done to identify the source in the hospital. The identity of the isolates was confirmed by Matrix Assisted Laser Desorption Ionisation Time of Flight mass spectroscopy and sequencing 26S and ITS region of rDNA. Molecular typing was done by fluorescent amplified fragment length polymorphism technique. Antifungal susceptibility testing was performed by CLSI broth dilution technique. ERG11 gene was sequenced to screen for mutations responsible for azole resistance. RESULTS AND CONCLUSION A total of eight C. auris was isolated during the four months (December 2018-March 2019) suggesting possible of outbreak in surgical ICU of tertiary care center in South India. C. auris (n = 8) was isolated from urine (n = 4), blood (n = 3) and ear discharge (n = 1) samples. Based on 26S sequence analysis all our isolates belonged to South Asian clade. All the isolates had minimum inhibitory concentration (MIC) of ≥16 µg/ml to fluconazole. ERG11 sequence exhibited amino acid substitution Y132F in all the isolates. The two environmental isolates clustered closely with an isolate from urine sample. Adherence to strict infection control practices prevented further spread of infection.
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Affiliation(s)
- Shivaswamy Umamaheshwari
- Department of Microbiology, Faculty of Life Sciences, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India.
| | - Sumana Mahadevaiah Neelambike
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | | | - Keerthi Sravanur Kumarswamy
- Department of Microbiology, Faculty of Life Sciences, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Shubha Gopal
- Department of Studies in Microbiology, University of Mysore, Mysuru, Karnataka, India
| | - Hariprasath Prakash
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 1600012
| | - Shivaprakash Mandya Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 1600012.
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Zvezdanova ME, Arroyo MJ, Méndez G, Candela A, Mancera L, Rodríguez JG, Serra JL, Jiménez R, Lozano I, Castro C, López C, Muñoz P, Guinea J, Escribano P, Rodríguez-Sánchez B; ASPEIN group. Detection of azole resistance in Aspergillus fumigatus complex isolates using MALDI-TOF mass spectrometry. Clin Microbiol Infect 2021:S1198-743X(21)00322-0. [PMID: 34147673 DOI: 10.1016/j.cmi.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The main goal of this study was to accurately detect azole resistance in species of the Aspergillus fumigatus complex by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). METHODS Identification of isolates (n = 868) was done with MALDI-TOF MS using both commercial and in-house libraries. To determine azole susceptibility, the EUCAST E.Def. 9.3.2 method was applied as the reference standard. Identification of resistant isolates was confirmed by DNA sequence analysis. Protein spectra obtained by MALDI-TOF MS were analysed to differentiate species within the A. fumigatus complex and to detect azole-resistant A. fumigatus sensu stricto isolates. RESULTS Correct discrimination of A. fumigatus sensu stricto from cryptic species was accomplished in 100% of the cases applying principal component analysis (PCA) to protein spectra generated by MALDI-TOF MS. Furthermore, a specific peak (4586 m/z) was found to be present only in cryptic species. The application of partial least squares (PLS) discriminant analysis allowed 98.43% (±0.038) discrimination between susceptible and azole-resistant A. fumigatus sensu stricto isolates. Finally, based on PLS and SVM, A. fumigatus sensu stricto isolates with different cyp51A gene mutations were correctly clustered in 91.5% of the cases. CONCLUSIONS MALDI-TOF MS combined with peak analysis is a novel tool that allows the differentiation of A. fumigatus sensu stricto from other species within the A. fumigatus complex, as well as the detection of azole-resistant A. fumigatus sensu stricto. Although further studies are still needed, the results reported here show the great potential of MALDI-TOF and machine learning for the rapid detection of azole-resistant Aspergillus fumigatus isolates from clinical origins.
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Sasani E, Khodavaisy S, Rezaie S, Salehi M, Yadegari MH. The relationship between biofilm formation and mortality in patients with Candida tropicalis candidemia. Microb Pathog 2021; 155:104889. [PMID: 33878395 DOI: 10.1016/j.micpath.2021.104889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/01/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Biofilm formation by Candida species is an influential virulence factor in candidemia pathogenesis. We investigated the relationship between biofilm formation of Candida tropicalis isolates with the clinical characteristics and mortality outcomes in patients with candidemia. MATERIALS AND METHODS Thirty-nine C. tropicalis isolates were recovered from patients with candidemia admitted to two university hospitals in Tehran, Iran. Biofilm mass and metabolic activity of C. tropicalis biofilms were assessed in vitro with two colorimetric methods. The sessile minimum inhibitory concentrations (SMICs) were evaluated in vitro by treating preformed biofilms with diluted concentrations of azoles according to CLSI-M27 A3/S4 protocol, followed by metabolic activity quantification. The expressions of ERG11, UPC2, MDR1, and CDR1 genes were also evaluated. RESULTS All C. tropicalis isolates produced biofilm. Respectively, higher <7-day and ≥7-day mortality rates were found among cases with high metabolic activity (46.7% vs. 13%, P = 0.03) and high biofilm mass (31.8% vs. 0, P = 0.029). Sessile cells had high resistance to fluconazole, voriconazole, and itraconazole. The azole minimum inhibitory concentrations (MICs) of C. tropicalis sessile were significantly greater than the planktonic minimum inhibitory concentrations (PMICs). In fluconazole-treated biofilms, the expression of ERG11 and UPC2 genes was increased. CONCLUSION Our findings highlight the importance of C. tropicalis biofilm formation as an important factor in candidemia pathogenesis and the clinical outcome of patients with candidemia.
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Affiliation(s)
- Elahe Sasani
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sassan Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Yadegari
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Assress HA, Selvarajan R, Nyoni H, Ogola HJO, Mamba BB, Msagati TAM. Azole antifungal resistance in fungal isolates from wastewater treatment plant effluents. Environ Sci Pollut Res Int 2021; 28:3217-3229. [PMID: 32914303 DOI: 10.1007/s11356-020-10688-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/30/2020] [Indexed: 06/11/2023]
Abstract
Wastewater treatment plants (WWTPs) can be significant sources of antifungal resistant fungi, which can disseminate further in the environment by getting into rivers together with effluents discharged from WWTPs and pose a risk for human health. In this study, the presence of azole resistance was determined in fungal isolates from treated effluents of two WWTPs using the standard microdilution method from Clinical and Laboratory Standards Institute (CLSI). A total of 41 fungal isolates representing 23 fungal species and 16 fungal genera were obtained. Fungal genera related to the known human and/or plant pathogens such as Aspergillus, Fusarium, and Candida were detected. Among the observed species, the susceptibility of Aspergillus fumigatus and Fusarium oxysporum was tested against fluconazole (FCZ), ketoconazole (KTZ), itraconazole (ITZ), and voriconazole (VCZ). The isolate A. fumigatus was susceptible to KTZ, ITZ, and VCZ, while it showed resistance against FCZ. On the contrast, the isolate F. oxysporum showed resistance to KTZ, ITZ, and VCZ. Comparatively, VCZ showed highest activity against both A. fumigatus and F. oxysporum. Analysis of the gene Cyp51A for the A. fumigatus isolate showed no evidence of drug resistance that could be related to point mutations and/or tandem repeats in the gene. To the best of our knowledge, this is the first susceptibility test study on A. fumigatus and F. oxysporum isolates from the WWTPs of South Africa. In conclusion, this study indicated an urgent need for thorough investigation with larger group of fungal isolates from different regions of South Africa to broadly understand the role of WWTPs in the dissemination of azole antifungal drug resistance.
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Affiliation(s)
- Hailemariam Abrha Assress
- College of Science Engineering and Technology, Nanotechnology and Water Sustainability Research Unit, UNISA Science Campus, University of South Africa, P.O. Box 392, UNISA 0003, Florida-Park, Roodepoort, Johannesburg, 1709, South Africa
| | - Ramganesh Selvarajan
- College of Agriculture and Environmental Sciences, UNISA Science Campus, University of South Africa, P.O. Box 392, UNISA 0003, Florida, Johannesburg, 1709, South Africa
| | - Hlengilizwe Nyoni
- College of Science Engineering and Technology, Nanotechnology and Water Sustainability Research Unit, UNISA Science Campus, University of South Africa, P.O. Box 392, UNISA 0003, Florida-Park, Roodepoort, Johannesburg, 1709, South Africa
| | - Henry Joseph Oduor Ogola
- College of Agriculture and Environmental Sciences, UNISA Science Campus, University of South Africa, P.O. Box 392, UNISA 0003, Florida, Johannesburg, 1709, South Africa
| | - Bhekie B Mamba
- College of Science Engineering and Technology, Nanotechnology and Water Sustainability Research Unit, UNISA Science Campus, University of South Africa, P.O. Box 392, UNISA 0003, Florida-Park, Roodepoort, Johannesburg, 1709, South Africa
- State Key Laboratory of Separation Membranes and Membrane Process/National Center for International Joint Research on Membrane Science and Technology, Tianjin, 300387, People's Republic of China
| | - Titus A M Msagati
- College of Science Engineering and Technology, Nanotechnology and Water Sustainability Research Unit, UNISA Science Campus, University of South Africa, P.O. Box 392, UNISA 0003, Florida-Park, Roodepoort, Johannesburg, 1709, South Africa.
- School of Life Sciences and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, P O Box 447, Tengeru, Arusha, United Republic of Tanzania.
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Nakano Y, Tashiro M, Urano R, Kikuchi M, Ito N, Moriya E, Shirahige T, Mishima M, Takazono T, Miyazaki T, Izumikawa K. Characteristics of azole-resistant Aspergillus fumigatus attached to agricultural products imported to Japan. J Infect Chemother 2020; 26:1021-1025. [PMID: 32576436 DOI: 10.1016/j.jiac.2020.05.008] [Citation(s) in RCA: 12] [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: 03/03/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
Due to the increase in the number of azole-resistant Aspergillus fumigatus, there is an urgent need of data to predict future trends and prevent further spreading. The intercountry transfer of resistant A. fumigatus on plant bulbs have been reported. We investigated existence and characteristics of resistant isolates attached to agricultural products imported to Japan. We purchased 292 samples in Japan. All samples were screened for the existence of azole-resistant A. fumigatus. For positive isolates, minimum inhibitory concentrations of the drugs were determined. We also analyzed Cyp51A, Hmg1, and Erg6 mutations of these isolates and conducted microsatellite genotyping. Fourteen azole-resistant isolates were detected, of which 13 were cultured from flower bulbs imported from the Netherlands. Among them 5 were from 11 bulbs of Hippeastrum (45.5%), 5 were from 24 bulbs of Gladiolus (20.8%), 2 were from 4 bulbs of Ixia (50.0%), and 1 was from 22 bulbs of Tulipa (4.5%). Only 1 resistant isolate was cultured from the 10 bulbs of Narcissus (10.0%) originating in Japan. Various novel mutations including Y121F/T289A in Cyp51A with no tandem repeat in promoter region were discovered from imported strains. Our study provides important data showing that agricultural imports provide a possible route for their intercontinental spread and raises the concern that strains harboring highly diverse Cyp51A mutations might increase in clinical settings in the future.
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Affiliation(s)
- Yuichiro Nakano
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Tashiro
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan.
| | - Ryo Urano
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Minori Kikuchi
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoki Ito
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Eriko Moriya
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoyuki Shirahige
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Maki Mishima
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan
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Bencova A, Goffa E, Morvova M, Valachovic M, Griač P, Toth Hervay N, Gbelska Y. The Absence of PDR16 Gene Restricts the Overexpression of CaSNQ2 Gene in the Presence of Fluconazole in Candida albicans. Mycopathologia 2020; 185:455-465. [PMID: 32451851 DOI: 10.1007/s11046-020-00459-4] [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: 01/20/2020] [Accepted: 05/18/2020] [Indexed: 01/02/2023]
Abstract
In yeast, the PDR16 gene encodes one of the PITP proteins involved in lipid metabolism and is regarded as a factor involved in clinical azole resistance of fungal pathogens. In this study, we prepared Candida albicans CaPDR16/pdr16Δ and Capdr16Δ/Δ heterozygous and homozygous mutant strains and assessed their responses to different stresses. The CaPDR16 deletion strains exhibited increased susceptibility to antifungal azoles and acetic acid. The addition of Tween80 restored the growth of Capdr16 mutants in the presence of azoles. However, the PDR16 gene deletion has not remarkable influence on sterol profile or membrane properties (membrane potential, anisotropy) of Capdr16Δ and Capdr16Δ/Δ mutant cells. Changes in halotolerance of C. albicans pdr16 deletion mutants were not observed. Fluconazole treatment leads to increased expression of ERG genes both in the wild-type and Capdr16Δ and Capdr16Δ/Δ mutant cells, and the amount of ergosterol and its precursors remain comparable in all three strains tested. Fluconazole treatment induced the expression of ATP-binding cassette transporter gene CaSNQ2 and MFS transporter gene CaTPO3 in the wild-type strain but not in the Capdr16Δ and Capdr16Δ/Δ mutants. The expression of CaSNQ2 gene markedly increased also in cells treated with hydrogen peroxide irrespective of the presence of CaPdr16p. CaPDR16 gene thus belongs to genes whose presence is required for full induction of CaSNQ2 and CaTPO3 genes in the presence of fluconazole in C. albicans.
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Affiliation(s)
- Alexandra Bencova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 842 15, Bratislava 4, Slovak Republic
| | - Eduard Goffa
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 842 15, Bratislava 4, Slovak Republic.,Department of Genetics, Cancer Research Institute, Biomedical Research Center, University Science Park for Biomedicine, Slovak Academy Sciences, Dúbravská cesta 9, 84505, Bratislava, Slovak Republic
| | - Marcela Morvova
- Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Mlynská dolina F1, 842 48, Bratislava, Slovak Republic
| | - Martin Valachovic
- Institute of Animal Biochemistry and Genetics CBS SAS, Dúbravská cesta 9, 840 05, Bratislava, Slovak Republic
| | - Peter Griač
- Institute of Animal Biochemistry and Genetics CBS SAS, Dúbravská cesta 9, 840 05, Bratislava, Slovak Republic
| | - Nora Toth Hervay
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 842 15, Bratislava 4, Slovak Republic
| | - Yvetta Gbelska
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovicova 6, 842 15, Bratislava 4, Slovak Republic.
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Singh A, Sharma B, Mahto KK, Meis JF, Chowdhary A. High-Frequency Direct Detection of Tri azole Resistance in Aspergillus fumigatus from Patients with Chronic Pulmonary Fungal Diseases in India. J Fungi (Basel) 2020; 6:E67. [PMID: 32443672 DOI: 10.3390/jof6020067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022] Open
Abstract
Aspergillosis due to azole-resistant Aspergillus fumigatus is a worldwide problem with major therapeutic implications. In patients with invasive aspergillosis, a low yield of fungal cultures results in underestimation of azole resistance. To detect azole resistance in A. fumigatus, we applied the AsperGenius® Resistance multiplex real-time polymerase chain reaction (PCR) assay to detect TR34/L98H, and TR46/T289A/Y121F mutations and the AsperGenius® G54/M220 RUO PCR assay to detect G54/M220 mutations directly in bronchoalveolar lavage (BAL) samples of 160 patients with chronic respiratory diseases in Delhi, India. Only 23% of samples were culture-positive compared to 83% positivity by A. fumigatus species PCR highlighting concerns about the low yield of cultures. Notably, 25% of BAL samples (33/160 patients) had azole resistance-associated mutation by direct detection using PCR assay. Detection of resistance-associated mutations was found mainly in 59% and 43% patients with chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA), respectively. Overall, a G54 mutation, conferring itraconazole resistance, was the predominant finding in 87.5% and 67% of patients with CPA and ABPA, respectively. In culture-negative, PCR-positive samples, we detected azole-resistant mutations in 34% of BAL samples. Azole resistance in chronic Aspergillus diseases remains undiagnosed, warranting standardization of respiratory culture and inclusion of rapid techniques to detect resistance markers directly in respiratory samples.
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Paul S, Singh S, Sharma D, Chakrabarti A, Rudramurthy SM, Ghosh AK. Dynamics of in vitro development of azole resistance in Candida tropicalis. J Glob Antimicrob Resist 2020; 22:553-61. [PMID: 32339847 DOI: 10.1016/j.jgar.2020.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Increasing incidence of azole resistance in Candida tropicalis, especially to fluconazole, has been seen in Asian countries including India. Limited knowledge is available on the molecular mechanisms associated with the development of azole resistance in C. tropicalis. The present study examined the dynamics of in vitro azole resistance in C. tropicalis after prolonged treatment with fluconazole. METHODS Nine fluconazole-susceptible isolates of C. tropicalis were used in this study. Fluconazole resistance was induced experimentally in C. tropicalis isolates. The stability of induced resistance and cross-resistance to other azoles was examined. The molecular mechanisms of azole resistance were assessed by measuring the expression and mutation analysis of different genes. RESULTS Varying degrees of resistance [five with minimum inhibitory concentrations (MICs) ≤32 mg/L and four with MICs ≥128 mg/L] were noticed, and the resistance was developed in 3 months. Of the nine resistant isolates, four induced resistant isolates with MICs ≥128 mg/L presented temporal resistance stability up to 10 subcultures. These four isolates presented cross-resistance to other azoles and also an inducible overexpression of transporters (CDR1, CDR2, CDR3 and MDR1), ergosterol biosynthesis pathway genes (ERG1, ERG2, ERG3 and ERG11), transcription factors (TAC1 and UPC2) and stress-responsive genes (HSP90 and MKC1) was noticed. No mutations were seen in any of the four genes (ERG1, ERG3, ERG11 and UPC2) tested. CONCLUSIONS Candida tropicalis isolates adapt themselves in the presence of continuous drug exposure and switch back to being susceptible in the absence of the drug. The acquisition of resistance in C. tropicalis is mediated by the overexpression of different resistance-related genes without any molecular alterations.
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Doğan Ö, Yeşilkaya A, Menekşe Ş, Güler Ö, Karakoç Ç, Çınar G, Kapmaz M, Aydın M, Keske Ş, Şahin S, Hacıseyitoğlu D, Yalçın D, Tekin S, Ataç N, Albayrak Ö, Aksu ED, Can F, Ergönül Ö. Effect of initial antifungal therapy on mortality among patients with bloodstream infections with different Candida species and resistance to antifungal agents: A multicentre observational study by the Turkish Fungal Infections Study Group. Int J Antimicrob Agents 2020; 56:105992. [PMID: 32335275 DOI: 10.1016/j.ijantimicag.2020.105992] [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: 01/21/2020] [Revised: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 01/05/2023]
Abstract
This study aimed to describe the effect of initial antifungal therapy on patient mortality and to detail the current distribution and resistance patterns of Candida spp. among patients with candidaemia. A prospective observational study was performed among consecutive patients with candidaemia from 10 Turkish medical centres between January 2015 and November 2018. The primary outcome was 10-day mortality. Species were identified using MALDI-TOF/MS. A total of 342 patients with candidaemia were included, of which 175 (51.2%) were male and 68 (19.9%) were aged <18 years. The most common species were Candida albicans (47.4%), Candida parapsilosis (26.6%), Candida tropicalis (9.6%) and Candida glabrata (7.6%). Among all Candida spp., the 10-day case fatality rate (CFR) was 32.2%. The CFR was highest in patients with C. albicans (57.3%) and lowest in patients with C. parapsilosis (21.8%). The resistance rate to fluconazole was 13% in C. parapsilosis, with no significant effect on mortality. No resistance to echinocandins was detected. In the multivariate analysis, being in the ICU [OR = 2.1 (95% CI 1.32-3.57); P = 0.002], renal failure [OR = 2.4 (1.41-3.97); P = 0.001], total parenteral nutrition [OR = 2 (1.22-3.47); P = 0.006], C. albicans infection [OR = 1.7 (1.06-2.82); P = 0.027] and echinocandin as primary agent [OR = 0.6 (0.36-0.99); P = 0.047] were significantly associated with mortality. Candidaemia is a deadly infection. Fluconazole resistance is emerging, although it was not significantly related to mortality. Using an echinocandin as the primary agent could be life-saving.
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Affiliation(s)
- Özlem Doğan
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey
| | - Ayşegül Yeşilkaya
- Department of Infectious Diseases and Clinical Microbiology, Başkent University, Ankara, Turkey
| | - Şirin Menekşe
- Department of Infectious Diseases and Clinical Microbiology, Koşuyolu State Hospital, Istanbul, Turkey
| | - Özlem Güler
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University, Kocaeli, Turkey
| | - Çağla Karakoç
- Department of Infectious Diseases and Clinical Microbiology, Liv Hospital, Istanbul, Turkey
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Ankara University, Istanbul, Turkey
| | - Mahir Kapmaz
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey
| | - Mehtap Aydın
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Istanbul, Turkey
| | - Şiran Keske
- Department of Infectious Diseases, American Hospital, Istanbul, Turkey
| | - Suzan Şahin
- Department of Infectious Diseases and Clinical Microbiology, Dr Lütfü Kırdar Research and Training Hospital, Istanbul, Turkey
| | - Demet Hacıseyitoğlu
- Department of Infectious Diseases and Clinical Microbiology, Dr Lütfü Kırdar Research and Training Hospital, Istanbul, Turkey
| | - Demet Yalçın
- Department of Infectious Diseases and Clinical Microbiology, Göztepe Medicalpark, Istanbul, Turkey
| | - Süda Tekin
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey
| | - Nazlı Ataç
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey
| | - Özgür Albayrak
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey
| | - Ekin Deniz Aksu
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey
| | - Füsun Can
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey
| | - Önder Ergönül
- Department of Infectious Diseases and Clinical Microbiology, Koç University, Istanbul, Turkey.
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Schauwvlieghe AFAD, Bredius RGM, Verdijk RM, Smiers FJW, van der Beek MT, Goemans BF, Zwaan CM, Brüggemann RJ, Rijnders BJA. Management of cerebral azole-resistant Aspergillus fumigatus infection: A role for intraventricular liposomal-amphotericin B. J Glob Antimicrob Resist 2020; 22:354-357. [PMID: 32251868 DOI: 10.1016/j.jgar.2020.03.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/17/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In the pre-azole era, central nervous system (CNS) infections with Aspergillus had a dismal outcome. Survival improved with voriconazole but CNS infections caused by azole-resistant Aspergillus fumigatus preclude its use. Intravenous liposomal-amphotericin B (L-AmB) is the preferred treatment option for azole-resistant CNS infections but has suboptimal brain concentrations. METHODS We describe three patients with biopsy-proven CNS aspergillosis where intraventricular L-AmB was added to systemic therapy. Two patients with azole-resistant aspergillosis and one patient with azole-susceptible CNS aspergillosis were treated with intraventricular L-AmB at a dose of 1mg weekly. RESULTS We describe three patients successfully treated with a combination of intravenous and intraventricular L-AmB. All three patients survived but one patient developed serious headaches, most likely not related to this treatment. CONCLUSIONS Intraventricular L-AmB may have a role in the treatment of therapy-refractory CNS aspergillosis when added to systemic therapy.
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Affiliation(s)
- A F A D Schauwvlieghe
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands.
| | - R G M Bredius
- Department of Paediatric Immunology, Section of Infections, Haematology, and Stem Cell Transplantation, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - R M Verdijk
- Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | - F J W Smiers
- Department of Paediatric Immunology, Section of Infections, Haematology, and Stem Cell Transplantation, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - M T van der Beek
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - B F Goemans
- Department of Haemato-oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, Netherlands
| | - C M Zwaan
- Department of Haemato-oncology, Princess Máxima Centre for Paediatric Oncology, Utrecht, Netherlands; Department of Paediatric Oncology/Haematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - R J Brüggemann
- Department of Pharmacy, Radboud Institute of Health Science, Radboud University Medical Center, Nijmegen, Netherlands; Center of Expertise in Mycology, Radboudumc, Nijmegen, Netherlands
| | - B J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
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Bassetti M, Vena A, Bouza E, Peghin M, Muñoz P, Righi E, Pea F, Lackner M, Lass-Flörl C. Antifungal susceptibility testing in Candida, Aspergillus and Cryptococcus infections: are the MICs useful for clinicians? Clin Microbiol Infect 2020; 26:1024-1033. [PMID: 32120042 DOI: 10.1016/j.cmi.2020.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/26/2019] [Revised: 02/08/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Invasive fungal infections (IFIs) represent a global issue and affect various patient populations. In recent years, resistant fungal isolates showing increased azole or echinocandin MICs have been reported, and their potential clinical impact has been investigated. AIMS To provide an update on the epidemiology of resistance among fungi (e.g., Candida spp., Aspergillus spp., and Cryptococcus spp.) and to offer a critical appraisal of the relevant literature regarding the impact of MICs on clinical outcome in patients with IFI. SOURCES PubMed search with relevant keywords along with a personal collection of relevant publications. CONTENT Although antifungal resistance has been associated with a poorer response to antifungal therapy in various studies, other factors such as comorbidities, septic shock and source of infection appear to be key determinants affecting the clinical outcome of patients with IFI. IMPLICATIONS Future international collaborative studies are required to tease out the relative contribution of in vitro antifungal resistance on patient outcomes, thus enabling the optimization of IFI management.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
| | - A Vena
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - E Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - M Peghin
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - P Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy; Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - F Pea
- Institute of Clinical Pharmacology, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - M Lackner
- Medical University of Innsbruck, Division of Hygiene and Medical Microbiology, Schöpfstrasse 41, A-6020 Innsbruck, Austria
| | - C Lass-Flörl
- Medical University of Innsbruck, Division of Hygiene and Medical Microbiology, Schöpfstrasse 41, A-6020 Innsbruck, Austria
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Prigitano A, Esposto MC, Grancini A, Passera M, Paolucci M, Stanzani M, Sartor A, Candoni A, Pitzurra L, Innocenti P, Micozzi A, Cascio GL, Delia M, Mosca A, Mikulska M, Ossi C, Fontana C, Pizzolante M, Gelmi M, Cavanna C, Lallitto F, Amato G, Vella A, Pagano L, Bandettini R, De Lorenzis G, Cogliati M, Romanò L, Tortorano A. Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy. J Glob Antimicrob Resist 2020; 22:231-237. [PMID: 32061880 DOI: 10.1016/j.jgar.2020.01.016] [Citation(s) in RCA: 4] [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: 12/11/2019] [Revised: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates from patients with haematological malignancies or who were undergoing haematopoietic stem cell transplantation and to identify the molecular mechanism of resistance. METHODS In this 28-month prospective study involving 18 Italian centres, Aspergillus isolates from surveillance cultures were collected and screened for azole resistance, and mutations in the cyp51A gene were identified. Resistant isolates were genotyped by microsatellite analysis, and the allelic profiles were compared with those of resistant environmental and clinical isolates from the same geographical area that had been previously genotyped. RESULTS There were 292 Aspergillus isolates collected from 228 patients. The isolates belonged mainly to the section Fumigati (45.9%), Nigri (20.9%), Flavi (16.8%) and Terrei (4.8%). Three isolates showed itraconazole resistance: Aspergillus fumigatus sensu stricto, Aspergillus lentulus (section Fumigati) and Aspergillus awamori (section Nigri). The itraconazole resistance rates were 1% and 1.48% considering all Aspergillus spp. isolates and the Aspergillus section Fumigati, respectively. The prevalence of azole resistance among all the patients was 1.3%. Among patients harbouring A. fumigatus sensu stricto isolates, the resistance rate was 0.79%. The A. fumigatus isolate, with the TR34/L98H mutation, was genotypically distant from the environmental and clinical strains previously genotyped. CONCLUSIONS In this study, the Aspergillus azole resistance rate was 1% (3/292). In addition to A. fumigatus sensu stricto, A. lentulus and A. awamori azole-resistant isolates were identified. Therefore, it is important have a correct identification at the species level to address a rapid therapy better, quickly understand the shift towards cryptic species and have an updated knowledge of the local epidemiology.
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Affiliation(s)
- A Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - M C Esposto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Grancini
- I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Passera
- Microbiology and Virology Unit, Asst. Papa Giovanni XXIII, Bergamo, Italy
| | - M Paolucci
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - M Stanzani
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - A Sartor
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - A Candoni
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - L Pitzurra
- Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy
| | - P Innocenti
- Laboratory of Microbiology and Virology, Comprensorio Sanitario di Bolzano-AS Alto Adige, Bolzano, Italy
| | - A Micozzi
- Department of Translational and Precision Medicine, Sapienza Università di Roma, Rome, Italy
| | - G Lo Cascio
- Microbiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Delia
- Department of Emergency and Organ Transplantation-UO Haematology with transplantation, AO Universitaria Policlinico di Bari, Bari, Italy
| | - A Mosca
- Interdisciplinary Department of Medicine, AO Universitaria Policlinico di Bari, Bari, Italy
| | - M Mikulska
- Università degli Studi di Genova (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - C Ossi
- Laboratory of Microbiology and Virology, San Raffaele Scientific Institute, Milan, Italy
| | - C Fontana
- Department of Experimental Medicine, University of Tor Vergata Polyclinic of Tor Vergata, Rome, Italy
| | - M Pizzolante
- Laboratory of Microbiology, Vito Fazzi Regional Hospital Lecce, Lecce, Italy
| | - M Gelmi
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Cavanna
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Lallitto
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Amato
- UOC. Patologia Clinica, AO A. Cardarelli, Naples, Italy
| | - A Vella
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Pagano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bandettini
- Clinical Pathology and Microbiology Laboratory Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - G De Lorenzis
- Department of Agricultural and Environmental Sciences-Production, Landscape, Agroenergy, Università degli Studi di Milano, Milan, Italy
| | - M Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - L Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Viegas C, Almeida B, Monteiro A, Paciência I, Rufo J, Aguiar L, Lage B, Diogo Gonçalves LM, Caetano LA, Carolino E, Gomes AQ, Twarużek M, Kosicki R, Grajewski J, Teixeira JP, Viegas S, Pereira C. Exposure assessment in one central hospital: A multi-approach protocol to achieve an accurate risk characterization. Environ Res 2020; 181:108947. [PMID: 31767353 DOI: 10.1016/j.envres.2019.108947] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 06/10/2023]
Abstract
The bioburden in a Hospital building originates not only from patients, visitors and staff, but is also disseminated by several indoor hospital characteristics and outdoor environmental sources. This study intends to assess the exposure to bioburden in one central Hospital with a multi-approach protocol using active and passive sampling methods. The microbial contamination was also characterized through molecular tools for toxigenic species, antifungal resistance and mycotoxins and endotoxins profile. Two cytotoxicity assays (MTT and resazurin) were conducted with two cell lines (Calu-3 and THP-1), and in vitro pro-inflammatory potential was assessed in THP-1 cell line. Out of the 15 sampling locations 33.3% did not comply with Portuguese legislation regarding bacterial contamination, whereas concerning fungal contamination 60% presented I/O > 1. Toxigenic fungal species were observed in 27% of the sampled rooms (4 out of 15) and qPCR analysis successfully amplified DNA from the Aspergillus sections Flavi and Fumigati, although mycotoxins were not detected. Growth of distinct fungal species was observed on Sabouraud dextrose agar with triazole drugs, such as Aspergillus section Versicolores on 1 mg/L VORI. The highest concentrations of endotoxins were found in settled dust samples and ranged from 5.72 to 23.0 EU.mg-1. While a considerable cytotoxic effect (cell viability < 30%) was observed in one HVAC filter sample with Calu-3 cell line, it was not observed with THP-1 cell line. In air samples a medium cytotoxic effect (61-68% cell viability) was observed in 3 out of 15 samples. The cytokine responses produced a more potent average cell response (46.8 ± 12.3 ρg/mL IL-1β; 90.8 ± 58.5 ρg/mL TNF-α) on passive samples than air samples (25.5 ± 5.2 ρg/mL IL-1β and of 19.4 ± 5.2 ρg/mL TNF-α). A multi-approach regarding parameters to assess, sampling and analysis methods should be followed to characterize the biorburden in the Hospital indoor environment. This study supports the importance of considering exposure to complex mixtures in indoor environments.
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Affiliation(s)
- Carla Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal.
| | - Beatriz Almeida
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Ana Monteiro
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, 1600-560, Lisbon, Portugal
| | - Inês Paciência
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Porto, Portugal
| | - João Rufo
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Lívia Aguiar
- INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
| | - Bruna Lage
- INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
| | - Lídia Maria Diogo Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Liliana Aranha Caetano
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Elisabete Carolino
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal
| | - Anita Quintal Gomes
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; University of Lisbon Institute of Molecular Medicine, Faculty of Medicine, Lisbon, Portugal
| | - Magdalena Twarużek
- Kazimierz Wielki University, Faculty of Natural Sciences, Institute of Experimental Biology, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Robert Kosicki
- Kazimierz Wielki University, Faculty of Natural Sciences, Institute of Experimental Biology, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Jan Grajewski
- Kazimierz Wielki University, Faculty of Natural Sciences, Institute of Experimental Biology, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - João Paulo Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
| | - Susana Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Portugal
| | - Cristiana Pereira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; INSA - Instituto Nacional de Saúde Dr. Ricardo Jorge, Departamento de Saúde Ambiental, Porto, Portugal
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Aneke CI, Rhimi W, Otranto D, Cafarchia C. Synergistic Effects of Efflux Pump Modulators on the Azole Antifungal Susceptibility of Microsporum canis. Mycopathologia 2020; 185:279-288. [PMID: 31894500 DOI: 10.1007/s11046-019-00419-7] [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: 07/27/2019] [Accepted: 12/14/2019] [Indexed: 02/07/2023]
Abstract
The microbiologic and clinical resistance of dermatophytes is seldom reported, and the mechanisms associated with resistance are not well known. This study investigated the effect of efflux pump modulators (EPMs) (i.e., haloperidol HAL and promethazine PTZ) and their inhibiting activity on the minimum inhibitory concentrations of itraconazole (ITZ) and fluconazole (FLZ) against selected M. canis strains. M. canis strains with low (≤ 1 μg/ml itraconazole and < 64 μg/ml fluconazole) and high (> 1 μg/ml itraconazole and ≥ 64 μg/ml fluconazole) azole MIC values were tested using Checkerboard microdilution assay. The disk diffusion assay, the minimum fungicidal concentration and the time-kill assay were also performed in order to confirm the results of checkerboard microdilution assay. The MIC values of ITZ and FLZ of M. canis decreased in the presence of subinhibitory concentrations of HAL and PTZ, the latter being more effective with a greater increased susceptibility. Synergism was observed in all strains with high azole MICs (FICI < 0.5) and no synergism in the strains with low azole MICs. A fungicidal activity was observed after 48 h of incubation when ITZ and FLZ were tested in combination with HAL or PTZ. These results suggest that the drug efflux pumps are involved in the defense mechanisms to azole drugs in M. canis strains. The synergism might be related to an increased expression of efflux pump genes, eventually resulting in azole resistance phenomena. Complementary studies on M. canis resistance are advocated in order to investigate the molecular mechanisms of this phenomenon.
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Affiliation(s)
- Chioma Inyang Aneke
- Dipartimento Di Medicina Veterinaria, Università Degli Studi "Aldo Moro", 70010, Valenzano (Bari), Italy.,Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, 410001, Nigeria
| | - Wafa Rhimi
- Dipartimento Di Medicina Veterinaria, Università Degli Studi "Aldo Moro", 70010, Valenzano (Bari), Italy.,Faculté Des Sciences de Bizerte, Université de Carthage, Zarzouna, Tunisia
| | - Domenico Otranto
- Dipartimento Di Medicina Veterinaria, Università Degli Studi "Aldo Moro", 70010, Valenzano (Bari), Italy
| | - Claudia Cafarchia
- Dipartimento Di Medicina Veterinaria, Università Degli Studi "Aldo Moro", 70010, Valenzano (Bari), Italy.
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Abstract
Candida albicans is the most frequently isolated opportunistic fungal pathogen in humans. However, patients with cervical lymphadenitis caused by Candida infection are rarely reported, and few studies have focused on the mechanisms underlying chronic Candida infection. In this study, we isolated a C. albicans strain (JL01) from a recurrent cervical lymphadenitis patient. The clinical isolate was identified by morphological observation and confirmed by DNA sequencing of the internal transcribed spacer (ITS) regions. Strain JL01 is resistant to azole antifungal drugs, but sensitive to amphotericin B. The strain is able to adapt to oxidative and osmotic stresses but is defective in filamentous and invasive growth. The strain displays attenuated virulence in a murine systemic infection model. RNA-sequencing analysis revealed that JL01 has a distinct gene expression profile compared with C. albicans reference strain SC5314; hundreds of transcripts were significantly dysregulated, including those related to morphogenesis and pathogenesis. Taken together, our clinical, virulence, morphological, and biological analyses suggest that the azole resistance, oxidative and osmotic stress tolerance, invasive defect, hypovirulence, and impaired interaction with the host immune system of strain JL01 may correlate with its ability to cause cervical lymphadenitis in the patient. Our research may contribute to elucidating the mechanism(s) underlying the drug resistance and immune escape of C. albicans in chronic fungal infection.
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Affiliation(s)
- Chengzhen Zhang
- Department of Dermatology, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Wenjuan Wang
- State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-yang Road, Shanghai 200031, China
| | - Qingtao Kong
- Department of Dermatology, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Fang Liu
- Department of Dermatology, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Jiangye Chen
- State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-yang Road, Shanghai 200031, China
| | - Hong Sang
- Department of Dermatology, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
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Danis Vijay D, Jayanthi S, Meenakshi N, Meharaj SHS, Sujhithra A, Perumal J. Characterization of virulence factors, antifungal resistance with ERG-11 gene among Candida species isolated from pulmonary samples. Microb Pathog 2019; 137:103750. [PMID: 31536801 DOI: 10.1016/j.micpath.2019.103750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/11/2019] [Accepted: 09/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Candida is a part of the normal oropharyngeal flora and the upper respiratory tract. Candida albicans(C. albicans), is the predominant species causing respiratory tract infections associated with pneumonia. Resistance to azole antifungal agents among the C. albicans may be due to alteration of the target enzymes, which are encoded in ERG11 gene. The biofilm formation may also be a cause to antifungal resistance. MATERIALS AND METHODS This study was conducted at Chettinad Hospital and Research Institute. Samples were collected from June 2018-June 2019, for a period of 1 year. After species confirmation, virulence factor among the Candida species were identified by hemolysis test, coagulase test and biofilm formation. Genotypic confirmation of C. albicans and their azole resistance due to ERG 11 gene were done using multiplex PCR. RESULTS In our study, 31 (55%) C. albicans, 8 (14%) Candida glabrata(C. glabrata) and 10 (17%) Candida tropicalis(C. tropicalis), three Aspergillus flavus(A. flavus), two Aspergillus fumigatous (A. fumigatous), one Aspergillus niger (A. niger) and one Mucor species were isolated. In C. albicans, 31 were positive for Germ tube and Chalmydospore formation. Six of candida species were isolated along with bacterial co infection. Among the Candida isolates, 17 (55%) C. albicans strains were strongly biofilm positive and 14(45%) were negative. The susceptibility pattern of (n = 31) C. albicans were as follows: fluconazole (21(68%) S, 10(32%) R), voriconazole (22(71%)S),9(21%) R) and Amphotericin B 31(100%) S). Among the 19 C. albicans, four were positive for ERG11 gene. CONCLUSION The isolation of C. albicans and non - albicans from respiratory specimens should be reconsidered as these organisms are re-emerging pathogens. Speciation is needed due to variation in species pathogenicity and their susceptibility.
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Affiliation(s)
- D Danis Vijay
- Department of Microbiology, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research & Education (CARE), Kelambakkam, 603103, Tamilnadu, India
| | - S Jayanthi
- Department of Microbiology, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research & Education (CARE), Kelambakkam, 603103, Tamilnadu, India.
| | - N Meenakshi
- Department of Respiratory Medicine, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research & Education (CARE), Kelambakkam, 603103, Tamilnadu, India
| | - S H Shifa Meharaj
- Department of Microbiology, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research & Education (CARE), Kelambakkam, 603103, Tamilnadu, India
| | - A Sujhithra
- Department of Cardiology, Faculty of Allied Health Sciences (FAHS), Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research & Education (CARE), Kelambakkam, 603103, Tamilnadu, India
| | - J Perumal
- Department of Microbiology, Chettinad Hospital and Research Institute (CHRI), Chettinad Academy of Research & Education (CARE), Kelambakkam, 603103, Tamilnadu, India
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Ballard E, Weber J, Melchers WJG, Tammireddy S, Whitfield PD, Brakhage AA, Brown AJP, Verweij PE, Warris A. Recreation of in-host acquired single nucleotide polymorphisms by CRISPR-Cas9 reveals an uncharacterised gene playing a role in Aspergillus fumigatus azole resistance via a non-cyp51A mediated resistance mechanism. Fungal Genet Biol 2019; 130:98-106. [PMID: 31128273 PMCID: PMC6876285 DOI: 10.1016/j.fgb.2019.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023]
Abstract
The human host comprises a range of specific niche environments. In order to successfully persist, pathogens such as Aspergillus fumigatus must adapt to these environments. One key example of in-host adaptation is the development of resistance to azole antifungals. Azole resistance in A. fumigatus is increasingly reported worldwide and the most commonly reported mechanisms are cyp51A mediated. Using a unique series of A. fumigatus isolates, obtained from a patient suffering from persistent and recurrent invasive aspergillosis over 2 years, this study aimed to gain insight into the genetic basis of in-host adaptation. Single nucleotide polymorphisms (SNPs) unique to a single isolate in this series, which had developed multi-azole resistance in-host, were identified. Two nonsense SNPs were recreated using CRISPR-Cas9; these were 213* in svf1 and 167* in uncharacterised gene AFUA_7G01960. Phenotypic analyses including antifungal susceptibility testing, mycelial growth rate assessment, lipidomics analysis and statin susceptibility testing were performed to associate genotypes to phenotypes. This revealed a role for svf1 in A. fumigatus oxidative stress sensitivity. In contrast, recapitulation of 167* in AFUA_7G01960 resulted in increased itraconazole resistance. Comprehensive lipidomics analysis revealed decreased ergosterol levels in strains containing this SNP, providing insight to the observed itraconazole resistance. Decreases in ergosterol levels were reflected in increased resistance to lovastatin and nystatin. Importantly, this study has identified a SNP in an uncharacterised gene playing a role in azole resistance via a non-cyp51A mediated resistance mechanism. This mechanism is of clinical importance, as this SNP was identified in a clinical isolate, which acquired azole resistance in-host.
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Affiliation(s)
- Eloise Ballard
- MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, UK
| | - Jakob Weber
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Willem J G Melchers
- Centre for Expertise in Mycology and Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Seshu Tammireddy
- Lipidomics Research Facility, Division of Biomedical Sciences, University of the Highlands and Islands, UK
| | - Phillip D Whitfield
- Lipidomics Research Facility, Division of Biomedical Sciences, University of the Highlands and Islands, UK
| | - Axel A Brakhage
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Alistair J P Brown
- MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, UK
| | - Paul E Verweij
- Centre for Expertise in Mycology and Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Adilia Warris
- MRC Centre for Medical Mycology at the University of Aberdeen, Aberdeen Fungal Group, Institute of Medical Sciences, University of Aberdeen, UK.
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Stauf R, Todt D, Steinmann E, Rath PM, Gabriel H, Steinmann J, Brill FHH. In-vitro activity of active ingredients of disinfectants against drug-resistant fungi. J Hosp Infect 2019; 103:468-473. [PMID: 31356854 DOI: 10.1016/j.jhin.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/26/2019] [Accepted: 07/23/2019] [Indexed: 12/24/2022]
Abstract
The biocidal activities of peracetic acid and ethanol were tested against nine clinical fungal isolates and four reference strains. Ethanol was active (≥4.0 log10 reduction) against yeasts at a concentration of 50% v/v and against moulds at 80% v/v. Exposure times in both cases were 1 min. Peracetic acid was active as a 0.25% solution against yeasts and as a 0.5% solution against moulds; exposure times in both cases were 5 min. Compared with the reference strains, clinical isolates, including multi-drug-resistant strains, showed similar or higher sensitivity to the active ingredients of disinfectants in vitro.
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Affiliation(s)
- R Stauf
- Institute for Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany
| | - D Todt
- Department for Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - E Steinmann
- Department for Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - P-M Rath
- Institute for Medical Microbiology, University Hospital Essen, Essen, Germany
| | - H Gabriel
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, Hamburg, Germany
| | - J Steinmann
- Institute for Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Nuremberg, Germany; Institute for Medical Microbiology, University Hospital Essen, Essen, Germany
| | - F H H Brill
- Dr. Brill + Partner GmbH, Institute for Hygiene and Microbiology, Hamburg, Germany.
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Prasad R, Nair R, Banerjee A. Multidrug transporters of Candida species in clinical azole resistance. Fungal Genet Biol 2019; 132:103252. [PMID: 31302289 DOI: 10.1016/j.fgb.2019.103252] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 06/04/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
Over-expression of the human P-glycoprotein (P-gp) in tumor cells is a classic example of an ABC protein serving as a hindrance to effective chemotherapy. The existence of proteins homologous to P-gp in organisms encompassing the entire living kingdom highlights extrusion of drugs as a general mechanism of multidrug resistance. Infections caused by opportunistic human fungal pathogens such as Candida species are very common and has intensified in recent years. The typical hosts, who possess suppressed immune systems due to conditions such as HIV and transplantation surgery etc., are prone to fungal infections. Prolonged chemotherapy induces fungal cells to eventually develop tolerance to most of the antifungals currently in clinical use. Amongst other prominent mechanisms of antifungal resistance such as manipulation of the drug target, rapid efflux achieved through overexpression of multidrug transporters has emerged as a major resistance mechanism for azoles. Herein, the azole-resistant clinical isolates of Candida species utilize a few select efflux pump proteins belonging to the ABC and MFS superfamilies, to deter the toxic accumulation of therapeutic azoles and thus, facilitating cell survival. In this article, we summarize and discuss the clinically relevant mechanisms of azole resistance in Candida albicans and non-albicans Candida (NAC) species, specifically highlighting the role of multidrug efflux proteins in the phenomenon.
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Affiliation(s)
- Rajendra Prasad
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Haryana, Gurgaon, Haryana, India.
| | - Remya Nair
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Haryana, Gurgaon, Haryana, India
| | - Atanu Banerjee
- Amity Institute of Integrative Science and Health and Amity Institute of Biotechnology, Amity University Haryana, Gurgaon, Haryana, India.
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Shi HZ, Chang WQ, Zhang M, Lou HX. Two natural molecules preferentially inhibit azole-resistant Candida albicans with MDR1 hyperactivation. Chin J Nat Med 2019; 17:209-217. [PMID: 30910057 DOI: 10.1016/s1875-5364(19)30023-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 11/25/2022]
Abstract
Antifungal drug resistance is a significant clinical problem, and antifungal agents that can evade resistance are urgently needed. In infective niches, resistant organisms often co-existed with sensitive ones, or a subpopulation of antibiotic-susceptible organisms may evolve into resistant ones during antibiotic treatment and eventually dominate the whole population. In this study, we established a co-culture assay in which an azole-resistant Candida albicans strain was mixed with a susceptible strain labeled with green fluorescent protein to mimic in vivo conditions and screen for antifungal drugs. Fluconazole was used as a positive control to verify the validity of this co-culture assay. Five natural molecules exhibited antifungal activity against both susceptible and resistant C. albicans. Two of these compounds, retigeric acid B (RAB) and riccardin D (RD), preferentially inhibited C. albicans strains in which the efflux pump MDR1 was activated. This selectivity was attributed to greater intracellular accumulation of the drugs in the resistant strains. Changes in sterol and lipid compositions were observed in the resistant strains compared to the susceptible strain, and might increase cell permeability to RAB and RD. In addition, RAB and RD interfered with the sterol pathway, further aggregating the decrease in ergosterol in the sterol synthesis pathway in the MDR1-activated strains. Our findings here provide an alternative for combating resistant pathogenic fungi.
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Affiliation(s)
- Hong-Zhuo Shi
- Department of Natural Product Chemistry, Key Laboratory of Chemical Biology of Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Jinan 250012, China
| | - Wen-Qiang Chang
- Department of Natural Product Chemistry, Key Laboratory of Chemical Biology of Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Jinan 250012, China
| | - Ming Zhang
- Department of Natural Product Chemistry, Key Laboratory of Chemical Biology of Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Jinan 250012, China
| | - Hong-Xiang Lou
- Department of Natural Product Chemistry, Key Laboratory of Chemical Biology of Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Jinan 250012, China.
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Binder J, Held J, Krappmann S. Impairing fluoride export of Aspergillus fumigatus mitigates its voricon azole resistance. Int J Antimicrob Agents 2019; 53:689-693. [PMID: 30763611 DOI: 10.1016/j.ijantimicag.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/23/2019] [Accepted: 02/06/2019] [Indexed: 01/27/2023]
Abstract
Fungi have evolved specific export activities to balance intracellular levels of the toxic ion fluoride, while the first-line antimycotic voriconazole contains fluorine. This study aimed to explore whether impaired fluoride export might result in altered susceptibilities of the human pathogenic mould Aspergillus fumigatus towards this antifungal compound. Functional characterization of the putative fluoride exporter in A. fumigatus was performed in the context of azole resistance by generating deletion strains that were assessed for their resistance against fluoride and voriconazole. The FexA fluoride exporter of A. fumigatus appears to be expressed constitutively, and targeting its encoding gene results in significantly increased sensitivity towards this halide. Impaired fluoride export correlates with increased susceptibility of an azole-resistant fexAΔ strain. These results demonstrate that the fexA-encoded gene product is the major fluoride export activity of A. fumigatus, and that voriconazole serves as a source of fluoride. However, these data do not support the application of voriconazole based on fluoride toxicity.
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Affiliation(s)
- Jasmin Binder
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Jürgen Held
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Sven Krappmann
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
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Hokken MWJ, Zoll J, Coolen JPM, Zwaan BJ, Verweij PE, Melchers WJG. Phenotypic plasticity and the evolution of azole resistance in Aspergillus fumigatus; an expression profile of clinical isolates upon exposure to itraconazole. BMC Genomics 2019; 20:28. [PMID: 30626317 PMCID: PMC6327609 DOI: 10.1186/s12864-018-5255-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/15/2018] [Indexed: 01/26/2023] Open
Abstract
Background The prevalence of azole resistance in clinical and environmental Aspergillus fumigatus isolates is rising over the past decades, but the molecular basis of the development of antifungal drug resistance is not well understood. This study focuses on the role of phenotypic plasticity in the evolution of azole resistance in A. fumigatus. When A. fumigatus is challenged with a new stressful environment, phenotypic plasticity may allow A. fumigatus to adjust their physiology to still enable growth and reproduction, therefore allowing the establishment of genetic adaptations through natural selection on the available variation in the mutational and recombinational gene pool. To investigate these short-term physiological adaptations, we conducted time series transcriptome analyses on three clinical A. fumigatus isolates, during incubation with itraconazole. Results After analysis of expression patterns, we identified 3955, 3430, 1207, and 1101 differentially expressed genes (DEGs), after 30, 60, 120 and 240 min of incubation with itraconazole, respectively. We explored the general functions in these gene groups and we identified 186 genes that were differentially expressed during the whole time series. Additionally, we investigated expression patterns of potential novel drug-efflux transporters, genes involved in ergosterol and phospholipid biosynthesis, and the known MAPK proteins of A. fumigatus. Conclusions Our data suggests that A. fumigatus adjusts its transcriptome quickly within 60 min of exposure to itraconazole. Further investigation of these short-term adaptive phenotypic plasticity mechanisms might enable us to understand how the direct response of A. fumigatus to itraconazole promotes survival of the fungus in the patient, before any “hard-wired” genetic mutations arise. Electronic supplementary material The online version of this article (10.1186/s12864-018-5255-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Margriet W J Hokken
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands. .,Center of Expertise in Mycology Radboudumc/CWZ, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands.
| | - Jan Zoll
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Jordy P M Coolen
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Bas J Zwaan
- Department of Plant Sciences, Laboratory of Genetics, Wageningen University, Droevendaalsesteeg 1, 6708PB, Wageningen, The Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA, Nijmegen, the Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, the Netherlands
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Engel TGP, Slabbers L, de Jong C, Melchers WJG, Hagen F, Verweij PE, Merkus P, Meis JF. Prevalence and diversity of filamentous fungi in the airways of cystic fibrosis patients - A Dutch, multicentre study. J Cyst Fibros 2018; 18:221-226. [PMID: 30514613 DOI: 10.1016/j.jcf.2018.11.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 04/25/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Progressive lung injury in Cystic Fibrosis (CF) patients can lead to chronic colonization with bacteria and fungi. Fungal colonization is obtained from the environment which necessitates locally performed epidemiology studies. We prospectively analyzed respiratory samples of CF patients during a 3-year period, using a uniform fungal culture protocol, focusing on filamentous fungi and azole resistance in Aspergillus fumigatus. METHODS Over a 3-year period, all respiratory specimens collected from CF patients in 5 Dutch CF centers, were analyzed. Samples were inoculated onto the fungal culture media Sabouraud dextrose agar (SDA) and Medium B+. All fungal isolates were collected and identified in one centre, using Amplified Fragment Length Polymorphism (AFLP) fingerprinting, rDNA PCR and ITS, calmodulin and β-tubulin sequencing. Azole resistance was assessed for all A. fumigatus using a qPCR assay followed by phenotypic confirmation. RESULTS Filamentous fungi were recovered from 699 patients from at least one respiratory sample, corresponding with 3787 cultured fungal species. A. fumigatus was cultured most often with a mean prevalence of 31.7%, followed by Penicillium species (12.6%), non-fumigatus Aspergillus species (5.6%), Scedosporium species (4.5%) and Exophiala dermatitidis and Cladosporium species (1.1% each). In total 107 different fungal species were identified, with 39 Penicillium species and 15 Aspergillus species. Azole resistance frequency in A. fumigatus was 7.1%, with TR34/L98H being the dominant resistance mechanism. CONCLUSION A vast diversity of filamentous fungi was demonstrated, dominated by Aspergillus and Penicillium species. We observed a mean azole resistance prevalence of 7.1% of A. fumigatus culture positive patients.
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Affiliation(s)
- Tobias G P Engel
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.
| | - Lydie Slabbers
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carmen de Jong
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Peter Merkus
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques F Meis
- Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
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Fan X, Xiao M, Zhang D, Huang JJ, Wang H, Hou X, Zhang L, Kong F, Chen SCA, Tong ZH, Xu YC. Molecular mechanisms of azole resistance in Candida tropicalis isolates causing invasive candidiasis in China. Clin Microbiol Infect 2018; 25:885-891. [PMID: 30472420 DOI: 10.1016/j.cmi.2018.11.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We investigated molecular mechanisms responsible for azole resistance in Candida tropicalis isolates. METHODS We studied 507 C. tropicalis isolates causing invasive candidiasis from ten hospitals over 5 years. Antifungal susceptibility was determined by broth microdilution methods. Point mutations in the C. tropicalis ERG11 gene that may confer azole resistance were explored and verified. The expression levels of ERG11, CYTb, MDR1 and CDR1 genes were compared in 20 fluconazole-susceptible and 20 fluconazole-resistant isolates. RESULTS Fluconazole-susceptible, -susceptible dose-dependent and -resistant strains accounted for 76.7% (389/507), 10.5% (53/507) and 12.8% (65/507) of C. tropicalis isolates, respectively. The ERG11 mutation A395T/W occurred in 10.7% (54/507) of isolates, all of which were resistant to fluconazole. The nucleotide mutation C461T/Y was the second most common (50/507 isolates, 9.9%), and all isolates carrying C461T/Y also had the mutation A395T/W. However, the presence of C461T did not contribute to the azole-resistant phenotype. Substitutions V125A, Y257H and G464S (<2% of isolates), which were reported for the first time in C. tropicalis, also conferred fluconazole non-susceptible phenotypes. Compared with fluconazole susceptible isolates, fluconazole-resistant isolates had higher ERG11 (fold expression level 1.42 versus 0.79, p < 0.01) but lower CYTb (fold expression level 1.26 versus 2.67, p < 0.01) gene expression levels. Three azole-resistant isolates carrying the wild-type ERG11 gene had higher levels of CDR1 and MDR1 expression. CONCLUSIONS ERG11 missense mutations were the major mechanism responsible for azole resistance in C. tropicalis isolates, but overexpression of ERG11, CDR1 and MDR1, as well as reduced expression of CYTb, also contributed to resistance.
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Affiliation(s)
- X Fan
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - M Xiao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - D Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - J-J Huang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - H Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - X Hou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - L Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - F Kong
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, The University of Sydney, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, The University of Sydney, Australia
| | - Z-H Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Y-C Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China.
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Güngör Ö, Sampaio-Maia B, Amorim A, Araujo R, Erturan Z. Determination of Azole Resistance and TR 34/L98H Mutations in Isolates of Aspergillus Section Fumigati from Turkish Cystic Fibrosis Patients. Mycopathologia 2018; 183:913-920. [PMID: 30187246 DOI: 10.1007/s11046-018-0297-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 04/11/2018] [Accepted: 08/24/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Aspergillus fumigatus is the species section Fumigati most frequently isolated from the respiratory tract of cystic fibrosis (CF) patients. Recent studies suggest that mutations in the Cyp51 gene, particularly TR34/L98H, are responsible for azole resistance. OBJECTIVES AND METHODS The focus of this study was on section Fumigati isolates isolated from the respiratory tract samples of CF patients. More specifically, the goal was to detect A. fumigatus isolates, test their antifungal susceptibility to itraconazole, voriconazole and posaconazole, and finally determine the presence of TR34/L98H and other mutations in the isolates Cyp51A gene. RESULTS AND CONCLUSIONS A set of 31 isolates of Aspergillus section Fumigati were obtained from the sputum samples of 6 CF patients and subsequently identified to species level by microsatellite genotyping. All isolates were determined as A. fumigatus and involved 14 different genotypes. The minimal inhibitory concentrations to the three azoles were determined by the E-test method, and the Cyp51A gene was sequenced. One of the genotypes was found to be resistant to all azoles but no mutations were detected in the Cyp51A gene, especially the TR34/L98H mutation. Therefore, mutations in genes other than Cyp51A or other distinct mechanisms may be responsible for this reported multiazole resistance found in a Turkish CF patient.
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Affiliation(s)
- Özge Güngör
- Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul University, 34093, Capa, Istanbul, Turkey.
| | - Benedita Sampaio-Maia
- Faculty of Dental Medicine, University of Porto, Porto, Portugal
- INEB, Instituto Nacional de Engenharia Biomédica da Universidade do Porto, Porto, Portugal
- i3S, Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Antonio Amorim
- i3S, Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Faculdade de Ciências, Universidade do Porto, Porto, Portugal
| | - Ricardo Araujo
- i3S, Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
- Department of Medical Biotechnology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Zayre Erturan
- Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul University, 34093, Capa, Istanbul, Turkey
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