5-aminolevulinic acid-based photodynamic therapy in combination with antifungal agents for adult kerion and facial ulcer caused by Trichophyton rubrum.

Dermatophytosis is the most common fungal infectious disease in the world, which is commonly caused by Trichophyton rubrum in China. The traditional therapies for treating dermatophytosis include topical and oral antifungal agents like terbinafine, griseofulvin, and azole antifungal drugs. However, 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) as a new alternative therapy avoids the side effects and drug resistance of traditional antifungal agents. We report two cases diagnosed as kerion and tinea faciei secondary to ulcers with CARD 9 deficiency, both of whom were infected by T.rubrum. They were both successfully treated by ALA-PDT combined with antifungal drugs, providing a feasible strategy for therapeutic choice for adult kerion and ulcer treatment.

Simultaneous infection with Fusarium proliferatum and Prototheca wickerhamii localized at different body sites.

2012 Elsevier Ltd. All rights reserved. Subcutaneous infections caused by two unusual fungi are rare. Here we report an elderly woman with long-term glucocorticoid use who was infected with Fusarium proliferatum on the right dorsum of the hand presenting with a verrucous plaque and Prototheca wickerhamii on the left dorsum of the hand presenting with geographic ulcers with erythematous plaques. The diagnosis was made through histopathological examination of skin samples and fungal culture, with identification through molecular examination. She was successfully treated with voriconazole.

Metagenomic analysis of viromes in tissues of wild Qinghai vole from the eastern Tibetan Plateau.

Rodents are natural reservoirs of diverse zoonotic viruses and widely distributed on the Tibetan Plateau. A comprehensive understanding of the virome in local rodent species could provide baseline of viral content and assist in efforts to reduce the risk for future emergence of rodent related zoonotic diseases. A total of 205 tissue and fecal samples from 41 wild Qinghai voles were collected. Metagenomic analyses were performed to outline the characteristics of the viromes, and phylogenetic analyses were used to identify the novel viral genomes. The virome distribution among five tissues (liver, lung, spleen, small intestine with content and feces) was also compared. We identified sequences related to 46 viral families. Novel viral genomes from distinct evolutionary lineages with known viruses were characterized for their genomic and evolutionary characteristics, including Hepatovirus, Hepacivirus, Rotavirus, and Picobirnavirus. Further analyses revealed that the core virome harbored by rodent internal tissues were quite different from the virome found in intestine and fecal samples. These findings provide an overview of the viromes in wild Qinghai voles, which are unique and the most common rodent species in the eastern Tibetan Plateau. A high diversity of viruses is likely present in rodent species in this area.

A Knowledge Survey on Health Education of Echinococcosis Among Students - Ganzi Tibetan Autonomous Prefecture, Sichuan Province, China, 2020.

What is already known about this topic?: Previous surveys have mainly focused on how well residents and primary school students have understood the core knowledge of echinococcosis control and are limited in terms of the comprehensiveness of the knowledge category and respondents. What is added by this report?: There were some shortcomings in related knowledge of echinococcosis among students, which showed a tendency to know methods but not the rationale. The differences among regions indicated a lack of a unified system for training educators and allocating comprehensive educational material. What are the implications for public health practices?: The results of this study provide evidence to potentially help improve health education programs in the new phase of echinococcosis prevention and control in China.

Association between tocilizumab treatment and clinical outcomes of COVID-19 patients: a systematic review and meta-analysis.

To explore and summarize the association between treatment with tocilizumab and clinical outcomes in COVID-19 patients. We performed a systematic review and meta-analysis (10 RCTs including 3378 patients in the tocilizumab group and 3142 patients in the control group). We systematically searched PubMed and MedRxiv for all RCTs as of June 1, 2021, to assess the benefits and harms of tocilizumab to treat patients with COVID-19. All analyses were carried out using RevMan version 5.4.1. There were nine RCTs published in peer-reviewed journals and one RCTs published as a preprint. The summary RR for all-cause mortality with tocilizumab was 0.89 (95% CI= 0.82-0.96, P= 0.003). There was no significant between-trial heterogeneity (I2= 28%, P= 0.19). However, all peer-reviewed RCTs showed no significant associations between treatment with tocilizumab and reductions in all-cause mortality. We notably found that tocilizumab significantly reduced the rate of intubation or death in patients with COVID-19 with 3 RCTs. Across the 8 RCTs, the summary RR for discharge with tocilizumab was 1.10 (95% CI= 1.03-1.16, P< 0.00001). There was no significant association of tocilizumab with harm on other patient-relevant clinical outcomes, including increasing secondary infection risk, patients of adverse events, or patients of serious adverse events. Tocilizumab significantly increased the rate of hospital discharges in COVID-19 patients. Still, it did not decrease all-cause mortality or increase the risk of secondary infections, patients of adverse events, or patients for serious adverse events. Evidence that tocilizumab affects clinical outcomes in patients with COVID-19 requires further proof.

Efficacy and secondary infection risk of tocilizumab, sarilumab and anakinra in COVID-19 patients: A systematic review and meta-analysis.

As the pandemic progresses, the pathophysiology of coronavirus disease 2019 (COVID-19) is becoming clearer and the potential for immunotherapy is increasing. However, clinical efficacy and safety of immunosuppressants (including tocilizumab, sarilumab and anakinra) treatment in COVID-19 patients are not yet known. We searched PubMed, Embase Medline, Web of Science and MedRxiv using specific search terms in studies published from 1 January 2020 to 20 December 2020. In total, 33 studies, including 3073 cases and 6502 controls, were selected for meta-analysis. We found that immunosuppressant therapy significantly decreased mortality in COVID-19 patients on overall analysis (odds ratio = 0.71, 95% confidence interval = 0.57-0.89, p = 0.004). We also found that tocilizumab and anakinra significantly decreased mortality in patients without any increased risk of secondary infection. In addition, we found similar results in several subgroups. However, we found that tocilizumab therapy significantly increased the risk of fungal co-infections in COVID-19 patients. This represents the only systematic review and meta-analysis to investigate the efficacy and secondary infection risk of immunosuppressant treatment in COVID-19 patients. Overall, immunosuppressants significantly decreased mortality but had no effect on increased risk of secondary infections. Our analysis of tocilizumab therapy showed a significantly increased risk of fungal co-infections in these patients.

Advances in research on echinococcoses epidemiology in China.

Echinococcoses are serious zoonotic diseases in China's vast, western and north-western pastoral areas that has one of the highest prevalence in the world. The two most common forms, cystic echinococcosis (CE) and alveolar echinococcosis (AE), are co-epidemic in some areas causing a grave threat to people's health and economic development. Echinococcus spp. are transmitted through domestic, sylvatic and mixed cycles involving many kinds of host. Successful transmission requires a favourable environment for the growth of the parasites and survival of their eggs, while the unique customs and religious beliefs in the endemic areas pose a challenge to the prevention and control of these parasites. Based on previous epidemiological studies, this paper reviews the particular factors affecting the transmission of Echinococcus parasites in China, with a focus on biological (parasite genotype and the species, age, sex and density of hosts), environmental (landscape and climate) and social (age, gender, ethnicity, education, occupation, life style, cultural customs, living conditions and hygiene practices of humans in the endemic areas). These three factors interact with each other and jointly determine the parasites' transmission intensity, the study of which supports the formulation of the strategies and measures that are significant for control of these infections.

CARD9 Deficiency in a Chinese Man with Cutaneous Mucormycosis, Recurrent Deep Dermatophytosis and a Review of the Literature.

Deficiency of caspase recruitment domain-containing protein 9 (CARD9) is an autosomal recessive primary immunodeficiency disorder, which typically predisposes immunocompetent individuals to single fungal infections and multiple fungal infections are very rare. We study an otherwise healthy 48-year-old man, who had been admitted to our hospital diagnosed with deep dermatophytosis caused by Trichophyton rubrum for three times at 29, 33 and 48 years old, respectively. At the age of 39 years, he suffered from cutaneous mucormycosis due to Mucor irregularis. Moreover, he had a long history of superficial fungal diseases and occasional oral candidiasis. Whole-exome sequencing revealed two compound heterozygous splicing variants in CARD9 gene, c. 184 + 5 G > T and c. 951G > A, confirmed by Sanger sequencing. Patients with recurrent fungal infections especially invasive fungal infections in the absence of known immunodeficiencies should be tested for CARD9 mutations.

Contribution to the echinococcosis control programme in China by NIPD-CTDR.

As a zoonotic parasitosis caused by the parasitism of Echinococcus larvae, echinococcosis imposes serious disease and economic burdens on human beings and society, and is thus a global public health issue. Its complex life history, wide distribution, the combined influence of various epidemic factors, coupled with the unique natural environment, customs, and religious beliefs in endemic areas, pose a huge challenge to the national echinococcosis control programme in China. Accurate early detection and confirmation of diagnosis of echinococcosis, the use of effective drugs, real-time surveillance of the infection status of populations and various hosts, controlling the source of infection, and blocking the route of transmission are of enormous significance for control. In this paper, the work by NIPD-CTDR on the prevention and control of echinococcosis in China is reviewed, with a view to providing reference for the further promotion of the national echinococcosis control programme.

Adult tinea capitis in China: A retrospective analysis from 2000 to 2019.

BACKGROUND: Tinea capitis (TC) is an infection of the scalp hair due to dermatophytes. Most commonly seen in prepubescent children, but data of adults tinea capitis (ATC) in China mainland are limited. OBJECTIVES: We aimed to evaluate epidemiological, clinical and mycological characteristics of ATC in China from 2000 to 2019. METHODS: We retrospectively analysed all ATC reported cases in China mainland, confirmed by mycological examination, by searching PubMed, Wanfang, Weipu and CNKI database. RESULTS: In sum, 40 papers involving 269 clinical cases were included. The average morbidity of ATC was calculated as 9.04% after standardisation. The sex ratio is 1:5.2 (31 male, 163 female); 76 people between 18 and 44 age level and 137 people between 45 and 89 age level were diagnosed as ATC. Culture or ITS sequencing identified Trichophyton violaceum in 70 cases (35.2%), Microsporum canis in 42 cases (21.1%), Trichophyton mentagrophyte in 32 cases (16.1%), Trichophyton rubrum in 23 cases (11.5%), Microsporum gypseum in 18 cases (9.0%), Trichophyton tonsurans in 6 cases (3.0%), Trichophyton schoenleini in 4 cases (2.0%), Epidermophyton floccosum in 2 cases (1.0%), Trichophyton verrucosum and Microsporum ferrugineum in one case (0.5%). ATC was easily to be diagnosed as furfur, seborrhoeic dermatitis (13%) or pustular and dermatocellulitis (11.15%).Six immunocompromised persons were recorded (2.2%). CONCLUSIONS: ATC mainly involves postmenopausal women. Trichophyton violaceum, M canis, T mentagrophyte remain the most common aetiological agent of ATC in China. Trichophyton rubrum own the much higher frequency in ATC than in children. For diversified clinical manifestations, recognising ATC profiles will help clinicians avoid misdiagnosis.

Magnetic nanoparticles encapsulated laccase nanoflowers: evaluation of enzymatic activity and reusability for degradation of malachite green.

Magnetic laccase nanoflowers (MNFs-Lac) were successfully prepared through encapsulating Fe3O4 magnetic nanoparticles into the interior of laccase nanoflowers by grafting N-(phosphonomethyl)iminodiacetic acid (PMIDA) as an interconnecting bridge between the magnetic nanoparticles and copper ions. The characterizations by scanning electron microscopy and transmission electron microscopy showed that MNFs-Lac were spherical, porous and flower-like crystals with diameters of ∼10 µm, and Fe3O4 nanoparticles were encapsulated in the interior of MNFs-Lac evenly. The enzymatic activity and reusability of MNFs-Lac were evaluated based on the degradation efficiency for malachite green (MG). The degradation parameters, concerning initial MG concentration, dosage of MNFs-Lac, reaction temperature, pH value and reaction time, were optimized through single-factor experiments. Under the optimal conditions, 25 mg·L-1 MG can be degraded almost completely by 1.5 g·L-1 MNFs-Lac within 15 min. When the MNFs-Lac were reused for 18 times, the degradation efficiency of MG was still as high as 90%. These results suggested that the modified preparation method improved greatly the reusability of MNFs-Lac, which made them more suitable to degrade MG in a water environment.

National Alveolar Echinococcosis Distribution - China, 2012-2016.

What is already known about this topic? Both alveolar echinococcosis (AE) and cystic echinococcosis are endemic in China, among which alveolar echinococcosis has a very high mortality rate. What is added by this report? The survey results showed the prevalence and scope of AE in China and identified high-risk groups including children, monks, herdsmen and illiterate people. At the same time, all the cases found in the survey (more than 90% of the patients did not go to the hospital for diagnosis and treatment before survey) were promptly diagnosed and treated. What are the implications for public health practice? This study provides information for the development of a plan for AE prevention and control and for the implementation of interventions targeted to high-risk populations.

Successful Treatment of Eczema-Like Mucormycosis in a Child by Combination of Intravenous Drip and Percutaneous Injection Amphotericin B.

We report a case of eczema-like cutaneous mucormycosis caused by Rhizopus arrhizus. A 4-year-old child was presented to our hospital with a history of gradually enlarging papule and plaque in the periumbilical area for nearly 4 years since 2 weeks after his birth, and it has been misdiagnosed as eczema for nearly 3 years. Based on histopathology examination, the fungus culture test and DNA sequencing, it was revealed that R. arrhizus should be the responsible fungus for skin infection. The patient was successfully cured by combination of intravenous drip and percutaneous injection amphotericin B for nearly 3 months, and no recrudescence was seen during a follow-up of 6-month observation.

Preparation of laccase-loaded magnetic nanoflowers and their recycling for efficient degradation of bisphenol A.

Bisphenol A (BPA) has been identified as one of the endocrine disrupting chemicals. However, the issue that BPA widely exists in various environments has puzzled people for decades. To develop highly efficient, easy separation, recyclable and reusable materials for BPA degradation in water, laccase-loaded magnetic nanoflowers (MNFs) were prepared by attaching amino-functionalized magnetic nanoparticles onto the laccase-inorganic hybrid nanoflowers. Characterization results showed that MNFs were spherical, porous and hierarchical structure with an average diameter of 15 µm to which magnetic nanoparticles was successfully attached through electrostatic force. MNFs exhibited excellent catalytic activity on BPA degradation under room temperature in the presence of ABTS. Under optimized conditions, MNFs reached 100% BPA degradation for only 5 min. In addition, it still retained over 92% of its initial activity after 60 days of storage at 4 °C, indicating that its thermal and storage stabilities have been improved. When the MNFs was recycled and reused 5 cycles, only 5% decrease in degradation efficiency of BPA was observed. These results suggest that MNFs possess great efficiency and reusability in the treatment of aqueous solution containing BPA and is a novel promising material.

The influence of the mating type on virulence of Mucor irregularis.

Mucor irregularis is an emerging fungal pathogen that cause cutaneous infection and could cause death. However, little is known about its mechanism of pathogenesis. There is evidence suggesting virulence vary with mating types in fungi, including the Mucorales. Here, we characterized the mating type locus of M. irregularis and the mating type ratio of 17 clinical isolates in China. Genomic data indicated M. irregularis is heterothallic having two mating types - bearing either SexP or SexM allele. Also, we employed a mice model to study the inflammation and pathological effects of different mating types. The comparison of the inflammatory response, cytokine profiles and Th-1, Th-2 and Th-17 cells numbers in each mating type treated mice showed that the severity and disease progress were enhanced in (+) mating type treated mice. One (+/0) mutant strain, with multiple mutations at the mating locus, had defects in sexual mating ability but appeared to be more virulent than the (-) mating type. Although (+) mating type appeared to be more virulent, most of our clinical isolates presented belonged to (-) mating type. Our findings support the involvement of MAT genes in sexual fertility, and the influence of mating type on the severity of cutaneous infection.

Tinea faciei in a newborn due to Trichophyton tonsurans.

We report here the first case of neonatal tinea faciei caused by Trichophyton tonsurans in mainland China. The mother of the infant had tinea corpris and tinea capitis while the father had tinea incongnito. The infections in the parents were mycologically confirmed to be due to Trichophyton tonsurans. Ttinea faciei in the infant was cured after two-week topical use of amorolfine cream. The mother ceased breastfeeding and took oral terbinafine for 4 weeks. No recurrence was observed in the infant during 12 months of follow-up.

Primary cutaneous zygomycosis caused by rhizomucor variabilis: a new endemic zygomycosis? A case report and review of 6 cases reported from China.

We report a case of primary cutaneous zygomycosis caused by Rhizomucor variabilis and review 6 cases reported from China that share similar features and are different from those cases caused by other species of Mucorales. It is noteworthy that all 6 of the cases were observed in 3 adjacent provinces of eastern China.

Genotype comparisons of strains of Candida albicans from patients with cutaneous candidiasis and vaginal candidiasis.

BACKGROUND: It is uncertain whether genotypes of Candida albicans (C. albicans) are associated with colonizing body locations or variant conditions of infection. The aim of this study was to investigate whether there are significant associations between strain genotypes and body sites of infection and to determine the potential pathogenesis of cutaneous candidiasis at multiple locations. METHODS: A total of 151 strains of C. albicans were isolated from 74 infant patients with cutaneous candidiasis and 61 female patients with vaginal candidiasis. Patients were grouped according to the body sites and underlying conditions of infection. Genotypes were identified by polymerase chain reaction (PCR) of the 25S rDNA and PCR-restriction fragment length polymorphism (RFLP) of ALT repeats digested with EcoRI and Clal. RESULTS: Ten genotypes were detected. There were significant differences in genotype frequencies between the two groups. However, we found no clear association between genotypes and the sites of cutaneous infection or the underlying conditions of vaginal candidiasis (VVC). In addition, strains of C. albicans from multiple cutaneous locations of the same patient had identical genotypes. CONCLUSIONS: Populations of C. albicans from patients with cutaneous and vaginal candidiasis were genetically different. However, the lack of genetic difference between strains from different body sites with cutaneous infections or from different underlying conditions for VVC suggests no evidence of genotype selection for different skin surfaces or patients with different underlying conditions for VVC.

Pyoderma gangrenosum with pulmonary involvement?

Pyoderma gangrenosum is a rare, painful, noninfectious, ulcerative, reactive neutrophilic skin condition. It is characterized by ulcers that can spread quickly showing undermined violaceous borders. Since there is no single diagnostic test, early diagnosis is always challenging. The aggressive nature of classical pyoderma gangrenosum may become apparent only with time. Pulmonary involvement of pyoderma gangrenosum maybe underreported. We describe a case of classical pyoderma gangrenosum in a 65-year-old man with pulmonary involvement, who presented with a painful fluctuate nodule and ulcer with mucopurulent and hemorrhagic exudates, and with a monoclonal gammopathy, IgA type. One month later the ulcer and hemoptysis all disappeared after treatment with glucocorticosteroids. The pulmonary manifestations of pyoderma gangrenosum were also reviewed.

[Association between environmental risk factor exposure in the first trimester and nonsyndromic cleft lip with or without cleft palate: a case-control study].

OBJECTIVE: To identify the environmental risk factors during the first trimester responsible for nonsyndromic cleft lip with or without cleft palate to collect data for prevention of this congenital defect. METHODS: A hospital-based case-control study was conducted to identify the risk factors by means of field investigation with standardized questionnaires. Single factor analysis and logistic regression of the data are performed using SPSS 13.0 software. RESULTS: Multifactorial analysis revealed that folic acid was significantly associated with lowered incidence of nonsyndromic cleft lip with or without cleft palate (OR=0.100, 95%CI: 0.032-0.312), whereas maternal infection (OR=4.155, 95%CI: 2.166-7.970), poisonous chemical exposure (OR=6.816, 95%CI: 2.528-18.381) and emotional stress (OR=3.250, 95%CI: 1.477-7.154) were risk factors for this defect. CONCLUSIONS: Sufficient follic acid intake and prevention of infection and poisonous chemical exposure during the first trimester are measures to reduce the risks of nonsyndromic cleft lip with or without cleft palate.