Significance of Aspergillus spp. isolation in defining cases of COVID-19 Associated Pulmonary Aspergillosis - CAPA.

COVID-19-Associated Pulmonary Aspergillosis (CAPA) is a relatively common complication in patients with severe forms of the disease caused by the SARS-CoV-2 virus. Diagnosing and confirming CAPA is challenging. In this study, Aspergillus spp. isolation in respiratory specimens from patients with COVID-19 was evaluated for identifying cases of CAPA. In 2020‒2021, 17 Aspergillus spp. were isolated from 15 COVID-19 patients admitted to a university hospital in Brazil. Patient records were retrospectively reviewed to obtain clinical-epidemiological data and other markers of Aspergillus spp. infection and then compared with the ECMM/ISHAM criteria for defining CAPA. Probable CAPA was defined in 5/10 patients, who had Aspergillus spp. isolated from Bronchoalveolar Lavage (BAL) or a positive galactomannan blood test. Additionally, anti-Aspergillus antibodies were detected in two of these patients, during active or follow-up phases of CAPA. In another seven patients with Aspergillus spp. isolated from tracheobronchial aspirate or sputum, CAPA was presumed, mainly due to deterioration of clinical conditions and new lung imaging suggestive of fungal infection. Antifungal agents to control CAPA, particularly voriconazole, were used in 9/15 cases. In cases of probable CAPA and remaining patients, clinical conditions and comorbidities were similar, with lethality being high, at 60% and 71%, respectively. The number of CAPA cases defined by scientific criteria was lower than that assumed in the clinical context. This was largely due to the lack of BAL collection for fungal culture and the non-intensive use of other markers of invasive aspergillosis. The isolation of Aspergillus spp. in different respiratory specimens should alert clinicians to the diagnosis of CAPA.

Aspects related to biofilm production and antifungal susceptibility of clinically relevant yeasts of the genus Trichosporon.

Trichosporonosis corresponds to a systemic fungal disease that leads to high mortality rates and is frequently associated with medical devices. It affects immunosuppressed patients in particular and is strongly linked to acquired human immunodeficiency, organ and tissue transplants, and malignant hematologic diseases such as leukemia and lymphomas. Trichosporon infections have been increasingly reported worldwide; however, little information is available either about their characteristics or the causative microorganism. Thus, the aims of the present study were: to investigate 59 yeasts of the genus Trichosporon by verifying the biofilm formation capacity of isolates; to analyze the susceptibility patterns of planktonic cells against the antifungals fluconazole, itraconazole, amphotericin-B, voriconazole, and caspofungin by comparing European Committee for Antimicrobial Susceptibility Testing (EUCAST) broth microdilution technique with the commercial method Etest; and to assess the susceptibility patterns of biofilm cells (sessile) against the same antifungals through broth microdilution. The ability to form biofilm on the surface of polystyrene plates was noted for all isolates, and 54.3% of samples were considered strong producers. Comparison between the antifungal susceptibility techniques evidenced that Etest showed higher and discordant minimum inhibitory concentrations (MICs) from those obtained by the microdilution method, especially for fluconazole, itraconazole, and caspofungin. Considering the susceptibility of biofilms, most species had high MIC50 and MIC90 against the tested antifungals, showing 4-to-66-fold higher concentrations for amphotericin B and 2-to-33-fold greater concentrations for caspofungin. These results highlight the importance of further studies with Trichosporon spp. for comparison between laboratory findings and in vivo response, considering both the susceptibility tests and the behavior of biofilm cells against drugs.

This study investigated 59 isolates of the medically important yeast Trichosporon in relation to their ability to form biofilms and the susceptibility of biofilms to antifungal agents. All isolates were able to produce biofilms and biofilms showed lower antifungal susceptibility.

Significance of Aspergillus spp. isolation in defining cases of COVID-19 Associated Pulmonary Aspergillosis - CAPA

ABSTRACT COVID-19-Associated Pulmonary Aspergillosis (CAPA) is a relatively common complication in patients with severe forms of the disease caused by the SARS-CoV-2 virus. Diagnosing and confirming CAPA is challenging. In this study, Aspergillus spp. isolation in respiratory specimens from patients with COVID-19 was evaluated for identifying cases of CAPA. In 2020-2021, 17 Aspergillus spp. were isolated from 15 COVID-19 patients admitted to a university hospital in Brazil. Patient records were retrospectively reviewed to obtain clinical-epidemiological data and other markers of Aspergillus spp. infection and then compared with the ECMM/ISHAM criteria for defining CAPA. Probable CAPA was defined in 5/10 patients, who had Aspergillus spp. isolated from Bronchoalveolar Lavage (BAL) or a positive galactomannan blood test. Additionally, anti-Aspergillus antibodies were detected in two of these patients, during active or follow-up phases of CAPA. In another seven patients with Aspergillus spp. isolated from tracheobronchial aspirate or sputum, CAPA was presumed, mainly due to deterioration of clinical conditions and new lung imaging suggestive of fungal infection. Antifungal agents to control CAPA, particularly voriconazole, were used in 9/15 cases. In cases of probable CAPA and remaining patients, clinical conditions and comorbidities were similar, with lethality being high, at 60% and 71%, respectively. The number of CAPA cases defined by scientific criteria was lower than that assumed in the clinical context. This was largely due to the lack of BAL collection for fungal culture and the non-intensive use of other markers of invasive aspergillosis. The isolation of Aspergillus spp. in different respiratory specimens should alert clinicians to the diagnosis of CAPA.

A neglected disease. Human sporotrichosis in a densely populated urban area in São Paulo, Brazil: clinical-epidemiological and therapeutic aspects.

Human sporotrichosis is caused by different Sporothrix species; however, Sporothrix brasiliensis is the main species, usually related to cat transmission in urban areas. A retrospective descriptive study was conducted at the Institute of Infectology Emílio Ribas from 2010 to 2018. Demography, clinical, diagnostic, and therapeutic data were obtained from medical records. Polymerase chain reaction of the calmodulin gene was performed to identify Sporothrix species. In addition, to evaluate the spread of the disease across São Paulo metropolitan region, TerraView version 4.2.2 software was used for geocoding cases according to residence addresses. Kernell's maps using QGIS software version 2.16.3 were constructed to determine the concentration of cases. Results: 260 cases of sporotrichosis were diagnosed between 2010 and 2018. We observed a 700% increment in the number of human cases in the 2016-2018 triennium compared with the 2013-2015 triennium. Female adults with a median age of 46 years old were the predominant infected group associated with cats' exposition at home care, although the age range of all patients was 01 to 86 years old. The main epidemiological risk of acquiring sporotrichosis was contact with cats, reported by 96.5% of the patients. Molecular identification showed that most of the tested isolates were Sporothrix brasiliensis. Lymphocutaneous form was observed in 59.2% and fixed cutaneous form in 37.5% of the patients. Regarding treatment, itraconazole was the main drug used (94.2%) with a cure rate of 98.8%. We observed an important spread of human sporotrichosis involving cat transmission caused by Sporothrix brasiliensis in a densely populated area of São Paulo state. These results are important to alert clinicians and dermatologists about the occurrence and progression of a neglected tropical disease in an urban area and the urgent necessity to include sporotrichosis as a differential diagnosis in the clinical investigation routine.

Comparing the phenotypic, genotypic, and proteomic identification of Trichosporon species: A globally emerging yeast of medical importance.

Trichosporon spp. are widely distributed in the nature, comprising species that inhabit different ecological niches and can be found in the water, soil, and body surface of animals and humans. Such microorganisms have been classically associated with superficial infections; however, in the last decades, they have also been related to disseminated infections in immunocompromised patients, behaving as opportunistic agents, which demands rapid and accurate species identification for efficient therapy. Concordance level between the traditional phenotypic method and the molecular technique (gold standard) in the identification of all 59 Trichosporon samples was 59.3%. Identification concordance between MALDI-TOF spectrometry and the molecular technique was 71.2%. No isolate of environmental origin was identifiable by MALDI-TOF mass spectrometry (MS), and 100% of such environmental isolates were discordant for IGS region sequencing and phenotypic characterization. Both comparisons evidenced greatest concordance in the identification of T. asahii. The species T. debeurmannianum, T. dermatis, T. venhuisii and T. insectorum were not properly identified by both MALDI-TOF MS and the phenotypic technique. MALDI-TOF MS, in particular, seems to be appropriate to investigate yeasts of the genus Trichosporon; however, database updates are still necessary, especially for species that are not common in the clinical routine. With the aim of helping understand the aspects involved in early and accurate diagnosis of infections caused by this opportunistic agent, the present study compared the phenotypic, molecular (IGS region) and mass-spectrometry (MALDI-TOF) identification of 59 yeasts of the genus Trichosporon which had clinical and environmental origin and were kept in a mycology collection.

The present study compared the phenotypic, genotypic, and mass-spectrometry (MALDI-TOF) identification of 59 yeasts of the genus Trichosporon. MALDI-TOF MS, in particular, seems to be appropriate to investigate this yeasts when compared to a molecular technique (gold standard).

First report of tinea corporis caused by Arthroderma benhamiae in Brazil.

Arthroderma benhamiae is a zoophilic dermathophyte that can cause highly inflammatory tinea corporis and tinea capitis in humans. This is the first report of a patient with dermatophytosis caused by A. benhamiae in Brazil. The lesion was an erythematous, annular plaque on the lumbar region that appeared few weeks after playing with a street cat in a 19-month-old girl. Initial presumed diagnosis was tinea corporis caused by Microsporum canis. Topical treatments were ineffective and the patient required systemic treatment with griseofulvin. Mycological diagnosis was inconclusive: morphological differentiation between M. canis and Trichophyton benhamiae may be difficult, especially when the latter present yellow colonies. The etiological agent was identified only by ITS sequencing of the isolates aligned with reference strains to A. benhamiae. This report highlights the importance of ITS sequencing in the identification of isolates from some cases of dermatophytosis, because conventional morphological diagnosis may result in misdiagnosis of the agent and delay proper treatment.

Estudo da resposta imune celular em pacientes com cromoblastomicose / Study of cellular immune response in patients with chromoblastomycosis

A cromoblastomicose é uma micose crônica que causa lesões granulomatosas e supurativas que atingem a pele e o tecido subcutâneo. Micose cosmopolita e freqüentemente observada no Brasil. As lesões aumentam progressivamente e posteriormente podem desenvolver um processo crônico e que geralmente não respondem a uma terapia convencional. Entretanto o mecanismo de defesa da resposta imune adaptativa, principalmente das células T na cromoblastomicose ainda não está definido. Em nosso estudo avaliamos a produção de citocinas e a resposta linfoproliferativa de diferentes amostras de sangue de pacientes com cromoblastomicose e indivíduos saudáveis in vitro após estimulação com antígenos do fungo. Além disso, nos acompanhamos esses pacientes sob terapia antifúngica em diferentes períodos de tratamento. Este estudo mostrou que a forma grave da cromoblastomicose é caracterizada pelo aumento na produção de IL-10 e deficiência na proliferação das células T após estimulação com antígenos do fungo. Ao contrario, pacientes com a forma leve da doença foram capazes de secretar predominantemente IFN-γ, que é uma citocina importante para defesa do hospedeiro. Em adição eles secretaram menores quantidades de IL-10 e suas células T proliferaram eficientemente in vitro após estimulação do fungo. Os pacientes avaliados após 6 meses de terapia antifúngica as células T proliferaram e secretaram altos níveis de IFN-γ eficientemente após estimulação. Ao contrário, pacientes com 12 meses de tratamento ocorreu um aumento na produção de IL-10 uma diminuição nos níveis de linfoproliferação. Interessantemente, os monócitos obtidos desses pacientes durante a doença foram capazes expressar moléculas co-estimulatorias (CD80 e CD86) e também aumento nos níveis de HLA-DR após estimulação com LPS. Além disso, monócitos desses pacientes secretam altos níveis de IL-12 e TNF-α, sugerindo que a suscetibilidade desses pacientes não apresentam uma deficiência na apresentação de antígeno por monócitos. Em suma, em nossos resultados mostraram que alta secreção de IFN-γ e eficiente proliferação de células T de pacientes com cromoblastomicose está diretamente relacionada com a forma leve da doença, enquanto que a produção de IL-10 e diminuição na proliferação de células T caracterizam a forma grave da doença

Chromoblastomycosis is a chronic granulomatous and suppurative disease that causes lesions mainly in skin and subcutaneous tissues. Although found worldwide, this mycosis is frequently observed in tropical countries such as Brazil. The skin lesions increase slowly and progressively in a chronic process that usually relapse even after canonical treatment. However, the mechanism of the host adaptive immune response, specially the role of T cells, in chromoblastomycosis is still unclear. In studies here, we evaluated the cytokine production and T cell response of peripheral blood mononuclear cells (PBMC) from different patients and healthy controls upon in vitro stimulation with fungal antigens. Moreover, we performed a follow-up study in patients undergoing long-term antifungal treatment. We collected PBMC samples from patients with an active form (either severe or mild skin lesions) of chromoblastomycosis and PBMC samples from healthy individuais. In PBMC from patients with a severe form of the disease we found a predominant production of IL-10 over IFN-gamma and a deficiency in T cell proliferation upon fungal antigen stimulation. In contrast, PBMC from patients in a mild form of the disease were able to secrete predominantly IFN-gamma, a cytokine important for host defense. In addition, they secreted low amounts of IL-10 and their T cells efficiently proliferated under in vitro stimulation with the fungal antigens. Surprisingly, the patients undergoing 6 months antifungal therapy PBMC from patients secreted higher amounts of IFN-gamma and their T cells proliferated efficiently upon stimulation. On the contrary, PBMC from patients after 12m of treatment showed an increase in IL-10 secretion followed by an inefficient T cell proliferation. Interestingly, monocytes obtained from patients during chronic phase of the disease were able to up-regulate their co-stimulatory molecules (CD80 and CD86) as well as their HLA-DR upon in vitro fungal stimulation. Moreover, monocytes from these patients secreted high amounts of pro-inflammatory cytokines IL-12 and TNF-alfa, suggesting that susceptibility of patients must be due to a immune deficiency other than a monocyte deactivation. Altogether, our data clearly show that a higher secretion of IFN-gamma and an efficient T cell proliferation of PBMC from infected individuals can distinguish the mild from the severe form of the chromoblastomycosis

Cellular immune response of patients with chromoblastomycosis undergoing antifungal therapy.

One of the most characteristic features of the chromoblastomycosis is its unresponsiveness to treatment. In order to analyzed whether during therapy could be observed a change of cellular immune response pattern, we evaluated the production of IL-10, TNF-alpha and IFN-gamma, as well as proliferation of peripheral blood mononuclear cell (PBMC) from patients in different periods of chemotherapy treatment. Our results showed that after 6 months of treatment cells from patients proliferated to fungal antigens and produced a significant level of IFN-gamma. However, after 1 year of treatment a low proliferation of T cells and production of IFN-gamma accompanied by an increase of IL-10 were observed when compared with 6 months of treatment.