Refractory sporotrichosis due to Sporothrix brasiliensis in humans appears to be unrelated to in vivo resistance
Refractory sporotrichosis due to Sporothrix brasiliensis in humans appears to be unrelated to in vivo resistance
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DOI：
10.1093/mmy/myw103
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发表时间：
2017-07-01
期刊：
影响因子：
2.9
通讯作者：
Zancope-Oliveira, Rosely Maria
中科院分区：
文献类型：
--
作者：
Almeida-Paes, Rodrigo;Evangelista Oliveira, Manoel Marques;Zancope-Oliveira, Rosely Maria
孢子丝菌病是由申克孢子丝菌复合体成员引起的亚急性至慢性感染。伊曲康唑是治疗该感染的首选抗真菌药物，特比萘芬和碘化钾可作为替代药物，阿替霉素B用于严重感染。抗真菌药敏数据与患者临床结局的相关性很低。本研究的目的是将难治性孢子虫病患者的临床和真菌学数据相关联。在这项工作中，抗真菌药敏性，确定根据参考M38-A2 CLSI协议，25孢子丝菌菌株，分离自7例人类孢子虫病与逆境中的治疗，提出。试验药物包括伊曲康唑、酮康唑、泊沙康唑、伏立康唑、特比萘芬和阿替霉素B。采用T3 B PCR指纹图谱鉴定真菌。该方法鉴定了所有菌株为巴西孢子丝菌，并且还证明了菌株之间的高度相似性。一般而言，伏立康唑对所有菌株均无效，并且观察到阿替霉素B的最小抑菌浓度（MIC）升高。在S.从本研究的患者分离的巴西曲霉。此外，没有观察到来自不同时期从同一患者分离的菌株的伊曲康唑和特比萘芬MIC值的显著增加。结果表明，通过参考方法测定的对特比萘芬和伊曲康唑的抗真菌药敏性在孢子虫病治疗失败中不起重要作用，并且在长期抗真菌治疗期间不太可能在S.巴西的。
Sporotrichosis is a subacute to chronic infection caused by members of the Sporothrix schenckii complex. Itraconazole is the first choice antifungal drug for treating this infection, with terbinafine and potassium iodide as alternatives and amphotericin B used in cases of severe infections. Correlation of antifungal susceptibility data with the clinical outcome of the patients is scarce. The aim of this study was to correlate clinical and mycological data in patients with refractory sporotrichosis. In this work, antifungal susceptibilities, determined according to the reference M38-A2 CLSI protocol, of 25 Sporothrix strains, isolated from seven human cases of sporotrichosis with adversities in the treatment, are presented. Tested drugs included itraconazole, ketoconazole, posaconazole, voriconazole, terbinafine, and amphotericin B. Fungi were identified using the T3B PCR fingerprinting. This method identified all strains as Sporothrix brasiliensis and also demonstrated a high degree of similarity between the strains. In general, voriconazole was ineffective against all strains, and elevated minimal inhibitory concentrations (MICs) were observed for amphotericin B. High itraconazole and terbinafine MICs were not observed in S. brasiliensis isolates from patients of this study. Moreover, a significant increase in itraconazole and terbinafine MIC values from strains isolated from the same patient in different periods was not observed. The results suggest that the antifungal susceptibility to terbinafine and itraconazole determined by the reference method does not play an important role in therapeutic failure of sporotrichosis and that acquisition of resistance during prolonged antifungal treatment is not likely to occur in S. brasiliensis.