Mycoses最新文献

{"title":"Azole resistance in Aspergillus flavus and associated fitness cost.","authors":"Elie Djenontin, Anne Debourgogne, Bita Mousavi, Laurence Delhaes, Muriel Cornet, Isabel Valsecchi, Makiath Adebo, Jacques Guillot, Françoise Botterel, Eric Dannaoui","doi":"10.1111/myc.13766","DOIUrl":"https://doi.org/10.1111/myc.13766","url":null,"abstract":"<p><strong>Background: </strong>The resistance of Aspergillus flavus to the azole antifungal drugs is an emerging problem. Mutations in the molecular targets of the azole antifungals - CYP 51 A, B and C - are possible mechanisms of resistance, but data to confirm this hypothesis are scarce. In addition, the behaviour of resistant strains in vitro and in vivo is not yet understood.</p><p><strong>Objectives: </strong>This study had 3 objectives. The first was to compare the sequences of CYP51 A, B and C in resistant and susceptible strains of A. flavus. The second was to look for the existence of a fitness cost associated with resistance. The third was to evaluate the activity of voriconazole and posaconazole on resistant strains in the Galleria mellonella model.</p><p><strong>Methods: </strong>The CYP51 A, B and C sequences of seven resistant strains with those of four susceptible strains are compared. Fitness costs were assessed by growing the strains in RPMI medium and testing their virulence in G. mellonella larvae. In addition, G. mellonella larvae infected with strains of A. flavus were treated with voriconazole and posaconazole.</p><p><strong>Results: </strong>In the CYP51A sequences, we found the A91T, C708T and A1296T nucleotide substitutions only in the resistant strains. The resistant strains showed a fitness cost with reduced in vitro growth and reduced virulence in G. mellonella. In vivo resistance to posaconazole is confirmed in a strain with the highest MIC for this antifungal agent.</p><p><strong>Conclusions: </strong>These results allow to conclude that some substitutions in CYP51 genes, in particular CYP51A, contribute to resistance to azole drugs in A. flavus. The study of the relationship between drug dosage and treatment duration with resistance and the reduction of fitness costs in resistant strains is a major perspective of this study. This work could help to establish recommendations for the treatment of infections with resistant strains of A. flavus.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13766"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616814","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":"The role of surgery for invasive pulmonary aspergillosis in paediatric hemato-oncology patients-Can we better define it?","authors":"Mohamed Hassan, Felicia Andresen, Uyen-Thao Le, Bernward Passlick, Severin Schmid, Alexander Puzik","doi":"10.1111/myc.13763","DOIUrl":"https://doi.org/10.1111/myc.13763","url":null,"abstract":"<p><strong>Background: </strong>Invasive pulmonary aspergillosis (IPA) is a serious condition with high morbidity and mortality in paediatric patients with cancer, haematological diseases or immunodeficiencies with or without allogeneic haematopoietic stem cell transplantation (HSCT). The role of surgical intervention for the management of IPA has scarcely been investigated.</p><p><strong>Objectives: </strong>The aim of this study was to present a single center experience of management of IPA in paediatric patients of an oncological ward, to determine the short and long-term outcomes after thoracic surgical interventions, and to outline the indications of surgical interventions in selected patients.</p><p><strong>Patients/methods: </strong>We conducted a retrospective study of 44 paediatric patients with proven and probable IPA treated in our institution between January 2003 and December 2021. The primary endpoint was the overall survival after surgical interventions. Secondary endpoints included post-operative morbidity and mortality.</p><p><strong>Results: </strong>The median age at diagnosis of IPA in our cohort was 11.79 years (range 0.11-19.6). The underlying conditions were malignancies in 34 (77%) patients and haematological or immunological disorders with allogeneic HSCT in 9 (23%) patients. We performed thoracic surgical interventions in 10 (22.7%) patients. Most patients received a video assisted thoracic surgery. Only one patient died within 90 days after surgery with a median follow-up time of 50 months. No other major post-operative complications occurred. The calculated 5-year survival rate from IPA for patients after surgical intervention with curative intention was 57% and 56% for patients without (p = .8216).</p><p><strong>Conclusions: </strong>IPA resulted in relevant morbidity and mortality in our paediatric patient cohort. Thoracic surgical interventions are feasible and may be associated with prolonged survival as a part of multidisciplinary approach in selected paediatric patients with IPA. Larger scale studies are necessary to investigate the variables associated with the necessity of surgery.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13763"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545042","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":"Global burden of fungal skin diseases: An update from the Global Burden of Diseases Study 2019.","authors":"Xiaocong Liu, Yishan Zhang, Yujing Hong, Hong Zhang","doi":"10.1111/myc.13770","DOIUrl":"https://doi.org/10.1111/myc.13770","url":null,"abstract":"<p><strong>Background: </strong>Fungal skin diseases are the most common and widespread fungal infections, exerting a significant impact on patients' socio-psychological health and the quality of life.</p><p><strong>Objectives: </strong>To assess and compare the global burden of fungal skin diseases in 2019 and over the past 30 years.</p><p><strong>Methods: </strong>Data were retrieved from the Global Burden of Disease Study 2019. Incidence and years lived with disability (YLDs) were used to assess the burden of fungal skin diseases. A total of 204 countries and territories were hierarchically organised into 21 regions and seven super-regions. Data were presented as absolute numbers and rates per 100,000 population, stratified by sex, age, year and location.</p><p><strong>Results: </strong>In 2019, the global incidence rate and YLD rate of fungal skin diseases were 21,277 (95% UI 19 298-23,399) and 42 (95% UI 17-88) per 100,000 population, respectively. Sub-Saharan Africa bore the heaviest disease burden, especially children aged 5-9 years had a significantly higher incidence rate, YLD rate and YLDs to incidence ratio compared to other regions. Moreover, more than half of the incident cases among the elderly came from high-income regions and Southeast Asia, East Asia, and Oceania. Over the past 30 years, the number of incident cases and YLDs of fungal skin diseases has been continuously increasing worldwide, but the incidence rates and YLD rates have not shown significant changes.</p><p><strong>Conclusions: </strong>The global burden of fungal skin diseases has been continuously rising. Children in Sub-Saharan Africa are experiencing higher disease incidence and severity compared to other regions.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13770"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759861","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":"Exploring treatment and antifungal resistance in an outbreak of tinea caused by Microsporum audouinii.","authors":"Claus Dall Johansen, Julia Jia Rui Shen, Karen Marie Thyssen Astvad, Gregor Borut Ernst Jemec, Jens Jørgen Christensen, Ditte Marie Lindhardt Saunte","doi":"10.1111/myc.13760","DOIUrl":"https://doi.org/10.1111/myc.13760","url":null,"abstract":"<p><strong>Background: </strong>Microsporum audouinii has resurged recently. Infections with the dermatophyte are difficult to treat, which raises the question if we treat M. audouinii infections with the most effective antifungal (AF) agent.</p><p><strong>Objectives: </strong>The aims of this study was to investigate an outbreak of tinea capitis (TC) in Denmark, address the challenges in outbreak management and to conduct two reviews regarding previous outbreaks and minimal inhibitory concentration (MIC).</p><p><strong>Methods: </strong>We used Wood's light, culture, direct microscopy, and PCR for screening and antifungal susceptibility testing (AFST) for treatment optimization. We performed two reviews to explore M. audouinii outbreaks and MIC values using broth microdilution method.</p><p><strong>Results: </strong>Of 73 screened individuals, 10 had confirmed M. audouinii infections. Clinical resistance to griseofulvin was observed in 4 (66%) cases. While previous outbreaks showed high griseofulvin efficacy, our study favoured terbinafine, fluconazole and itraconazole in our hard-to-treat cases. AFST guided the choice of AF. Through the literature search, we identified five M. audouinii outbreaks, where differences in management included the use of Wood's light and prophylactic topical AF therapy. Terbinafine MIC values from the literature ranged from 0.002 to 0.125 mg/L.</p><p><strong>Conclusion: </strong>Use of Wood's light and preventive measurements were important for limiting infection. The literature lacked MIC data for griseofulvin against M. audouinii, but indicated sensitivity for terbinafine. The clinical efficacy for M. audouinii treatment was contradictory favouring both terbinafine and griseofulvin. AFST could have a key role in the treatment of difficult cases, but lack of standardisation of AFST and MIC breakpoints limits its usefulness.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13760"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469560","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":"Cutaneous fusarium disease and leukaemias: A systematic review.","authors":"Paulina Nundehui Cortés-López, Estefanía Guzmán-Montijo, Claudia Erika Fuentes-Venado, Roberto Arenas, Alexandro Bonifaz, Rodolfo Pinto-Almazán, Erick Martínez-Herrera","doi":"10.1111/myc.13759","DOIUrl":"10.1111/myc.13759","url":null,"abstract":"<p><p>The present study analyses the clinical characteristics of patients diagnosed with cutaneous fusarium through a systematic review of cases reported in literature. A total of 39 cases were included, of which 53% were men, 30% were women, and in 17% the sex was not specified. The age ranged from 5 to 85 years. Most cases were reported in Brazil, followed by Japan and United States of America. The most common agent was Fusarium solani, in 37.5% of the patients. Most of the affected individuals had acute myeloid leukaemia and some of the predisposing factors, which included induction chemotherapy, febrile neutropenia, and bone marrow transplantation. The clinical topography of the lesions was located in 27.5% and disseminated in 72.5%, with the most observed clinical feature outstanding the presence of papules and nodules with central necrosis in 47% of the cases. Longer survival was demonstrated in those treated with more than three antifungals. It is concluded that cutaneous fusarium is a complex and challenging clinical entity, infection in patients with leukaemias underscores the need for thorough care to decrease morbidity and mortality.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13759"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620405","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":"Propensity of Candida spp. prosthetic joint infection clinical isolates to form aggregates in synovial fluid and the clinical ramifications.","authors":"James B Doub, Hamda Siddiqui","doi":"10.1111/myc.13769","DOIUrl":"https://doi.org/10.1111/myc.13769","url":null,"abstract":"<p><strong>Background: </strong>Bacterial aggregation has been shown to occur in synovial fluid which are resistant to high concentrations of antibiotics. Yet the propensity of Candida spp. to form aggregates is unknown.</p><p><strong>Objective: </strong>To assess the ability of numerous Candida spp. to form synovial fluid aggregates and the clinical ramifications of the aggregates.</p><p><strong>Methods: </strong>Nine different Candidal prosthetic joint infection clinical isolates were evaluated for their ability to form aggregates at static and dynamic conditions and their resistance to high concentrations of amphotericin. Furthermore, the ability of tissue plasminogen activator (TPA) to disrupt the aggregates and enhance amphotericin activity was assessed.</p><p><strong>Results: </strong>The results show that all species of Candida spp. evaluated formed aggregates in synovial fluid under dynamic conditions that were resistant to amphotericin. Yet no aggregates formed in tryptic soy broth under any conditions or in synovial fluid under static conditions. As well, when TPA was combined with amphotericin there was a statistically significant decrease (p < .005) in the amount of colony forming units per mL for all Candidal species evaluated. Interestingly, for Candida krusei there was no colony forming units observed after exposure to TPA and amphotericin.</p><p><strong>Conclusion: </strong>Our findings suggest that Candidal species form synovial fluid aggregates that are resistant to high dose amphotericin similar to those that occur with bacteria. However, the varying ability of the different Candida spp. to form hyphae and pseudohyphae compared to yeast cells may have direct impacts on the hardiness of the aggregates and thereby have clinical ramifications with respect to treatment durations.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13769"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748646","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 and microbiological characteristics of a hospital outbreak of Candida auris in a referral hospital in Lima, Peru.","authors":"Giancarlo Pérez-Lazo, Roxana Sandoval-Ahumada, Fernando Soto-Febres, José Ballena-López, Liliana Morales-Castillo, Lucy Trujillo-Gregorio, Rocio Garay-Quintana, Berenice Arenas-Ramírez","doi":"10.1111/myc.13765","DOIUrl":"10.1111/myc.13765","url":null,"abstract":"<p><strong>Background: </strong>Candida auris, a multidrug-resistant fungal pathogen, has received considerable attention owing to its recent surge, especially in South America, which coincides with the ongoing global COVID-19 pandemic. Understanding the clinical and microbiological characteristics of outbreaks is crucial for their effective management and control.</p><p><strong>Objective: </strong>This retrospective observational study aimed to characterize a C. auris outbreak at a Peruvian referral hospital between January 2021 and July 2023.</p><p><strong>Methods: </strong>Data were collected from hospitalized patients with positive C. auris culture results. Microbiological data and antifungal susceptibility test results were analysed. Additionally, infection prevention and control measures have been described. Statistical analysis was used to compare the characteristics between the infected and colonized patients.</p><p><strong>Results: </strong>Thirty-three patients were identified, mostly male (66.7%), with a median age of 53 years. Among them, 18 (54.5%) were colonized, and 15 (45.5%) were infected. Fungemia was the predominant presentation (80%), with notable cases of fungemia in tuberculosis patients with long-stay devices for parenteral anti-tuberculosis therapy. Seventy-five percent of the isolates exhibited fluconazole resistance. Echinocandins were the primary treatment, preventing fungemia recurrence within 30 days. Infected patients had significantly longer hospital stays than colonized patients (100 vs. 45 days; p = .023). Hospital mortality rates were 46.7% and 25% in the infected and fungemia patients, respectively. Simultaneous outbreaks of multidrug-resistant bacteria were documented.</p><p><strong>Conclusions: </strong>This study underscores the severity of a C. auris outbreak at a referral hospital in Peru, highlighting its significant impact on patient outcomes and healthcare resources. The high prevalence of fluconazole-resistant isolates, leading to prolonged hospital stay and high mortality rates, particularly in cases of fungemia, underscores the critical need for effective infection prevention and control strategies.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13765"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141580313","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":"Mechanism of azole resistance in Candida vulturna, an emerging multidrug resistant pathogen related with Candida haeumulonii and Candida auris.","authors":"Daiana Macedo, Indira Berrio, Patricia Escandon, Soledad Gamarra, Guillermo Garcia-Effron","doi":"10.1111/myc.13757","DOIUrl":"https://doi.org/10.1111/myc.13757","url":null,"abstract":"<p><strong>Background: </strong>Candida vulturna is an emerging pathogen belonging to the Metshnikowiaceae family together with Candida auris and Candida haemulonii species complex. Some strains of this species were reported to be resistant to several antifungal agents.</p><p><strong>Objectives: </strong>This study aims to address identification difficulties, evaluate antiungal susceptibilities and explore the molecular mechanisms of azole resistance of Candida vulturna.</p><p><strong>Methods: </strong>We studied five C. vulturna clinical strains isolated in three Colombian cities. Identification was performed by phenotypical, proteomic and molecular methods. Antifungal susceptibility testing was performed following CLSI protocol. Its ERG11 genes were sequenced and a substitution was encountered in azole resistant isolates. To confirm the role of this substitution in the resistance phenotype, Saccharomyces cerevisiae strains with a chimeric ERG11 gene were created.</p><p><strong>Results: </strong>Discrepancies in identification methods are highlighted. Sequencing confirmed the identification as C. vulturna. Antifungal susceptibility varied among strains, with four strains exhibiting reduced susceptibility to azoles and amphotericin B. ERG11 sequencing showed a point mutation (producing a P135S substitution) that was associated with the azole-resistant phenotype.</p><p><strong>Conclusions: </strong>This study contributes to the understanding of C. vulturna's identification challenges, its susceptibility patterns, and sheds light on its molecular mechanisms of azole resistance.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13757"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759862","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":"Potential emergence of terbinafine resistance by squalene epoxidase gene mutations: An 18-month cohort study of onychomycosis patients in the United States.","authors":"Aditya K Gupta, Tong Wang, Shruthi Polla Ravi, Elizabeth A Cooper, Mary A Bamimore, Sara A Lincoln, Hui-Chen Foreman, Vincent Piguet, Wayne L Bakotic","doi":"10.1111/myc.13768","DOIUrl":"https://doi.org/10.1111/myc.13768","url":null,"abstract":"<p><strong>Background: </strong>There is a concerning rise in antifungal-resistant dermatophytosis globally, with resistance to terbinafine conferred by point mutations in the squalene epoxidase (SQLE) gene.</p><p><strong>Objectives: </strong>Report changes in the prevalence and profile of SQLE mutations in onychomycosis patients in the United States.</p><p><strong>Methods: </strong>A longitudinal cohort study of toenail samples was collected from suspected onychomycosis patients over an 18-month period from 2022 to 2023. Samples were submitted from across the United States and subjected to multiplex real-time polymerase chain reactions for dermatophyte detection, with further screening of SQLE mutations at four known hotspots (393^Leu, 397^Phe, 415^Phe and 440^His).</p><p><strong>Results: </strong>A total of 62,056 samples were submitted (mean age: 57.5 years; female: 60.4%). Dermatophytes were detected in 38.5% of samples, primarily Trichophyton rubrum complex (83.6%) and T. mentagrophytes complex (10.7%). A survey of SQLE mutations was carried out in 22,610 dermatophyte samples; there was a significant increase in the prevalence of SQLE mutations between the first quarter of 2022 and the second quarter of 2023 (29.0 to 61.9 per 1000 persons). The Phe397Leu substitution was the predominant mutation; Phe415Ser and His440Tyr have also emerged which were previously reported as minor mutations in skin samples. The temporal change in mutation rates can be primarily attributed to the Phe415Ser substitution. Samples from elderly patients (>70 years) are more likely to be infected with the T. mentagrophytes complex including strains harbouring the Phe415Ser substitution.</p><p><strong>Conclusion: </strong>The prevalence of SQLE mutations among onychomycosis patients with Trichophyton infections may be underestimated. Older individuals may have a higher risk.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 7","pages":"e13768"},"PeriodicalIF":4.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734647","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":"Epidemiologic features and therapeutic strategies of kerion: A nationwide multicentre study.","authors":"Ruixin Deng, Xiaoqing Chen, Dongyan Zheng, Yuanyuan Xiao, Bilin Dong, Cunwei Cao, Lin Ma, Zhongsheng Tong, Min Zhu, Zehu Liu, Sha Lu, Meng Fu, Yun Jin, Bin Yin, Fuqiu Li, Xiaofang Li, Palida Abliz, Hongfang Liu, Yu Zhang, Nan Yu, Weiwei Wu, Xincai Xiong, Jingsi Zeng, Huaiqiu Huang, Yanping Jiang, Guanzhi Chen, Weihua Pan, Hong Sang, Ying Wang, Yun Guo, Dongmei Shi, Jianxun Yang, Yuping Ran, Jin Hu, Lianjuan Yang, Shuang Bai, Jin Yu, Xiaowen Wang, Ruoyu Li","doi":"10.1111/myc.13751","DOIUrl":"10.1111/myc.13751","url":null,"abstract":"<p><strong>Background: </strong>Kerion is a severe type of tinea capitis that is difficult to treat and remains a public health problem.</p><p><strong>Objectives: </strong>To evaluate the epidemiologic features and efficacy of different treatment schemes from real-world experience.</p><p><strong>Methods: </strong>From 2019 to 2021, 316 patients diagnosed with kerion at 32 tertiary Chinese hospitals were enrolled. We analysed the data of each patient, including clinical characteristics, causative pathogens, treatments and outcomes.</p><p><strong>Results: </strong>Preschool children were predominantly affected and were more likely to have zoophilic infection. The most common pathogen in China was Microsporum canis. Atopic dermatitis (AD), animal contact, endothrix infection and geophilic pathogens were linked with kerion occurrence. In terms of treatment, itraconazole was the most applied antifungal agent and reduced the time to mycological cure. A total of 22.5% of patients received systemic glucocorticoids simultaneously, which reduced the time to complete symptom relief. Furthermore, glucocorticoids combined with itraconazole had better treatment efficacy, with a higher rate and shorter time to achieving mycological cure.</p><p><strong>Conclusions: </strong>Kerion often affects preschoolers and leads to serious sequelae, with AD, animal contact, and endothrix infection as potential risk factors. Glucocorticoids, especially those combined with itraconazole, had better treatment efficacy.</p>","PeriodicalId":18797,"journal":{"name":"Mycoses","volume":"67 6","pages":"e13751"},"PeriodicalIF":4.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199476","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}