51
|
Francis JR, Villanueva P, Bryant P, Blyth CC. Mucormycosis in Children: Review and Recommendations for Management. J Pediatric Infect Dis Soc 2018; 7:159-164. [PMID: 29294067 DOI: 10.1093/jpids/pix107] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/17/2017] [Indexed: 12/14/2022]
Abstract
Mucormycosis represents the third most common invasive fungal infection in children, and recent studies have suggested a rising incidence. Its case fatality rate is high, especially for neonates. Clinical presentation is influenced by underlying risk factors; associations with immunosuppression, neutropenia, diabetes, and prematurity have been described. It has been implicated in several hospital outbreaks. Diagnosis requires a high index of suspicion and evaluation with histopathology, culture, and, increasingly, molecular identification. Surgical debridement and antifungal therapies are the cornerstone for combatting invasive mucormycosis. However, the severity and relative rarity of this disease make comparative clinical trials for evaluating antifungal therapies in children difficult to conduct. Hence, therapeutic decisions are derived mainly from retrospective case series, in vitro data, and animal models. In this review, we summarize the literature on the epidemiology and diagnosis of this invasive fungal infection and provide suggestions on the management of mucormycosis in children.
Collapse
Affiliation(s)
- Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Paola Villanueva
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Penelope Bryant
- Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia
| | - Christopher C Blyth
- Department of Paediatric Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia.,School of Medicine, University of Western Australia, Perth.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth
| |
Collapse
|
52
|
Outbreak of Invasive Wound Mucormycosis in a Burn Unit Due to Multiple Strains of Mucor circinelloides f. circinelloides Resolved by Whole-Genome Sequencing. mBio 2018; 9:mBio.00573-18. [PMID: 29691339 PMCID: PMC5915733 DOI: 10.1128/mbio.00573-18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Mucorales are ubiquitous environmental molds responsible for mucormycosis in diabetic, immunocompromised, and severely burned patients. Small outbreaks of invasive wound mucormycosis (IWM) have already been reported in burn units without extensive microbiological investigations. We faced an outbreak of IWM in our center and investigated the clinical isolates with whole-genome sequencing (WGS) analysis. We analyzed M. circinelloides isolates from patients in our burn unit (BU1, Hôpital Saint-Louis, Paris, France) together with nonoutbreak isolates from Burn Unit 2 (BU2, Paris area) and from France over a 2-year period (2013 to 2015). A total of 21 isolates, including 14 isolates from six BU1 patients, were analyzed by whole-genome sequencing (WGS). Phylogenetic classification based on de novo assembly and assembly free approaches showed that the clinical isolates clustered in four highly divergent clades. Clade 1 contained at least one of the strains from the six epidemiologically linked BU1 patients. The clinical isolates were specific to each patient. Two patients were infected with more than two strains from different clades, suggesting that an environmental reservoir of clonally unrelated isolates was the source of contamination. Only two patients from BU1 shared one strain, which could correspond to direct transmission or contamination with the same environmental source. In conclusion, WGS of several isolates per patients coupled with precise epidemiological data revealed a complex situation combining potential cross-transmission between patients and multiple contaminations with a heterogeneous pool of strains from a cryptic environmental reservoir. Invasive wound mucormycosis (IWM) is a severe infection due to environmental molds belonging to the order Mucorales. Severely burned patients are particularly at risk for IWM. Here, we used whole-genome sequencing (WGS) analysis to resolve an outbreak of IWM due to Mucor circinelloides that occurred in our hospital (BU1). We sequenced 21 clinical isolates, including 14 from BU1 and 7 unrelated isolates, and compared them to the reference genome (1006PhL). This analysis revealed that the outbreak was mainly due to multiple strains that seemed patient specific, suggesting that the patients were more likely infected from a pool of diverse strains from the environment rather than from direct transmission among them. This study revealed the complexity of a Mucorales outbreak in the settings of IWM in burn patients, which has been highlighted based on WGS combined with careful sampling.
Collapse
|
53
|
Liu M, Bruni GO, Taylor CM, Zhang Z, Wang P. Comparative genome-wide analysis of extracellular small RNAs from the mucormycosis pathogen Rhizopus delemar. Sci Rep 2018; 8:5243. [PMID: 29588481 PMCID: PMC5869740 DOI: 10.1038/s41598-018-23611-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/16/2018] [Indexed: 12/17/2022] Open
Abstract
Rhizopus delemar is an emerging fungal pathogen causing devastating mucormycosis in immunocompromised individuals. The organism remains understudied and there are urgent needs for new methods of rapid disease diagnosis for timely therapy. Extracellular vesicles with encapsulated RNAs have recently been discovered to have great potential applications for disease diagnoses and treatments. To explore the utilization of ex-RNA in studies of mucormycosis, we have performed RNA-Seq of ex-sRNAs from two clinical strains of R. delemar. Approximately 3.3 and 3.2 million clean reads were obtained from FGSC-9543 and CDC-8219 strains, respectively. The median sequence length of the sRNAs was 22 nts, with a minimum of 18 and a maximum of 30 nts. Further annotation identified 560 and 526 miRNAs from FGSC-9543 and CDC-8219 strains, respectively. miRNA target prediction and analysis of GO and KEGG pathways have revealed that the regulation of metabolism, secondary metabolite biosynthesis, and two-component system signaling are important during growth. We have also validated RNA-Seq by qRT-PCR and Northern blotting analysis of randomly selected miRNAs. Our results show that R. delemar has a rich reservoir of secreted ex-sRNAs and our studies could facilitate the development of improved diagnostic methods as well as elucidating virulence mechanisms for R. delemar infection.
Collapse
Affiliation(s)
- Muxing Liu
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, Nanjing, China
| | - Gillian O Bruni
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA
| | - Christopher M Taylor
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA
| | - Zhengguang Zhang
- Department of Plant Pathology, College of Plant Protection, Nanjing Agricultural University, Nanjing, China
| | - Ping Wang
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA.
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, 70118, USA.
| |
Collapse
|
54
|
Fréalle E, Rocchi S, Bacus M, Bachelet H, Pasquesoone L, Tavernier B, Mathieu D, Millon L, Jeanne M. Real-time polymerase chain reaction detection of Lichtheimia species in bandages associated with cutaneous mucormycosis in burn patients. J Hosp Infect 2018; 99:68-74. [PMID: 29432820 DOI: 10.1016/j.jhin.2018.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cutaneous mucormycoses, mainly due to Lichtheimia (Absidia), have occurred on several occasions in the Burn Unit of the University Hospital of Lille, France. AIM To investigate the potential vector role of non-sterile bandages used to hold in place sterile gauze used for wound dressing. METHODS Mycological analysis by conventional culture, Mucorales real-time polymerase chain reaction (qPCR), and Lichtheimia species-specific qPCR were performed on eight crepe and six elasticized bandages that were sampled on two independent occasions in March 2014 and July 2016. Characteristics of the seven Lichtheimia mucormycoses which occurred in burn patients between November 2013 and July 2016 were also collected to assess the epidemiological relationship between potentially contaminated bandages and clinical infections. FINDINGS One Lichtheimia corymbifera strain was isolated from a crepe bandage by culture, and Lichtheimia spp. qPCR was positive in six out of eight crepe and four out of six elasticized bandages. Using species-specific qPCR, Lichtheimia ramosa, Lichtheimia ornata, and L. corymbifera were identified in six out of ten, five out of ten, and four out of ten bandages, respectively. In patients with mucormycosis, L. ramosa and L. ornata were present in five and two cases, respectively. CONCLUSION Our data support the utility of Mucorales qPCR for epidemiological investigations, the potential role of these bandages in cutaneous mucormycoses in burn patients in our centre, and, consequently, the need for sterile bandages for the dressing of extensive wounds.
Collapse
Affiliation(s)
- E Fréalle
- Université de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CNRS, UMR 8204, F-59000 Lille, France; Inserm, U1019, F-59000 Lille, France; CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France.
| | - S Rocchi
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Laboratoire de Parasitologie-Mycologie, CHU de Besançon, France
| | - M Bacus
- CHU Lille, Pôle d'Anesthésie-Réanimation, Centre de Traitement des Brûlés, F-59000 Lille, France
| | - H Bachelet
- CHU Lille, Pharmacie Centrale, F-59000 Lille, France
| | - L Pasquesoone
- CHU Lille, Service de chirurgie plastique, esthétique et reconstructrice - Centre de Traitement des Brûlés, F-59000 Lille, France
| | - B Tavernier
- CHU Lille, Pôle d'Anesthésie-Réanimation, Centre de Traitement des Brûlés, F-59000 Lille, France
| | - D Mathieu
- CHU Lille, Pôle de Réanimation, F-59000 Lille, France
| | - L Millon
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Laboratoire de Parasitologie-Mycologie, CHU de Besançon, France
| | - M Jeanne
- CHU Lille, Pôle d'Anesthésie-Réanimation, Centre de Traitement des Brûlés, F-59000 Lille, France
| |
Collapse
|
55
|
Westerling G, Davis M, Khuon D. Do donated linens put patients at risk for fungal infections during hospitalization? A pediatric case investigation and subsequently implemented process changes. Am J Infect Control 2018; 46:118-119. [PMID: 29174656 DOI: 10.1016/j.ajic.2017.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Daliya Khuon
- Pediatric Infectious Diseases, Helen DeVos Children's Hospital Infection Prevention, Grand Rapids, MI
| |
Collapse
|
56
|
Sivagnanam S, Sengupta DJ, Hoogestraat D, Jain R, Stednick Z, Fredricks DN, Hendrie P, Whimbey E, Podczervinski ST, Krantz EM, Duchin JS, Pergam SA. Seasonal clustering of sinopulmonary mucormycosis in patients with hematologic malignancies at a large comprehensive cancer center. Antimicrob Resist Infect Control 2017; 6:123. [PMID: 29225797 PMCID: PMC5718160 DOI: 10.1186/s13756-017-0282-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/23/2017] [Indexed: 12/22/2022] Open
Abstract
Background Invasive Mucorales infections (IMI) lead to significant morbidity and mortality in immunocompromised hosts. The role of season and climatic conditions in case clustering of IMI remain poorly understood. Methods Following detection of a cluster of sinopulmonary IMIs in patients with hematologic malignancies, we reviewed center-based medical records of all patients with IMIs and other invasive fungal infections (IFIs) between January of 2012 and August of 2015 to assess for case clustering in relation to seasonality. Results A cluster of 7 patients were identified with sinopulmonary IMIs (Rhizopus microsporus/azygosporus, 6; Rhizomucor pusillus, 1) during a 3 month period between June and August of 2014. All patients died or were discharged to hospice. The cluster was managed with institution of standardized posaconazole prophylaxis to high-risk patients and patient use of N-95 masks when outside of protected areas on the inpatient service. Review of an earlier study period identified 11 patients with IMIs of varying species over the preceding 29 months without evidence of clustering. There were 9 total IMIs in the later study period (12 month post-initial cluster) with 5 additional cases in the summer months, again suggesting seasonal clustering. Extensive environmental sampling did not reveal a source of mold. Using local climatological data abstracted from National Centers for Environmental Information the clusters appeared to be associated with high temperatures and low precipitation. Conclusions Sinopulmonary Mucorales clusters at our center had a seasonal variation which appeared to be related to temperature and precipitation. Given the significant mortality associated with IMIs, local climatic conditions may need to be considered when considering center specific fungal prevention and prophylaxis strategies for high-risk patients.
Collapse
Affiliation(s)
- Shobini Sivagnanam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, E4-100, Seattle, WA 98109 USA
| | - Dhruba J Sengupta
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, WA USA
| | - Daniel Hoogestraat
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, WA USA
| | - Rupali Jain
- Department of Pharmacy, University of Washington Medical Center, Seattle, WA USA
| | - Zach Stednick
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, E4-100, Seattle, WA 98109 USA
| | - David N Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, E4-100, Seattle, WA 98109 USA.,Clincial Research Division, Fred Hutchinson Cancer Res. Ctr, Seattle, WA USA.,Department of Medicine, University of Washington Medical Center, Seattle, WA USA
| | - Paul Hendrie
- Clincial Research Division, Fred Hutchinson Cancer Res. Ctr, Seattle, WA USA.,Department of Medicine, University of Washington Medical Center, Seattle, WA USA
| | - Estella Whimbey
- Department of Medicine, University of Washington Medical Center, Seattle, WA USA
| | | | - Elizabeth M Krantz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, E4-100, Seattle, WA 98109 USA
| | - Jeffrey S Duchin
- Public Health, Seattle and King County, Seattle, WA USA.,Department of Medicine, University of Washington Medical Center, Seattle, WA USA
| | - Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North, E4-100, Seattle, WA 98109 USA.,Clincial Research Division, Fred Hutchinson Cancer Res. Ctr, Seattle, WA USA.,Department of Medicine, University of Washington Medical Center, Seattle, WA USA.,Infection Prevention, Seattle Cancer Care Alliance, Seattle, WA USA
| |
Collapse
|
57
|
Heudorf U, Gasteyer S, Müller M, Serra N, Westphal T, Reinheimer C, Kempf V. Handling of laundry in nursing homes in Frankfurt am Main, Germany, 2016 - laundry and professional clothing as potential pathways of bacterial transfer. GMS HYGIENE AND INFECTION CONTROL 2017; 12:Doc20. [PMID: 29238652 PMCID: PMC5715555 DOI: 10.3205/dgkh000305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: In accordance with the German Infection Protection Act, the treatment and handling of laundry was checked by the Public Health Department in 2016 in all Frankfurt nursing homes with special focus on the staff's clothing. Methods: On-site visits and surveys were conducted in all 44 nursing homes in Frankfurt/Main, Germany, and random microbiological examinations of 58 reprocessed and 58 already worn protective gowns were performed to determine the numbers of the colony forming units (cfu) and microbiological differentiation of the pathogen species. Results: 41 (93%) of the 44 homes tested had contracted a certified laundry service. 23 (52%) of the homes also ran a laundry of their own; in 21 of these, laundry was reprocessed and disinfected in an industrial washing machine. Regular technical or microbiological tests were carried out in 16 or 12 of the home-owned laundries, respectively. Only 31 homes (70%) provided uniforms for their employees. The staff's clothing was processed in 25 homes by the external laundry, in 9 homes by the internal laundry, and in 12 homes, the nursing staff had to do this privately at their own home. Used coats exhibited significantly higher contamination than freshly prepared ones (median: 80 vs. 2 cfu/25 cm2; P 95 percentile: 256 cfu vs. 81 cfu/25 cm2). Clothing prepared in private homes showed significantly higher contamination rates than those washed in the certified external laundry or in the nursing homes themselves (Median: 16 cfu/25 cm2 vs. 0.5-1 cfu/25 cm2). Conclusion: Considering various publications on pathogen transfers and outbreaks due to contaminated laundry in medical facilities, the treatment of laundry, in particular the uniforms, must be given more attention, also in nursing homes for the elderly. The private reprocessing of occupational clothing by the employees at home must be rejected on hygienic principles, and is furthermore prohibited by law in Germany.
Collapse
Affiliation(s)
- Ursel Heudorf
- Public Health Department of the City of Frankfurt/Main, Germany
| | | | - Maria Müller
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Nicole Serra
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Tim Westphal
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Claudia Reinheimer
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Volkhard Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany
| |
Collapse
|
58
|
Benedict K, Richardson M, Vallabhaneni S, Jackson BR, Chiller T. Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks. THE LANCET. INFECTIOUS DISEASES 2017; 17:e403-e411. [PMID: 28774697 DOI: 10.1016/s1473-3099(17)30443-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/12/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022]
Abstract
Several high-profile outbreaks have drawn attention to invasive fungal infections (IFIs) as an increasingly important public health problem. IFI outbreaks are caused by many different fungal pathogens and are associated with numerous settings and sources. In the community, IFI outbreaks often occur among people without predisposing medical conditions and are frequently precipitated by environmental disruption. Health-care-associated IFI outbreaks have been linked to suboptimal hospital environmental conditions, transmission via health-care workers' hands, contaminated medical products, and transplantation of infected organs. Outbreak investigations provide important insights into the epidemiology of IFIs, uncover risk factors for infection, and identify opportunities for preventing similar events in the future. Well recognised challenges with IFI outbreak recognition, response, and prevention include the need for improved rapid diagnostic methods, the absence of routine surveillance for most IFIs, adherence to infection control practices, and health-care provider awareness. Additionally, IFI outbreak investigations have revealed several emerging issues, including new populations at risk because of travel or relocation, occupation, or immunosuppression; fungal pathogens appearing in geographical areas in which they have not been previously recognised; and contaminated compounded medications. This report highlights notable IFI outbreaks in the past decade, with an emphasis on these emerging challenges in the USA.
Collapse
Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Malcolm Richardson
- Mycology Reference Centre, University Hospital of South Manchester and University of Manchester, Manchester, UK
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
59
|
Lowe CD, Sainato RJ, Stagliano DR, Morgan MM, Green BP. Primary Cutaneous Mucormycosis in an Extremely Preterm Infant Successfully Treated with Liposomal Amphotericin B. Pediatr Dermatol 2017; 34:e116-e119. [PMID: 28523894 DOI: 10.1111/pde.13124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous mucormycosis is a rare but often fatal invasive fungal infection that occurs most commonly in patients with diabetes, malignancy, and other immunocompromising conditions. We report an extremely preterm (<28 weeks) baby boy who developed polymicrobial sepsis and primary cutaneous mucormycosis within his first 10 days of life. He was successfully treated with medical management alone since he was not a candidate for surgery. Successful treatment of cutaneous mucormycosis without surgical debridement has been reported on only two other occasions. This case highlights the importance of rapid and thorough evaluation of skin lesions when evaluating preterm infants and other immunocompromised patients, even when other sources of infection have been identified.
Collapse
Affiliation(s)
- Christopher D Lowe
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rebecca J Sainato
- Department of Pediatric Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - David R Stagliano
- Department of Pediatric Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Maribel M Morgan
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, Texas
| | - Brian P Green
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland
| |
Collapse
|
60
|
Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods Mol Biol 2017; 1508:17-65. [PMID: 27837497 DOI: 10.1007/978-1-4939-6515-1_2] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.
Collapse
Affiliation(s)
- David A Enoch
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK.
| | - Huina Yang
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Sani H Aliyu
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Christianne Micallef
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| |
Collapse
|
61
|
Openshaw JJ, Morris WM, Lowry GV, Nazmi A. Reduction in bacterial contamination of hospital textiles by a novel silver-based laundry treatment. Am J Infect Control 2016; 44:1705-1708. [PMID: 27561434 DOI: 10.1016/j.ajic.2016.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/19/2022]
Abstract
Treating hospital patient textiles with ionic silver after each washing results in a significant decrease in microbial contamination. Although further study is needed to better understand the role textiles play in hospital-acquired infections and to quantify the influence of silver textile treatment on health care-associated infection risk and patient outcomes, ionic silver treatment of textiles may prove useful in hospital-acquired infection reduction strategies.
Collapse
Affiliation(s)
- John J Openshaw
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA.
| | | | - Gregory V Lowry
- Civil & Environmental Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Aydin Nazmi
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA
| |
Collapse
|
62
|
|
63
|
Invasive Cutaneous Rhizopus Infections in an Immunocompromised Patient Population Associated with Hospital Laundry Carts. Infect Control Hosp Epidemiol 2016; 37:1251-3. [PMID: 27457379 DOI: 10.1017/ice.2016.157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
64
|
Heaton SM, Weintrob AC, Downing K, Keenan B, Aggarwal D, Shaikh F, Tribble DR, Wells J. Histopathological techniques for the diagnosis of combat-related invasive fungal wound infections. BMC Clin Pathol 2016; 16:11. [PMID: 27398067 PMCID: PMC4937573 DOI: 10.1186/s12907-016-0033-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective management of trauma-related invasive fungal wound infections (IFIs) depends on early diagnosis and timely initiation of treatment. We evaluated the utility of routine staining, histochemical stains and frozen section for fungal element identification. METHODS A total of 383 histopathological specimens collected from 66 combat-injured United States military personnel with IFIs were independently reviewed by two pathologists. Both periodic acid-Schiff (PAS) and Gomori methenamine silver (GMS) stains were used on 74 specimens. The performance of the two special stains was compared against the finding of fungal elements via any histopathological method (ie, special stains or hematoxylin and eosin). In addition, the findings from frozen sections were compared against permanent sections. RESULTS The GMS and PAS results were 84 % concordant (95 % confidence interval: 70 to 97 %). The false negative rate of fungal detection was 15 % for GMS and 44 % for PAS, suggesting that GMS was more sensitive; however, neither stain was statistically significantly superior for identifying fungal elements (p = 0.38). Moreover, 147 specimens had frozen sections performed, of which there was 87 % correlation with permanent sections (60 % sensitivity and 98 % specificity). In 27 permanent sections, corresponding cultures were available for comparison and 85 % concordance in general species identification was reported. CONCLUSIONS The use of both stains does not have an added benefit for identifying fungal elements. Furthermore, while the high specificity of frozen section may aid in timely IFI diagnoses, it should not be used as a stand-alone method to guide therapy due to its low sensitivity.
Collapse
Affiliation(s)
- Sarah M Heaton
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Amy C Weintrob
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA ; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Kevin Downing
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Bryan Keenan
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Deepak Aggarwal
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Justin Wells
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | | |
Collapse
|
65
|
Vijayakumar R, Saleh Al-Aboody M, Sandle T. A review of melanized (black) fungal contamination in pharmaceutical products-incidence, drug recall and control measures. J Appl Microbiol 2016; 120:831-41. [DOI: 10.1111/jam.12888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 12/17/2022]
Affiliation(s)
- R. Vijayakumar
- Department of Medical Laboratory; College of Science AlZulfi; Majmaah University; AlZulfi Saudi Arabia
| | - M. Saleh Al-Aboody
- Department of Medical Laboratory; College of Science AlZulfi; Majmaah University; AlZulfi Saudi Arabia
| | - T. Sandle
- Microbiology; Bio Products Laboratory; Elstree Hertfordshire UK
| |
Collapse
|
66
|
Douglas AP, Chen SCA, Slavin MA. Emerging infections caused by non-Aspergillus filamentous fungi. Clin Microbiol Infect 2016; 22:670-80. [PMID: 26812445 DOI: 10.1016/j.cmi.2016.01.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/02/2016] [Accepted: 01/09/2016] [Indexed: 12/25/2022]
Abstract
There are three broad groups of non-Aspergillus moulds: the mucormycetes, the hyalohyphomycetes and the phaeohyphomycetes. Infections with these pathogens are increasingly reported, particularly in the context of increasing use of immunosuppressant agents and improved diagnostics. The epidemiology of non-Aspergillus mould infections varies with geography, climate and level of immunosuppression. Skin and soft-tissue infections are the predominant presentation in the immunocompetent host and pulmonary and other invasive infections in the immunocompromised host. The more common non-Aspergillus moulds include Rhizopus, Mucor, Fusarium and Scedosporium species; however, other emerging pathogens are Rasamsonia and Verruconis species, which are discussed in this article. Outbreaks of non-Aspergillus mould infections have been increasingly reported, with contaminated medical supplies and natural disasters as common sources. Currently culture and other conventional diagnostic methods are the cornerstone of diagnosis. Molecular methods to directly detect and identify mould pathogens in tissue and body fluids are increasingly used.
Collapse
Affiliation(s)
- A P Douglas
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, University of Sydney, New South Wales, Australia
| | - M A Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
67
|
Disaster Risk Management. CIOTTONE'S DISASTER MEDICINE 2016. [PMCID: PMC7151855 DOI: 10.1016/b978-0-323-28665-7.00028-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
68
|
Cheng VCC, Chen JHK, Wong SCY, Leung SSM, So SYC, Lung DC, Lee WM, Trendell-Smith NJ, Chan WM, Ng D, To L, Lie AKW, Yuen KY. Hospital Outbreak of Pulmonary and Cutaneous Zygomycosis due to Contaminated Linen Items From Substandard Laundry. Clin Infect Dis 2015; 62:714-721. [DOI: 10.1093/cid/civ1006] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/01/2015] [Indexed: 01/02/2023] Open
|
69
|
Cutaneous Mucormycosis: Mycological, Clinical, and Therapeutic Aspects. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0236-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
70
|
Herriage T, Hooke MC, Streifel A, Slaker B. Utilization of an Intravenous Line Lifter Within a Pediatric Oncology Population. J Pediatr Oncol Nurs 2015. [PMID: 26219301 DOI: 10.1177/1043454215589922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Young children with cancer often have central lines. When ambulating during an intravenous infusion, their tubing drags on the hospital floor resulting in contamination of the exterior of the tubing. The tubing can then contaminate the children's linens, where central line procedures occur, increasing the risk of a central lineassociated blood stream infection. The purpose of this project was to evaluate the IV Line Lifter as a device to decrease contamination of the exterior of IV tubing. Baseline adenosine triphosphate bioluminescence testing was used on the exterior IV tubing to quantify organic matter as relative light units. The bioluminescence tests were performed on ambulatory, inpatient children with cancer ages 2 to 10 years, preimplementation (n = 29) and postimplementation (n = 18) of the IV Line Lifter. Relative light unit levels significantly decreased postimplementation (P < .001). Users of the device reported ease of ambulation when using the device and a willingness to use again. Results support the need for an IV Line Lifter to keep IV tubing off of the hospital floor, to ease ambulation, and decrease the risk of central line-associated blood stream infection.
Collapse
Affiliation(s)
- Teresa Herriage
- Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Mary C Hooke
- Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Andrew Streifel
- Department of Environmental Health and Safety, University of Minnestoa, Minneapolis, MN, USA
| | | |
Collapse
|
71
|
Davoudi S, Graviss LS, Kontoyiannis DP. Healthcare-associated outbreaks due to Mucorales and other uncommon fungi. Eur J Clin Invest 2015; 45:767-73. [PMID: 25989947 DOI: 10.1111/eci.12467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/16/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Healthcare-associated outbreaks of fungal infections, especially with uncommon and emerging fungi, have become more frequent in the past decade. MATERIALS AND METHOD Here, we reviewed the history and definition of healthcare-associated outbreaks of uncommon fungal infections and discussed the principles of investigating, containing and treatment of these outbreaks. RESULTS In case of these uncommon diseases, occurrence of two or more cases in a short period is considered as an outbreak. Contaminated medical devices and hospital environment are the major sources of these outbreaks. Care must be taken to differentiate a real infection from colonization or contamination. Defining and identifying cases, describing epidemiologic feature of cases, finding and controlling the source of the outbreak, treating patients, and managing asymptomatic exposed patients are main steps for outbreak elimination. These fungal outbreaks are not only difficult to detect but also hard to treat. Early initiation of appropriate antifungal therapy is strongly associated with improved outcomes in infected patients. Choice of antifungal drugs should be made based on spectrum, pharmacodynamic and pharmacokinetic characteristics and adverse effects of available drugs. Combination antifungal therapy and surgical intervention may be also helpful in selected cases. CONCLUSIONS A multidisciplinary approach and close collaboration between all key partners are necessary for successful control of fungal outbreaks.
Collapse
Affiliation(s)
- Setareh Davoudi
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Linda S Graviss
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
72
|
Healthcare Laundry and Textiles in the United States: Review and Commentary on Contemporary Infection Prevention Issues. Infect Control Hosp Epidemiol 2015; 36:1073-88. [PMID: 26082994 DOI: 10.1017/ice.2015.135] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Healthcare professionals have questions about the infection prevention effectiveness of contemporary laundry processes for healthcare textiles (HCTs). Current industrial laundry processes achieve microbial reductions via physical, chemical, and thermal actions, all of which result in producing hygienically clean HCTs. European researchers have demonstrated that oxidative laundry additives have sufficient potency to meet US Environmental Protection Agency benchmarks for sanitizers and disinfectants. Outbreaks of infectious diseases associated with laundered HCTs are extremely rare; only 12 such outbreaks have been reported worldwide in the past 43 years. Root cause analyses have identified inadvertent exposure of clean HCTs to environmental contamination (including but not limited to exposure to dust in storage areas) or a process failure during laundering. To date, patient-to-patient transmission of infection has not been associated with hygienically clean HCTs laundered in accordance with industry process standards. Occupationally acquired infection involved mishandling of soiled HCTs and failure to use personal protective equipment properly. Laboratory studies of antimicrobial treatments for HCTs demonstrate a wide range of activity from 1 to 7 log10 reduction of pathogens under various experimental conditions. Clinical studies are needed to evaluate potential use of these treatments for infection prevention. Microbiological testing of clean HCTs for certification purposes is now available in the United States. Key features (eg, microbial sampling strategy, numbers of textiles sampled) and justification of the testing are discussed.
Collapse
|
73
|
Affiliation(s)
- Anastasia P. Litvintseva
- Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Mary E. Brandt
- Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rajal K. Mody
- Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shawn R. Lockhart
- Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
74
|
McClusky J, Davis M, Dahl K. A gap in patient tape storage and use practices puts patients at risk for cutaneous fungal infections. Am J Infect Control 2015; 43:182-4. [PMID: 25530556 DOI: 10.1016/j.ajic.2014.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/27/2022]
Abstract
We report a case of a cutaneous fungal infection in a 12-year-old oncology patient related to patient tape. Our facility had no established guidelines for patient tape. A survey conducted of multiple local healthcare facilities revealed no existing policies or standards of care related to tape storage or use. This reveals a gap in practice. We call for formal recommendations for tape storage and use to enhance patient safety.
Collapse
Affiliation(s)
- Jessica McClusky
- Department of Infection Control and Prevention, Helen DeVos Children's Hospital, Grand Rapids, MI.
| | - Mallory Davis
- Department of Infection Control and Prevention, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Karen Dahl
- Children's Hospital of Central California, Fresno, CA
| |
Collapse
|
75
|
Abstract
Developmental dysplasia of the hip (DDH) is a common paediatric orthopaedic problem. There are various options for treatment dependent on the age and presentation. In closed and open reduction of DDH, we use a hip spica cast for immobilisation after the procedure. We present an unusual case of fungal growth on a hip spica. A 7-month-old girl presented to our institution with clusters of yellowish-white outgrowths resembling mushrooms from her spica. To the best of our knowledge, this is the first reported case of fungal growth on a hip spica following DDH treatment. It is of utmost importance to be aware of any growth on a hip spica, as this requires a prompt change of spica to avoid further complications. We recommend that the integrity of the spica and the skin be checked at regular intervals in patients with a hip spica.
Collapse
Affiliation(s)
- Yuen Chan
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Veenesh Selvaratnam
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Neeraj Garg
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
76
|
Fungi associated with drug recalls and rare disease outbreaks. ACTA ACUST UNITED AC 2014; 41:1591-7. [DOI: 10.1007/s10295-014-1503-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
Abstract
Fungi rarely cause disease outbreaks associated with use of microbe-contaminated drugs. These rare episodes typically involve a restricted spectrum of common environmental species with relatively low virulence, rather than classical pathogens. Review of data involving over-the-counter contact lens solutions and prescription drug-related recalls revealed six episodes during the past decade with significant adverse health and financial impact (including loss of vision and death). Contaminations involved fungi mostly identified with the genera Aspergillus, Exserohilum, Fusarium, Paecilomyces, and Rhizopus. These organisms are noted for their capacity to produce resistant morphotypes (chlamydoconidia, ascospores) under various adverse conditions, generally with temperature survival/tolerances markedly in excess of maximal growth temperatures. High constituent levels of melanin, trehalose and heat-shock proteins facilitate differential survival of morphotypes following exposures to toxic chemicals and temperatures above 80 °C. Adverse environmental factors that induce resistant morphotypes are suggested to occur more readily in situ than during in vitro testing. Rare unexplained, sporadic drug contamination episodes with select thermotolerant fungi may relate, in part, to resistant dormant stages.
Collapse
|