Clinical Spectrum, Molecular Characterization, Antifungal Susceptibility Testing of Exophiala spp. From India and Description of a Novel Exophiala Species, E. arunalokei sp. nov.
Clinical Spectrum, Molecular Characterization, Antifungal Susceptibility Testing of Exophiala spp. From India and Description of a Novel Exophiala Species, E. arunalokei sp. nov.
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DOI：
10.3389/fcimb.2021.686120
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发表时间：
2021
影响因子：
5.7
通讯作者：
Kaur H
中科院分区：
文献类型：
--
作者：
Singh S;Rudramurthy SM;Padhye AA;Hemashetter BM;Iyer R;Hallur V;Sharma A;Agnihotri S;Gupta S;Ghosh A;Kaur H
外瓶霉属是重要的机会主义病原体，在免疫抑制和健康个体中引起皮下甚至致命的播散性感染，但没有对来自印度的外瓶霉属物种的分离株进行系统的研究。从国家病原真菌培养物保藏中心（NCCPF）检索了24株外瓶霉属分离株，并根据CLSI-M38 A3指南通过表型和分子方法（ITS区测序）进行了鉴定，随后进行了抗真菌药敏试验（AFST）。使用Medline和科克伦数据库对截至2021年1月1日的印度病例文献进行了审查。 E.皮肤炎（n = 8）、E. jeanselmei（n = 6），E. spinifera（n = 6）、刺壳E. mesophila（n = 1）、E. oligosperma（n = 1），E.通过ITS、β-tubulin和β-actin的序列测定，发现了一个新种，即异生E. arunalokei sp. nov.（n = 1）.对E. jeanselmei分析表明，绝大多数（83%）的E.皮肤炎均为B型。阿替霉素、伊曲康唑、伏立康唑、米卡芬净、卡泊芬净、阿尼芬净和泊沙康唑的MIC 50（mg/L）分别为1、0.25、0.125、0.125、0.062和0.062。在文献回顾中又发现了16例病例，并发现E。皮肤炎伴手术史（p = 0.013）、浸润性疾病（p = 0.032）和E.中嗜中性粒细胞伴结核（p = 0.026）。据我们所知，这是印度首次阐明外瓶霉属物种的分子和临床特征的研究，也是印度首次报告人类感染E。xenobiotica和E. arunalokei。
Exophiala spp. are important opportunist pathogens causing subcutaneous or even fatal disseminated infections in otherwise both immunosuppressed and healthy individuals but there are no systematic studies on the isolates of Exophiala species from India. Twenty-four isolates of Exophiala species were retrieved from the National Culture Collection of Pathogenic Fungi (NCCPF) and identified phenotypically and by molecular methods (ITS region sequencing) followed by antifungal susceptibility testing (AFST) as per CLSI-M38A3 guidelines. A review of the literature of cases from India was performed up to 1st January 2021 using the Medline and Cochrane database. E. dermatitidis (n = 8), E. jeanselmei (n = 6), E. spinifera (n = 6), E. mesophila (n = 1), E. oligosperma (n = 1), E. xenobiotica (n = 1) were identified and the sequencing of ITS, β-tubulin and β-actin revealed a novel species, E. arunalokei sp. nov. (n = 1). The ITS sequence phylogram of E. jeanselmei revealed that the majority (83%) formed a separate cluster close to type A while majority (75%) of E. dermatitidis were type B. The MIC50 (mg/L) of amphotericin, itraconazole, voriconazole, micafungin, caspofungin, anidulafungin, and posaconazole, was 1, 0.25, 0.125, 0.12, 0.125, 0.062, and 0.062, respectively. Sixteen more cases were identified on the literature review and a significant association of E. dermatitidis with history of surgical procedures (p = 0.013), invasive disease (p = 0.032) and of E. mesophila with tuberculosis (p = 0.026) was seen. This, to the best of our knowledge is the first study from India elucidating the molecular and clinical characteristics of Exophiala species and the first Indian report of human infection due to E. xenobiotica and E. arunalokei.