Table of Content

28 April 2021, Volume 16 Issue 2

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Original articles

The first case of endophthalmitis caused by Paraconiothyrium cyclothyrioides in China

WU Lisha, ZHU Hongjun

2021, 16(2):  73-76. 

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Objective To report the first case of endophthalmitis caused by Paraconiothyrium cyclothyrioides in China and analyze the fungal biological characteristics, infection routes and treatment. Methods The strain was isolated from anterior chamber sediment of the injured left eye, and was identified based on growth temperature, microscopic morphologies and ITS sequence analysis. Results The strain grew well at 25℃, and the macroscopic morphology on PDA showed a woolly grayish-white colony and folded surface. But the strain grew slowly at 35℃ with soybean-size white convex colony. After cultivation at 25℃ and 35℃ numerous nodular hyphae were found under the microscope, and no conidia were observed. ITS sequence analysis showed the strain was Paraconiothyrium cyclothyrioides. Conclusion This was the first report of endophthalmitis caused by Paraconiothyrium cyclothyrioides in China.

Study on the pathogenesis of melanin in Fonsecaea monophora

Wang Li, Wang Wei

2021, 16(2):  77-83. 

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Objective To know whether melanin contributes to disease pathogenesis of Fonsecaea monophora. Methods In this study, one albino mutant (CBS125149) was generated from a parent meristematic mutant (CBS122845) of Fonsecaea monophora. Transmission electron microscopy (TEM) profiles showed that melanin in the parent strains appeared as electron-dense granules which located on the cell wall surface. The cell wall fractions from the two different strains were extracted by an alkali-acid method. The different strains or its cell wall fractions were interacted with the activated RAW264.7. Gene expression of i-NOS gene was detected by real time PCR. Expression of nitric oxide(NO) was detected by Griess method. Otherwise, expression results of IL-12, TNF-α, IL-10 was detected by ELISA. Results The pigmented strain and its cell wall fraction could reduce the expression of inducible nitric oxide synthase (i-NOS) gene and inhibit the synthesis of nitric oxide(NO)in vitro (P<0.05). An exacerbated Th2 response and inhibited Th1 response occurred in the interaction between activated RAW264.7 with the pigmented strain or its cell wall fraction. Conclusion Our results suggest that melanin plays an importantrole in fungal escaping from the oxidative burst of macrophages. Melanin causes a negatively Th1 immune response and favors the persistence of the fungal infection.

Genotype analysis of Cryptococcus gattii species complex in Guangxi, southern China

LI Bingkun, HUANG Chunyang, LI Xiuying, ZHENG Yanqing, PAN Kaisu, LIAO Wanqing, CAO Cunwei

2021, 16(2):  84-89. 

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Objective To explore the genotype characteristics and population structure characteristics of Cryptococcus gattii species complex in Guangxi, China, and to clarify the evolutionary relationship between Guangxi clinical isolates and global strains. Methods Clinical strains of Cryptococci isolated from clinically diagnosed patients with cryptococcosis between 2014 and 2018 were collected, and Cryptococci were preliminarily screened using CGB medium. Multi-site series typing (MLST) was used to determine genotype. Phylogenetic tree construction through MEGA7 software;Principal component analysis using R language. In vitro susceptibility test of antifungal agents was performed using m27-A3 protocol using microbroth dilution. Results Among the 120 strains of clinical Cryptococcus, 11 strains of Cryptococcus gattii species complex were isolated, 6 strains belonged to C.deuterogattii (AFLP6/VGⅡ), and 5 belonged to C.gattii sensus stricto (AFLP4/VGI). Strains of AFLP6/VGⅡ from Guangxi, were genetically variable and mainly originated and evolved from the Brazilian C.deuterogattii in South America. All isolates were sensitive to antifungal drugs. Conclusion Our study suggests that highly pathogenic AFLP6/VGⅡ may occur in Guangxi China, and effective national surveillance of C. gattii species complex is necessary.

Clinical observation of 5% amorolfine liniment in the treatment of 68 cases of distal lateral subungual onychomycosis

HU Xin, WANG Yanlong, LV Sha, LIN Yitong, LI Fuqiu

2021, 16(2):  90-95,112. 

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Objective To observe the efficacy and safety of 5% amorolfine liniment in the treatment of distal lateral subungual onychomycosis. Methods Cases with typical clinical manifestations of distal lateral subungual onychomycosis and positive fungal microscopy were topically applied by 5% amorolfine liniment for 36-week (once a week). Calculating the clinical effective rate, mycological clearance rate, the scoring clinical index of onychomycosis, the onychomycosis severity index and the dermatology life quality index before and after treatment. Recording the patient's adverse reactions and satisfaction. Collecting diseased nail tissue for fungal culture. Results Sixty-eight patients were recruited, and the clinical effective rate was 66.1%; the mycological clearance was 82.4%. The clinically effective and the mycological clearance of 2^nd-5^th toenail affected patients were higher. Except for slight pain, burning and erythema, all patients were tolerated. 76.47% of the patients were satisfied with the treatment effect. The life quality improved significantly before and after. Conclusion 5% amorolfine liniment is a safe and effective approach for distal lateral subungual onychomycosis, and can be used for patients who resist or are not suitable for systemic medication.

The effect of microevolution on the interaction between Trichosporon assahii and mice macrophage RAW264.7

PENG Zhuoying, LIAO Yong, YANG Xin, ZHANG Qianyu, YANG Rongya

2021, 16(2):  96-100. 

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Objective To study the effect of microevolution on the interaction between T.asahii and mice macrophage RAW264.7. Methods The original strain (TO) and the evolutional strain (TEVO) were co-cultured with RAW264.7 respectively, then detecting the differences of RAW264.7 phagocytosis and killing the two strains, and the cytotoxicity of the two strains on RAW264.7; analyzing the changes of the cytokines which were secreted by RAW264.7. Results The phagocytic capacity and killing rate of RAW264.7 to TO were significantly higher than that of TEVO. TO had stronger cytotoxicity to RAW264.7 than TEVO. When RAW264.7 and strains were co-cultured with 1:3 or 1:6 for 24h, the secretion of TNF-α and IL-6 by macrophages which co-cultured with TO were higher than that of TEVO, while the secretion of cytokines in TEVO group were higher than that of TO group when co-cultured at 1:9. Conclusion The interaction between the evolutional strain with macrophage was significantly weaker than the original strain which provides a good basis for the long-term coexistence of the evolutional strain in the host.

Antifungal effect of pyrogallic acid combined with azoles on Candida

ZHANG Guanyi, YAO Dongting, HU Xiaobo

2021, 16(2):  101-105. 

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Objective To understand the drug sensitivity of clinical strains of Candida glabrata and the antifungal effect of pyrogallic acid combined with azoles on Candida. Methods One hundred and sixteen clinical isolates of Candida glabrata, 49 strains of Candida albicans,42 strains of Candida tropicalis, 4 strains of Candida krusei, and 13 strains of Candida parapsilosi were collected and tested for drug susceptibility using ATB FUNGUS3 drug sensitivity test strip. At the same time, the antifunal effect of pyrogallic acid combined with azoles on Candida was detected by the checkerboard broth dilution method. Results Of the 116 strains of Candida glabrata, 14.66%(17 strains) were resistant to fluconazole, 22.41%(26 strains) were non-wild-type for itraconazole and 81.03%(94 strains) were non-wild-type for voriconazole. The antifunal effect of pyrogallic acid on 5 kinds of Candida, the MIC value of 46.55% Candida glabrata was 64 μg/mL, the MIC value of 34.69% Candida albicanswas 64 μg/mL, and the MIC value of 59.52% Candida tropicaliswas 64 μg/mL, 25% grams of Candida MIC value of 128 μg/mL, 46.15 Candida nearly MIC value of 128 μg/mL. When azole drugs were combined with pyrogallic acid, 100%, 99.14% and 99.14% of Candida glabrata showed synergistic or additive effects on fluconazole, itraconazole and voriconazole respectively, and there was no significant difference(P>0.05), while Candida albicans,Candida tropicalis, Candida krusei, and Candida parapsilosits all showed irrelevant and antagonistic effects. Compared with the drug alone, 81.03%, 68.1% and 77.59% of Candida glabrata decreased the MIC values of fluconazole, itraconazole, and voriconazole by 2-3 concentration gradients, and there was a statistical difference between drug-resistant and non-resistant groups(P<0.05). Conclusion Candida glabrata hadresistance to azoles, and non-wild-type strain of voriconazole has the highest proportion. When pyrogallic acid was used alone, the antifunal effect of Candida glabrata among the 5 groups of Candida was better, and the antifunal effect of the sensitive group was more significant than the drug-resistant group. The combination of pyrogallic acid and azoles significantly reduced the MIC value of Candida glabrata drugs, and the effect of the drug-resistant group was more significant than that of the non-resistant group, providing experimental evidence for the treatment of clinical Candida glabrata infection by integrated Chinese and western medicine.

Dynamic changes of blood routine and immune function in patients with fungal esophagitis during antifungal therapy

ZHANG Chunmei, ZHAO Ting, HE Xiaoli, PENG Lei

2021, 16(2):  106-110. 

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Objective To analyze the dynamic changes of blood routine and immune function in patients with fungal esophagitis. Methods Fourty-two cases of mycotic esophagitis in our hospital were included in the experimental group, and the patients were given fluconazole and clotrimazole antifungal treatment; 42 cases of reflux esophagitis in the same period were included in the control group, and given routine treatment. Blood routine examination and immune function monitoring were carried out dynamically in the two groups at the time of admission, 1, 3, 5, 7 and 14 days after treatment. During the treatment, adverse reactions were observed. Results During the treatment, the white blood cell count in the experimental group showed a downward trend, while the percentage of neutrophils showed an upward trend; in the control group, the white blood cell count showed a downward trend, and there were no significant changes in the neutrophil count. There were significant differences in WBC count among the groups on 1 d, 3 d, 5 d, 7 d, 14 d after treatment (P<0.05); on admission, on 1 d, 3 d, 5 d, 7 d, the neutrophil comparison between the groups was significant (P<0.05), while on the 14th day of treatment, there were no significant differences in the percentage of neutrophils among the groups (P>0.05). CRP levels in the experimental group and the control group showed a downward trend, and there were significant differences between the two groups on the 1st, 3rd, 5th, 7th and 14th days of treatment (P<0.05); the IgM and IgG of the experimental group and the control group were increased, and the differences between the two groups were statistically significant (P<0.05). Conclusions Most of the patients with fungal esophagitis had decreased immune function and neutrophil ratio. During the treatment, routine blood test and dynamic monitoring of immune function could provide clinical basis for curative effect evaluation of patients with fungal esophagitis.

Short articles

Application of PAS staining and fungal fluorescence staining in the diagnosis of subcutaneous mycoses

XU Yan, ZHANG Lian, ZHONG Baiyu, ZHANG Jing, ZHAI Zhifang

2021, 16(2):  111-112. 

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Efficacy of long-term antibacterial materials combined with miconazole nitrate cream in the treatment of tinea pedis

HE Chunfeng, GAO Jian, LIU Wenhong, MA Weimin, REN Runxia, CHEN Li, DU Hua

2021, 16(2):  113-115,120. 

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Guideline interpretation

The interpretation of the 2019 global guideline for the diagnosis and management of mucormycosis: ECMM and MSG ERC

LIANG Guanzhao, LIU Weida

2021, 16(2):  116-120. 

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Case reports

A case report of Alternaria alternate-induced cutaneous alternariosis in a patient with pulmonary sarcoidosis

GUO Yanyang, HAI Luming, SUN Xiaoran, YAN Dong, ZHU Guannan, WANG Lei, WANG Gang, FU Meng

2021, 16(2):  121-124. 

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Female, 61-year-old, diagnosed with pulmonary sarcoidosis and treated with oral glucocorticoid for a period of 7 months. She was presented with red plaque in both dorsal hands and wrists for 3 months. Histology revealed mild acanthosis, mixed infiltration of neutrophils, lymphocytes, plasma cells and multinuclear giant cells was found in the superficial and middle dermis. Importantly, Scattered yeast-like structures with thick wall were noted in dermis. Irregular swollen hyphae and yeast-likes spore with thick wall were observed in Grocott's stain. In addition, brownish greycolony was isolated from the lesion. Brown septate spores were observed under microscopy. The colony was identified as Alternaria alternate by ITS sequencing. Oral itraconazole(200 mg/day) and topical sertaconazole nitrate cream (twice per day) were prescribed for 4 months. The lesions were subsided and no flare at half year follow-up.

Trichosporon asahii sepsis in a patient with acute myeloid leukemia and literature review

YE Li, GAO Lingsu, DING Meiqi, WANG Lu

2021, 16(2):  125-127. 

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A case of acute leukemia with high fever during myelosuppression stage after chemotherapywas treated by broad-spectrum antibiotics. But high fever arose again after the patient's body temperature being improved. The first febrile blood culture result showed Streptococcus mitis/Staphylococcus. Trichosporon asahii was found in the second febrile blood culture. Serum cryptococcal antigen test (immunocolloidal gold method) was positive, chest CT showed lung infection. After the addition of domestic voriconazole, the body temperature once dropped and rose again. The patient who switched to imported voriconazole did not have fever again, and continued to take voriconazole orally. After 2 months, the chest CT lung lesions improved.

A case of disseminated Talaromyces marneffei

WU Rongqun, XU Wenying, LI Lili, CHEN Xingchun, WEI Haiming, XIE Zhi

2021, 16(2):  128-130,140. 

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A 32-year-old man was admitted because of recurrent episodes of lymphadenectasis, fever and skin rashes for two years. Broad-spectrum antibiotics and anti-tuberculosis therapy were ineffective. Lung CT showed multiple nodules in both lungs and the serum was positive for anti-IFN-γ. Disseminated Talaromyces marneffei was diagnosed by skin biopsy, lymph node biopsy, lung biopsy. Amphotericin B liposome combined with voriconazole had a good therapeutic effect.