Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
J Infect Dev Ctries. 2020 Dec 31;14(12):1424-1430. doi: 10.3855/jidc.12997.
For the best management of the zygomycosis in immunocompromised patients, the present study aims to detect and identify the etiologic agents by DNA sequencing method and their related factors in clinical samples of patients.
Clinical samples from 1,058 patients admitted in 11 university hospitals in Shiraz, Southern Iran were collected between July 2015 and July 2018. All samples (bronchoalveolar lavage, sputum, blood, tissue) were examined by routine microscopic and culture tests for zygomycetes. The etiologic agents were identified by the molecular method and sequencing.
Direct microscopic examinations or pathology smear, culture, and PCR were positive in 61 (5.8%), 15 (1.4%), and 103 (9.7%) patients, respectively. According to EORTC/MSG criteria, the rates of proven, probable, and possible zygomycosis were 59.2% (61/103), 14.6% (15/103), and 26.2% (27/103 patients), respectively. The most prevalent etiologic agents according to sequencing were Rhizopus oryzae (44 cases), Rhizopus microsporus (31 cases), Rhizopus stolonifer (15 cases). Twenty-two patients (21.4%) with positive PCR died. There were significant relations between zygomycosis and the underlying disease (p = 0.043) and prior antifungal therapy (p = 0.023). White blood cell count was in the normal range in 14.1% of patients, and the means of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were 65 mm/hour and 57 mg/L, respectively.
Molecular methods and sequencing may have considered as suitable tools to diagnose zygomycosis. Identification of the etiologic agents may be considered as the future antifungal therapy and management of the respective patients.
为了更好地管理免疫功能低下患者的接合菌病，本研究旨在通过 DNA 测序方法检测和鉴定临床样本中的病原体及其相关因素。
本研究于 2015 年 7 月至 2018 年 7 月期间，在伊朗南部设拉子的 11 所大学医院共采集了 1058 名患者的临床样本。所有样本（支气管肺泡灌洗液、痰、血、组织）均通过常规显微镜和培养试验进行接合菌检查。通过分子方法和测序鉴定病原体。
直接显微镜检查或病理涂片、培养和 PCR 在 61 例（5.8%）、15 例（1.4%）和 103 例（9.7%）患者中呈阳性。根据 EORTC/MSG 标准，确诊、可能和疑似接合菌病的比例分别为 59.2%（61/103）、14.6%（15/103）和 26.2%（27/103 例）。根据测序结果，最常见的病原体依次为稻根霉（44 例）、微小根毛霉（31 例）、匐枝根霉（15 例）。22 例（21.4%）PCR 阳性患者死亡。接合菌病与基础疾病（p = 0.043）和既往抗真菌治疗（p = 0.023）显著相关。14.1%的患者白细胞计数正常，红细胞沉降率（ESR）和 C 反应蛋白（CRP）的平均值分别为 65mm/h 和 57mg/L。
分子方法和测序可作为诊断接合菌病的合适工具。鉴定病原体可作为未来抗真菌治疗和管理相应患者的依据。
