Laboratory Diagnosis of Mucormycosis: Current Status and Future Perspectives

Lackner, Michaela; Caramalho, Rita; Lass‐Flörl, Cornelia

doi:10.2217/fmb.14.23

Cited by 119 publications

(136 citation statements)

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“…The strains were cultured on supplementary minimal medium (SUP) agar (13) at 37°C (except that Mucor spp. were grown at 30°C) for 3 to 5 days and preidentified to genus level by micromorphological (Olympus CX21 microscope; Olympus, USA) and macromorphological (Axioplan microscope; Zeiss, Germany) characteristics (6,14). Species were determined by internal transcribed spacer (ITS) direct sequencing (15).…”

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confidence: 99%

Etest Cannot Be Recommended for In Vitro Susceptibility Testing of Mucorales

Caramalho

Maurer

Binder

et al. 2015

Antimicrob Agents Chemother

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e Amphotericin B and posaconazole susceptibility patterns were determined for the most prevalent Mucorales, following EUCAST (European Committee on Antimicrobial Susceptibility Testing) broth microdilution guidelines. In parallel, Etest was performed and evaluated against EUCAST. The overall agreement of MICs gained with Etest and EUCAST was 75.1%; therefore, Etest cannot be recommended for antifungal susceptibility testing of Mucorales. Amphotericin B was the most active drug against Mucorales species in vitro, while the activities of posaconazole were more restricted. Mucormycoses are rapidly progressing and frequently lethal infections caused by fungi associated with the order Mucorales (1). Rhizopus is the most commonly found genus, followed by the genera Lichtheimia and Mucor (1). Antifungal treatment options consist of lipid formulations of amphotericin B (AMB) as the first-line therapy (2) and posaconazole (PSC) as salvage therapy (3, 4). The rising number of breakthrough mucormycoses (5-7) has stimulated interest in antifungal susceptibility testing (AST) of Mucorales. Phylogenetic studies found that Mucorales embrace a very heterogeneous group of fungi, with their evolutionary distances mirrored in various levels of intrinsic antifungal susceptibilities (8, 9). The recommended international standard methods of the CLSI (Clinical and Laboratory Standards Institute) (10), and EUCAST (European Committee for Antimicrobial Susceptibility Testing) (11) are based on broth microdilution assays. However, ready-to-use commercial tests, such as the Etest, are popular for routine application, as they are simpler to perform and more time efficient (12). To use and exchange data generated with the Etest in routine laboratories, an evaluation of this commercial test compared to a gold standard method is needed.The aims of the present study were 2-fold: to determine amphotericin B and posaconazole susceptibility patterns for the most frequent agents of mucormycoses and to compare the results obtained with Etest and EUCAST.The strain set comprised 131 Mucorales; the clinical strains were collected between 2008 and 2014 in routine laboratory testing at the University Hospital of Innsbruck (see Table S2 in the supplemental material), and an additional 38 reference strains were gained from the Fungal Biodiversity Centre (CBS, Utrecht, The Netherlands) (see Table S3). The strains were cultured on supplementary minimal medium (SUP) agar (13) at 37°C (except that Mucor spp. were grown at 30°C) for 3 to 5 days and preidentified to genus level by micromorphological (Olympus CX21 microscope; Olympus, USA) and macromorphological (Axioplan microscope; Zeiss, Germany) characteristics (6, 14). Species were determined by internal transcribed spacer (ITS) direct sequencing (15). Mycelium was harvested for genomic DNA extraction as previously described (16). ITS sequences were identified with BLAST comparative nucleic acid sequence analysis of sequences in the NCBI database (www.ncbi.nlm.nih.gov/BLAST).In vitro antifungal susceptibilit...

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confidence: 99%

Etest Cannot Be Recommended for In Vitro Susceptibility Testing of Mucorales

Caramalho

Maurer

Binder

et al. 2015

Antimicrob Agents Chemother

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“…Classic clinical features are fever, pain, headache, facial swelling, nasal congestion, ocular involvement with visual loss, and limitation of eye movement. In pulmonary or disseminated infections, the signs and symptoms are similar to those of other fungal or bacterial infections (1,4).…”

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confidence: 86%

“…The members of this order with variable antifungal susceptibility patterns include Mucor, Absidia, Rhizopus, Rhizomucor, and Lichtheimia. This order is environmental fungi with rapidly progressive and life-threatening infections in immunocompromised patients with underlying diseases like diabetes mellitus, neutropenia, bone marrow transplants, hematological malignancies, and advanced AIDS (1). Interestingly, there are reports of patients with this infection with no immune compromising conditions (2,3).…”

Section: Introductionmentioning

confidence: 99%

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Sequence Base Identification of Respiratory Mucormycosis

Badiee

Choopanizadeh

Khosravi

2017

Jundishapur J Microbiol

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Background: Mucormycosis is an uncommon fungal infection in immunocompromised patients during the past decades. Identification of causative agents could play an important role in the management of infected patients. Objectives: The aim of the present study was the identification of etiologic agents of respiratory tract mucormycosis, based on sequencing methods. Methods: Sinus tissue, bronchoalveolar lavage, and blood samples from the patients with suspected invasive fungal diseases were collected. Sinus tissue and bronchoalveolar lavage were examined by microscopic examination and cultured on Sabouraud dextrose agar. Blood samples were cultured on BACTEC medium. Semi-nested polymerase chain reaction (PCR) for diagnosis of mucormycosis was performed on samples, and products of positive PCR were sequenced and manually viewed with Chromas version 2.24 software. Pathology reports were collected from patients' files. Results: Direct microscopic examinations, culture, and semi-nested PCR were positive in 11.7% (19/163), 6.7% (11/163), and 10.4% (17/163) of patients, respectively. None of the blood cultures were positive for Mucorales. The etiologic agents were Rhizopus oryzae (10 cases), R. microsporus (5 cases), and new species (2 cases). This new sequence (645 bp) was published in Gene bank and European Nucleotide archive of EMBL-EBI, and demonstrated 98% identity with Lichtheimia (Absidia) corymbifera genus. Conclusions: Management of mucormycosis has an important role in the treatment and outcome of such infections. Molecular assay and DNA sequencing could be used in parallel with conventional mycology techniques to identify Mucorales and for best management of respective infections.

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“…Además, la supervivencia está relacionada con la forma clínica de presentación: 90% en las formas cutáneas aisladas, 87% en sinusitis sin afectación cerebral, 45% en formas rinocerebrales, 36% en las pulmonares, 33% en la enfermedad cerebral focal, 16% en las formas diseminadas y 10% en las gastrointestinales 9,10 . Debido a la gran velocidad de crecimiento y capacidad invasora de estos hongos, el diagnóstico precoz de la mucormicosis es clave para asegurar el éxito terapéutico 10 .La terapia incluye farmacos antifúngicos y la intervención quirúrgica con debridación amplia, y resección de los tejidos afectados 4,11 .…”

Section: Introductionunclassified

Mucormicosis rinosinusal por Mucor hiemalis en una paciente con Leucemia Mieloide aguda.

2016

Bol. Micol.

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RESUMENSe reporta un caso clínico de una paciente femenina de 41 años, con antecedentes de leucemia mieloide aguda (LMA) en remisión. Estudiada por hematología, se confirmó recaída de LMA M4. Se inició quimioterapia. La paciente evolucionó con pancitopenia severa. Presentó dos episodios de neutropenia febril, el primero fue asociado a un absceso glúteo que se trató con antibacterianos, y el segundo a compromiso rinosinusal y úlcera necrótica de punta nasal, columela, tabique, cornete inferior izquierdo y paladar duro. Debido a la clínica e imá-genes radiológicas, se sospechó mucormicosis, por lo que se realizó cirugía con debridación extensa y se inició tratamiento antimicótico con anfotericina B desoxicolato. El cultivo de tejido informó abundante desarrollo de Mucor hiemalis. Se mantuvo pancitopénica durante aproximadamente un mes, siendo diariamente evaluada por un equipo multidisciplinario. Se hicieron varios aseos quirúrgicos, en el último se encontró tejido vital. La paciente completó diez días con anfotericina B desoxicolato y posteriormente se hizo traslape a posaconazol oral. Se realizó mielograma de control que evidenció remisión completa de recaída de LMA. Se dio de alta a su domicilio al día 40 de hospitalización, con hemograma adecuado y tratamiento oral con posaconazol para completar 6 semanas en total. ABSTRACTWe report a case of a 41-years-old female patient with a history of acute myeloid leukemia (AML) in remission. Hematology studies confirmed relapse of AML M4. Chemotherapy was started. The patient developed severe pancytopenia. She presented two episodes of febrile neutropenia, Bol. Micol. 2016; 31(2): 51-58 MICOLOGÍA MÉDICA

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Laboratory Diagnosis of Mucormycosis: Current Status and Future Perspectives

Cited by 119 publications

References 83 publications

Etest Cannot Be Recommended for In Vitro Susceptibility Testing of Mucorales

Etest Cannot Be Recommended for In Vitro Susceptibility Testing of Mucorales

Sequence Base Identification of Respiratory Mucormycosis

Mucormicosis rinosinusal por Mucor hiemalis en una paciente con Leucemia Mieloide aguda.

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