The current state of clinical mycology in Africa: a European Confederation of Medical Mycology and International Society for Human and Animal Mycology survey.

Africa, although not unique in this context, is a favourable environment for fungal infections, given the high burden of risk factors. An online survey was developed asking about laboratory infrastructure and antifungal drug availability. We received 40 responses (24·4% response rate) of 164 researchers contacted from 21 African countries. Only five institutions (12·5%) of 40 located in Cameroon, Kenya, Nigeria, Sudan, and Uganda potentially fulfilled the minimum laboratory requirements for European Confederation of Medical Mycology Excellence Centre blue status. Difficulties included low access to susceptibility testing for both yeasts and moulds (available in only 30% of institutions) and Aspergillus spp antigen detection (available in only 47·5% of institutions as an in-house or outsourced test), as well as access to mould-active antifungal drugs such as amphotericin B deoxycholate (available for 52·5% of institutions), itraconazole (52·5%), voriconazole (35·0%), and posaconazole (5·0%). United and targeted efforts are crucial to face the growing challenges in clinical mycology.

The current state of Clinical Mycology in Eastern and South-Eastern Europe.

The ability of medical centers in Eastern and South-Eastern Europe to diagnose and treat fungal infections remains unknown. In order to investigate that, here we conducted a cross-sectional online survey, released at both The International Society for Human & Animal Mycology (ISHAM) and European Confederation of Medical Mycology (ECMM) websites. A total of 31 institutions responded to the questionnaire. Most centers (87.1%, n = 27) had access to Aspergillus spp. ELISA galactomannan testing as well as to Cryptococcus spp. antigen testing (83.9%, n = 26). Serological tests were mostly available for Aspergillus species (80.6%, n = 25); and most institutions reported access to mold-active antifungal drugs (83.9%; n = 26), but 5-flucytosine was available to only 29% (n = 9) of the participant centers. In conclusion, this study represents the first attempt to document the strengths and limitations of the Eastern and South-Eastern European region for diagnosing and treating fungal diseases. LAY SUMMARY: Our article is about the availability of diagnostic and treatments tools related to fungal infections in the countries of Eastern and South-Eastern region. Surveys like these are important to understand the gaps and point towards the fungal infections as a global health issue.

Phenotypic and molecular characterisation of Sporothrix globosa of diverse origin from India.

Sporotrichosis is one of the neglected tropical diseases causing subcutaneous chronic granulomatous lesion by thermally dimorphic fungi belonging to Sporothrix species. Sporothrix brasiliensis, Sporothrix mexicana and Sporothrix globosa are the common pathogenic species. In Asian countries, S. globosa constitutes nearly 99.3% of all Sporothrix species. We studied 63 cases of sporotrichosis of geographically diverse origin from India and Sporothrix isolates were characterised for its growth in different media, temperatures, ability to assimilate sugars and antifungal susceptibility profile. Molecular characterization was performed by sequencing of the calmodulin (CAL), beta tubulin (BT) and translational elongation factor 1-alpha (TEF-1α) and typing by fluorescent amplified fragment length polymorphism (FAFLP). In patients who presented with fixed (49.2%), lymphocutaneous lesions (23.8%), in 26.9% the details were not known, none had systemic dissemination. All the isolates tested were Sporothrix globosa and that could grow up to 35 °C and unable to grow at and beyond 37 °C. The assimilation of sucrose, ribitol and raffinose helps in identifying S. globosa. Sequences of CAL or BT or TEF-1α can differentiate S. globosa from other species in the complex. FAFLP results exhibited low genetic diversity. No correlation was noted between genotypes and clinical presentation, or geographic distribution. Itraconazole, terbinafine and posaconazole showed good in vitro antifungal activity against S. globosa whereas fluconazole and micafungin had no activity. S. globosa of Indian origin is relatively less pathogenic than other pathogenic Sporothrix species as it does not cause systemic dissemination and in the diagnostic laboratory, incubation of the cultures below 37 °C is essential for effective isolation.

Occurrence of Cryptococcus neoformans and other yeast-like fungi in environmental sources in Bonaire (Dutch Caribbean).

INTRODUCTION: We report here the presence of Cryptococcus neoformans, and other potentially pathogenic yeasts and yeast-like fungi in environmental sources in Bonaire. METHODS: Seventy environmental samples comprising 40 samples of old pigeon droppings, 18 of woody debris from hollows of living trees of Caesalpinia ('Divi Divi'), Ziziphus jujuba (Red Indian date), Tamarindus indica (Tamarind), Terminalia catappa (Tropical almond), Azadirachta indica (Neem) and 3 of other unidentified species of trees, 3 of latex from a rubber tree and 6 of coral dust were processed for isolation of pathogenic Cryptococcus spp. and other potentially pathogenic yeasts and yeast-like fungi. A variety of mycological media were employed. Identification of the isolates was done with conventional techniques and species identification was done by matrix-assisted laser desorption ionization-time of flight mass spectrometry. RESULTS: Three of the 40 samples from old pigeon droppings yielded Cryptococcus neoformans, constituting the first record of environmental occurrence of this important pathogenic yeast in the Dutch Caribbean. Other potentially pathogenic yeasts and yeast-like fungi recovered from these environmental samples included 6 isolates each of Candida albicans, 8 of Candida parapsilosis, 4 each of Candida metapsilosis and Candida orthopsilosis, 2 each of Candida carpophila, Candida famata, Candida fabianii and Candida pelliculosa, 7 of Candida spp., 5 of Trichosporon spp. and 2 of Sporobolomyces spp. CONCLUSIONS: This study has demonstrated for the first time the occurrence of C. neoformans in a natural habitat in the Dutch Caribbean. The recovery of many species of potentially pathogenic yeast-like fungi and yeasts from environmental sources is remarkable.

Mitochondrial DNA analysis of Sporothrix schenckii in India, Thailand, Brazil, Colombia, Guatemala and Mexico.

Up to now, 30 mitochondrial DNA(mtDNA)and 4 rDNA types of Sporothrix schenckii strains have been identified. Here, seventy-six isolates of S. schenckii from Mexico, Guatemala, Brazil, Thailand and India were genotyped and studied epidemiologically by mtDNA restriction fragment length polymorphisms(RFLP)and internal transcribed spacer region(ITS)-RFLP analysis and two new mtDNA types, Type 31 and Type 32, were found. Type 30, previously reported by Mora-Cabrera et al. was confirmed to be Type 3 and designated as blank. Of 48 isolates from Mexico, 41 belonged to Group A wherein Type 2(13 isolates), Type 3(10)and Type 28(7)were dominant. All ten isolates from India and Thailand belonged to Group B. The 52 Group A and 24 Group B isolates corresponded to rDNA Type I and Type IV , respectively, reported by Watanabe et al.(Nippon Ishinkin Gakkai Zasshi 45: 165-175, 2004).