Aspergillus fumigatus endocarditis in a pediatric liver transplant recipient: favorable outcome without cardiac surgery

Abstract:  Transplant recipients are very susceptible to invasive aspergillosis, which increases mortality rate. Disseminated aspergillosis in the liver transplant recipient can affect virtually any organ and endocarditis is often lethal despite cardiac surgery and antifungal therapy. We report the case of a eight-month-old girl who presented with Aspergillus fumigatus endocarditis 18 days after liver transplantation that was successfully treated by a combination of antifungal drugs associated to a low dosage of immunosuppressive therapy.     

48株眼科分离真菌的抗真菌药物敏感性测定

目的研究眼科分离真菌对常用抗真菌药的敏感性.方法测定5种抗真菌药物两性霉素B(AmB)、克霉唑(CMZ)、咪康唑(MKZ)、酮康唑(KCZ)、氟康唑(FCZ)对4种48株眼科分离真菌茄病镰孢菌14株、串珠镰孢菌12株、黄曲霉菌12株、烟曲霉菌10株的最小抑菌浓度(MIC)范围、MIC50,MIC90,以及不同菌量、不同pH值对MIC值的影响.结果AmB抑菌作用居5种药物之首;CMZ,MCZ的作用强度基本相同,次于AmB;KCZ药效比以上3种稍差;FCZ则对4种菌的体外抑制作用不显著.当培养基的pH值在6～8之间时,药物的抑菌作用无明显变化.改变接种量,CMZ,MCZ,KCZ的MIC值随菌量减少而变小,但AmB,FCZ的抑菌作用则无明显变化.结论5种抗真菌药物对4种48株眼科分离真菌的体外抑制作用强度依次为AmB＞CMZ,MCZ＞KCZ＞FCZ.     

伊曲康唑增强义齿软衬材料抗菌性的研究

目的:义齿佩带者常见口腔问题是念珠菌性义齿性口炎的发生,而义齿软衬材料的使用可增加义齿性口炎的易感性。本研究拟探讨在软衬材料中加入伊曲康唑后对抗菌性的影响。方法:选用德国梅卡硅橡胶室温固化软衬材料、COE SOFT软衬材料、日进软衬材料、自凝软衬垫等四种材料。抗真菌药物伊曲康唑分别按0%、3%、6%、9%(W/W)药物/试件的比例加入各材料中,分别制成标准试件后通过培养方法监测材料对白色念珠菌标准株的抗菌性以及时相关系。结果:在4种材料中,加入伊曲康唑试件对念珠菌的抑制性能较之同种未加入伊曲康唑者均有增加,具有统计学差异。不同材料中加入药物后,其抗菌性有一定的时间差异,但都在第6~8 d后抗菌性明显减低。6%W/W药物材料比例试件测试结果与9%者差异无统计学意义,但与0%或3%比较,抗菌效果增加。结论:无论何种材料,其表面念珠菌的生长抑制作用均与药物浓度有关,随着时间的推移,高浓度药物的材料对念珠菌生长抑制作用衰退较慢,但一定时间后,药物作用无明显差异;加入6%的浓度时即可达到有效抑菌作用。提示在软衬材料中加入伊曲康唑可作为暂时性软衬材料短期使用时预防义齿性口炎的积极措施。     

Terbinafine‐resistant strain of Trichophyton interdigitale strain isolated from a tinea pedis patient

Trichophyton interdigitale is an anthropophilic species that is frequently isolated from tinea unguium and tinea pedis throughout the world. In the present study, antifungal susceptibility testing was performed on T. interdigitale isolates from Japanese patients (isolated in 2017–2018; 24 strains) to assess itraconazole (ITZ) and terbinafine (TRF) susceptibility of these strains. E‐test determinations revealed that the mean ITZ minimum inhibitory concentration (MIC) of the 24 strains was 0.023 mg/L (range, 0.064–1). Clinical Laboratory Standards Institute M38‐A2 determinations revealed that the mean TRF MIC of 23 of the 24 strains was less than 0.03125 mg/L. Among these strains, one (NUBS18016) had a TRF MIC of 2 mg/L, confirming its resistance to TRF. The predicted amino acid sequences of the squalene epoxidase (SQLE) gene from the TRF‐resistant strain (NUBS18016) was 100% identical to the SQLE gene sequence of the reference strain T. interdigitale, indicating that no gene mutations were present in NUBS18016. Therefore, the TRF‐resistance mechanism of our TRF‐resistant strain NUBS18016 has not been defined. Dermatologists should be cautious about the prevalence of foot dermatophytosis due to antifungal drug‐resistant strains.     

Comparison of in vitro activities of 11 antifungal agents against Trichophyton verrucosum isolates associated with a variety hosts and geographical origin

The high prevalence of dermatophytosis in animals is usually associated with extra expenditure on prevention, diagnosis and long-term treatment. Humans are usually infected from animals, also from asymptomatic carriers, through direct contact or indirectly via fungus-bearing hair, scales and fomites. Despite the medical importance of Trichophyton verrucosum infections, there are limited in vitro data on the fungal susceptibility to antifungal drugs, including new-generation triazoles, imidazoles and allyloamines. The aim of the current study was to evaluate comprehensively the in vitro activity of 11 antifungal drugs against a large collection of T. verrucosum isolates obtained in Poland, Latvia, Lithuania and Slovakia from humans and animals using a microdilution assay. In vitro susceptibility testing of 11 antifungal drugs was performed according to the Clinical and Laboratory Standards Institute (CLSI) document M38. The MICs of clotrimazole, ciclopirox, enilconazole, miconazole, naftifine and terbinafine against all T. verrucosum isolates were below 1 μg/mL, whereas those of fluconazole, griseofulvin, itraconazole, ketoconazole and voriconazole were above 1 μg/mL. Ciclopirox was demonstrated to have superior activity against all strains in comparison with the other drugs, whereas fluconazole exerted the weakest in vitro effect and exhibited the highest MIC values. Our study has shown that drugs of different chemical origin have satisfactory antifungal activity and can be promising candidates for the treatment of T. verrucosum dermatophytosis. Moreover, no significant disparity in drug sensitivity between isolates obtained from different hosts and geographical regions have been demonstrated.     

Immunosuppression in the Management of Presumed Non-infective Uveitis; Are We Sure What We are Treating? Notes on the Antimicrobial Properties of the Systemic Immunosuppressants

ABSTRACT

Purpose

To describe the antimicrobial effects of immunosuppressants used for presumed autoimmune uveitis, and to discuss the potential importance of these effects in the context of increasing knowledge of the human microbiomes and their influence on inflammation.     

Efficacy of long‐term treatment with efinaconazole 10% solution in patients with onychomycosis,including severe cases: A multicenter,single‐arm study

We evaluated the efficacy of efinaconazole 10% topical solution in long‐term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE‐t, suggested that efinaconazole treatment improved the patients’ quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long‐term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.