Three thermotolerant “Lichtheimia-like” isolates from patients suffering from mucormycosis (nasopharyngeal swab of a liver transplant recipient, gastric biopsy of a renal transplant recipient, and skin biopsy of a man with burn, respectively) were characterized. Phenotypic characteristics, including colony morphology, microscopic morphology and thiamine dependency, were determined. Microscopic examination of agar block smear preparations showed that most side branches of the three “Lichtheimia-like” isolates and Lichtheimia ramosa were circinate, with abundant pleomorphic giant cells with fingerlike projections commonly observed. Sequence analysis of four loci (internal transcribed spacer region of the ribosomal DNA, partial elongation factor 1-α gene, partial β-actin gene, and the D1-D2 region of 28S rRNA) showed that the three “Lichtheimia-like” isolates and L. ramosa formed a distinct cluster, and are closely related to, but distinct from, other Lichtheimia sp.. A new species, Lichtheimia hongkongensis (synonym of L. ramosa), was proposed to describe this fungus. It was also hypothesized that a proportion of “A. corymbifera (L. corymbifera)” reported in the literature could be L. hongkongensis. In this study, 13 fungal strains that were reported as “A. corymbifera (L. corymbifera)” in the literature in an 11-year period were collected. Microscopic examination of agar block smear preparations of these 13 strains revealed unique characteristics of L. hongkongensis, including circinate side branches and pleomorphic giant cell with finger-like projections. Phylogenetic analysis also showed that all 13 strains are closely related with L. hongkongensis. It was confirmed that a significant number of reported A. corymbifera (L. corymbifera) infections are L. hongkongensis infections which are of global distribution. In order to confirm the distinct phylogenetic position of L. hongkongensis, the mitochondrial genomes of three L. hongkongensis strains and a strain of L. corymbifera were sequenced. L. hongkongensis HKU21, HKU22 and HKU23 have circular mitochondrial genomes with sizes ranging from 31830 bp to 32167 bp, which contain 39 to 41 genes transcribed by both strands. L. corymbifera HKU25 has a circular mitochondrial genome of size 37262 bp, which contains 41 genes that are transcribed by both strands. All the four mitochondrial genomes contain a complete set of tRNAs, the small and the large rRNAs, as well as the basic 14 protein-coding genes. Analysis of gene order showed that the three L. hongkongensis strains are clustered together. It is also shown that the Lichtheimia group is also closely related to Rhizopus oryzae, which is a member of Mucorales. A mouse model was used to determine if there is a difference in virulence between L. hongkongensis and L. corymbifera. The groups of mice challenged with L. hongkongensis have a higher survival rate than those challenged with L. corymbifera. Intravenous administration of Lichtheimia spores resulted in an infection in livers and spleens as indicated by positive cultures. The number of spores that could be recovered from these organs was significantly lower in mice challenged with L. hongkongensis than those challenged with L. corymbifera, indicating that L. hongkongensis could be less virulent than L. corymbifera. / published_or_final_version / Microbiology / Doctoral / Doctor of Philosophy

Thesis (M.D.)--Boston University

Orientador: Angélica Zaninelli Schreiber / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T22:10:52Z (GMT). No. of bitstreams: 1 SilvaFonseca_AdenilzaCristinada_M.pdf: 2857134 bytes, checksum: 9329779ba094b04efc1a51c3932a5dfd (MD5) Previous issue date: 2014 / Resumo: Introdução: Mucormicose é uma infecção oportunista invasiva causada por fungos filamentosos denominados de Mucorales, antes Zygomycetes, de difícil tratamento e, com mau prognóstico em pacientes imunocomprometidos, caracterizada por manifestações rinocerebrais, pulmonares ou disseminadas. Espécies dos gêneros Rhizopus, Mucor, Absidia (Lichtheimia) e Rhizomucor, são os Mucorales mais isolados de pacientes. São micro-organismos resistentes a voriconazol e equinocandinas in vitro e in vivo. A terapia inclui a reversão dos fatores predisponentes, retirada cirúrgica da área infectada e administração de antifúngicos, em geral, anfotericina B, de atividade terapêutica limitada e muitos efeitos colaterais. Objetivos: Identificação dos isolados de Mucorales selecionados para o estudo por metodologia clássica e técnicas moleculares; padronização da técnica de microdiluição em caldo para avaliação de suscetibilidade aos antifúngicos isolados: anfotericina B; 5-fluorocitosina; fluconazol; micafungina; itraconazol; voriconazol; miconazol e terbinafina de outros gêneros de Mucorales que não Rhizopus spp.; avaliação da Concentração Inibitória Fracional para determinação do tipo de interação que ocorre entre as combinações de antifúngicos anfotericina B x itraconazol; anfotericina B x voriconazol; terbinafina x itraconazol; terbinafina x voriconazol e terbinafina x anfotericina B; padronização da metodologia de avaliação dinâmica de crescimento para o gênero Rhizopus sp. e Rhizopus oryzae (LIF 1832), para possível estabelecimento de correlação clínico-laboratorial já que este foi isolado de um paciente em tratamento de mucormicose. Metodologia: Estudo realizado com 10 isolados clínicos de Mucorales com identificação morfológica prévia de gênero. A identificação molecular foi realizada com os iniciadores ITS1/ITS4; ITS4/ITS5 e NL1/NL4. Os testes de suscetibilidade aos antifúngicos isolados, in vitro, foram realizados pelo método de microdiluição em caldo (CLSI M38-A2). Os antifúngicos combinados foram analisados de acordo com a metodologia do "tabuleiro de xadrez". Já a avaliação dinâmica de crescimento de hifas frente aos antifúngicos anfotericina B, itraconazol e terbinafina para o isolado Rhizopus oryzae (LIF 1832) foi realizada através do sistema Biocell-Tracer?. Resultados: As identificações morfológica e molecular foram discordantes para os isolados LIF 1237 e 1832, classificados morfologicamente como Absidia (Lichtheimia) sp. e Rhizomucor sp. e identificados como Rhizopus oryzae após sequenciamento de DNA. Considerando todos os isolados, as concentrações inibitórias mínimas (CIMs) foram de: 8 a ? 16 µg/mL para micafungina, de 0,25 a 8 µg/mL para anfotericina B, ? 64 µg/mL para 5-fluorocitosina, de 16 a ? 64 µg/mL para fluconazol, de 1 a > 8 µg/mL para itraconazol, > 8 µg/mL para voriconazol; de 0,25 a 4 µg/mL para miconazol e de 0,031 a > 128 µg/mL para terbinafina. As interações resultantes da combinação de antifúngicos foram de: 100% de sinergismo entre anfotericina B x voriconazol e anfotericina B x itraconazol; 90% de sinergismo entre terbinafina x itraconazol; 80% de sinergismo entre terbinafina x voriconazol e 100% de sinergismo para a combinação de terbinafina x anfotericina B. As taxas de inibição de crescimento das hifas do isolado Rhizopus oryzae (LIF 1832) frente aos valores de CIMs obtidos pelo método de microdiluição em caldo foram: 88.25% para anfotericina B; 0% para itraconazol e 98,70% para terbinafina. O teste com a combinação de concentrações séricas de itraconazol e terbinafina resultaram em 49,8% de taxa de inibição. Conclusões: Foi observada divergência entre identificação morfológica e molecular para dois isolados. Perfis diferentes de sensibilidade aos antifúngicos foram observados dependendo das espécies. Os antifúngicos mais ativos contra a maioria dos isolados foram anfotericina B e itraconazol. Valores de CIM bem baixos para terbinafina foram observados para Cunninghamella bertholletiae e Syncephalastrum racemosum e todos os isolados foram altamente resistentes a micafungina, 5-fluorocitosina, fluconazol e voriconazol. Os testes de antifúngicos combinados mostraram redução da CIM dos antifúngicos em associação. CIMs elevadas para terbinafina foram observadas para os isolados de R. oryzae e R. stolonifer enquanto que no teste de combinação valores baixos de CIMs foram encontrados, o que ressalta a importância da combinação de antifúngicos no manejo de mucormicose. A taxa de inibição do crescimento das hifas para o isolado LIF 1832 frente aos antifúngicos isolados sugere que hifas podem ser mais suscetíveis que esporos frente aos antifúngicos avaliados. Apesar de não muito alta, a taxa de inibição de crescimento das hifas frente à anfotericina B e à combinação das concentrações séricas de terbinafina e itraconazol pode estar favoravelmente relacionada ao desfecho clínico do paciente em tratamento de mucormicose / Abstract: Introduction: Mucormycosis is an invasive opportunistic infection caused by filamentous fungi called Mucorales (formerly Zygomycetes), difficult to treat, and with poor prognosis in immunocompromised patients, characterized by rhino-cerebral, pulmonary or disseminated manifestations. Species of the genera Rhizopus, Mucor, Absidia (Lichtheimia) and Rhizomucor are the Mucorales most commonly isolated from patients and show resistance to voriconazole and echinocandins in vitro and in vivo. Therapy includes to reverse predisposing factors, surgical removal of the infected area and administration of antifungal agents, in general, Amphotericin B, with limited therapeutic activity and many side effects. Objectives: identification of selected Mucorales isolates by morphological and molecular methods; standardization of broth microdilution for antifungal susceptibility assessment of other Mucorales genera except Rhizopus to the alone antifungals: amphotericin B, fluorocytosine, fluconazole, Itraconazole, voriconazole ; miconazole and terbinafine; establish Fractional Inhibitory Concentration to determine the type of interaction that occurs between combinations of Amphotericin B/Itraconazole; Amphotericin B/Voriconazole; Terbinafine/Itraconazole; Terbinafine/Voriconazole and Terbinafine/Amphotericin B; standardization of the dynamic growth methodology for evaluation Rhizopus sp. and study of isolate Rhizopus oryzae (LIF 1832), for possible establishment of clinical-laboratory correlation this was isolated from a patient undergoing treatment for mucormycosis. Material and Methods: This study evaluated 10 clinical Mucorales isolates with previous morphological gender identification. The molecular identification was performed with primers ITS1/ITS4; ITS4/ITS5 and NL1/NL4. The antifungal susceptibility in vitro was performed by broth microdilution method (CLSI M38-A2). Antifungal combinations were analyzed according to the "chessboard" methodology . The dynamic evaluation of hyphal growth for the isolate Rhizopus oryzae (LIF 1832) for the antifungals amphotericin B, terbinafine and itraconazole, was carried through the BioCell-Tracer system. Results: The morphological and molecular identifications were discordant for LIF 1237 and LIF 1832 isolates, classified morphologically as Absidia (Lichtheimia) sp. and Rhizomucor sp. and after DNA sequencing both as Rhizopus oryzae. Considering all isolates, the minimum inhibitory concentrations (MICs) were 8 to ? 16 µg/mL for Micafungin; from 0.25 to 8 µg/mL for Amphotericin B , ? 64 µg/mL for 5 ¿ Fluorocytosine; of 16 to ? 64 µg/mL for Fluconazole; 1 to > 8 µg/mL for Itraconazole; > 8 µg/mL for Voriconazole ; 0.25 to 4 µg/mL for Miconazole and from 0.031 to > 128 µg/mL for Terbinafine. Interactions resulting from the combination of antifungals were: 100% synergism for Amphotericin B/Voriconazole and Amphotericin B/Itraconazole; 90% synergism between Terbinafine/Itraconazole; 80% synergism between Terbinafine/Voriconazole and 100% synergism for the combination Terbinafine/ Amphotericin B. The hyphae growth inhibition rates obtained for microdilution method MIC values for Rhizopus oryzae (LIF 1832) were 88.25%, for Amphotericin B; 0% for itraconazole and 98.70% to terbinafine. Combined Itraconazole and Terbinafine serum concentrations showed 49.8% of growth inhibition rate. Conclusions: Divergence between morphological and molecular identification for two isolates was observed. Different antifungal susceptibility profiles were observed depending on the species. The most active antifungal agents were Amphotericin B and Itraconazole. MICs for Terbinafine very low were observed to the Syncephalastrum racemosum and C.bertholletiae and all isolates were highly resistant to Micafungin, 5- Fluorocytosine, Fluconazole and Voriconazole. It was possible to observe antifungal MIC reduction in combined tests. MICs high for terbinafine alone were observerd to the Rhizopus oryzae and Rhizopus stolonifer while in the combo test low MIC values were observed, which highlights the importance of combining antifungal drugs in the management of mucormycosis. The hypha growth inhibition rates obtained for Rhizopus oryzae (LIF 1832) against antifungal isolates suggest that hyphae may be more susceptible to antifungal agents against spores. Although not too high, the hyphae growth inhibition rate obtained for the combination serum achievable concentrations of Terbinafine and Itraconazole can probably be related to the clinical outcome / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas