{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:20:07Z","timestamp":1791958807908,"version":"4.3.4"},"reference-count":33,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2025,5,14]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Chromoblastomycosis, a fungal neglected tropical disease, is acquired through traumatic inoculation and is clinically characterized by a chronic granulomatous infection of the skin and subcutaneous tissue.\n                      <jats:italic toggle=\"yes\">Fonsecaea pedrosoi<\/jats:italic>\n                      is the most commonly reported etiologic agent globally. Itraconazole is considered first-line therapy, but successful treatment with terbinafine, voriconazole, and posaconazole has been reported.\n                      <jats:italic toggle=\"yes\">F. pedrosoi<\/jats:italic>\n                      minimum inhibitory concentration (MIC) data are limited, and epidemiological cutoffs (ECVs) are lacking; such data are important to help monitor antifungal resistance trends and guide initial antifungal selection. Thus, we performed antifungal susceptibility testing (AFST) on\n                      <jats:italic toggle=\"yes\">F. pedrosoi<\/jats:italic>\n                      isolates and determined the MIC distributions and ECVs. AFST on\n                      <jats:italic toggle=\"yes\">Fonsecaea pedrosoi<\/jats:italic>\n                      isolates was conducted at six laboratories from October 2023 to June 2024. Species identification was previously confirmed by DNA sequence analysis. AFST was performed by CLSI M38 standard broth microdilution method for itraconazole, voriconazole, posaconazole, isavuconazole, ketoconazole, terbinafine, flucytosine, and amphotericin B. The ECVs were established using the iterative statistical method with ECOFFinder (version 2.1) following CLSI M57 guidelines. We analyzed MIC results from 148\n                      <jats:italic toggle=\"yes\">Fonsecaea pedrosoi<\/jats:italic>\n                      isolates. The calculated ECVs were itraconazole, 0.5 \u00b5g\/mL; voriconazole, 0.5 \u00b5g\/mL; posaconazole, 0.5 \u00b5g\/mL; isavuconazole, 1 \u00b5g\/mL; ketoconazole, bimodal, no ECV determined; terbinafine, 0.25 \u00b5g\/mL; flucytosine, rejected; and amphotericin, 8 \u00b5g\/mL. These\n                      <jats:italic toggle=\"yes\">Fonsecaea pedrosoi<\/jats:italic>\n                      ECVs, obtained through a multicenter international effort, provide a baseline to better understand the\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      antifungal susceptibility profile of this species and monitor resistance. Clinicians and researchers can use these values to detect non-wild-type isolates with reduced susceptibility, reevaluate therapeutic options, and investigate potential clinical resistance if treatment failure occurs.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Chromoblastomycosis is a neglected tropical disease caused by an environmental, dematiaceous fungus. This fungal disease is acquired after a break in the skin that allows the fungus to enter, leading to a chronic infection in the skin and subcutaneous tissue. It is difficult to treat and often requires years of antifungal treatment.\n                        <jats:italic toggle=\"yes\">Fonsecaea pedrosoi<\/jats:italic>\n                        is the most reported causative agent globally. Limited antifungal susceptibility data exist for\n                        <jats:italic toggle=\"yes\">F. pedrosoi<\/jats:italic>\n                        making interpreting minimum inhibitory concentration (MIC) results difficult. We performed antifungal susceptibility testing on 148\n                        <jats:italic toggle=\"yes\">F<\/jats:italic>\n                        .\n                        <jats:italic toggle=\"yes\">pedrosoi<\/jats:italic>\n                        isolates to establish MIC distributions and epidemiologic cutoff values (ECVs) for eight antifungals, including those commonly used to treat chromoblastomycosis. The calculated ECVs for the commonly used antifungals itraconazole and terbinafine were 0.5 and 0.25 \u00b5g\/mL, respectively. ECVs can be helpful in choosing potential treatment options for\n                        <jats:italic toggle=\"yes\">F. pedrosoi<\/jats:italic>\n                        and monitoring antifungal resistance epidemiology.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/jcm.01903-24","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T11:55:09Z","timestamp":1743767709000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":9,"title":["Establishment of epidemiological cutoff values for\n                    <i>Fonsecaea pedrosoi<\/i>\n                    , the primary etiologic agent of chromoblastomycosis, and eight antifungal medications"],"prefix":"10.1128","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5707-528X","authenticated-orcid":true,"given":"Dallas J.","family":"Smith","sequence":"first","affiliation":[{"name":"Mycotic Diseases Branch, Centers for Disease Control and Prevention","place":["Atlanta, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia S. C.","family":"Melhem","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Mato Grosso do Sul","place":["Campo Grande, Brazil"]},{"name":"Tropical Medicine Institute, Medical School, University of S\u00e3o Paulo","place":["S\u00e3o Paulo, Brazil"]},{"name":"Mycology Unit, Parasitology and Mycology Department, S\u00e3o Paulo State University","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessy","family":"Dirven","sequence":"additional","affiliation":[{"name":"Westerdijk Fungal Biodiversity Institute","place":["Utrecht, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concei\u00e7\u00e3o Maria Pedrozo e Silva","family":"de Azevedo","sequence":"additional","affiliation":[{"name":"Post-graduation Program of Health Science, Federal University of Maranhao","place":["S\u00e3o Lu\u00eds, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirlei Garcia","family":"Marques","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio Cedro","place":["S\u00e3o Lu\u00eds, Brazil"]},{"name":"Department of Infectious Diseases and Infection Control, Universidade Federal do Maranh\u00e3o, EBSERH","place":["S\u00e3o Lu\u00eds, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna","family":"Jacomel Favoreto de Souza Lima","sequence":"additional","affiliation":[{"name":"Post-graduation Program of Microbiology, Parasitology and Pathology, Federal University of Parana","place":["Curitiba, Brazil"]},{"name":"Radboudumc\/CWZ Center of Expertise for Mycology","place":["Nijmegen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vania Aparecida","family":"Vicente","sequence":"additional","affiliation":[{"name":"Post-graduation Program of Microbiology, Parasitology and Pathology, Federal University of Parana","place":["Curitiba, Brazil"]},{"name":"Post-graduation Program of Engineering Bioprocess and Biotechnology, Federal University of Parana","place":["Curitiba, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria da Gl\u00f3ria","family":"Teixeira Sousa","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina FMUSP, Institute of Tropical Medicine, Universidade de Sao Paulo","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Venturini","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Mato Grosso do Sul","place":["Campo Grande, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2225-5122","authenticated-orcid":true,"given":"Nathan P.","family":"Wiederhold","sequence":"additional","affiliation":[{"name":"Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center","place":["San Antonio, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Seyedmousavi","sequence":"additional","affiliation":[{"name":"Microbiology Service, National Institutes of Health Clinical Center","place":["Bethesda, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe J.","family":"Dufresne","sequence":"additional","affiliation":[{"name":"Laboratoire de sant\u00e9 publique du Qu\u00e9bec, Institut National de Sant\u00e9 Publique du Qu\u00e9bec (INSPQ)","place":["Sainte-Anne-de-Bellevue, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5344-257X","authenticated-orcid":true,"given":"Sybren","family":"de Hoog","sequence":"additional","affiliation":[{"name":"Radboudumc\/CWZ Center of Expertise for Mycology","place":["Nijmegen, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4383-5994","authenticated-orcid":true,"given":"Shawn R.","family":"Lockhart","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Centers for Disease Control and Prevention","place":["Atlanta, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5622-1916","authenticated-orcid":true,"given":"Ferry","family":"Hagen","sequence":"additional","affiliation":[{"name":"Westerdijk Fungal Biodiversity Institute","place":["Utrecht, The Netherlands"]},{"name":"Department of Medical Microbiology, University Medical Center Utrecht","place":["Utrecht, The Netherlands"]},{"name":"Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam","place":["Amsterdam, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Wagner de C. L.","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Infection Control, Universidade Federal do Maranh\u00e3o, EBSERH","place":["S\u00e3o Lu\u00eds, Brazil"]},{"name":"Instituto D\u00b4Or de Pesquisa e Ensino, IDOR","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00032-16"},{"key":"e_1_3_3_3_2","unstructured":"World Health Organization. 2021. Ending the neglect to attain the sustainable development goals: a road map for neglected tropical diseases 2021\u20132030. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789240010352"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009611"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1439-0507.2001.00613.x"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1992.tb04252.x"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myac086"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.1996.tb15658.x"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad124"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1590\/s0036-46652005000600006"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3109\/09546630903585074"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/mmy.40.5.529.534"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1590\/s0036-46652010000600008"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkw325"},{"key":"e_1_3_3_15_2","unstructured":"U.S. Food and Drug Administration. 2016. FDA Drug Safety Communication: FDA warns that prescribing of Nizoral (ketoconazole) oral tablets for unapproved uses including skin and nail infections continues; linked to patient death. Available from: https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-fda-warns-prescribing-nizoral-ketoconazole-oral-tablets-unapproved"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-022-00720-1"},{"key":"e_1_3_3_17_2","volume-title":"Isolated from patients with chromoblastomycosis in Rio de Janeiro, Brazil. Reynolds TB","author":"Coelho RA","year":"2018","unstructured":"Coelho RA, Brito-Santos F, Figueiredo-Carvalho MHG, Gutierrez-Galhardo MC, Valle ACF, et al., editor. 2018. Molecular identification and antifungal susceptibility profiles of clinical strains of Fonsecaea spp. In Isolated from patients with chromoblastomycosis in Rio de Janeiro, Brazil. Reynolds TB. Vol. 12."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01655-09"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myz034"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.02127-23"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1439-0507.2004.00984.x"},{"key":"e_1_3_3_22_2","unstructured":"CLSI M57. 2024 Principles and procedures for the development ofepidemiological cutoff values for antifungal susceptibility testing. Available from: https:\/\/clsi.org\/standards\/products\/microbiology\/documents\/m57"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02416-16"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0012562"},{"key":"e_1_3_3_25_2","unstructured":"CLSI M38. 2024 Reference method for broth dilution antifungal susceptibility testing of filamentous fungi. Available from: https:\/\/clsi.org\/standards\/products\/microbiology\/documents\/m38"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.63049\/OHM.24.11.3"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/20499361231161387"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(90)70282-m"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-022-01091-2"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab444"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.8.3341-3346.2005"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.8.3147-3150.2004"},{"key":"e_1_3_3_33_2","unstructured":"CDC & FDA Antimicrobial Resistance Isolate Bank. Atlanta (GA): CDC. Accessed 26 July 2024"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2006.01377.x"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.01903-24","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.01903-24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T09:01:12Z","timestamp":1747213272000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/jcm.01903-24"}},"subtitle":[],"editor":[{"given":"Kimberly E.","family":"Hanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,14]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,14]]}},"alternative-id":["10.1128\/jcm.01903-24"],"URL":"https:\/\/doi.org\/10.1128\/jcm.01903-24","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,14]]},"assertion":[{"value":"2024-12-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e01903-24"}}