Manifestaciones clínicas y radiológicas de la Aspergilosis Pulmonar: Informe de tres casos / Pulmonary aspergillosis, an approach to clinical and radiological manifestations. Report of three cases

RESUMEN La aspergilosis pulmonar, causada por el hongo oportunista Aspergillus, afecta principalmente a individuos inmunocomprometidos. Este reporte presenta tres casos: Una mujer de 18 años con leucemia aguda desarrolló dificultad respiratoria y patrones bilaterales de "árbol en brote" en la tomografía computarizada (TC). A pesar del tratamiento con voriconazol, falleció debido a insuficiencia respiratoria. Una mujer de 58 años con diabetes y EPOC presentó disnea y hemoptisis. Las imágenes revelaron una lesión cavitada, confirmando un aspergiloma. Se consideró la cirugía debido a la hemoptisis activa. Una mujer de 41 años con antecedentes de tuberculosis presentó fiebre y síntomas respiratorios. La TC mostró lesiones cavitadas y bronquiectasias, confirmando aspergilosis crónica. Respondió bien al voriconazol. Estos casos destacan la variabilidad en la aspergilosis pulmonar y subrayan la importancia de un diagnóstico y tratamiento oportunos para mejorar los resultados en los pacientes.

ABSTRACT Pulmonary aspergillosis, caused by the opportunistic fungus Aspergillus, primarily affects immunocompromised individuals. This report presents three cases: An 18-year-old female with acute leukemia developed respiratory distress and bilateral "tree-in-bud" patterns on CT. Despite voriconazole treatment, she succumbed to respiratory failure. A 58-year-old female with diabetes and COPD had dyspnea and hemoptysis. Imaging revealed a cavitated lesion, confirming aspergilloma. Surgery was considered due to active hemoptysis. A 41-year-old female with a history of tuberculosis presented with fever and respiratory symptoms. CT showed cavitated lesions and bronchiectasis, confirming chronic aspergillosis. She responded well to voriconazole. These cases highlight the variability in pulmonary aspergillosis and underscore the importance of timely diagnosis and treatment to improve patient outcomes.

Micosis pulmonar causada por Penicillium spp: reporte de caso en paciente con fibrosis quística / Pulmonary mycosis caused by Penicillium spp: case report in a patient with cystic fibrosis

Se presenta el caso de un paciente masculino de 15 años con diagnóstico de fibrosis quística. Este desarrolló una sintomatología caracterizada por tos húmeda, no cianozante ni emetizante, sin un patrón temporal específico. Asociado a esto, nuevas lesiones nodulares bilaterales fueron identificadas en una tomografía de tórax. El abordaje diagnóstico incluyó una broncoscopia y la toma de un lavado broncoalveolar, que identificó la presencia de un microorganismo micótico poco común: Penicillium spp. Se inició tratamiento con voriconazol oral durante 14 días, resultando en una mejora clínica y radiológica significativa. El cultivo de expectoración posterior mostró un resultado negativo para Penicillium spp. Aunque la incidencia de exacerbaciones pulmonares causadas por agentes micóticos en pacientes con fibrosis quística es relativamente baja, se observa un incremento gradual, posiblemente relacionado con el uso prolongado de antimicrobianos de amplio espectro. La importancia de reportar este caso radica en el papel incierto que estos microorganismos juegan en la progresión del daño pulmonar, subrayando la necesidad de un seguimiento a mediano y largo plazo en estos pacientes.

This report discusses a 15-year-old male patient diagnosed with cystic fibrosis who developed clinical symptoms characterized by productive cough, not associated with cyanosis or vomiting, and without a specific time pattern. Associated with these symptoms, new bilateral nodular lesions were identified in a chest CT scan. Diagnostic approach included bronchoscopy and bronchoalveolar lavage, which identified a rare fungal organism: Penicillium spp. Treatment with oral voriconazole for 14 days was initiated, resulting in significant clinical and radiological improvement. Subsequent sputum culture showed a negative result for Penicillium spp. Although the incidence of pulmonary exacerbations caused by fungal agents in patients with cystic fibrosis is relatively low, there is a gradual increase, possibly related to the prolonged use of broad-spectrum antimicrobials. The importance of reporting this case lies in the uncertain role these organisms play in the progression of lung damage, highlighting the need for medium and long-term follow-up in these patients.

Neumonía por Aspergillus en paciente pos-COVID-19

Introducción: La enfermedad por el nuevo coronavirus SARS-CoV-2 (COVID-19) se extendió rápidamente por todo el mundo y generó un gran desafío. La aparición de coinfecciones se encuentra entre las complicaciones más graves que pueden desarrollar los enfermos. La aspergilosis pulmonar se ha identificado como una complicación de la neumonía por la COVID-19 en los pacientes ventilados en las unidades de cuidados intensivos. Objetivo: Presentar un caso clínico poco común de aspergilosis pulmonar. Caso clínico: Se presenta el caso de una paciente con historia reciente de la COVID-19, con un cuadro clínico enteral dado por diarreas, vómitos e insuficiencia respiratoria en el que concomitan la evolución de un cáncer de colon y neumonía asociada a la ventilación provocada por Aspergillus niger. Conclusiones: La aspergilosis pulmonar asociada a la COVID-19 es una complicación que debe considerarse y buscarse en pacientes con historia reciente de esta enfermedad.

Introduction: The new SARS-CoV-2 coronavirus disease (COVID-19) spread rapidly throughout the world, which created a great challenge. The appearance of coinfections is among the most serious complications that these patients can develop. Pulmonary aspergillosis has been identified as a complication of COVID-19 pneumonia among ventilated patients in intensive care. Objective: To present an unusual clinical case of pulmonary aspergillosis. Clinical case: It is presented the case of a patient with a recent history of COVID-19, with an enteral clinical picture of diarrhea and vomiting plus respiratory failure, in which the evolution of colon cancer and ventilator-associated pneumonia caused by Aspergillus niger are concomitant. Conclusions: Pulmonary aspergillosis associated with COVID-19 is a complication that should be considered and sought in patients with a recent history of this disease.

Progress in zinc homeostasis-related genes in Aspergillus fumigatus / 中华微生物学和免疫学杂志

Aspergillus fumigatus is an opportunistic pathogenic fungus transmitted through the air. It targets the the lungs of immunocompromised patients and can cause severe invasive aspergillosis. Zinc, an essential trace element for microbial growth, is required by all fungi, including Aspergillus fumigatus. Some studies have shown a direct correlation between the virulence of fungi within the host and the uptake of zinc by them. However, zinc in the human body mostly binds to zinc-binding proteins, resulting in ion concentrations in the host′s tissue microenvironment much lower than the optimal growth concentration for fungi. There are several zinc transport proteins in Aspergillus fumigatus, enabling it to efficiently absorb zinc even in the condition of zinc deficiency. These proteins also protect the cells of Aspergillus fumigatu from the damage caused by excessive zinc. This article is to provide a comprehensive overview of the roles of zinc homeostasis regulation in the growth, development and virulence of Aspergillus fumigatus as well as the related genes, summarize the current research status of genes regulating zinc levels in Aspergillus fumigatus and investigate whether interference with zinc homeostasis in Aspergillus fumigatus will be a new generation of adjunctive therapy for invasive aspergillosis or antifungal strategy.

The application of agro-food agriculture in lipase production by Aspergillus tubingensis strain: Inductive effect of olive-pomace

Aims@#The aim of this study was to cultivate the fungus Aspergillus tubingensis (MO503), which was isolated and identified from Algerian soil using submerged fermentation. The focus was on the production of lipase, achieved through utilizing a minimal medium from agro-food industries. Specifically, the study investigated the potential of three waste sources – olive-pomace, Pistacia lentiscus fruit remains and olive mill wastewater as substrates for enhancing lipase production. @*Methodology and results@#The three aforementioned wastes were chosen to ascertain their value and determine the most cost-effective option. Factorial analysis of variance (ANOVA) was employed to evaluate the waste with a significant effect on lipase production, as this enables determining differences among the various waste sources. Growth monitoring revealed a maximum lipase activity of 1030 ± 0,039 U at pH 5.4 for olive pomace. A series of biochemical purification techniques displayed a visible band on the polyacrylamide gel obtained through SDS-PAGE. Lipolytic activity was evidenced by zymography in the presence of olive oil. The antibacterial activities of purified lipase exhibited a high sensitivity against Gram-negative bacteria compared to Gram-positive bacteria. @*Conclusion, significance and impact of study@#In addition to its activity against Gram-negative bacteria, the lipid degradation facilitated by these lipases in olive oil offers promising applications in the textile and therapeutic industries.

Bioburden, phenotypic and spectroscopic characterisation of toxigenic and atoxigenic Aspergillus section Flavi from poultry feeds in Kelantan, Malaysia and Katsina, Nigeria

Aims@#The natural coexistence of high humidity and warm temperatures in Malaysia and Nigeria and poor storage facilities used by most poultry feed vendors provide suitable conditions for the proliferation of aflatoxigenic fungi and aflatoxigenesis. This study aims to characterise and evaluate the toxigenicity of Aspergillus section Flavi (ASF) from Malaysian and Nigerian poultry feeds. @*Methodology and results@#This study utilised standard mycological techniques to determine the bioburden and distribution of mycoflora in 132 and 144 Malaysian and Nigerian poultry feeds, respectively. The ASF isolated from the samples were tested for aflatoxigenicity by thin-layer chromatography (TLC) and then characterised by multivariate using attenuated total reflectance fourier transformed infrared spectroscopy (ATR-FTIR). A total of 128 and 75 mould fungal isolates belonging to 12 and 11 species were obtained from the Malaysian and Nigerian samples with a bioburden ranging from 2.0 to 6.97 log CFU/g and the highest overall mean count of 5.66 ± 4.51 log CFU/g and 5.6 ± 4.76 log CFU/g, respectively. Aspergillus fumigatus, Aspergillus felis, Aspergillus flavus/parasiticus and Fusarium graminearum were predominant in poultry feeds from both countries. Overall, 16 ASF were isolated (Malaysia = 7, Nigeria = 9), of which only three produce aflatoxins. The multivariate cluster analysis of ATR-FTIR spectra showed 97.78% similarity between the toxigenic and atoxigenic ASF with primary differences at 600 to 800 cm-1 and 2927 to 4000 cm-1 only.@*Conclusion, significance and impact of study@#The bioburden of fungal flora in the samples was higher than the ICMSF's acceptable range of 2.0 to 5.0 log CFU/g, indicating that they could be hazardous to poultry and necessitate stricter control measures. Irrespective of the country/source of samples, the ATR-FTIR has discriminated the toxigenic from atoxigenic ASF, implying its promising prospects for rapid identification of toxigenic ASF.

Research progress of nitrobenzoyl sesquiterpenoids as marine characteristic natural products / 药学学报

Sesquiterpenoids are widely found in nature, while nitrobenzoyl sesquiterpenoids are relatively rare. Twelve natural nitrobenzoyl sesquiterpenoids were all derived from marine Aspergillus fungi, which are typical natural products with marine characteristics. These natural products exhibit good antitumor, antiviral, and inhibition of osteoclast differentiation activity, especially in the treatment of osteoclast-related diseases, showing good medicinal development value. This article reviews the natural product sources, chemical structure, chemical synthesis, biosynthesis, bioactivity, and pharmacological mechanisms of nitrobenzoyl sesquiterpenoids and predicts and discusses their absorption, distribution, metabolism, excretion, toxicity (ADME/T), and drug-likeness, providing a comprehensive understanding of the natural products of nitrobenzoyl sesquiterpenoids from marine sources and their potential for pharmaceutical development.

Inactivation of isolated fungi on Erythrina velutina Willd. seeds through atmospheric plasma

Abstract This study aimed to evaluate the effect of atmospheric plasma application on the inactivation of fungi on the surface of Erythrina velutina seeds and on isolated fungal colonies. Two experiments were conducted using a completely randomized design. First, plasma was applied to the surface of the seeds using helium gas and atmospheric plasma for 3, 6, and 9 min in addition to the control (untreated seeds), constituting seven treatments with five repetitions each. In the second experiment, Petri dishes containing the inoculum of different fungi were treated with atmospheric air plasma for 3, 6, and 9 min (Air-3, Air-6, and Air-9) and were compared with untreated fungi in Petri dishes without treatment (control), totaling four treatments and five repetitions each. We found that the application of atmospheric air plasma to E. velutina seeds for 9 min had an antimicrobial effect on the fungi Aspergillus niger, Aspergillus flavus, Fusarium sp., Brachysporium sp., and Rhizopus sp. The formation of fungal colonies isolated from E. velutina seeds was also inhibited by 3 min of exposure to atmospheric air plasma, except for A. niger, whose inhibition occurred after 6 min of exposure to atmospheric plasma.

Resumo Este trabalho teve como objetivo avaliar o efeito da aplicação de plasma atmosférico na inativação de fungos na superfície de sementes de Erythrina velutina e em colônias fúngicas isoladas. Dois experimentos foram realizados em delineamento inteiramente casualizado: no primeiro, o plasma foi aplicado na superfície das sementes usando gás hélio e plasma atmosférico por três, seis e nove minutos, além do controle (sementes sem tratamento), constituindo sete tratamentos com cinco repetições cada; no segundo experimento, placas de Petri contendo o inóculo de diferentes fungos foram tratadas com plasma atmosférico por três, seis e nove minutos (Air-3, Air-6 e Air-9) e comparadas com fungos não tratados em placas de Petri sem tratamento (controle), totalizando quatro tratamentos e cinco repetições cada. Descobrimos que a aplicação de plasma atmosférico nas sementes de E. velutina por nove minutos teve efeito antimicrobiano sobre os fungos Aspergillus niger, Aspergillus flavus, Fusarium sp., Brachysporium sp. e Rhizopus sp. A formação de colônias fúngicas isoladas de sementes de E. velutina também foi inibida por três minutos de exposição à aplicação de plasma atmosférico, exceto para A. niger, cuja inibição ocorreu a partir de 6 minutos de exposição à aplicação de plasma atmosférico.

Inactivation of isolated fungi on Erythrina velutina Willd. seeds through atmospheric plasma / Inativação de fungos isolados em sementes de Erythrina velutina Willd. por meio do plasma atmosférico

Abstract This study aimed to evaluate the effect of atmospheric plasma application on the inactivation of fungi on the surface of Erythrina velutina seeds and on isolated fungal colonies. Two experiments were conducted using a completely randomized design. First, plasma was applied to the surface of the seeds using helium gas and atmospheric plasma for 3, 6, and 9 min in addition to the control (untreated seeds), constituting seven treatments with five repetitions each. In the second experiment, Petri dishes containing the inoculum of different fungi were treated with atmospheric air plasma for 3, 6, and 9 min (Air-3, Air-6, and Air-9) and were compared with untreated fungi in Petri dishes without treatment (control), totaling four treatments and five repetitions each. We found that the application of atmospheric air plasma to E. velutina seeds for 9 min had an antimicrobial effect on the fungi Aspergillus niger, Aspergillus flavus, Fusarium sp., Brachysporium sp., and Rhizopus sp. The formation of fungal colonies isolated from E. velutina seeds was also inhibited by 3 min of exposure to atmospheric air plasma, except for A. niger, whose inhibition occurred after 6 min of exposure to atmospheric plasma.

Resumo Este trabalho teve como objetivo avaliar o efeito da aplicação de plasma atmosférico na inativação de fungos na superfície de sementes de Erythrina velutina e em colônias fúngicas isoladas. Dois experimentos foram realizados em delineamento inteiramente casualizado: no primeiro, o plasma foi aplicado na superfície das sementes usando gás hélio e plasma atmosférico por três, seis e nove minutos, além do controle (sementes sem tratamento), constituindo sete tratamentos com cinco repetições cada; no segundo experimento, placas de Petri contendo o inóculo de diferentes fungos foram tratadas com plasma atmosférico por três, seis e nove minutos (Air-3, Air-6 e Air-9) e comparadas com fungos não tratados em placas de Petri sem tratamento (controle), totalizando quatro tratamentos e cinco repetições cada. Descobrimos que a aplicação de plasma atmosférico nas sementes de E. velutina por nove minutos teve efeito antimicrobiano sobre os fungos Aspergillus niger, Aspergillus flavus, Fusarium sp., Brachysporium sp. e Rhizopus sp. A formação de colônias fúngicas isoladas de sementes de E. velutina também foi inibida por três minutos de exposição à aplicação de plasma atmosférico, exceto para A. niger, cuja inibição ocorreu a partir de 6 minutos de exposição à aplicação de plasma atmosférico.

Resistencia a los azoles en cepas de Aspergilus fumigatus sensu stricto aislados de muestras clínicas respiratorias

Introducción. La aspergilosis invasiva presenta alta mortalidad en pacientes con enfermedades crónicas e inmunocomprometidos. Aspergillus fumigatus sensu stricto (AFSS) es el principal agente etiológico y su tipificación requiere de métodos moleculares. La incidencia incrementada de AI resistentes a los antifúngicos demanda un diagnóstico certero y oportuno. Métodos. Se estudiaron 20 cepas de la micoteca del Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, aisladas de muestras respiratorias e identificadas como Aspergillus fumigatus sensu lato mediante el estudio macroscópico y microscópico. Las cepas fueron referidas a la Universidad Nacional del Litoral para su tipificación mediante una PCR screening para AFSS basada en secuencias del gen CYP51A y el estudio de sensibilidad antifúngica para voriconazol (VOR), itraconazol (ITC), posaconazol (POS), isavuconazol (ISA), anidulafungina (ANF), caspofungina (CSF) y anfotericina B (AMB) obteniendo la concentración inhibitoria mínima (CIM) mediante el protocolo de CLSI M38M51S-Ed3. Resultados. Las 20 cepas fueron identificadas como AFSS. Ninguna de las cepas tuvo una CIM por encima del punto de corte clínico (VOR), ni epidemiológico (ITC, ISA, AMB y CSF). POS fue la droga más potente frente a la colección de cepas evaluadas (media geométrica (GM) de CIM de 0,042 µg/ml). Conclusiones. Todos los aislamientos fueron tipificados como AFSS sensibles a los azoles según los puntos de corte clínico, posaconazol tuvo la mayor actividad antifúngica. Nuestros hallazgos aportan a incrementar la escasa información sobre la etiología y sensibilidad a los antifúngicos de uso clínico de las aspergilosis invasiva en nuestro país.

Introduction. Invasive Aspergillosis (IA) poses a significant threat to patients with chronic diseases and compromised immune systems, with Aspergillus fumigatus sensu stricto (AFSS) being the primary etiological agent. Accurate and timely diagnosis is crucial, particularly given the rising incidence of IA strains resistant to antifungals, necessitating molecular methods for typing. Methods. Twenty strains from Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, mycological collection, previously identified as Aspergillus fumigatus sensu lato through macroscopic and microscopic analysis, were studied. These strains were forwarded to the Universidad Nacional del Litoral for AFSS typing using a PCR screening based on CYP51A gene sequences. Antifungal susceptibility testing was performed for Voriconazole (VOR), Itraconazole (ITC), Posaconazole (POS), Isavuconazole (ISA), Anidulafungin (ANF), Caspofungin (CSF), and Amphotericin B (AMB), obtaining Minimum Inhibitory Concentrations (MICs) according to CLSI M38M51S-Ed3. Results. All 20 strains were identified as AFSS. None of the strains exhibited MICs above the clinical breakpoint (VOR) or the epidemiological cutoffs (ITC, ISA, AMB, and CSF). POS demonstrated the highest potency against the strain collection, with a geometric mean MIC of 0,042 µg/ml. Conclusions. All isolates were classified as azole-sensitive Aspergillus fumigatus sensu stricto (AFSS) based on clinical cutoff points, particularly posaconazole, which exhibited superior antifungal activity. Our findings contribute to augmenting the limited information on the etiology and clinical antifungal sensitivity of IA in our country.

Micheli y el género Aspergillus / Micheli and genus Aspergillus

Pier Antonio Micheli nació en Florencia, Italia, en el año 1697. Fue un destacado científico, botánico y se le considera el padre de la micología. Dedicó su vida a la taxonomía y al estudio de especies no conocidas de plantas, hongos y líquenes. En 1729 publicó el libro Nova Plantarum Genera, donde describió 1900 plantas, entre las que se encontraban 900 hongos y líquenes. Aquí describió especies de hongos como Botrytis, Mucor y Aspergillus, las cuales tienen importancia en patología médica, animal y vegetal hasta el día de hoy. Murió el 1 de enero de 1737, en su natal Florencia, de una enfermedad pulmonar cuya causa no está bien clara. El legado de Micheli sigue presente y constituye un ejemplo para todos aquellos que se dedican al difícil arte de la taxonomía en sus distintas áreas y en especial a la micología

Pier Antonio Micheli was born in Florence, Italy, in 1697. He was a prominent scientist, botanist and is considered the father of mycology. He dedicated his life to taxonomy and the study of unknown species of plants, fungi, and lichens. In 1729 he published the book Nova Plantarum Genera, where he described 1900 plants, including 900 fungi and lichens. There he described fangal species such as Botrytis, Mucor and Aspergillus, wich are of importance in medical, animal, and plant pathology to this day. He died on January 1, 1737, in his native Florence, due to a lung disease whose cause is unclear. Micheli's legacy is still present, constituting an example for all those who are dedicated to the difficult art of taxonomy in its different areas, especially to mycology.

Infección por Aspergillus flavus y Rhizopus oryzae complex en paciente con diabetes mellitus / Infection due to Aspergillus flavus and Rhizopus oryzae complex in a patient with diabetes mellitus

La sinusitis micótica es una condición patológica que puede presentarse en pacientes con diabetes mellitus y estar asociada a una crisis hiperglucémica. Es una entidad agresiva con complicaciones locales que incluyen afectación de la órbita y el sistema nervioso central, y compromiso vascular. A pesar del tratamiento quirúrgico y antimicótico, la mortalidad es de hasta el 75 %. Se describe el caso de una paciente con diagnóstico de cetoacidosis diabética y signos de oftalmoplejía unilateral que llevaron al estudio con resonancia magnética del sistema nervioso central; se encontraron signos de sinusitis, meningitis y cerebritis. Los estudios microbiológicos iniciales fueron negativos, y los biomarcadores galactomanano sérico y el antígeno de Cryptococcus también fueron negativos. Tras el manejo quirúrgico, se llegó a la identificación de Aspergillus flavus y Rhizopus spp. en el tejido de los senos paranasales. La paciente recibió tratamiento con posaconazol y, tras dos meses de seguimiento, había presentado mejoría clínica. La infección fúngica dual y la infección por A. flavus son entidades poco frecuentes y de relevancia clínica, sin casos presentados previamente en nuestro país por lo que este corresponde a un caso de interés clínico.

Fungal sinusitis is a pathology that can occur in patients with diabetes mellitus and be associated with a hyperglycemic crisis. It is an aggressive entity with local complications that include involvement of the orbit or the central nervous system, and vascular involvement. Despite surgical and antifungal treatment, mortality raises up to 75%. We report the case of a female patient with a diagnosis of diabetic ketoacidosis and signs of unilateral ophthalmoplegia, which led to the study with magnetic resonance imaging of the central nervous system, finding signs of sinusitis, meningitis, and cerebritis. Initial microbiological studies were negative, and biomarkers such as serum galactomannan and Cryptococcus antigen were also negative. After surgical management and the identification of Aspergillus flavus and Rhizopus spp. in sinus tissue, the patient received treatment with posaconazole and after two months of follow-up she presented clinical improvement. Dual fungal infection and infection by A. flavus are uncommon and clinically relevant entities, with no cases previously reported in our country, therefore this corresponds to a case of clinical interest.

Clinical presentation and fungal species distribution in otomycosis in a tertiary care hospital

Objective: Otomycosis is a common fungal ear infection in tropical and subtropical regions worldwide. This study aimed to perform mycological analysis on fungal debris from the external auditory canals of the patients to study the most common clinical presentation and fungal species distribution in otomycosis. Materials and Methods: Patients who met the inclusion criteria for this cross-sectional study were included and evaluated after providing written informed consent. After obtaining a thorough medical history, ear swabs for culture, sensitivity, and potassium hydroxide were provided. Patients with positive culture results were studied between September 2019 and March 2021. Results: Among 103 cases observed for 18 months in the Department of ENT, Rajarajeswari Medical College, and Hospital, Bengaluru, India, we found that males (56.31%) were more affected than females (43.68%). Itching (67.96%) was the most primary and common symptom that was observed, followed by pain (20.38%), and the most common predisposing factor was the usage of earbuds (26.21%) followed by water in the ear (23.3%) and oil in the ear (16.50%). Unilateral infection was most common (96%), and the left ear was most affected (64.07%). Aspergillus niger was the most common fungal isolate (60.19%), and otomycosis was very common in postmonsoon (October–December) (58.25%). Conclusion: The most frequent fungal isolates in otomycosis are from the Aspergillus and Candida species. The left ear was typically affected by otomycosis, which frequently had a unilateral predominance. The most common clinical symptoms were itching and pain.

Molecular epidemiology and antifungal susceptibilities of Aspergillus species isolated from patients with invasive aspergillosis

SUMMARY OBJECTIVE: The aim of this study was to evaluate the demographic data, molecular epidemiology, and in vitro antifungal susceptibility results of patients with Aspergillus isolated from various clinical specimens. METHODS: A total of 44 Aspergillus strains were studied. The definition of invasive aspergillosis in patients was made according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Strains were phenotypically and molecularly identified. Demographic characteristics of patients and genotypes of strains were evaluated. Phylogenetic analysis was done by the The Unweighted Pair-Group Method with Arithmetic Mean (UPGMA). Antifungal susceptibility of strains was determined according to The Clinical and Laboratory Standards Institute (CLSI)-M61-Ed2 and The European Committee on Antimicrobial Susceptibility Testing (EUCAST). RESULTS: A total of 11 patients were classified as proven and 33 as probable invasive aspergillosis. There was a statistically significant difference in age groups, subdisease, neutropenic, and receiving chemotherapy between groups. A total of 23 strains were identified as Aspergillus fumigatus, 12 as Aspergillus niger, 6 as Aspergillus flavus, and 3 as Aspergillus terreus. Phylogenetic analysis revealed five different genotypes. No statistical difference was found in the comparisons between patients groups and genotype groups. There was a statistically significant difference between genotype groups and voriconazole, posaconazole, and itraconazole Minimum Inhibition Concentration (MIC). CONCLUSION: Accurate identification of strains and antifungal susceptibility studies should be performed due to azole and amphotericin B resistance. Genotyping studies are important in infection control due to identifying sources of infection and transmission routes.

A case of Aspergillus salwaensis-induced spinal infection / 中国热带医学

@#Abstract: To report a case of Aspergillus salwaensis-induced spinal infection and its laboratory detection. The inflammatory granulation and necrotic tissue samples of a patient with spinal infection were collected from, the Affiliated Hospital of Chengde Medical College on June 17, 2020 for direct smear microscopy and culture, and the isolated strain was identified by microscopy by smear staining, matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF-MS), molecular identification and in vitro antifungal susceptibility test. The patient was 62 years old female and presented with recurrent chest and back pain with no obvious cause. The initial diagnosis was spinal infection, after 7 days of treatment with levofloxacin, the effect was not good. Surgery was then performed remove the lesion via posterior thoracic debridement, and fungal hypha was observed under microscope in tissue specimens. The isolated strains had no typical structure, MALDI-TOF-MS was used for identification for many times, but there was no identification result. After 7 days of fluconazole treatment, the patient's condition improved, and her chest and back pain were alleviated compared to before surgery. The patient was discharged and followed up in the outpatient department, the fungus was later identified as Aspergillus salwaensis by sequence analysis of the internal transcribed spacer (ITS) gene sequencing, and the patient's antifungal medication was changed to voriconazole after with the attending physician. The patient consciously recovered well with no pain in the operative area and normal spinal activity at 1 year follow-up. The possibility of spinal fungal infection should be considered in patients with back pain without a clear cause and poor response to routine antibiotic treatment. Direct smear report of microscopic results are very important for guiding clinical antibiotic selection for rare filament fungi with atypical colony and microscopic morphology and unsuccessful MALDI-TOF-MS identification, molecular biological methods such as ITS sequence analysis can be helpful for early identification of the fungal species, improving identification speed.

Expression of β-glucosidase An-bgl3 from Aspergillus niger for conversion of scopolin / 生物工程学报

Scopoletin is a coumarin compound with various biological activities including detumescence and analgesic, insecticidal, antibacterial and acaricidal effects. However, interference with scopolin and other components often leads to difficulties in purification of scopoletin with low extraction rates from plant resource. In this paper, heterologous expression of the gene encoding β-glucosidase An-bgl3 derived from Aspergillus niger were carried out. The expression product was purified and characterized with further structure-activity relationship between it and β-glucosidase analyzed. Subsequently, its ability for transforming scopolin from plant extract was studied. The results showed that the specific activity of the purified β-glucosidase An-bgl3 was 15.22 IU/mg, the apparent molecular weight was about 120 kDa. The optimum reaction temperature and pH were 55 ℃ and 4.0, respectively. Moreover, 10 mmol/L metal ions Fe2+ and Mn2+ increased the enzyme activity by 1.74-fold and 1.20-fold, respectively. A 10 mmol/L solution containing Tween-20, Tween-80 and Triton X-100 all inhibited the enzyme activity by 30%. The enzyme showed affinity towards scopolin and tolerated 10% methanol and 10% ethanol solution, respectively. The enzyme specifically hydrolyzed scopolin into scopoletin from the extract of Erycibe obtusifolia Benth with a 47.8% increase of scopoletin. This demonstrated that the β-glucosidase An-bgl3 from A. niger shows specificity on scopolin with good activities, thus providing an alternative method for increasing the extraction efficiency of scopoletin from plant material.

A case of pulmonary aspergillus infection in underground coal mine workers / 中华劳动卫生职业病杂志

The underground environment is dark and humid, and it is easy to breed pathogenic microorganisms. A lump in the right lung of a coal mine underground transport worker was found druing occupational health examination. CT examination showed that the lump was located in the posterior segment of the upper lobe of the right lung, with point strip calcification, liquefaction necrosis, and proximal bronchial stenosis and occlusion. MRI examination FS-T(2)WI and DWI showed "target sign", annular low signal around the central high signal, and low mixed signal around the periphery, and annular high signal in the isosignal lesions on T(1)WI. Then the pulmonary aspergillus infection was confirmed by pathology.

Seven drimane-type sesquiterpenoids from an earwig-associated Aspergillus sp / 中国天然药物

Drimane-type sesquiterpenoids are widely distributed in fungi. From the ethyl acetate extract of the earwig-derived Aspergillus sp. NF2396, seven new drimane-type sesquiterpenoids, named drimanenoids A-G (1-7), were isolated. Their structures were elucidated by diverse spectroscopic analysis including high-resolution ESI-MS, one- and two-dimensional NMR spectroscopy. Drimanenoids A-F (1-6) are new members of drimane-type sesquiterpenoid esterified with unsaturated fatty acid side chain at C-6. Drimanenoids C (3), D (4) and F (6) showed antibacterial activity against five types of bacteria with different inhibition diameters. Drimanenoid D (4) exhibited moderate cytotoxicity against human myelogenous leukemia cell line K562 with an IC50 value of 12.88 ± 0.11 μmol·L-1.

Clinical characteristics and treatment of central nervous system aspergillosis: an analysis of 37 cases / 中华神经科杂志

Objective:To summarize the clinical characteristics and therapeutic efficacy of central nervous system (CNS) aspergillosis.Methods:The clinical manifestations, laboratory examination, neuroimaging features, treatment and prognosis of 37 cases of CNS aspergillosis diagnosed and treated in the First Medical Center of People′s Liberation Army General Hospital from January 2000 to January 2021 were retrospectively analyzed. According to the correlation between intracranial lesions and paranasal sinus lesions, they were divided into two groups: rhino-cerebral aspergillosis (RA, n=21) group and cerebral aspergillosis (CA, n=16) group. Results:Only 16.2% (6/37) of CNS aspergillosis patients had a clear background of immunosuppression, but 35.1% (13/37) were complicated with diabetes. The most common clinical manifestations were headache (73.0%, 27/37), cranial nerve involvement (59.5%, 22/37) and fever (37.8%, 14/37). Cerebrospinal fluid characteristics included increased pressure (53.8%, 14/26), increased white blood cell count (46.7%, 14/30), decreased glucose (30.0%, 9/30), increased protein (70.0%, 21/30), and high positive results of the metagenomic next-generation sequencing (mNGS) of pathogenic microorganism (7/10). Cranial magnetic resonance imaging showed that commonly involved sites were sinus, orbital apex, posterior orbit, cavernous sinus (43.2%, 16/37) and cerebral lobes (27.0%, 10/37). Treatment options included antifungal drugs alone (64.9%, 24/37), combination of drugs and surgery (27.0%, 10/37) and surgery alone (8.1%, 3/37). Compared with the CA group, RA group had fewer males [47.6% (10/21) vs 14/16, χ2=6.34, P=0.012] and older age [(54.2±19.4) years vs (38.4±18.4) years, t=2.50, P=0.017], and was more prone to headache [85.7% (18/21) vs 9/16, χ2=4.00, P=0.046) and cranial nerve involvement [81.0% (17/21) vs 5/16, χ 2=9.31, P=0.006]. The misdiagnosis rate of these patients in the early stage was 73.0% (27/37). A total of 29 patients (85.3%, 29/34) were treated with voriconazole successively, and the course of treatment was 3.0 (0.5, 10.4) months. Compared with salvage therapy, the mortality of primary therapy was lower (4/17 vs 9/12, χ2=7.54, P=0.006). All patients were followed up to December 2021, and 17 patients died, with a mortality rate of 45.9% (17/37). Conclusions:CNS aspergillosis may have no definite immunosuppressive background. Some of CNS aspergillosis patients are complicated with diabetes, and the clinical manifestations of the disease lack specificity, with high misdiagnosis rate in the early stage, no inflammatory changes in cerebrospinal fluid, and high positive rate of mNGS for pathogenic microorganism. Early and long-term application of voriconazole can significantly reduce the mortality rate.

Role of innate immune cells in host immune responses against Aspergillus fumigatus / 中华微生物学和免疫学杂志

Aspergillus fumigatus ( A. fumigatus) is an environmental filamentous fungus and an opportunistic pathogen that can cause chronic and invasive aspergillosis. The development of aspergillosis is the result of the interaction between the host and the pathogen, and the symptoms of A. fumigatus infection varied in patients with different immune status. The host innate immune response to inhaled fungal spores is a key determinant of the development of aspergillosis. This review focused on the role of innate immune cells including macrophages, neutrophils, natural killer cells, natural killer T cells and mast cells in host defense against A. fumigatus, aiming to provide reference for further research on the pathogenesis, clinical prevention and treatment of aspergillosis.