Chinese Journal of Mycology

Guidelinesforthe diagnosis andtreatment oftinea corporis andtinea crurisin China

The Working Group on Guidelinesforthe Diagnosis and Treatment of Tinea corporis and Tinea Crurisin China

2023, 18(3): 193-197.

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Pathogenic distribution characteristics of fungal bloodstream infection in Sichuan Province from 2019 to 2021

DENG Jin, YIN Lin, JIANG Haiyan, KUANG Linghan, PENG Xi, YANG Xianggui, NI Sujiao, ZHANG Bangqin, FENG Jinfang, WANG Yanling, MA Yushan, CHEN Zongyao, ZHONG Hanyu, WU Xianli, LI Kun, WANG Ling, GAO Wei, YANG Xueqiang, ZHU Jun, CHEN Yu, ZHANG Xian, SUN Changjun, LUO Jun, LI Yumei, LI Yan, ZHANG Bin, XIE Ning, WANG Jun, XIE Yi, KANG Mei

2023, 18(3): 198-204,210.

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Objective To collect the fungal bloodstream infection data from the Sichuan Provincial Center of China Fungal Disease Surveillance System, to analyze the distribution characteristics and the susceptibility to antifungal drugs of pathogens, and to provide epidemiological data for fungal bloodstream infections in Sichuan Province. Methods The data of outpatient, emergency, and inpatient fungal bloodstream infections in 28 hospitals from January 1, 2019, to December 31, 2021, were studied. The clinical and laboratory data of fungal bloodstream infection were analyzed using Whonet 5.6 and Microsoft Excle pivot table. information. Results From January 1, 2019, to December 31, 2021, Candida accounted for 88.8% (1083/1 220) of the 1 220 fungal strains was reported by 28 hospitals. Candida albicans was the main species, accounting for 35.3% (431/1 220).and Cryptococcus neoformans being fifth in the total number of isolates, accounting for 8.3% (101/1 220). Males accounted for 56.6% (690/1 220), and female patients were less (43.4%, 530/1 220); 79.8% cases were middle-aged and elderly patients (>46 years old) and 34.8% cases were from the intensive care unit. C. albicans had the highest sensitivity to fluconazole (85.7%); resistance rates of C.tropicalis to fluconazole and voriconazole were 43.4% and 43.3%, respectively. by C. albicans isolates were dominated in Most hospitals, however, C. parapsilosis was mostly isolated in children's specialized hospitals. Conclusion The pathogens of fungal bloodstream infection and their antifungal drug susceptibility have regional characteristics. Accurately grasping the epidemiological data in the region can provide a basis for the clinical selection of antifungal drugs.

Diagnostic value of quantitative real-time PCR in bronchoalveolar lavage fluid for HIV-negative talaromycosis marneffei

LIAO Liuwei, PAN Kaisu, LI Bingkun, ZHENG Dongyan, CAO Cunwei, ZHENG Yanqing

2023, 18(3): 205-210.

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Objective To determine the loads of Talaromyces marneffei (TM) in bronchoalveolar lavage fluid (BALF) of the patients with non-HIV-infected talaromycosis marneffei (TSM) by quantitative real-time PCR (qPCR) and to evaluate the diagnostic value of it. Methods A total of 17 cases of non-HIV-infected TSM patients with pulmonary infection symptoms and 33 cases of patients with other fungal infections in the lung or non-infected patients were collected from The First Affiliated Hospital of Guangxi Medical University from September 2019 to June 2022. Samples of blood and BALF were collected from every patient at the same time. Extracting DNA from their BALF and serum, and then using qPCR to measure the loads of TM in these samples. Fungal culture of BALF was performed at the same time. Results In 17 cases of TSM, only 11.8% (2/17) of these cases were positive for qPCR measured in serum, but the positive rate of BALF qPCR was 90.0% (9/10) in patients with positive BALF fungal culture. Besides, there were 2 cases with positive BALF qPCR test results but with negative fungal culture of TM using the same sample. All the serum and BALF qPCR of other fungal infections in the lung or non-infected patients in this study were negative. In the TSM group, the median Cq value for BALF qPCR detection was 31.40 cycles (range 20.71-35.59). The qPCR showed a substantial agreement with the gold standard (kappa:0.708) and superiority to the fungal culture (kappa: 0.653) and directly microscopy-examined (kappa: 0.220). Conclusion This study showed that using qPCR to measure the loads of TM in BALF could have a high value in the early diagnosis of non-HIV-infected TSM patients with pulmonary infection symptoms.

Analysis of pathogen distribution pattern and clinical features of 124 cases of otomycosis in Guangzhou

XIANGJieying, XU Zhiping, WANG Rong, XU Jianrong, XIE Zhenmou, XUE Yaohua

2023, 18(3): 211-215.

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Objective To analyze the clinical characteristics and pathogen distribution of 124 cases of otomycosis in Guangzhou. Methods The clinical data of one hundred and twenty-four patients diagnosed with otomycosis and positive fungal cultures from the otorhinolaryngology department of Guangzhou First People's Hospital between January 2020 to January 2022 were retrospectively analyzed. Results The 124 patients were mainly 18-40 years old (78/124, 62.9%). Unclean ear picking (55/124, 44.4%) and frequent use of earphones (45/124, 36.3%) were the main factors for causing otomycosis. The most common clinical feature was pruritus (96/124, 77.4%), followed by fluid/pus, hearing loss, pain and tinnitus. A total of 94 strains of Aspergillus (94/124, 75.81%) were isolated, including 37 strains of Aspergillus terreus (29.8%) and 34 strains of Aspergillus niger(27.4%). Moreover, 19 strains of Candida (15.3%), 5 strains of Penicillium (4.0%), 5 strains of Malassezia (4.0%) and 1 strain of Trichophyton rubrum (0.8%) were isolated. Unclean ear picking was positively correlated with Aspergillus infection (P<0.05), hearing loss and pain were positively correlated with Aspergillus infection (P<0.05), and ear canal pruritus was positively correlated with Candida infection (P<0.05). Conclusion Aspergillus and Candida were the main fungal pathogens of otomycosis, and Malassezia was the opportunistic pathogen of otomycosis. There was an association of clinical features with pathogen distribution pattern,which should be caused by clinical attention.

Direct microscopy of fluid aspirated from bursa or joint is helpful for early diagnosis of protothecal bursitis or protothecal arthritis

XIE Xinzhe, LU Sha, CAI Wenying, ZHANGJunmin, LI Jiahao, LIN Li, XI Liyan

2023, 18(3): 216-220.

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Objective To investigate the early diagnosis value and clinical application of direct microscopy of fluid aspirated from bursa or joint for diagnosing protothecal bursitis or protothecal arthritis. Methods In this paper, we reported a case of Prototheca wickerhamii infective interdigital arthritis admitted in our department in March 2022, and then we reviewed the literatures about protothecal bursitis or protothecal arthritison published in PubMed, CNKI and Wanfang Database from January 1, 1964 to May 31,2022. We analyzed the main etiological examination methods in different patients and the early diagnostic value of direct microscopy of fluid aspirated from bursa or joint. Results After selection, 18 articles (21 cases) conforming to the aim of the study were included. The main etiological examination methods included fungal culture and histologic examination, while fungal direct microscopy was often ignored.Among the 22 patients, only 2 patients underwent both direct microscopy and fungal culture, 18 patients underwent fungal culture without direct microscopy, and the remaining 2 patients were diagnosed by histologic examination without direct microscopy and fungal culture. Conclusions Direct microscopy of fluid aspirated from bursa or joint is helpful for early diagnosis of protothecal bursitis or protothecal arthritis.It deserves attention and promotion caused it lacks properly clinical application.

Analysis of clinical features and death-related risk factors of Candida bloodstream infection

YANG Yang, ZHANG Xiaoli, WANGJianmin, GONG Xue

2023, 18(3): 221-225.

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Objective To explore the clinical features of Candida bloodstream infection. Methods The clinical data of 62 patients diagnosed with Candida bloodstream infection in our hospital from January 2017 to December 2021 were collected, and the distribution of pathogen, clinical characteristics and risk factors of death were analyzed. Results A total of 65 strains of fungi were isolated from 62 patients with Candida bloodstream infection, mainly distributed in the intensive care unit (33 strains), urology (7 strains) and hematology (6 strains) departments; the strains were Candida albicans (29.2%), Candida glabrata (26.2%), Candida parapsilosis (21.5%), and Candida tropicalis (18.5%), and the overall non-susceptibility rate to fluconazole was 38.5%. Among 62 patients with Candida bloodstream infection 34 died, and the mortality rate was 54.8%; Univariate analysis showed that admission to intensive care unit, mechanical ventilation, combined lung infection, severe hypoalbuminemia, and no antifungal therapy within 48 hours after positive blood culture were associated with mortality (P<0.05). Logistic regression analysis showed that severe hypoalbuminemia(OR=7.924,95% CI 1.851~34.599,P=0.006) and failure to initiate antifungal therapy within 48 hours after the initial blood culture report(OR=6.828,95% CI 1.377~33.852,P=0.019) were independent risk factors for death. Non-albicans Candida infection was the main, and severe hypoalbuminemia was an independent risk factor for death in patients with Candida bloodstream infection. Early antifungal therapy was important for patient prognosis. Conclusion Candida bloodstream infection patients were characterized by multiple comorbidities and high mortality.

mNGS-assisted diagnosis ofcutaneousinfectious granuloma caused byfungi

YANG Qiuhong, HUANG Xin, YUAN Xiaoying

2023, 18(3): 226-228,231.

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Comparison offungalfluorescence staining and PASstaininginthe diagnosis of pulmonarycryptococcus

PAN Lianlian, ZHU Chen, MEI Yong

2023, 18(3): 229-231.

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Pathogenic distribution andriskfactor analysis of COPD patients with secondary pulmonaryfungalinfections

ZHANG Peiyun, DUN Jun, LUO Xinyue, HENG Xin, WANG Songping

2023, 18(3): 232-235,245.

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Talaromyces marneffei infection in a suspected healthy host: a case report and literature review

LIU Huanjun, GUO Shuxia, WANG Yanmei, XU Xiaoyan

2023, 18(3): 236-240.

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A 28-year-old male patient was admitted to the hospital because of "half a month of abdominal pain". After a week of anti-infection treatment at the local clinic, he was transferred to our hospital. Physical examination revealed that several enlarged lymph nodes could be palpable bilaterally in the subjaw, subchin and neck, with a maximum of 30mm×30mm, toughness, smooth surface and good range of motion. There was no rash. Auscultation of the heart and lungs was normal. The abdominal wall was tough, the middle and upper abdomen was tender. There was no rebound pain and muscle tension, the mass could be touched, located in the left middle and upper abdomen, the maximum was about 60mm×40mm, not easy to move. The liver and spleen were not touched under the ribs. Bowel sounds were normal, and there was no edema in both lower limbs. Lymph node biopsy, next generation sequencing (NGS) and other related examinations were completed to confirm the diagnosis of Talaromyces marneffei infection. Amphotericin B was micropumped for nearly half a month, and then voriconazole was used intravenously for half a month. After discharge, oral voriconazole was continued for 2 months. The immune function of the patient was normal and there was no underlying disease. Three months later, the patient reexamined and the results showed that there was no swelling of the superficial lymph nodes. The abdomen was soft, without tenderness, rebound pain and muscle tension, and no abdominal mass was touched. Abdominal CT showed that the lymph nodes were reduced and the range was reduced. The condition improved significantly and was under follow-up.

Two cases of pulmonary cryptococcosis diagnosed by metagenomic next-generation sequencing

YU Ke, WU Lili, HUANG He, ZHANG Min, DENG Haiyan

2023, 18(3): 241-245.

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Pulmonary cryptococcosis is one of the most common pulmonary fungal infections. It lacks clinical and imaging specificity and is easy to be misdiagnosed and missed. The diagnosis of pulmonary cryptococcosis mostly depends on etiology and histopathology. The metagenomic next-generation sequencing technology that has emerged in recent years provides new ideas for the early and rapid diagnosis and treatment of infectious diseases. This article reports the clinical characteristics and the process of diagnosis and treatment of 2 cases of pulmonary cryptococcosis patients, with no previous immunocompromised diseases and no complaining of respiratory symptoms. Physical examination found no obvious signs, chest computed tomography (CT) scan showed a round solid nodules in the outer area of the lung field. They were finally diagnosed rapidly by the the metagenomic next-generation sequencing(mNGS) technology of bronchoalveolar lavage fluid and received treatment on time.

Bloodstream infection caused by Prototheca wickerhamii:a case report and review of the literatures

ZHANG Xu, LI Chen, PAN Juan, LI Zuyi, NIE Ge

2023, 18(3): 246-249,253.

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A 44-year-old male farmer presented with erythematous plaques of the whole body, diffusely infiltrated erosions on his left leg and fever. Smooth, creamy-white, yeast-like colonies grew from skin biopsy specimen and blood specimen after 72 h of incubation. Electron microscopy demonstrated 'morula' or daisy-like appearance of its endosporulating sporangia. These findings were consistent with a diagnosis of protothecosis. The patient was treated with fluconazole and itraconazole but finally died. This case and the literature review will increase the knowledge of this pathogen.

A case of chromoblastomycosis caused by Fonsecaea monophora

MA Shanshan, LI Jin, LU Weiping, HUANG Qing, LEI Xia, LI Min

2023, 18(3): 250-253.

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To report a case of chromoblastomycosis caused by Fonsecaea monophora in Chongqing. An 81-year-old male patient came to our hospital with ulcer and pain for more than one year after the skin on the inner side of his left upper arm was cut by an iron piece. Histopathological examination and fungal culture were performed on the skin lesions of the patients, and the cultured colonies were identified by morphology and molecular biology methods. Colony morphology: dark brown and black colonies were observed. Microscopically, cladosporium and rostrum sporulation were observed. Histopathological examination of the lesions showed chronic granulomatous changes. Sequencing of the internal transcribed spacer (ITS) region was identified as Fonsecaea monophora. According to the laboratory culture results and clinical data analysis, this case was identified as chromoblastomycosis caused by Fonsecaea monophora. Oral itraconazole 200mg twice a day, combined with drug application topically and photodynamic therapy was effective.

A case of Prototheca wickerhamii infection in lower limbs

ZHAO Yue, LING Yong, OUYANG Feng, QUE Manfang

2023, 18(3): 254-256,260.

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A 39-year-old man was found to have reduced blood cells during physical examination 8 years ago. Cyclosporine and prednisone were taken for a long time, after undergoing bone marrow, flow cytometry and other examinations to diagnose paroxysmal nocturnal hemoglobinuria (PNH). More than 2 months ago,his left lower extremity was scratched, accompanied by ulceration, redness, swelling and pain. Recently he had been admitted to the hospital and immune indicators were reduced, accompanying by secondary hyperglycemia. Wound tissues and secretions were taken for pathological examination and pathogenic testing. Piperacillin/tazobactam was used for empirical anti-infective therapy. After being diagnosed with Prototheca wickerhamii infection, the antibiotic was replaced by amphotericin B according to antimicrobial susceptibility testing. The dosage of the 1st day was 1 mg, the 2nd to 4th days were 10mg and 5th-10th days were 25 mg once a day. Due to elevated creatinine,the dosage was reduced to 15 mg every other day and wound care was performed at the same time. At last, there was no obvious inflammatory secretion and the wound had healed, when re-examining one month later.

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