Background and Methods: To identify recent trends in the frequency of zygomycosis in autopsy cases, we conducted epidemiological analysis every four years from 1989 to 2009 using national data reported in the “Annual of Pathological Autopsy Cases in Japan.” Results: 153,615 cases were autopsied, of which 6622 (4.3%) were found to have had mycosis. Among these, there were 243 cases (3.7%) of zygomycosis, which was the fourth most predominant causative agent of mycoses among the monopathogen mycoses. Of the complicated mycoses, zygomycosis accounted for 56 cases. A total of 299 cases with zygomycoses were observed. The frequency of zygomycosis appeared to be generally stable over the twenty-year period from 1989 to 2009, at around 4% of autopsy cases having mycosis. Younger patients tended to have severe and complicated infections that were characteristic of zygomycosis, compared with non-zygomycosis. The pulmonary and gastrointestinal (GI) systems were the most common foci in our analysis, reflecting the severity of zygomycosis in these sites. Hematological disease was the most frequent underlying disease, but there was a peak of neonatal infections in 2009, which was the first time that this was observed in our studies. Conclusion: These results of the epidemiological analysis of autopsy cases with mycosis demonstrate that clinicians should promptly recognize and treat zygomycosis.
The risk of invasive fungal infections (IFIs) is extremely high in patients with hematological malignancies due to the prolonged and profound neutropenia and immunosuppression after chemotherapy and hematopoietic stem cell transplantation. There has been increasing interest in mucormycosis despite its relatively uncommon occurrence, because occasional breakthrough infections have been observed under anti-Aspergillus prophylaxis. The aggressive nature of mucormycosis easily leads to high mortality because of delays in diagnosis and incorrect treatment decisions, which are due in part to lack of adjunctive diagnostic tools and having similar clinical and radiological features with invasive aspergillosis. The only currently available antifungals against Mucorales in Japan are amphotericin B formulations. Thus, comprehensive therapeutic strategies, including surgery, should be considered to achieve a successful outcome.
Feline sporotrichosis has been reported in Malaysia since the 1990’s. Since then, studies have revealed that clinical clade D, Sporothrix schenckii sensu stricto, of a single clonal strain is the most common cause of this disease in Malaysia. The prevalence of a single clonal strain from a clinical clade was never before reported in Asia in a specific geographical niche. This raises the possibility of a process of purifying selection and subsequent clonal proliferation. While agricultural practices may serve as the selective pressure, direct causality has yet to be established. Studies into the thermo-tolerability of the Malaysian clonal strain of S. schenckii sensu stricto revealed that a small minority of clinical isolates have the capacity to grow at 37℃, while the majority displayed low susceptibility to commonly used antifungals in clinical practice, such as itraconazole (ITZ) and terbinafine (TRB). Despite unestablished breakpoints, suspected resistance (MIC > 4 mg/mL) towards amphotericin B (AMB) and fluconazole (FLC) was recorded in the isolates. This explains the often lack of clinical response in feline patients treated with recommended doses of antifungals, including ITZ. Coupled with the potential zoonotic transmission to clients and veterinarians, protracted treatment period, and subsequent cost of treatment, prognosis of feline sporotrichosis is often regarded to be poor. The use of a higher dose of ITZ has been reported, and an adoption of this high-dose treatment regime is reported in this manuscript, with complete cure achieved in cases of recalcitrant and/or unresponsive feline sporotrichosis, which would otherwise be euthanized.
Morphology and molecular characteristics of Microsporum gypseum clinical isolates obtained from the fur of a normal rabbit (n=1) and the soil from 10 different rabbit hutches in six elementary schools (n=10) were examined. Isolates were also identified by sequence analysis of the internal transcribed spacer (ITS) region. All 11 isolates demonstrated homology with the Arthroderma fulvum ITS sequence. Furthermore, PCR analysis for the presence of mating type genes detected positivity for MAT1-1 (n=10) and MAT1-2 (n=1). However, no mating reaction was detected between A. fulvum reference strains and the clinical isolates.
医療の現場では早期診断，治療の方向づけをするうえでリアルタイムに得られる検査結果が求められている．そこで患者の傍らでリアルタイムに実施して診断，治療に役立つ有益な情報を得る検査がpoint of care testing（POCT）である．感染症領域でのPOCTは，初期治療に役立つ情報を診療時間内に得られる迅速検査として利用価値が高い． 感染症迅速診断検査キットは，細菌，ウイルス，真菌，原虫疾患などを対象に多岐にわたり，多くの起炎病原体に対する製品が市販されている．これらのうちPOCTとして用いられている測定法は，イムノクロマトグラフィー法（immunochromatography assay：ICA）である．ICAは操作が簡便であるため，医師や看護師でも検査を行える． わが国の臨床現場では血清診断法を補助的に用いて深在性真菌症を早期に臨床診断し，治療に結びつける努力が行われてきた．しかし，検査法は煩雑で本格的な臨床検査の部類に入るため，POCTのカテゴリーからは外れる．近年，POCTとして米国では真菌感染症の診断にLAMP法が試みられている．深在性真菌症の早期診断のために簡便かつ精度の高いPOCTによる検査法の開発が期待される．