Infections due to Candida spp. are frequent, particularly in immunocompromised and intensive care unit patients. Antifungal susceptibility tests are now required to optimize antifungal treatment ...given the emergence of acquired antifungal resistance in some Candida species. An antifungal susceptibility automated method, the Vitek 2 system (VK2), was evaluated. VK2 was compared to the CLSI broth microdilution reference method and the Etest procedure. For this purpose, 205 clinical isolates of Candida spp., including 11 different species, were tested for fluconazole, voriconazole, and amphotericin B susceptibility. For azoles, essential agreement ranged from 25% to 100%, depending on the method used and the Candida species tested. Categorical agreements for all of the species averaged 92.2% and ranged from 14.3 to 100%, depending on the 24-h or 48-h MIC reading by the Etest and CLSI methods and on the Candida species. Results obtained for Candida albicans showed excellent categorical and essential agreements with the two comparative methods. For Candida glabrata, the essential agreement was high with the CLSI method but low with the Etest method, and several very major errors in interpretation were observed between VK2 and the Etest method for both azoles. Low MICs of fluconazole were obtained for all of the Candida krusei isolates, but the VK2 expert software corrected all of the results obtained to resistant. Amphotericin B results showed MICs of less-than or equal to1 mg/liter for 201 (VK2), 190 (CLSI), and 202 (Etest) isolates. The AST-YS01 Vitek 2 card system (bioMérieux) is a reliable and practical standardized automated antifungal susceptibility test. Nevertheless, more assays are needed to better evaluate C. glabrata fluconazole sensitivity.
Candida glabrata
has emerged as a major pathogen in invasive candidiasis in recent years. Currently, guidelines for invasive candidiasis treatment recommend fluconazole or an echinocandin as the ...first-line therapy. Nevertheless, the resistance of
Candida glabrata
to echinocandin is an emerging problem and has been partly associated with mutations in the
FKS1
and
FKS2
genes. The Etest® is an appropriate method for determining antifungal susceptibility in emergency routine diagnosis. In this work, we evaluated the reliability of the Etest® in comparison with the two reference broth microdilution methods, Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST), to assess the caspofungin resistance of 193 isolates of
Candida glabrata
. The interpretation of minimum inhibitory concentration (MIC) values was also discussed according to different breakpoints. Moreover,
FKS1
and
FKS2
mutations were investigated for isolates with high MICs. Our results showed that the MIC
50
value was similar to the MIC
90
value for each method. The Etest® method showed the lowest MIC values, whereas EUCAST presented the highest. Categorical agreement between the Etest® and CLSI methods was 100 % and 36 % using the breakpoints proposed by Arendrup et al. (Antimicrob Agents Chemother 56(7):3965–3968,
2012
) and Pfaller et al. (Int J Antimicrob Agents 38(1):65–69,
2011
), respectively. Two isolates showed high MIC values with the three methods and both presented
FKS2
mutations. A novel
FKS2
mutation was also reported for one isolate. Future epidemiological studies should also evaluate the reliability of the Etest® to detect echinocandin resistance, as it remains a routine method.
Fungi are widely implicated in chronic rhinosinusitis. Direct microscopic examination (DME) is used to confirm the biological diagnosis of fungal rhinosinusitis (FRS). Diagnostic sensitivity of DME ...is better than culture, however DME does not allow fungal species identification. In this study, we included 54 sinus samples demonstrating hyphae on DME. Direct sequencing was compared to culture for the identification of the fungal species. Sequence analysis identified fungi in 81.5% of cases while culture was positive in only 31.5%. The most common genus was Aspergillus and the identified species belonged to section Fumigati or to section Flavi. Among other fungi identified by sequence analysis, Schizophyllum commune was present in three samples attesting to the importance of this Basidiomycetes in FRS. Our results clearly demonstrate the superiority of sequencing compared to culture when performed on specimens with hyphal elements at DME, and contributes to the epidemiological knowledge of fungi involved in FRS.
Confirmation of fungal origin of onychopathy by mycological examination is essential. For that purpose, in parallel to the cultivation of biological samples, achieving a sensitive and informative ...direct examination of nail fragments and subungual material is primordial. Among the direct examination techniques, and inspired from a technique of reference in histo-pathology (the "periodic acid-Schiff reagent" reaction), the simplified technique of PAS staining according to Hotchkiss and MacManus is the technique of choice. Easy to implement and very sensitive, it can immediately and formally confirm the diagnosis of onychomycosis, mention the type of fungus (yeast, dermatophyte, Hyphomycete opportunistic) and suspect a possible multiple involvement.
La confirmation de l’origine fongique d’une onychopathie par un examen mycologique est essentielle. Pour ce faire, en parallèle à la mise en culture des échantillons biologiques, la réalisation d’un ...examen direct sensible et informatif des fragments d’ongle et de matière sous-unguéale est primordiale. Parmi les techniques d’examen direct proposées, et inspirées de la reconnaissance comme référence par les histo-pathologistes de la réaction « acide périodique – réactif de Schiff » pour colorer les parois fongiques, la technique simplifiée de coloration PAS selon Hotchkiss et MacManus est une technique de choix. Simple à mettre en œuvre et très sensible, elle permet de confirmer d’emblée et formellement le diagnostic d’onychomycose, d’évoquer le type de champignon responsable (levure, dermatophyte, hyphomycète opportuniste) et de suspecter une éventuelle implication multiple.
Confirmation of fungal origin of onychopathy by mycological examination is essential. For that purpose, in parallel to the cultivation of biological samples, achieving a sensitive and informative direct examination of nail fragments and subungual material is primordial. Among the direct examination techniques, and inspired from a technique of reference in histo-pathology (the “periodic acid-Schiff reagent” reaction), the simplified technique of PAS staining according to Hotchkiss and MacManus is the technique of choice. Easy to implement and very sensitive, it can immediately and formally confirm the diagnosis of onychomycosis, mention the type of fungus (yeast, dermatophyte, Hyphomycete opportunistic) and suspect a possible multiple involvement.
Since echinocandins are recommended as first line therapy for invasive candidiasis, detection of resistance, mainly due to alteration in FKS protein, is of main interest. EUCAST AFST recommends ...testing both MIC of anidulafungin and micafungin, and breakpoints (BPs) have been proposed to detect echinocandin-resistant isolates. We analyzed MIC distribution for all three available echinocandins of 2,787 clinical yeast isolates corresponding to 5 common and 16 rare yeast species, using the standardized EUCAST method for anidulafungin and modified for caspofungin and micafungin (AM3-MIC). In our database, 64 isolates of common pathogenic species were resistant to anidulafungin, according to the EUCAST BP, and/or to caspofungin, using our previously published threshold (AM3-MIC ≥ 0.5 mg/L). Among these 64 isolates, 50 exhibited 21 different FKS mutations. We analyzed the capacity of caspofungin AM3-MIC and anidulafungin MIC determination in detecting isolates with FKS mutation. They were always identified using caspofungin AM3-MIC and the local threshold while some isolates were misclassified using anidulafungin MIC and EUCAST threshold. However, both methods misclassified four wild-type C. glabrata as resistant. Based on a large data set from a single center, the use of AM3-MIC testing for caspofungin looks promising in identifying non-wild-type C. albicans, C. tropicalis and P. kudiravzevii isolates, but additional multicenter comparison is mandatory to conclude on the possible superiority of AM3-MIC testing compared to the EUCAST method.
Schizophyllum commune is a basidiomycete fungus of the agaricomycetes class. It is usually found in forest habitats in the form of saprophytic and lignicolous fungus. Its implication in human ...pathology is rare, only 50 clinical cases among which 18 cases of sinusitis have been described in the last 60 years. We report two new cases of sinusitis. The first was a 57-year-old woman with chronic sinusitis and the second was a 56-year-old man suffering from an allergic sinusitis. This basidiomycete was identified after isolation in culture both by macroscopic and microscopic aspect and molecular biology. In both cases, evacuation and drainage by surgical debridment were sufficient to obtain a cure. The main bioclinical characteristics of Schizophyllum commune infection are provided.Original Abstract: Schizophyllum commune est un basidiomycete de la classe des agaricomycetes. Il est trouve dans les habitats forestiers en tant que saprophyte lignicole. Son implication en pathologie humaine est rare, seulement 50 cas cliniques dont 18 cas de sinusites ont ete decrits depuis 60 ans. Nous rapportons deux nouveaux cas de sinusites survenues chez une femme de 57 ans et un homme de 56 ans. Il s'agissait d'un cas de sinusite chronique et d'un cas de sinusite allergique ou ce basidiomycete a ete identifie apres isolement en culture a la fois par son aspect microscopique, macroscopique et par la biologie moleculaire. Dans les deux cas, l'evacuation et le drainage par debridement chirurgical ont ete suffisants pour obtenir la guerison. Nous rappelons ici les principales caracteristiques biocliniques d'une atteinte par Schizophyllum commune.
Histoplasma
capsulatum is a nonendemic fungus in Europe. Epidemiological, clinical biological features and follow-up of seven imported cases in France were reported. These cases underlined the ...difficulties of such diagnosis in nonendemic areas due to greatly variable asymptomatic period, and lack of specific clinical signs. Thus, anamnesis should be carefully analysed; mucocutaneous signs and immunosuppression should be systematically investigated. Biological diagnosis requires multiple sites sampling and long-term conservation of culture medium.
Histoplasma
capsulatum est un champignon qui n’est pas endémique en Europe. Les caractéristiques épidémiologiques, cliniques et biologiques, ainsi que le suivi de sept cas d’histoplasmose importés en France sont rapportés. Observés en zone non endémique, ces cas soulignent les écueils de ce diagnostic en particulier du fait de très longues périodes asymptomatiques et de l’absence de signes cliniques spécifiques. Ainsi, il apparaît essentiel d’analyser soigneusement l’anamnèse des patients, et de rechercher systématiquement la présence des signes cutanéo-muqueux et d’une immunodépression. La confirmation du diagnostic par la mise en œuvre de méthodes biologiques nécessite des prélèvements au niveau de plusieurs sites et une conservation prolongée des milieux de culture.
Schizophyllum commune est un basidiomycète de la classe des agaricomycètes. Il est trouvé dans les habitats forestiers en tant que saprophyte lignicole. Son implication en pathologie humaine est ...rare, seulement 50 cas cliniques dont 18 cas de sinusites ont été décrits depuis 60
ans. Nous rapportons deux nouveaux cas de sinusites survenues chez une femme de 57
ans et un homme de 56
ans. Il s’agissait d’un cas de sinusite chronique et d’un cas de sinusite allergique où ce basidiomycète a été identifié après isolement en culture à la fois par son aspect microscopique, macroscopique et par la biologie moléculaire. Dans les deux cas, l’évacuation et le drainage par débridement chirurgical ont été suffisants pour obtenir la guérison. Nous rappelons ici les principales caractéristiques biocliniques d’une atteinte par
Schizophyllum commune.
Schizophyllum commune is a basidiomycete fungus of the agaricomycetes class. It is usually found in forest habitats in the form of saprophytic and lignicolous fungus. Its implication in human pathology is rare, only 50 clinical cases among which 18 cases of sinusitis have been described in the last 60 years. We report two new cases of sinusitis. The first was a 57-year-old woman with chronic sinusitis and the second was a 56-year-old man suffering from an allergic sinusitis. This basidiomycete was identified after isolation in culture both by macroscopic and microscopic aspect and molecular biology. In both cases, evacuation and drainage by surgical debridment were sufficient to obtain a cure. The main bioclinical characteristics of
Schizophyllum commune infection are provided.
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