51
|
Sprute R, Salmanton-García J, Sal E, Malaj X, Ráčil Z, Ruiz de Alegría Puig C, Falces-Romero I, Barać A, Desoubeaux G, Kindo AJ, Morris AJ, Pelletier R, Steinmann J, Thompson GR, Cornely OA, Seidel D, Stemler J. Invasive infections with Purpureocillium lilacinum: clinical characteristics and outcome of 101 cases from FungiScope® and the literature. J Antimicrob Chemother 2021; 76:1593-1603. [PMID: 33599275 PMCID: PMC8120338 DOI: 10.1093/jac/dkab039] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/25/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To provide a basis for clinical management decisions in Purpureocillium lilacinum infection. METHODS Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed. RESULTS We identified 101 cases with invasive P. lilacinum infection. Main predisposing factors were haematological and oncological diseases in 31 cases (30.7%), steroid treatment in 27 cases (26.7%), solid organ transplant in 26 cases (25.7%), and diabetes mellitus in 19 cases (18.8%). The most prevalent infection sites were skin (n = 37/101, 36.6%) and lungs (n = 26/101, 25.7%). Dissemination occurred in 22 cases (21.8%). Pain and fever were the most frequent symptoms (n = 40/101, 39.6% and n = 34/101, 33.7%, respectively). Diagnosis was established by culture in 98 cases (97.0%). P. lilacinum caused breakthrough infection in 10 patients (9.9%). Clinical isolates were frequently resistant to amphotericin B, whereas posaconazole and voriconazole showed good in vitro activity. Susceptibility to echinocandins varied considerably. Systemic antifungal treatment was administered in 90 patients (89.1%). Frequently employed antifungals were voriconazole in 51 (56.7%) and itraconazole in 26 patients (28.9%). Amphotericin B treatment was significantly associated with high mortality rates (n = 13/33, 39.4%, P = <0.001). Overall mortality was 21.8% (n = 22/101) and death was attributed to P. lilacinum infection in 45.5% (n = 10/22). CONCLUSIONS P. lilacinum mainly presents as soft-tissue, pulmonary or disseminated infection in immunocompromised patients. Owing to intrinsic resistance, accurate species identification and susceptibility testing are vital. Outcome is better in patients treated with triazoles compared with amphotericin B formulations.
Collapse
Affiliation(s)
- Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Ertan Sal
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Xhorxha Malaj
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Zdeněk Ráčil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- Charles University, First Faculty of Medicine, Institute of Clinical and Experimental Hematology, Prague, Czech Republic
| | | | - Iker Falces-Romero
- Clinical Microbiology and Parasitology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Aleksandra Barać
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Guillaume Desoubeaux
- Department of Parasitology-Mycology-Tropical Medicine, Tours University hospital, France
| | - Anupma Jyoti Kindo
- Department of Microbiology, SriRamachandra Institute of Higher Education and Research, Chennai, India
| | - Arthur J Morris
- Clinical Microbiology Laboratory, LabPLUS, Auckland City Hospital, Auckland, 1023, New Zealand
| | - René Pelletier
- Laboratoire de Microbiologie, L'Hôtel-Dieu de Québec du Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Joerg Steinmann
- Institute for Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Nuremberg Hospital, Nuremberg, Germany
| | - George R Thompson
- Department of Internal Medicine Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
- Department of Medical Microbiology and Immunology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine, and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany
| | - Danila Seidel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jannik Stemler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | | |
Collapse
|
52
|
Tschopp J, Perentes JY, Beigelman-Aubry C, Berezowska S, Lovis A, Spertini O, Bochud PY, Lamoth F. Invasive Hormographiella aspergillata infection in patients with acute myeloid leukemia: Report of two cases successfully treated and review of the literature. Med Mycol Case Rep 2021; 32:68-72. [PMID: 33996425 PMCID: PMC8095099 DOI: 10.1016/j.mmcr.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022] Open
Abstract
Hormographiella aspergillata is a rare cause of invasive mold infection, mostly described in patients with hematological malignancies. We describe two cases of invasive H. aspergillata infections in patients with acute myeloid leukemia, successfully managed with complete surgical resection of the lesions and antifungal therapy of voriconazole alone or liposomal amphotericin B, followed by voriconazole, highlighting the key role of a multidisciplinary approach for the treatment of this rare and severe invasive mold infection.
Collapse
Affiliation(s)
- Jonathan Tschopp
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Jean Yannis Perentes
- Department of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Sabina Berezowska
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Alban Lovis
- Department of Pulmonology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Olivier Spertini
- Department of Hematology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland.,Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| |
Collapse
|
53
|
Breakthrough Mucormycosis Developing on Mucorales-Active Antifungals Portrays a Poor Prognosis in Patients with Hematologic Cancer. J Fungi (Basel) 2021; 7:jof7030217. [PMID: 33802827 PMCID: PMC8002622 DOI: 10.3390/jof7030217] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 01/15/2023] Open
Abstract
Although breakthrough mucormycosis (BT-MCR) is known to develop on mold-active antifungals without Mucorales activity, it can also occur while on Mucorales-active antifungals. Herein, we retrospectively compared the characteristics and outcomes of patients with hematologic malignancies (HMs) or hematopoietic stem cell transplant (HSCT) who developed BT-MCR on mold-active antifungals with or without Mucorales activity. Of the patients developing BT-MCR, 16 were on Mucorales-active antifungals (9 isavuconazole, 6 posaconazole, 1 amphotericin B), and 87 were on other mold-active agents (52 voriconazole, 22 echinocandins, 8 itraconazole, 5 echinocandin + voriconazole). Both groups were largely comparable in clinical characteristics. Patients developing BT-MCR while on Mucorales-active antifungals had higher 42-day mortality, from either symptom onset (63% versus 25%, p = 0.006) or treatment initiation (69% versus 39%, p = 0.028). In multivariate Cox regression analysis, exposure to Mucorales-active antifungals prior to BT-MCR had a hazard ratio of 2.40 (p = 0.015) for 42-day mortality from treatment initiation and 4.63 (p < 0.001) for 42-day mortality from symptom onset. Intensive care unit (ICU) admission and APACHE II score at diagnosis, non-recovered severe neutropenia, active HM, and amphotericin B/caspofungin combination treatment were additional independent predictors of 42-day mortality. In summary, BT-MCR on Mucorales-active antifungals portrays poor prognosis in HM/HSCT patients. Moreover, improvements in early diagnosis and treatment are urgently needed in these patients.
Collapse
|
54
|
Dadwal SS, Hohl TM, Fisher CE, Boeckh M, Papanicolaou G, Carpenter PA, Fisher BT, Slavin MA, Kontoyiannis DP. American Society of Transplantation and Cellular Therapy Series, 2: Management and Prevention of Aspergillosis in Hematopoietic Cell Transplantation Recipients. Transplant Cell Ther 2021; 27:201-211. [PMID: 33781516 PMCID: PMC9088165 DOI: 10.1016/j.jtct.2020.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
The Practice Guidelines Committee of the American Society of Transplantation and Cellular Therapy partnered with its Transplant Infectious Disease Special Interest Group to update its 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A completely fresh approach was taken with the goal of better serving clinical providers by publishing each standalone topic in the infectious disease series as a concise format of frequently asked questions (FAQs), tables, and figures. Adult and pediatric infectious disease and HCT content experts developed, then answered FAQs, and finalized topics with harmonized recommendations that were made by assigning an A through E strength of recommendation paired with a level of supporting evidence graded I through III. This second guideline in the series focuses on invasive aspergillosis, a potentially life-threatening infection in the peri-HCT period. The relevant risk factors, diagnostic considerations, and prophylaxis and treatment approaches are reviewed.
Collapse
Affiliation(s)
- Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California.
| | - Tobias M Hohl
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cynthia E Fisher
- Division of Infectious Diseases, University of Washington, Seattle, Washington
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Genofeva Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brian T Fisher
- Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - Monica A Slavin
- Department of Infectious Disease, and National Center for Infections in Cancer, Peter McCallum Cancer Center, Melbourne, Victoria, Australia
| | - D P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
55
|
Elitzur S, Fischer S, Arad-Cohen N, Barg A, Ben-Harosh M, Danino D, Elhasid R, Gefen A, Gilad G, Levy I, Shachor-Meyouhas Y, Weinreb S, Izraeli S, Barzilai-Birenboim S. Disseminated Mucormycosis in Immunocompromised Children: Are New Antifungal Agents Making a Difference? A Multicenter Retrospective Study. J Fungi (Basel) 2021; 7:jof7030165. [PMID: 33668990 PMCID: PMC7996519 DOI: 10.3390/jof7030165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mucormycosis is a life-threatening infection with a tendency for angioinvasion that may lead to progressive dissemination. Disseminated mucormycosis, defined as the involvement of two or more non-contiguous sites, is rare in children, and data concerning its management and outcome are scarce. The aim of this study was to assess the contemporary management strategies and outcomes of disseminated mucormycosis in the pediatric population. METHODS We conducted a retrospective search in six large tertiary medical centers for all cases of disseminated mucormycosis that occurred between 2009-2020 in patients aged 1-20 years. RESULTS Twelve cases were identified. Underlying conditions included hematological malignancies (n = 10), solid tumor (post-autologous hematopoietic stem cell transplantations; n = 1), and solid organ (liver) transplantation (n = 1). In all cases, amphotericin B formulations were administered as first-line therapy; in eight cases, they were also administered in combination with an echinocandin or triazole. Seven patients underwent surgical debridement procedures. The six-week mortality was 58%. Among the patients diagnosed between 2009-2015, one of the six survived, and of those diagnosed between 2016-2020, four of the six were salvaged. CONCLUSIONS Disseminated mucormycosis is a life-threatening and often fatal disease, and improved diagnostic and therapeutic strategies are needed. Nevertheless, in this population-based study, five patients (42%) were salvaged through combined liposomal amphotericin/triazole treatment and extensive surgical interventions.
Collapse
Affiliation(s)
- Sarah Elitzur
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children’s Medical Center, 4920235 Petah Tikva, Israel; (S.F.); (G.G.); (S.I.); (S.B.-B.)
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
- Correspondence:
| | - Salvador Fischer
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children’s Medical Center, 4920235 Petah Tikva, Israel; (S.F.); (G.G.); (S.I.); (S.B.-B.)
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
| | - Nira Arad-Cohen
- Pediatric Hematology-Oncology Department, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, 3109601 Haifa, Israel; (N.A.-C.); (A.G.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 3200003 Haifa, Israel;
| | - Assaf Barg
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
- Division of Pediatric Hematology, Oncology and BMT, The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, 5262161 Ramat Gan, Israel
| | - Miriam Ben-Harosh
- Department of Pediatric Hematology-Oncology, Soroka Medical Center, Ben Gurion University, 8489501 Beer Sheva, Israel;
| | - Dana Danino
- Pediatric Infectious Disease Unit Soroka Medical Center, Ben Gurion University, 8489501 Beer Sheva, Israel;
| | - Ronit Elhasid
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
- Department of Pediatric Hemato-Oncology, Sourasky Medical Center, 6423906 Tel Aviv, Israel
| | - Aharon Gefen
- Pediatric Hematology-Oncology Department, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, 3109601 Haifa, Israel; (N.A.-C.); (A.G.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 3200003 Haifa, Israel;
| | - Gil Gilad
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children’s Medical Center, 4920235 Petah Tikva, Israel; (S.F.); (G.G.); (S.I.); (S.B.-B.)
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
| | - Itzhak Levy
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
- Pediatric Infectious Disease Unit, Schneider Children’s Medical Center, 4920235 Petah Tikva, Israel
| | - Yael Shachor-Meyouhas
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 3200003 Haifa, Israel;
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, 3109601 Haifa, Israel
| | - Sigal Weinreb
- Pediatric Hematology-Oncology, Hadassah Hebrew University Medical Center, 9112000 Jerusalem, Israel;
| | - Shai Izraeli
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children’s Medical Center, 4920235 Petah Tikva, Israel; (S.F.); (G.G.); (S.I.); (S.B.-B.)
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
| | - Shlomit Barzilai-Birenboim
- The Rina Zaizov Division of Pediatric Hematology-Oncology, Schneider Children’s Medical Center, 4920235 Petah Tikva, Israel; (S.F.); (G.G.); (S.I.); (S.B.-B.)
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel; (A.B.); (R.E.); (I.L.)
| |
Collapse
|
56
|
Prista Leão B, Abreu I, Cláudia Carvalho A, Sarmento A, Santos L. Mucormycosis: Literature review and retrospective report of 15 cases from Portugal. Curr Med Mycol 2021; 6:47-53. [PMID: 34195460 PMCID: PMC8226049 DOI: 10.18502/cmm.6.4.5437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose: Prevalence of mucormycosis is growing with the increase of the population at risk. Current recommendations for its management are mostly based on retrospective studies. 3 study aimed to present the cumulative experience of an Infectious Diseases Department from a Portuguese hospital in the management of mucormycosis and discuss the potential gaps in the diagnostic and therapeutic approaches of this infection. Materials and Methods: For the purposes of the study, the electronic hospital database was searched for adult patients with mucormycosis from 1996 to 2019 based on the definition provided by the Consensus Definitions of Invasive Fungal Disease. Demographic, clinical, treatment, and outcome data were collected and compared to what had been described in the related literature. Results: In total, 15 cases of mucormycosis were found, including 11 cases with sinus involvement (10 with central nervous system involvement), two pulmonary, and two gastrointestinal infections. Diabetes mellitus (n=7) and corticosteroid therapy (n=7) were frequent risk factors. Median duration of symptoms before the suspicion of diagnosis was 26 days (3-158). The diagnosis was confirmed in 12 patients mostly by histopathology (n=9); the culture was positive only once. Systemic antifungals and surgical debridement were the backbones of treatment; however, side effects, the need for therapeutic drug monitoring, and the anatomical location of lesions added complexity to management. Overall, seven patients died, two of them before the consideration of clinical suspicion. Conclusion: More medications are becoming available for the treatment of mucormycosis. Nevertheless, we believe that its prognosis will only significantly change through the increase of awareness and reduction of the time to diagnosis. An effective multidisciplinary approach among surgeons, infectious diseases specialists, radiologists, microbiologists, and anatomopathologists is critical to the achievement of this goal.
Collapse
Affiliation(s)
- Beatriz Prista Leão
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal.,Both authors contributed equally to this manuscript as joint first authors
| | - Isabel Abreu
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal.,Both authors contributed equally to this manuscript as joint first authors
| | - Ana Cláudia Carvalho
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| |
Collapse
|
57
|
Lamoth F, Lewis RE, Kontoyiannis DP. Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections. J Fungi (Basel) 2020; 7:jof7010017. [PMID: 33396870 PMCID: PMC7823995 DOI: 10.3390/jof7010017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Invasive fungal infections (IFIs) are associated with high mortality rates and timely appropriate antifungal therapy is essential for good outcomes. Emerging antifungal resistance among Candida and Aspergillus spp., the major causes of IFI, is concerning and has led to the increasing incorporation of in vitro antifungal susceptibility testing (AST) to guide clinical decisions. However, the interpretation of AST results and their contribution to management of IFIs remains a matter of debate. Specifically, the utility of AST is limited by the delay in obtaining results and the lack of pharmacodynamic correlation between minimal inhibitory concentration (MIC) values and clinical outcome, particularly for molds. Clinical breakpoints for Candida spp. have been substantially revised over time and appear to be reliable for the detection of azole and echinocandin resistance and for outcome prediction, especially for non-neutropenic patients with candidemia. However, data are lacking for neutropenic patients with invasive candidiasis and some non-albicans Candida spp. (notably emerging Candida auris). For Aspergillus spp., AST is not routinely performed, but may be indicated according to the epidemiological context in the setting of emerging azole resistance among A. fumigatus. For non-Aspergillus molds (e.g., Mucorales, Fusarium or Scedosporium spp.), AST is not routinely recommended as interpretive criteria are lacking and many confounders, mainly host factors, seem to play a predominant role in responses to antifungal therapy. This review provides an overview of the pre-clinical and clinical pharmacodynamic data, which constitute the rationale for the use and interpretation of AST testing of yeasts and molds in clinical practice.
Collapse
Affiliation(s)
- Frederic Lamoth
- Infectious Diseases Service and Institute of Microbiology, University Hospital of Lausanne, Lausanne University, 1011 Lausanne, Switzerland;
| | - Russell E. Lewis
- Clinic of Infectious Diseases, S’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-792-6237; Fax: +1-713-745-6839
| |
Collapse
|
58
|
A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis. Infection 2020; 49:1055-1060. [PMID: 33331988 PMCID: PMC7745708 DOI: 10.1007/s15010-020-01561-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 infection might induce a significant and sustained lymphopenia, increasing the risk of developing opportunistic infections. Mucormycosis is a rare but severe invasive fungal infection, mainly described in immunocompromised patients. The first case of a patient diagnosed with coronavirus disease (COVID-19) who developed a pulmonary mucormycosis with extensive cavitary lesions is here reported. This case highlights how this new coronavirus might impair the immune response, exposing patients to higher risk of developing opportunistic infections and leading to worse outcomes.
Collapse
|
59
|
Misidentification of Scedosporium boydii Infection as Aspergillosis in a Patient with Chronic Renal Failure. Case Rep Infect Dis 2020; 2020:9727513. [PMID: 32670645 PMCID: PMC7333029 DOI: 10.1155/2020/9727513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023] Open
Abstract
Aspergillosis is a commonly diagnosed fungal infection. Histopathologic examination alone can have diagnostic pitfalls due to the overlapping of fungal morphology. We report a case of Scedosporium boydii infection initially misdiagnosed as aspergillosis. The patient presented to the hospital with shortness of breath and chest and abdominal pain. Laboratory tests revealed leukocytosis and elevated serum liver enzymes, myoglobin and lipase. He died of hypotensive shock and brain abscesses despite antibiotic treatment. Autopsy revealed invasive fungal infection in the heart, thyroid, and brain with presence of 45-degree angled, branching hyphae. The initial diagnosis of aspergillosis was made; however, further molecular studies identified the organism as S. boydii. This report reveals the potential pitfalls of morphologic diagnosis alone; and the necessity of other testing modalities to render an accurate diagnosis which is crucial for appropriate.
Collapse
|
60
|
Brunet K, Rammaert B. Mucormycosis treatment: Recommendations, latest advances, and perspectives. J Mycol Med 2020; 30:101007. [PMID: 32718789 DOI: 10.1016/j.mycmed.2020.101007] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022]
Abstract
Mucormycosis are life-threatening fungal infections especially affecting immunocompromised or diabetic patients. Despite treatment, mortality remains high (from 32 to 70% according to organ involvement). This review provides an update on mucormycosis management. The latest recommendations strongly recommend as first-line therapy the use of liposomal amphotericin B (≥5mg/kg) combined with surgery whenever possible. Isavuconazole and intravenous or delayed-release tablet forms of posaconazole have remained second-line. Many molecules are currently in development to fight against invasive fungal diseases but few have demonstrated efficacy against Mucorales. Despite in vitro efficacy, combinations of treatment have failed to demonstrate superiority versus monotherapy. Adjuvant therapies are particularly complex to evaluate without prospective randomized controlled studies, which are complex to perform due to low incidence rate and high mortality of mucormycosis. Perspectives are nonetheless encouraging. New approaches assessing relationships between host, fungi, and antifungal drugs, and new routes of administration such as aerosols could improve mucormycosis treatment.
Collapse
Affiliation(s)
- K Brunet
- INSERM U1070, Poitiers, France; Faculté de médecine et pharmacie, université de Poitiers, Poitiers, France; Service de mycologie-parasitologie, département des agents infectieux, CHU de Poitiers, Poitiers, France.
| | - B Rammaert
- INSERM U1070, Poitiers, France; Faculté de médecine et pharmacie, université de Poitiers, Poitiers, France; Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France
| |
Collapse
|
61
|
Anastasopoulou A, DiPippo AJ, Kontoyiannis DP. Non-Aspergillus invasive mould infections in patients treated with ibrutinib. Mycoses 2020; 63:787-793. [PMID: 32458510 DOI: 10.1111/myc.13120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Invasive mould infections (IMIs) are very rare in patients with lymphoid malignancies. However, IMIs, mostly due to Aspergillus species, have been increasingly reported in such patients receiving ibrutinib (IBR). There is paucity of information regarding non-Aspergillus invasive mould infections (NAIMIs) in this setting, OBJECTIVES: To review our recent experience and the published literature on the topic. PATIENTS/METHODS We present a case of invasive sinusitis caused by Fusarium in a patient with refractory chronic lymphocytic leukaemia (CLL) who was treated with IBR and review the 12 published cases of NAIMIs during IBR. RESULTS Nearly all cases of NAIMIs in the setting of IBR use were encountered in patients with CLL. Mixed fungal infections, brain involvement and late-onset infections were common. CONCLUSIONS Although rare, NAIMIs should be considered in patients who receive IBR.
Collapse
Affiliation(s)
- Amalia Anastasopoulou
- Department of Infectious Diseases, Infection Control, and Employee Health, MD Anderson Cancer Center, University of Texas Houston, Houston, TX, USA
| | - Adam J DiPippo
- Division of Pharmacy, MD Anderson Cancer Center, University of Texas Houston, Houston, TX, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control, and Employee Health, MD Anderson Cancer Center, University of Texas Houston, Houston, TX, USA
| |
Collapse
|
62
|
Glampedakis E, Erard V, Lamoth F. Clinical Relevance and Characteristics of Aspergillus calidoustus and Other Aspergillus Species of Section Usti. J Fungi (Basel) 2020; 6:jof6020084. [PMID: 32545485 PMCID: PMC7344933 DOI: 10.3390/jof6020084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022] Open
Abstract
The Aspergilli of section Usti (group ustus) are represented by over 20 species, of which Aspergillus calidoustus is the most relevant human pathogen. Invasive aspergillosis (IA) caused by these fungi is rare but could represent an emerging issue among the expanding population of patients with long-term immunosuppression receiving antifungal prophylaxis. Clinicians should be aware of this unusual type of IA, which often exhibits distinct clinical features, such as an insidious and prolonged course and a high occurrence of extra-pulmonary manifestations, such as skin/soft tissue or brain lesions. Moreover, these Aspergillus spp. pose a therapeutic challenge because of their decreased susceptibility to azole drugs. In this review, we outline the microbiological and clinical characteristics of IA due to Aspergillus spp. of section Usti and discuss the therapeutic options.
Collapse
Affiliation(s)
- Emmanouil Glampedakis
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Véronique Erard
- Clinique de Médecine et spécialités, infectiologie, HFR-Fribourg, 1708 Fribourg, Switzerland;
| | - Frederic Lamoth
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-314-1010
| |
Collapse
|
63
|
Jenks J, Seidel D, Cornely O, Chen S, van Hal S, Kauffman C, Miceli M, Heinemann M, Christner M, Jover Sáenz A, Burchardt A, Kemmerling B, Herbrecht R, Steinmann J, Shoham S, Gräber S, Pagano L, Deeren D, Aslam S, Taplitz R, Revankar S, Baddley J, Mehta S, Reed S, Slavin M, Hoenigl M. Voriconazole plus terbinafine combination antifungal therapy for invasive Lomentospora prolificans infections: analysis of 41 patients from the FungiScope® registry 2008–2019. Clin Microbiol Infect 2020; 26:784.e1-784.e5. [DOI: 10.1016/j.cmi.2020.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 12/29/2022]
|
64
|
Lazarus JE, Branda JA, Gandhi RG, Barshak MB, Zachary KC, Barczak AK. Disseminated Intravascular Infection Caused by Paecilomyces variotii: Case Report and Review of the Literature. Open Forum Infect Dis 2020; 7:ofaa166. [PMID: 32617367 PMCID: PMC7314584 DOI: 10.1093/ofid/ofaa166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/07/2020] [Indexed: 11/14/2022] Open
Abstract
Paecilomyces variotii is a ubiquitous environmental saprophyte with worldwide distribution. Commonly found in soil and decomposing organic material [1, 2], P. variotii can also be isolated from drinking water [3] and indoor and outdoor air [4-6]. In immunocompetent hosts, P. variotii has been reported as a cause of locally invasive disease including prosthetic valve endocarditis [7, 8], endophthalmitis [9, 10], rhinosinusitis [11, 12], and dialysis-associated peritonitis [13, 14]. In contrast, disseminated infections are more commonly reported in immunocompromised patients, including those with chronic granulomatous disease [15], solid malignancy [16], acute leukemia [17], lymphoma [18], multiple myeloma [19], and after stem cell transplant for myelodysplasia [20]. In 1 case series examining invasive infections by non-Aspergillus molds, P. variotii was the most common cause after Fusarium spp. [21]. Here, we present the case of an immunocompetent patient with extensive intravascular infection involving prosthetic material. We describe successful induction therapy with combination antifungals and extended suppression with posaconazole with clinical quiescence and eventual normalization of serum fungal biomarkers.
Collapse
Affiliation(s)
- Jacob E Lazarus
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ronak G Gandhi
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miriam B Barshak
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kimon C Zachary
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amy K Barczak
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| |
Collapse
|
65
|
Jenks JD, Seidel D, Cornely OA, Chen S, van Hal S, Kauffman C, Miceli MH, Heinemann M, Christner M, Jover Sáenz A, Burchardt A, Kemmerling B, Herbrecht R, Steinmann J, Shoham S, Gräber S, Pagano L, Deeren D, Slavin MA, Hoenigl M. Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope ® registry. Mycoses 2020; 63:437-442. [PMID: 32080902 DOI: 10.1111/myc.13067] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L prolificans infections. METHODS We performed a retrospective review of medical records of patients with invasive L prolificans infection in the FungiScope® registry of rare invasive fungal infections. Patients diagnosed between 01 January 2008 and 09 September 2019 were included in for analysis. RESULTS The analysis included 41 patients with invasive L prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (P = .012), with a positive trend observed for treatment regimens that included voriconazole (P = .054). CONCLUSIONS Lomentospora prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is the preferred option for now, the hope lies with novel antifungals currently under development.
Collapse
Affiliation(s)
- Jeffrey D Jenks
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Clinical and Translational Fungal Research Group, University of California San Diego, San Diego, CA, USA
| | - Danila Seidel
- Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, CECAD-Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University Hospital Cologne, Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, CECAD-Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University Hospital Cologne, Cologne, Germany
| | - Sharon Chen
- Sydney Medical School, Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sebastiaan van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Carol Kauffman
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marisa H Miceli
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Melina Heinemann
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Christner
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alfredo Jover Sáenz
- Territorial Unit of Nosocomial Infection and antibiotic policy (TUNI), University Hospital Arnau de Vilanova, Lleida, Spain
| | - Alexander Burchardt
- Department of Hematology, Hospital of Justus Liebig University, Giessen, Germany
| | - Björn Kemmerling
- Department of Hematology, Hospital of Justus Liebig University, Giessen, Germany
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Strasbourg University Hospital, Strasbourg, France
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.,Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandra Gräber
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Livio Pagano
- Department of Hematology, Fondazione Policlinico A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dries Deeren
- Department of Hematology, AZ Delta, Roeselare, Belgium
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, Vic., Australia
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Clinical and Translational Fungal Research Group, University of California San Diego, San Diego, CA, USA.,Department of Medicine, ECMM Excellence Centre of Medical Mycology, Medical University of Graz, Graz, Austria
| |
Collapse
|