Abstract:Objective To investigate the pathogenic distribution of invasive fungal infections(IFD)combined with slow plus acute liver failure(ACLF)and therisk factors and predictive model construction.Methods Patients admitted to our hospital with ACLF secondary to IFD from March 2021 to March 2024 were retrospectively included in the IFD group(n=63),and patients with ACLF who did not develop any infections during the same period were also included in the non-IFD group(n=95).The site of fungal infection and the pathogenic distribution in the IFD group were analysed,risk factors were assessed using logistic regression model,predictive value was assessed using subject's work characteristic curve(ROC),and a decision tree model was constructed.Results Among the 63 patients with ACLF-IFD in this study,the largest partof ca-ses were thepatients with gastrointestinal infections,accounting for 34.92%;63 fungal strains were detected,and Candida albicans was the most frequently isolatedstrain,accounting for 42.86%.Logistic multifactorial results showed that the using duration of the broad-spectrum antimicrobial drugs,invasive manipulation,total bilirubin(TBil),the International Normali-sed Ratio(INR),the end-stage liver model score(MELD)were independent risk factors for ACLF-IFD(P<0.05);albu-min(ALB)and prothrombin activity(PTA)were protective factors(P<0.05).The results of the ROC curve showed that all of the above factors and the combined prediction were statistically significant(P<0.05)for the assessment of ACLF-IFD,with the combination of predictive assessment of ACLF-IFD had an AUC=0.996,95%CI of 0.990～1.000,sensitiv-ity of 0.968,and specificity of 1.000.The decision tree model has a total of 5 layers,17 nodes,and 9 leaf nodes.The model selected 6 risk factors as nodes of the model,MELD,TBil,invasive manipulation,PTA,ALB and INR,of which MELD was the most important predictor,and the classification accuracy of the model was 95.80%.Conclusion The duration of broad-spectrum antimicrobial use,invasive operation,TBil,INR,and MELD are independent risk factors for ACLF-IFD,and ALB and PTA are protective factors for it,so patients with the above mentioned influencing factors need to be paid close attentionduring the treatment period.

Abstract:A 47-year-old male patient was admitted to the hospital due to renal failure caused by polycystic kidney disease.After admission for the fifth hemodialysis,he began to have headache,dizziness,low-grade fever,and repeated seizures.Pulmonary CT showed signs of infection.Cryptococcal antigen was positive in serum and cerebrospinal fluid,and Cryptococ-cus neoformans was detected in blood culture and cerebrospinal fluid mNGS.The patient was diagnosed with disseminated cryptococcosis and cryptococcal meningitis.After antifungal treatment with fluconazole and voriconazole,the seizures were completely relieved,the body temperature returned to normal,and the pulmonary infection was significantly improved.

Abstract:Objective To analyze the outbreak of Candida pelliculosa fungemia in neonatal intensive care unit(NICU),explore the causes of the outbreak,and determine the relevant risk factors.Methods Retrospective analysis of clinical data from 14 neonates with Candida pelliculosa-associated bloodstream infection in the Neonatal Intensive Care Unit(NICU)of Ordos Central Hospital,Inner Mongolia Autonomous Region,between January 1,2016,and March 27,2020,as the exper-imental group.They were compared with 56 children without fungal infection(control group 1)and 18 children with candi-demia other than Candida pelliculosa(control group 2).The potential risk factors of Candida pelliculosa in newborns were analyzed.Through the monitoring of children,medical staff and the environment,the source of infection was determined.Results The risk factors of Candida pelliculosa fungemia include low birth weight,premature delivery,central venous catheterization,mechanical ventilation,surgery,broad-spectrum and the application of antibiotics.The risk factors had no significant difference between Candida pelliculosa infection and candidemia other than Candida pelliculosa.All patients were treated with fluconazole after definite diagnosis and were cured.No Candida pelliculosa was found in the hands of chil-dren,nurses or the environment,and the source of infection was not determined.Conclusions Candida pelliculosa is a relatively rare fungal pathogen in neonatal fungal infections,sharing similar risk factors with other Candida infections.Giv-en the unique vulnerability of neonates,healthcare workers must strictly implement infection control measures and remain particularly vigilant in monitoring potential outbreaks.

Abstract:Objective To investigate whether the CVF1 gene enhances the virulence of Candida albicans in vulvovaginal candidiasis(VVC),we constructed a CVF1-deficient strain(cvf1Δ)and infected both human epidermal carcinoma A-431 cells and a murine VVC model.Methods Estrogenized mice were intravaginally inoculated with wild-type(WT,SC5314),cvf1Δ,or complemented(cvf1Δ::CVF1)strains.Vaginal symptoms were monitored,fungal loads in lavage fluid were quantified,and hyphal morphology was assessed.A-431 cells were infected with these strains to measure lactate dehydrogen-ase(LDH)release(indicating cytotoxicity),intracellular survival,and inflammatory cytokine(TNF-α,IL-6,IL-1β)levels.Results Compared to WT and cvf1Δ::CVF1-infected mice,cvf1Δ-infected mice exhibited no typical VVC symptoms(e.g.,increased yellow discharge)and had significantly reduced fungal loads,though hyphal morphology remained unaffected.In A-431 cells,cvf1Δ showed lower intracellular survival,reduced LDH release,and diminished induction of TNF-α,IL-6,and IL-1β versus WT and cvf1Δ::CVF1.Conclusion CVF1 is a critical virulence gene in C.albicans-mediated VVC,gov-erning fungal persistence,host damage,and proinflammatory responses.

Abstract:Objective To study the diagnosis and treatment processes of keratitis caused by Lasiodiplodia theobromae and reviews the literature of the past 10 years.Methods Corneal scraping samples were collected from the affected areas of 2 keratitis patients admitted to our hospital.Two samples were respectively subjected to microscopy examination,fungal cul-ture,molecular biological examination,and the in-vitro antimierobial susceptibility of the isolated pathogen were performed.Results In both patients,the pathogens were identified as Lasiodiplodia theobromae.In-vitro antimierobial susceptibility tests showed that the pathogens were relatively sensitive to voriconazole and amphotericin B,with minimum inhibitory con-centrations(MICs)of 1 μg/mL and 2 μg/mL,respectively.And clinical use was effective.The previously published studies generally suggest that the affected sites of Lasiodiplodia theobromae were mainly the cornea and body surface.For body surface infections,voriconazole was the first-choice treatment,while for corneal infections,combined treatment with ampho-tericin B was required in addition to other therapies.Conclusions Keratitis caused by Lasiodiplodia theobromae is relatively rare in clinical practice,with great difficulties in diagnosis and treatment.Strain identification and in-vitro antimierobial sus-ceptibility tests may provide more precise medication guidance for clinical practice.

Abstract:Objective To analyze the clinical characteristics and to explore the clinical efficacy and safety of amphotericin B cholesterol sulfate complex in the treatment of patients with AIDS complicated with invasive fungal infection.Methods The clinical data of 79 patients with AIDS complicated with invasive fungal infection treated with amphotericin B cholesterol sul-fate complex in the Third People's Hospital of Kunming were retrospectively analyzed.The basic information,clinical out-come and incidence of related adverse reactions were statistically analyzed.Results Among the 79 patients,there were 25 cases of cryptococcosis,32 cases of talaromycosis,5 cases of aspergillosis,and 17 were other fungal diseases.The total ef-fective rate of amphotericin B cholesterol sulfate complex was 78.48%,and the incidence of adverse reactions was 56.96%.Conclusion Most patients with AIDS complicated with invasive fungal infection did not receive regular ART,and counts of CD4 cells were low.Amphotericin B cholesterol sulfate complex was effective and the incidence of adverse reactions was high.However,it could be improved after symptomatic treatment.Close attention should be paid to the occurrence of ad-verse reactions in clinical applications.

Abstract:Objective To analyze the clinical manifestations and high risk factors of prognosis of 295 patients with invasive pulmonary fungal infection.Methods From November 2019 to July 2024,295 patients with invasive pulmonary fungal in-fection in Department of Critical Care Medicine,First Hospital of Qinhuangdao City were selected,and their clinical data were collected retrospectively.After treatment,244 patients survived and 51 patients died within 30 days.The clinical mani-festations and chest computerized scanning(CT)of patients with invasive pulmonary fungal infection were analyzed,prog-nostic risk factors were evaluated using logistic regression analysis.Results The clinical manifestations of 295 patients with invasive pulmonary fungal infection were mainly rales and fever in the lungs,accounting for more than 80%.The CT images of the chest were mainly patchy shadows and cavities,accounting for more than 30%.312 strains of pathogenic fungi isola-ted from 295 patients with invasive pulmonary fungal infection were mainly Candida albicans,C.tropicalis and Aspergil-lus,accounting for 49.04%,20.83%and 18.91%respectively.Multivariate logistic analysis showed that the high risk factors of prognosis of patients with invasive pulmonary fungal infection included acute kidney injury,mechanical ventilation,low level of peripheral blood Hb and low level of peripheral blood PLT(OR=1.679,1.353,1.952,1.384,P<0.05).Conclusion The clinical manifestations and chest CT of patients with invasive pulmonary fungal infection had no specific manifestations.The main pathogens were C.albicans,C.tropicalis and Aspergillus.The high-risk factors affecting the prognosis of patients with invasive pulmonary fungal infection mainly include acute kidney injury,mechanical ventilation,low level of peripheral blood Hb and low level of peripheral blood PLT.Therefore,targeted treatment and nursing measures could be adopted to intervene in high-risk patients.

Abstract:Objective To explore the diagnostic value and correlation of the(1,3)-β-D glucan test(G test)combined with procalcitonin and C-reactive protein in Candida spp.bloodstream infections,in order to provide theoretical basis for the ear-ly diagnosis of candidemia.Method Thirty-seven patients diagnosed with Candida infection through blood culture at Inner Mongolia Autonomous Region People's Hospital from July 2019 to December 2023 were collected as the fungal group,and 206 patients with negative blood culture were randomly collected as the control group during the same period.The diagnostic value and correlation of G test,PCT,CRP and their combined detection were retrospectively analyzed,and the clinical char-acteristics of different candidemia groups were compared.Result Among the 37 cases in the fungal group,the primary de-partment distribution was ICU(45.95%).The average levels of age,G test,and PCT in the 37 treatment groups were 81.00 years old,87.82 pg/mL,and 1.39 ng/mL respectively,which were significantly higher than those in the 206 control groups(70.50 years old,37.50 pg/mL,and 0.431.39 ng/mL),with statistical significance(P<0.05).However,CRP had no statistical significance between the two groups(P>0.05).The correlation coefficient between G test and PCT was 0.266,and there was a weak correlation between the two(P<0.05);The correlation coefficient between PCT and CRP was 0.35,indicating a moderate strength correlation(P<0.05);There was no significant correlation between G test and CRP(P=0.168).The area under the ROC curve,sensitivity,and specificity for the diagnosis of candidemia were 0.839,0.784,and 0.84 for the G test alone(with a critical value of 41.96 pg/mL);The PCTs were tested separately at 0.720,0.703,and 0.655(with a critical value of 0.755ng/mL);When conducting G test and PCT combined detections:0.860,0.811,0.845.The average PCT level in the Candida albicans group was 7.35 ng/mL,which was higher than 0.625 ng/mL in other Can-dida groups,and the difference was statistically significant(P=0.007).Conclusion Candidemia patients tend to be older and mainly originated from the ICU,with elevated levels of G-test and PCT.The G-test and PCT have a certain degree of correlation;their combined detection significantly enhances the early diagnostic value for candidemia,improving the sensitivi-ty and specificity of individual tests.Most cases of candidemia are caused by Candida albicans,but there has been an in-creasing trend in non-Candida albicans infections in recent years.In the prevention and treatment of candidemia,attention should be paid to the high infection rate in ICU and the avoidance of mixed infections.

Abstract:Objective To analyze the distribution of pathogenic fungi in superficial fungal infections in Hainan Province and the drug susceptibility characteristics of yeasts,providing a basis for clinical diagnosis and treatment.Methods A retrospec-tive analysis was conducted on 1118 cases of positive fungal cultures from the dermatology department of the Fifth People's Hospital of Hainan Province from January 2018 to December 2023,focusing on the distribution of fungal species,infection sites,and yeast drug susceptibility results.Results The majority of the 1118 strains were derived from onychomycosis pa-tients(75.49%),followed by tinea corporis(8.32%)and tinea pedis(7.07%).Among them,yeasts and yeast-like fungi accounted for 57.6%(644 cases),with Candida parapsilosis(18.41%)being the most common,often found in nail speci-mens;dermatophytes accounted for 27.01%(302 cases),with Trichophyton rubrum(17.62%)being the most prevalent,commonly found in toenail specimens.The drug susceptibility results showed that Candida glabrata and Candida dublini-ensis had susceptibility rates>90%to most drugs,while Candida albicans had a susceptibility rate of only 36.0%to itra-conazole,and Candida tropicalis showed low susceptibility rates to five drugs.Conclusion The fungal culture specimens in this hospital are primarily derived from nail specimens,leading to significant differences in species distribution compared to reports from other regions.The susceptibility of yeasts to antifungals varies by species and requires continuous monitoring.

Abstract:Objective To investigate the correlation factors of fungal infection(FI)in patients with digestive tract malig-nancies during chemotherapy.Methods 57 patients with FI during chemotherapy for digestive tract malignant tumors from March 2023 to September 2024 in the Department of Gastroenterology of the First Affiliated Hospital of Air Force Military Medical University were selected as FI group,and 103 patients without FI during chemotherapy for digestive tract malignant tumors during the same period were selected as non-FI group.The distribution and drug resistance of FI were analyzed.Clinical data were collected,and logistic regression analysis was performed to identify factors affecting FI occurrence during chemotherapy.A FI regression prediction model was constructed based on these factors,and its predictive value,goodness of fit,and consistency were evaluated.Results 62 strains of fungi were isolated by fungal culture identification,including Candida albicans(45.16%),C.glabrata(32.26%),C.tropicalis(12.90%),and C.krusei(9.68%).The 62 fungal strains showed varying degrees of drug resistance.Except for C.krusei's natural resistance to fluconazole,C.albicans,C.glabrata,and C.tropicalis showed certain resistance rates to ketoconazole and miconazole.Logistic regression analysis re-vealed that age(OR=2.469,95%CI=1.184-5.147),history of fungal infection(OR=3.137,95%CI=1.361-7.229),comorbid diabetes(OR=3.245,95%CI=1.139-9.243),long-term use of glucocorticoids(OR=4.198,95%CI=1.085-16.246),types of antibiotics used(OR=4.418,95%CI=1.069-18.256),and presence of malnutrition(OR=8.834,95%CI=2.074-37.625)were influencing factors for FI during chemotherapy.The regression prediction model constructed based on these factors showed an area under curve(AUC)of 0.726 in receiver operating characteristic curve(ROC)analysis.Hos-mer-Lemeshow test showed no overfitting,and internal validation demonstrated good consistency.Conclusions Fungal in-fections during chemotherapy in patients with digestive tract malignancies are primarily caused by C.albicans and C.gla-brata.Age,history of fungal infection,comorbid diabetes,long-term use of glucocorticoids,types of antibiotics used,and presence of malnutrition can affect the occurrence of FI.The regression prediction model based on these factors shows good predictive performance and can provide reference for clinical prevention and management.

Abstract:Objective To evaluate the effects ofKangfu gelcombined with miconazole nitrate on the clinical efficacy,vaginal microecology,and inflammatory level in patients with vulvovaginal candidiasis,and to provide new treatment strategyof pa-tients with vulvovaginal candidiasis.Methods A total of 124 patients with vulvovaginal candidiasis who were treated in the Department of Obstetrics and Gynecology of the Second Hospital of Shanxi Medical University from April 2022 to July 2023 were selected as the research subjects of this study.They were divided into group A and group B by the random number method,with 62 patients in each group.The patients in group A were treated with miconazole nitrate suppositories,and the patients in group B were treated withKangfu gel in addition to the treatment regimen of group A.All patients returned for follow-up 1 week and 6 months after the end of the 1-week treatment course.The clinical efficacy,improvement of clinical symptoms,Candida clearance rate,recurrence rate,changes and differences in vaginal microecology,and levels of inflam-matory factors in vaginal secretions were compared between the two groups.Results The median age of the 124 enrolled patients was 35(32,36)years old,and the median duration of the disease was 3(3,4)weeks.Among them,76(61.29%)patients had a history of pregnancy,and 14(11.29%)patients were postmenopausal.At the 1-week follow-up after the end of treatment,the total effective rate of treatment in group A was 87.10%(54/62),and that in group B was 96.77%(60/62).The total effective rate in group B was higher than that in group A(P<0.05).The average improvement times of vul-var pruritus,abnormal vaginal discharge,and vulvar burning pain symptoms in group B were all shorter than those in group A(P<0.05).One week after the end of treatment,the Candida clearance rate in group B was higher than that in group A,and the recurrence rate in group B within 6 months of follow-up was lower than that in group A(P<0.05).The vaginal mi-croecology indexes of both groups improved after treatment.The vaginal pH value in group B after treatment was lower than that in group A,and the improvement of flora diversity and the proportion of Lactobacillus as the dominant bacteria in group B were higher than those in group A(P<0.05).The levels of IL-1β,IL-6,and tumor necrosis factor-α(TNF-α)in vaginal secretions of both groups decreased after treatment compared with those before treatment,and the decrease in group B was more significant(P<0.05).During the treatment and follow-up process,the incidence of adverse reactions in group A was 9.7%,which was higher than 4.84%in group B,but there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Kangfu gel as an adjuvant to miconazole nitrate has a more significant clin-ical efficacy in the treatment of patients with vulvovaginal candidiasis,and shows certain advantages in the improvement of clinical symptoms,Candida clearance rate,recurrence rate,vaginal microecology,and inflammatory level.

Abstract:Invasive aspergillosis (IA) is a serious opportunistic infection that mainly been found in individuals with a compromised immune system.As Aspergillus species worldwide and the increasing number of immunocompromised hosts,IA brings a heavy burden to our country.In addition,early diagnosis is difficult and effective treatments are lacking,which leaded to the high mortality of IA (39 ％ ～ 100 ％).Currently,further nationwide epidemiological research of IA is needed in China.

Abstract:Objective To understand the clinical features,predisposing factors,and pathogens of fungal diseases in Nanning,Guangxi region and improve the clinician's understanding of fungal infections.Methods From July 2009 to July 2014 at the First Affiliated Hospital of Guangxi Medical University,10 042 cases of fungal infections were confirmed by clinical features and microbiological examinations.Then data were further analyzed by using SPSS 16.0 statistical software.Results Among 10 042 cases,the maximum was tinea pedis (2 793 cases,27.81％),followed by 1 883 (18.75％) cases of onychomycosis,1 238 cases (12.32 ％) of tinea corporis,1 232 cases (12.27 ％) of Malassezia folliculitis,1 170 cases of tinea versicolor,1 124 cases (11.65 ％) of tinea cruris,291 cases (2.90 ％) of cutaneous candidiasis,182 cases of tinea manus (1.82 ％),129 cases (1.28％) of tinea capitis.Distribution of strains including 2 511 (25.00％) strains of Trichophyton rubrum,2 402 (23.92 ％) strains of Malassezia,2 373 (23.63 ％) strains of Candida.Superficial mycoses and the isolates varied with gender,ages,and seasons.Conclusion The predominant superficial mycosis was tinea pedis,and the predominant pathogen was Trichophyton rubrum.But Candida infection had grown significantly,this epidemic trend was similar to most parts of our country and had its own characterics.