Antifungal resistance has increased rapidly in recent years. The invasive fungal infections caused by the resistant pathogenic fungi have become one of the important reasons resulting in death of patients. In this review, we briefly described the current status concerning defining criteria, epidemiology, resistant mechanisms and treating strategies for resistant fungi in China.

Proteases play an important role in fungal physiology and growth and in infection of pathogenic fungi as well. Fungal proteases may be involved in adhesion, colonization, spreading and escaping from the host immune response. Some proteases are considered as allergens, which can induce asthma and allergic diseases. Knowledge of the pathogenesis of the proteases will increase our understanding about the action of each fungal protease and will help to provide clues for the diagnosis and treatment of fungal infection.

Phaeohyphomycosis is a collection of superficial cutaneous, subcutaneous and(or) systemic infections caused by diverse dematiaceous fungi. The clinical records and clinical samples collected from a patient with a diagnosis of skin and subcutaneous phaeohyphomycosis progressed to disseminated phaeohyphomycosis were subjected to assays for potential genetic and immune defects that might associate with the infection. Two new compound heterozygous missense mutations on caspase recruitment domain-containing protein 9 gene (CARD9) (p.R35Q and p．E81K) were detected. Compared with the healthy donors, the proportions of Th1 and Th17 cells in the patient’s peripheral blood lymphocytes (PBLs) were low and the patient’s peripheral blood mononuclear cells (PBMCs) had impaired innate and adaptive immune responses against Phialophora verrucosa (P. verrucosa). The results indicated that CARD9 protein may play an important role in the pathogenesis of phaeohyphomycosis.

The purpose of the present study is to investigate the composition of intestinal Candida in community healthy population and emergency intensive care unit (EICU) patients. The stool or rectal swab samples were collected from 1 732 community healthy people in Shanghai between May 2014 and July 2014, and from 191 EICU patients in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between February 2014 and January 2015. After fungal culture, individual colonies were collected and further identified by amplifying and sequencing of internal transcribed spacers (ITSs). The composition characteristics of intestinal fungi in the two groups were analyzed by statistical method. The results demonstrated that, in the intestinal tract of community healthy population, 9 Candida species were detected. The Candida colonization rate of community healthy population was 13.16%, and the colonization rates of two or three Candida species were 3.81% and 0, respectively. While in the intestinal tract of EICU patients, only 5 Candida species were cultured. The Candida colonization rate of EICU patients was 37.17%, and the colonization rates of two or three Candida species were 9.95% and 2.09%, respectively. The positive rates of common intestinal Candida in community healthy population and EICU patients were Candida albicans (C. albicans) (5.25% vs. 27.23%), C. glabrata (5.83% vs. 13.61%), C. tropicalis (0.52% vs. 7.33%), C. parapsilosis (4.16% vs. 2.09%), C. metapsilosis (1.10% vs. 1.05%). It is concluded that the colonization rate of intestinal Candida in EICU patients is significantly higher than that in community healthy population (P<0.001). The colonization rates of two or three Candida species in EICU patients are also higher than those in community healthy population (P＝0.001, P<0.001). EICU patients have a higher colonization rate of intestinal Candida, to a certain extent, could increase the probability of Candida infection.

The present paper aims to retrospectively analyze the antimicrobial agent susceptibilities and clinical distributions of Enterococcus faecalis (E. faecalis) and E. faecium causing bloodstream infection in a tertiary hospital in Shanghai, and to lay a foundation for the clinical treatment of infections caused by these bacteria. The collected strains of E. faecalis and E. faecium were isolated between February 2012 and September 2016. The bacteria were identified by bioMérieux VITEK antimicrobial susceptibility testing system, and their clinical distribution and drug resistance were analyzed. Thirty E. faecalis and 17 E. faecium strains were obtained. E. faecalis strains were mainly from urology, gastroenterology and hematology departments, accounting for 13.33%, 16.67% and 10.00%, respectively. The resistance rates of E. faecalis to penicillin, ampicillin, ciprofloxacin, levofloxacin, tetracycline and erythromycin were 13.33%, 10.00%, 36.67%, 33.33%, 66.67% and 60.00%, respectively. The resistance rates of E. faecium to these antimicrobial agents were 88.24%, 82.35%, 88.24%, 76.47%, 23.53% and 70.59%, respectively. The resistance rates of E. faecium to penicillin, ampicillin, ciprofloxacin and levofloxacin were significantly higher than those of E. faecalis and the resistance rate to tetracycline was significantly lower than that of E. faecalis. Most of the E. faecium (29.41%) samples were from gastroenterology department. Both were sensitive to tigecycline, linezolid and vancomycin. However, the minimum inhibition concentration of vancomycin against E. faecium was significantly lower than that of E. faecalis. This study provided data support for the empirical treatment of infections caused by the two bacteria.

The present paper aims to investigate the relationship between human papillomavirus 16 (HPV16) infection in cervical diseases, and to provide scientific basis for prevention and treatment of cervical cancer. The proportion of HPV16 in different cervical diseases, the prevalence of HPV16 infection in the patients with cervical intraepithelial neoplasia (CIN) Ⅱ and higher diseases in different age groups, and the prevalence of simple and multiple infections of HPV were analyzed. A total of 1 057 patients infected with HPV were selected, and subjected to sub-typing for HPVs. The results revealed that 352 patients were HPV16 positive and the proportion of HPV16 detection was the highest in CIN Ⅲ group. The proportion of HPV16 positive was significantly different among varied cervical diseases (P<0.05) and it gradually increased along with the increased disease grade (P<0.05). There were significant differences in the prevalence of HPV16 infection in the patients with CIN Ⅱ and higher diseases among different age groups (P<0.05). The prevalence increased with the increased age (P<0.05). The prevalence of HPV16 infection in the patients with CIN Ⅱ and higher diseases was significant different between HPV simple and multiple infections (P<0.05). With types of HPV increasing, the prevalence showed a tendency of increase. The research indicates that there is certain relationship between HPV16 infection and high-grade cervical lesions. The older persons infected with HPV16 have the greater risks for cervical cancer. Taking the persistent infection of HPV16 into account, timely diagnosis and treatment for HPV infection could reduce the occurrence of high-grade CIN and cervical cancer.

Talaromyces marneffei (T. marneffei) infection in healthy subjects is rare. A case of osteolysis plus Sweet’s syndrome like lesions associated with T. marneffei infection was presented. The patient was human immunodeficiency virus (HIV) negative. The osteolysis caused by T. marneffei was detected first and Sweet’s syndrome like lesions were developed during antifungal treatment with amphotericin B and itraconazole. After the treatment with amphotericin B, itraconazole and glucocorticoids, the patient’s condition gradually improved.

Coccidioidomycosis, an infection caused by Coccidioides spp., is traditionally recognized as an endemic fungal disease mainly restricted in part of North America. However, imported cases in non-endemic areas are increasingly reported, indicating a paradigm shift on the epidemiology of coccidioidomycosis. The clinical manifestations of coccidioidomycosis vary significantly, ranging from mild self-limited upper respiratory infection to severe disseminated ones, leading a challenge for the diagnosis of the disease. Although China is not an endemic area of coccidioidomycosis, it is important for domestic healthcare providers to stay alert of the disease. This review aims to summarize the current advances in the epidemiology and clinical aspects of coccidioidomycosis.

Human cytomegalovirus (HCMV) is a common human pathogen with a high infection rate up to 40%-100% worldwide. Studies have shown that HCMV-infected patients are susceptible to cardiovascular and cerebrovascular diseases, in which atherosclerosis (AS) plays a crucial role in the pathological process of multiple cardiovascular and cerebrovascular diseases. Larger epidemiologic data also indicate the presence of HCMV DNA and antibody in atherosclerotic plaques and vessel walls. Meanwhile, meta analysis has been conducted to demonstrate HCMV infection is the risk factor of atherosclerosis, which implies HCMV may be associated with the formation and development of atherosclerosis. In this review, the contribution of HCMV to vascular pathology with particular focus on atherosclerosis is reviewed.

microRNAs (miRNAs) are a class of non-coding small RNAs with the length of about 22 nucleotides. More than 35 000 miRNAs have been found in plants, animals and viruses since its discovery in Caenorhabditis elegans in 1993. They participate in a variety of biological processes involved in cell differentiation, apoptosis, metabolism, signal transduction, immune responses, and act as critical transcription factors. miRNAs can be encoded both by viruses and host cells. Virus-encoded miRNAs can alter the internal environment of host, and host-encoded miRNAs also have effect on survival of virus. This article aims to review the functions of miRNAs in virus-host interactions.