Mycoses最新文献

{"title":"Pentraxin 3 as a Potential Biomarker of Invasive Fusariosis in Onco-Haematological Patients.","authors":"Larissa Simão Gandolpho, Elaine Cristina Francisco, Giovanni Luis Breda, Celso Arrais-Rodrigues, Arnaldo Lopes Colombo","doi":"10.1111/myc.70095","DOIUrl":"https://doi.org/10.1111/myc.70095","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the clinical use of pentraxin 3 serum level as a biomarker for screening episodes of invasive fusariosis among high-risk onco-haematological patients.</p><p><strong>Methods: </strong>We analysed 63 serum samples from patients with invasive mould diseases and controls, which had been collected between 2009 and 2021 and stored at the Special Mycology Laboratory of Universidade Federal de São Paulo, Brazil. Material included samples from eight patients with invasive fusariosis, nine with invasive aspergillosis, and control groups comprising 20 healthy individuals, eight neutropenic patients with acute myeloid leukaemia, and eight allogeneic haematopoietic stem cell transplant recipients without any concomitant infection, and 10 neutropenic individuals who developed a microbiologically documented gram-negative bacteremia. PTX3 levels were quantified using an enzyme-linked immunosorbent assay (ELISA), and statistical analyses were performed using SPSS Statistics v.28.0, California USA.</p><p><strong>Results: </strong>The optimal PTX3 detection threshold was established at 10 pg/mL, with the highest levels observed in patients with invasive aspergillosis (5532.8 pg/mL) and invasive fusariosis (3718.1 pg/mL). Healthy controls revealed PTX3 levels ranging from 109.9 to 385.7 pg/mL. Significant differences were noted among all groups (p < 0.001), with PTX3 levels exceeding 1000 pg/mL exclusively in patients with IMDs. Notably, high PTX3 serum levels were detected in four out of the eight samples that had been collected 1-5 days before the diagnosis of fusariosis by culture.</p><p><strong>Conclusions: </strong>Our results suggest that serum PTX3 quantification holds significant potential for screening patients with suspected invasive fusariosis among onco-haematological patients, similar to its role in invasive aspergillosis.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 8","pages":"e70095"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144743155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning Models for CT Segmentation of Invasive Pulmonary Aspergillosis, Mucormycosis, Bacterial Pneumonia and Tuberculosis: A Multicentre Study.","authors":"Yun Li, Feifei Huang, Deyan Chen, Youwen Zhang, Xia Zhang, Lina Liang, Junnan Pan, Lunfang Tan, Shuyi Liu, Junfeng Lin, Zhengtu Li, Guodong Hu, Huai Chen, Chengbao Peng, Feng Ye, Jinping Zheng","doi":"10.1111/myc.70084","DOIUrl":"10.1111/myc.70084","url":null,"abstract":"<p><strong>Background: </strong>The differential diagnosis of invasive pulmonary aspergillosis (IPA), pulmonary mucormycosis (PM), bacterial pneumonia (BP) and pulmonary tuberculosis (PTB) are challenging due to overlapping clinical and imaging features. Manual CT lesion segmentation is time-consuming, deep-learning (DL)-based segmentation models offer a promising solution, yet disease-specific models for these infections remain underexplored.</p><p><strong>Objectives: </strong>We aimed to develop and validate dedicated CT segmentation models for IPA, PM, BP and PTB to enhance diagnostic accuracy. Methods：Retrospective multi-centre data (115 IPA, 53 PM, 130 BP, 125 PTB) were used for training/internal validation, with 21 IPA, 8PM, 30 BP and 31 PTB cases for external validation. Expert-annotated lesions served as ground truth. An improved 3D U-Net architecture was employed for segmentation, with preprocessing steps including normalisations, cropping and data augmentation. Performance was evaluated using Dice coefficients. Results：Internal validation achieved Dice scores of 78.83% (IPA), 93.38% (PM), 80.12% (BP) and 90.47% (PTB). External validation showed slightly reduced but robust performance: 75.09% (IPA), 77.53% (PM), 67.40% (BP) and 80.07% (PTB). The PM model demonstrated exceptional generalisability, scoring 83.41% on IPA data. Cross-validation revealed mutual applicability, with IPA/PTB models achieving > 75% Dice for each other's lesions. BP segmentation showed lower but clinically acceptable performance ( ＞72%), likely due to complex radiological patterns.</p><p><strong>Conclusions: </strong>Disease-specific DL segmentation models exhibited high accuracy, particularly for PM and PTB. While IPA and BP models require refinement, all demonstrated cross-disease utility, suggesting immediate clinical value for preliminary lesion annotation. Future efforts should enhance datasets and optimise models for intricate cases.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70084"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, Significance and Clinical Outcomes of Bloodstream Infections Caused by Non-Candida and Non-Cryptococcus Yeasts.","authors":"Adam G Stewart, Kevin B Laupland, Felicity Edwards, Monica A Slavin, Sharon C-A Chen","doi":"10.1111/myc.70093","DOIUrl":"https://doi.org/10.1111/myc.70093","url":null,"abstract":"<p><strong>Introduction: </strong>Fungaemia due to non-Candida and non-Cryptococcus yeasts is uncommon but clinically significant, particularly in immunocompromised hosts. We aimed to describe the epidemiology, microbiology and outcomes of bloodstream infections (BSIs) caused by these organisms.</p><p><strong>Methods: </strong>We identified all BSIs due to non-Candida and non-Cryptococcus yeasts over a 20-year period using statewide laboratory and administrative health databases.</p><p><strong>Results: </strong>Seventy-five unique episodes were identified. The most frequent genera were Trichosporon (n = 31, 41.3%), Rhodotorula (n = 26 34.7%) and Saccharomyces (n = 10, 13.3%) species. Antifungal susceptibility testing performed in 33 (44%) episodes revealed high MICs (> 16 mg/L) to echinocandins for Trichosporon and Rhodotorula species. Fluconazole MICs were universally elevated ( <math> <semantics><mrow><mo>≥</mo></mrow> <annotation>$$ ge $$</annotation></semantics> </math>  32 mg/L) in Rhodotorula spp. but lower in Saccharomyces cerevisiae (2-4 mg/L). Voriconazole and posaconazole had good in vitro activity across all genera where tested. Thirty-day mortality was 22.7%, with the highest rate observed in S. cerevisiae (50.0%). Mortality was associated with malignancy (aHR 4.71, 95% CI 1.00-22.25), heart failure (aHR 11.31, 95% CI 1.66-77.14) and intensive care unit (ICU) admission (aHR 7.05, 95% CI 0.99-50.36). The presence of a central line may be protective (aHR 0.17, 95% CI 0.03-1.04). Rhodotorula infection was associated with lower mortality on univariable analysis (HR 0.11, 95% CI 0.14-0.86) compared with Trichosporon species.</p><p><strong>Conclusion: </strong>Although rare, fungaemia due to non-Candida and non-Cryptococcus yeasts is associated with significant mortality and antifungal resistance. Species identification and susceptibility testing are crucial to guide treatment. Increased awareness is essential in high-risk patients, particularly those with malignancy, heart failure, or requiring ICU admission.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70093"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexually Transmitted Dermatophyte Infections-A Scoping Review.","authors":"Aditya K Gupta, Amanda Liddy, Lee Megal, Baruch Kaplan, Avner Shemer, Ditte Marie L Saunte, Tong Wang","doi":"10.1111/myc.70088","DOIUrl":"10.1111/myc.70088","url":null,"abstract":"<p><p>Sexually transmitted dermatophyte infections are an emerging public health concern, with increasing incidence reported across multiple countries. These infections are mainly spread through direct skin-to-skin contact during sexual activity and are more commonly found in individuals with high-risk sexual practices. The likelihood of infection is heightened by frequent pubic hair grooming or regular use of shared spaces like gyms and saunas. Clinically, presentations are often severe, widespread and atypical, which may delay diagnosis or lead to misidentification. Accurate species-level identification is critical and increasingly reliant on molecular sequencing techniques, including ITS and tef1α regions, which are also valuable for strain surveillance and contact tracing. Management strategies should emphasise systemic antifungal therapy, with consideration for adjunctive topical agents or antibiotics in cases of secondary infection. Individualised treatment plans may require extended therapy durations or combination regimens to ensure clinical resolution. In addition to pharmacologic intervention, education on hygiene practices, risk of reinfection and the importance of environmental decontamination and follow-up care is essential for preventing recurrence and curbing transmission.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70088"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cut-Offs and Diagnostic Performance of IgG Against Recombinant Aspergillus fumigatus Antigens in Differentiating ABPA From Asthma.","authors":"Ritesh Agarwal, Valliappan Muthu, Inderpaul Singh Sehgal, Kuruswamy Thurai Prasad, Sahajal Dhooria, Mani Singh, Mandeep Garg, Ashutosh N Aggarwal, Shivaprakash M Rudramurthy, Arunaloke Chakrabarti","doi":"10.1111/myc.70087","DOIUrl":"10.1111/myc.70087","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic cut-off values for IgG antibodies against recombinant Aspergillus fumigatus (rAsp) antigens in allergic bronchopulmonary aspergillosis (ABPA) remain unclear.</p><p><strong>Objectives: </strong>To derive and validate diagnostic cut-offs for IgG antibodies against rAsp f 1, f 2 and f 4 in ABPA and assess their diagnostic performance in distinguishing ABPA from asthma.</p><p><strong>Methods: </strong>In this case-control study, we prospectively enrolled consecutive subjects with asthma and ABPA. We measured serum IgG levels against rAsp f 1, rAsp f 2 and rAsp f 4 using a fluorescent enzyme immunoassay. Subjects were randomly split into derivation (50%) and validation (50%) cohorts. Cut-offs were derived using receiver operating characteristic (ROC) curves and Youden's index. Additionally, we performed Bayesian latent class analysis (BLCA) using two-component Gaussian mixture models to derive unbiased cut-offs. Diagnostic performance was assessed using sensitivity, specificity and the area under the ROC curve (AUROC).</p><p><strong>Results: </strong>Of 375 participants, 261 had ABPA and 114 had asthma. ROC-derived AUROC values for rAsp f 1, f 2 and f 4-IgG were 0.63, 0.47 and 0.52, while the cut-off values were 10.1 mgA/L, 10.3 mgA/L and 10.5 mgA/L, respectively. Sensitivity was ≤ 42% for all antigens, while specificity exceeded 89%. BLCA yielded cut-offs of 18.6, 14.9 and 13.7 mgA/L for f 1, f 2 and f 4, respectively, with similarly poor sensitivity and high specificity.</p><p><strong>Conclusions: </strong>IgG antibodies against rAsp f 1, f 2 and f 4 exhibit high specificity but poor sensitivity in identifying ABPA, limiting their utility as standalone diagnostic markers.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70087"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcomes in Patients With Cryptococcaemia From a Large Population-Based Cohort.","authors":"Adam G Stewart, Kevin B Laupland, Felicity Edwards, Ian Gassiep, Sophia Koo, Sarah P Hammond, Sharon C-A Chen, Monica A Slavin","doi":"10.1111/myc.70091","DOIUrl":"https://doi.org/10.1111/myc.70091","url":null,"abstract":"<p><strong>Background: </strong>Cryptococcus bloodstream infections (BSIs) or cryptococcaemia are severe opportunistic infections with high mortality, predominantly affecting immunocompromised individuals or those with end-stage organ disease. Population-based studies examining infection trends and associations between host factors, geography, antifungal resistance, and clinical outcomes are few.</p><p><strong>Methods: </strong>Blood cultures with growth of Cryptococcus species were retrospectively identified over a 20-year period (January 1, 2000-December 31, 2019) from a state-wide database. Clinical, microbiological and outcome information was also obtained. Survival analyses were used to establish associations between clinical or microbiological characteristics and mortality.</p><p><strong>Results: </strong>A total of 118 cryptococcaemia episodes (115 patients) were identified, with Cryptococcus neoformans complex causing 98 episodes (83.1%). HIV-associated infections represented 28 episodes (23.7%), with non-HIV episodes (n = 90) more likely to be associated with comorbidities including solid organ transplantation, malignancy, chronic kidney disease, and rheumatological conditions. Overall, 30-day all-cause mortality was 34%, with higher mortality in non-HIV-associated cases (41.7% vs. 12.5%, HR 0.29; 95% CI 0.09-0.94). Of C. neoformans complex isolates with a fluconazole MIC <math> <semantics><mrow><mo>≥</mo></mrow> <annotation>$$ ge $$</annotation></semantics> </math> 8 mg/L, 6 (46%) were observed in the most recent 5-year period. Thirty-day (p = 0.85) and 1-year (p = 0.35) mortality increased in a stepwise fashion with increasing fluconazole MIC values in C. neoformans complex infection. Fifty-three episodes (49.1%) documented isolated cryptococcaemia. Patients with additional sites of infection, including CNS involvement, experienced longer hospital stays. Those living in a regional or remote area (HR 1.33; 95% CI 0.68-2.61) or with older age (HR 1.02; 95% CI 1.00-1.04) experienced higher rates of death, although these findings were not statistically significant.</p><p><strong>Conclusion: </strong>Cryptococcus BSI is a highly lethal condition, particularly among non-HIV infected individuals. We highlight the prognostic importance of blood culture collection in patients with suspected cryptococcal infection. Identifying contemporary risk factors for mortality is critical to understanding what drives poor outcomes. There is a need for continued surveillance of fluconazole susceptibility among Cryptococcus species.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70091"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESCMID-EFISG Survey on Diagnostic and Therapeutic Capacity for Invasive Fungal Infections in Belgium, the Netherlands, and Luxembourg: A Focus on High Azole Resistance.","authors":"Robina Aerts, Lize Cuypers, Eelco F J Meijer, Michel Kohnen, Jacques F Meis, Oliver A Cornely, Katrien Lagrou, Jon Salmanton-García","doi":"10.1111/myc.70092","DOIUrl":"10.1111/myc.70092","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive fungal infections (IFI) are a major clinical challenge, particularly in immunocompromised patients, and are associated with high morbidity and mortality. With the increasing prevalence of immunosuppressive conditions and ageing populations, the incidence of IFI is rising globally.</p><p><strong>Objective: </strong>This survey aims to evaluate the diagnostic and therapeutic capacities for IFI in Belgium, the Netherlands, and Luxembourg (Benelux), a region of high azole-resistance among Aspergillus fumigatus isolates.</p><p><strong>Methods: </strong>A survey evaluating the diagnostic and therapeutic capacity for IFI was conducted in the Benelux. Data were collected from specialists via an online case report form between March and September 2023. The survey addressed patient characteristics, access to microbiology labs, diagnostic methods (microscopy, culture, molecular diagnostics, etc.), IFI incidence, and the availability of antifungal drugs and therapeutic drug monitoring.</p><p><strong>Results: </strong>In total, 32 hospitals responded to the questionnaire (12 [38%] from the Netherlands, 19 [59%] from Belgium and one [3%] from Luxembourg). Antifungal susceptibility tests were available in 29 institutions (91%), constituting 84% of the centres in Belgium and 100% for the Netherlands (p = 0.265). Aspergillus PCR testing was available in 12 centres in Belgium (63%) while in 11 centres in the Netherlands (92%, p = 0.108). Mucorales PCR testing was available in 56% of centres. Treatment with at least one amphotericin B formulation was only available in 84% of the responding centres. Therapeutic drug monitoring (TDM), although recommended, was possible for voriconazole in 26 centres (81%) while for posaconazole in 24 centres (75%). Significantly more testing (diagnostic tests and TDM) was outsourced in Belgium compared to the Netherlands (p < 0.001).</p><p><strong>Conclusions: </strong>Antifungal susceptibility testing is widely available in Belgium and the Netherlands, but implementation in areas with high azole resistance for Aspergillus fumigatus is not yet universal, and techniques vary. Tests for coinfections, like Mucorales PCR, were only available in half of the centres. More testing is outsourced in Belgium, likely due to differences in reference centre organisation, country size, transport, and reimbursement. Delays in diagnosis can impact patient outcomes, so awareness of test availability and transport times is crucial.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70092"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician's Compliance to Clinical Practice Guidelines and Outcomes of Patients With Invasive Candidiasis in a University Hospital in Thailand.","authors":"Nantaporn Pirogard, Piriyaporn Chongtrakool, Darunee Lertsudkanung, Methee Chayakulkeeree","doi":"10.1111/myc.70094","DOIUrl":"10.1111/myc.70094","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive candidiasis is a life-threatening fungal infection associated with high mortality rates. Adherence to clinical practice guidelines (CPG) has been shown to improve patient outcomes. This study aimed to evaluate physician compliance with CPG following the implementation of care bundles and locally developed CPG and to assess the impact of CPG implementation on patient mortality.</p><p><strong>Methods: </strong>This quasi-experimental study utilised a historical cohort control design. Candidemia patients treated at Siriraj Hospital in Bangkok, Thailand, from November 2021 to April 2024 were enrolled. A prospective cohort group received CPG for invasive candidiasis, modified from ESCMID recommendations, covering eight facets. Education care bundles, including clinical policy, training, infographic sheets, leaflets and SMS alerts, were also implemented. Each CPG item was scored as 0, 1 or 2, representing non-compliance, partial compliance and full compliance, respectively. A total compliance score below eight indicates poor compliance. Physician compliance and 30-day mortality rates were analysed.</p><p><strong>Results: </strong>A total of 112 patients were included in the study: 56 in the historical control group and 56 in the prospective intervention group. Both groups exhibited similar baseline characteristics and risk factors for candidemia. Following the implementation of the CPG and care bundles, physician compliance significantly improved across several metrics. Notable increases were observed in: initiating anti-fungal therapy within 24 h (OR = 6.00, 95% CI [2.41-14.96], p < 0.001), receipt of appropriate anti-fungal therapy, specifically with echinocandins or amphotericin B (OR = 9.17, 95% CI [1.11-75.96], p = 0.03), catheter removal or source control within 48 h (OR = 37.17, 95% CI [4.68-295.39], p < 0.001), obtaining blood cultures at least every other day (OR = 19.15, 95% CI [7.35-49.86],p < 0.001), continuing anti-fungal therapy for at least 14 days after the first negative culture (OR = 3.30, 95% CI [1.42-7.67], p = 0.005), conducting echocardiography (0% vs. 16.1%, p = 0.003), performing fundoscopy (OR = 5.24, 95% CI [1.79-15.30], p = 0.001). There was a significant improvement in compliance scores, with ≥ 8 being more prevalent in the intervention group compared to controls (OR = 5.39, 95% CI [1.98-14.69], p < 0.001). The mean compliance score was 8 ± 2 in the control group and 11 ± 2 in the intervention group (p < 0.001). Additionally, the all-cause 30-day mortality rate decreased significantly from 55.4% in the control group to 35.7% in the intervention group (OR = 0.45, 95% CI [0.21-0.96], p = 0.04).</p><p><strong>Conclusions: </strong>The implementation of CPG and care bundles for invasive candidiasis significantly enhanced physician compliance and improved patient survival. These findings support the continued adoption of CPG and care bundles in the management of invasive candidiasis.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70094"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Antifungal Prophylaxis Needed for Acute Myeloid Leukaemia Patients Treated With Venetoclax-Based Regimens? A Systematic Review and Meta-Analysis.","authors":"Pedro Robson Costa Passos, Valbert Oliveira Costa Filho, Mariana Macambira Noronha, Cilomar Martins de Oliveira Filho","doi":"10.1111/myc.70089","DOIUrl":"10.1111/myc.70089","url":null,"abstract":"<p><p>Acute myeloid leukaemia (AML) patients undergoing venetoclax (VEN)-based regimens are at risk for invasive fungal infections (IFIs), but the benefit of antifungal prophylaxis (AFP) in this setting remains uncertain. We evaluated the efficacy of AFP in preventing invasive fungal infections (IFI), improving overall survival (OS) and best response among AML patients treated with VEN-based therapies. A systematic search of PubMed, EMBASE and Cochrane databases was conducted for studies comparing AFP use to no prophylaxis in AML patients under VEN-based regimens. Data were synthesised using Bayesian meta-analysis. Seven retrospective studies involving 960 patients were included. The pooled analysis yielded an odds ratio (OR) of 0.84 (95% credible interval: 0.39-1.59) for probable or confirmed IFIs with AFP use. The computed probability of OR < 1 for IFI infection was 74.8% for probable or confirmed IFIs and 71.8% for confirmed IFIs, indicating substantial uncertainty and no clear evidence of a real effect. AFP did not significantly alter OS (hazard ratio = 0.82, 95% confidence interval: 0.58-1.16) or response rates. Mould-active antifungals were underutilised in most studies, and the most used antifungals were fluconazole (35.2%) and posaconazole (34.8%). Our analysis highlights the need for prospective studies and risk stratification to evaluate the role of mould-active agents in this population.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70089"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serological Response and Associated Prognostic Factors in Paracoccidioidomycosis: A 15-Year Retrospective Study.","authors":"Wdson Luis Lima Kruschewsky, Alice Heck Rodrigues Costa, Mariane Taborda, Mônica Scarpelli Martinelli Vidal, Adriana Satie Gonçalves Kono Magri, Gil Benard, Vítor Falcão de Oliveira, Marcello Mihailenko Chaves Magri","doi":"10.1111/myc.70096","DOIUrl":"https://doi.org/10.1111/myc.70096","url":null,"abstract":"<p><strong>Background: </strong>Small studies have used various serological methods to evaluate the response to paracoccidioidomycosis (PCM) treatment, with limited use of counterimmunoelectrophoresis (CIE). This study assessed CIE titres during and after PCM therapy and their prognostic value for serological negativity.</p><p><strong>Methods: </strong>In this retrospective study, we reviewed medical records of patients with positive serology in proven or probable PCM from 2006 to 2021 at University of São Paulo. We performed multivariate logistic regression to identify independent variables associated with CIE titre negativity.</p><p><strong>Results: </strong>This study included 144 participants, totalling 979 serology samples analysed, with a predominance of middle-aged adults (median age 50 years), males (n = 112, 78%) and chronic form (n = 112, 78%). Trimethoprim-sulfamethoxazole (n = 79, 55%) and itraconazole (n = 55, 38%) were the drugs most commonly used. The median treatment time was 24 months (IQR 16-37). Median initial CIE titre was 1:32 (IQR 1:16-1:128). Thirty-seven patients (26%) had a negative CIE titre, and 105 patients (73%) had CIE titres ≤ 1:4 at the last medical appointment. In multivariate analysis, only positive direct microscopy examination (OR 0.32, p = 0.043) was an independent factor related to non-negativity serology. The time to negativity was shorter in female sex and negative microscopy.</p><p><strong>Conclusion: </strong>The serology using CIE presented a strong association with clinical response, making it a valuable method for monitoring patients with PCM. Most patients achieved CIE titres ≤ 1:4 during antifungal therapy, which was strongly associated with a successful clinical response.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70096"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}