Objective Based on the Galleria mellonella infection model, the effect of sub-MIC fluconazole on the virulence of Candida glabrata was investigated. Methods Non repetitive Candida glabrata strains clinically isolated from Qinghai Provincial People’s Hospital from April 2021 to October 2022 were collected, and the minimum inhibitory concentration (MIC) of fluconazole against Candida glabrata was determined by ATB method. The virulence of Candida glabrata was tested by the Galleria mellonella infection model, and the success of the model was evaluated by pathological and pathogenic methods. Effects of puncture and different sub-MIC FLUs on healthy Galleria mellonella: the control group did not do any treatment, and the experimental group was divided into three groups, namely PBS group (10 μL PBS), FLU subgroup(inject 10 μL fluconazole solution respectively, making the FLU concentration in the body of infected Galleria mellonella 0.5 mg/kg, 1 mg/kg, 2 mg/kg, 4 mg/kg, 8 mg/kg, and 16 mg/kg) and puncture group (micro syringe puncture but no injection). Use 2.50×10⁶ yeasts /larva infected with Galleria mellonella, after 2 h, the control group was injected with 10 μL PBS, the experimental group was injected with different concentrations of FLU working solution, observing the therapeutic effect on the Galleria mellonella infected by Candida glabrata. Results The MIC of fluconazole to 9 clinically isolated Candida glabrata was 8 mg/L~32 mg/L, and that of Candida glabrata ATCC2001 was 32 mg/L. Yeast-like spores were detected in the pathological section of the intestinal tissue of the Galleria mellonell in the experimental group, and Candida glabra was cultured in the intestinal tissue.No fungus was found in the pathological section and fungal culture of the intestinal tissue in the control group. Puncture could cause damage to the Galleria mellonella, but the mortality was less than 10%. 1/2 MIC fluconazole could improve the survival rate of Candida glabrata infected Galleria mellonella with statistical significance(P<0.05),while 1/4 MIC, 1/8 MIC,1/16 MIC fluconazole had no significant intervention effect on the survival rates of Candida glabrata infected Galleria mellonella compared with PBS and the difference was not statistically significant (P>0.05). Conclusion 1/2 MIC fluconazole had inhibitory effect on the virulence of Candida glabrata, but the concentration below 1/2 MIC had no obvious protective effect.

Objective To analyze the clinical features and high-risk factors of Pneumocystis jirovecii pneumonia (PJP), explore the value of metagenomic sequencing (mNGS) in the diagnosis of PJP, and seek possible prognostic indicators in PJP patients. Methods From April 2020 to December 2021, the clinical data of 20 PJP patients admitted to our department were collected, and their clinical characteristics were analyzed. The differences in laboratory indexes before and after treatment and the value of different detection methods in diagnosis were compared. Results Pneumocystis infection was detected by NGS in BALF of 20 patients, meanwhile, the positive rate of blood G test was 90%. However, neither smears nor cultures of the pathogen showed signs of pneumocystis infection. After anti-PJP treatment, 14 cases were clinically relieved, and the difference in peripheral blood lymphocyte. Conclusion Compared with the sensitivity of conventional etiological smears and cultures, mNGS showed better value in the diagnosis of PJP. NGS could identify pathogens with high sensitivity. In addition, peripheral blood lymphocytes were positively correlated with disease recovery and could be used as one of the laboratory markers of prognosis in PJP patients.

Objective The distribution of infection and drug susceptibility characteristics of Candida parapsilosis complex strains were studied in Guizhou. Detection of the biofilm formation capacity of strains and the expression level of its CDC28 gene were performed. Methods The BACTEC^TM FX and Phoenix-100 instrument were used to identify the strains isolated in there tertiary first class hospitals in Guizhou from January 2017 to December 2019. The Candida parapsilosis complex group was identified by gene sequencing. ATB FUNGUS 3 kit was used to detect drug susceptibility of strains. The Candida parapsilosis biofilms formation capacitywas detected, and the expression levels of their CDC28 genes were detected using qRT-PCR. Results A total of 163 strains of Candida parapsilosis complex were isolated and identified, of which Candida parapsilosis type I, II and III accounted for 73.0%, 6.1% and 20.9% respectively. Urine and blood specimens got the most isolated strains (both 50 strains). Among the ioslates from infected bloodstream, type I, II and III accounted for 54.0%, 10.0% and 36.0% respectively. Three genotype strains were not significantly resistant to antifungal drugs. Among the 17 clinical strains, 16 (94.1%) had biofilm formation ability, of which 2, 4 and 10 strains had strong, general and weak biofilm formation capacity. CDC28 expressed upregulation in 2 strains with strong and 3 strains with general ability. Conclusion The isolated Candida parapsilosis complex was dominated by type I, and the three genotype strains were not obviously resistant to antifungal drugs. Different Candida parapsilosis showed different biofilm formation capacity, and the CDC28 gene might be associated with biofilm formation.

Objective To determine the expression level of EREG in the blood-brain barrier infected by Cryptococcus neoformans and to explore the role of EREG crossing the blood-brain barrier. Methods To construct the model of blood brain barrier in vitro by using Cryptococcus neoformans and Transwell chamber, and PBS was used as the control group. According to the time of Cryptococcus infection, divided into three groups: 3 h, 6 h and 12 h. The changes of the adhesion and penetration ability of Cryptococcus to the blood-brain barrier were detected by detecting the transmembrane resistance of single cells in the upper chamber of the Transwell and the suspension coating in the lower chamber of the Transwell at different time of infection, and the expression level of EREG in vascular endothelial cells during the process was detected. Results The expression of EREG was significantly increased and positively correlated with the time of infection during the course of cryptococcal infection with microvascular endothelial cells. Conclusion These results indicated that the ability of Cryptococcus to cross the blood-brain barrier was closely related to the expression level of EREG.

Objective The aim of this study is to the clinical features of fungal spheroid fungal sinusitis and osteitis. Methods The clinical data of 105 FBS patients (110 sinuses in total) were retrospectively analyzed,the clinical features of their symptoms, signs, image, pathology, and osteitis were summarized and analyzed. Results Among the 110 sinuses, 97 sinuses (88.2%) were located in the maxillary sinus, and 13 sinuses (11.8%) were located in the sphenoid sinus; 97 sinuses (88.2%) had different degrees of bone thickening compared with the contralateral sinus. The wall bone of lesion sinus and contralateral sinus were significantly different in bone thickness (0.34±0.17 vs. 0.14±0.08), CT value (1161.5±322.5 vs. 864.2±482.8), GOSS score (3.0±1.4 vs. 0.3±0.9) .Pathological observation showed manifestations of osteomyelitis accompanied by bone remodeling activities. Conclusion Fungal spheroid fungal sinusitis prefer to occurs in the maxillary sinus and sphenoid sinus, mainly in single sinus. Most of the wall bone around the lesion sinuses have obvious osteitis, which is mainly characterized by bone thickening and increased CT value.

Periprosthetic fungal infection was a catastrophic complication after artificial joint replacement, and its diagnosis and treatment had always been one of the hot research topics in the field of orthopedics. A case of a 66-year-old immunocompetent man who underwent total knee arthroplasty and infected with Candida glabrata six years later with signs of prosthetic infection were reported. The pathogenic diagnosis and anti-fungal therapy might provide a reference for the drug treatment of periprosthetic fungal infection after artificial joint replacement.

Kerion is a fungal skin disease caused by the infection of Microspore genus,which can lead to a large area of cicatricial alopecia and affect the physical and mental health of patients. Early correct diagnosis is extremely important. Fungal pathogen detection is the main basis for the diagnosis of tinea capitis at present, but there is a certain false negative rate in fungal direct microscopic examination, and it takes a long time for fungal culture. One case of kerion in a child was diagnosed by dermatoscopy and fungal fluorescence staining. Fluconazole combined with glucocorticoid treatment was satisfactory.

A 10-year-old male patient presented with erythema,pustules and alopecia on the scalp with pain for more than 1 week. The fungal microscopic examination was positive, and Trichophyton mentagrophytes was suggested by fungal culture, The diagnosis of kerion was made.After being given terbinafine tablets combined with itraconazole capsules for antifungal and methylprednisolone anti-inflammatory treatment, the skin lesions were healed without scars, and the hair growth was normal.

A 40-year-old female patient with myelodysplastic syndrome had recurrent fever after bone marrow transplantation. Blood culture showed that the bloodstream was infected with 2 strains of fungi. 18S ribosomal RNA (18S rRNA) sequencing results showed that one of the fungi was Trichosporon assahii and the other was Magnusiomyces clavatus. The two fungi were rare fungi, both sensitive to voriconazole. Due to the long time of identification and drug sensitivity, the patient did not wait for the adjustment of reasonable antifungal drugs, and died due to persistent neutropenia and fungemia. This case was the first report in Chinese of bloodstream mixed infection of Trichosporon asahii and Magnusiomyces clavatus in patients with hematological diseases.

A 6-year-old girl presented with a light erythema on her right cheek with no scales or pustules. Under dermoscopy, the diseased hair was found to be shortened with a few scales on the root. By fluorescent staining, the diseased hair was surrounded by transparent hyphae which emitted bright blue fluorescence, and the hyphae grew along the direction of the hair shaft, some of which were extended to the surroundings. No hyphae or spores were found in the dandruff under the dermoscopy. The pathogen was identified by morphology and molecular biology as Athroderma otae (teleomorph of Microsporum canis). The diagnosis of tinea of vellus hair on a child’s face was made. Oral itraconazole capsule 100 mg/d and topical terbinafine cream were administrated. After 4 weeks’ follow-up, the child’s facial background color returned to normal, and microscopic examination showed negative result, so the medications were stopped. There was no recurrence in 3 months’ follow-up.

The patient was a 44-year-old female with erythema and papules on her face for 16 years, ulcers and black crusts for 8 years. Dermatological examination: diffuse swelling erythema, large well-demarcated ulcers with necrotic eschar on her face. She presented bilateral eyelid ectropion and lost her sight of the right eye. The patient was diagnosed as chronic cutaneous mucormycosis caused by Mucor irregulari after direct microscopic examination, fungal culture and molecular identification. Intravenous amphotericin B was given. The lesions were significantly improved but left atrophic scar.