世界卫生组织真菌重点病原清单的启示

世界卫生组织于2022年10月制定了首份真菌重点病原清单,旨在加强全球对真菌感染和抗真菌药物耐药性的响应,关注并推动进一步的研究和政策干预。该真菌重点病原清单及其制定过程对于我国病原真菌及侵袭性真菌病（IFD）工作具有新的重要的启示作用：应加强我国IFD的公共卫生干预措施;进一步提高我国IFD及病原真菌的实验室检测与临床监管能力;有针对性地增加投资与支持以用于IFD诊疗和防控的创新性研发。     

中国人群哮喘和环境真菌关系的研究进展

真菌是引起哮喘的重要过敏原之一,已证实真菌感染与哮喘之间存在密切关系。目前我国有关真菌与哮喘的研究中,多为临床医生对疾病的发病机制与诊断治疗等方面的相关研究,仅从个体角度出发研究真菌与哮喘的关系,存在较多局限性。本文基于公共卫生的角度,将我国国内开展的真菌致哮喘的发病机制、真菌相关哮喘疾病的流行病学分布特征、环境中真菌浓度水平的监测以及相应的防治措施等研究加以总结,从人群的角度探讨真菌与哮喘的关系。     

病原真菌基因组流行病学研究进展

基因组流行病学研究为病原真菌的遗传进化、传播和表型研究提供了新的视角, 其核心技术是全基因组测序技术和生物信息学分析, 极大地弥补了传统分子分型技术的不足。通过将病原真菌的全部遗传信息和流行病学调查相结合, 能够预测病原真菌的传播途径和传播风险, 为制定真菌防控的公共卫生策略提供理论基础。本文将对分子流行病学、基因组流行病学的发展以及基因组流行病学在病原真菌的遗传关系、溯源及进化、耐药性以及毒力、全基因组关联分析等方面的应用进行综述, 并对病原真菌基因组流行病学未来发展做出展望。     

病理学标本中检出61例真菌感染病例的调查研究

目的调查61例真菌感染病例的菌型分布、感染部位及感染诱因,为防治真菌机会感染提供依据. 方法对61例真菌感染病例的年龄、性别、原发基础疾病、感染病原真菌、感染部位、感染诱因等进行病例统计与分析. 结果 61例病例经组织化学PAS糖原染色镜检确认为真菌感染;61例患者均有不同程度的原发基础疾病,均有慢性炎症史,其中鼻窦炎发病率最高(62.3%);患者均使用过广谱抗生素,种类为2～9种,使用时间最长者达>90 d;病原真菌以曲霉菌属为主(49.2%),白色念珠菌次之(26.1%). 结论真菌感染呈逐年上升趋势,要重视真菌的检测,以早期发现、有效地控制真菌感染.     

216株深部酵母样真菌感染分布及耐药性分析

目的了解医院住院患者深部常见酵母样真菌感染的病种分布及对常用抗真菌药物的耐药特点,为临床合理选用抗真菌药物提供依据。方法采用法国科玛嘉念珠菌显色培养基鉴定真菌菌种,采用酵母样真菌药敏试剂盒(微量稀释法)进行体外药敏试验,应用WHONET5.4软件对药物敏感试验的数据进行分析。结果引起深部真菌感染最常见的酵母样真菌为白色假丝酵母菌,占56.5%,热带假丝酵母菌、光滑假丝酵母菌、近平滑假丝酵母菌和克柔假丝酵母菌分别占14.8%、12.5%、8.8%和5.1%,另有5株酵母样真菌未鉴定到种水平。该216株酵母样真菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑的耐药率分别为3.2%、3.7%、7.9%、8.8%和6.0%。结论白色假丝酵母菌和热带假丝酵母菌是引起深部真菌感染最常见的酵母样真菌,目前对常用抗真菌药物耐药现象不十分严重,但对唑类抗真菌药耐药应引起足够重视。医院应加强对抗真菌药物的耐药性监测,以指导临床的合理用药。     

323株酵母样真菌的分离鉴定与耐药性分析

由于临床抗生素、免疫抑制剂和激素的广泛使用，以及各种器官移植术的普遍开展，使免疫功能低下的人群不断增加。从而使得各种条件致病菌的感染有增加的趋势。其中也包括真菌感染的增加。同时随着抗真菌药物的使用，真菌也象细菌一样产生了耐药性。为了解真菌感染与耐药状况，我们对分离自临床标本的323株酵母样真菌进行了鉴定及耐药性测定。     

568例临床真菌培养标本结果分析

近年来,由于临床上皮肤病的日渐增多,真菌感染率也有所上升.2003年我们对568例真菌送检标本,进行了真菌培养和鉴定,通过对结果分析有192例浅部真菌、70例念珠菌属感染,真菌感染有上升趋势,而临床医生对此重视不够.     

医院真菌感染及研究进展

近年来 ,由于医学领域各项技术的飞速发展和广泛应用 ,使各种重症患者的病死率有所下降 ,但同时也使各种严重免疫缺损患者的数量显著增加 ,他们受到相对较弱侵袭性微生物感染的机会俱增 ,尤其是机会真菌的感染。深部真菌感染在医院真菌感染中占重要地位 ,其发病常有多种诱因 ,诱因可以来自体内 ,也可来自体外。目前 ,从总体来看 ,我国对真菌引起的医院感染还缺少具体评价 ,对真菌感染检验、监测、控制水平和普及、重视程度与真菌感染的发病情况相比还较为滞后。本文对医院真菌感染研究现状 ;真菌感染类型 ;感染真菌致病性的确定原则 ;真菌感…     

2012-2014年医院获得性深部真菌感染的临床分布及药敏结果

摘要:目的 对医院获得性深部真菌感染的临床分布及药敏结果进行分析,为临床医院感染防控及合理用药提供依据。方法 对2012年1月至2014年12月某三甲医院经实验室证实的深部真菌感染病例检出的真菌菌株信息、药敏结果以及相关临床信息进行收集、整理、分析。结果 共检出医院获得性深部真菌267株,来源于264例患者;患者年龄大于60岁占78.11%,死亡34例（病死率为12.88%）。标本来源以血标本（37.08%）与痰标本（34.83%）为主。病例来源前四位的科室为:重症医学科、急诊科、老年病房和血液内科。白色假丝酵母菌对各种抗真菌药物耐药率普遍要低,光滑假丝酵母菌与热带假丝酵母菌对三唑类抗真菌药物均耐药性较高。结论 重症医学科、急诊科、老年病房和血液内科是医院获得性深部真菌感染防控的重点科室。目前,真菌耐药的问题没有达到细菌耐药的严重程度,但非白色假丝酵母菌对抗真菌药物的耐药性,尤其是三唑类药物的耐药情况应引起足够关注。     

酵母样真菌感染及对氟康唑药敏结果分析

目的 了解酵母菌引起的深部真菌感染菌种分布，用氟康唑对其进行药物敏感监测。方法 选择氯化三苯四氮唑(TTC)培基上不同颜色菌落，用API20AUX做菌种鉴定；用纸片扩散法与微量稀释法测定分离菌对氟康唑的敏感性。结果 295株酵母样真菌中，白色念珠菌179株、热带念珠菌51株、近平滑念珠菌42株，三者占酵母样真菌分离率的92％，药敏结果显示，氟康唑除对3株光滑念珠菌全部耐药外，对其余菌株MIC值均在0．125～4μg／ml之间。结论 目前临床深部真菌感染以白色念珠菌、热带念珠菌和近平滑念珠菌等为主，且对氟康唑有较好的体外抗菌活性。     

肺结核患者合并医院真菌感染的相关因素分析

目的 探讨肺结核患者合并医院真菌感染的菌种分类及感染相关危险因素,为临床预防和治疗真菌感染提供参考依据.方法 回顾性调查156例肺结核合并医院真菌感染患者的病案资料,真菌培养与药敏试验按照《全国临床检验操作规程》进行.结果 肺结核患者真菌感染部位以呼吸道感染率最高,占67.3％;主要病原性真菌为白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌,分别占61.5％、15.4％、8.3％;真菌感染的危险因素为患者原发结核病的严重程度、年龄、住院天数、接受多种侵入性诊疗操作等.结论 临床医师应采取干预措施,预防肺结核患者发生医院真菌感染.     

血培养中真菌的分布及耐药性分析

目的了解医院24个月住院患者血培养中分离真菌的分布及耐药性。方法患者血培养标本经BacT/AlerT120血培养仪培养,分离所得菌株用法国生物-梅里埃公司API20c AUX系统进行鉴定和K-B法做药敏。结果在4135份标本中,分离菌株110株,阳性率为2.7%,其中居前3位的真菌为白色念珠菌(29%)、热带念珠菌(21%)、葡萄牙念珠菌(9%),检出菌数量居前3位的病区为肝胆科(25%)、脑外科(24%)、急救部(10%)。结论真菌感染在临床呈上升趋势,对真菌感染和耐药监测很重要。     

Potential transmission pathways of clinically relevant fungi in indoor swimming pool facilities

Possible transmission pathways of fungi in indoor swimming pool facilities were assessed through fungal counting in different areas of the facilities and typing of the collected fungal isolates. Air, water and surface samples were collected from seven different indoor swimming pool facilities. Fungal species were identified based on their internal transcribed spacer (ITS) sequences. Maximum fungal concentrations of 6.2?CFU/cm², 1.39?CFU/100?mL, and 202?CFU/m³ were found on surfaces, in water and air, respectively. In total, 458 isolates were obtained, belonging to 111 fungal species, of which 50 species were clinically relevant. Phialophora oxyspora (13.3%) and Trichosporon dohaense (5.0%) were the most frequently isolated species and were merely detected on floors, as were the dermatophytes, Trichophyton interdigitale and T. rubrum. Penicillium spp. and Aspergillus spp. were the dominant fungi in water and air. No typical patterns of fungal concentrations along the preferential pathways of pool visitors were observed, however, sites where pool visitors converge while moving from one room (e.g. dressing room) to another (e.g. shower room) and walking barefoot displayed the highest fungal concentrations thus posing the highest risk of contamination. The dispersal of fungi on floors is most likely facilitated by the pool visitors and cleaning tools. Clinically relevant fungi, including the ones rarely identified in nature, were widely detected on floors, in water and in air, as well as on cleaning tools and flexibeams. Preventive measures such as cleaning should minimize the prevalence of clinically relevant fungi in swimming pool facilities since these potentially pose health risks to those vulnerable for infections.     

Keratinolytic fungi in sewage sludge applied to devastated urban soil. A preliminary experiment

The qualitative and quantitative (q/q) changes of keratinolytic fungi in soil mixtures with added sewage sludge were examined during a preliminary reclamation experiment. Sludge before land application was characterized by the weak growth of keratinolytic fungi. In devastated urban soil, abundant fungal growth was observed. Over a 19‐month reclamation period, decreasing frequency of Chrysosporium concurrent with the enrichment of the mixture with the geophilic dermatophytes Arthroderma quadrifidum and A. uncinatum were clearly seen. The results are discussed with respect to possible ecological factors influencing the occurrence of keratinolytic fungi in the materials examined. The public health risk associated with the application of sewage sludge for reclamation is also discussed.     

Exposure to airborne fungi, MVOC and mycotoxins in biowaste-handling facilities

Health impacts due to fungi in indoor air can only be estimated reliably, if both fungal propagules and fungal secondary metabolites are qualified and quantified. In the present study, the fungal species composition in a compost facility is compared to the spectrum of microbial metabolites in the air with regard to the physiological properties of different fungal species. A number of relevant fungi was tested for the production of both volatile and non-volatile metabolites on different substrata. The profiles of mycotoxins and microbial volatile organic compounds (MVOC) turned out to be specific for certain species in pure culture. Consequently, the fungi may have different toxicological health impacts, though information on the relevance of microbial volatiles is still limited.     

Fungal contamination of air conditioning units in operating theatres in India

Postoperative fungal infections may be caused by discharge of spores from contaminated air conditioning (AC) units. The filters of such units may act as a nidus for the growth of fungi. In this survey, filters of AC units in 25 operating theatres in India were evaluated quarterly over two years. The overall rate of fungal colonization of the AC filters was 26%. In addition, window-mounted AC units had higher fungal counts than wall-mounted AC units. We conclude that although the exact load of fungal spores necessary to initiate infections is unknown, AC units in operating theatres should be meticulously maintained and frequently monitored to minimize the chances of growth and proliferation of potentially pathogenic fungi. Data from this study also suggest that the design of the AC unit may play an important role in reducing fungal spore counts in the air of operating theatres in developing countries.     

抗菌药物使用继发酵母样真菌感染的调查与耐药性分析

目的 调查抗菌药物继发院内真菌感染的情况,以减少继发真菌感染的发生.方法 对2007-2008年使用抗菌药的住院患者为试验组进行真菌培养,对照组为入院抗菌药物使用前的临床标本.结果 应用抗菌药物继发真菌感染达35.5%,占同期真菌感染的80.9%,白色假丝酵母菌为主要致病菌,占59.8%;感染部位以呼吸道最多;药敏试验结果,两性霉素B敏感率85.1%;酮康唑敏感率最低,为54.0%,其他药物耐药性也有所增加.结论 使用抗菌药物的住院患者酵母样真菌感染率高,与对照组比较有差异,出现了不同程度的耐药株,提示临床临床选用抗菌药物注意真菌继发感染,治疗真菌感染应以培养和药敏试验为依据.     

Drug resistance in human pathogenic fungi

Since the therapy of the mycoses, particularly the systemic mycoses, is relatively long-term in nature, emergence of resistance to antifungal drugs during the treatment of period would be of considerable clinical importance. However, most reports of resistance to antifungal agents among human pathogenic fungi indicate that naturally-occurring resistance is very rare, and that the induction of resistant mutants or variants is much more difficult to achieve in vitro and in vivo than with bacteria. As a matter of fact, amphotericin B and some other classic antifungals have not as yet posed a broadly significant problem relative to drug resistance despite their widespread and frequent use. Fungal resistance has thus received little attention, in contrast to the critical importance of bacterial resistance frequently caused by a variety of antibacterial chemotherapeutic agents, until a single exception to this generalization arose with the advent of flucytosine. This new development has aroused great interest in the problem of fungal resistance among the scientists involved with medical mycology. It is generally believed that fungi, like bacteria, are intrinsically capable of developing resistance to antifungal agents. As illustrated by flucytosine, inherently resistant mutants to antifungals occur within sensitive strains of human pathogenic fungi with significant frequency. Given the relatively high degree of such primary resistance, these mutants should develop secondary resistance during therapy, thus resulting in considerable limitations in the clinical usefulness of the antifungals. Virtually, all unsuccessful cases of mycoses treated with some of the recently exploited antifungal drugs, albeit scarce to date, would obviously be attributable to the occurrence of secondary resistance. The exploitation of new antifungal drugs thus requires investigations of their resistance as one of the most important research projects to be undertaken before receiving approval for use on humans. This paper reviews from various aspects the literature on resistance to various classic and novel antifungal agents among human pathogenic fungi. The resistance of some nonpathogenic fungi to these agents will also be described from genetic and biochemical points of view.