Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Laboratório de Pesquisa Clínica em Dermatologia Infecciosa - Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Front Cell Infect Microbiol. 2022 May 27;12:893501. doi: 10.3389/fcimb.2022.893501. eCollection 2022.
The zoonotic transmission of sporotrichosis due to occurs largely in Rio de Janeiro state, Brazil since the 1990´s. Most patients infected with respond well to itraconazole or terbinafine. However, a few patients have a slow response or do not respond to the treatment and develop a chronic infection. The aim of this study was to analyze strains of against five different drugs to determine minimal inhibitory concentration distributions, to identify non-wild type strains to any drug evaluated and the clinical aspects of infections caused by them. This study evaluated 100 spp. strains obtained from 1999 to 2018 from the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, which were identified through a polymerase chain reaction using specific primers for species identification. Two-fold serial dilutions of stock solutions of amphotericin B, itraconazole, posaconazole, ketoconazole and terbinafine prepared in dimethyl sulfoxide were performed to obtain working concentrations of antifungal drugs ranging from 0.015 to 8.0 mg/L. The broth microdilution reference method was performed according the M38-A2 CLSI guideline. All strains were identified as and thirteen were classified as non-wild type, two of them against different drugs. Non-wild type strains were identified throughout the entire study period. Patients infected by non-wild type strains presented prolonged treatment times, needed increased antifungal doses than those described in the literature and one of them presented a permanent sequel. In addition, three of them, with immunosuppression, died from sporotrichosis. Despite the broad use of antifungal drugs in hyperendemic areas of sporotrichosis, an emergence of non-wild type strains did not occur. The results of antifungal susceptibility tests should guide sporotrichosis therapy, especially in immunosuppressed patients.
由于 引起的孢子丝菌病的人畜共患病传播在巴西里约热内卢州自 20 世纪 90 年代以来就很普遍。大多数感染 的患者对伊曲康唑或特比萘芬反应良好。然而，少数患者的反应缓慢或对治疗无反应，发展为慢性感染。本研究旨在分析对五种不同药物的 株，以确定最小抑菌浓度分布，鉴定对任何评估药物的非野生型株以及由它们引起的感染的临床方面。本研究评估了 1999 年至 2018 年期间从 Fiocruz 的 Evandro Chagas 国家传染病研究所获得的 100 株 spp. 株，这些株通过使用用于物种鉴定的特异性引物的聚合酶链反应进行鉴定。在二甲基亚砜中制备两性霉素 B、伊曲康唑、泊沙康唑、酮康唑和特比萘芬的储备溶液的两倍系列稀释液，以获得 0.015 至 8.0 mg/L 的抗真菌药物工作浓度。根据 M38-A2 CLSI 指南进行肉汤微量稀释参考方法。所有株均被鉴定为 ，其中 13 株被分类为非野生型，其中两株针对不同的药物。在整个研究期间都鉴定出非野生型株。感染非野生型株的患者治疗时间延长，需要比文献中描述的更高剂量的抗真菌药物，其中一人出现永久性后遗症。此外，其中三人因孢子丝菌病而患有免疫抑制，死亡。尽管在孢子丝菌病的高流行地区广泛使用抗真菌药物，但并未出现非野生型株的出现。 抗真菌药敏试验的结果应指导孢子丝菌病的治疗，尤其是在免疫抑制患者中。
