The evaluation of MALDI-TOF and conventional methods for the identification of Trichosporon species isolated from onychomycosis infection: Comparison of the MALDI-TOF and conventional methods

Rabiye Altınbaş; Hafize Sav

doi:10.5281/zenodo.7723129

Authors

Rabiye Altınbaş Dr. Ersin Arslan Training and Research Hospital, Department of Mycology, Gaziantep, Turkey https://orcid.org/0000-0003-2535-0480
Hafize Sav Kayseri City Hospital, Department of Mycology, Kayseri, Turkey https://orcid.org/0000-0001-8435-396X

DOI:

https://doi.org/10.5281/zenodo.7723129

Keywords:

MALDI-TOF, Onychomycosis, Trichosporon species, yeast identification

Abstract

Objective: Onychomycosis is one of the most common nail diseases and accounts for approximately half of all nail abnormalities. It has been noted that yeast-like microorganisms of the genus Trichosporon, which are the cause of uncommon but medically important infections, have increased in recent years as fungal agents causing onychomycosis. In this study, it was aimed to evaluate the MALDI-TOF MS and conventional methods used for identification of Trichosporon species isolated from nail samples.

Methods: The Cerrahpasa Medical Faculty Mycology Laboratory nail sample records of two years were retrospectively reviewed. The performance of conventional methods (morphological and biochemical identification by API 20C AUX), and MALDI-TOF MS method was compared for identification performance at the species level.

Results: The gender distribution of the patients with Trichosporon isolated samples was found as 67% female and 33% male. The anatomical region involvement was 97% toenail and 3% fingernail. Direct microscopy with KOH was found to be positive in 73% of nail samples. Identification performance at the species level of the MALDI-TOF MS method was found higher than the conventional method. 100% of the 33 non-Candida yeasts were defined as Trichosporon spp. with both methods. Among those, 58% were identified at the species level by conventional method and 85% by MALDI-TOF MS method. Non-Candida yeast distribution of 33 isolates by the API 20C AUX method was 40% T. asahii, 12% T. mucoides, 6% T. inkin and it was 40% T. asahii, 30% T. mucoides, 9% T. inkin, 6% Trichosporon debeurmannianum by the MALDI-TOF MS method.

Conclusion: The MALDI-TOF MS method was found to be superior to the conventional method in Trichosporon species identification.

References

Gupta AK, Stec N, Summerbell RC, Shear NH, Piguet V, Tosti A, et al. Onychomycosis: a review. J Eur Acad Dermatol Venereol. 2020;34(9):1972-90.

Colombo AL, Padovan AC, Chaves GM. Current knowledge of Trichosporon spp. and Trichosporonosis. Clin Microbiol Rev. 2011;24:682-700.

Liu XZ, Wang QM, Göker M, Groenewald M, Kachalkin AV, Lumbsch HT, et al. Towards an integrated phylogenetic classification of the Tremellomycetes. Stud Mycol. 2015;81:85-147.

Guo LN, Yu SY, Hsueh PR, Al-Hatmi AMS, Meis JF, Hagen F, et al. Invasive Infections Due to Trichosporon: Species Distribution, Genotyping, and Antifungal Susceptibilities from a Multicenter Study in China. J Clin Microbiol. 2019;57:e01505-18.

Francisco EC, de Almeida Junior JN, de Queiroz Telles F, Aquino VR, Mendes AVA, de Andrade Barberino MGM, et al. Species distribution and antifungal susceptibility of 358 Trichosporon clinical isolates collected in 24 medical centres. Clin Microbiol Infect. 2019;25:909.e1-909.e5.

de Hoog GS, Guarro J, Gené J, Ahmed S, Al-Hatmi AMS, Figueras MJ, et al. Atlas of clinical fungi (2019). http://www.clinicalfungi.org.

Martínez-Herrera E, Duarte-Escalante E, Reyes-Montes MDR, Arenas R, Acosta-Altamirano G, Moreno-Coutiño G, et al. Molecular identification of yeasts from the order Trichosporonales causing superficial infections. Rev Iberoam Micol. 2021;38(3):119-24.

Kolecka A, Khayhan K, Groenewald M, Theelen B, Arabatziis M, Velegraki A, et al. Identification of medically relevant species of arthroconidial yeasts by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2013;51:2491-500.

Taj-Aldeen SJ, Al-Ansari N, Shafei SE, Meis JF, Curfs-Breuker I, Theelen B, et al. Molecular identification and susceptibility of Trichosporon species isolated from clinical specimens in Qatar: isolation of Trichosporon dohaense, J Clin Microbiol. 2009;47:1791–99.

de Almeida Junior JN, Figueiredo DSY, Toubas D, Del Negro GMB, Motta AL, Rossi F, et al. Usefulness of matrix assisted laser desorption ionisation-time-of-flight mass spectrometry for identifying clinical Trichosporon isolates. Clin Microbiol Infect. 2014:20;784–90.

Van Belkum A, Chatellier S, Girard V, Pincus D, Deol P, Dunne M. Progress in proteomics for clinical microbiology: MALDI-TOF MS for microbial species identification and more. Expert Rev Proteomics. 2015;12:595–605.

Thomas J, Jacobson GA, Narkowicz CK, Peterson GM, Burnet H, Sharpe C. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther. 2010;35(5):497-519.

Larone DH, editor. Medically important fungi. 6th ed. Washing-ton: American Society for Microbiology; 2018.

Walsh TJ, Groll A, Hiemenz J, Fleming R, Roilides E, Anaissie E. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect. 2004;10 (1):48 –66.

Ortega-Springall MF, Arroyo-Escalante S, Arenas R. Onycholysis and Chromonychia: A Case Caused by Trichosporon inkin. Skin Appendage Disord. 2016;1(3):144-6.

de Magalhães AR, Nishikawa MM, de Mondino SSB, de Macedo HW, da Silva da Rocha EM, de Souza Baptista AR. Trichosporon isolation from human ungueal infections: is there a pathogenic role? An Bras Dermatol. 2016;91(2):173-9.

Araújo AJG, Bastos OMP, Souza MAJ, de Oliveira JC. Onychomycosis caused by emergent fungi: clinical analysis, diagnosis and revision. An Bras Dermatol. 2003;78(4):445-55.

Han MH, Choi JH, Sung KJ, Moon KC, Koh JK. Onychomycosis and Trichosporon beigelii in Korea. Int J Dermatol. 2000;39(4):266–69.

Gunduz T, Metin DY, Sacar T, Hilmioğlu S, Baydur H, İnci R, et al. Onychomycosis in primary school children: association with socioeconomic conditions. Mycoses. 2006;49:431.

Manzano-Gayosso P, Méndez-Tovar LJ, Arenas R, Hernández-Hernández F, Millán-Chiu B, Torres-Rodríguez JM, et al. Onychomycosis-causing yeasts in four Mexican dermatology centers and their antifungal susceptibility to azolic compounds. Rev Iberoam Micol. 2011;28:32–5.

Méndez-Tovar LJ, Anides-Fonseca A, Vázquez-Hernández A, Galindo-González M, Díaz-Madrid M, Berdón-Castro A, et al. Micosis among five highly underprivileged Mexican communities. Gac Med Méx 2006;142:381–86.

Relloso S, Arechavala A, Guelfand L, Maldonado I, Walker L, Iris Agorio I. Onychomycosis: multicentre epidemiological, clinical and mycological study. Rev Iberoam Micol. 2012;29:157–63.

Cengiz FP, Cemil BC, Emiroglu N, Bahali AG, Ozkaya DB, Su O, et al. Etiology of Onychomycosis in Patients in Turkey. J Am Podiatr Med Assoc. 2018;108(3):253-56.

Guo LN, Yu SY, Hsueh PR, Al-Hatmi AMS, Meis JF, Hagen F, et al. Invasive Infections Due to Trichosporon: Species Distribution, Genotyping, and Antifungal Susceptibilities from a Multicenter Study in China Journal of Clinical Microbiology. 2019;57(2):e01505-18.

Yenişehirli G, Bulut Y, Sezer E, Günday E. Onychomycosis infections in the Middle Black Sea Region, Turkey. Int J Dermatol. 2009;48(9):956-9.

Gupta M, Sharma NL, Kanga AK, Mahajan VK, Tegta GR. Onychomycosis: Clinico-mycologic study of 130 patients from Himachal Pradesh, India. Indian J Dermatol Venereol Leprol. 2007;73(6):389-92.

Francisco EC, de Almeida Junior JN, de Queiroz Telles F, Aquino VR, Mendes AVA, de Andrade Barberino MGM, et al. Species distribution and antifungal susceptibility of Trichosporon clinical isolates collected in 24 medical centres. Clin Microbiol Infect. 2019;25:909.e1-909.e5.

Aslani N, Janbabaei G, Abastabar M, Meis JF, Babaeian M, Khodavaisy S, et al. Identification of uncommon oral yeasts from cancer patients by MALDI-TOF mass spectrometry. BMC Infect Dis. 2018;18(1):24.

Dhiman N, Hall L, Wohlfiel SL, Buckwalter SP, Wengenack NL. Performance and cost analysis of matrix-assisted laser desorption ionization-time of flight mass spectrometry for routine identification of yeast. J Clin Microbiol. 2011;49:1614-6.