Mycoses最新文献

{"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":"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}

{"title":"Clade Distinction and Tracking of Clonal Spread by Fourier-Transform Infrared Spectroscopy in Multicenter Candida (Candidozyma) auris Outbreak.","authors":"Camylla C de Melo, Halana L N L de Oliveira, Bruna R Souza, Carla V R Moura, Rodrigo Oliveira, Rafael W Bastos, Karoline Kristina Kemmerich, João N de Almeida-Júnior, Arnaldo Lopes Colombo, Bram Spruijtenburg, Jacques F Meis, Patrice Le Pape, Carolyn G J Moonen, Reginaldo G de Lima-Neto","doi":"10.1111/myc.70085","DOIUrl":"10.1111/myc.70085","url":null,"abstract":"<p><strong>Background: </strong>Candida (Candidozyma) auris has distinct genetic clades. Clade distinction is relevant for infection control and epidemiological purposes. State-of-the-art typing methodologies for clade distinction are based on genomic approaches, such as short tandem repeat (STR) analysis and whole-genome sequencing (WGS). However, they are time-consuming and expensive. Fourier transform infrared spectroscopy (FT-IR) is an alternative tool for strain typing based on their unique biochemical spectral profiles.</p><p><strong>Objectives: </strong>To apply FT-IR to differentiate C. auris clades and evaluate epidemiological relationships based on biochemical data among isolates from a multicenter C. auris outbreak in the state of Pernambuco, northeastern Brazil.</p><p><strong>Methods: </strong>Sixty-nine C. auris strains from clades I, II, III, and IV were analysed. Fifty-nine were clade IV strains obtained from three outbreaks that took place in Pernambuco state, northeastern Brazil. An adjusted FT-IR spectroscopy protocol was applied to obtain carbohydrates and lipid fingerprints. Short Tandem Repeat (STR) analysis was used in order to validate the spectroscopy approach.</p><p><strong>Results: </strong>The adjusted preparation protocol for FT-IR analysis improved the spectral quality by 31.42% compared to standard protocol. FT-IR allowed us to discriminate C. auris clades I to IV. Moreover, important similarities were observed in C. auris clade IV strains obtained from two of the three hospitals, based on polysaccharides (1300-800 cm^-1) plus lipids (3000-2800 cm^-1 and 1500-1400 cm^-1) spectra. STR confirmed the similarity results obtained by FT-IR, clustering the strains from two different hospitals.</p><p><strong>Conclusions: </strong>The IR Biotyper is fast, easy-to-use, and a promising alternative for moderate-to-high-complexity laboratories to differentiate C. auris clades. Furthermore, this technique has the potential for isolate-level source tracking, which could be valuable for monitoring transmission routes in clinical settings.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70085"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560538","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":"Development and Validation of an Explainable Machine Learning Model for Predicting Invasive Fungal Infection in Acute-On-Chronic Liver Failure Within 28 Days.","authors":"Fei-Xiang Xiong, Jian-Guo Yan, Xue-Jie Zhang, Yang Zhou, Xiao-Min Ji, Rong-Hua Jin, Yi-Xin Hou","doi":"10.1111/myc.70090","DOIUrl":"https://doi.org/10.1111/myc.70090","url":null,"abstract":"<p><strong>Background and objective: </strong>Acute-on-chronic liver failure (ACLF) is associated with significantly higher short-term mortality, and the presence of invasive fungal infection (IFI) further increases this risk. This study aims to develop a ML model that predicts the risk of IFI in ACLF patients.</p><p><strong>Methods: </strong>This study included 1112 patients divided into a training set and a validation set, with another 188 patients serving as an external validation cohort. The Recursive Feature Elimination (RFE) method was used to select the most significant variables for model development. Four machine learning algorithms were compared to identify the optimal model. The models were evaluated and compared using C-index, time-dependent ROC curves, decision curve analysis (DCA), and calibration curves. The LIME (Local Interpretable Model-Agnostic Explanations) method was used to identify the high-risk populations utilised by the model.</p><p><strong>Results: </strong>778 patients were included in the training set, 334 in the internal validation set, and 188 in the external validation set. The study found that Random Forest (RF) was the best-performing ML algorithm. In the training set, the RF model achieved an AUROC of 0.922 (0.911-0.933), significantly higher than MELD (0.854, 0.835-0.873, p < 0.001), CLIF-C OF (0.753, 0.724-0.783, p < 0.001), and CLIF-C ACLF (0.879, 0.863-0.896, p = 0.020). The same trend was observed in both the internal and external validation sets. The time-dependent ROC curve showed that the RF model outperformed the other scores for predicting the risk of IFI in 28 days. DCA and calibration curves also demonstrated superior clinical benefits for the RF model across all datasets. LIME revealed bacterial infection (BI), Na < 136 mmol/L, CRP (C-reactive protein) > 20.1 g/L, and TBIL(Total Bilirubin) > 196.7 μmol/L as the high-risk groups.</p><p><strong>Conclusion: </strong>The RF model effectively predicts the risk of IFI in ACLF patients. The application of LIME enables the identification of high-risk populations, providing clinical value for patient management.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70090"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649909","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":"Invasive Mould Infections in Chronic Granulomatous Disease: A Multicenter Study From Türkiye.","authors":"Zeynep Ergenc, Sevgi Bilgic Eltan, Betul Gemici Karaaslan, Ayca Kiykim, Sevgi Aslan Tuncay, Seyhan Yilmaz, Pinar Canizci Erdemli, Aylin Dizi Isik, Burcu Parlak, Mahir Serbes, Adilia Warris, Ahmet Ozen, Elif Karakoc-Aydiner, Dilek Ozcan, Haluk Cokugras, Safa Baris, Eda Kepenekli","doi":"10.1111/myc.70086","DOIUrl":"10.1111/myc.70086","url":null,"abstract":"<p><strong>Background: </strong>Chronic Granulomatous Disease (CGD) is a rare primary immunodeficiency, predisposing to life-threatening invasive mould infection (IMI). While antifungal prophylaxis has improved outcomes, IMI remains the leading cause of mortality in CGD. This study aimed to evaluate the clinical and fungal epidemiology of IMI among CGD patients in Türkiye and explore diagnostic and treatment challenges.</p><p><strong>Methods: </strong>Demographics, clinical characteristics, IMI episodes, diagnostic methods, and antifungal prophylaxis regimens of 72 CGD patients followed at the Division of Paediatric Immunology of Marmara, Cerrahpaşa and Çukurova University School of Medicine, Türkiye between 1991 and 2022 were analysed. IMI episodes were classified as proven, probable, or possible based on the European Organisation for Research and Treatment of Cancer/Mycoses Study Group criteria.</p><p><strong>Results: </strong>Of the patients, 79.1% were male, and 52.8% had autosomal-recessive CGD (AR-CGD). Forty-two IMI episodes were detected in 39 (54.2%) patients, predominantly involving the lungs. Proven IMI accounted for 28.5% of episodes, with Aspergillus fumigatus as the most frequent pathogen. Patients with X-linked CGD experienced earlier IMI onset than AR-CGD (34.0 months (IQR: 18.0-65.5) versus 122.0 months (IQR: 40.25-240.0; p = 0.005)). Presentation with IMI led to the CGD diagnosis in 20 (51.3%) patients, while 19 (48.7%) developed IMI under itraconazole prophylaxis (median: 96.0 months, IQR: 48.0-153.0). Of 13 deaths (18.0%), 84.6% were associated with IMI.</p><p><strong>Conclusions: </strong>Our study highlights the persistently high burden of IMI among CGD patients, despite antifungal prophylaxis. Challenges in diagnosis, including limited access to invasive biopsy and diagnostic modalities, and gaps in prophylactic monitoring, underscore the need for optimised management strategies.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"68 7","pages":"e70086"},"PeriodicalIF":4.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12225591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553971","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}