Spectrum of clinically significant melanized fungi in NIH hospitalized patients and their antifungal susceptibility profiles
Bibliographic record
Abstract
Melanized fungi have occasionally been identified as causative agents of severe phaeohyphomycoses, chromoblastomycosis, and mycetoma. In a retrospective study conducted from January 2012 to December 2022, a total of 133 melanized fungi were isolated from hospitalized patients at the NIH Clinical Center, both with and without known underlying predisposing factors. Isolate identification was based on phenotypic characteristics, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS), and PCR sequencing of the rDNA internal transcribed spacer (ITS) region. Members of the black yeast order Chaetothyriales were the most prevalent (40, 30%), predominantly Exophiala dermatitidis (30/40, 75%). Other major groups included: Capnodiales (30, 22.6%), Pleosporales (24, 18%), Mycosphaerellales (19, 14.3%), Calosphaeriales (8, 6%), and Venturiales (7, 5.3%). MALDI-ToF often failed to accurately identify the isolates, except for E. dermatitidis, which yielded scores ≥2. ITS sequencing was effective in accurately identifying the melanized fungi encountered in clinical settings. Antifungal susceptibility testing against eight antifungal agents showed that azoles, micafungin, and terbinafine exhibited in vitro activity against most isolates. In contrast, olorofim and amphotericin B were less effective. Notably, Phaeoacremonium species (Calosphaeriales) exhibited distinct antifungal susceptibility patterns. Accurate identification of melanized fungi in clinical laboratories is essential for selecting effective antifungal therapy, understanding susceptibility patterns to available agents, supporting epidemiological monitoring, and ultimately enhancing clinical outcomes in patients affected by these often complex and opportunistic infections.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".