Search Results (87)

Superficial fungal infections (SFIs) remain a common dermatological issue in the pediatric population, with varying prevalence across regions and age groups. This study aimed to assess the epidemiology of SFIs among children and adolescents in northern Poland in the years 2019 to 2024. A retrospective analysis was conducted on 1237 patients under 18 years of age who underwent direct mycological examination and culture, due to suspicion of SFIs. Data were evaluated based on age, gender, infection site, fungal species identified, and place of residence. The prevalence of SFIs in the studied population was 21.4%. The most frequently isolated fungi were Microsporum canis and Trichophyton rubrum complex. Infection patterns varied by age: tinea capitis and tinea cutis glabrae predominated in younger children, while adolescents were more affected by tinea pedis and onychomycosis. A higher proportion of positive results was observed in rural patients, although more urban dwellers were tested. Species distribution also varied with gender and place of residence. No significant change in SFI prevalence or pathogen profile was observed over the study period. This study provides updated insights into the epidemiology of SFIs in Polish children, highlighting the influence of demographic and environmental factors. The findings underscore the importance of accurate diagnosis and suggest a need for further research into behavioral and socio-economic contributors to infection patterns. Full article

Tinea incognito is an incorrectly diagnosed form of fungal infection due to a changed clinical picture as a result of systemic or topical corticosteroids or even local immunomodulators. This type of skin lesion is most often located on the trunk but can affect any part of the body. We present a case report of 76-year-old woman with a history of systemic lupus erythematosus who was admitted to hospital because of extensive, painful, and burning erythematous and papular lesions in an annular pattern, covered with a thick, yellow crust, located on the scalp and neck. The skin lesions were accompanied by extensive hair loss. The patient had previously undergone intensified treatment of the underlying disease due to the exacerbation of skin lesions of a subacute cutaneous lupus erythematosus type. A suspicion of tinea incognito was raised, and direct mycological examination and culture confirmed the presence of dermatophytes (Microsporum spp.). Tinea incognito can be difficult to diagnose because the clinical picture is relatively nonspecific and can mimic other dermatoses, such as subacute lupus erythematosus. Therefore, in doubtful cases it is necessary to perform a direct test and culture for fungal infection, especially before initiating treatment with glucocorticosteroids and other immunosuppressive agents. Full article

The EORTC/MSGERC definition lacks sufficient sensitivity for diagnosing invasive pulmonary aspergillosis (IPA) in patients with autoimmune inflammatory rheumatic diseases (AIIRDs). We hypothesized that the partial fulfillment of the EORTC/MSGERC definition can improve its diagnostic sensitivity. This retrospective observational study included patients with AIIRDs on immunosuppressive therapy who underwent serum galactomannan antigen testing for suspected IPA. Patients who fulfilled the clinical features or mycological evidence as per the EORTC/MSGERC definition were considered as having “potential IPA.” We compared the clinical characteristics of 364 patients who were categorized into 3 groups—potential IPA (n = 29), proven/probable IPA (n = 24), and non-IPA (n = 311; not meeting any definition). The potential and proven/probable IPA groups had significantly lower survival rates than the non-IPA group (p < 0.001). The potential IPA (adjusted hazard ratio [aHR], 2.0; 95% confidence interval [CI], 1.1–3.8) and proven/probable IPA (aHR, 2.6; 95% CI, 1.4–4.9) were independent risk factors for mortality. Compared with the EORTC/MSGERC definition, our proposed criteria improved sensitivity based on the diagnosis at the end of observation (50.0%, 100.0%, respectively). The characteristics and mortality rates of patients were similar between the potential and proven/probable IPA groups. Using these criteria for clinical diagnosis may provide high sensitivity. Full article

(1) Background: T. rubrum is the most important agent in tinea pedis, tinea manuum, tinea cruris, tinea corporis, and even in subcutaneous dermatophytosis. T. rubrum must overcome several obstacles to adhere, grow, and invade the host, for which their virulence factors are important. Previous studies have demonstrated the capability of T. rubrum strains to produce proteases, phospholipases, hemolysins, and elastases. The aim of this work was the genotypic identification of clinical isolates of T. rubrum to subsequently determine production of the main phenotypic virulence factors associated with this pathogen responsible for different types of dermatophytosis in Mexican patients. (2) Methods: Twenty samples of T. rubrum were obtained from different body parts of patients treated in the Mycology section. The colonies were transferred to specific agars to analyze the production of phenotypical virulence factors (lipase, phospholipase, hemolysin, and elastase). (3) Results: Almost all the strains of T. rubrum showed growth in the test culture medium. A significantly smaller size of the halo diameter of elastase (26.51 ± 11.95 mm) in comparison to lipase (59.51 ± 16.00 mm) and phospholipase (55.97 ± 19.60 mm) was measured. Additionally, a significantly reduced size of the halo diameter of hemolysin (42.01 ± 5.49 mm) was observed compared to lipase. When comparing the virulence factors, greater expression of lipase was observed, followed by phospholipase, hemolysins, and elastase. T. rubrum strains were classified as being between high and ultra-lipase producers; most of the strains were also considered low producers of phospholipase and hemolysins; and most of the strains (n = 13) were classified as non-producers of elastase. (4) Conclusions: Almost all the T. rubrum strains of the study were found to be ultra-producers of lipase, and low producers of hemolysins and phospholipases. Elastase was the least expressed virulence factor in these strains. Full article

Background: Superficial candidiasis (SC) is widespread in humans worldwide. This study aimed to evaluate species distribution patterns and antifungal susceptibility through cluster analysis. Methods: A total of 180 Candida strains isolated from skin and nail samples of 1593 examined patients with suspected superficial fungal infection were identified by Matrix-assisted laser desorption in ionization-time of flight mass spectrometry (MALDI-TOF MS; Zybio EXS2600, China). Antifungal susceptibility was assessed using the commercial Integral System YEASTS Plus test (ISYPT; Liofilchem^®, Italy). Agglomerative hierarchical cluster analysis was used to analyze species distribution and susceptibility. Results: Candida parapsilosis (44.4%) and C. albicans (40%) were the most prevalent causative agents of SC. Cluster analysis established two defined clusters. Cluster 1 (121 isolates) showed a statistically significant difference compared to Cluster 2 (54 isolates) in species distribution (C. albicans was dominant in the first and C. parapsilosis in the second cluster) as well as in susceptibility to ECN (p ≤ 0.001), KCA (p = 0.030), CLO (p ≤ 0.001), MCZ (p ≤ 0.001), ITZ (p ≤ 0.001), and FLU (p ≤ 0.006). Conclusion: The fact that one-third of isolates exhibited low sensitivity to antifungals highlights the need for a new approach in SC treatment, emphasizing the importance of mycological analyses, including in vitro testing of antifungal effectiveness. Full article

Background: Trichophyton indotineae terbinafine-resistant infections are emerging in healthy individuals. Luliconazole, an imidazole antifungal that is effective against skin infections, faces challenges due to low water solubility and poor skin penetration. This study aimed to formulate a luliconazole-loaded nanostructured lipid-carrier (NLC) gel in a Carbopol-based system to enhance drug absorption and efficacy in a guinea pig model of dermatophytosis. Methods: Luliconazole-loaded nanostructured lipid carriers (NLCs) were prepared using a solvent evaporation method and gel formulation. Skin absorption and retention were assessed via Franz diffusion cells. The antifungal efficacy was tested against T. indotineae in thirty guinea pigs with induced tinea corporis, divided into five treatment groups. Mycological, clinical, and histopathological evaluations were conducted, along with skin irritation studies for safety. Results: LCZ-NLC demonstrated significantly better skin penetration than simple luliconazole gel, with cumulative drug penetration of 71.8 ± 3.7 μg/cm² versus 50.9 ± 4.2 μg/cm² after 24 h. Both formulations achieved complete infection resolution after 21 and 28 days, with reduced inflammation and no local irritations. On day 21, the LCZ-NLC 1% gel significantly reduced lesion scores and mycological evidence of infection compared to the terbinafine-treated groups, untreated controls, and NLC-gel-treated group (p < 0.05). Histopathological analysis indicated a reduction in both epidermal thickening and fungal burden in the models that received treatment with the LCZ-NLC 1% gel. Conclusions: Luliconazole-loaded lipid carriers enhance drug absorption and efficacy, suggesting shorter treatment durations and improved patient outcomes for resistant fungal infections. However, further studies are warranted to correlate these findings with clinical outcomes. Full article

Background/Objectives: Invasive pulmonary aspergillosis (IA) is a common infectious disease in patients with hematological diseases. The prevention, early detection, and establishment of treatment strategies for IA are important. The serum galactomannan antigen (GM) mycological test for IA diagnosis, included in the mycology criteria of the European Organization for Research and Treatment of Cancer-Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), is widely used because of its high sensitivity and specificity. However, false-positive results are a concern. Methods: We retrospectively analyzed all GM tests performed at our department in the clinical practice setting between April 2003 and January 2012. Results: Of the 330 cases and 2155 samples analyzed, 540 (25%) were positive (≥0.5). Among the underlying diseases, positivity rates were the highest for multiple myeloma (MM), with 61.3%. By type, positivity rates for IgG, IgA, Bence-Jones protein, and IgD were 71.7%, 33.3%, 57.1%, and 34.6%, respectively. Seventeen out of eighteen cases that were GM-positive at MM diagnosis were false positives, according to the 2008 EORTC/MSG criteria. The IgG and GM values were not directly correlated. Of the seventeen false-positive cases identified, two developed IA during anti-myeloma treatments, and GM values did not become negative during the treatment in most cases. Conclusions: Although subclinical IA may be included in a higher GM index, the results may be prone to false positives; particularly in IgG-type MM, the results should thus be interpreted cautiously. Full article

Conventional diagnosis of fungal infections of the skin, nail, and hair requires both expertise in mycology and prolonged cultures. We evaluated a new molecular tool based on an innovative technology, the DendrisKIT^®DP, combining a pan-fungal PCR, a DNA chip and a decision algorithm using machine learning, for the diagnosis of superficial fungal infections directly from clinical samples. It enables the simultaneous detection of Candida albicans and twelve dermatophytes, providing faster results than conventional techniques. Among 85 clinical samples (50 skin scrapings, 29 nail specimens, and 6 hair specimens) routinely tested by microscopic examination and cultures that were retrospectively tested by the DendrisKIT^®DP, we found a sensitivity of 83.9% and a specificity of 88.9%. This performance appeared satisfactory compared to microscopy and culture, and results were achieved much faster than with cultures, saving time for patient management. Moreover, thanks to the continuous improvement in the identification algorithm due to enriching the database, its performance is likely to be further enhanced. Full article

The identification of species within filamentous fungi is crucial in various fields such as agriculture, environmental monitoring, and medical mycology. Traditional identification methods based on morphology have a low demand for advanced equipment usage and heavily depend on manual observation and expertise. However, this approach may struggle to differentiate between species in a genus due to their potential visual similarities, making the process time-consuming and subjective. In this study, we present an AI-based fungal species recognition model that utilizes deep learning techniques applied to time-lapse images. The training dataset, derived from fungi strains in the IBT Culture Collection, comprised 26,451 high-resolution images representing 110 species from 35 genera. The dataset was divided into a training set and validation subsets. We implemented three advanced deep learning architectures—ResNet50, DenseNet-121, and Vision Transformer (ViT)—to assess their effectiveness in accurately classifying fungal species. By utilizing images from early growth stages (days 2–3.5) for training and testing and later stages (days 4–7) for validation, our approach shortens the fungal identification process by 2–3 days, significantly reducing the associated workload and costs. Among the models, the Vision Transformer achieved the highest accuracy of 92.6%, demonstrating the effectiveness of our method. This work contributes to the automation of fungal identification, providing a reliable and efficient solution for monitoring fungal growth and diversity over time, which would be useful for culture collections or other institutions that handle a large number of new isolates in their daily work. Full article

Clinical and mycological data are essential for the optimal management of patients with Candida vaginitis (CV), particularly in cases of (i) azole-resistant C. albicans vaginitis, (ii) recurrent CV, and (iii) CV in pregnant women. The present retrospective single-center study investigated the antifungal activity of six commonly used antifungals against randomly selected vaginal isolates recovered from 68 pregnant women in Adana, Türkiye, including C. albicans, petite C. glabrata, non-petite C. glabrata, and C. krusei, using the disk diffusion method at pH 4 and 7. Furthermore, the antifungal activities of fluconazole and itraconazole were also assessed using the broth microdilution method. For all isolates, the mean inhibition zone diameters were narrower for itraconazole and ketoconazole and larger for miconazole at pH 4 than pH 7 (p < 0.05). For nystatin, zone diameters were wider in C. albicans and petite C. glabrata at pH 4 (p < 0.001 and p < 0.001). Remarkably, clotrimazole was more active at pH 4 than at pH 7, except against non-petite C. glabrata isolates. Based on the broth microdilution results, the resistance rate was higher at pH 4 than at pH 7 in all isolates. Candida glabrata petite isolates exhibited MIC values 2 to 5 times higher than those of the non-petite isolates for both fluconazole and itraconazole. This study highlights the potent activity of topical antifungals (miconazole, nystatin, and clotrimazole) for the treatment of CV in pregnant women and highlights the need to identify petite and non-petite mutants of vaginal C. glabrata isolates to obtain more reliable data and for antifungal susceptibility testing prior to decision-making. The results of the two antifungal susceptibility methods were compared for C. albicans and C. glabrata isolates, and the reliability of the disk diffusion test was discussed. Full article

Microsporum canis, a zoophilic dermatophyte, infects the stratum corneum and keratinized tissues like hair and nails in cats and dogs, with cats serving as the primary reservoir. Most human infections arise from animal contact. We present the case of a girl aged 8 with skin scalp lesions persisting for two months. Several scalp lesions, with a maximum diameter of 4 cm, presented as erythematous plaques with superficial scaling, yellow crusts, and edematous areas with purulent exudate. Dermoscopy revealed yellow crusts on an erythematous background, along with white scales, pustules, broken hairs, and comma hairs. Ultraviolent-enhanced fluorescence dermoscopy (UEFD) showed slight celadon green fluorescence, which enhanced the diagnosis and further helped to monitor the treatment. The PCR test confirmed the presence of M. canis. Treatment included topical ciclopirox and oral terbinafine. Lesions on the scalp and noticeable hair regrowth were observed in the areas of hair loss after two months. Kerion celsi can result in severe alopecia. To prevent scarring associated with hair loss in children, early mycological diagnostics, supported by dermoscopy and UEFD, is recommended. Full article

Chlorinated and fluorinated nitrophenols (HNCs) are widely used in agriculture and industry, with a global market valued at USD $25 billion, one which is expected to grow by 5% by 2030. However, these compounds pose significant environmental risks; they are classified as toxic by the International Agency for Research on Cancer (IARC). Existing treatment methods include advanced oxidation, adsorption, and bioremediation, though to date, there has been only limited research on fungal remediation of these halogenated pollutants. This study aims to explore a sustainable approach by using fungi’s potential to degrade HNCs in minimal media. Ten fungi were selected through literature screening; Caldariomyces fumago and Curvularia sp. were highly effective, degrading over 50% of 2-chloro-4-nitrophenol (2C4NP) and 80% of 5-fluoro-2-nitrophenol (5F2NP) within 24 and 48 h, respectively. Additionally, five strains showed degradation potential for fluorinated compounds. Further studies revealed C. fumago could degrade up to 1 mM of chlorinated compounds and 12 mM of fluorinated compounds, far exceeding any known environmental concentrations of HNCs; importantly, ecotoxicology tests demonstrated reductions in toxicity of 77% and 85%, respectively. This work highlights fungi’s underexplored ability to degrade toxic HNCs, offering a sustainable mycoremediation strategy and positioning mycology as a critical tool for future environmental remediation efforts. Full article

Background: Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in patients with haematological malignancies. Accurate diagnosis of IA is challenging due to non-specific symptoms and the impact of antifungal prophylaxis on biomarker sensitivity. Methods: This retrospective study evaluated the diagnostic performance of three serum biomarkers: Aspergillus Galactomannan Ag VirClia Monotest^® (VirClia), Wako β-D-Glucan Test^® (Wako BDG), and MycoGENIE Real-Time PCR^® (MycoGENIE PCR). True positives were defined as patients with proven or probable IA (n = 14), with a positive Platelia Aspergillus Antigen^® (Platelia) serving as a mycological criterion. True negatives were identified as patients with a positive Platelia assay but classified as non-probable IA (n = 10) and outpatients who consistently tested negative with the Platelia test throughout the study period (n = 20). Results: Most patients diagnosed with proven or probable IA were acute myeloid leukaemia or myelodysplastic syndrome patients receiving mould-active antifungal prophylaxis or treatment (71%). VirClia demonstrated high sensitivity (100%) for detecting IA, with a specificity of 83%. Wako BDG and MycoGENIE PCR showed lower sensitivities for IA (57% and 64%, respectively). MycoGENIE PCR detected Aspergillus spp. and Mucorales in two patients. Conclusions: Accurate diagnosis of IA remains challenging, especially in patients who have received mould-active antifungal treatment. VirClia showed comparable performance to Platelia, suggesting its potential for routine use. However, Wako BDG and MycoGENIE PCR results were less favourable in our study cohort. Nevertheless, MycoGENIE PCR detected two probable co-infections with Aspergillus spp. and Mucorales. Full article

Onychomycosis is a recalcitrant fungal infection of the nail unit that can lead to secondary infections and foot complications. Accurate pathogen identification by confirmatory testing is recommended to improve treatment outcomes. In this study, we reviewed the records of 710,541 patients whose nail specimens were sent to a single molecular diagnostic laboratory between 2015 and 2024. PCR testing revealed a more comprehensive spectrum of pathogens than previously reported, which was corroborated by the demonstration of fungal invasion on histopathology. Consistent with our current understanding, the T. rubrum complex (54.3%) are among the most common pathogens; however, a significant portion of mycology-confirmed diagnoses were caused by the T. mentagrophytes complex (6.5%), Aspergillus (7.0%) and Fusarium (4.5%). Females were significantly more likely to be infected with non-dermatophytes molds (NDMs; OR: 2.0), including Aspergillus (OR: 3.3) and Fusarium (OR: 2.0), and yeasts (OR: 1.5), including Candida albicans (OR: 2.0) and C. parapsilosis (OR 1.6), than males. The T. mentagrophytes complex became more prevalent with age, and conversely the T. rubrum complex became less prevalent with age. Patients aged ≥65 years also demonstrated a higher likelihood of contracting onychomycosis caused by NDMs (OR: 1.6), including Aspergillus (OR: 2.2), Acremonium (OR: 3.5), Scopulariopsis (OR: 2.9), Neoscytalidium (OR: 3.8), and yeasts (OR: 1.8), including C. albicans (OR: 1.9) and C. parapsilosis (OR: 1.7), than young adults. NDMs (e.g., Aspergillus and Fusarium) and yeasts were, overall, more likely to cause superficial onychomycosis and less likely to cause dystrophic onychomycosis than dermatophytes. With regards to subungual onychomycosis, Aspergillus, Scopulariopsis and Neoscytalidium had a similar likelihood as dermatophytes. The advent of molecular diagnostics enabling a timely and accurate pathogen identification can better inform healthcare providers of appropriate treatment selections and develop evidence-based recommendations. Full article

Candida parapsilosis is a common cause of non-albicans Candida species causing candidemia, particularly invasive candidiasis. This study aimed to characterize candidemia due to the C. parapsilosis complex with serial episodes, including clinical and mycological features. Methods: Blood isolates of the C. parapsilosis complex were collected from February 2019 to January 2023 at a tertiary Korean hospital. Species identification was performed using Vitek 2 or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and antifungal susceptibility testing was performed using the Sensititre YeastOne^® system. Clinical information was collected, and characteristics were analyzed according to single or serial isolates. Results: A total of 586 blood isolates of the C. parapsilosis complex were recovered from 68 candidemia patients during the study period. Of them, only the first isolate per patient was investigated. The only two isolates were resistant to fluconazole and no isolate was resistant to echinocandins, amphotericin B, or 5-FC. A single episode of candidemia occurred in 35 patients, while serial episodes occurred in 33 patients. Underlying liver diseases, use of vasopressors, ICU admission, severe sepsis, and CVC use were more frequent in patients with serial episodes. There was no significant difference in the median MIC values of antifungal agents or the use of azoles or amphotericin B between single and serial episodes. However, patients with serial episodes more frequently received echinocandin therapy. Overall, there was no significant difference in the 30-day mortality rate between patients with single and serial episodes. Conclusion: Our data indicate that several factors related to the underlying conditions of the patients are associated with C. parapsilosis candidemia with serial episodes, rather than the characteristics of Candida itself. Full article