特比萘芬和伊曲康唑联合应用对暗色孢科真菌的体外药敏试验研究

目的本试验探讨特比萘芬和伊曲康唑单独及联合应用对54株暗色孢科真菌的体外相互作用。方法应用美国国家临床和实验室标准研究所(CLSI)的M38-A方案。菌悬液终浓度为(0.4～5)×106CFU/ml,孵育温度35℃,培养时间5～7d。各药单独和联合应用时的MIC值均为与生长对照孔相比100%生长抑制的最低药物浓度;药物间相互作用用分数抑菌浓度(FIC值)表示;FIC<1认为有协同作用,1≤FIC<2认为有相加作用,FIC=2认为无相关性,FIC>2认为有拮抗作用。结果单独用药时特比萘芬在紧密着色霉、裴氏着色霉、卡氏支孢霉和疣状瓶霉组中MIC的几何均数分别为0.198μg/ml,0.372μg/ml,0.215μg/ml,0.456μg/ml,伊曲康唑在紧密着色霉、裴氏着色霉、卡氏支孢霉和疣状瓶霉组中MIC的几何均数分别为0.232μg/ml,0.323μg/ml,0.186μg/ml和0.315μg/ml。体外联合用药时二者MIC几何均数低于其单独应用时的MIC值。在54株受试菌中,联合用药时协同作用为29.6%(16/54),相加作用为68.5%(37/54),拮抗作用为1.9%(1/54)。结论特比萘芬和伊曲康唑联合应用时表现以协同和相加作用为主,很少菌株表现拮抗现象。     

树突状细胞与马尔尼菲青霉酵母体外相互作用的研究

本文探讨了树突状细胞(DCs)在抗马尔尼菲青霉感染免疫中的作用。用细胞因子 rhGM-CSF 和rhIL-4诱导人外周血单核细胞分化为树突状细胞, 观察DCs的形态, 并用流式细胞仪进行DCs的表型测定, ELISA方法检测培养上清液IL-12p70的浓度, 混合淋巴细胞反应检测DCs刺激T淋巴细胞的增殖能力, 实时荧光定量PCR检测趋化因子受体CCR7、CXCR4的mRNA的表达。倒置显微镜下可见诱导获得的DCs细胞形态不规则, 表面伸展出大量树突。与马尔尼菲青霉酵母共同培养24 h后DCs的胞内含有大量的酵母细胞; 细胞表型CD86、CD83、HLA-DR和CD40的表达明显增高; 刺激T淋巴细胞增殖的能力增强; 趋化因子受体CCR7和CXCR4的mRNA表达量增加且能够产生IL-12p70但产生的量低于LPS刺激组。DCs能吞噬加热灭活的马尔尼菲青霉酵母, 并趋于成熟, 抗原呈递能力增加, 但是产生IL-12p70的量较低, 可能造成宿主抗马尔尼菲青霉酵母的细胞免疫功能的不足。     

小鼠巨噬细胞吞噬马尔尼菲青霉酵母相细胞的实验观察

目的探讨小鼠腹腔巨噬细胞对马尔尼菲青霉酵母相细胞的影响,为研究抗马尔尼菲青霉的免疫机制提供一定的实验依据。方法将马尔尼菲青霉酵母相细胞与小鼠腹腔巨噬细胞在体内和体外两种方式下进行共培养,分别于60min、120min、240min和360min后进行菌落形成单位(CFU)计数,统计分析体内组与体外组CFU数结果的差异性。利用钙荧光白染色巨噬细胞胞内的马尔尼菲青霉酵母相细胞,荧光显微镜下观察细胞形态特征的变化。结果经体内和体外两种方式共培养,两组之间的CFU计数差异无统计学意义,但两组内不同时间点的CFU计数差异存在统计学意义。荧光显微镜下可见巨噬细胞内的酵母细胞被钙荧光白染上淡蓝色荧光。结论小鼠腹腔巨噬细胞在体内、外对马尔尼菲青霉酵母相细胞不起明显的杀灭或溶解作用,其最大的吞噬时间为共培养240min。钙荧光白染色可快速有效的区分巨噬细胞与真菌,是一种良好的检测真菌方法。     

树突状细胞与马尔尼菲青霉酵母体外相互作用的研究

本文探讨了树突状细胞(DCs)在抗马尔尼菲青霉感染免疫中的作用.用细胞因子rhGM-CSF和rhIL-4诱导人外周血单核细胞分化为树突状细胞,观察DCs的形态,并用流式细胞仪进行DCs的表型测定,ELISA方法检测培养上清液IL-12p70的浓度,混合淋巴细胞反应检测DCs刺激T淋巴细胞的增殖能力.实时荧光定量PCR检测趋化因子受体CCR7、CXCR4的mRNA 的表达.倒置显微镜下可见诱导获得的DCs细胞形态不规则,表面伸展出大量树突.与马尔尼菲青霉酵母共同培养24 h后DCs的胞内含有大量的酵母细胞;细胞表型CD86、CD83、HLA-DR和CD40的表达明显增高;刺激T淋巴细胞增殖的能力增强;趋化因子受体CCR7和CXCR4的mRNA表达量增加且能够产生IL-12p70但产生的量低于LPS刺激组.DCs能吞噬加热灭活的马尔尼菲青霉酵母,并趋于成熟,抗原呈递能力增加,但是产生IL-12p70的量较低,可能造成宿主抗马尔尼菲青霉酵母的细胞免疫功能的不足.     

联合应用抗真菌药物对不同地区来源红色毛癣菌的体外敏感性实验

目的调查联合应用抗真菌药物对不同地区来源红色毛癣菌的体外抗真菌作用,探讨药物的体外相互作用及地区因素对红色毛癣菌药物敏感性的影响。方法以M38-A方案测定酮康唑、萘替芬、联合使用酮康唑萘替芬以及单用特比萘芬对红色毛癣菌的最小抑菌浓度(MIC),并计算了酮康唑与萘替芬的药物间抑菌浓度指数(FICI)。结果联合使用酮康唑萘替芬组的最小抑菌浓度显著低于单用酮康唑、萘替芬组,和单用特比萘芬组的疗效相似。北京的红色毛癣菌株对上述药物的敏感度均低于上海和南京的菌株。结论联合应用抗真菌药物优于单用,地区差异可能会影响红色毛癣菌对药物的敏感性。     

低氧对曲霉和假丝酵母体外两性霉素B、伊曲康唑和棘白素药敏试验的影响[英]／Warn PA…／／J Antimicrobial Chemother．

抗真菌药在体外和体内的效果有很大差异,可靠的体外药敏试验在对真菌病的用药是有帮助的。已知许多因素可影响真菌的最低抑菌浓度(MIC)测定,如培养基、菌悬液的浓度、试验方法的选择(多量稀释法或微量稀释法)和培养温度。作者研究了不同氧浓度对真菌体外药敏试验的影响。     

两性霉素B联合伊曲康唑或卡泊芬净治疗恶性血液病并发侵袭性真菌感染

目的观察两性霉素B联合伊曲康唑或卡泊芬净治疗恶性血液病患者并发侵袭性真菌感染(IFI)的临床疗效及安全性。方法收集我院联合治疗患者9例,对其疗效及毒副反应进行分析研究。结果9例患者7例有效,1例无效,1例停药。低钾是最常见的副反应,其他副反应包括畏寒、发热及肝、肾功能受损。结论两性霉素B联合伊曲康唑或卡泊芬净治疗IFI,经济、有效,患者依从性较好。     

米卡芬净对分离自中国的念珠菌和曲霉临床株体外抑菌活性的研究

目的了解新型抗真菌药物米卡芬净(micafungin,MFG)对分离自中国的念珠菌和曲霉临床株的体外抑菌活性。方法参照CLSI(Clinical and Laboratory Standards Institute,以前为NCCLS)制定的M27-A2和M38-A方案测定86株念珠菌和35株曲霉的最低抑菌浓度(MIC)或最低有效浓度(MEC)。结果MFG对大多数念珠菌属和曲霉属均有较好的抑菌作用。对念珠菌属的MIC90从高到低依次为:氟康唑(FLC)敏感的白念珠菌、热带念珠菌、光滑念珠菌为0.125μg/ml,FLC耐药和剂量依赖敏感株为0.25μg/ml,克柔念珠菌为0.5μg/ml,近平滑念珠菌8μg/ml,季也蒙念珠菌>16μg/ml。MFG对烟曲霉的MEC90为≤0.03μg/ml,对非烟曲霉的曲霉属MEC90为0.06μg/ml。MFG与唑类药物、两性霉素B(AMB)不存在交叉耐药,对FLC耐药的念珠菌、伊曲康唑耐药的曲霉、AMB不敏感的曲霉均有好的抑菌活性。结论MFG对多数念珠菌属和曲霉属(包括对唑类耐药和AMB不敏感的菌株)有较好的体外抑菌作用。     

两性霉素B脂质体、氟胞嘧啶和伊曲康唑联合治疗隐球菌性脑膜炎的临床回顾性研究

目的 观察两性霉素B脂质体、氟胞嘧啶和伊曲康唑联合治疗非AIDS、非器官移植隐球菌性脑膜炎患者的疗效和安全性,探讨非AIDS、非器官移植隐球菌性脑膜炎患者诱导治疗的新方案.方法 采用回顾性病例对照研究,18例非AIDS、非器官移植隐球菌性脑膜炎患者诱导期分别接受两性霉素B脂质体、氟胞嘧啶和伊曲康唑联合(研究组n=7)与两性霉素B、氟胞嘧啶和氟康唑联合治疗(对照组n=11).比较两组治疗方案在临床症状、体征变化、病死率、病原学转阴率、脑脊液改变等方面的差异及血常规、肝肾功能损害等不良反应发生情况.结果 治疗前研究组和对照组脑脊液新型隐球菌培养阳性分别为5例和8例(P =0.676),治疗1周后分别为5例和8例(P =0.676),治疗2周后分别为2例和4例(P =0.572),治疗3周后分别为0例和1例(P=0.611),治疗4周后,无死亡病例,两组脑脊液新型隐球菌培养均为阴性,脑脊液生化两组之间差异无统计学意义,对照组较研究组丙氨酸氨基转移酶(156.82±41.30 vs 97.00±22.02,P=0.003)、尿素氮(8.45±3.18 vs 5.54±1.28,P=0.020)升高更明显.结论 两性霉素B脂质体、氟胞嘧啶及伊曲康唑联合治疗非AIDS、非器官移植隐球菌性脑膜炎患者疗效确切,安全性较好,可以作为诱导期治疗的选择.     

卡泊芬净、米卡芬净对8种皮肤癣菌体外抑菌活性的研究

目的评价棘白菌素类抗真菌药物卡泊芬净（caspofungin）、米卡芬净（micafungin）针对常见致病性皮肤癣菌的体外抗菌活性。方法参考CLSI制定的M38-A2方案。测定82株常见皮肤癣菌的最低有效浓度（minimal effective concentrations,MECs）。结果按照MEC90浓度从高到低,米卡芬净对紫色毛癣菌和断发毛癣菌的MEC90是0.25μg/mL;对犬小孢子菌、疣状毛癣菌的MEC90为0.06μg/mL;对红色毛癣菌、须癣毛癣菌、石膏小孢子菌、絮状表皮癣菌的MEC90均在0.03μg/mL。②卡泊芬净对红色毛癣菌、紫色毛癣菌和断发毛癣菌的MEC90为1μg/mL;对须癣毛癣菌、犬小孢子菌、石膏小孢子菌、絮状表皮癣菌和疣状毛癣菌的MEC90为0.5μg/mL。③根据中位数检验,米卡芬净对几种皮肤癣菌的MEC值均低于卡泊芬净的MEC值,统计学比较有显著性差异（P〈0.05）。结论米卡芬净和卡泊芬净对皮肤癣菌有较强的抑菌作用,米卡芬净的MEC值低于卡泊芬净。     

伊曲康唑联合卡泊芬净或特比萘芬对球形孢子丝菌体外抑菌作用的研究

目的探讨伊曲康唑联合卡泊芬净或特比萘芬时对球形孢子丝菌酵母相和菌丝相的体外抑菌作用。方法参照标准的微量液基稀释法及棋盘微量稀释法对33株球形孢子丝菌行药敏试验,结果使用抑菌浓度指数(FICI)判定"协同""不相关"和"拮抗"。结果伊曲康唑与卡泊芬净联合对球形孢子丝菌酵母相菌株的协同率为93.94%(31/33),与特比萘芬联合的协同率为60.61%(20/33);伊曲康唑与卡泊芬净或特比萘芬联合对菌丝相菌株协同率分别为96.97%(32/33)、84.5%(28/33)。对所有受试菌株均未观察到上述药物的拮抗作用。结论体外联合药敏试验结果显示伊曲康唑与卡泊芬净或特比萘芬联合有较好的协同作用。     

In vitro activities of voriconazole, fluconazole, itraconazole and amphotericin B against non Candida albicans yeast isolates

Antifungal susceptibility testing was performed on 197 yeast isolates from the BCCM/IHEM biomedical fungi and yeasts collection (Belgian Co-ordinated Collections of Micro-organisms / IPH-Mycology) to study the in vitro activity of voriconazole against fluconazole, itraconazole and amphotericin B. MICs of the four antifungal agents were determined by an adapted NCCLS M27-A microdilution reference method. MIC readings were visually and spectrophotometrically determined. Optical density data were used for calculation of the MIC endpoints. For amphotericin B, the MIC endpoint was defined as the minimal antifungal concentration that exerts 90% inhibition, compared to the control growth. The azoles endpoints were determined at 50% inhibition of growth. The MIC distribution of voriconazole susceptibilities showed that 193 isolates had a MIC < or = 2 microg/ml and 185 a MIC < or = 1 microg/ml. Cross-tabulation of voriconazole, fluconazole, and itraconazole MICs indicated that voriconazole MICs raised with fluconazole and itraconazole MICs. The in vitro data obtained in this study suggest that voriconazole may also be effective treating yeast infection in patients infected with fluconazole or itraconazole resistant isolates.     

In vitro activity of amphotericin B cochleates against Leishmania chagasi

Cochleate delivery vehicles are a novel lipid-based system with potential for delivery of amphotericin B (AmB). In this study, the efficacy of cochleates was evaluated by examining the in vitro activity of AmB cochleates (CAMB) against Leishmania chagasi in a macrophage model of infection. We demonstrate that CAMB is nontoxic to macrophages at concentrations as high as 2.5 μg/mL, whereas the conventional formulation, AmB deoxycholate, showed high toxicity at this concentration. The in vitro activity of CAMB against L. chagasi was found to be similar to that of the reference drug AmB deoxycholate, with ED50s of 0.017 μg/mL and 0.021 μg/mL, respectively. Considering that L. chagasi affects organs amenable to cochleate-mediated delivery of AmB, we hypothesize that CAMB will be an effective lipid system for the treatment of visceral leishmaniasis.     

In vitro synergistic activity of diketopiperazines alone and in combination with amphotericin B or clotrimazole against Candida albicans

The synergistic anticandidal activity of three diketopiperazines [cyclo-(l-Pro-l-Leu) (1), cyclo-(d-Pro-l-Leu) (2), and cyclo-(d-Pro-l-Tyr) (3)] purified from a Bacillus sp. N strain associated with entomopathogenic nematode Rhabditis (Oscheius) in combination with amphotericin B and clotrimazole was investigated using the macrodilution method. The minimum inhibitory concentration and minimum fungicidal concentration of the diketopiperazines was compared with that of the standard antibiotics. The synergistic anticandidal activities of diketopiperazines with amphotericin B or clotrimazole were assessed using the checkerboard and time-kill methods. The results of the present study showed that the combined effects of diketopiperazines with amphotericin B or clotrimazole predominantly recorded synergistic (<0.5). Time-kill study showed that the growth of the Candida was completely attenuated after 12–24 h of treatment with 50:50 ratios of diketopiperazines and antibiotics. These results suggest that diketopiperazines combined with antibiotics may be microbiologically beneficial and not antagonistic. These findings have potential implications in delaying the development of resistance as the anticandidal effect is achieved with lower concentrations of both drugs (diketopiperazines and antibiotics). The cytotoxicity of diketopiperazines was also tested against two normal human cell lines (L231 lung epithelial and FS normal fibroblast) and no cytotoxicity was recorded for diketopiperazines up to 200 μg/mL. The in vitro synergistic activity of diketopiperazines with antibiotics against Candida albicans is reported here for the first time.     

两性霉素B和伏立康唑对临床真菌的体外抗菌活性分析

目的比较两性霉素B和伏立康唑对临床真菌的体外抗菌活性。方法用两性霉素B和伏立康唑的E-test条对分离自临床标本的116株真菌进行体外药敏试验,其中热带念珠菌15株,光滑念珠菌14株,近平滑念珠菌11株,克柔念珠菌6株,新生隐球菌8株,阿萨希毛孢子菌9株,烟曲霉29株,黄曲霉15株,黑曲霉1株,镰刀菌属7株,根霉属1株,以ATCC22019光滑念珠菌为质控菌株。结果两性霉素B对阿萨希毛孢子菌、镰刀菌、黄曲霉的MIC90均为64μg/ml,对其余受试菌株的MIC90均≤1μg/ml,伏立康唑对镰刀菌的MIC90为64μg/ml,对大部分受试菌株的MIC90均≤2μg/ml。结论除对某些真菌可能无效外,两性霉素B和伏立康唑可能适用于治疗大多数的真菌感染。     

Protein profiling of the dimorphic, pathogenic fungus, Penicillium marneffei

Background

Penicillium marneffei is a pathogenic fungus that afflicts immunocompromised individuals having lived or traveled in Southeast Asia. This species is unique in that it is the only dimorphic member of the genus. Dimorphism results from a process, termed phase transition, which is regulated by temperature of incubation. At room temperature, the fungus grows filamentously (mould phase), but at body temperature (37°C), a uninucleate yeast form develops that reproduces by fission. Formation of the yeast phase appears to be a requisite for pathogenicity. To date, no genes have been identified in P. marneffei that strictly induce mould-to-yeast phase conversion. In an effort to help identify potential gene products associated with morphogenesis, protein profiles were generated from the yeast and mould phases of P. marneffei.

Results

Whole cell proteins from the early stages of mould and yeast development in P. marneffei were resolved by two-dimensional gel electrophoresis. Selected proteins were recovered and sequenced by capillary-liquid chromatography-nanospray tandem mass spectrometry. Putative identifications were derived by searching available databases for homologous fungal sequences. Proteins found common to both mould and yeast phases included the signal transduction proteins cyclophilin and a RACK1-like ortholog, as well as those related to general metabolism, energy production, and protection from oxygen radicals. Many of the mould-specific proteins identified possessed similar functions. By comparison, proteins exhibiting increased expression during development of the parasitic yeast phase comprised those involved in heat-shock responses, general metabolism, and cell-wall biosynthesis, as well as a small GTPase that regulates nuclear membrane transport and mitotic processes in fungi. The cognate gene encoding the latter protein, designated RanA, was subsequently cloned and characterized. The P. marneffei RanA protein sequence, which contained the signature motif of Ran-GTPases, exhibited 90% homology to homologous Aspergillus proteins.

Conclusion

This study clearly demonstrates the utility of proteomic approaches to studying dimorphism in P. marneffei. Moreover, this strategy complements and extends current genetic methodologies directed towards understanding the molecular mechanisms of phase transition. Finally, the documented increased levels of RanA expression suggest that cellular development in this fungus involves additional signaling mechanisms than have been previously described in P. marneffei.     

In vitro activity of amphotericin B and anidulafungin against Candida spp. biofilms

Invasive infections caused by Candida spp. are increasing worldwide and are becoming an important cause of morbidity and mortality in immunocompromised patients. A large number of manifestations of candidiasis are associated with the formation of biofilms on inert or biological surfaces. Candida spp. biofilms are recalcitrant to treatment with conventional antifungal therapies. The aim of this study was dual 1) to determine the prevalence of biofilm producers among clinical isolates from catheter (16 C. albicans ) and blood culture (2 C. albicans and 30 C. tropicalis), and 2) to determine the activity of amphotericin B and anidulafungin against C. albicans and C. tropicalis biofilms of 24 and 48 hours of maturation. Biofilms were developed using a 96-well microtitre plate model and production and activity of antifungal agents against biofilms were determined by the tetrazolium (XTT) reduction assay. Of catheter and blood isolates, 62.5 and 56.25%, respectively, produced biofilms. By species, 68.42% of C. albicans and 53.33% of C. tropicalis were biofilm producers. C. albicans biofilms showed more resistance to amphotericin B and anidulafungin than their planktonic counterparts. Complete killing of biofilms was never achieved, even at the highest concentrations of the drugs tested. Anidulafungin displayed more activity than amphotericin B against C. albicans biofilms of 24 hours of maturation (GM MIC 0.354 vs. 0.686 microg/ml), but against C. tropicalis biofilms amphotericin B was more active (GM MIC 11.285 vs. 0.476 microg/ml). In contrast, against biofilms with 48 hours maturation, amphotericin B was more active against both species.     

马内菲青霉蛋白酶的体外诱导及其活性测定

目的 建立马内菲青霉蛋白酶的体外诱导方法并进行活性测定。方法 制作酶诱导培养基, 在不同pH 条件下培养马内菲青霉, 在280 nm紫外光下分光光度法检测不同诱导时间的蛋白酶活性。结果 成功诱导并定量测定了马内菲青霉在不同pH条件下、不同诱导时间的体外蛋白酶产出量。pH 4. 0 时, 菌株在第6 天出现分泌高峰; pH 5. 6 时, 菌株在第3 天出现分泌高峰; 而pH 7. 2 时, 菌株几乎无蛋白酶产出。结论 建立了马内菲青霉蛋白酶产出的体外诱导和检测方法, 为进一步研究马内菲青霉体外蛋白酶的理化特性提供了途径。