Departments of Medical Mycology.
J Clin Microbiol. 2013 Oct;51(10):3331-7. doi: 10.1128/JCM.01486-13. Epub 2013 Jul 31.
Nonsporulating molds (NSMs), especially basidiomycetes, have predominantly been reported as human pathogens responsible for allergic and invasive disease. Their conventional identification is problematic, as many isolates remain sterile in culture. Thus, inconclusive culture reports might adversely affect treatment decisions. The clinical significance of NSMs in pulmonary mycoses is poorly understood. We sequenced the internal transcribed spacer (ITS) region and D1/D2 domain of the larger subunit (LSU) of 52 NSMs isolated from respiratory specimens. The basidiomycetes were the predominant NSMs, of which Schizophyllum commune was the most common agent in allergic bronchopulmonary mycosis (ABPM), followed by Ceriporia lacerata in invasive fungal disease. Porostereum spadiceum, Phanaerochaete stereoides, Neosartorya fischeri, and Marasmiellus palmivorus were the other molds observed. Application of ITS and LSU region sequencing identified 92% of the isolates. The antifungal susceptibility data revealed that all basidiomycetes tested were susceptible to amphotericin B and resistant to caspofungin, fluconazole, and flucytosine. Except for 3 isolates of S. commune and a solitary isolate of M. palmivorus, all basidiomycetes had low MICs for itraconazole, posaconazole, and voriconazole. Basidiomycetes were isolated from patients with ABPM, invasive pulmonary mycosis/pneumonia, or fungal balls. In addition, the majority of the basidiomycetes were isolated from patients with chronic respiratory disorders who were sensitized to one of the basidiomycetous fungi and demonstrated precipitating antibodies against the incriminating fungi, indicating an indolent tissue reaction. Thus, isolation of basidiomycetes from the lower respiratory tract could be significant, and it is important to monitor these patients in order to prevent subsequent lung damage.
非孢子形成霉菌（NSM），尤其是担子菌，主要被报道为引起过敏和侵袭性疾病的人类病原体。它们的常规鉴定存在问题，因为许多分离株在培养中仍然无菌。因此，不确定的培养报告可能会对治疗决策产生不利影响。NSM 在肺部真菌感染中的临床意义尚未被充分理解。我们对从呼吸道标本中分离出的 52 株 NSM 进行了内部转录间隔区（ITS）和大亚基（LSU）D1/D2 结构域的测序。担子菌是主要的 NSM，其中 S.commune 是变应性支气管肺真菌病（ABPM）中最常见的病原体，其次是侵袭性真菌病中的 C.lacerata。P.spadiceum、P.stereoides、N.fischeri 和 M.palmivorus 是其他观察到的霉菌。ITS 和 LSU 区域测序的应用可鉴定出 92%的分离株。抗真菌药敏数据显示，所有测试的担子菌均对两性霉素 B 敏感，对卡泊芬净、氟康唑和氟胞嘧啶耐药。除了 3 株 S.commune 和一株单独的 M.palmivorus 分离株外，所有担子菌对伊曲康唑、泊沙康唑和伏立康唑的 MIC 均较低。担子菌从 ABPM、侵袭性肺部真菌感染/肺炎或真菌球患者中分离出来。此外，大多数担子菌是从对一种担子菌真菌过敏且对可疑真菌有沉淀抗体的慢性呼吸道疾病患者中分离出来的，表明组织反应缓慢。因此，从下呼吸道分离出担子菌可能具有重要意义，重要的是要监测这些患者，以防止随后的肺部损伤。
