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Cryptococcus neoformans infection is an important cause of meningitis in HIV/AIDS endemic regions. Antifungals for its management include amphotericin B, flucytosine, and fluconazole. Recently, treatment of this mycosis with sertraline has been studied with variable clinical outcomes. The aim of the study was to assess the in vitro antifungal effect of sertraline against clinical isolates of Cryptococcus spp. as well as its in vivo activity in a murine model of cryptococcal meningoencephalitis. The in vitro susceptibility to fluconazole, amphotericin B, voriconazole and sertraline of 153 Cryptococcus spp. strains were evaluated according to CLSI procedures. Fungal tissue burden, serum antigenaemia and histopathology, together with the therapeutic efficacy of amphotericin B (3 mg/kg), fluconazole (15 mg/kg), and sertraline (3, 10, and 15 mg/kg) were evaluated in mice intracranially inoculated with one isolate of Cryptococcus neoformans. All strains were susceptible to the antifungals studied and exhibited growth inhibition with sertraline at clinically relevant concentrations. Sertraline at a dose of 15 mg/kg reduced the fungal burden in the brain and spleen with an efficacy comparable to that of fluconazole. In conclusion, sertraline exhibited an excellent in vitro-in vivo anti-cryptococcal activity, representing a possible new alternative for the clinical management of meningeal cryptococcosis.

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Candida parapsilosis is considered as an important emerging fungal pathogen and was recently found to be a complex that include three species, i.e., Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis. The aim of this study was to determine the in vitro aspartyl proteinase, phospholipase, esterase and hemolysin activities of 65 clinical isolates of the C. parapsilosis complex, which had been previously identified by RFLP-BanI analysis. Of the enzymes evaluated, aspartyl proteinase was the least produced by the C. parapsilosis species complex. Phospholipase and esterase were strongly expressed by C. orthopsilosis (67% of isolates), while 10% and 13% of C. parapsilosis sensu stricto isolates were strong producers, respectively, of these two enzymes. In contrast, high production of both enzymes was not detected in C. metapsilosis. Hemolysin activity was significantly more abundant in C. orthopsilosis (87%) than C. parapsilosis sensu stricto (67%). Overall, C. orthopsilosis isolates were statistically associated with the production of hemolysins (P= 0.048) and phospholipases (P< 0.0001) compared to isolates of C. parapsilosis sensu stricto or C. metapsilosis. Furthermore, a statistical association was found between isolates recovered from blood and phospholipase production (P= 0.017). The distribution of isolates obtained from blood was 30% of C. parapsilosis sensu stricto, 67% of C. orthopsilosis and 20% of C. metapsilosis.

Background Mucormycosis is a rare, invasive disease associated with high mortality rates, produced by opportunistic pathogens related to the Mucorales order and characterised by a diverse range of clinical forms; acute rhino‐orbital‐cerebral and pulmonary symptoms are the most reported ones. Objectives To report the experience of mucormycosis observed in a tertiary‐care hospital in Mexico for 35 years. Methods This was a retrospective, descriptive and observational study on mucormycosis at a tertiary‐care hospital in Mexico from January 1985 to December 2019. Demographic and clinical data and mycological and histopathological records were selected. Results Two hundred fourteen proven cases of mucormycosis for 35 years at a tertiary‐care hospital in Mexico were included. Most of the cases were male patients with a median age of 45 years. The two most associated underlying diseases were diabetes mellitus (76.6%) and haematologic malignancy (15.4%). The three primary clinical forms were as follows: rhino‐orbito‐cerebral (75.9%), cutaneous (8.41%) and pulmonary (7.47%) mucormycosis. The most isolated agents were Rhizopus arrhizus (58.4%) and Lichtheimia corymbifera (12.3%). The overall therapeutic response was 58.5%, and the best response was observed with amphotericin B deoxycholate and surgical debridement. Conclusion Mucormycosis is an emerging disease, and its incidence has increased at our hospital over the years. In this study, the rhino‐cerebral clinical type was the most frequent in patients with uncontrolled diabetes; the main aetiological agent was R. arrhizus. Early diagnosis, control of the underlying disease and prompt management may increase the survival rate.