Table of Content

28 February 2023, Volume 18 Issue 1

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Original articles

Meta-analysis of trimethoprim-sulfamethoxazole combined with caspofungin in the treatment of Pneumocystis jirovecii pneumonia

DUNA Yan, XU Yuan, YANG Changqing, ZHANG Jinping

2023, 18(1):  1-7. 

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Objective To systematically evaluate the efficacy and safety of trimethoprim-sulfamethoxazole (TMP/SMZ) combined with caspofungin in the treatment of Pneumocystis jirovecii pneumonia (PJP). Methods PubMed, Embase, Cochrane library, CBM, CNKI, Wanfang, VIP were searched for clinical randomized controlled trials of TMP/SMZ combined with caspofungin in the treatment of PJP, and Meta-analysis was performed. The outcome indicators were total effective rate, incidence of adverse reactions Statistical analysis was performed using RevMan 5.4 software. Results A total of 20 studies were included, involving 1 802 PJP patients. Meta-analysis results showed that compared with TMP/SMZ monotherapy, the effective rate of TMP/SMZ combined with caspofungin in the treatment of PJP was significantly improved, [RR =1.29, 95% CI (1.22,1.37),P< 0.00001], and no Increase the incidence of adverse drug reactions [RR =0.91,95% CI(0.79, 1.05),P=0.21>0.05]. Conclusion The effect of TMP/SMZ combined with caspofungin in the treatment of PJP is better than that of TMP/SMZ monotherapy, without increasing adverse drug reactions, and it is recommended for clinical use.

Characteristics and risk factors of fungal infection after urinary surgery

YAN Qiu, LIU Hong

2023, 18(1):  8-11,18. 

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Objective To investigate the characteristics and risk factors of postoperative fungal infection in urinary system. Methods The clinical data of 762 patients with urinary system diseases who underwent urological surgery in our hospital from June 2017 to may 2021 were retrospectively analyzed. According to whether they had urinary system and blood fungal infection after operation, they were divided into infection group (n=75) and non infection group (n=687). The clinical data of the two groups were compared, and univariate analysis and logistic regression analysis were performed. Results 75 of the 762 patients had postoperative fungal infection, the incidence was 9.84%. The main disease type was urinary calculi, the main pathogen was Candida, and the main indwelling catheters were DJ tube and catheter; Among 75 cases of fungal infection after urinary system operation, 69 cases were asymptomatic, 5 cases had frequent urination, urgency and pain, and 1 case had chills, fever and low back pain. The results of univariate analysis showed that the proportion of age >65 years, open operation, operation time ≥ 30 min, drainage tube retention time >7 d, antibacterial drug use time ≥ 3 d in the infection group was higher than that in the non infection group (P<0.05), and the blood glucose level and CRP level in the infection group were higher than those in the non infection group (P<0.05); Logistic multivariate analysis showed that age (OR=1.604), operation method (OR=1.139), catheter retention time (OR=2.537), blood glucose level (OR=2.753), antibacterial drug use time (OR=2.508) and CRP (OR=3.057) were independent risk factors for fungal infection after urinary surgery (P<0.05). Conclusion The common pathogen of postoperative fungal infection in urinary system was Candida and most of them had no clinical symptoms. The common disease was urinary calculi. The common catheters indwelling were DJ tube and catheter. Age >65 years old, open surgery, catheter retention time >7 d, elevated blood glucose level, more than 3 d use of antibiotics, and elevated CRP were independent risk factors for postoperative urinary fungal infection, which need targeted intervention.

Distribution of pathogenic yeast species of vulvovaginitis and its epidemiological characteristics

ZHOU Yihua, DENG Shuwen, ZHANG Lu, ZHANG Hong, ZHAO Rongfen, WANG Yufeng, SUN Yanxia, ZHU Hui

2023, 18(1):  12-18. 

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Objective To investigate the epidemiological characteristics of vulvovaginitis caused by different yeast spp. Methods Totally 1 083 yeast isolates were collected from patients with vulvovaginal candidiasis (VVC). These isolates were identified to the species level according to the genes of 26S rRNA D1/D2 domain. The clinical characteristics VVC cases caused by these different species were analyzed. Results The results showed that Candida albicans remain the prodominent species(71.38%) causing VVC, while Non-candida albicans (NAC) account for 28.62% among which C.glabrata account for 19.02%. The risk factors included 20-40 years of age, being married,and pregnancy. NACs were more often isolated in pregnant women. The incidence of recurrent vaginal candidiasis caused by non-albicans Candida were higher. Conclusion Routine culture of secretion from VVC patients, molecular identification to species level of VVC causative agents, and identification of non-albicans Candida species would help clinicians to explore an effective therapy for VVC.

Experimental study on the in vitro antibacterial activity of Medi hair spray dressing against Malassezia

GAO Ruijia, LIU Shirui, SUN Jinpeng, FAN Jinghua, LI Fuqiu

2023, 18(1):  19-23,41. 

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Objective Two in vitro drug sensitivity test methods, ager plate diffusion method (punch method) and microliquid-based dilution method, were used to observe the in vitro antibacterial activity of Medi hair spray dressing and its main components(Microbial antimicrobial peptide) against common Malassezia on the surface of seborrheic dermatitis lesions of the head. Methods Medi Hair Spray Dressing with different concentration, microbial antimicrobial peptide were used as the experimental group, and Caile lotion (concentration 2% ketoconazole lotion), blank solvent of Medi Hair Spray Dressing were used as the control group,and the diameters of the inhibition zone were compared in each group. The inhibitory effect on Malassezia in vitro was tested by agar plate diffusion method (punch method) and microdilution method, and the MIC (minimum inhibitory concentration) values were also determined. Results Medi Hair Spray Dressing and microbial antimicrobial peptide inhibited Malassezia to varying degrees in vitro,and the effect was positively correlated with drug concentration. Medi Hair Spray Dressing MIC was 0.977 μL/mL;microbial antimicrobial peptide MIC was 3.907 μL/mL. Conclusion Medi Hair Spray Dressing is safe,and has a better inhibition of Malassezia effect.

A retrospective analysis of cases caused by Rhodotorula mucilaginosa

ZHU Xinlin, LI Chen, HU Dongying, CHEN Xianzhen, CHEN Tianyang, CHEN Tiancheng, LIAO Wanqing, CHEN Min, PAN Weihua

2023, 18(1):  24-32. 

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Objective To analyze epidemiological and clinical characteristics of infections caused by Rhodotorula mucilaginosa, and to provide a scientific basis for improving the clinical diagnosis and treatment of R. mucilaginosa infections. Methods Using the methods of literature review and meta-analysis to analyze retrospectively the information of patient's nationality, sex and aged composition, risk factors, onset organs, diagnostic and therapeutic methods and prognosis of R. mucilaginosa worldwide in the past two decades. Results A total of 45 related literatures were included, including 60 cases of patients infected by R. mucilaginosa. R. mucilaginosa infections was most common in Europe. The gender ratio of the infection host was 1.68:1, predominantly in people aged 0-10 years and 40-50 years, and the blood system was the most commonly affected site. Most patients had underline diseases or other risk factors such as trauma and surgery, and there was no early specific symptom with chief complaints of fever. Diagnosis of R. mucilaginosa infections mainly relied on culture. The mortality rate was as high as 12.5%, except in patients with unknown prognosis. Conclusion The incidence of R. mucilaginosa infections has increased recently worldwide. The most commonly affected site was blood system, and the diagnosis mainly depends on culture. Strengthening the in vitro antifungal susceptibility monitoring and the studying of epidemiology for R. mucilaginosa are benefical to improve the clinical diagnosis and prognosis of R. mucilaginosa infections.

Clinical value of rapid on site evaluation in the diagnosis of pulmonary cryptococcosis

WANG Hansheng, CHEN Dan, REN Tao, YOU Hui, WEI Na, LUO Guoshi, WANG Meifang

2023, 18(1):  33-37,57. 

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Objective To explore the accuracy and timeliness of rapid on-site evaluation site (ROSE) in the diagnosis of pulmonary cryptococcosis by percutaneous lung biopsy. Methods A retrospective analysis of 25 cases of percutaneous lung biopsy pathologically diagnosed as pulmonary cryptococcus, including patient imaging, ROSE and pathological diagnosis results, time-consuming, and diagnosis costs was performed. Results Based on the final diagnosis, and the accuracy, sensitivity, and specificity of ROSE were 80%, 80%, and 100%, respectively. The average time for the issuance of ROSE and pathology reports were (10±1) min and (81±1.4) h, respectively; the diagnosis cost were 220 and 450 yuan, respectively. Conclusion ROSE had high accuracy and timeliness in the diagnosis of Cryptococcus neoformans pneumonia, and economic cost savings. It is worthy of application and promotion in the diagnosis of cryptococcus neoformans pneumonia in respiratory intervention.

Efficacy and safety of Meifute^® antifungal solution combined with Feijia^® antifungal solution in the treatment of onychomycosis

XU Xiaoguang, YIN Jiankai, LIU Zhu, ZHENG Rui, LIU Weida, WEN Hai

2023, 18(1):  42-46. 

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Objective To evaluate the efficacy and safety of Meifute^® antifungal solution combined with Feijia^® antifungal solution in the treatment of onychomycosis. Methods From December 2020 to November 2022, 120 patients were enrolled in Fumei Outpatient Departments for this study. First of all, a single-session soak in Meifute^® antifungal solution was used to treat tinea pedis; and then, diseased nails were treated with Feijia^® antifungal solution once a week for 28 weeks routinely; finally, another time of Meifute^® antifungal solution treatment was given to consolidate the effect. Efficacy and safety evaluation was performed after treatment, and a questionnaire survey of treatment satisfaction was carried out after the completion of the treatment course. Results Finally 112 patients completed the study and 588 nails were included. Efficacy and satisfaction:overall effective rate was 58.0% (341/588), the cure rate was 20.6% (121/588), and the comprehensive satisfactory rate was 93.8% (105/112). The efficacy of the first toenail (52.9%) was lower than that of other toenails (60.7%). And there was no significant difference in the clinical response rate between DLSO (56.6%) and TDO (61.4%). Safety:The adverse reactions were all local symptoms, such as subungual hemorrhage (2 cases), exfoliation of epidermis around nails (4 cases), mild redness and swelling of skin (6 cases), mild to moderate burning or tingling (16 cases) after soak. All patients could tolerate the process without serious adverse reactions. Conclusion The use of Meifute^® antifungal solution combined with Feijia^® antifungal solution is simple, effective, safe, and highly compliant in the treatment of onychomycosis, so it can be regarded as a clinical alternative treatment for onychomycosis.

Case reports

Combination of fractional ablative carbon dioxide laser and photodynamic therapy in Sporotrichosis treatment: A case report

ZHAO Mingdan, HUANG Mengya, WANG Jinshu, ZHOU Xun

2023, 18(1):  47-48,70. 

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A 62-year-old women came to our hospital because of nodules on the right hands for six months, nodules on the right arms for three months. A diagnosis of sporotrichosis was made based on typical manifestations, including positive fungal culture, histopathological and genetic examinations. Daily oral itraconazole combined with fractional laser and photodynamic therapy three times, that case was cured after one month.