101
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Coinfection pulmonary mucormycosis and aspergillosis with disseminated mucormycosis involving gastrointestinalin in an acute B-lymphoblastic leukemia patient. Braz J Microbiol 2021; 52:2063-2068. [PMID: 34218427 PMCID: PMC8254622 DOI: 10.1007/s42770-021-00554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/21/2021] [Indexed: 11/06/2022] Open
Abstract
Pulmonary mucormycosis and aspergillosis with disseminated mucormycosis involving gastrointestinalin is a very rare but lethal infection leading to extreme mortality. Herein, we present a unique case of pulmonary coinfection with Cunninghamella bertholletiae and Aspergillus flavus, with disseminated mucormycosis involving the jejunum caused by C. bertholletiae in an acute B-lymphocytic leukemia (B-ALL) patient with familial diabetes. Early administration of active antifungal agents at optimal doses and complete resection of all infected tissues led to improved therapeutic outcomes.
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102
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Arfaj L, Aloqpi F, Elsayad W, Tayeb S, Rabie N, Samannodi M. A fatal case of disseminated mucormycosis in an immunocompetent patient post traumatic injury. IDCases 2021; 25:e01182. [PMID: 34168958 PMCID: PMC8209080 DOI: 10.1016/j.idcr.2021.e01182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Mucormycosis, is an invasive infection caused by fungi. Mainly it affects patients with immunosuppressive conditions but can occur in immuncompetent host in specific situation such us direct skin inoculation by traumatic injury. We present a 56-year-old patient who hospitalized due to left orbital cellulitis and necrotizing fasciitis post traumatic injury. A diagnosis of invasive mucormycosis was established by tissue histopathology and culture. Despite daily surgical debridement and amphotericin B, the infection disseminated to central nervous system led to fatal outcome. We conclude that mucormycosis can disseminate in immunocompetent population and leads to death.
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Affiliation(s)
- Lama Arfaj
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Fatinah Aloqpi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Waleed Elsayad
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Sarah Tayeb
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Nada Rabie
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Mohammed Samannodi
- Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.,Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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103
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Martín Gómez MT, Salavert Lletí M. [Mucormycosis: Current and future management perspective]. Rev Iberoam Micol 2021; 38:91-100. [PMID: 34144835 DOI: 10.1016/j.riam.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/20/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Infections caused by mucorales, with an increasing incidence after candidiasis and aspergillosis, are characterized by the fast angioinvasion of blood vessels and invasion of neighboring organs or structures. Mucorales most commonly cause rhinocerebral, pulmonary, cutaneous, digestive or disseminated infections, and their spread is favored by certain underlying diseases (diabetes, kidney failure) and risk factors (neutropenia, immunosuppression, iron overload). These infections have a high mortality rate, over 40% in many series, and the key to their cure depends on both an early diagnosis and an antifungal treatment, associated in most cases with extensive surgical debridement and other adjunctive therapies. Currently, there are international guidelines, not only local ones, for the management of mucormycosis, in which it is considered by consensus and with a strong recommendation that first-line treatment with high-dose liposomal amphotericin B is the best choice. The combined antifungal treatment of polyene agents with triazoles or candins remains in open debate.
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Affiliation(s)
- María Teresa Martín Gómez
- Sección de Micología, Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Miguel Salavert Lletí
- Unidad de Enfermedades Infecciosas (Área Clínica Médica), Hospital Universitario y Politécnico La Fe, Valencia, España.
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104
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Chao A, Vazquez JA. Fungal Infections of the Gastrointestinal Tract. Gastroenterol Clin North Am 2021; 50:243-260. [PMID: 34024440 DOI: 10.1016/j.gtc.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The thinking about fungi has evolved from unusual agents considered contaminants and colonizers to actual pathogens. Fungi are ubiquitous in nature and are found throughout in association with food, soil, mammals, and insects. Fungi have become important pathogens in animals and humans causing infections extending from superficial disease to disseminated infection. Because the gastrointestinal tract is continually exposed to fungi, it is frequently colonized and infected by numerous yeast and other fungi. It is also the origin of many disseminated fungal infections. The increased incidence of fungal infections has led to the approval and use of novel antifungals.
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Affiliation(s)
- Andrew Chao
- Division of Infectious Disease, Department of Medicine, Medical College of Georgia/Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Jose A Vazquez
- Division of Infectious Disease, Department of Medicine, Medical College of Georgia/Augusta University, 1120 15th Street, Augusta, GA 30912, USA.
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105
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Wilmes D, Coche E, Rodriguez-Villalobos H, Kanaan N. Fungal pneumonia in kidney transplant recipients. Respir Med 2021; 185:106492. [PMID: 34139578 DOI: 10.1016/j.rmed.2021.106492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
Fungal pneumonia is a dreaded complication encountered after kidney transplantation, complicated by increased mortality and often associated with graft failure. Diagnosis can be challenging because the clinical presentation is non-specific and diagnostic tools have limited sensitivity and specificity in kidney transplant recipients and must be interpreted in the context of the clinical setting. Management is difficult due to the increased risk of dissemination and severity, multiple comorbidities, drug interactions and reduced immunosuppression which should be applied as an important adjunct to therapy. This review will focus on the main causes of fungal pneumonia in kidney transplant recipients including Pneumocystis, Aspergillus, Cryptococcus, mucormycetes and Histoplasma. Epidemiology, clinical presentation, laboratory and radiographic features, specific characteristics will be discussed with an update on diagnostic procedures and treatment.
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Affiliation(s)
- D Wilmes
- Division of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - E Coche
- Division of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - H Rodriguez-Villalobos
- Division of Microbiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - N Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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106
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Abstract
Mucormycosis is a rare but aggressive fungal disease that mainly affects patients with poorly controlled diabetes mellitus and those who are severely immunocompromised, including patients with hematological malignancies and solid organ transplant recipients. Early recognition of infection is critical for treatment success, followed by prompt initiation of antifungal therapy with lipid formulation amphotericin B. Posaconazole and isavuconazole should be used for stepdown and salvage therapy. Surgical debridement is key for tissue diagnosis and treatment and should be pursued urgently whenever possible. In addition to surgery and antifungal therapy, reverting the underlying risk factor for infection is important for treatment response.
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Affiliation(s)
- Julie M Steinbrink
- Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Hanes House, Duke University Medical Center, 315 Trent Drive, Durham, NC 27710, USA
| | - Marisa H Miceli
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, F4005 UH-South- SPC 5226, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
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107
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Galletta K, Alafaci C, D'Alcontres FS, Maria ME, Cavallaro M, Ricciardello G, Vinci S, Grasso G, Granata F. Imaging features of perineural and perivascular spread in rapidly progressive rhino-orbital-cerebral mucormycosis: A case report and brief review of the literature. Surg Neurol Int 2021; 12:245. [PMID: 34221576 PMCID: PMC8247725 DOI: 10.25259/sni_275_2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Rhinocerebral mucormycosis (ROCM) is an opportunistic fungal infection originating from the paranasal sinuses with extension to the brain. A delayed diagnosis can rapidly result in a poor prognosis. ROCM commonly affects patients with diabetes or immunocompromised states with a variable progression. Case Description: We report the case of a 59-year old patient with an untreated diabetes who developed a ROCM with rapidly progressive neurological symptoms. From the onset of sinus pain, nasal congestion, he rapidly developed facial swelling and masticatory dysfunction. The patient underwent sinus surgery which allowed Rhizopus oryzae to be isolated. Accordingly, a systemic therapy by intensive intravenous amphotericin B was started. Nevertheless, the infection rapidly resulted in bilateral cavernous sinuses thrombosis and occlusion of the left internal carotid artery providing the subsequent patient death. Conclusion: Mucormycosis is a life-threatening fungal infection in diabetic and/or immunosuppressed patients. Our case demonstrates the three main mechanisms for infection spreading that are direct, perineural, and perivascular diffusion. Clear identification of the main risk factors, proper assessment of clinical features, and radiological findings may improve the chance for an early diagnosis and patient survival.
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Affiliation(s)
- Karol Galletta
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Concetta Alafaci
- Department of Biomedical Sciences and Morphological and Functional Imaging, Section of Neurosurgery, Messina, Italy
| | | | - Mormina Enrico Maria
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Marco Cavallaro
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Giorgia Ricciardello
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Sergio Vinci
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Neurosurgery, University of Palermo, Palermo, Italy
| | - Francesca Granata
- Department of Biomedical, Dental Science and Morphological and Functional Images, Messina, Italy
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108
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Larcher R, Platon L, Amalric M, Brunot V, Besnard N, Benomar R, Daubin D, Ceballos P, Rispail P, Lachaud L, Bourgeois N, Klouche K. Emerging Invasive Fungal Infections in Critically Ill Patients: Incidence, Outcomes and Prognosis Factors, a Case-Control Study. J Fungi (Basel) 2021; 7:330. [PMID: 33923333 PMCID: PMC8146331 DOI: 10.3390/jof7050330] [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: 03/15/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 12/29/2022] Open
Abstract
Comprehensive data on emerging invasive fungal infections (EIFIs) in the critically ill are scarce. We conducted a case-control study to characterize EIFIs in patients admitted to a French medical ICU teaching hospital from 2006 to 2019. Among 6900 patients, 26 (4 per 1000) had an EIFI: Mucorales accounted for half, and other isolates were mainly Saprochaete, Fusarium and Scedosporium. EIFIs occurred mostly in patients with immunosuppression and severe critical illness. Antifungal treatments (mainly amphotericin B) were administered to almost all patients, whereas only 19% had surgery. In-ICU, mortality was high (77%) and associated with previous conditions such as hematological malignancy or cancer, malnutrition, chronic kidney disease and occurrence of acute respiratory distress syndrome and/or hepatic dysfunction. Day-90 survival rates, calculated by the Kaplan-Meier method, were similar between patients with EIFIs and a control group of patients with aspergillosis: 20%, 95% CI (9- 45) versus 18%, 95% CI (8- 45) (log-rank: p > 0.99). ICU management of such patients should be assessed on the basis of underlying conditions, reversibility and acute event severity rather than the mold species.
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Affiliation(s)
- Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
- PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34090 Montpellier, France
| | - Laura Platon
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
| | - Matthieu Amalric
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
| | - Vincent Brunot
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
| | - Noemie Besnard
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
| | - Racim Benomar
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
| | - Delphine Daubin
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
| | - Patrice Ceballos
- Hematology Department, Saint Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France;
| | - Philippe Rispail
- Mycology and Parasitology Laboratory, Lapeyronie Hospital, Montpellier University Hospital, 34090 Montpellier, France; (P.R.); (L.L.); (N.B.)
| | - Laurence Lachaud
- Mycology and Parasitology Laboratory, Lapeyronie Hospital, Montpellier University Hospital, 34090 Montpellier, France; (P.R.); (L.L.); (N.B.)
- MiVEGEC (Infectious Diseases and Vectors: Ecology, Genetic, Evolution and Control), IRD (Research and Development Institute), CNRS, University of Montpellier, 911 Avenue Agropolis, 34394 Montpellier, France
| | - Nathalie Bourgeois
- Mycology and Parasitology Laboratory, Lapeyronie Hospital, Montpellier University Hospital, 34090 Montpellier, France; (P.R.); (L.L.); (N.B.)
- MiVEGEC (Infectious Diseases and Vectors: Ecology, Genetic, Evolution and Control), IRD (Research and Development Institute), CNRS, University of Montpellier, 911 Avenue Agropolis, 34394 Montpellier, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 371, Avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.P.); (M.A.); (V.B.); (N.B.); (R.B.); (D.D.); (K.K.)
- PhyMedExp, INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34090 Montpellier, France
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109
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Stanford FA, Matthies N, Cseresnyés Z, Figge MT, Hassan MIA, Voigt K. Expression Patterns in Reductive Iron Assimilation and Functional Consequences during Phagocytosis of Lichtheimia corymbifera, an Emerging Cause of Mucormycosis. J Fungi (Basel) 2021; 7:jof7040272. [PMID: 33916756 PMCID: PMC8065604 DOI: 10.3390/jof7040272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 12/30/2022] Open
Abstract
Iron is an essential micronutrient for most organisms and fungi are no exception. Iron uptake by fungi is facilitated by receptor-mediated internalization of siderophores, heme and reductive iron assimilation (RIA). The RIA employs three protein groups: (i) the ferric reductases (Fre5 proteins), (ii) the multicopper ferroxidases (Fet3) and (iii) the high-affinity iron permeases (Ftr1). Phenotyping under different iron concentrations revealed detrimental effects on spore swelling and hyphal formation under iron depletion, but yeast-like morphology under iron excess. Since access to iron is limited during pathogenesis, pathogens are placed under stress due to nutrient limitations. To combat this, gene duplication and differential gene expression of key iron uptake genes are utilized to acquire iron against the deleterious effects of iron depletion. In the genome of the human pathogenic fungus L. corymbifera, three, four and three copies were identified for FRE5, FTR1 and FET3 genes, respectively. As in other fungi, FET3 and FTR1 are syntenic and co-expressed in L. corymbifera. Expression of FRE5, FTR1 and FET3 genes is highly up-regulated during iron limitation (Fe-), but lower during iron excess (Fe+). Fe- dependent upregulation of gene expression takes place in LcFRE5 II and III, LcFTR1 I and II, as well as LcFET3 I and II suggesting a functional role in pathogenesis. The syntenic LcFTR1 I–LcFET3 I gene pair is co-expressed during germination, whereas LcFTR1 II- LcFET3 II is co-expressed during hyphal proliferation. LcFTR1 I, II and IV were overexpressed in Saccharomyces cerevisiae to represent high and moderate expression of intracellular transport of Fe3+, respectively. Challenge of macrophages with the yeast mutants revealed no obvious role for LcFTR1 I, but possible functions of LcFTR1 II and IVs in recognition by macrophages. RIA expression pattern was used for a new model of interaction between L. corymbifera and macrophages.
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Affiliation(s)
- Felicia Adelina Stanford
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research, and Infection Biology—Hans Knöll Institute (HKI), 07745 Jena, Germany; (F.A.S.); (N.M.); (M.I.A.H.)
- Institute of Microbiology, Friedrich Schiller University Jena, 07743 Jena, Germany;
| | - Nina Matthies
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research, and Infection Biology—Hans Knöll Institute (HKI), 07745 Jena, Germany; (F.A.S.); (N.M.); (M.I.A.H.)
- Institute of Microbiology, Friedrich Schiller University Jena, 07743 Jena, Germany;
| | - Zoltán Cseresnyés
- Applied Systems Biology, Leibniz Institute for Natural Product Research, and Infection Biology—Hans Knöll Institute, 12622 Jena, Germany;
| | - Marc Thilo Figge
- Institute of Microbiology, Friedrich Schiller University Jena, 07743 Jena, Germany;
- Applied Systems Biology, Leibniz Institute for Natural Product Research, and Infection Biology—Hans Knöll Institute, 12622 Jena, Germany;
| | - Mohamed I. Abdelwahab Hassan
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research, and Infection Biology—Hans Knöll Institute (HKI), 07745 Jena, Germany; (F.A.S.); (N.M.); (M.I.A.H.)
- Institute of Microbiology, Friedrich Schiller University Jena, 07743 Jena, Germany;
- National Research Centre, Pests & Plant Protection Department, 33rd El Buhouth St., Dokki, Giza 12622, Egypt
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research, and Infection Biology—Hans Knöll Institute (HKI), 07745 Jena, Germany; (F.A.S.); (N.M.); (M.I.A.H.)
- Institute of Microbiology, Friedrich Schiller University Jena, 07743 Jena, Germany;
- Correspondence: or ; Tel.: +49-3641-532-1395
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110
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Borman AM, Fraser M, Patterson Z, Palmer MD, Johnson EM. In Vitro Antifungal Drug Resistance Profiles of Clinically Relevant Members of the Mucorales (Mucoromycota) Especially with the Newer Triazoles. J Fungi (Basel) 2021; 7:271. [PMID: 33918216 PMCID: PMC8065934 DOI: 10.3390/jof7040271] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
Mucoromycoses (infections caused by members of the order Mucorales, phylum Mucoromycota [ex-Zygomycota]) are highly destructive, rapidly progressive infections, with dire prognoses especially when they occur in immunocompromised hosts. Current treatment guidelines recommend liposomal formulations of amphotericin B with adjunctive surgery as first line therapy, with the newer triazoles posaconazole or isavuconazole as alternative treatments, or as salvage therapy. Among the many organisms belonging to this order, a limited number of species in the genera Rhizopus, Mucor, Lichtheimia and Rhizomucor are responsible for most cases of human infection. Here, we present the minimum inhibitory concentration data (MICs) for amphotericin B, posaconazole, isavuconazole, itraconazole and voriconazole with a panel of over 300 isolates of the five most common agents of human infection (Lichtheimia corymbifera, Rhizopus arrhizus, R. microsporus, Rhizomucor pusillus and Mucor spp.) determined using the CLSI broth microdilution method. In agreement with previous studies, the most active antifungal drug for all Mucorales was amphotericin B, with MICs within the range that would predict susceptibility with Aspergillus fumigatus. Conversely, MICs for voriconazole against all species tested were high, and above the range associated with clinical efficacy with A. fumigatus. Interestingly, whilst isavuconazole and posaconazole MIC distributions indicated in vitro activity against some members of the Mucorales, activity was species-dependent for both agents. These data underscore the importance of accurate identification of the causative agents of mucoromycosis, coupled with antifungal susceptibility testing of individual isolates, in determining the optimal treatment of infections caused by these aggressive opportunistic human fungal pathogens.
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Affiliation(s)
- Andrew M. Borman
- UK National Mycology Reference Laboratory, Public Health England, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK; (M.F.); (Z.P.); (M.D.P.)
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter EX4 4QD, UK
| | - Mark Fraser
- UK National Mycology Reference Laboratory, Public Health England, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK; (M.F.); (Z.P.); (M.D.P.)
| | - Zoe Patterson
- UK National Mycology Reference Laboratory, Public Health England, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK; (M.F.); (Z.P.); (M.D.P.)
| | - Michael D. Palmer
- UK National Mycology Reference Laboratory, Public Health England, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK; (M.F.); (Z.P.); (M.D.P.)
| | - Elizabeth M. Johnson
- UK National Mycology Reference Laboratory, Public Health England, Science Quarter, Southmead Hospital, Bristol BS10 5NB, UK; (M.F.); (Z.P.); (M.D.P.)
- Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter EX4 4QD, UK
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111
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Prakash H, Chakrabarti A. Epidemiology of Mucormycosis in India. Microorganisms 2021; 9:523. [PMID: 33806386 PMCID: PMC8000977 DOI: 10.3390/microorganisms9030523] [Citation(s) in RCA: 212] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
Mucormycosis is an angioinvasive disease caused by saprophytic fungi of the order Mucorales. The exact incidence of mucormycosis in India is unknown due to the lack of population-based studies. The estimated prevalence of mucormycosis is around 70 times higher in India than that in global data. Diabetes mellitus is the most common risk factor, followed by haematological malignancy and solid-organ transplant. Patients with postpulmonary tuberculosis and chronic kidney disease are at additional risk of developing mucormycosis in this country. Trauma is a risk factor for cutaneous mucormycosis. Isolated renal mucormycosis in an immunocompetent host is a unique entity in India. Though Rhizopus arrhizus is the most common etiological agent of mucormycosis in this country, infections due to Rhizopus microsporus, Rhizopus homothallicus, and Apophysomyces variabilis are rising. Occasionally, Saksenaea erythrospora, Mucor irregularis, and Thamnostylum lucknowense are isolated. Though awareness of the disease has increased among treating physicians, disease-associated morbidity and mortality are still high, as patients seek medical attention late in the disease process and given the low affordability for therapy. In conclusion, the rise in the number of cases, the emergence of new risk factors and causative agents, and the challenges in managing the disease are important concerns with mucormycosis in India.
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Affiliation(s)
- Hariprasath Prakash
- Medical Microbiology, Department of Public Health, International Higher School of Medicine, Issyk-Kul Regional Campus, Cholpon-Ata 722125, Kyrgyzstan
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India;
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112
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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.
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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.)
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113
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Singh A, Choudhary I, Handa AC. Chasing the culprit in shadow - Sinonasal mucormycosis in an immunocompetent host. Trop Doct 2021; 51:665-668. [PMID: 33567999 DOI: 10.1177/0049475521991354] [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]
Abstract
Rhino-orbital mucormycosis is an uncommon, rapidly progressive, fulminant, angio-invasive deep mycosis usually affecting individuals with underlying immunosuppression, the most common being diabetes mellitus. In such, the course may be fatal with dissemination. Early detection with control of underlying predisposing conditions is critical with respect to the prognosis. Rarely, mucormycosis may develop in an immunocompetent host, when its non-specific symptomatology and inconspicuous radiological findings may obscure its diagnosis. Any delay in treatment predisposes to multi-organ morbidity and potential mortality. We present an immunocompetent adult with no underlying predisposing illness who was harbouring invasive sinonasal mucormycosis causing orbital cellulitis. A high index of suspicion is mandatory.
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Affiliation(s)
- Anup Singh
- Attending consultant, ENT, Department of Otolaryngology and Head & Neck Surgery, 204687Medanta-The Medicity, Gurugram, India
| | - Ishan Choudhary
- Junior Resident, Department of Otolaryngology and Head & Neck Surgery, 204687Medanta-The Medicity, Gurugram, India
| | - Aru C Handa
- Associate Director, ENT, Department of Otolaryngology and Head & Neck Surgery, 204687Medanta-The Medicity, Gurugram, India
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114
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Jestin M, Azoulay E, Pène F, Bruneel F, Mayaux J, Murgier M, Darmon M, Valade S. Poor outcome associated with mucormycosis in critically ill hematological patients: results of a multicenter study. Ann Intensive Care 2021; 11:31. [PMID: 33569700 PMCID: PMC7876194 DOI: 10.1186/s13613-021-00818-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022] Open
Abstract
Background Mucormycosis is an emerging fungal infection that may lead to multi-organ failure, especially in patients with hematological malignancies (HM). We performed a retrospective, cohort study, in five intensive care units (ICU) to assess the outcome of critically ill patients with HM and mucormycosis between 2002 and 2018. The secondary objective was to identify prognostic factors in this setting. Results Twenty-six patients were included with a median age of 38 years [IQR, 26–57]). Acute leukemia was the most frequent underlying disease (50%). Nine patients (35%) underwent allogeneic stem cell transplantation (SCT). Nineteen patients (73%) had neutropenia and 16 (62%) had received steroids. The main reason for admission was acute respiratory failure (n = 14, 54%) followed by shock (n = 5 19%). The median SOFA score at admission was 7 [5–8]. According to EORTC/MSG criteria, mucormycosis was "proven" in 14 patients (54%), "probable" in 5 (19%) and “possible” in 7 (27%) in whom diagnosis was made by qPCR. Rhizopus and Mucor were the most frequent documented species. Seven patients (27%) had concurrent Aspergillus infection. Mucormycosis was diagnosed 1 day [−4 to + 6] after ICU admission. Sixteen patients (62%) had pulmonary involvement and ten (38%) rhino-cerebral involvement. Infection was disseminated in eight patients (31%). Twenty-two patients (85%) were treated with liposomal amphotericin B; 12 (46%) received antifungal combination including posaconazole in 7. Eight patients (31%) underwent curative surgery. Twenty-one patients (81%) required invasive mechanical ventilation (IMV), 18 (69%) vasopressors, and 9 (35%) renal replacement therapy. ICU and hospital mortality rates were 77% and 88%, respectively. The median overall survival was 9 days [3–22]. IMV was strongly associated with ICU mortality (p < 0.001) Three variables were associated with day 90 mortality in a Cox model including allogeneic SCT (HR 4.84 [95% CI 1.64–14.32]), SOFA score (1.19 [1.02–1.39]) and dual therapy (3.02 [1.18–7.72]). Conclusions Mucormycosis is associated with a high mortality rate in patients with HM, especially in allogeneic SCT recipients. Benefit of ICU management in these patients should be assessed before admission and strategies aiming to improve these patients’ outcome are urgently needed.
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Affiliation(s)
- Matthieu Jestin
- Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université de Paris, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Frédéric Pène
- Service de Médecine Intensive Et Réanimation, AP-HP, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Fabrice Bruneel
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Julien Mayaux
- Service de Pneumologie, Médecine Intensive Et Réanimation, Hôpital Universitaire Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Martin Murgier
- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire de Saint-Etienne, 25 Boulevard Pasteur, 42055, Saint-Etienne, France
| | - Michael Darmon
- Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université de Paris, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Sandrine Valade
- Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. .,Université de Paris, 85 Boulevard Saint-Germain, 75006, Paris, France.
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115
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Muthu V, Agarwal R, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Chakrabarti A. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:538-549. [PMID: 33418022 DOI: 10.1016/j.cmi.2020.12.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medical-surgical therapy in PM. METHODS We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medical-surgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medical-surgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor. RESULTS We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7-62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000-2009, and 2010-2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medical-surgical therapy was associated with a significantly lower RD (95%CI) of death: -0.32 (-0.49 to -0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors. CONCLUSIONS While PM is still associated with high mortality, we noted improved survival over time. Combined medical-surgical therapy improved survival compared to medical treatment alone.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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116
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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.
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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
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Brunet K, Arrivé F, Martellosio JP, Lamarche I, Marchand S, Rammaert B. Corticosteroids alter alveolar macrophage control of Lichtheimia corymbifera spores in an ex vivo mouse model. Med Mycol 2020; 59:694-700. [PMID: 33369666 DOI: 10.1093/mmy/myaa104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 11/12/2022] Open
Abstract
Alveolar macrophages (AM) are the first-line lung defense against Mucorales in pulmonary mucormycosis. Since corticosteroid use is a known risk factor for mucormycosis, the aim of this study was to describe the role of corticosteroids on AM capacities to control Lichtheimia corymbifera spore growth using a new ex vivo model. An in vivo mouse model was developed to determine the acetate cortisone dose able to trigger pulmonary invasive infection. Then, in the ex vivo model, male BALB/c mice were pretreated with the corticosteroid regimen triggering invasive infection, before AM collection through bronchoalveolar lavage. AMs from corticosteroid-treated mice and untreated control AMs were then exposed to L. corymbifera spores in vitro (ratio 1:5). AM control of fungal growth, adherence/phagocytosis, and oxidative burst were assessed using optical densities by spectrophotometer, flow cytometry, and 2', 7'-dichlorofluoresceine diacetate fluorescence, respectively. Cortisone acetate at 500 mg/kg, at D-3 and at D0, led to pulmonary invasive infection at D3. Co-incubated spores and AMs from corticosteroid-treated mice had significantly higher absorbance (fungal growth) than co-incubated spores and control AMs, at 24 h (P = .025), 36 h (P = .004), and 48 h (P = .001). Colocalization of spores with AMs from corticosteroid-treated mice was significantly lower than for control AMs (7.6 ± 1.9% vs 22.3 ± 5.8%; P = .003), reflecting spore adherence and phagocytosis inhibition. Finally, oxidative burst was significantly increased when control AMs were incubated with spores (P = 0.029), while corticosteroids hampered oxidative burst from treated AMs (P = 0.321). Corticosteroids enhanced fungal growth of L. corymbifera through AM phagocytosis inhibition and burst oxidative decrease in our ex vivo model. LAY SUMMARY The aim of this study was to describe the impact of corticosteroids on alveolar macrophage (AM) capacities to control Mucorales growth in a new murine ex vivo model. Corticosteroids enhanced fungal growth of L. corymbifera through AM phagocytosis inhibition and burst oxidative decrease.
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Affiliation(s)
- Kévin Brunet
- INSERM U1070, Poitiers, France.,Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France.,Centre Hospitalo-Universitaire de Poitiers, service de Mycologie-Parasitologie, Département des agents infectieux, Poitiers, France
| | - François Arrivé
- INSERM U1070, Poitiers, France.,Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France.,Centre Hospitalo-Universitaire de Poitiers, service de Maladies infectieuses et tropicales, Poitiers, France
| | - Jean-Philippe Martellosio
- INSERM U1070, Poitiers, France.,Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France.,Centre Hospitalo-Universitaire de Poitiers, service de Maladies infectieuses et tropicales, Poitiers, France
| | | | - Sandrine Marchand
- INSERM U1070, Poitiers, France.,Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France.,Centre Hospitalo-Universitaire de Poitiers, service de Toxicologie et Pharmacocinétique, Poitiers, France
| | - Blandine Rammaert
- INSERM U1070, Poitiers, France.,Université de Poitiers, Faculté de médecine et pharmacie, Poitiers, France.,Centre Hospitalo-Universitaire de Poitiers, service de Maladies infectieuses et tropicales, Poitiers, France
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118
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Thatipelli S, Santoiemma P, Echenique IA, Green R, Ison MG, Ladner D, Kanwar YS, Stosor V. Donor-derived renal allograft mucormycosis in a combined liver and kidney transplantation: Case report and review of the literature. Transpl Infect Dis 2020; 23:e13534. [PMID: 33251715 DOI: 10.1111/tid.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/13/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
Mucormycosis infrequently may present with isolated renal involvement. Among solid organ transplant recipients, renal allograft mucormycosis has been most often associated with medical tourism or transplantation outside of the western world. We report a case of an HIV/HCV co-infected woman who underwent simultaneous liver and kidney transplantation with a Public Health Service increased risk donor organ. 16 days after transplant, she developed massive hematuria and was found to have renal allograft Rhizopus spp. involvement, we surmise to have been from donor-derived infection. Therapy included nephrectomy, debridement, liposomal amphotericin B, and posaconazole with survival. We reviewed PubMed indexed, English-language cases of isolated renal mucormycosis in general, in HIV/AIDS, and from donor-derived renal allograft infections.
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Affiliation(s)
- Sneha Thatipelli
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phillip Santoiemma
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Richard Green
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Northwestern University Transplant Outcomes Research Collaboration, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela Ladner
- Northwestern University Transplant Outcomes Research Collaboration, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yashpal S Kanwar
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Northwestern University Transplant Outcomes Research Collaboration, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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119
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Bonifaz A, Tirado-Sánchez A, Hernández-Medel ML, Araiza J, Kassack JJ, Del Angel-Arenas T, Moisés-Hernández JF, Paredes-Farrera F, Gómez-Apo E, Treviño-Rangel RDJ, González GM. Mucormycosis at a tertiary-care center in Mexico. A 35-year retrospective study of 214 cases. Mycoses 2020; 64:372-380. [PMID: 33253454 DOI: 10.1111/myc.13222] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mucormycosis is a rare, invasive disease associated with high mortality rates, produced by opportunistic pathogens related to the Mucorales order and characterised by a diverse range of clinical forms; acute rhino-orbital-cerebral and pulmonary symptoms are the most reported ones. OBJECTIVES To report the experience of mucormycosis observed in a tertiary-care hospital in Mexico for 35 years. METHODS This was a retrospective, descriptive and observational study on mucormycosis at a tertiary-care hospital in Mexico from January 1985 to December 2019. Demographic and clinical data and mycological and histopathological records were selected. RESULTS Two hundred fourteen proven cases of mucormycosis for 35 years at a tertiary-care hospital in Mexico were included. Most of the cases were male patients with a median age of 45 years. The two most associated underlying diseases were diabetes mellitus (76.6%) and haematologic malignancy (15.4%). The three primary clinical forms were as follows: rhino-orbito-cerebral (75.9%), cutaneous (8.41%) and pulmonary (7.47%) mucormycosis. The most isolated agents were Rhizopus arrhizus (58.4%) and Lichtheimia corymbifera (12.3%). The overall therapeutic response was 58.5%, and the best response was observed with amphotericin B deoxycholate and surgical debridement. CONCLUSION Mucormycosis is an emerging disease, and its incidence has increased at our hospital over the years. In this study, the rhino-cerebral clinical type was the most frequent in patients with uncontrolled diabetes; the main aetiological agent was R. arrhizus. Early diagnosis, control of the underlying disease and prompt management may increase the survival rate.
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Affiliation(s)
- Alexandro Bonifaz
- Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | | | | | - Javier Araiza
- Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Juan J Kassack
- Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | | | | | | | - Erick Gómez-Apo
- Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Rogelio de J Treviño-Rangel
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Gloria M González
- Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
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120
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Shao W, Zhang Z, Feng H, Liang C, Liu D. Pulmonary mucormycosis: a case of pulmonary arterial hypertension, Westermark sign, and bronchopleural fistula. J Int Med Res 2020; 48:300060520971450. [PMID: 33249953 PMCID: PMC7708708 DOI: 10.1177/0300060520971450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We herein describe a patient with pulmonary mucormycosis and acute myelogenous leukemia. Computed tomography showed a widened pulmonary artery, a bronchopleural fistula, and the Westermark sign. Despite worsening hemoptysis, the operation was delayed for 6 months. The operation was very complicated and difficult. A thorough preoperative examination, adequate preoperative preparation, appropriate surgical timing, and rich clinical and surgical experience were the keys to successful surgery in this case.
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Affiliation(s)
- Weipeng Shao
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing, China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Chaoyang Liang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Deruo Liu
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing, China
- Deruo Liu, Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, No. 2 Yinghua East Road, Beijing 100029, China.
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Introduction of a Comprehensive Diagnostic and Interdisciplinary Management Approach in Haematological Patients with Mucormycosis: A Pre and Post-Intervention Analysis. J Fungi (Basel) 2020; 6:jof6040268. [PMID: 33171634 PMCID: PMC7712937 DOI: 10.3390/jof6040268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022] Open
Abstract
Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016-2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012-2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012-2015 and 2016-2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012-2015 and 0/7 patients in 2016-2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients.
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Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and Diagnosis of Mucormycosis: An Update. J Fungi (Basel) 2020; 6:jof6040265. [PMID: 33147877 PMCID: PMC7711598 DOI: 10.3390/jof6040265] [Citation(s) in RCA: 292] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022] Open
Abstract
Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. Τhe epidemiology of mucormycosis is evolving as new immunomodulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future.
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Affiliation(s)
- Anna Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-2107-462-607
| | | | - Maria Drogari-Apiranthitou
- Fourth Department of Internal Medicine, General University Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece;
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Amanati A, Barzegar H, Pouladfar G, Sanaei Dashti A, Abtahi MB, Khademi B, Ashraf MJ, Badiee P, Hamzavi SS, Kashkooe A. Orbital mucormycosis in immunocompetent children; review of risk factors, diagnosis, and treatment approach. BMC Infect Dis 2020; 20:770. [PMID: 33076815 PMCID: PMC7574198 DOI: 10.1186/s12879-020-05460-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages. CASE PRESENTATION Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children. CONCLUSIONS Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.
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Affiliation(s)
- Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamide Barzegar
- Shiraz University of Medical Sciences, Namazi Hospital, 7193711351, Zand Ave, Shiraz, Iran.
| | - Gholamreza Pouladfar
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Sanaei Dashti
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Bagher Abtahi
- Shiraz University of Medical Sciences, Namazi Hospital, 7193711351, Zand Ave, Shiraz, Iran
| | - Bijan Khademi
- Department and Research Center of Otolaryngology, Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Parisa Badiee
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedeh Sedigheh Hamzavi
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Shiraz University of Medical Sciences, Namazi Hospital, 7193711351, Zand Ave, Shiraz, Iran.
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Stemler J, Hamed K, Salmanton-García J, Rezaei-Matehkolaei A, Gräfe SK, Sal E, Zarrouk M, Seidel D, Abdelaziz Khedr R, Ben-Ami R, Ben-Chetrit E, Roth Y, Cornely OA. Mucormycosis in the Middle East and North Africa: Analysis of the FungiScope ® registry and cases from the literature. Mycoses 2020; 63:1060-1068. [PMID: 32485012 DOI: 10.1111/myc.13123] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Regional differences in the underlying causes, manifestations and treatment of mucormycosis have been noted in studies covering Europe, Asia and South America. OBJECTIVES To review cases of mucormycosis across the Middle East and North Africa (MENA) region in order to identify epidemiological, treatment and outcome trends in this region. PATIENTS/METHODS Cases of proven or probable invasive mucormycosis from the region were identified from the FungiScope® database and the medical literature. For each case, information on underlying condition, site of infection, pathogenic species, therapeutic intervention, type of antifungal therapy and outcome were analysed. RESULTS We identified 310 cases of mucormycosis in the MENA region. The number of reported cases increased by decade from 23 before 1990 to 127 in the 2010s. In this region, the most common underlying conditions associated with mucormycosis were diabetes mellitus (49.7%) and conditions associated with immunosuppression (46.5%). The majority of patients received treatment with antifungals (93.5%), with a large proportion treated with both antifungals and surgery (70.6%). Overall mortality rates decreased from 47.8% before 1990 to 32.3% in the 2010s. CONCLUSIONS The number of reported cases of mucormycosis in the MENA region has risen over the past few decades, in line with increases in the number of patients with underlying conditions associated with this infection. Although the majority of patients received treatment with antifungal therapies and/or surgery, the associated mortality rate remains high and there is a clear need for more effective prevention and treatment strategies in the MENA region.
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Affiliation(s)
- Jannik Stemler
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Kamal Hamed
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Jon Salmanton-García
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Ali Rezaei-Matehkolaei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Stefanie K Gräfe
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Faculty of Medicine, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Ertan Sal
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Marouan Zarrouk
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Danila Seidel
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Reham Abdelaziz Khedr
- Pediatric Oncology Department, National Cancer Institute, Cairo University, Egypt/Children's Cancer Hospital, Egypt
| | - Ronen Ben-Ami
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Yehudah Roth
- Department of Otolaryngology - Head & Neck Surgery, Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon, Israel
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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125
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Evaluation of MucorGenius® mucorales PCR assay for the diagnosis of pulmonary mucormycosis. J Infect 2020; 81:311-317. [DOI: 10.1016/j.jinf.2020.05.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
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126
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Pagano L, Dragonetti G, De Carolis E, Veltri G, Del Principe MI, Busca A. Developments in identifying and managing mucormycosis in hematologic cancer patients. Expert Rev Hematol 2020; 13:895-905. [PMID: 32664759 DOI: 10.1080/17474086.2020.1796624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Mucormycoses represent a rare but very aggressive class of mold infections occurring in patients with hematological malignancies (HMs). In the past, patients at high risk of invasive mucomycosis (IM) were those affected by acute myeloid leukemia but over the last ten years the prophylaxis with a very effective mold-active drug, such as posaconazole, has completely modified the epidemiology. In fact, IM is now observed more frequently in patients with lymphoproliferative disorders who do not receive antifungal prophylaxis. AREAS COVERED The attention was focused on the epidemiology, diagnosis, prophylaxis and treatment of IM in HMs. Authors excluded pediatric patients considering the different epidemiology and differences in treatment given the limitation of the use of azoles in the pediatric field. A systematic literature review was performed using PubMed database listings between February 2014 and February 2020 using the following MeSH terms: leukemia, hematological malignancies, stem cell transplantation, mucormycosis, molds, prophilaxis, treatment. EXPERT OPINION The epidemiology of mucormycosis in HMs is changing in the last years. The availability of drugs more effective than in the past against this infection has reduced the mortality; however, a timely diagnosis remains a relevant problem potentially influencing the outcome of hematologic patients with IM.
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Affiliation(s)
- Livio Pagano
- Hematology Section, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy.,Hematology Section, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Giulia Dragonetti
- Hematology Section, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Elena De Carolis
- Microbiology Section, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Giuseppe Veltri
- Radiology Section, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Maria Ilaria Del Principe
- Ematologia, Dipartimento Di Biomedicina E Prevenzione, Università Degli Studi Di Roma "Tor Vergata" , Roma, Italy
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' Della Salute E Della Scienza , Turin, Italy
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127
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Koehler P, Mellinghoff SC, Lagrou K, Alanio A, Arenz D, Hoenigl M, Koehler FC, Lass-Flörl C, Meis JF, Richardson M, Cornely OA. Development and validation of the European QUALity (EQUAL) score for mucormycosis management in haematology. J Antimicrob Chemother 2020; 74:1704-1712. [PMID: 30770712 DOI: 10.1093/jac/dkz051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mucormycosis is a life-threatening infection in immunocompromised patients and in haematological malignancy patients in particular. OBJECTIVES Our aim was to develop and evaluate a scoring tool to measure adherence to current guidelines for mucormycosis. METHODS Current guidelines of scientific societies on mucormycosis management were reviewed. We assembled diagnostic, treatment and follow-up milestones and designed the EQUAL Mucormycosis Score. The EQUAL Mucormycosis Score was evaluated in the ECMM Excellence Centres. RESULTS An 18-item tool with one to three points per item resulted in a maximum achievable score depending on disease complexity and ranging from 25 to 32 points. Given variable patient disease course, the diagnostic score is higher in patients with positive fungal culture and biopsy, thus reflecting more decision points and higher management complexity. Eleven patients from two centres were included during the study period. A total of 200 EQUAL Mucormycosis Score points were achieved, which is 62.7% of the maximum EQUAL Mucormycosis Score of 319 points achievable in that cohort (median 18 points, range 7-27). The total score accomplished for diagnostic procedures was 112 of 165 points (67.9%), for first-line treatment 54 of 88 (61.4%) and for follow-up management 34 of 66 points (51.5%). CONCLUSIONS The EQUAL Mucormycosis Score quantitates adherence to current guideline recommendations for mucormycosis management. With 62.7% of maximum achievable score points, a first result is obtained that may serve as a reference for future evaluations. It remains to be shown whether guideline adherence and mortality rates correlate.
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Affiliation(s)
- Philipp Koehler
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany.,CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Sibylle C Mellinghoff
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany.,CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Katrien Lagrou
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology and Immunology, Excellence Centre for Medical Mycology (ECMM), KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine and National Reference Centre for Mycosis, Excellence Centre for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium
| | - Alexandre Alanio
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris-Diderot, Sorbonne Paris Cité University, Paris, France.,Institut Pasteur, Molecular Mycology Unit, CNRS CMR2000, Paris, France
| | - Dorothee Arenz
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, UCSD, San Diego, CA, USA
| | - Felix C Koehler
- CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Excellence Centre for Medical Mycology (ECMM), Medical University of Innsbruck, Innsbruck, Austria
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Excellence Centre for Medical Mycology (ECMM), Centre of Expertise in Mycology Radboudumc/CWZ, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Malcolm Richardson
- Mycology Reference Centre, Excellence Centre for Medical Mycology (ECMM), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, Excellence Centre for Medical Mycology (ECMM), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Oliver A Cornely
- Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany.,CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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128
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Garcia-Vidal C, Carratalà J, Lortholary O. Defining standards of CARE for invasive fungal diseases in solid organ transplant patients. J Antimicrob Chemother 2020; 74:ii16-ii20. [PMID: 31222312 DOI: 10.1093/jac/dkz039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Fungal infection in solid organ transplant (SOT) recipients is a challenge for physicians. Our aim was to review progress made within the past decade in managing the most important invasive fungal diseases in SOT recipients. Standards of care for candidosis, aspergillosis, mucormycosis and cryptococcosis in this special population are summarized.
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Affiliation(s)
- Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Olivier Lortholary
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Molecular Mycology Unit, CNRS UMR, Paris, France.,Paris Descartes University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, APHP, Necker Enfants Malades University Hospital, Paris, France
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129
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In Vitro Evaluation of Radiolabeled Amphotericin B for Molecular Imaging of Mold Infections. Antimicrob Agents Chemother 2020; 64:AAC.02377-19. [PMID: 32393491 DOI: 10.1128/aac.02377-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/02/2020] [Indexed: 12/17/2022] Open
Abstract
Invasive pulmonary aspergillosis and mucormycosis are life-threatening complications in immunocompromised patients. A rapid diagnosis followed by early antifungal treatment is essential for patient survival. Given the limited spectrum of biomarkers for invasive mold infections, recent studies have proposed the use of radiolabeled siderophores or antibodies as molecular probes to increase the specificity of radiological findings by nuclear imaging modalities. While holding enormous diagnostic potential, most of the currently available molecular probes are tailored to the detection of Aspergillus species, and their cost-intensive and sophisticated implementation restricts their accessibility at less specialized centers. In order to develop cost-efficient and broadly applicable tracers for pulmonary mold infections, this study established streamlined and high-yielding protocols to radiolabel amphotericin B (AMB) with the gamma emitter technetium-99m (99mTc-AMB) and the positron emitter gallium-68 (68Ga-AMB). The radiochemical purity of the resulting tracers consistently exceeded 99%, and both probes displayed excellent stability in human serum (>98% after 60 to 240 min at 37°C). The uptake kinetics by representative mold pathogens were assessed in an in vitro Transwell assay using infected endothelial cell layers. Both tracers accumulated intensively and specifically in Transwell inserts infected with Aspergillus fumigatus, Rhizopus arrhizus, and other clinically relevant mold pathogens compared with their accumulation in uninfected inserts and inserts infected with bacterial controls. Inoculum-dependent enrichment was confirmed by gamma counting and autoradiographic imaging. Taken together, this pilot in vitro study proposes 99mTc-AMB and 68Ga-AMB to be facile, stable, and specific probes, meriting further preclinical in vivo evaluation of radiolabeled amphotericin B for molecular imaging in invasive mycoses.
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130
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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.
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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
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131
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Mousavi B, Botterel F, Costa JM, Arné P, Guillot J, Dannaoui E. Occurrence and species diversity of human-pathogenic Mucorales in commercial food-stuffs purchased in Paris area. Med Mycol 2020; 57:739-744. [PMID: 30428080 DOI: 10.1093/mmy/myy121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 12/23/2022] Open
Abstract
Mucormycoses are life-threatening fungal diseases that affect a variety of patients including those with diabetes mellitus or hematological malignancies. The responsible agents, the Mucorales, are opportunistic pathogens originating from the environment such as soil or decaying organic matter. The aim of the present study was to assess the prevalence and diversity of human-pathogenic species of Mucorales in commercially available foodstuffs in France. All food samples were purchased from January 2014 to May 2015 in France. A total of 159 dried food samples including spices and herbs (n = 68), herbal tea (n = 19), cereals (n = 19), vegetables (n = 14), and other foodstuffs (n = 39) were analyzed. Each strain of Mucorales was identified phenotypically, and molecular identification was performed by ITS sequencing. From the 28 (17.6%) samples that were culture-positive for Mucorales, 30 isolates were recovered. Among the isolates, 13 were identified as Rhizopus arrhizus var. arrhizus, 10 R. arrhizus var. delemar, two Rhizopus microsporus, one Lichtheimia corymbifera, three Lichtheimia ramosa, and one Syncephalastrum racemosum. Culture-positive samples originated from different countries (Europe, Asia) and brands. The samples most frequently contaminated by Mucorales were spices and herbs (19/68, 27.9%), followed by herbal tea (2/19, 10.5%), cereals (2/19, 10.5%), other food products (5/39, 12.8%). The present study showed that human-pathogenic Mucorales were frequently recovered from commercially available foodstuffs in France with a large diversity of species. The potential danger represented by Mucorales present in food for immunocompromised patients should be further analyzed.
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Affiliation(s)
- Bita Mousavi
- Dynamyc Research Group (EA 7380), Paris Est Créteil University, Ecole nationale vétérinaire d'Alfort, France
| | - Françoise Botterel
- Dynamyc Research Group (EA 7380), Paris Est Créteil University, Ecole nationale vétérinaire d'Alfort, France
| | | | - Pascal Arné
- Dynamyc Research Group (EA 7380), Paris Est Créteil University, Ecole nationale vétérinaire d'Alfort, France
| | - Jacques Guillot
- Dynamyc Research Group (EA 7380), Paris Est Créteil University, Ecole nationale vétérinaire d'Alfort, France
| | - Eric Dannaoui
- Dynamyc Research Group (EA 7380), Paris Est Créteil University, Ecole nationale vétérinaire d'Alfort, France.,Paris-Descartes University, Faculty of Medicine, APHP, European Georges Pompidou Hospital, Parasitology-Mycology Unit, Microbiology department, Paris, France
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132
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Claustre J, Larcher R, Jouve T, Truche AS, Nseir S, Cadiet J, Zerbib Y, Lautrette A, Constantin JM, Charles PE, Daubin C, Coudroy R, Dellamonica J, Argaud L, Phelouzat P, Contou D, Pocquet J, Voiriot G, Navellou JC, Lavagne P, Durand M, Cornet M, Schwebel C, Terzi N. Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy. Ann Intensive Care 2020; 10:74. [PMID: 32514787 PMCID: PMC7280386 DOI: 10.1186/s13613-020-00673-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/04/2020] [Indexed: 12/30/2022] Open
Abstract
Background Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic low susceptibility to antifungal agents. We aimed to describe the epidemiology of mucormycosis in intensive care units (ICU) and evaluate the outcomes. We performed a retrospective multi-center study in 16 French ICUs between 2008 and 2017. We compared the patients who survived in ICU and the patients who did not to identify factors associated with ICU survival. Then, we focused on the subgroup of patients with hematological malignancies. Results Mucormycosis was diagnosed in 74 patients during the study period. Among them, 60 patients (81%) were immunocompromised: 41 had hematological malignancies, 9 were solid organ transplant recipients, 31 received long-term steroids, 11 had diabetes, 24 had malnutrition. Only 21 patients survived to ICU stay (28.4%) with a median survival of 22 days (Q1–Q3 = 9–106) and a survival rate at day 28 and day 90, respectively, of 35.1% and 26.4%. Survivors were significantly younger (p = 0.001), with less frequently hematological malignancies (p = 0.02), and less malnutrition (p = 0.05). Median survival in patients with hematological malignancies (n = 41) was 15 days (Q1–Q3 = 5–23.5 days). In this subgroup, curative surgery was a major factor associated with survival in multivariate analysis (odds ratio = 0.71, [0.45–0.97], p < 0.001). Conclusion Overall prognosis of mucormycosis in ICU remains poor, especially in patients with hematological malignancies. In this subgroup of patients, a therapeutic strategy including curative surgery was the main factor associated with survival.
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Affiliation(s)
- Johanna Claustre
- Service de Pneumologie, CH Annecy Genevois, 1 Avenue de l'hôpital, 74370, Epagny Metz-Tessy, France.
| | - Romaric Larcher
- Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France
| | - Thomas Jouve
- Université Grenoble Alpes, Grenoble, France.,Service Hospitalo-universitaire de Néphrologie, CHU Grenoble Alpes, Grenoble, France
| | - Anne-Sophie Truche
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Saad Nseir
- Réanimation Médicale, CHU Lille, Lille, France
| | - Julien Cadiet
- Service de médecine intensive Réanimation, CHU Nantes, Nantes, France
| | | | | | | | | | | | - Remi Coudroy
- Réanimation médicale, CHU Poitiers, Poitiers, France
| | - Jean Dellamonica
- Médecine Intensive Réanimation, CHU Nice, Université Côte d'Azur, Nice, France
| | | | | | - Damien Contou
- Réanimation polyvalente, CH Argenteuil, Argenteuil, France
| | | | | | | | - Pierre Lavagne
- Réanimation Polyvalente Chirurgicale, CHU Grenoble Alpes, Grenoble, France
| | - Michel Durand
- Réanimation Cardio-vasculaire et Thoracique, CHU Grenoble Alpes, Grenoble, France
| | - Muriel Cornet
- Université Grenoble Alpes, Grenoble, France.,Laboratoire de Mycologie-Parasitologie, CHU Grenoble Alpes, Grenoble, France
| | - Carole Schwebel
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Nicolas Terzi
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
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133
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CRISPR-Cas9-Based Mutagenesis of the Mucormycosis-Causing Fungus Lichtheimia corymbifera. Int J Mol Sci 2020; 21:ijms21103727. [PMID: 32466287 PMCID: PMC7279233 DOI: 10.3390/ijms21103727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
Lichtheimia corymbifera is considered as one of the most frequent agents of mucormycosis. The lack of efficient genetic manipulation tools hampers the characterization of the pathomechanisms and virulence factors of this opportunistic pathogenic fungus. Although such techniques have been described for certain species, the performance of targeted mutagenesis and the construction of stable transformants have remained a great challenge in Mucorales fungi. In the present study, a plasmid-free CRISPR-Cas9 system was applied to carry out a targeted gene disruption in L. corymbifera. The described method is based on the non-homologous end-joining repair of the double-strand break caused by the Cas9 enzyme. Using this method, short, one-to-five nucleotide long-targeted deletions could be induced in the orotidine 5′-phosphate decarboxylase gene (pyrG) and, as a result, uracil auxotrophic strains were constructed. These strains are applicable as recipient strains in future gene manipulation studies. As we know, this is the first genetic modification of this clinically relevant fungus.
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134
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Berot V, Bernigaud C, Ferchiou A, Ingen-Housz-Oro S, Hüe S, Ajzenberg C, Thomas S, Wieliczko-Duparc E, Billaud E, Ait-Ammar N, Ortonne N, Botterel F, Chosidow O. Extensive cutaneous and muscular mucormycosis complicating insulin pump treatment. J Eur Acad Dermatol Venereol 2020; 34:e486-e489. [PMID: 32242983 DOI: 10.1111/jdv.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- V Berot
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Bernigaud
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Research Group Dynamyc, EA7380, Faculté de médecine Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Créteil, France
| | - A Ferchiou
- Department of Immunology, AP-HP, Henri Mondor Hospital, Créteil, France.,INSERM U955, Equipe 21, Université Paris-Est, Créteil, France
| | - S Ingen-Housz-Oro
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S Hüe
- Department of Immunology, AP-HP, Henri Mondor Hospital, Créteil, France.,INSERM U955, Equipe 16, Université Paris-Est, Créteil, France
| | - C Ajzenberg
- Department of Diabetology and Endocrinology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S Thomas
- Quality and Risks Management, AP-HP, Henri Mondor Hospital, Créteil, France
| | - E Wieliczko-Duparc
- Regional Coordinator of Medical Device Surveillance, Materiovigilance et Réactovigilance Ile-de-France, AP-HP, Henri Mondor Hospital, Créteil, France
| | - E Billaud
- Department of Pharmacology, AP-HP, European Georges Pompidou Hospital, Paris, France
| | - N Ait-Ammar
- Research Group Dynamyc, EA7380, Faculté de médecine Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Créteil, France.,Unit of Mycology and Parasitology, Department of microbiology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - N Ortonne
- Department of Pathology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - F Botterel
- Research Group Dynamyc, EA7380, Faculté de médecine Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Créteil, France.,Unit of Mycology and Parasitology, Department of microbiology, AP-HP, Henri Mondor Hospital, Créteil, France
| | - O Chosidow
- Department of Dermatology, AP-HP, Henri Mondor Hospital, Créteil, France.,Research Group Dynamyc, EA7380, Faculté de médecine Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Créteil, France
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135
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Ruhnke M, Cornely OA, Schmidt-Hieber M, Alakel N, Boell B, Buchheidt D, Christopeit M, Hasenkamp J, Heinz WJ, Hentrich M, Karthaus M, Koldehoff M, Maschmeyer G, Panse J, Penack O, Schleicher J, Teschner D, Ullmann AJ, Vehreschild M, von Lilienfeld-Toal M, Weissinger F, Schwartz S. Treatment of invasive fungal diseases in cancer patients-Revised 2019 Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Mycoses 2020; 63:653-682. [PMID: 32236989 DOI: 10.1111/myc.13082] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects. OBJECTIVES Since the last edition of recommendations for 'Treatment of invasive fungal infections in cancer patients' of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre-emptive therapy of probable IFD. METHODS The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English-language publications from January 1975 up to September 2019 using the key terms such as 'invasive fungal infection' and/or 'invasive fungal disease' and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis. RESULTS AFT of IFDs in cancer patients may include not only antifungal agents but also non-pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials. CONCLUSIONS Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information.
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Affiliation(s)
- Markus Ruhnke
- Division of Haematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,ECMM Excellence Centre of Medical Mycology, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | | | - Nael Alakel
- Department I of Internal Medicine, Haematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Boris Boell
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation & Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Justin Hasenkamp
- Clinic for Haematology and Medical Oncology with Department for Stem Cell Transplantation, University Medicine Göttingen, Göttingen, Germany
| | - Werner J Heinz
- Schwerpunkt Infektiologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Marcus Hentrich
- Hämatologie und Internistische Onkologie, Innere Medizin III, Rotkreuzklinikum München, München, Germany
| | - Meinolf Karthaus
- Department of Haematology & Oncology, Municipal Hospital Neuperlach, München, Germany
| | - Michael Koldehoff
- Klinik für Knochenmarktransplantation, Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen (AöR), Essen, Germany
| | - Georg Maschmeyer
- Department of Hematology, Onclogy and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Jens Panse
- Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Universitätsklinikum Aachen, Aachen, Germany
| | - Olaf Penack
- Division of Haematology & Oncology, Department of Internal Medicine, Charité University Medicine, Campus Rudolf Virchow, Berlin, Germany
| | - Jan Schleicher
- Klinik für Hämatologie Onkologie und Palliativmedizin, Katharinenhospital, Stuttgart, Germany
| | - Daniel Teschner
- III. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Andrew John Ullmann
- Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany
| | - Maria Vehreschild
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,ECMM Excellence Centre of Medical Mycology, Cologne, Germany.,Zentrum für Innere Medizin, Infektiologie, Goethe Universität Frankfurt, Frankfurt am Main, Deutschland.,Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Köln, Deutschland
| | - Marie von Lilienfeld-Toal
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Florian Weissinger
- Division of Haematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Stefan Schwartz
- Division of Haematology & Oncology, Department of Internal Medicine, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
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136
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Pan J, Tsui C, Li M, Xiao K, de Hoog GS, Verweij PE, Cao Y, Lu H, Jiang Y. First Case of Rhinocerebral Mucormycosis Caused by Lichtheimia ornata, with a Review of Lichtheimia Infections. Mycopathologia 2020; 185:555-567. [PMID: 32388712 DOI: 10.1007/s11046-020-00451-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lichtheimia species are emerging opportunistic fungal pathogens in the Mucorales, causing serious skin and respiratory infections in immunocompromised patients. Established agents are Lichtheimia corymbifera and L. ramosa, while L. ornata is a novel agent. Available data on a species-specific analysis of Lichtheimia infections are limited. METHODS The first case of a fatal rhino-orbital-cerebral infection in a hematopoietic stem cell transplantation recipient caused by L. ornata is reported; the agent was identified by sequencing the ITS ribosomal region. We reviewed the literature on mucormycosis due to Lichtheimia species between 2009 and 2018, with an analysis of risk factors and epidemiological and clinical data. RESULTS In addition to our Lichtheimia ornata case, 44 cases of human Lichtheimia were analyzed. Lichtheimia predominated in Europe (68.2%), followed by Asia (16%), and Africa (9%). The most common underlying condition was hematological malignancy (36.3%), followed by trauma/major surgery (27.3%), while diabetes mellitus was rare (11.4%). Site of infection was mostly skin and soft tissues (45.5%) and lung (25%), while relatively few cases were disseminated (13.6%) or rhinocerebral (11.4%). Mortality (36.4%) was mainly due to disseminated and rhinocerebral infections. CONCLUSION In contrast to Rhizopus, the most common agent of mucormycosis recorded in patients with diabetes mellitus, Lichtheimia infections were primarily associated with hematological malignancies and major skin barrier damage. Given the fact that classical rhinocerebral mucormycosis remains difficult to treat, independent of causative species, timely application of amphotericin B accessory to debridement may be required for patient survival.
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Affiliation(s)
- Junling Pan
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Clement Tsui
- Department of Pathology, Sidra Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mengxing Li
- Department of Hematology, The Affiliated Hospital, Guizhou Medical University, Guiyang, China
| | - Kun Xiao
- Department of Radiology, Guiyang Third People's Hospital, Guiyang, China
| | - G Sybren de Hoog
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Yu Cao
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Hongguang Lu
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Yanping Jiang
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China. .,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands. .,Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
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137
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Son HJ, Song JS, Choi S, Jung J, Kim MJ, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH. Risk factors for mortality in patients with pulmonary mucormycosis. Mycoses 2020; 63:729-736. [PMID: 32304253 DOI: 10.1111/myc.13092] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pulmonary mucormycosis (PM) represents a serious burden in terms of morbidity and mortality in immunocompromised patients. Studies of prognostic factors in patients with PM are limited and have involved small numbers of patients. METHODS Adult patients diagnosed with proven and probable PM according to the modified definitions of the EORTC/MSG 2008 in a tertiary hospital in Seoul, South Korea, between 2008 and 2019 were retrospectively enrolled. RESULTS A total of 49 patients including 31 (63%) with proven PM and 18 (37%) with probable PM were enrolled. The 90-day mortality rate was 49% (24/49). Neutropenia, thrombocytopenia, use of voriconazole at clinical suspicion, positivity of non-sterile culture, use of steroid and treatment without surgery were more common in fatal cases than non-fatal cases. Voriconazole use at clinical suspicion for invasive mould pneumonia (OR 6.91, P = .01) and prolonged neutropenia (OR 4.86, P = .03) were independent risk factors for mortality. Voriconazole use at clinical suspicion was associated with positive galactomannan (GM) assay (OR 5.93, P = .02) and history of invasive pulmonary aspergillosis (OR, 6.88, P = .05). CONCLUSION About half of the patients with PM died within 90 days of diagnosis, and fatal outcomes were common in patients with prolonged neutropenia and empirical voriconazole use. Caution is needed in using voriconazole even in patients with positive GM results and prior histories of invasive pulmonary aspergillosis in whom PM cannot be ruled out by differential diagnosis.
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Affiliation(s)
- Hyo-Ju Son
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sungim Choi
- Department of Infectious Diseases, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hoffmann C, Guillerm G, Le Pape P, Carausu L, Lavergne RA, Nevez G, Le Gal S. Mucorales DNA detection in serum specimens for early diagnosis of mucormycosis. Diagn Microbiol Infect Dis 2020; 97:115004. [PMID: 32156450 DOI: 10.1016/j.diagmicrobio.2020.115004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
Abstract
We report a case of pulmonary mucormycosis in a patient with T-cell acute lymphoblastic leukemia. The diagnosis of mucormycosis was initially based on mycological examination of a pulmonary specimen. However, we describe how it could have been made 2 months earlier using polymerase chain reaction assays targeting Mucorales species on serum specimens.
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Affiliation(s)
- Claire Hoffmann
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France
| | - Gaëlle Guillerm
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Patrice Le Pape
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, CHU de Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France
| | - Liana Carausu
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Rose-Anne Lavergne
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, CHU de Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France.
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139
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Mihailides L, Croda M, Forrestel AK. Recognition and Management of Angioinvasive Fungal Infections. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00296-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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140
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Shao W, Zhang J, Ma S, Feng H, Zhang Z, Liang C, Liu D. Characteristics of pulmonary mucormycosis and the experiences of surgical resection. J Thorac Dis 2020; 12:733-740. [PMID: 32274139 PMCID: PMC7139020 DOI: 10.21037/jtd.2019.12.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Pulmonary mucormycosis (PM) is a relatively rare but fatal infection. However, detailed surgery data have been lacking. We summarized the characteristics of this rare disease and clarified the experiences of surgical resection Methods We conducted a single-center retrospective study of seven patients with PM who underwent surgical resection at China-Japan Friendship Hospital from May 2011 to May 2018. Results Patient ages ranged from 18 to 70 years, with a median age of 47 years. Manual workers (85.7%) were the most common occupation and their educational level was also below high school. Diabetes was the most common underlying condition. The most common radiographic finding was lobar consolidation. Three patients directly underwent open thoracotomy, one patient underwent video-assisted thoracic surgery (VATS) and three patients converted from VATS to thoracotomy. The median operation time was 240 min [interquartile range (IQR), 150–390 min], the median intraoperative blood loss was 500 mL (IQR, 100–1,200 mL) and the median intraoperative blood transfusion was 600 mL (IQR, 0–1,600 mL). In-hospital, 90-day, 1-year and 5-year mortality were 14.3%, 14.3%, 28.8% and 42.9%, respectively. Conclusions PM is a rare but fatal infection. Due to chest adhesion and vascular invasion, the proportion of massive bleeding and long operation time has increased sharply.
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Affiliation(s)
- Weipeng Shao
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Jun Zhang
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Shanwu Ma
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyang Liang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
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141
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Giacobbe DR, Riccardi N, Vena A, Bassetti M. Mould Infections of Traumatic Wounds: A Brief Narrative Review. Infect Dis Ther 2020; 9:1-15. [PMID: 32072492 PMCID: PMC7054562 DOI: 10.1007/s40121-020-00284-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
Mould infections may follow traumatic injuries, with direct fungal inoculum in the site of injury and subsequent angioinvasion, possibly resulting in tissue necrosis and systemic dissemination. The pathogenesis of mould infections following trauma injuries presents unique features compared with classical mould infections occurring in neutropenic or diabetic patients, because a large fraction of post-traumatic mould infections is observed in previously healthy individuals. Most of the published clinical experience and research on mould infections following traumatic injuries regards soldiers and infections after natural disasters. However, following trauma and soil contamination (e.g., agricultural or automotive injuries) other immunocompetent individuals may develop mould infections. In these cases, delays in correct diagnosis and treatment may occur if pertinent signs such as necrosis and absent or reduced response to antibacterial therapy are not promptly recognized. Awareness of mould infections in at-risk populations is needed to rapidly start adequate laboratory workflow and early antifungal therapy in rapidly evolving cases to improve treatment success and reduce mortality.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
| | - Niccolò Riccardi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
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142
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Mensa J, Dueñas Gutiérrez C, Cardozo C, Rodríguez Fernández L, Kestler M, Muñoz P, Bouza E. Neck infection after allogenic hematopoietic progenitors transplantation. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:130-136. [PMID: 32056419 PMCID: PMC7111238 DOI: 10.37201/req/100.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Mensa
- Dr. Josep Mensa, Infectious Disease Service, Hospital Clinic I Provincial, Barcelona, Spain.
| | | | | | | | | | | | - E Bouza
- Dr. Emilio Bouza, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain.
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143
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Koehler P, Mellinghoff SC, Stemler J, Otte F, Berkhoff A, Beste N, Budin S, Cornely FB, Evans JM, Fuchs F, Pesch L, Rebholz AW, Reiner O, Schmitt M, Schuckelt J, Spiertz A, Salmanton-García J, Kron F, Cornely OA. Quantifying guideline adherence in mucormycosis management using the EQUAL score. Mycoses 2020; 63:343-351. [PMID: 31876327 DOI: 10.1111/myc.13047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Mucormycosis is a difficult-to-diagnose life-threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany. METHODS We performed a retrospective chart review of patients with mucormycosis at the University Hospital of Cologne. Data collection comprised items for quality assessment in mucormycosis management according to the EQUAL Mucormycosis Score and economics. RESULTS Of 29 patients identified, 27 were documented retrospectively. Eight patients of 18 with neutropenia (>10 days) or receiving allogeneic stem cell transplantation (44.4%) received mould active prophylaxis. Chest CT was done in 21 patients (77.8%), while BAL and direct microscopy of BAL fluid was performed in 22 patients (81.5%), culture in 22 (81.5%) and fungal PCR in 24 (88.9%). First-line treatment was liposomal amphotericin B in 19 patients (70.4%). Isavuconazole or posaconazole with therapeutic drug monitoring was used in four (14.8%) and in one patient (3.7%), respectively. In our cohort, crude mortality was 51.9% (n = 14) with a median survival time of 113 days. During the management of the 27 patients, 450 points (53.8%) of the maximum EQUAL Mucormycosis Score were achieved (median 15 points, range 6-30). CONCLUSIONS We observed management of mucormycosis aligning with current guidelines and hope to encourage other groups to use the EQUAL Score in routine clinical settings. Future studies will evaluate whether guideline adherence in mucormycosis management improves patient outcome.
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Affiliation(s)
- Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Sibylle C Mellinghoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Jannik Stemler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | | | | | | | | | - Florian B Cornely
- University of Cologne, Cologne, Germany.,Medical University of Varna, Varna, Bulgaria
| | | | - Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Florian Kron
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,FOM University of Applied Sciences, Essen, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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144
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Wand O, Unterman A, Izhakian S, Fridel L, Kramer MR. Mucormycosis in lung transplant recipients: A systematic review of the literature and a case series. Clin Transplant 2020; 34:e13774. [PMID: 31860739 DOI: 10.1111/ctr.13774] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mucormycosis is a rare infection in lung transplant recipients (LTR). Our objective was to better define the clinical presentation and optimal management of this frequently lethal infection. METHODS A systematic review of the literature was performed to identify all published cases of mucormycosis in LTR using PubMed/MEDLINE. These cases were analyzed together with a new case series from our clinic. RESULTS Literature search yielded 44 articles matching the inclusion criteria, describing 121 cases. Six additional cases were identified from our clinic. Data regarding infection site and outcome were available for a total of 53 patients. The lungs were the most common site of infection (62%), followed by rhinocerebral and disseminated disease. Most cases (78%) developed in the first post-transplant year, with over 40% of them in the first month. Additional risk factors for mucormycosis were identified in over half of the patients. Surgical debridement was uncommon in pulmonary infection (9%). Posaconazole therapy was used in 35% of cases, mostly in combination with amphotericin B. Overall mortality was 32% but varied according to site of infection. CONCLUSION Mucormycosis in LTRs tends to be an early post-surgical infection, associated with additional risk factors and intensified immunosuppressive states, and most often affects the lungs, where surgical debridement is rarely feasible. Posaconazole as first-line therapy should be further explored.
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Affiliation(s)
- Ori Wand
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pulmonary Division, Meir Medical Center, Kfar-Sava, Israel
| | - Avraham Unterman
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Yale University School of Medicine, New Haven, CT, USA
| | - Shimon Izhakian
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel
| | - Ludmila Fridel
- Pathology Institute, Rabin Medical Center, Petach Tiqwa, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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145
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Garcia A, Fan YY, Vellanki S, Huh EY, Vanegas D, Wang SH, Lee SC. Nanoemulsion as an Effective Treatment against Human-Pathogenic Fungi. mSphere 2019; 4:e00729-19. [PMID: 31852807 PMCID: PMC6920514 DOI: 10.1128/msphere.00729-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/30/2019] [Indexed: 11/30/2022] Open
Abstract
Infections triggered by pathogenic fungi cause a serious threat to the public health care system. In particular, an increase of antifungal drug-resistant fungi has resulted in difficulty in treatment. A limited variety of antifungal drugs available to treat patients has left us in a situation where we need to develop new therapeutic approaches that are less prone to development of resistance by pathogenic fungi. In this study, we demonstrate the efficacy of the nanoemulsion NB-201, which utilizes the surfactant benzalkonium chloride, against human-pathogenic fungi. We found that NB-201 exhibited in vitro activity against Candidaalbicans, including both planktonic growth and biofilms. Furthermore, treatments with NB-201 significantly reduced the fungal burden at the infection site and presented an enhanced healing process after subcutaneous infections by multidrug-resistant C. albicans in a murine host system. NB-201 also exhibited in vitro growth inhibition activity against other fungal pathogens, including Cryptococcus spp., Aspergillus fumigatus, and Mucorales Due to the nature of the activity of this nanoemulsion, there is a minimized chance of drug resistance developing, presenting a novel treatment to control fungal wound or skin infections.IMPORTANCE Advances in medicine have resulted in the discovery and implementation of treatments for human disease. While these recent advances have been beneficial, procedures such as solid-organ transplants and cancer treatments have left many patients in an immunocompromised state. Furthermore, the emergence of immunocompromising diseases such as HIV/AIDS or other immunosuppressive medical conditions have opened an opportunity for fungal infections to afflict patients globally. The development of drug resistance in human-pathogenic fungi and the limited array of antifungal drugs has left us in a scenario where we need to develop new therapeutic approaches to treat fungal infections that are less prone to the development of resistance by pathogenic fungi. The significance of our work lies in utilizing a novel nanoemulsion formulation to treat topical fungal infections while minimizing risks of drug resistance development.
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Affiliation(s)
- Alexis Garcia
- South Texas Center for Emerging Infectious Diseases (STCEID), Department of Biology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Yong Yi Fan
- Michigan Nanotechnology Institute for Medicine & Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Sandeep Vellanki
- South Texas Center for Emerging Infectious Diseases (STCEID), Department of Biology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Eun Young Huh
- South Texas Center for Emerging Infectious Diseases (STCEID), Department of Biology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - DiFernando Vanegas
- South Texas Center for Emerging Infectious Diseases (STCEID), Department of Biology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Su He Wang
- Michigan Nanotechnology Institute for Medicine & Biological Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Soo Chan Lee
- South Texas Center for Emerging Infectious Diseases (STCEID), Department of Biology, University of Texas at San Antonio, San Antonio, Texas, USA
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146
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McGraw C, Carrick M, Ekengren F, Berg G, Lieser M, Orlando A, Madayag R, Tanner Ii A, Kelly M, Banton K, Bar-Or D. Severe fungal infections following blunt traumatic injuries: A 5-year multicenter descriptive study. Injury 2019; 50:2234-2239. [PMID: 31630781 DOI: 10.1016/j.injury.2019.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/12/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aggressive and timely treatment of post-traumatic fungal infections is the most efficacious way to reduce morbidity and mortality. Compared to the military trauma population, studies reporting on fungal infections in civilian trauma are not well described. The purpose of this study was to describe characteristics of civilian trauma patients who developed fungal infections and to identify common risk factors and report any delays between injury and treatment. METHODS This was a five-year (1/1/2013-3/1/2018) retrospective, descriptive study across six level 1 trauma centers. All consecutively admitted trauma patients (≥18 years) with laboratory-confirmed fungal wound infections were included. Patients with solely candida wound isolates were excluded. Patient demographics, clinical wound and infection characteristics, organisms cultured, treatment modalities, length of stay, in-hospital mortality, and any diagnostic or treatment delays were described. RESULTS Of the 54,521 trauma patients screened for fungal infection, 12 were identified. All patients suffered major injuries after blunt trauma (abbreviated injury score 3-5) and sustained wound contamination, and in nine patients, the cause of injury was motor vehicle. Six had open wounds/fractures on admission. The geographical region with the highest rate of fungal infection was Texas (n = 7), followed by Kansas (N = 3), then Missouri (N = 2). First symptoms of infection (leukocytosis or fever (n = 10)) presented a median of 6.3 (4.1-9.8) days after injury. Wound management entailed a combination of debridements (n = 8), negative pressure wound therapy (n = 9), amputation (n = 6), and antifungal treatment (n = 10). All fungal isolates identified from the wound site were hyphomycetes. A median of 2.1 (1.8-4.0) days passed from diagnosis to first antifungal treatment, and 3 patients died. CONCLUSIONS Our study shows the challenges surrounding diagnosis and treatment of fungal infections secondary to trauma. Non-specific fungal infection symptoms, such as leukocytosis and fever, typically presented a week after injury. Vigilance for investigating risk factors and infection symptoms may help clinicians with more timely management of trauma patients with a severe fungal infection.
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Affiliation(s)
- Constance McGraw
- Medical City Plano, Trauma Research Department, Plano, TX, United States; Wesley Medical Center, Trauma Research Department, Wichita, KS, United States; Research Medical Center, Trauma Research Department, Kansas City, MO, United States; St. Anthony Hospital, Trauma Research Department, Lakewood, CO, United States; Penrose Hospital, Trauma Research Department, Colorado Springs, CO, United States; Swedish Medical Center, Trauma Research Department, Englewood, CO, United States
| | - Matthew Carrick
- Medical City Plano, Trauma Services Department, Plano, TX, United States
| | - Francie Ekengren
- Wesley Medical Center, Trauma Services Department, Wichita, KS, United States
| | - Gina Berg
- Wesley Medical Center, Trauma Services Department, Wichita, KS, United States
| | - Mark Lieser
- Research Medical Center, Trauma Services Department, Kansas City, MO, United States
| | - Alessandro Orlando
- Medical City Plano, Trauma Research Department, Plano, TX, United States; Wesley Medical Center, Trauma Research Department, Wichita, KS, United States; Research Medical Center, Trauma Research Department, Kansas City, MO, United States; St. Anthony Hospital, Trauma Research Department, Lakewood, CO, United States; Penrose Hospital, Trauma Research Department, Colorado Springs, CO, United States; Swedish Medical Center, Trauma Research Department, Englewood, CO, United States
| | - Robert Madayag
- St. Anthony Hospital, Trauma Services Department, Lakewood, CO, United States
| | - Allen Tanner Ii
- Penrose Hospital, Trauma Services Department, Colorado Springs, CO, United States
| | - Michael Kelly
- Penrose Hospital, Trauma Services Department, Colorado Springs, CO, United States
| | - Kaysie Banton
- Swedish Medical Center, Trauma Services Department, Englewood, CO, United States
| | - David Bar-Or
- Medical City Plano, Trauma Research Department, Plano, TX, United States; Wesley Medical Center, Trauma Research Department, Wichita, KS, United States; Research Medical Center, Trauma Research Department, Kansas City, MO, United States; St. Anthony Hospital, Trauma Research Department, Lakewood, CO, United States; Penrose Hospital, Trauma Research Department, Colorado Springs, CO, United States; Swedish Medical Center, Trauma Research Department, Englewood, CO, United States.
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147
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Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, Mellinghoff SC, Mer M, Pana ZD, Seidel D, Sheppard DC, Wahba R, Akova M, Alanio A, Al-Hatmi AMS, Arikan-Akdagli S, Badali H, Ben-Ami R, Bonifaz A, Bretagne S, Castagnola E, Chayakulkeeree M, Colombo AL, Corzo-León DE, Drgona L, Groll AH, Guinea J, Heussel CP, Ibrahim AS, Kanj SS, Klimko N, Lackner M, Lamoth F, Lanternier F, Lass-Floerl C, Lee DG, Lehrnbecher T, Lmimouni BE, Mares M, Maschmeyer G, Meis JF, Meletiadis J, Morrissey CO, Nucci M, Oladele R, Pagano L, Pasqualotto A, Patel A, Racil Z, Richardson M, Roilides E, Ruhnke M, Seyedmousavi S, Sidharthan N, Singh N, Sinko J, Skiada A, Slavin M, Soman R, Spellberg B, Steinbach W, Tan BH, Ullmann AJ, Vehreschild JJ, Vehreschild MJGT, Walsh TJ, White PL, Wiederhold NP, Zaoutis T, Chakrabarti A. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. THE LANCET. INFECTIOUS DISEASES 2019; 19:e405-e421. [PMID: 31699664 PMCID: PMC8559573 DOI: 10.1016/s1473-3099(19)30312-3] [Citation(s) in RCA: 896] [Impact Index Per Article: 179.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/10/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Abstract
Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
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Affiliation(s)
- Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany.
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Dorothee Arenz
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, and the Department of Infectious Diseases, Westmead Hospital, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Eric Dannaoui
- Université Paris-Descartes, Faculté de Médecine, APHP, Hôpital Européen Georges Pompidou, Unité de Parasitologie-Mycologie, Service de Microbiologie, Paris, France
| | - Bruno Hochhegger
- Radiology, Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, Brazil; Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven and Clinical Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Russell E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Mervyn Mer
- Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Zoi D Pana
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Danila Seidel
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Donald C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Roger Wahba
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alexandre Alanio
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Abdullah M S Al-Hatmi
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands; Centre of Expertise in Mycology RadboudUMC/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; Ministry of Health, Directorate General of Health Services, Ibri, Oman
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University School of Medicine, Sıhhiye Ankara, Turkey
| | - Hamid Badali
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ronen Ben-Ami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Medical Center, Tel- Aviv, Israel
| | - Alexandro Bonifaz
- Dermatology Service & Mycology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Stéphane Bretagne
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Methee Chayakulkeeree
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arnaldo L Colombo
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dora E Corzo-León
- Department of Epidemiology and Infectious Diseases, Hospital General Dr Manuel Gea González, Mexico City, Mexico; Medical Mycology and Fungal Immunology/Wellcome Trust Strategic Award Program, Aberdeen Fungal Group, University of Aberdeen, King's College, Aberdeen, UK
| | - Lubos Drgona
- Oncohematology Clinic, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Andreas H Groll
- InfectiousDisease Research Program, Department of Paediatric Hematology/Oncology and Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany
| | - Jesus Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación v Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Claus-Peter Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nikolay Klimko
- Department of Clinical Mycology, Allergology and Immunology, North Western State Medical University, St Petersburg, Russia
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Fanny Lanternier
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Cornelia Lass-Floerl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Korea
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Badre E Lmimouni
- School of Medicine and Pharmacy, University Mohammed the fifth, Hay Riad, Rabat, Morocco
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iaşi, Romania
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rita Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Yaba, Lagos, Nigeria; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Livio Pagano
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli -IRCCS- Universita Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Pasqualotto
- Federal University of Health Sciences of Porto Alegre, Hospital Dom Vicente Scherer, Porto Alegre, Brazil
| | - Atul Patel
- Infectious Diseases Clinic, Vedanta Institute of Medical Sciences, Navarangpura, Ahmeddabad, India
| | - Zdenek Racil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Malcolm Richardson
- UK NHS Mycology Reference Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Markus Ruhnke
- Hämatologie & Internistische Onkologie, Lukas-Krankenhaus Bünde, Onkologische Ambulanz, Bünde, Germany
| | - Seyedmojtaba Seyedmousavi
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran; Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Neeraj Sidharthan
- Department of Hemato Oncology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham University, Kochi, India
| | - Nina Singh
- Division of Infectious Diseases, University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System, Infectious Diseases Section, University of Pittsburgh, Pittsburgh, PA, USA
| | - János Sinko
- Infectious Diseases Unit, Szent Istvan and Szent Laszlo Hospital, Budapest, Hungary
| | - Anna Skiada
- Department of Infectious Diseases, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Monica Slavin
- University of Melbourne, Melbourne, VIC, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Melbourne, VIC, Australia
| | - Rajeev Soman
- P D Hinduja Hospital & Medical Research Centre, Department of Medicine, Veer Sarvarkar Marg, Mumbai, India
| | - Brad Spellberg
- Los Angeles County and University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - William Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapur, Singapore
| | - Andrew J Ullmann
- Department for Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Jörg J Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas J Walsh
- Departments of Medicine, Pediatrics, Microbiology & Immunology, Weill Cornell Medicine, and New York Presbyterian Hospital, New York City, NY, USA
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, UHW, Heath Park, Cardiff, UK
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Shadrivova OV, Burygina EV, Klimko NN. Molecular Diagnostics of Mucormycosis in Hematological Patients: A Literature Review. J Fungi (Basel) 2019; 5:jof5040112. [PMID: 31795369 PMCID: PMC6958327 DOI: 10.3390/jof5040112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES to analyze the results of molecular methods applying for the diagnosis of mucormycosis in hematologic patients based on a literature review. DATA SOURCES A systematic search in databases PubMed, Google Scholar for August 2019. Review eligibility criteria: original articles published in English, studies of molecular methods for the diagnosis of mucormycosis in hematologic patients. RESULTS We analyzed the research data from 116 hematological patients with mucormycosis, including children (6%). Patients with localized forms of mucormycosis prevailed (72%), and lung involvement was diagnosed in 58% of these cases. For molecular verification of the causative agent of mucormycosis, blood serum was most often used, less commonly postoperative and autopsy material, biopsy specimens, formalin-fixed paraffin-embedded samples and bronchoalveolar lavage, pleural fluid and sputum. The sensitivity of molecular diagnostics of mucormycosis in a cohort of hematological patients was 88.2%. CONCLUSION The use of molecular techniques along with standard mycological methods will improve the diagnostics of mucormycosis in hematologic patients. However, prospective studies of the effectiveness of molecular methods for the diagnosis of mucormycosis of various etiologies in hematological patients, including children, using bronchoalveolar lavage (BAL) and cerebrospinal fluid (CSF) are needed.
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Treatment of Non-Aspergillus Mold Infections: a Focus on Mucormycosis and Fusariosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00205-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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