Abstract:Objective To investigate the pathogenic characteristics and T lymphocyte immune features in children with severe mycoplasmal pneumonia complicated by pulmonary fungal infection.Methods Retrospective inclusion of 37 children with severe mycoplasmal pneumonia complicated by fungal infection admitted to Taiyuan Central Hospital pediatric department from July 2022 to July 2024 formed Group A.An additional 50 children with severe mycoplasmal pneumonia without complications during the same period formed Group B.Concurrently,50 healthy children undergoing routine physical examinations were randomly selected to form Group C.Pathogenic characteristics of Group A were analyzed.Inflammatory markers[neutrophil-to-lymphocyte ratio(NLR),serum amyloid A(SAA),erythrocyte sedimentation rate(ESR)],pulmonary function indicators[peak expiratory flow(PEF),maximum voluntary ventilation(MVV),forced expiratory volume in one second to forced vital capacity ratio(FEV1/FVC)],T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+),and nutritional status indicators(vitamin A,vitamin D).Results In Group A,39 fungal strains were detected among 37 children with severe mycoplasmal pneumonia complicated by pulmonary fungal infection.Candida albicans was the most prevalent,followed by Aspergillus fumigatus,Mucorales,Candida parapsilosis,and Pneumocystis.Both Groups A and B exhibited significantly higher levels of NLR,SAA,ESR,and CD8+compared to Group C,with Group A showing significantly higher values than Group B(P＜0.05).The levels of PEF,MVV,FEV1/FVC,CD3+,CD4+,CD4+/CD8+,vitamin A,and vitamin D were significantly lower in Groups A and B than in Group C,with Group A being significantly lower than Group B.All differences were statistically significant(P＜0.05).ROC analysis revealed that NLR,SAA,ESR,PEF,MVV,FEV1/FVC,CD3+,CD4+,CD8+,CD4+/CD8+,vitamin A,and vitamin D levels were statistically significant predictors of pulmonary fungal infection in children with severe mycoplasmal pneumonia(P＜0.05).Conclusion Severe mycoplasmal pneumonia complicated by pulmonary fungal infection is predominantly caused by Candida albicans.Affected children exhibit intense inflammatory responses,immune dysfunction,poor pulmonary function,and malnutrition.Therefore,clinical management requires early monitoring of relevant indicators,prompt implementation of comprehensive therapeutic measures to reduce inflammation and modulate immunity,emphasis on fungal prevention and treatment,and improvement of patient prognosis.

Abstract:Objective To optimize the fluconazole dosing regimen for patients with renal insufficiency suffering from invasive candidiasis and provide a reference for individualized medication in special populations.Methods Patients with renal insufficiency were grouped according to the glomerular filtration rate(GFR).Based on the pharmacokinetics/pharmacodynamics(PK/PD)model of fluconazole,the distribution of common clinical dosing regimens,pharmacokinetic(PK)parameters,and the minimum inhibitory concentration(MIC)of Candida was simulated by Monte Carlo simulation(MCS)using Crystal Ball software.The probability of target attainment(PTA)≥90%or the cumulative fraction of response(CFR)≥90%was used as the evaluation index.Results In the case where the MIC of the target Candida could be accurately obtained,when MIC≤1 mg/L,a dose of 100 mg/d(when MIC=1 mg/L,the dose for patients with mild renal insufficiency needed to be increased to 200 mg/d)could meet the requirement of PTA≥90%;when MIC=2 mg/L,for patients with mild or moderate renal insufficiency,the maintenance dose recommended in the package insert(for patients with severe renal insufficiency,a dose of 100 mg/d was required)could meet the requirement of PTA≥90%;when MIC=4 mg/L,only a dose of 200 mg/d for patients with severe renal insufficiency could meet the requirement of PTA≥90%;and when MIC>4 mg/L,the dose recommended in the package insert could not meet the requirement of PTA≥90%.In the case where only the strain could be identified but the accurate drug susceptibility results could not be obtained,a dose of 200 mg/d for patients with mild renal insufficiency could meet the requirement of CFR≥90%for the target Candida;while patients with moderate or severe renal insufficiency required a dose of 100 mg/d to meet the requirement of CFR≥90%.Conclusion For patients with renal insufficiency using fluconazole,factors such as the Candida strain,MIC value,and the degree of renal function impairment should be comprehensively considered to achieve individualized dosing.

Abstract:Objective To analyze the types,age,gender and temporal change trend characteristics of pathogenic fungi causing superficial fungal diseases in a hospital in Shanghai from 2020 to 2024,theoretical support is provided for the diagnosis and treatment of related diseases.Methods The clinical data of patients with superficial mycosis who underwent fungal microscopic examination,fungal culture,and molecular biological testing in the Clinical Laboratory of Medical Mycology,the Second Affiliated Hospital of Naval Medical University were retrospectively collected from July 2020 to July 2024.The population characteristics such as gender and age of the patients,as well as the types and clinical distribution of pathogenic fungi were analyzed.Results A total of 3469 patients with superficial mycosis were included.The types of fungal specimens were dander,nail dander,nail groove secretions,broken or diseased hair,dandruff,secretions of the external genitalia,dander or pseudomembrane,and oral mucosa.The main pathogenic fungi were Trichophyton in 1782 strains(51.37%)and Candida in 888 strains(25.60%).The middle-aged group(aged 31-60 years)accounts for the largest proportion,among patients with tinea manuum,tinea pedis,tinea corporis,tinea cruris,tinea faciei,onychomycosis,and skin and mucous membrane fungal infections,while Malassezia mainly infects young people aged 15 to 30.Among patients of tinea pedis,tinea corporis,tinea cruris,tinea faciei,pityriasis versicolor and onychomycosis,the proportion of males is higher than that of females(P<0.05).In the past five years,fungal infections of the nails and hands have shown a downward trend,while infections of Malassezia have shown an upward trend.Conclusion The main pathogens of superficial mycosis in this hospital are Trichophyton and Candida.Different types of infections have specific high-incidence age groups.The distribution characteristics and epidemic trends of superficial mycosis are roughly consistent with the situation in most regions of China in recent years,but they also have their own unique features.

Abstract:Objective To analyze the clinical characteristics,vaginal microecology and drug resistance of 368 patients with recurrent vulvovaginal candidiasis.Methods From February 2022 to December 2024,368 patients with recurrent vulvovaginal candidiasis admitted to Quanzhou First Hospital Affiliated to Fujian Medical University were studied.The clinical characteristics,the distribution and the drug resistance of pathogenic strains,the vaginal microecology of recurrent vulvovaginal candidiasis cases infected with different strains wereanalyzed.Results The main clinical features of recurrent vulvovaginal candidiasis cases included age distribution range of 21 to 40 years old,fertility history,abortion/induced labor history,education level of junior high school and below,and non-standard use of antifungal drugs.The pathogenic strains included Candida albicans and non-C.albicans,accounting for 78.53%and 21.47%,respectively.The resistance rate of C.albicans to itraconazole and clotrimazole was lower than that of non-C.albicans,and the resistance rate of C.albicans to miconazole was higher than that of non-C.albicans(P＜0.05).The proportion of patients with score of Nugent 0-3 points,flora density+/++,white blood cells≤10/HP in the C.albicans group was lower than that in the non-C.albicans group,and the proportion of patients with flora diversity+++and dominant pathogens Gardnerella was higher than that in the non-C.albicans group(P＜0.05).Conclusion The clinical characteristics of patients with recurrent vulvovaginal candidiasis included the main age distribution range of 21-40 years old,with fertility history,history of abortion/induction of labor,education level of junior high school and below,and irregular use of antifungal drugs.The pathogenic strains included C.albicans and non-C.albicans.Compared with non-C.albicans,the resistance rate of C.albicans to itraconazole and clotrimazole was low,and the resistance rate to miconazole was high.There are significant differences in score of Nugent,flora density,flora diversity,dominant pathogens and white blood cells between the two vaginal microecologies.

Abstract:Objectives Relevant studies have shown an association between plasma lipids and the development of candidiasis,but the causal relationship is not clear at present.In this study,Mendelian randomization(MR)was used to analyze the causal relationship between plasma lipids and candidiasis.Methods The causal association of plasma lipids in candidiasis was investigated using two-way Mendelian randomization,with plasma lipids as the exposure factor and associated single nucleotide polymorphisms(SNPs)as instrumental variables(IVs).The primary method of analysis was an inverse variance weighted(IVW)analysis,along with sensitivity analyses to test the reliability of the MR analysis results.Results Positive MR analysis demonstrated that plasma lipids ceramide(d40:1),ceramide(d40:2),phosphatidylethanolam-ine(18:0_0:0),phosphatidylcholine(16:1_18:2),and phosphatidylcholine(O-16:0_20:3)exerted a protective effect against candidiasis.Sensitivity Q-test,MR-Egger regression,and MR-PRESSO test indicated the absence of heterogeneity and horizontal pleiotropy among the selected instrumental variables.No reverse causality was observed between candidiasis and the following plasma lipids:ceramide(d40:1),ceramide(d40:2),phosphatidylethanolamine(18:0_0:0),phosphatidylcholine(16:1_18:2),and phosphatidylcholine(O-16:0_20:3).Conclusion This study suggests a causal relationship between plasma lipids and candidiasis.

Abstract:Objective To analyze the early warning factors of fungal bloodstream infection in severely burned patients and the significance of the expression of human telomere repeat binding factor 1(TRF1)mRNA,human telomere repeat binding factor 2(TRF2)mRNA,myeloid cell trigger receptor 1(TREM1)and soluble hemoglobin scavenger receptor(sCD163).Methods A total of 534 patients with severe burns admitted to the General Hospital of Ningxia Medical University from January 2020 to January 2025 were selected as the research objects.According to the occurrence of fungal bloodstream infection,the patients were divided into the infection group(52 cases)and the non-infection group(482 cases).The etiological characteristics and single factors of fungal bloodstream infection in patients with severe burns were statistically analyzed,and the early warning factors of fungal bloodstream infection in patients with severe burns were analyzed.The diagnostic value of TRF1 mRNA,TRF2 mRNA,TREM1 and sCD163 expression for fungal bloodstream infection in patients with severe burns was analyzed.Results A total of 55 strains of pathogenic fungi were isolated from 52 patients with fungal bloodstream infection.The main pathogenic fungi were Candida albicans and C.parapsilosis,accounting for 30.91%and 20.00%,respectively.The burn area,number of operations before infection,acute physiology and chronic health evaluation(APACHE II)score,sequential organ failure score,proportion of patients with broad-spectrum antibiotic use time≥7 d,proportion of patients with broad-spectrum antibiotic types≥3,TRF1 mRNA,TRF2 mRNA,TREM1 and sCD163 expression levels in the infected group were higher than those in the non-infected group(P＜0.05).Larger burn area,broad-spectrum antibiotic use time≥7 d,broad-spectrum antibiotic types≥3,and higher expression levels of TRF1 mRNA,TRF2 mRNA,TREM1,and sCD163 were all early warning factors for fungal bloodstream infection in patients with severe burns(OR=1.454,1.655,1.534,1.621,1.820,1.853,1.662,P＜0.05).The area under the curve of the combined detection of TRF1 mRNA,TRF2 mRNA,TREM1 and sCD163 expression in the diagnosis of fungal bloodstream infection in patients with severe burns was higher than that of the four alone(P＜0.05),and the sensitivity and improvement were 78.85%and 85.89%,respectively.Conclusion The main pathogenic fungi of severe burn patients with fungal bloodstream infection were C.albicans and C.parapsilosis.The occurrence of fungal bloodstream infection could increase the expression levels of TRF1 mRNA,TRF2 mRNA,TREM1 and sCD163.The early warning factors included large burn area,broad-spectrum antibiotic use time≥7 d,broad-spectrum antibiotic types≥3,and higher expression levels of TRF1 mRNA,TRF2 mRNA,TREM1 and sCD163.Further analysis of the combined expression of TRF1 mRNA,TRF2 mRNA,TREM1 and sCD163 could improve the diagnostic value of fungal bloodstream infection in patients with severe burns.

Abstract:Objective To investigate the species distribution and antifungal susceptibility profiles of superficial Candida infections in Shanghai Skin Disease Hospital.Methods A total of 144 Candida isolates were collected from clinical specimens(including groin,nails,and genitalia)between November 2024 and April 2025.Species identification was performed using ITS(internal transcribed spacer)sequencing.Antifungal susceptibility testing was conducted in accordance with the CLSI M27-A4 guideline.Results Of the 144 pathogenic isolates,Candida albicans(54.2%)and Candida parapsilosis(33.3%)were the predominant species.C.albicans exhibited high susceptibility to echinocandins and amphotericin B,but showed a resistance rate of 12.82%to fluconazole.C.parapsilosis showed high susceptibility to most antifungal drugs,with 100%susceptibility to echinocandins,voriconazole,and itraconazole,and the 89.58%susceptibility to fluconazole.Candida tropical was susceptible to echinocandins and amphotericin B,but showed a significant resistance to azole drugs.All C.tropical isolates exhibited reduced susceptibility(non-wild-type)to posaconazole,with one isolate resistant to fluconazole and one to voriconazole.Meyerozyma guilliermondii,Candida metapsilosis and Meyerozyma caribbica were mostly susceptible to antifungal drugs,with less resistance observed.Most strains of C.haemulonii,C.dermatis,Wickerhamomyces anomalus,and Debaryomyces hansenii also exhibited low MIC values across antifungal drugs tested.However,C.haemulonii showed a significant resistance tendency to fluconazole(with MIC 128 μg/mL)and terbinafine(64 μg/mL).C.dermatis had elevated MICs to echinocandins(8 μg/mL)and 5-fluorocytosine(16 μg/mL).Conclusion C.albicans and C.parapsilosis are the leading pathogens in superficial candidiasis.The significant interspecies differences in antifungal susceptibility observed necessitates species-level identification and ongoing resistance surveillance to guide effective individualized therapy.

Abstract:Objective Based on itraconazole as the lead compound,a series of derivatives(6a-6k)were designed and synthesized to identify highly potent,low-toxicity,and selective antifungal candidates through in vitro screening,while investigating their structure-activity relationships(SAR).Methods Using medicinal chemistry optimization strategies,11 novel itraconazole derivatives were designed and synthesized.The in vitro antifungal activity of the target compounds was determined by the microbroth dilution method,while their antifungal spectrum was assessed via spot assay.The inhibitory effects on fungal hyphae formation and biofilm growth were systematically evaluated.Additionally,we employ Swiss ADME tools to predict the pharmacokinetic properties of compounds,thereby conducting a comprehensive assessment of the compounds.Results All target compounds exhibited significant antifungal activity.Notably,compounds 6c and 6f demonstrated the most potent efficacy,with MIC80 values as low as 0.0156 μg/mL against multiple pathogenic fungi.Importantly,compound 6c also exhibited strong inhibitory activity against drug-resistant strains(MIC80=0.25 μg/mL).At a concentration of 0.0625 μg/mL,compound 6c effectively suppressed hyphae formation in Candida albicans(SC5314).In addition,at the concentration of 0.25 μg/mL,compound 6c has a significant effect on both early and mature biofilm formation.Conclusion Compound 6c exhibits broad-spectrum antifungal activity,including potent inhibition against drug-resistant strains,while also inhibiting hyphae and biofilm formation.It holds potential for further investigation as a candidate antifungal drug molecule.

Abstract:Objective Examine the risk factors and pathogenic distribution of lung fungal infections in patients who have experienced severe trauma.Methods A retrospective study was conducted on patients with severe trauma complicated with pulmonary fungal infection admitted to the Emergency Department of the First Affiliated Hospital of the Air Force Medical University from January 2022 and December 2024,as well as patients with severe trauma without infection during the same period.Gathered clinical information from two patient groups,analyzed risk factors for pulmonary fungal infections in patients who had experienced severe trauma using a multiple logistic regression model,assessed predictive value using receiver operating characteristic(ROC)curves,and used the CHAID algorithm to build a decision tree model based on risk factors.Results A total of 73 cases were collected from the infected group and 219 cases were collected from the uninfected group.Among the 73 patients in the infection group,a total of 89 fungal strains were detected,with Candida albicans making up the largest percentage(30.34%);multivariate analysis revealed that the following factors were independent risk factors for severe trauma patients with concurrent pulmonary fungal infections:age(OR=1.092,95%CI 1.018-1.171),diabetes(OR=3.591,95%CI 1.352-9.541),acute kidney injury(AKI)(OR=2.960,95%CI 1.004-8.722),APACHE Ⅱ score(OR=1.405,95%CI 1.220-1.619),ICU stay time(OR=1.409,95%CI 1.254-1.583),and tracheotomy assisted ventilation time(OR=2.397,95%CI 1.720-3.341).ROC analysis revealed that the aforementioned indicators and combined prediction were statistically significant(P＜0.05)for severe trauma patients with concurrent pulmonary fungal infections.The combined detection diagnostic efficacy study showed that the sensitivity was 84.9%and the specificity was 91.8%(AUC=0.945,95%CI 0.915-0.976).With a 90.4%classification accuracy,the decision tree model demonstrated that the ICU stay length at the first level was the most significant predictor.Conclusion For severe trauma patients with pulmonary fungal infection,independent risk factors included age,diabetes,AKI,APACHE Ⅱ score,length of stay in intensive care unit,and tracheotomy assisted ventilation time.A more user-friendly presentation format can be offered by the ROC curve and decision tree model,which can also early on detect the potential of severe trauma patients who are complicated by pulmonary fungal infection.The risk of infection can be decreased by using efficient prevention and control strategies.

Abstract:Objective To evaluate the diagnostic value of targeted next-generation sequencing(tNGS)in Pneumocystis jirovecii pneumonia(PJP)in non-HIV-infected patients.Methods Clinical data were retrospectively analyzed for non-HIV-infected PJP patients and non-HIV/non-PJP pneumonia patients who underwent tNGS testing in No.909 Hospital from January 2022 to December 2024.Using clinical composite diagnosis as the gold standard,the diagnostic performance of tNGS,polymerase chain reaction(PCR),and serum(1,3)-β-D-glucan(BDG)assays for detecting Pneumocystis.jirovecii and co-pathogens in bronchoalveolar lavage fluid(BALF)was evaluated.Results A total of 115 non-HIV-infected pneumonia patients were included,including 54 PJP cases.Compared to the gold standard,tNGS demonstrated 100%sensitivity,specificity,negative predictive value,positive predictive value,and accuracy for PJP diagnosis,surpassing the corresponding values from PCR and serum BDG.Among the 54 PJP patients,tNGS identified 8 cases(14.81%)of simple Pneumocystis jirovecii infection and 46 cases(85.19%)of mixed infections.The detection rate of tNGS for mixed infection was significantly higher than conventional pathogen testing(85.19%vs.66.67%,P=0.024).In BALF samples,tNGS detected a total of 147 pathogen.Apart from Pneumocystis jirovecii,the most common pathogens were Epstein-Barr virus(13 cases),Candida albicans(11 cases),Human herpesvirus-5(9 cases),and Acinetobacter baumannii(8 cases).Conclusion tNGS provides accurate diagnosis of PJP in non-HIV-infected patients and offers advantages in identifying mixed infections.

Abstract:Objective To investigate the species identification,drug sensitivity and genomic characteristics of Candida auris in Hebei Yanda Hospital from January 1,2025 to June 30,2025,and to provide a basis for formulating infection control strategies within the hospital.Methods Two cases of C.auris were traced back to their sources.The initial identification was confirmed by MALDI-TOF MS mass spectrometry.The minimum inhibitory concentrations of antifungal drugs were detected using Sensititre YeastOne,and genomic sequencing analysis was conducted.Results The initial identification was C.haemulonii and C.famata,which were confirmed as C.auris by Vitek MS mass spectrometry.The drug sensitivity test showed that both strains were significantly resistant to fluconazole,and they were highly similar to the South Asian clade B8441(Clade I)type and had variations in the drug resistance genes ERG11_Y132F,TAC1B_A583S and FCY1_S70R.Conclusions This study reveals the drug resistance characteristics and molecular traceability of C.auris in Hebei Yanda Hospital,which is a South Asian clade B8441(Clade I)type resistant to fluconazole.It provides a scientific basis for establishing an early warning mechanism and optimizing the diagnosis and treatment plan in clinical practice.

Abstract:A 71-year-old woman was admitted to Shengli Oil Field Central Hospital on September 2,2021,due to"recurrent abdominal pain for over 10 days".Initially,the patient presented with abdominal pain as the predominant symptom,later progressed to low back pain with restricted movement.The patient was in a forced lateral decubitus position.A approximately 20 cm long surgical scar from a previous cholecystectomy,which was visible in the right upper abdomen.Left abdominal tenderness,thoracolumbar kyphosis,and localized tenderness with rebound pain were present.After admission,comprehensive investigations were performed.On September 18,2021,the patient underwent a CT-guided thoracic vertebra biopsy.Culture of the aspirated lavage fluid showed Candida albicans.Following definitive diagnosis,antifungal therapy with fluconazole was initiated for 5 days without clinical improvement.Treatment was switched to micafungin for more than 2 months,followed by sequential oral fluconazole capsules.The patient's condition stabilized and she was discharged on January 29,2022 with continued fluconazole therapy.Regular follow-ups were maintained in the Infectious Diseases Clinic until fluconazole was discontinued in June 2023,post-treatment monitoring for 6 months showed no evidence of disease recurrence.

Abstract:Objective To explore the risk factors for fungal infections in female patients with pelvic abscesses and evaluate the predictive efficacy of each factor.Methods This study was a prospective,observational study.A total of 255 female patients with pelvic abscesses who were hospitalized in the Department of Obstetrics and Gynecology of Wuhan No.1 Hospital from February 2021 to January 2025 were enrolled as the research subjects.The enrolled patients were divided into a group with concurrent fungal infection and a group without concurrent fungal infection according to whether they had a concurrent fungal infection during the treatment process.The differences in general clinical data,factors related to pelvic abscesses,treatment-related factors,and routine laboratory test indicators between the two groups of patients were compared.Multivariate logistic regression analysis was used to screen the independent influencing factors related to the risk of concurrent fungal infection in female patients with pelvic abscesses.The receiver operating characteristic(ROC)curve was plotted to analyze the value of the combined prediction of concurrent fungal infection in patients by each influencing factor.Results The age range of the enrolled female patients with pelvic abscesses was 23 to 69 years old,and the median age was 42(37,50)years old.Among them,44 cases had concurrent fungal infections,and the incidence of concurrent fungal infections was 17.3%.The age,proportion of patients with diabetes mellitus,proportion of patients with malnutrition,maximum body temperature,abscess size,course of disease,proportion of patients using glucocorticoids,proportion of patients using sex hormone drugs,proportion of patients with indwelling urinary catheters,duration of antibiotic use,types of antibiotics used,proportion of carbapenem use,neutrophil count before treatment,C-reactive protein,procalcitonin and erythrocyte sedimentation rate(ESR)in the group with concurrent fungal infection were all higher than those in the group without concurrent fungal infection,while the albumin(ALB)and IgG were lower than those in the group without concurrent fungal infection(P＜0.05).Multivariate logistic regression analysis indicated that age,malnutrition,abscess size,use of glucocorticoids,duration of antibiotic use,types of antibiotics used,neutrophil count,and ESR were all independent risk factors for the risk of concurrent fungal infection in female patients with pelvic abscesses,and IgG was an independent protective factor for the risk of concurrent fungal infection in female patients with pelvic abscesses(P＜0.05).ROC curve analysis showed that the area under the curve(95%CI)of the combined prediction of the risk of concurrent fungal infection in female patients with pelvic abscesses by the above 9 influencing factors was 0.847(0.785-0.909),with a sensitivity of 84.53%and a specificity of 80.25%.Conclusion Age,malnutrition,abscess size,use of glucocorticoids,antibiotic use,neutrophil count,ESR,and IgG are all influencing factors for concurrent fungal infection in female patients with pelvic abscesses.Based on the above indicators,the risk of concurrent fungal infection in patients can be effectively predicted.

Abstract:Objective To investigate the influencing factors of combined invasive pulmonary aspergillosis(IPA)in patients with chronic obstructive pulmonary disease(COPD),in order to guide the development of clinically rational preventive countermeasures.Methods The clinical data of 53 patients with COPD combined with IPA admitted to General Hospital of Ningxia Medical University from January 2020 to November 2024 were retrospectively collected as the study group,and the clinical data of 53 patients with COPD not combined with IPA were collected as the control group.The microbiological examination results of the patients in the study group were analyzed,the general conditions,laboratory examination data,clinical manifestations and chest CT manifestations of the two groups were compared,and the risk factors of IPA in COPD patients were analyzed by multifactorial logistic regression.Results Among the 53 patients with COPD combined with IPA,Aspergillus filaments was detected in one case by lung tissue puncture pathology and the diagnosis was confirmed by positive microbiological culture of Aspergillus fumigatus.The remaining 52 cases were diagnosed clinically.Microbiological culture of 53 cases of COPD combined with IPA revealed 53 fungal strains,including 35 isolates of Aspergillus fumigatus(66.04%),6 isolates of Aspergillus niger(11.32%),6 isolates of Aspergillus flavus(11.32%),4 isolates of Aspergillus oryzae(7.55%)and 2 isolates of Aspergillus terreus(3.77%).The study group had a higher percentage of combination of diabetes mellitus,having hypoalbuminemia,systemic use of hormones,using≥3 types of antimicrobial drugs,using antimicrobial drugs for≥14 d,having invasive operations,having a hospitalization time of≥14 d,fever,hemoptysis,and corona sign,nodular shadow,and cavitation(P＜0.05).Multifactorial logistic regression analysis showed that the combination of diabetes mellitus(OR=3.080),having hypoalbuminemia(OR=2.630),systemic use of hormones(OR=3.108),using≥3 types of antimicrobial drugs(OR=2.210),using antimicrobial drugs for≥14 d(OR=1.929),having invasive operation(OR=2.421),and hospitalization time≥14 d(OR=2.793)were all risk factors for comorbid IPA in patients with COPD(P＜0.05).Conclusion The main causative organism in patients with COPD combined with IPA was Aspergillus fumigatus,and its occurrence were closely related to the combination of diabetes mellitus,having hypoalbuminemia,systemic use of hormones,using≥3 types of antimicrobial drugs,using antimicrobial drugs for≥14 d,having invasive operations,having a hospitalization time of≥14 d.Clinics could formulate reasonable preventive countermeasures accordingly to reduce the risk of IPA in patients with COPD.

Abstract:The patient,a 53-year-old female,was a farmer with multiple dark red plaques,nodules,cysts and scars on the right arm for more than a year.There was no desquamation on the skin surface,no special symptoms such as itching and tingling.There were no obvious blisters,pustules,erosion,ulcers,fissures,impregnation and other special rashes.Based on the results of skin histopathology,fungal culture,etc.,the diagnosis was made of dermatophytosis caused by Exophiala jeanselmei,According to the results of antifungal sensitivity,itraconazole capsules and topical naltifen ketoconazole cream were administered.After 8 weeks of treatment,the affected area was significantly flattened and the broken area healed.

Abstract:Objective To analyze the treatment failure status and influencing factors of clotrimazole suppositories in patients with first-diagnosed vulvovaginal candidiasis(VVC).Method This prospective study included 183 patients with first-diagnosed VVC treated in Wuhan No.1 Hospital between January 2023 and January 2025.All received single-agent clotrimazole suppositories for 1 week and were classified into effective treatment and treatment failure groups based on clin-ical response.Demographic characteristics,disease severity,treatment-related factors,and pretreatment laboratory pa-rameters were compared between groups.Independent risk factors for treatment failure were identified via logistic regres-sion analysis.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive efficacy of combined factors.Result Among 179 patients completing treatment and follow-up(median age 31(29,33)years),19(10.6%)experienced treatment failure.Univariate and multivariate logistic regression analyses iden-tified severe disease,complex infection,poor medication adherence,higher pretreatment vaginal pH,and elevated estro-gen level as independent risk factors for treatment failure,while higher pretreatment serum IgG level was protective factor(all P<0.05).The ROC curve for the predictive model incorporating these six factors showed an AUC of 0.880(95%CI:0.793-0.967).Conclusion Disease severity,infection type,medication adherence,vaginal pH,IgG,and estrogen levels are independently associated with clotrimazole treatment failure in first-diagnosed VVC patients.

Abstract:Objective To explore the epidemiological characteristics of superficial fungal infections by analyzing data from health check-up participants,providing a basis for clinical prevention and treatment.Methods Using descriptive epi-demiological methods,we analyzed the three-dimensional distribution characteristics and pathogen spectrum composition of participants whose physical examination packages included dermatological examinations at the Second Affiliated Hospital of Naval Medical University from January to December 2024.ArcMap 10.2 software was used for visualizing trends in the epidemiological features of superficial fungal infections.Results Among 150 participants,30 cases(20.00%)of superfi-cial fungal infections were identified,including dermatophytes(22 cases,73.33%),Candida(6 cases,20.00%),Malas-sezia(1 case,3.33%)and Aspergillus(1 case,3.33%).The infection rate in the≥51 age group(35.56%)was signifi-cantly higher than in the 31-50(15.09%)and 18-30(11.54%)age groups(P<0.05).The infection rate was 22.86%in males and 17.50%in females,with no statistically significant difference(P>0.05).By occupation,infection rates were:manual workers 30.00%,office workers 7.50%,service industry workers 26.67%,and others 13.33%.Manual workers had a significantly higher infection rate than other occupational groups(P<0.05).Among 40 participants who frequently sweated,12(30%)were infected;among 70 with occasional sweating,10(14.29%)were infected;among 40 with rare sweating,8(20%)were infected.Among 35 participants who often wore tight clothing,14(40%)were infected;among 65 occasional wearers,12(18.46%)were infected;among 50 rare wearers,4(8%)were infected.Those who frequently sweated or wore tight clothing showed significantly elevated infection rates(P<0.05 for both).Conclusion Clinical health education should be strengthen for high-risk groups—such as maintaining skin cleanliness and dryness,avoiding tight clothing-to reduce infection risk.For patients with suspected superficial fungal infections,microscopic examination and fungal culture should be performed.

Abstract:A 63-year-old male patient admitted to Beijing Hospital presented with exertional dyspnea for 2 years and aggravated symptoms with cough and sputum production for 5 months.He had a long-term history of pigeon breeding.Di-agnostic findings include positive serum cryptococcal capsular antigen,chest CT revealing bilateral diffuse ground-glass o-pacities with three-density sign in mid-lower lung fields and elevated lymphocyte proportion in bronchoalveolar lavage fluid.According to HP-2020 guideline and cryptococcosis-2024 guideline,he was diagnosed as hypersensitivity pneumonitis com-plicated with cryptococcosis.Considering the risk of corticosteroid-induced fungal dissemination,sequential therapy was implemented.Initial fluconazole therapy showed limited clinical or radiographic improvement.Prednisone was initiated af-ter achieving cryptococcal antigen seroconversion,resulting in significant symptom resolution.Although the cooccurrence of hypersensitivity pneumonitis and pulmonary cryptococcosis is rare in clinical practice,their shared etiological factors.Pre-treatment screening for pulmonary cryptococcosis is imperative prior to corticosteroid therapy to reduce the risk of Cryptococcus dissemination.

Abstract:Objective To investigate the clinical manifestations,imaging features,treatment methods and prognosis of pulmonary aspergillosis caused by Aspergillus tubingensis,and to provide reference for subsequent clinical treatment.Methods The clinical data and the characteristics of antifungal susceptibility test of 9 patients with Aspergillus tubingen-sis infection identified by stroma-assisted laser desorption ionization time-of-flight mass spectrometry in The First Affiliated Hospital of Hebei North University were collected.Results Nine patients mainly presented with fever,cough with expec-toration,hemoptysis or blood-streaked sputum,chest pain,chest tightness and shortness of breath.Galactomannan(GM)and G tests showed no abnormalities.The main imaging manifestations were bronchiectasis,pleural effusion and multiple patchy infiltrates.The pathogenic species was identified as Aspergillus tubingensis by matrix-assisted laser desorption/ion-ization time-of-flight mass spectrometry.All nine patients received antifungal treatment.The drug sensitivity test results showed that Aspergillus tubingensis was naturally resistant to fluconazole,and was relatively sensitive to micafungin,anidulafungin and caspofungin.It was sensitive to posaconazole,voriconazole.The drug sensitivity results of amphotericin B and 5-fluorocytosine were intermediate.Conclusion Patients with pulmonary aspergillosis caused by Aspergillus tubin-gensis mainly have underlying lung diseases and diabetes.There are no specific manifestations in imaging.Diagnosis is con-firmed through culture of sputum,bronchoalveolar lavage fluid,and pleural effusion from the patient.The drug sensitivity tests are completed to ultimately provide effective treatment for the patient.

Abstract:Objective To analyze the distribution and drug resistance of yeast-like fungi isolated from clinical sterile body fluid specimens from 2020 to 2024,providing evidence for the rational use of antifungal drugs in clinical practice.Methods A retrospective analysis was conducted on the identification,antimicrobial susceptibility testing results,and clin-ical data of yeast-like fungi isolated from sterile body fluid specimens of inpatients at Guangdong Provincial Second Hospital of Traditional Chinese Medicine from January 2020 to December 2024.Results A total of 290 non-repeated yeast-like fun-gi were isolated in past five years.The main isolates were Candida albicans(42.07%),C.tropicalis(20.69%),C.glabrata(15.52%)and C.parapsilosis complex(7.59%).Since 2023,The isolation rate of C.auris also showed an in-creasing trend.The majority of fungemia patients were males(53.45%)and were aged≥65-year-old(56.90%).The de-partment with the highest distribution percentage was the Acupuncture and Rehabilitation Ward(42.07%),and the high-est specimen separation rate was of blood(52.76%).The sensitivity rate of C.albicans to the monitored antifungal drugs exceeds 80%.C.parapsilosis exhibited nearly 100%susceptibility,except for one strain resistant to voriconazole.Both C.tropicalis and C.auris show significant resistance to azole drugs,with sensitivity rates below 50%.C.auris,in parti-cular,exhibits severe resistance to fluconazole,with a sensitivity rate of only 25%in 2024.Both amphotericin B and 5-fluorocytosine demonstrates high sensitivity to predominant Candida species,exceeding 90%.Conclusion Over the past 5 years,the main species isolated from clinical sterile body fluid specimens were Candida species,with C.albicans being the most predominant.Different species exhibit varying sensitivities to antifungal drugs.It is of great significance to strengthen the monitoring of the species,distribution and drug resistance of clinically isolated fungi for guiding the appro-priate use of antifungal drugs and controlling nosocomial infection.