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巴西芽生菌病慢性患者和获得性免疫缺陷综合征患者分离株毒力相关表型的演变。

Evolution of virulence-related phenotypes of Sporothrix brasiliensis isolates from patients with chronic sporotrichosis and acquired immunodeficiency syndrome.

机构信息

Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil.

Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.

出版信息

Braz J Microbiol. 2021 Mar;52(1):5-18. doi: 10.1007/s42770-020-00297-y. Epub 2020 May 22.

Abstract

Sporotrichosis in immunocompromised patients has a high morbidity and may cause deaths. Particularly, patients with acquired immunodeficiency syndrome (AIDS) with low T CD4 counts develop a chronic disease, with severe and widespread forms. Recently, the ability of Sporothrix brasiliensis, the main agent of zoonotic sporotrichosis, to increase its virulence in a diabetic patient without HIV infection was described. Since it was a unique finding, it is not known how often this occurs in patients with chronic and refractory sporotrichosis. The aim of this study is to compare sequential Sporothrix isolates obtained from patients with sporotrichosis and AIDS in order to detect changes in virulence-related phenotypes and acquisition of antifungal resistance during the evolution of the disease. Fungal growth in different substrates, antifungal susceptibility, thermotolerance, resistance to oxidative stress, and production of hydrolytic enzymes were evaluated. Correlations were assessed between clinical and phenotypic variables. Sixteen isolates, all identified as S. brasiliensis, obtained from five patients were studied. They grew well on glucose and N-acetyl-D-glucosamine, but poorly on lactate. Except from isolates collected from two patients, which were non-wild type for terbinafine, they were considered wild type for the antifungal drugs tested. Thermotolerance of the isolates was moderate to high. Except for phytase and phospholipase, isolates were able to produce virulence-related enzymes on different levels. Changes in all studied phenotypes were observed during the course of the disease in some patients. The results show that the HIV-driven immunosuppression is more relevant than fungal phenotypes on the unfavorable outcomes of disseminated sporotrichosis.

摘要

免疫功能低下患者的孢子丝菌病发病率高,可能导致死亡。特别是艾滋病(AIDS)患者 T CD4 计数低,会发展为慢性疾病,表现为严重和广泛的形式。最近,描述了动物源性孢子丝菌病的主要病原体巴西利什孢子丝菌(Sporothrix brasiliensis)在未感染 HIV 的糖尿病患者中增加毒力的能力。由于这是一个独特的发现,目前尚不清楚在患有慢性和难治性孢子丝菌病的患者中这种情况有多常见。本研究旨在比较从患有孢子丝菌病和 AIDS 的患者中获得的连续孢子丝菌分离株,以检测在疾病演变过程中与毒力相关的表型变化和获得抗真菌耐药性。评估了在不同基质中真菌生长、抗真菌药敏性、耐热性、氧化应激抗性和水解酶产生情况。评估了临床和表型变量之间的相关性。研究了从五名患者中获得的 16 个分离株,均鉴定为巴西利什孢子丝菌。它们在葡萄糖和 N-乙酰-D-葡萄糖胺上生长良好,但在乳酸上生长不良。除了从两名患者中分离出的两种分离株对特比萘芬非野生型外,它们被认为对测试的抗真菌药物为野生型。分离株的耐热性为中等到高度。除植酸酶和磷脂酶外,分离株能够在不同水平上产生与毒力相关的酶。在一些患者的疾病过程中观察到所有研究表型的变化。结果表明,HIV 驱动的免疫抑制与真菌表型相比,对播散性孢子丝菌病的不良结局更为重要。

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