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引起角膜炎的镰刀菌属的抗真菌药敏性、临床特征及生物膜耐药性:疾病控制面临的一项挑战

Antifungal susceptibility, clinical findings, and biofilm resistance of Fusarium species causing keratitis: a challenge for disease control.

作者信息

Santos Manzi de Souza Pedro de Freitas, Milanez Edlâny Pinho Romão, de Andrade Ana Raquel Colares, Silva Lua, Silva Maria Laína, Monteiro Ruan Costa, Rodrigues Anderson Messias, de Souza Collares Maia Débora Castelo Branco, de Melo Guedes Glaucia Morgana, de Aguiar Cordeiro Rossana

机构信息

Federal University of Ceará Fortaleza, Ceará, Brazil.

Emílio Ribas Diagnostic Medicine, Ceará, Brazil.

出版信息

Braz J Microbiol. 2025 Mar;56(1):341-352. doi: 10.1007/s42770-024-01611-8. Epub 2025 Jan 16.

DOI:10.1007/s42770-024-01611-8
PMID:39821607
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11885700/
Abstract

Fusarium keratitis (FK) is an important clinical condition that can lead to blindness and eye loss, and is most commonly caused by the Fusarium solani species complex (FSSC). This study evaluated the susceptibility of planktonic cells and biofilms of FSSC (n = 7) and non-FSSC (n = 7) isolates obtained from patients with keratitis from a semi-arid tropical region to amphotericin B (AMB), natamycin (NAT), voriconazole (VRZ), efinaconazole (EFZ), and luliconazole (LCZ). Analysis of clinical data showed that trauma was the most common risk factor for FK patients. Disease onset was longer in non-FSSC group (3-30 days) than in the FSSC group (3-7 days). FSSC strains were less susceptible to AMB and VRZ than non-FSSC strains (p < 0.05). Susceptibility to NAT, LCZ and EFZ was similar between isolates of FSSC and non-FSSC groups. Overall, patients infected with non-FSSC showed a better response to antifungal treatment. Corneal transplantation was more common in patients infected with FSSC (3/7) than in those infected with non-FSSC (1/7). Mature biofilms showed a poor response to antifungal treatment. Patients infected with Fusarium strains capable of forming antifungal tolerant biofilms had more complex therapeutic management, requiring two antifungals and/or corneal transplantation (p < 0.05). This study highlights the importance of mycological diagnosis and the antifungal susceptibility testing in the clinical management of FK. The ability of Fusarium to form antifungal tolerant biofilms poses a challenge to clinicians and urges the development of new antibiofilm therapeutics.

摘要

镰刀菌角膜炎(FK)是一种重要的临床病症,可导致失明和视力丧失,最常见的病因是茄病镰刀菌复合体(FSSC)。本研究评估了从半干旱热带地区角膜炎患者分离出的FSSC菌株(n = 7)和非FSSC菌株(n = 7)的浮游细胞及生物膜对两性霉素B(AMB)、那他霉素(NAT)、伏立康唑(VRZ)、依氟康唑(EFZ)和卢立康唑(LCZ)的敏感性。临床数据分析表明,外伤是FK患者最常见的危险因素。非FSSC组(3 - 30天)的发病时间比FSSC组(3 - 7天)更长。FSSC菌株比非FSSC菌株对AMB和VRZ的敏感性更低(p < 0.05)。FSSC组和非FSSC组分离株对NAT、LCZ和EFZ的敏感性相似。总体而言,感染非FSSC的患者对抗真菌治疗的反应更好。FSSC感染患者(3/7)比非FSSC感染患者(1/7)更常进行角膜移植。成熟生物膜对抗真菌治疗反应不佳。感染能够形成抗真菌耐受性生物膜的镰刀菌菌株的患者治疗管理更为复杂,需要两种抗真菌药物和/或角膜移植(p < 0.05)。本研究强调了真菌学诊断和抗真菌药敏试验在FK临床管理中的重要性。镰刀菌形成抗真菌耐受性生物膜的能力给临床医生带来了挑战,并促使开发新的抗生物膜治疗方法。