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    28 August 2019, Volume 14 Issue 4
    Original articles
    Comparison of immune responses of yeast form and hyphae form Candida albicans to infection of vaginal epithelial cells
    WANG Yu-ting, WANG Yu-zhu, LIU Jin-yan, MENG Ling-ning, LI Wei-hua, XIANG Ming-jie
    2019, 14(4):  193-199. 
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    Objective Candida albicans has morphological plasticity and can switch morphology among yeast form and hyphal form. In this study, the two different forms of Candida albicans stimulate the vaginal epithelial cells in order to compare the differences in immune response caused by them. Methods Vaginal epithelial cell lines VK2/E6E7 were treated as model. Different concentrations of activated Candida albicans and heat-inactivated Candida albicans SC5314 (MOI=10,50,100) were given to in vitro stimulate vaginal epithelial cell lines. Real-time fluorescent quantitative PCR (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA) method were used to determine the expression of proinflammatory factor TNF-α and chemokines IL-8 under different infection stage(3 h,6 h,12 h). Results Activated Candida alibcans showed hyphal form in K-SFM medium while the heat-inactivated one showed yeast form. Two infection groups showed difference in expression of IL-8 and TNF-α compared to the uninfected group significantly. Under various MOI conditions, the mRNA level of[JP+3]cytokines released by hyphal form infection group was significantly higher than that of yeast form. In especial, at the concentration of MOI=10, the protein level of cytokines released by hyphal form was higher than that of the yeast form. However, the condition turned to reversion with the increase of MOI. Conclusion Both yeast and hyphal form of Candida albicans can induce significant immune responses in vaginal epithelial cells. What's more, hyphal form can induce the immune response of vaginal epithelial cells stronger than that of yeast form under MOI=10. The difference in the immune response intensity by the two-form infection group suggested that the mechanisms of the immunity might be different between the two groups.

    In vitro study of the effect of romidepsin on fluconazole againgst Candida albicans
    CAI Qing, YANG Lian-juan, GAO Zhi-qin, REN Hong-jin, YANG Hong, TAN Jing-wen
    2019, 14(4):  200-203,216. 
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    Objective To investigate the influence of romidepsin on fluconazole's antifungal activities to Candida albicans in vitro. Methods A total of 15 C. albicans strains were studied. Susceptibility of fluconazole with or without different concentrations romidepsin was determined according to the CLSI microdilution method M27-A3. Results The tested strains included five fluconazole sensitive strains, five dose-dependent strains and five resistant strains. The inhibition of romidepsin (2 μg/mL and 4 μg/mL) markedly reduced the MIC, the trailing growth and the growth of most C. albicans strains. Conclusions Romidepsin has enhancing effect on fluconazole against C. albicans in vitro and can inhibit the tailing growth of fluconazole.

    Retrospective analysis of 149 cases of cryptococcal meningitis with AIDS
    LU Yan-qiu, WU Yu-shan, QIU Dan, CHEN Yao-kai
    2019, 14(4):  204-209. 
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    Objective To describe the demographic characteristics, laboratory profile, therapeutic and outcome of cases diagnosed as cryptococcal meningitis with AIDS in Chongqing. Methods We analyzed the cryptococcosis cases diagnosed in the Chongqing Public Health Medical Center from January 2016 to January 2018.The diagnosis was confirmed by culture on Sabouraud's dextrose agar and/or by India ink preparation. The diagnosis methods were assessed by using culture as reference. Results A total of 149 cases of cryptococcal meningitis were diagnosed. The mean age of the patients was 42.54±12.94 years, and the male dominated(72.5%).The median CD4+ count was 24.00 cells/μL. India ink staining presented positive rate at 98.00%, the sensitivity at 96.80%,the specificity at 100.00%,and the diagnostic coincidence rate at 61.1%.The hospital mortality rate was 12.08% (18/149).Youth (18~44 years) and middle age (44~60 years), weight loss within 2 kg, normal or decreased chloride in cerebrospinal fluid before the initiation of anti-fungal treatment were the protective factors for the hospitalized patients,while the headache, disturbance of consciousness, fatigue, baseline CD4+ T cells for the number of 5~12 cells/μL, the initial the brain pressure greater than 250mm/H2O as risk factors. Age of 18~44 years was the independent protective factor, disturbance of consciousness and fatigue were two independent risk factors for hospitalized patients. The difference was statistically significant. Conclusion The mortality of patients with AIDS combined with cryptococcal meningitis was high, the clinical manifestations were complex, and the prognosis was influenced by many factors, so it was necessary to attach great importance to the medical workers and strengthen the comprehensive management of the disease.

    Majocchi's granuloma due to autoinoculation of Trichophyton rubrum and review of literature
    ZHAOYing, LI Li, CHEN Lian-jun, ZHU Jun-hao, ZHANG Qiang-qiang
    2019, 14(4):  210-216. 
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    Objective To report a case of Majocchi's granuloma due to autoinoculation and review related literatures to provide ideas for diagnosis and treatment of Majocchi's granuloma. Method A case of Majocchi's granuloma on face was due to autoinoculation of Trichophyton rubrum. Clinical characters of Majocchi's granulomain immunocompetent patients were also reviewed. Results Totally there were 58 published papers including case reports and related articles were enrolled. Among71 cases, there were 35 immunocompetent patients including 24 males and 11 females. The clinical characters of the 35 immunocompetent patients were summarized. The initial misdiagnosis rate during the first clinic visit was 57.1% (20/35). Systemic antifungal drugs were the first choice for treatment. Conclusion Comprehensive and careful physical examination, confirmation of basic skin lesion and collection of detailed medical history could provide important clues for accurate diagnosis.

    Retrospective analysis of 1935 clinical deep Aspergillus isolates
    SU Hui-lin, CHEN Zong-qian, ZHU Jun-hao, LI Li, ZHANG Qiang-qiang, XU Jin-hua, ZHU Min
    2019, 14(4):  217-221. 
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    Objective To investigate the constitutionand the clinical distribution of the Aspergillus species in our hospital. To study the underlying diseases of aspergillosis patients and guide the prevention and treatment of aspergillosis. Methods Clinical information of the Aspergillus species strains isolated in the mycology laboratoryof hospital from January 2012 to December 2018 was collected for statistical analysis. Results In total 1935 Aspergillus isolates from culture-positive specimen, there were 159 Aspergillus niger, 77 Aspergillus flavus, 863 Aspergillus fumigatus and 836 undefined Aspergillus species. Aspergillus fumigates strains were mainly isolated from respiratory specimens. Hospitalized patients with A. fumigatus specimens were mainly distributed in the departments of infectious diseases, respiratory diseases, geriatrics, intensive care unit (ICU), antibiotics, senior wards and neurosurgery. The main underlying diseases of patients with clinical diagnosis of A. fumigatus infection were infectious disease, other chronic lung disease, tumor, rheumatic disease, diabetes and so on. Conclusion A. fumigatus was the most common Aspergillus species in the clinic in our hospital and mainly caused lung infection. Patients in departments mentioned above with related underlying diseases should be alert to Aspergillus infection.

    Isolates distribution and drug sensitivity test of invasive yeast-like fungi infection in Hebei
    LI Fang, LI zhi-rong, ZHAO Ying, ZHAO Jian-hong, ZHANG Yan-hai, DONG Ai-ying, LIU Jin-lu, GUO Yan-yan, SUN Yan, ZHAO Wen-shen, XIE Shou-jun, WEI Hong-lian, ZHANG Jin-yan, REN Hong-tao, WANG Jian-sheng, WU Xiang-kun, GUANG Xiao, LI Dong-qing, DU Hong-li, GUO Ying-hui, XU Ying-chun, XIAO Meng, YANG Wen-Hang, XU Xiao-lin
    2019, 14(4):  222-227. 
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    Objective To investigate the composition, distribution and in vitro drug sensitivity of invasive yeast-like fungi infections isolates in 16 tertiary teaching hospitals in Hebei, and to provide a reference for the rational use of antifungal drugs. Methods The isolated strains of invasive yeast-like fungi infection patients in Hebei were collected, and the composition of the strains was analyzed, Sensititre YeastOne color sensitive plate was used to test the susceptibility of 9 antifungal agents. Results A total of 260 invasive yeast strains were detected, of which C. albicans was the most important pathogen (42.31%), and non-C.albicans (57.69%), including C.tropicalis (19.23%), C.parapsilosis complex(18.08%)and C.glabrata(9.23%).The resistance rates of C. albicans to fluconazole, voriconazole and itraconazole were 2.8%, 1.9% and 0.9%, respectively. The resistance rates of C.tropicalis to fluconazole and voriconazole were 12.8%. The resistance rates of C.parapsilosis complex to fluconazole and voriconazole were 14.9% and 10.6%, respectively. The resistance rate of C.albicans, C.tropicalis and C.parapsilosis complex to echinococcins was almost 0%. Conclusion C.albicans was the most common pathogen ofinvasive yeast-like fungi infection, but non-C.albicans infection had exceeded 50%. C. albicans was still highly susceptible to antifungal drugs, but the susceptibility rates of azoles were different among different Candida species. Echinomycins had high activity against C. albicans, C. tropicalis and C. parapsilosis.

    Improvement of the purification method of cryptococcal capsular polysaccharide glucuronoxylomannan
    LAI Rui, SONG Ying, LIU Wei-you, YUAN Xiao-liang
    2019, 14(4):  228-231. 
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    Objective To explore a simpler, less time-consuming, and more efficient glucuronoxylomannan (GXM) purification method compared with the traditional one which adapts ethanol and cetyltrimethylammonium bromide (CTAB) to specifically precipitate and purify GXM. Methods The GXM-CTAB complex was obtained by specifically precipitating 250 mL of H99 and R265 cultures with ethanol and CTAB. Then, the GXM-CTAB complex was separated using a 24:1 chloroform:isoamyl alcohol mixture. Next, GXM was precipitated by adding 3 volumes of isopropanol. Results About 7.8 mg and 18 mg of H99GXM and R265GXM were respectively obtained from 250 mL of the culture using the GXM modified purification method. The acquisition rates (GXM/GXM and GalXM mixed polysaccharides) were 39% (7.8/20) and 45% (18/40), respectively. In addition, the traditional GXM purification process takes a total of 2 weeks while the modified method only takes 8 days. Conclusion The GXM modification purification method used in this study is comparable to the extraction efficiency of the traditional method, also the purification time is shortened and the extraction process is simpler.

    Case reports
    A cases of adult black-dot ringworm due to Trichophyton violaceum
    XIE Zhen-mou, ZENG Wei-ying, HUANG Jin-mei, LIU Ying-hui, OU Jiang-li, LIU Hong-fang
    2019, 14(4):  235-237. 
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    A 36-year-old female patient presented to our clinic with complaints of black dots on the scalp for more than 10 years. The signs of black dots, comma hair and corkscrew hair could be seen in the dermatoscope. Direct fungal fluorescence microscopic examination showed a large amount of spores. Culture on Sabouraud dextrose agar revealed purple colonies, short-thick septa hyphae and chlamydospores could be found on the slide culture. Trichophyton violaceum was identified as the causative phathogen by nrDNA ITS sequencing. Oral itraconazole(0.2g/d) was administered to this patient combined with topical application of ketoconazole lotion and terbinafine spray. After 4 weeks treatment, the patient was cured and was still in the follow-up now.

    Clinical observation and drug sensitivity test of TaXi power in the treatment of tinea pedis
    ZHAO Yi-ding, TIAN Gai-miao, SUN Dan, YAN Xiao-ning
    2019, 14(4):  240-244. 
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    Objective To investigate the clinical curative effect and fungal clearance effect of Chinese medicine TaXi power in the treatment of tinea pedis. Methods One hundred and sixty-seven cases were randomly divided into two groups. The treatment group included 83 cases were treated by TaXi power liquid and sertaconazole nitrate cream topically twice a day for 4 weeks. The control group included 84 cases were treated by sertaconazole nitrate cream topically twice a day for 4 weeks. Visits were scheduled on preliminary diagnosis,4,6 weeks after treatment. The scores of the symptoms and signs, the effect onset time, the effective rate and the fungal clearance rate were compared respectively. The minimum inhibitory concentrations of Trichophyton rubrum, Trichophyton mentagrophytes and Candida albicans were tested by microdilution method. Result The effective rate of the treatment group was 92.8%. The effective rate of the control group was 82.1%. There were significant differences between the two groups (P<0.05). The effect onset time of the treatment group was shorter than that of the control group(P<0.05). The fungal clearance rate of the treatment group was higher than that of the control group(P<0.05) TaXi power had inhibitory effects on Candida albicans, Trichophyton rubrum and Trichophyton mentagrophytes in vitro. The MICs were 0.125 g/mL, 0.5 g/mL and 0.25 g/mL. Conclusion TaXi power in the treatment of tinea pedis has exactly clinical curative effect. It has an inhibitory effect on common superficial fungi, and it can be promoted and applied in clinic.

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