Nihon Ishinkin Gakkai Zasshi
Online ISSN : 2434-5237
Print ISSN : 2434-5229
Current issue
Displaying 1-5 of 5 articles from this issue
  • Current Status of Fungal Species Identification Using MALDI-TOF MS and Fully Automated Genetic Testing System
    Makiko Kiyosuke
    2022 Volume 63 Issue 4 Pages 81-87
    Published: October 31, 2022
    Released on J-STAGE: November 30, 2022
     Microbiological tests for the diagnosis of deep-seated mycosis have low sensitivity, are time-consuming, and vary widely among facilities and even among technicians. In recent years, with the increase of non-albicans Candida species, outbreaks of Candida auris, and emergence of fungal drug resistance, novel mass spectrometry and genetic testing have become commonly available. While the use of new diagnostic tools in microbiology laboratories is expected to increase, the skills in basic culture testing and proper utilization of the latest equipment remain important. This review summarizes the current status and updates on fungal identification using conventional methods as well as the latest equipment, including mass spectrometry and fully automated genetic testing in laboratories.
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  • Tsuyoshi Yamada
    2022 Volume 63 Issue 4 Pages 89-92
    Published: October 31, 2022
    Released on J-STAGE: November 30, 2022
     With the emergence of antimicrobial resistance as one of the leading public health threats of the 21st century, antifungal drug resistance in dermatophytes is also becoming a real problem in dermatology. In 2017, our Japan/Switzerland collaborative research team found 17 dermatophyte strains showing reduced susceptibility to terbinafine, one of the major antifungal drugs for superficial mycoses among just over 2,000 clinical Trichophyton rubrum and Trichophyton interdigitale isolates in Switzerland. Since then, increasing numbers of dermatophyte clinical isolates resistant to this drug have been documented. More recently, dermatophyte clinical isolates with reduced susceptibility to azole compounds, a widely used class of antifungal medications, have been isolated. Furthermore, we recently found a new mechanism of azole resistance involving the overexpression of CYP51B resulting from additional copies of this gene in Trichophyton indotineae, a new dermatophyte species independent of T. interdigitale. This paper reviews the current status of our understanding of the epidemiology and mechanisms of antifungal drug resistance in dermatophytes.
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  • Kazuhiko Nakajima, Takashi Ueda, Kaoru Ichiki, Kaori Ishikawa, Kumiko ...
    2022 Volume 63 Issue 4 Pages 93-98
    Published: October 31, 2022
    Released on J-STAGE: November 30, 2022
     Candidemia is a primary invasive fungal infection in hospitalized patients and results in high mortality. Antifungal stewardship (AFS) improves the prognosis of candidemia, reduces the adverse effects of antifungal drugs, and counteracts the suppression of resistance. The treatment required for candidemia is presented as a bundle. Better therapeutic effects can be expected by adhering to this bundle. We managed candidemia using the ACTIONs bundle and investigated the risk factors for a poor prognosis. Administration of antifungal drugs 2 weeks after blood culture negativity was associated with an improved prognosis. Cirrhosis/liver dysfunction, low prognostic nutritiosn index, and high Acute Physiology and Chronic Health Evaluation II score were associated with poor prognosis.
     The choice of the most appropriate antifungal drug type, drug dosage, and duration of treatment are important factors for improving the prognosis. Notable risk factors for a poor prognosis include old age, renal dysfunction, liver dysfunction, and immunosuppression. However, it is often difficult to control these background factors. Furthermore, the patient's nutritional index and lymphocyte count are considered predictors of the prognosis. Improving the patient's nutritional status is one measure that should be taken to improve the prognosis of candidemia. In this review, we outline the practice of AFS and the disease background factors associated with prognosis.
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