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López-Medrano F, Fernández-Ruiz M, Silva JT, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Moreno A, Carratalà J, Blanes M, Hernández D, Fariñas MC, Andrés A, Aguado JM. Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study. Am J Transplant 2016; 16:3220-3234. [PMID: 27105907 DOI: 10.1111/ajt.13837] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/17/2016] [Indexed: 01/25/2023]
Abstract
The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; p-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Harbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A P de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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152
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Llinares P, Ruiz I, Zaragoza R, Ferrer R, Rodríguez AH, Maseda E, Grau S. EPICO 3.0. Empirical antifungal therapy in critically-ill hematology patients. Rev Iberoam Micol 2016; 33:206-215. [PMID: 27751781 DOI: 10.1016/j.riam.2016.06.002] [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: 03/17/2016] [Revised: 06/06/2016] [Accepted: 06/20/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Although in the past decade the management of invasive fungal infections has improved, a number of controversies persist regarding empirical antifungal treatment in critically-ill hematology patients. AIMS To identify key clinical knowledge to elaborate a set of recommendations, with a high level of consensus, necessary for the approach to fungal infections in critically-ill hematology patients. METHODS A Spanish prospective questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists in fungal invasive infections from six scientific national societies; intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases. They responded to 10 questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category must be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm. RESULTS Assess administering antifungal treatment to patients with high/medium risk factors and fever for over 4 days after onset of antibiotic therapy, and in the event of negative galactomannan or if no detection analysis has been performed and no relevant findings in the sinus and chest computed tomography (CT) have been detected, (1) in the case the patient did not receive prophylaxis, or was administered fluconazole, caspofungin treatment is recommended; (2) in the event the patient received prophylaxis with an azole with activity against filamentous fungi, the administration of liposomal amphotericin B is recommended and caspofungin as second choice therapy; (3) in the event that the prophylaxis received was an echinocandin, liposomal amphotericin B therapy is recommended and voriconazole as second choice. Assess administering antifungal treatment in patients with high/medium risk factors and fever for more than 4 days after onset of antibiotic therapy, and in the event of a positive galactomannan and/or sinus and chest CT suggests fungal infection caused by filamentous fungi, (1) in the event the patient did not receive antifungal prophylaxis or was administered fluconazole, the recommended treatment of choice is voriconazole or liposomal amphotericin B; (2) if the patient received prophylaxis with an azole with activity against filamentous fungi, the administration of liposomal amphotericin B with caspofungin is recommended and monotherapy with liposomal amphotericin B or the combination of voriconazole and anidulafungin are recommended as second choice therapies; (3) in the event an echinocandin was administered as prophylaxis, liposomal amphotericin B or voriconazole are the recommended treatments of choice. Consider the administration of antifungal treatment in patients with high/medium risk factors and fever for more than 4 days after onset of antibiotic therapy, and in the event of a negative galactomannan and the sinus and chest CT suggests fungal infection caused by filamentous fungi, (1) if the patient did not receive prophylaxis or was administered fluconazole, the recommended treatment of choice is liposomal amphotericin B or voriconazole; (2) in the case the patient received prophylaxis with an azole with activity against filamentous fungi, the administration of liposomal amphotericin B is recommended as first choice therapy and liposomal amphotericin B combined with caspofungin as second choice; (3) in the event an echinocandin was administered as prophylaxis, liposomal amphotericin B or voriconazole are the recommended treatments of choice. CONCLUSIONS The empirical antifungal approach in critically-ill hematology patients requires the application of the broad range of knowledge and skills described in our recommendations and algorithm. These recommendations, based on the DELPHI methodology, may help to identify potential patients, standardize their management and improve overall prognosis.
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Affiliation(s)
- Pedro Llinares
- Infectious Diseases Service, A Coruña University Complex Hospital, A Coruña, Spain.
| | - Isabel Ruiz
- Infectious Diseases Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rafael Zaragoza
- Intensive Care Medicine Service, Dr. Peset University Hospital, Valencia, Spain
| | - Ricard Ferrer
- Intensive Care Medicine Service, Mutua de Terrassa University Hospital, Barcelona, Spain
| | | | - Emilio Maseda
- Anesthesiology Service, La Paz University Hospital, Madrid, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
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153
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Alanio A, Bretagne S. Performance evaluation of multiplex PCR including Aspergillus-not so simple! Med Mycol 2016; 55:56-62. [PMID: 27664168 DOI: 10.1093/mmy/myw080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 04/25/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022] Open
Abstract
Multiplex PCRs have been designed for including species other than Aspergillus fumigatus for the diagnosis of invasive aspergillosis, such as microarrays, liquid-phase array, and electrospray-ionization mass spectrometry (PCR/ESI MS). These methods are based on the selection of multiple primers to amplify different species with the specificity checked by hybridization to a probe or by base composition of the amplicon for the PCR/ESI MS. When testing complex samples such as respiratory specimens, some clinically relevant species can be missed. Indeed, it is impossible to design primers able to amplify all the known fungal species with the same efficiency. Therefore, the best amplified species may not be the most clinically relevant. Multiplex assays have also been proposed to detect A. fumigatus DNA and azole resistance. Since the gene responsible for azole resistance is single copy and the gene used for detection is multicopy, only the high fungal loads can be evaluated. Thus, although interesting for investigating mycobiome, the multiplex assays should be used with cautious for the diagnosis of IA or the detection of resistance. For the diagnosis of invasive aspergillosis, validated quantitative PCRs specifically targeting A. fumigatus or a limited set of species to increase sensitivity is a safer option.
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Affiliation(s)
- Alexandre Alanio
- Paris-Diderot, Sorbonne Paris Cité University.,Parasitology-Mycology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut Pasteur, Molecular Mycology Unit, CNRS URA3012, National Reference Center of Invasive Mycoses and Antifungals, Paris, France
| | - Stéphane Bretagne
- Paris-Diderot, Sorbonne Paris Cité University .,Parasitology-Mycology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut Pasteur, Molecular Mycology Unit, CNRS URA3012, National Reference Center of Invasive Mycoses and Antifungals, Paris, France
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154
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Visentin A, Gurrieri C, Imbergamo S, Lessi F, Di Maggio SA, Frezzato F, Adami F, Zambello R, Piazza F, Semenzato G, Trentin L. Epidemiology and risk factors of invasive fungal infections in a large cohort of patients with chronic lymphocytic leukemia. Hematol Oncol 2016; 35:925-928. [PMID: 27641225 DOI: 10.1002/hon.2343] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Centro di Eccellenza per la Ricerca Biomedica Avanzata, Venetian Institute of Molecular Medicine, Padua, Italy
| | - Carmela Gurrieri
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Centro di Eccellenza per la Ricerca Biomedica Avanzata, Venetian Institute of Molecular Medicine, Padua, Italy
| | - Silvia Imbergamo
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Federica Lessi
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Federica Frezzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Centro di Eccellenza per la Ricerca Biomedica Avanzata, Venetian Institute of Molecular Medicine, Padua, Italy
| | - Fausto Adami
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Renato Zambello
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Centro di Eccellenza per la Ricerca Biomedica Avanzata, Venetian Institute of Molecular Medicine, Padua, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Centro di Eccellenza per la Ricerca Biomedica Avanzata, Venetian Institute of Molecular Medicine, Padua, Italy
| | - Gianpietro Semenzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Centro di Eccellenza per la Ricerca Biomedica Avanzata, Venetian Institute of Molecular Medicine, Padua, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Centro di Eccellenza per la Ricerca Biomedica Avanzata, Venetian Institute of Molecular Medicine, Padua, Italy
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155
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Pagano L, Busca A, Candoni A, Cattaneo C, Cesaro S, Fanci R, Nadali G, Potenza L, Russo D, Tumbarello M, Nosari A, Aversa F. Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations. Blood Rev 2016; 31:17-29. [PMID: 27682882 DOI: 10.1016/j.blre.2016.09.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022]
Abstract
Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in immunocompromised patients. Patients with hematological malignancies undergoing conventional chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation are considered at high risk, and Aspergillus spp. represents the most frequently isolated micro-organisms. In the last years, attention has also been focused on other rare molds (e.g., Zygomycetes, Fusarium spp.) responsible for devastating clinical manifestations. The extensive use of antifungal prophylaxis has reduced the infections from yeasts (e.g., candidemia) even though they are still associated with high mortality rates. This paper analyzes concurrent multiple predisposing factors that could favor the onset of fungal infections. Although neutropenia is common to almost all hematologic patients, other factors play a key role in specific patients, in particular in patients with AML or allogeneic HSCT recipients. Defining those patients at higher risk of IFIs may help to design the most appropriate diagnostic work-up and antifungal strategy.
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Affiliation(s)
- Livio Pagano
- Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italy.
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Anna Candoni
- Clinica Ematologica, Azienda Ospedaliero-Universitaria Santa Maria Misericordia, Udine, Italy
| | | | - Simone Cesaro
- Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rosa Fanci
- Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze, Italy
| | - Gianpaolo Nadali
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Leonardo Potenza
- UOC Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Domenico Russo
- Cattedra di Ematologia, Unità di Malattie del Sangue e Trapianto di Midollo Osseo, Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia e ASST Spedali Civili, Brescia, Italy
| | - Mario Tumbarello
- Istituto di Malattie Infettive, Università Cattolica S. Cuore, Roma, Italy
| | - Annamaria Nosari
- Divisione di Ematologia e Centro Trapianti Midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Franco Aversa
- Hematology and BMT Unit, Department of Clinical and Experimental Medicine, University of Parma, Italy
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156
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Klimko N, Kozlova Y, Khostelidi S, Shadrivova O, Borzova Y, Burygina E, Vasilieva N, Denning DW. The burden of serious fungal diseases in Russia. Mycoses 2016; 58 Suppl 5:58-62. [PMID: 26449508 DOI: 10.1111/myc.12388] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/01/2015] [Accepted: 07/05/2015] [Indexed: 12/14/2022]
Abstract
The incidence and prevalence of fungal infections in Russia is unknown. We estimated the burden of fungal infections in Russia according to the methodology of the LIFE program (www.LIFE-worldwide.org). The total number of patients with serious and chronic mycoses in Russia in 2011 was three million. Most of these patients (2,607,494) had superficial fungal infections (recurrent vulvovaginal candidiasis, oral and oesophageal candidiasis with HIV infection and tinea capitis). Invasive and chronic fungal infections (invasive candidiasis, invasive and chronic aspergillosis, cryptococcal meningitis, mucormycosis and Pneumocystis pneumonia) affected 69,331 patients. The total number of adults with allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation was 406,082.
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Affiliation(s)
- N Klimko
- I. Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - Y Kozlova
- I. Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - S Khostelidi
- I. Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - O Shadrivova
- I. Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - Y Borzova
- I. Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - E Burygina
- I. Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - N Vasilieva
- I. Metchnikov North-Western State Medical University, St. Petersburg, Russia
| | - D W Denning
- Manchester Academic Health Science Centre, The National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester, UK
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157
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Beardsley J, Denning DW, Chau NV, Yen NTB, Crump JA, Day JN. Estimating the burden of fungal disease in Vietnam. Mycoses 2016; 58 Suppl 5:101-6. [PMID: 26449514 PMCID: PMC4606745 DOI: 10.1111/myc.12382] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/14/2015] [Accepted: 05/02/2015] [Indexed: 12/18/2022]
Abstract
Data regarding the prevalence of fungal infections in Vietnam are limited yet they are likely to occur more frequently as increasingly sophisticated healthcare creates more iatrogenic risk factors. In this study, we sought to estimate baseline incidence and prevalence of selected serious fungal infections for the year 2012. We made estimates with a previously described actuarial method, using reports on the incidence and prevalence of various established risk factors for fungal infections from Vietnam, or similar environments, supplemented by personal communications. Global data were used if local data were unavailable. We estimated 2 352 748 episodes of serious fungal infection occurred in Vietnam in 2012. Frequent conditions included recurrent vaginal candidiasis (3893/100 000 women annually), tinea capitis (457/100 000 annually) and chronic pulmonary aspergillosis (61/100 000/5 year period). We estimated 140 cases of cryptococcal meningitis, 206 of penicilliosis and 608 of Pneumocystis jirovecii pneumonia. This is the first summary of Vietnamese fungal infections. The majority of severe disease is due to Aspergillus species, driven by the high prevalence of pulmonary tuberculosis. The AIDS epidemic highlights opportunistic infections, such as penicilliosis and cryptococcosis, which may complicate immunosuppressive treatments. These estimates provide a useful indication of disease prevalence to inform future research and resource allocation but should be verified by further epidemiological approaches.
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Affiliation(s)
- J Beardsley
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - D W Denning
- The National Aspergillosis Centre, The University of Manchester, Manchester, UK
| | - N V Chau
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - N T B Yen
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - J A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - J N Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Wellcome Trust Intermediate Fellow, London, UK
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158
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Khwakhali US, Denning DW. Burden of serious fungal infections in Nepal. Mycoses 2016; 58 Suppl 5:45-50. [PMID: 26449506 DOI: 10.1111/myc.12393] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/29/2015] [Accepted: 08/04/2015] [Indexed: 12/14/2022]
Abstract
There are few reports of serious fungal infections in Nepal though the pathogenic and allergenic fungi including Aspergillus species are common in the atmosphere. Herein, we estimate the burden of serious fungal infections in Nepal. All published papers reporting fungal infection rates from Nepal were identified. When few data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence. Of the 27.3 M population, about 1.87% was estimated to suffer from serious fungal infections annually. We estimated the incidence of fungal keratitis at 73 per 100,000 annually. Chronic obstructive pulmonary disease is common with 215,765 cases, contributing to 1119 cases of invasive aspergillosis annually. Of 381,822 adult asthma cases, we estimated 9546 patients (range 2673-13,364) develop allergic bronchopulmonary aspergillosis and 12,600 have severe asthma with fungal sensitisation. Based on 26,219 cases of pulmonary tuberculosis, the annual incidence of new chronic pulmonary aspergillosis (CPA) cases was estimated at 1678 with a 5 year period prevalence of 5289, 80% of CPA cases. Of 22,994 HIV patients with CD4 counts <350 not on antiretrovirals, Pneumocystis pneumonia was estimated at 990 cases annually. Cases of oral and oesophageal candidiasis in HIV/AIDS patients were estimated at 10,347 and 2950, respectively. There is a significant burden of serious fungal infections in Nepal. Epidemiological studies are necessary to validate these estimates.
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Affiliation(s)
| | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, The University of Manchester, Manchester, UK
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159
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Lagrou K, Maertens J, Van Even E, Denning DW. Burden of serious fungal infections in Belgium. Mycoses 2016; 58 Suppl 5:1-5. [PMID: 26449500 DOI: 10.1111/myc.12389] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 07/16/2015] [Indexed: 12/27/2022]
Abstract
We aimed to estimate the total number of serious fungal infections occurring yearly in Belgium. The number of cryptococcal infections was retrieved from the National Reference Center for Mycosis. Populations at risk and fungal infections frequencies in these populations were used to estimate incidence or prevalence of other fungal infections. The Belgian population consists of 11.10 million people. Cryptococcal meningitis is rare. In all, 15 of the 1227 newly diagnosed HIV/AIDS cases presented with Pneumocystis jirovecii pneumonia. This accounts for ±14% of total PCP cases (n = 120). The incidence of candidaemia is estimated as 5/100,000 resulting in 555 cases and 213 deaths. A total number of 675 invasive aspergillosis cases and ≥169 deaths attributed to this infection were calculated. Chronic pulmonary aspergillosis is estimated to be prevalent in 662 cases. Allergic bronchopulmonary aspergillosis cases were estimated to be 23,119 applying a 2.5% and 15% rate in adult asthma and cystic fibrosis patients respectively. Severe asthma with fungal sensitisation cases was estimated to be 30,402. There were 174,760 women with recurrent Candida vaginitis assuming a 6% rate in women aged between 15 and 50. Approximately 233,000 people of the Belgian population (2.1%) are estimated to suffer from a fungal infection on a yearly basis.
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Affiliation(s)
- Katrien Lagrou
- Department of Microbiology and Immunology, Catholic University Leuven, Leuven, Belgium.,Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Johan Maertens
- Department of Microbiology and Immunology, Catholic University Leuven, Leuven, Belgium
| | - Ellen Van Even
- Department of Laboratory Medicine, National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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160
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Alanio A, Sturny-Leclère A, Benabou M, Guigue N, Bretagne S. Variation in copy number of the 28S rDNA of Aspergillus fumigatus measured by droplet digital PCR and analog quantitative real-time PCR. J Microbiol Methods 2016; 127:160-163. [DOI: 10.1016/j.mimet.2016.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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161
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Mariette C, Tavernier E, Hocquet D, Huynh A, Isnard F, Legrand F, Lhéritier V, Raffoux E, Dombret H, Ifrah N, Cahn JY, Thiébaut A. Epidemiology of invasive fungal infections during induction therapy in adults with acute lymphoblastic leukemia: a GRAALL-2005 study. Leuk Lymphoma 2016; 58:586-593. [DOI: 10.1080/10428194.2016.1204652] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Clara Mariette
- Department of Hematology and UMR 5525 CNRS-UJF, University Hospital, Grenoble, France
| | - Emmanuelle Tavernier
- Department of Hematology Saint-Etienne, University Hospital, Saint-Etienne, France
| | - Didier Hocquet
- Infection Control Department, University Hospital, Besançon, France
| | - Anne Huynh
- Department of Hematology, University Hospital, Toulouse, France
| | - Françoise Isnard
- Department of Hematology, University Hospital, Saint-Antoine, France
| | - Faezeh Legrand
- Department of Hematology, University Hospital, Nice, France
| | - Véronique Lhéritier
- Department of Hematology Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL), Coordination Office, Pierre Bénite, France
| | - Emmanuel Raffoux
- Department of Hematology, University Paris Diderot, Institut Universitaire d’Hématologie (IUH), University Hospital Saint-Louis, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Hervé Dombret
- Department of Hematology, University Paris Diderot, Institut Universitaire d’Hématologie (IUH), University Hospital Saint-Louis, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Norbert Ifrah
- Department of Hematology and Inserm U 892/CNRS 6299, University Hospital, Angers, France
| | - Jean-Yves Cahn
- Department of Hematology and UMR 5525 CNRS-UJF, University Hospital, Grenoble, France
| | - Anne Thiébaut
- Department of Hematology and UMR 5525 CNRS-UJF, University Hospital, Grenoble, France
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162
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López-Medrano F, Silva JT, Fernández-Ruiz M, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Lumbreras C, Moreno A, Carratalà J, Blanes M, Hernández D, Hernández-Méndez EA, Fariñas MC, Perelló-Carrascosa M, Morales JM, Andrés A, Aguado JM. Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study. Am J Transplant 2016; 16:2148-57. [PMID: 26813515 DOI: 10.1111/ajt.13735] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/13/2016] [Indexed: 01/25/2023]
Abstract
Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Arbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A Ponce de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - C Lumbreras
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - E A Hernández-Méndez
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - M Perelló-Carrascosa
- Department of Nephrology, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J M Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i + 12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study. Transplant Direct 2016; 2:e90. [PMID: 27819031 PMCID: PMC5082998 DOI: 10.1097/txd.0000000000000584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/05/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is a major cause of invasive fungal infection in kidney transplant recipients (KTR), and it has a high mortality rate. However, its impact on patients and graft survival has not been well defined in the current era of voriconazole first-line therapy. METHODS We retrospectively collected all cases of KTR-associated IA occurring at Necker Enfants Malades Hospital, Paris, from 2003 to 2013. These cases were compared with a group of controls (1:3) who were matched by age, year of kidney transplantation, and sex. The characteristics of IA were also studied. RESULTS Sixteen patients developed IA after KTR. Most IA cases were limited to the lungs (81.3%), with mild respiratory symptoms in only 53% of the patients. The patients were administered voriconazole (n = 15, 94%) and/or posaconazole (n = 2, 13%). The 12-week and 1-year postinfection survival rates were 94% and 81%, respectively. Compared with the controls (n = 46), patients and death-censored graft survivals rates were significantly lower after IA (P = 0.017 and 0.001, respectively). In the patients with IA, the occurrences of cardiovascular diseases before transplantation (P < 0.0001), delayed graft function (P < 0.0001), and infectious complications (0.0018) were significantly more frequent. CONCLUSIONS Even with voriconazole therapy, the prognosis of patients with IA after kidney transplantation is still poor. When the patients survive to IA, they have a high risk of graft loss.
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An estimate of the burden of serious fungal diseases in Greece. Eur J Clin Microbiol Infect Dis 2016; 35:1115-20. [PMID: 27086365 DOI: 10.1007/s10096-016-2642-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/29/2016] [Indexed: 01/19/2023]
Abstract
Data on the epidemiology of serious fungal infections in Greece are scarce. Our aim was to calculate the burden of serious fungal diseases in Greece. A thorough literature search for papers reporting epidemiological data on serious fungal diseases in Greece was performed. Where no Greek data existed, we used a structured set of assumptions to estimate fungal disease burden, based on specific high-risk populations. Of the 10.8 million population, 85.5 % are adults and 27 % are over 60 years of age. The annual fungal disease estimates are as follows: 142,337 Greek women get recurrent vaginal thrush (2,632 cases/100,000 females); there are 889 cases of esophageal candidiasis (8.2 cases/100,000); annual incidence of Pneumocystis pneumonia is 112 cases; chronic pulmonary aspergillosis prevalence is 386 cases; there are 20,843 patients with allergic bronchopulmonary aspergillosis and 27,744 with severe asthma with fungal sensitization; candidaemia incidence is 541 cases (5.0/100,000); there are 81 cases of Candida peritonitis; invasive aspergillosis occurs in 1,125 patients. According to our calculations, 194,067 individuals (1.79 cases/100,000) in Greece suffer from serious fungal diseases each year. This is the first attempt to determine the burden of fungal diseases in Greece, and provides a crude estimate on its impact on public health.
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165
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Sun KS, Tsai CF, Chen SCC, Chen YY, Huang WC. Galactomannan Testing and the Incidence of Invasive Pulmonary Aspergillosis: A 10-Year Nationwide Population-Based Study in Taiwan. PLoS One 2016; 11:e0149964. [PMID: 26900697 PMCID: PMC4764294 DOI: 10.1371/journal.pone.0149964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/08/2016] [Indexed: 11/20/2022] Open
Abstract
Background The clinical impact of the galactomannan (GM) test for the diagnosis of invasive pulmonary aspergillosis (IPA) is controversial. Our study evaluated the incidence and trends of IPA and GM testing in patients with aspergillus infections. Methods We conducted a nationwide inpatient population study using the Taiwan National Health Insurance Research Database. A total of 346 IPA (62.14% male) patients from the years 2002 to 2011 were identified for inclusion in the study. Results The average incidence of IPA was 1.51 per million person-years. Over the study period, we observed an increasing trend from 0.94 to 2.06 per million person-years (P < 0.0001). We observed male predominance in IPA incidence (M/F: 1.85/1.15). Both males and females showed significantly increasing trends of IPA incidence over time (0.87 to 4.55 and 0.36 to 2.07 per million person-years for the males and females, respectively). GM testing for IPA significantly increased from 2002 to 2011, and the GM test was utilized more frequently for males than females. The increase in the incidence of IPA might be positively associated with the increase in GM testing over the past decade. Conclusion The incidence rates of both IPA and GM testing have increased over time. GM testing is recommended for the early diagnosis of patients with suspected aspergillosis.
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Affiliation(s)
- Kuo-Shao Sun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, City, Taiwan
| | - Yih-Yuan Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Wan-Chun Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- * E-mail:
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166
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Maertens JA, Raad II, Marr KA, Patterson TF, Kontoyiannis DP, Cornely OA, Bow EJ, Rahav G, Neofytos D, Aoun M, Baddley JW, Giladi M, Heinz WJ, Herbrecht R, Hope W, Karthaus M, Lee DG, Lortholary O, Morrison VA, Oren I, Selleslag D, Shoham S, Thompson GR, Lee M, Maher RM, Schmitt-Hoffmann AH, Zeiher B, Ullmann AJ. Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. Lancet 2016; 387:760-9. [PMID: 26684607 DOI: 10.1016/s0140-6736(15)01159-9] [Citation(s) in RCA: 615] [Impact Index Per Article: 76.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Isavuconazole is a novel triazole with broad-spectrum antifungal activity. The SECURE trial assessed efficacy and safety of isavuconazole versus voriconazole in patients with invasive mould disease. METHODS This was a phase 3, double-blind, global multicentre, comparative-group study. Patients with suspected invasive mould disease were randomised in a 1:1 ratio using an interactive voice-web response system, stratified by geographical region, allogeneic haemopoietic stem cell transplantation, and active malignant disease at baseline, to receive isavuconazonium sulfate 372 mg (prodrug; equivalent to 200 mg isavuconazole; intravenously three times a day on days 1 and 2, then either intravenously or orally once daily) or voriconazole (6 mg/kg intravenously twice daily on day 1, 4 mg/kg intravenously twice daily on day 2, then intravenously 4 mg/kg twice daily or orally 200 mg twice daily from day 3 onwards). We tested non-inferiority of the primary efficacy endpoint of all-cause mortality from first dose of study drug to day 42 in patients who received at least one dose of the study drug (intention-to-treat [ITT] population) using a 10% non-inferiority margin. Safety was assessed in patients who received the first dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00412893. FINDINGS 527 adult patients were randomly assigned (258 received study medication per group) between March 7, 2007, and March 28, 2013. All-cause mortality from first dose of study drug to day 42 for the ITT population was 19% with isavuconazole (48 patients) and 20% with voriconazole (52 patients), with an adjusted treatment difference of -1·0% (95% CI -7·8 to 5·7). Because the upper bound of the 95% CI (5·7%) did not exceed 10%, non-inferiority was shown. Most patients (247 [96%] receiving isavuconazole and 255 [98%] receiving voriconazole) had treatment-emergent adverse events (p=0·122); the most common were gastrointestinal disorders (174 [68%] vs 180 [69%]) and infections and infestations (152 [59%] vs 158 [61%]). Proportions of patients with treatment-emergent adverse events by system organ class were similar overall. However, isavuconazole-treated patients had a lower frequency of hepatobiliary disorders (23 [9%] vs 42 [16%]; p=0·016), eye disorders (39 [15%] vs 69 [27%]; p=0·002), and skin or subcutaneous tissue disorders (86 [33%] vs 110 [42%]; p=0·037). Drug-related adverse events were reported in 109 (42%) patients receiving isavuconazole and 155 (60%) receiving voriconazole (p<0·001). INTERPRETATION Isavuconazole was non-inferior to voriconazole for the primary treatment of suspected invasive mould disease. Isavuconazole was well tolerated compared with voriconazole, with fewer study-drug-related adverse events. Our results support the use of isavuconazole for the primary treatment of patients with invasive mould disease. FUNDING Astellas Pharma Global Development, Basilea Pharmaceutica International.
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Affiliation(s)
- Johan A Maertens
- Department of Hematology, Universitaire Ziekenhuizen Leuven, KU Leuven, Belgium
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kieren A Marr
- Department of Medicine, John Hopkins University, Baltimore, MD, USA; Department of Oncology, John Hopkins University, Baltimore, MD, USA
| | - Thomas F Patterson
- The University of Texas Health Science Center San Antonio and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Oliver A Cornely
- Department of Internal Medicine, Clinical Trials Centre Cologne, ZKS Köln, Center for Integrated Oncology CIO Köln Bonn, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), German Centre for Infection Research, University of Cologne, Cologne, Germany
| | - Eric J Bow
- Departments of Medical Microbiology and Infectious Diseases, and Internal Medicine, the University of Manitoba, Winnipeg, Canada; Infection Control Services, CancerCare Manitoba, Winnipeg, Canada
| | - Galia Rahav
- The Chaim Sheba Medical Center, Tel-Hashomer, and Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Dionysios Neofytos
- Division of Infectious Diseases, John Hopkins University, Baltimore, MD, USA
| | - Mickael Aoun
- Division of Infectious Diseases, Jules Bordet Institute, Brussels, Belgium
| | - John W Baddley
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Michael Giladi
- Infectious Disease Unit, Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Werner J Heinz
- University of Würzburg Medical Center, Würzburg, Germany
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - William Hope
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Meinolf Karthaus
- Klinik für Hämatologie und Onkologie, Klinikum Neuperlach, Munich, Germany
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Olivier Lortholary
- Université Paris Descartes, Centre d'Infectiologie Necker Pasteur, Hôpital Necker Enfants Malades, IHU Imagine and Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France
| | - Vicki A Morrison
- University of Minnesota and Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Ilana Oren
- Infectious Diseases Unit, Rambam Health Care Campus, and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Shmuel Shoham
- Department of Medicine, John Hopkins University, Baltimore, MD, USA
| | | | - Misun Lee
- Astellas Pharma Global Development, Northbrook, IL, USA
| | | | | | | | - Andrew J Ullmann
- Julius-Maximilians-University, Department of Internal Medicine II, Infectious Diseases, Würzburg, Germany.
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Cabaret O, Bonnal C, Canoui-Poitrine F, Emirian A, Bizouard G, Levesque E, Maitre B, Fihman V, Decousser JW, Botterel F. Concomitant presence of Aspergillus fumigatus and Stenotrophomonas maltophilia in the respiratory tract: a new risk for patients with liver disease? J Med Microbiol 2016; 65:414-419. [PMID: 26872817 DOI: 10.1099/jmm.0.000233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Concomitant lung colonization by Aspergillus fumigatus and Stenotrophomonas maltophilia was reported mainly in patients with cystic fibrosis (CF) and immunocompromised patients. The aim of the study was to assess the frequency of co-culture of A. fumigatus and S. maltophilia in respiratory samples of hospitalized patients, and to determine its associated factors. Between 2007 and 2011, all patients who had A. fumigatus in their respiratory samples were retrospectively enrolled in the study. Their clinical and laboratory data, including the presence of S. maltophilia in a respiratory sample, were collected within the same month. Of the 257 enrolled patients (372 respiratory samples), 71 % were immunocompromised and 32 % had chronic respiratory disease. S. maltophilia was isolated within the same month in 20 patients (7.8 %). In the univariate analysis, factors associated with concomitant culture of A. fumigatus and S. maltophilia were liver disease (P = 0.009), orotracheal intubation (P = 0.001), ventilator-associated pneumonia (P = 0.006), central venous catheter (P = 0.003), parenteral nutrition (P = 0.008) and culture of Pseudomonas aeruginosa in respiratory samples (P = 0.002). In the multivariate analysis, the simultaneous presence of P. aeruginosa in the respiratory tract (odds ratio (OR) = 3.19, 95 % confidence interval (CI) 1.11-9.14, P = 0.031), liver disease (OR = 3.92, 95 % CI 1.32-11.62, P = 0.014) and orotracheal intubation (OR = 3.42, 95 % CI 1.17-9.96, P = 0.024) were independently associated with the co-culture of S. maltophilia and A. fumigatus. Factors independently associated with the concomitant culture of A. fumigatus and S. maltophilia were identified. These results support a future prospective study focusing on liver disease and its complications.
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Affiliation(s)
- Odile Cabaret
- Unité de Mycologie, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Christine Bonnal
- Unité de Mycologie, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Florence Canoui-Poitrine
- Université Paris Est Créteil,LIC EA4393, Créteil,France.,Service de Santé publique, AP-HP, Hôpital Henri-Mondor,Créteil,France
| | - Aurélie Emirian
- Unité de Bactériologie-Hygiène, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Geoffray Bizouard
- Université Paris Est Créteil,LIC EA4393, Créteil,France.,Service de Santé publique, AP-HP, Hôpital Henri-Mondor,Créteil,France
| | - Eric Levesque
- Département d'anesthésie et de réanimation, DHU VIC, AP-HP, Hôpital Henri-Mondor,Créteil,France
| | - Bernard Maitre
- Unité de Pneumologie, Réanimation médicale Hôpital Henri Mondor, Centre Intercommunal de Créteil,Créteil,France
| | - Vincent Fihman
- Unité de Bactériologie-Hygiène, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Jean-Winoc Decousser
- Unité de Bactériologie-Hygiène, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
| | - Françoise Botterel
- Unité de Mycologie, DHU VIC, AP-HP, Hôpital Henri Mondor and Département de Microbiologie,Créteil,France
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168
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Marchionni E, Parize P, Lefevre A, Vironneau P, Bougnoux ME, Poiree S, Coignard-Biehler H, DeWolf SE, Amazzough K, Barchiesi F, Jullien V, Alanio A, Garcia-Hermoso D, Wassef M, Kania R, Lortholary O, Lanternier F. Aspergillus spp. invasive external otitis: favourable outcome with a medical approach. Clin Microbiol Infect 2016; 22:434-7. [PMID: 26802213 DOI: 10.1016/j.cmi.2015.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 01/08/2023]
Abstract
Aspergillus spp. invasive external otitis (IEO) is a rare infection. We performed a seven-year, single-centre retrospective study from 2007 to 2014 including all patients with proven Aspergillus spp. IEO. Twelve patients were identified. All patients had a poorly controlled diabetes mellitus and one underwent solid organ transplant. The most frequently isolated species was Aspergillus flavus (n = 10) and voriconazole was the first-line therapy in all cases, with a median length of treatment of 338.5 days (158-804 days). None of the patients underwent extensive surgery. The clinical outcome was excellent. However, otological sequelae were reported, including hearing impairment (n = 7) and facial palsy (n = 3).
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Affiliation(s)
- E Marchionni
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Infectious Diseases Department, Marche Polytechnic University, Ancona, Italy
| | - P Parize
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - A Lefevre
- Department of Radiology, Necker-Enfants Malades Hospital, Paris, France
| | - P Vironneau
- Department of Oto-Rhino-Laryngology, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - M E Bougnoux
- Microbiology Laboratory, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France; Biology and Pathogenicity Unit, Institut Pasteur, Paris, France
| | - S Poiree
- Department of Radiology, Necker-Enfants Malades Hospital, Paris, France
| | - H Coignard-Biehler
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - S E DeWolf
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - K Amazzough
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - F Barchiesi
- Infectious Diseases Department, Marche Polytechnic University, Ancona, Italy
| | - V Jullien
- Department of Pharmacology, Paris Descartes University, Sorbonne Paris Cité, Inserm U1129, Hôpital Européen Georges-Pompidou, Paris, France
| | - A Alanio
- Parasitology-Mycology Laboratory, Lariboisière-Saint Louis Hospital, Paris, France
| | - D Garcia-Hermoso
- Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France
| | - M Wassef
- Department of Pathology, Faculty of Medicine, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - R Kania
- Department of Oto-Rhino-Laryngology, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - O Lortholary
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France; Institut Pasteur, Unite de Mycologie Moleculaire, CNRS URA3012, Paris, France
| | - F Lanternier
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France; Institut Pasteur, Unite de Mycologie Moleculaire, CNRS URA3012, Paris, France.
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169
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Santos T, Aguiar B, Santos L, Romaozinho C, Tome R, Macario F, Alves R, Campos M, Mota A. Invasive Fungal Infections After Kidney Transplantation: A Single-center Experience. Transplant Proc 2016; 47:971-5. [PMID: 26036497 DOI: 10.1016/j.transproceed.2015.03.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Invasive fungal infections (IFI) affecting transplant recipients are associated with increased mortality and graft dysfunction. OBJECTIVE Describe the frequency, clinical features, and outcomes of IFI (except pneumocystis infection) in kidney transplant recipients. METHOD Single-center descriptive study including every kidney transplant recipient with a culture-proven or probable IFI between 2003 and 2013, according to the EORTC-MSG criteria. RESULTS We identified 45 IFI. There were 13 cases of invasive candidiasis (C. albicans: 6 and non-C. albicans candidial spp.: 7), 11 cases of pulmonary aspergillosis (A. fumigatus: 9 and A. flavus: 2); 11 cases of subcutaneous mycosis (Alternaria spp.: 9, Paecilomyces spp.: 1, and Pseudallescheria spp.: 1); 7 cases of cryptococcosis; 2 cases of pneumonia by non-Aspergillus molds (Mucor spp.: 1 and Cunninghamella spp.: 1); and 1 case of Geotrichum capitatum pneumonia. All patients were recipients from deceased donors. Six cases occurred in the first 3 months post-transplant, 15 cases between the third and twelfth months, and 21 cases after the twelfth month. Treatment options were fluconazole for Candida infections, voriconazole or caspofungin for aspergillosis, liposomal amphotericin for cryptococcosis, and itraconazole plus excision or cryotherapy for subcutaneous mycosis. Fifteen patients died (33%). Mortality rates were 15% for invasive candidiasis, 45% for aspergillosis, 71% for cryptococcosis, 100% for non-Aspergillus molds and G. capitatum pneumonia, and 0% for subcutaneous mycosis. Six patients who survived (14%) started regular hemodialysis. CONCLUSION IFI still have a high mortality and morbidity in kidney transplant recipients, as verified in this report. We reinforce the need for a high index of suspicion and prompt treatment.
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Affiliation(s)
- T Santos
- Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal.
| | - B Aguiar
- Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal
| | - L Santos
- Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal
| | - C Romaozinho
- Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal
| | - R Tome
- Clinical Pathology Department, Coimbra University Hospital, Coimbra, Portugal
| | - F Macario
- Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal
| | - R Alves
- Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal
| | - M Campos
- Nephrology Department, Coimbra University Hospital, Coimbra, Portugal
| | - A Mota
- Kidney Transplant Unit, Urology and Kidney Transplant Department, Coimbra University Hospital, Coimbra, Portugal
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170
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Staudinger T, Pène F. Current insights into severe sepsis in cancer patients. Rev Bras Ter Intensiva 2016; 26:335-8. [PMID: 25607260 PMCID: PMC4304459 DOI: 10.5935/0103-507x.20140051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/17/2014] [Indexed: 01/28/2023] Open
Affiliation(s)
- Thomas Staudinger
- Intensive Care Unit, Department of Medicine I, Medical University of Vienna/General Hospital of Vienna, Vienna, Austria
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique, Hôpitaux de Paris, Paris, France
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171
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Wang L, Hu J, Sun Y, Huang H, Chen J, Li J, Ma J, Li J, Liang Y, Wang J, Li Y, Yu K, Hu J, Jin J, Wang C, Wu D, Xiao Y, Huang X. Does High-Dose Cytarabine Cause More Fungal Infection in Patients With Acute Myeloid Leukemia Undergoing Consolidation Therapy: A Multicenter, Prospective, Observational Study in China. Medicine (Baltimore) 2016; 95:e2560. [PMID: 26825897 PMCID: PMC5291567 DOI: 10.1097/md.0000000000002560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Invasive fungal infection (IFI) remains as a significant cause of morbidity and mortality in patients with acute myelogenous leukemia (AML). Here, we report the subgroup analysis of China Assessment of Antifungal Therapy in Haematological Disease (CAESAR) study to evaluate the risk of IFI in patients with AML in 1st remission receiving high-dose cytarabine (HiDAC) as consolidation. A total of 638 patients with AML in 1st complete remission were selected from the database. Among them, 130 patients received HiDAC alone with total dose of 2-3 g/m(2) × 6 while 508 patients received multiple-agent combination chemotherapy (multiagent chemo group). The patients' characteristics were generally not different but more patients in HiDAC group had peripherally inserted central catheter (61.5% vs 44.5%, P = 0.002). The median duration of neutropenia was 8.0 days in both HiDAC (2-20) and multiagent chemo group (2-28). Number of patients with prolonged neutropenia (>14 days) tended to be more in multiagent chemo group but not significant different (16.3% vs 8.8%, respectively). There was no significant difference between 2 groups in persistent neutropenic fever (40.8% vs 33.1%), antifungal treatment (11.5% vs 11.4%), and incidence of proven/probable IFI (4 probable in HiDAC vs 1 proven/4 probable in multiagent chemo, P = 0.35) or possible IFI. As to the clinical outcome in terms of duration of hospitalization and death in remission, there was a trend of shorter duration of hospitalization in HiDAC (19 days, 3-70) compare to multiagent chemo group (21 days, 1-367, P = 0.057) while no death documented in HiDAC group and only 2 patients died in the multiagent chemo group (0.4%). As to risk factors associated with IFI in all 638 patients, there was a trend of more IFI in patients with severe neutropenia (3.0%, P = 0.089) and previous history of IFI (3.85%, P = 0.086) while the antifungal prophylaxis was not associated significantly reduced IFI. Overall, our data support the perception that HiDAC alone as consolidation in first remission AML patients was well tolerated and not associated with increased hematological toxicity and IFI than conventional combination chemotherapy. Antifungal prophylaxis may not necessary except for patients with previous history of IFI.
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Affiliation(s)
- Ling Wang
- From the Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai (LW, JH); Peking University Institute of Hematology, Peking University, People's Hospital, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing (YS, XH); The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou (HH, JJ); Shanghai Children's Medical Center, Shanghai (JC); Jiangsu Province Hospital, Nanjing (JL); Harbin Hematologic Tumor Institution, Harbin (JM); The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou (JL); Tangdu Hospital, Fourth Military Medical University, Xi'an (YL); Changhai Hospital of the Second Military Medical University, Shanghai (JW); The First Affiliated Hospital of China Medical University, Shengyang (YL); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou (KY); Fujian Medical University Union Hospital, Fuzhou (JH); The First People's Hospital of Shanghai, Shanghai (CW); The First Affiliated Hospital of Soochow University, Suzhou (DW); and The General Hospital of Guangzhou Military Command of PLA, Guangzhou, People's Republic of China (YX)
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Arendrup MC, Jensen RH, Cuenca-Estrella M. In Vitro Activity of ASP2397 against Aspergillus Isolates with or without Acquired Azole Resistance Mechanisms. Antimicrob Agents Chemother 2016; 60:532-6. [PMID: 26552973 PMCID: PMC4704222 DOI: 10.1128/aac.02336-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 11/01/2015] [Indexed: 11/20/2022] Open
Abstract
ASP2397 is a new compound with a novel and as-yet-unknown target different from that of licensed antifungal agents. It has activity against Aspergillus and Candida glabrata. We compared its in vitro activity against wild-type and azole-resistant A. fumigatus and A. terreus isolates with that of amphotericin B, itraconazole, posaconazole, and voriconazole. Thirty-four isolates, including 4 wild-type A. fumigatus isolates, 24 A. fumigatus isolates with alterations in CYP51A TR/L98H (5 isolates), M220 (9 isolates), G54 (9 isolates), and HapE (1 isolate), and A. terreus isolates (2 wild-type isolates and 1 isolate with an M217I CYP51A alteration), were analyzed. EUCAST E.Def 9.2 and CLSI M38-A2 MIC susceptibility testing was performed. ASP2397 MIC50 values (in milligrams per liter, with MIC ranges in parentheses) determined by EUCAST and CLSI were 0.5 (0.25 to 1) and 0.25 (0.06 to 0.25) against A. fumigatus CYP51A wild-type isolates and were similarly 0.5 (0.125 to >4) and 0.125 (0.06 to >4) against azole-resistant A. fumigatus isolates, respectively. These values were comparable to those for amphotericin B, which were 0.25 (0.125 to 0.5) and 0.25 (0.125 to 0.25) against wild-type isolates and 0.25 (0.125 to 1) and 0.25 (0.125 to 1) against isolates with azole resistance mechanisms, respectively. In contrast, MICs for the azole compounds were elevated and highest for itraconazole: >4 (1 to >4) and 4 (0.5 to >4) against isolates with azole resistance mechanisms compared to 0.125 (0.125 to 0.25) and 0.125 (0.06 to 0.25) against wild-type isolates, respectively. ASP2397 was active against A. terreus CYP51A wild-type isolates (MIC 0.5 to 1), whereas MICs of both azole and ASP2397 were elevated for the mutant isolate. ASP2397 displayed in vitro activity against A. fumigatus and A. terreus isolates which was independent of the presence or absence of azole target gene resistance mutations in A. fumigatus. The findings are promising at a time when azole-resistant A. fumigatus is emerging globally.
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Delsuc C, Cottereau A, Frealle E, Bienvenu AL, Dessein R, Jarraud S, Dumitrescu O, Le Maréchal M, Wallet F, Friggeri A, Argaud L, Rimmelé T, Nseir S, Ader F. Putative invasive pulmonary aspergillosis in critically ill patients with chronic obstructive pulmonary disease: a matched cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:421. [PMID: 26631029 PMCID: PMC4668635 DOI: 10.1186/s13054-015-1140-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/18/2015] [Indexed: 12/03/2022]
Abstract
Introduction Patients with advanced chronic obstructive pulmonary disease (COPD) are at risk for developing invasive pulmonary aspergillosis. A clinical algorithm has been validated to discriminate colonization from putative invasive pulmonary aspergillosis (PIPA) in Aspergillus-positive respiratory tract cultures of critically ill patients. We focused on critically ill patients with COPD who met the criteria for PIPA. Methods This matched cohort study included critically ill patients with COPD from two university hospital intensive care units (ICUs). We studied the risk factors for PIPA as well as the impact of PIPA on short- and long-term outcomes. Whether PIPA was associated with a pattern of bacterial colonization and/or infection 6 months before and/or during ICU stay was assessed. In addition, antifungal strategies were reviewed. Results Fifty cases of PIPA in critically ill patients with COPD in the ICU were matched with one hundred control patients with COPD. The ICU short- and the long-term (at 1 year) mortality were significantly increased in the PIPA group (p < 0.001 for all variables). PIPA was a strong independent risk factor for mortality in the ICU (odds ratio 7.44, 95 % confidence interval 2.93–18.93, p < 0.001) before vasopressor therapy, renal replacement therapy, and duration of mechanical ventilation. Before ICU admission, the use of corticosteroids and antibiotics significantly increased the risk of PIPA (p = 0.004 and p < 0.001, respectively). No significant difference in bacterial etiologic agents responsible for colonization and/or infection was found between the groups. Antifungal treatment was started in 64 % of PIPA cases, with a poor impact on the overall outcome. Conclusions PIPA was a strong death predictor in critically ill patients with COPD. The use of corticosteroids and antibiotics before ICU admission was a risk factor for PIPA. PIPA was not associated with a specific bacterial pattern of colonization or infection. Prompting antifungal treatment in critically ill patients with COPD who have PIPA may not be the only factor involved in prognosis reversal.
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Affiliation(s)
- Claire Delsuc
- Département d'Anesthésie et de Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Aurélie Cottereau
- Département de Réanimation médicale, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
| | - Emilie Frealle
- Laboratoire de Parasitologie et de Mycologie médicale, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
| | - Anne-Lise Bienvenu
- Laboratoire de Parasitologie et de Mycologie médicale, Centre de Biologie Nord, Hospices Civils de Lyon, Lyon, France.
| | - Rodrigue Dessein
- Laboratoire de Bacteriologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
| | - Sophie Jarraud
- Département de Microbiologie, Centre de Biologie Est, Hospices Civils de Lyon, Bron, F-69677, France. .,Inserm U1111, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, Lyon, France.
| | - Oana Dumitrescu
- Inserm U1111, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, Lyon, France. .,Département de Microbiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, F-69495, France.
| | - Marion Le Maréchal
- Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France.
| | - Florent Wallet
- Département d'Anesthésiologie et de Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
| | - Arnaud Friggeri
- Département d'Anesthésiologie et de Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
| | - Laurent Argaud
- Service de Réanimation médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Thomas Rimmelé
- Département d'Anesthésie et de Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Saad Nseir
- Département de Réanimation médicale, Centre Hospitalier Régional Universitaire de Lille, Lille, France. .,Faculté de Médecine, Université de Lille, Lille, France.
| | - Florence Ader
- Inserm U1111, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, Lyon, France. .,Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, F-69004, Lyon, France. .,Département des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69317, Lyon cedex 04, France.
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Bonnal C, Leleu C, Brugière O, Chochillon C, Porcher R, Boelle PY, Menotti J, Houze S, Lucet JC, Derouin F. Relationship between Fungal Colonisation of the Respiratory Tract in Lung Transplant Recipients and Fungal Contamination of the Hospital Environment. PLoS One 2015; 10:e0144044. [PMID: 26629994 PMCID: PMC4667873 DOI: 10.1371/journal.pone.0144044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/12/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Aspergillus colonisation is frequently reported after lung transplantation. The question of whether aspergillus colonisation is related to the hospital environment is crucial to prevention. METHOD To elucidate this question, a prospective study of aspergillus colonisation after lung transplantation, along with a mycological survey of the patient environment, was performed. RESULTS Forty-four consecutive patients were included from the day of lung transplantation and then examined weekly for aspergillus colonisation until hospital discharge. Environmental fungal contamination of each patient was followed weekly via air and surface sampling. Twelve patients (27%) had transient aspergillus colonisation, occurring 1-13 weeks after lung transplantation, without associated manifestation of aspergillosis. Responsible Aspergillus species were A. fumigatus (6), A. niger (3), A. sydowii (1), A. calidoustus (1) and Aspergillus sp. (1). In the environment, contamination by Penicillium and Aspergillus was predominant. Multivariate analysis showed a significant association between occurrence of aspergillus colonisation and fungal contamination of the patient's room, either by Aspergillus spp. in the air or by A.fumigatus on the floor. Related clinical and environmental isolates were genotyped in 9 cases of aspergillus colonisation. For A. fumigatus (4 cases), two identical microsatellite profiles were found between clinical and environmental isolates collected on distant dates or locations. For other Aspergillus species, isolates were different in 2 cases; in 3 cases of aspergillus colonisation by A. sydowii, A. niger and A. calidoustus, similarity between clinical and environmental internal transcribed spacer and tubulin sequences was >99%. CONCLUSION Taken together, these results support the hypothesis of environmental risk of hospital acquisition of aspergillus colonisation in lung transplant recipients.
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Affiliation(s)
- Christine Bonnal
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
| | - Christopher Leleu
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- University Pierre et Marie Curie-Paris 6, Paris, France
| | - Olivier Brugière
- AP-HP, Service de Pneumologie B, Unité de Transplantation Pulmonaire, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
| | - Christian Chochillon
- AP-HP, Laboratory of Parasitology and Mycology, Bichat-Claude Bernard University Hospital, Paris, France
| | - Raphael Porcher
- Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, UMR 1153, Inserm, Université Paris Descartes, Paris, France
| | - Pierre-Yves Boelle
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique–U1136, Paris, France
| | - Jean Menotti
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
- AP-HP, Laboratory of Parasitology and Mycology, Saint-Louis University Hospital, Paris, France
| | - Sandrine Houze
- AP-HP, Laboratory of Parasitology and Mycology, Bichat-Claude Bernard University Hospital, Paris, France
- UMR 216, Mère et enfants face aux infections tropicales, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Jean-Christophe Lucet
- University Pierre et Marie Curie-Paris 6, Paris, France
- Paris Diderot University, IAME, UMR 1137, F-75018 Paris, France
| | - Francis Derouin
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018, Paris, France
- AP-HP, Laboratory of Parasitology and Mycology, Saint-Louis University Hospital, Paris, France
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175
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Busca A, Tortorano AM, Pagano L. Reviewing the importance and evolution of fungal infections and potential antifungal resistance in haematological patients. J Glob Antimicrob Resist 2015; 3:237-241. [DOI: 10.1016/j.jgar.2015.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 12/11/2022] Open
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176
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Grau S, Solano C, García-Vidal C, Jarque I, Barrueta JA, Peral C, Rodríguez I, Rubio-Rodríguez D, Rubio-Terrés C. Cost Analysis of the Use of Voriconazole, Posaconazole and Micafungin in the Primary Prophylaxis of Invasive Fungal Infections in Recipients of Allogeneic Hematopoietic Stem Cell Transplants. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2015; 3:153-161. [PMID: 35619591 PMCID: PMC9117112 DOI: 10.36469/9832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objectives: Compare the cost of the primary prophylaxis of invasive fungal infections (IFI) with voriconazole, posaconazole, and micafungin in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) in hospitals of the National Health System (NHS) in Spain. Methods: A cost analysis was made for 100 days and 180 days of prophylaxis and a decision tree model was developed. The efficacy rate of IFI prophylaxis and survival rate with liposomal amphotericin B treatment of prophylaxis failures were obtained from randomized trials and a meta-analysis of mixed treatment comparisons. The model simulation was interrupted with IFI treatment (prophylaxis failures). The costs of medication and its intravenous administration in the hospital (in the case of micafungin) were considered. Results: In the non-modeled analysis, the savings per patient of prophylaxis with voriconazole ranged from €1,709 to €9,655 compared with posaconazole oral solution, from €1,811 to €9,767 compared with posaconazole gastro-resistant tablets and from €3,376 to €7,713 compared with micafungin. In the modeled analysis, the mean cost per patient of the prophylaxis and treatment of IFIs was €6,987 to €7,619 with voriconazole, €7,749 with posaconazole, and €22,424 with micafungin. Therefore, the savings per patient of prophylaxis with voriconazole was €130 to €3,664 and €11,132 to €30,374 compared with posaconazole and micafungin, respectively. The result remained stable after modification of the number of days of antifungal prophylaxis and the cost of antifungal treatment of failures. Conclusion: Taking into account this model, antifungal prophylaxis with voriconazole in recipients of hematopoietic progenitor transplants, compared with posaconazole or micafungin, may represent savings for hospitals in Spain.
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177
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Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole. Antimicrob Agents Chemother 2015; 59:7857-61. [PMID: 26392507 DOI: 10.1128/aac.01506-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/17/2015] [Indexed: 01/23/2023] Open
Abstract
Invasive aspergillosis (IA) is a severe disseminated fungal disease that occurs mostly in immunocompromised patients. However, central nervous system IA, combining meningitis and skull base involvement, does not occur only in groups with classic risk factors for IA; patients with chronic renal failure and diabetes mellitus are also at risk for more chronic forms. In both of our proven IA cases, voriconazole monotherapy was effective without surgery, and cerebrospinal fluid and serum 1,3-β-d-glucan test results were initially positive, in contrast to galactomannan antigen results.
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178
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Blyth CC, Gilroy NM, Guy SD, Chambers ST, Cheong EY, Gottlieb T, McGuinness SL, Thursky KA. Consensus guidelines for the treatment of invasive mould infections in haematological malignancy and haemopoietic stem cell transplantation, 2014. Intern Med J 2015; 44:1333-49. [PMID: 25482744 DOI: 10.1111/imj.12598] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mould species represent the pathogens most commonly associated with invasive fungal disease in patients with haematological malignancies and patients of haemopoietic stem cell transplants. Invasive mould infections in these patient populations, particularly in the setting of neutropenia, are associated with high morbidity and mortality, and significantly increase the complexity of management. While Aspergillus species remain the most prevalent cause of invasive mould infections, Scedosporium and Fusarium species and the Mucormycetes continue to place a significant burden on the immunocompromised host. Evidence also suggests that infections caused by rare and emerging pathogens are increasing within the setting of broad-spectrum antifungal prophylaxis and improved survival times placing immunosuppressed patients at risk for longer. These guidelines present evidence-based recommendations for the antifungal management of common, rare and emerging mould infections in both adult and paediatric populations. Where relevant, the role of surgery, adjunctive therapy and immunotherapy is also discussed.
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Affiliation(s)
- C C Blyth
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia; Department of General Paediatrics, Princess Margaret Hospital for Children, Subiaco, Western Australia; PathWest Laboratory Medicine WA, Subiaco, Western Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia
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179
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International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus. Drug Resist Updat 2015; 21-22:30-40. [PMID: 26282594 DOI: 10.1016/j.drup.2015.08.001] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome(®)). In regions with environmental resistance rates of ≥10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class.
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180
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Hasseine L, Cassaing S, Robert-Gangneux F, Fillaux J, Marty P, Gangneux JP, Sirvent A, Mondain V, Hyvernat H, Rosenthal E, Cointault O, Lavayssière L, Georges B, Berry A, de Guibert S, Nimubona S, Revest M, Tattevin P. High negative predictive value diagnostic strategies for the reevaluation of early antifungal treatment: A multicenter prospective trial in patients at risk for invasive fungal infections. J Infect 2015; 71:258-65. [DOI: 10.1016/j.jinf.2015.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 03/09/2015] [Accepted: 04/10/2015] [Indexed: 11/25/2022]
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181
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Garcia-Hermoso D, Alanio A, Cabaret O, Olivi M, Foulet F, Cordonnier C, Costa JM, Bretagne S. High diversity of non-sporulating moulds in respiratory specimens of immunocompromised patients: should all the species be reported when diagnosing invasive aspergillosis? Mycoses 2015. [DOI: 10.1111/myc.12356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dea Garcia-Hermoso
- Institut Pasteur; Molecular Mycology Unit; National Reference Center of Invasive Mycoses and Antifungals; Paris France
- CNRS URA3012; Paris France
| | - Alexandre Alanio
- Institut Pasteur; Molecular Mycology Unit; National Reference Center of Invasive Mycoses and Antifungals; Paris France
- CNRS URA3012; Paris France
- Laboratoire de Parasitologie-Mycologie; Groupe hospitalier Lariboisière-Saint Louis; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
- Sorbonne Paris Cité; Université Paris Diderot; Paris France
| | - Odile Cabaret
- Laboratoire de Parasitologie-Mycologie; Groupe hospitalier Albert Chenevier-Henri Mondor; Assistance Publique-Hôpitaux de Paris (APHP); Créteil France
- Université Paris-Est-Créteil; Créteil France
| | | | - Françoise Foulet
- Laboratoire de Parasitologie-Mycologie; Groupe hospitalier Albert Chenevier-Henri Mondor; Assistance Publique-Hôpitaux de Paris (APHP); Créteil France
| | - Catherine Cordonnier
- Université Paris-Est-Créteil; Créteil France
- Département d'Hématologie; Groupe Hospitalier Albert Chenevier-Henri Mondor; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
| | | | - Stéphane Bretagne
- Institut Pasteur; Molecular Mycology Unit; National Reference Center of Invasive Mycoses and Antifungals; Paris France
- CNRS URA3012; Paris France
- Laboratoire de Parasitologie-Mycologie; Groupe hospitalier Lariboisière-Saint Louis; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
- Sorbonne Paris Cité; Université Paris Diderot; Paris France
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182
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Rammaert B, Jouvion G, de Chaumont F, Garcia-Hermoso D, Szczepaniak C, Renaudat C, Olivo-Marin JC, Chrétien F, Dromer F, Bretagne S. Absence of Fungal Spore Internalization by Bronchial Epithelium in Mouse Models Evidenced by a New Bioimaging Approach and Transmission Electronic Microscopy. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:2421-30. [PMID: 26165863 DOI: 10.1016/j.ajpath.2015.04.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/08/2015] [Accepted: 04/27/2015] [Indexed: 11/28/2022]
Abstract
Clinical data and experimental studies suggest that bronchial epithelium could serve as a portal of entry for invasive fungal infections. We therefore analyzed the interactions between molds and the bronchial/bronchiolar epithelium at the early steps after inhalation. We developed invasive aspergillosis (Aspergillus fumigatus) and mucormycosis (Lichtheimia corymbifera) murine models that mimic the main clinical risk factors for these infections. Histopathology studies were completed with a specific computer-assisted morphometric method to quantify bronchial and alveolar spores and with transmission electron microscopy. Morphometric analysis revealed a higher number of bronchial/bronchiolar spores for A. fumigatus than L. corymbifera. The bronchial/bronchiolar spores decreased between 1 and 18 hours after inoculation for both fungi, except in corticosteroid-treated mice infected with A. fumigatus, suggesting an effect of cortisone on bronchial spore clearance. No increase in the number of spores of any species was observed over time at the basal pole of the epithelium, suggesting the lack of transepithelial crossing. Transmission electron microscopy did not show spore internalization by bronchial epithelial cells. Instead, spores were phagocytized by mononuclear cells on the apical pole of epithelial cells. Early epithelial internalization of fungal spores in vivo cannot explain the bronchial/bronchiolar epithelium invasion observed in some invasive mold infections. The bioimaging approach provides a useful means to accurately enumerate and localize the fungal spores in the pulmonary tissues.
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Affiliation(s)
- Blandine Rammaert
- Unit of Molecular Mycology, Institut Pasteur, Paris, France; URA 3012, The French National Centre for Scientific Research (CNRS), Paris, France; Infectious and Tropical Diseases Service, Hôpital Necker-Enfants Malades, APHP, Paris, France; Paris Diderot University, Bio Sorbonne Paris Cité, Paris, France.
| | - Grégory Jouvion
- Unit of Human and Animal Model Histopathology, Institut Pasteur, Paris, France; Paris Descartes University, PRES Sorbonne-Paris-Cité, Paris, France
| | | | - Dea Garcia-Hermoso
- Unit of Molecular Mycology, Institut Pasteur, Paris, France; URA 3012, The French National Centre for Scientific Research (CNRS), Paris, France
| | - Claire Szczepaniak
- Cellular Health Imaging Center, Université d'Auvergne, Clermont Ferrand, France
| | - Charlotte Renaudat
- Unit of Molecular Mycology, Institut Pasteur, Paris, France; URA 3012, The French National Centre for Scientific Research (CNRS), Paris, France
| | | | - Fabrice Chrétien
- Unit of Human and Animal Model Histopathology, Institut Pasteur, Paris, France; Paris Descartes University, PRES Sorbonne-Paris-Cité, Paris, France; Neuropathology Service, Centre Hospitalier Sainte-Anne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Françoise Dromer
- URA 3012, The French National Centre for Scientific Research (CNRS), Paris, France
| | - Stéphane Bretagne
- Unit of Molecular Mycology, Institut Pasteur, Paris, France; Paris Diderot University, Bio Sorbonne Paris Cité, Paris, France; Parasitology-Mycology Service, Hôpital St Louis, AP-HP, Paris, France
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183
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Klingspor L, Saaedi B, Ljungman P, Szakos A. Epidemiology and outcomes of patients with invasive mould infections: a retrospective observational study from a single centre (2005-2009). Mycoses 2015; 58:470-7. [DOI: 10.1111/myc.12344] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lena Klingspor
- Division of Clinical Microbiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Baharak Saaedi
- Division of Clinical Microbiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Per Ljungman
- Division of Haematology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Attila Szakos
- Division of Pathology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
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184
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Bernardeschi C, Foulet F, Ingen-Housz-Oro S, Ortonne N, Sitbon K, Quereux G, Lortholary O, Chosidow O, Bretagne S. Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review. Medicine (Baltimore) 2015; 94:e1018. [PMID: 26131805 PMCID: PMC4504535 DOI: 10.1097/md.0000000000001018] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Invasive aspergillosis (IA) has poor prognosis in immunocompromised patients. Skin manifestations, when present, should contribute to an early diagnosis. The authors aimed to provide prevalence data and a clinical and histologic description of cutaneous manifestations of primary cutaneous IA (PCIA) and secondary CIA (SCIA) in a unique clinical series of IA and present the results of an exhaustive literature review of CIA. Cases of proven and probable IA with cutaneous manifestations were retrospectively extracted from those registered between 2005 and 2010 in a prospective multicenter aspergillosis database held by the National Reference Center for Invasive Mycoses and Antifungals, Pasteur Institute, France. Patients were classified as having PCIA (i.e., CIA without extracutaneous manifestations) or SCIA (i.e., disseminated IA). Among the 1,410 patients with proven or probable IA, 15 had CIA (1.06%), 5 PCIA, and 10 SCIA. Hematological malignancies were the main underlying condition (12/15). Patients with PCIA presented infiltrated and/or suppurative lesions of various localizations not related to a catheter site (4/5), whereas SCIA was mainly characterized by disseminated papules and nodules but sometimes isolated nodules or cellulitis. Histologic data were available for 11 patients, and for 9, similar for PCIA and SCIA, showed a dense dermal polymorphic inflammatory infiltrate, with the epidermis altered in PCIA only. Periodic acid Schiff and Gomori-Grocott methenamine silver nitrate staining for all but 2 biopsies revealed hyphae compatible with Aspergillus. Aspergillus flavus was isolated in all cases of PCIA, with Aspergillus fumigatus being the most frequent species (6/10) in SCIA. Two out 5 PCIA cases were treated surgically. The 3-month survival rate was 100% and 30% for PCIA and SCIA, respectively. Our study is the largest adult series of CIA and provides complete clinical and histologic data for the disease. Primary cutaneous IA should be recognized early, and cases of extensive necrosis should be treated surgically; its prognosis markedly differs from that for SCIA. Any suppurative, necrotic, papulonodular, or infiltrated skin lesion in an immunocompromised patient should lead to immediate biopsy for histologic analysis and mycological skin direct examination and culture.
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Affiliation(s)
- Céline Bernardeschi
- Dermatology Department, UPEC (CB, SI-H-O, OC); Mycology and Parasitology Department (FF); Pathology Department, AP-HP, Henri Mondor Hospital, Créteil (NO); Pasteur Institute, National Reference Center for Invasive Mycoses and Antifungals, Paris (KS, OL, SB); Skin Cancer Unit, Nantes University Hospital (GQ); Infectious Diseases and Tropical Medicine Department, AP-HP, Necker-Enfants malades Hospital, Necker-Pasteur Infectious Diseases Center, IHU Imagine, Paris (OL); Université Paris Descartes (NO, OL); Université Paris-Est-Créteil UPEC, Créteil (OC); Mycology and Parasitology Department, AP-HP, Saint Louis Hospital, Paris (SB); Université Paris Diderot (SB); INSERM Centre d'Investigation Clinique, Créteil, (OC); and EA EpidermE, UPEC, Créteil, France (SI-H-O, OC)
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185
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Pagano L, Lyon S. Celebrating 40 years of progress in bone marrow transplantation: a report from the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation. Future Microbiol 2015; 9:1117-21. [PMID: 25405881 DOI: 10.2217/fmb.14.95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The European Society for Blood and Marrow Transplantation was established in 1974 to enable scientists and physicians involved in clinical bone marrow transplantation to share their experience and develop cooperative studies. The organization celebrated its 40th anniversary with a meeting that considered hematopoietic stem cell transplantation not as a standalone procedure, but as part of a complex therapeutic program managed by a multidisciplinary professional team. The role of antifungal prophylaxis, emerging resistance in Aspergillus, the management of mucormycosis and new guidelines on antifungal therapy were among the topics discussed by the physicians, nurses, allied health professionals and scientists attending the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation.
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Affiliation(s)
- Livio Pagano
- Haematology Department, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
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186
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Frange P, Bougnoux ME, Lanternier F, Neven B, Moshous D, Angebault C, Lortholary O, Blanche S. An update on pediatric invasive aspergillosis. Med Mal Infect 2015; 45:189-98. [DOI: 10.1016/j.medmal.2015.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/09/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
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187
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Burden of serious fungal infections in the Dominican Republic. J Infect Public Health 2015; 9:7-12. [PMID: 26027476 DOI: 10.1016/j.jiph.2015.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/21/2015] [Accepted: 04/03/2015] [Indexed: 12/17/2022] Open
Abstract
The Dominican Republic (DR) is the second largest Caribbean nation and, with Haiti, the DR accounts for nearly three-quarters of the cases of human immunodeficiency virus (HIV) infection in the Caribbean region and the highest rates of TB in the Americas. The present study estimated the burden of serious fungal infections and some other mycoses in the DR. The data were extracted from the World Health Organization Stop Tuberculosis (WHO STOP TB) program, the Joint United Nations Program on HIV/AIDS (UNAIDS), and searches for relevant literature via MEDLINE, PubMed, MedFacts, and so on. The chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and severe asthma with fungal sensitization (SAFS) rates were derived from the asthma and TB rates. When no data regarding mycoses were available, we used specific populations at risk and the frequencies of fungal infection in each of these populations to estimate the national prevalence. Among its population of 10,090,000, we estimated that 221,027 (2.2%) have a serious fungal infection, including 158,134 women with recurrent vulvovaginal candidiasis. We estimated high numbers of 25,150 for ABPA and 34,000 for severe asthma fungal sensitization (SAFS) (250 and 529/100,000, respectively). CPA was common, with an estimated 2122 cases, of which 707 followed pulmonary TB. The annual prevalence of CPA was estimated to be 1374 cases. Four cases of histoplasmosis and several cases of chromoblastomycosis have also been reported. Pityriasis versicolor and tinea capitis are frequent in children, and 11% have kerion. Local epidemiological investigations are urgently required to validate or modify these estimates of serious fungal infections in the DR.
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188
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Nationwide Surveillance of Azole Resistance in Aspergillus Diseases. Antimicrob Agents Chemother 2015; 59:4569-76. [PMID: 25987612 DOI: 10.1128/aac.00233-15] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/12/2015] [Indexed: 01/12/2023] Open
Abstract
Aspergillus disease affects a broad patient population, from patients with asthma to immunocompromised patients. Azole resistance has been increasingly reported in both clinical and environmental Aspergillus strains. The prevalence and clinical impact of azole resistance in different patient populations are currently unclear. This 1-year prospective multicenter cohort study aimed to provide detailed epidemiological data on Aspergillus resistance among patients with Aspergillus disease in Belgium. Isolates were prospectively collected in 18 hospitals (April 2011 to April 2012) for susceptibility testing. Clinical and treatment data were collected with a questionnaire. The outcome was evaluated to 1 year after a patient's inclusion. A total of 220 Aspergillus isolates from 182 patients were included. The underlying conditions included invasive aspergillosis (n = 122 patients), allergic bronchopulmonary aspergillosis (APBA) (n = 39 patients), chronic pulmonary aspergillosis (n = 10 patients), Aspergillus bronchitis (n = 7 patients), and aspergilloma (n = 5 patients). The overall azole resistance prevalence was 5.5% (95% confidence interval [CI] 2.8 to 10.2%) and was 7.0% (4/57; 95% CI, 2.3 to 17.2%) in patients with APBA, bronchitis, aspergilloma, or chronic aspergillosis and 4.6% in patients with invasive aspergillosis (5/108; 95% CI, 1.7 to 10.7%). The 6-week survival in invasive aspergillosis was 52.5%, while susceptibility testing revealed azole resistance in only 2/58 of the deceased patients. The clinical impact of Aspergillus fumigatus resistance was limited in our patient population with Aspergillus diseases.
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189
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Matthaiou DK, Christodoulopoulou T, Dimopoulos G. How to treat fungal infections in ICU patients. BMC Infect Dis 2015; 15:205. [PMID: 25930035 PMCID: PMC4419464 DOI: 10.1186/s12879-015-0934-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/21/2015] [Indexed: 12/22/2022] Open
Abstract
Fungal infections represent a major burden in the critical care setting with increasing morbidity and mortality. Candidiasis is the leading cause of such infections, with C. albicans being the most common causative agent, followed by Aspergillosis and Mucormycosis. The diagnosis of such infections is cumbersome requiring increased clinical vigilance and extensive laboratory testing, including radiology, cultures, biopsies and other indirect methods. However, it is not uncommon for definitive evidence to be unavailable. Risk and host factors indicating the probability of infections may greatly help in the diagnostic approach. Timely and adequate intervention is important for their successful treatment. The available therapeutic armamentarium, although not very extensive, is effective with low resistance rates for the newer antifungal agents. However, timely and prudent use is necessary to maximize favorable outcomes.
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Affiliation(s)
- Dimitrios K Matthaiou
- Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, 1 Rimini str, Haidari-Athens, 12462, Greece.
| | - Theodora Christodoulopoulou
- Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, 1 Rimini str, Haidari-Athens, 12462, Greece.
| | - George Dimopoulos
- Department of Critical Care, University Hospital ATTIKON, Medical School, University of Athens, 1 Rimini str, Haidari-Athens, 12462, Greece.
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190
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Ananda-Rajah MR, Kontoyiannis D. Isavuconazole: a new extended spectrum triazole for invasive mold diseases. Future Microbiol 2015; 10:693-708. [DOI: 10.2217/fmb.15.34] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT Isavuconazole is the first broad spectrum prodrug triazole with efficacy against invasive fungal diseases including aspergillosis and mucormycosis. Characteristics include linear dose-proportional pharmacokinetics, intravenous and oral formulations allowing therapeutic streamlining, once daily dosing, absence of nephrotoxic solubilizing agents and excellent oral bioavailability independent of prandial status and gastric acidity. An open label noncomparator study demonstrated encouraging results for isavuconazole as primary or salvage therapy for a range of fungi including mucormycosis. Isavuconazole had fewer premature drug discontinuations and adverse events in the eye, hepatobiliary and psychiatry systems than the comparator agent, voriconazole in a randomized double-blind clinical trial. Cross-resistance of isavuconazole best correlates with voriconazole. In vitro resistance is not invariably predictive of clinical failure. Isavuconazole signals progress in pharmacokinetics, bioavailability and toxicity/tolerability supported by clinical efficacy from Phase III trials.
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Affiliation(s)
| | - Dimitrios Kontoyiannis
- Department of Infectious Diseases, Infection Control & Employee Health, Unit 1416, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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191
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Guigue N, Lardeux S, Alanio A, Hamane S, Tabouret M, Bretagne S. Importance of operational factors in the reproducibility of Aspergillus galactomannan enzyme immune assay. PLoS One 2015; 10:e0124044. [PMID: 25860967 PMCID: PMC4393237 DOI: 10.1371/journal.pone.0124044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 03/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background The Platelia Aspergillus Ag assay (Bio-Rad) is designed for detecting Aspergillus galactomannan (GM) and is widely used for diagnosing invasive aspergillosis but is hampered by variable occurrences of unreproducible positive results. Frequency and origin of these unreproducible results have not been formally studied. Methods Different technicians simultaneously performed four tests on 550 consecutive sera from adult patients (Test#1-Test#2 for extraction#1 and Test#3-Test#4 for extraction#2). The samples were classified as confirmed negative [all tests with GM optical density index (GM-ODI) <0.5], confirmed positive (all tests with GM-ODI ≥0.5), extraction unreproducible positive (Test#1 and Test#2 ODIs ≥0.5, and Test#3 and Test#4 GM-ODIs <0.5, or conversely), and ELISA unreproducible positive (only one test with GM-ODI ≥0.5). The samples with positive and negative GM-ODIs within the assay coefficient of variation values were classified as non-conclusive. Four similar additional tests were performed after ≤72h storage at 4°C and a new GM test after 8 months at -20°C. Results Five-hundred-twenty sera (94.5%) were confirmed negative, 15 (2.7%) confirmed positive, 4 (0.7%) extraction unreproducible positive, 6 (1.1%) ELISA unreproducible positive, and 5 (0.9%) non-conclusive. Upon retesting, the unreproducible positive results turned negative except for one which turned non-conclusive. The confirmed positive and non-conclusive had similar GM-ODIs (p>0.4) upon retesting after storage ≤72h at 4°C (n = 20) or eight months at -20°C (n = 17). Conclusions Operational unreproducible positives represent 33% of the GM-positive results and a second sample evaluation appears mandatory to avoid useless investigations or treatments. When operational artifacts are excluded, GM remains stable at standard storage conditions.
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Affiliation(s)
- Nicolas Guigue
- Laboratoire de Parasitologie-Mycologie, Groupe hospitalier Lariboisière-Saint Louis, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, Groupe hospitalier Lariboisière-Saint Louis, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- CNRS URA3012, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France
| | - Samia Hamane
- Laboratoire de Parasitologie-Mycologie, Groupe hospitalier Lariboisière-Saint Louis, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | | | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, Groupe hospitalier Lariboisière-Saint Louis, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- CNRS URA3012, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France
- * E-mail:
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192
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Invasive Fungal Infections in Pediatric Solid Organ Transplant Patients: Epidemiology and Management. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0217-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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193
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British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases. THE LANCET. INFECTIOUS DISEASES 2015; 15:461-74. [PMID: 25771341 DOI: 10.1016/s1473-3099(15)70006-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Invasive fungal diseases are an important cause of morbidity and mortality in a wide range of patients, and early diagnosis and management are a challenge. We therefore did a review of the scientific literature to generate a series of key recommendations for the appropriate use of microbiological, histological, and radiological diagnostic methods for diagnosis of invasive fungal diseases. The recommendations emphasise the role of microscopy in rapid diagnosis and identification of clinically significant isolates to species level, and the need for susceptibility testing of all Aspergillus spp, if treatment is to be given. In this Review, we provide information to improve understanding of the importance of antigen detection for cryptococcal disease and invasive aspergillosis, the use of molecular (PCR) diagnostics for aspergillosis, and the crucial role of antibody detection for chronic and allergic aspergillosis. Furthermore, we consider the importance of histopathology reporting with a panel of special stains, and emphasise the need for urgent (<48 hours) and optimised imaging for patients with suspected invasive fungal infection. All 43 recommendations are auditable and should be used to ensure best diagnostic practice and improved outcomes for patients.
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194
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Hsu LY, Lee DG, Yeh SP, Bhurani D, Khanh BQ, Low CY, Norasetthada L, Chan T, Kwong YL, Vaid AK, Alejandria I, Mendoza M, Chen CY, Johnson A, Tan TY. Epidemiology of invasive fungal diseases among patients with haematological disorders in the Asia-Pacific: a prospective observational study. Clin Microbiol Infect 2015; 21:594.e7-11. [PMID: 25749561 DOI: 10.1016/j.cmi.2015.02.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/12/2015] [Accepted: 02/22/2015] [Indexed: 12/15/2022]
Abstract
We conducted a 2-year multicentre prospective observational study to determine the epidemiology of and mortality associated with invasive fungal diseases (IFDs) among patients with haematological disorders in Asia. Eleven institutions from 8 countries/regions participated, with 412 subjects (28.2% possible, 38.3% probable and 33.5% proven IFDs) recruited. The epidemiology of IFDs in participating institutions was similar to Western centres, with Aspergillus spp. (65.9%) or Candida spp. (26.7%) causing the majority of probable and proven IFDs. The overall 30-day mortality was 22.1%. Progressive haematological disorder (odds ratio [OR] 5.192), invasive candidiasis (OR 3.679), and chronic renal disease (OR 6.677) were independently associated with mortality.
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Affiliation(s)
- L Y Hsu
- National University Hospital, National University Health System, Singapore.
| | - D G Lee
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S P Yeh
- China Medical University Hospital, Taiwan
| | - D Bhurani
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - B Q Khanh
- National Institute of Hematology and Blood Transfusion, Hanoi, Viet Nam
| | - C Y Low
- Singapore General Hospital, Singapore
| | | | - T Chan
- Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Y L Kwong
- Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - A K Vaid
- Maedanta Medicity, Gurgaon, India
| | - I Alejandria
- National Kidney and Transplant Institute, Quezon City, Philippines
| | - M Mendoza
- National Kidney and Transplant Institute, Quezon City, Philippines
| | - C Y Chen
- National Taiwan University Hospital, Taiwan
| | - A Johnson
- International Health Management Associates, Inc., Schaumburg, IL, USA
| | - T Y Tan
- Changi General Hospital, Singapore
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195
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Heylen L, Maertens J, Naesens M, Van Wijngaerden E, Lagrou K, Bammens B, Claes K, Evenepoel P, Meijers B, Kuypers D, Sprangers B. Invasive Aspergillosis After Kidney Transplant: Case-Control Study. Clin Infect Dis 2015; 60:1505-11. [DOI: 10.1093/cid/civ103] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/03/2015] [Indexed: 12/19/2022] Open
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196
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Variability of voriconazole plasma concentrations after allogeneic hematopoietic stem cell transplantation: impact of cytochrome p450 polymorphisms and comedications on initial and subsequent trough levels. Antimicrob Agents Chemother 2015; 59:2305-14. [PMID: 25645831 DOI: 10.1128/aac.04838-14] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Voriconazole (VRC) plasma trough concentrations (Cmin) are highly variable, and this could affect treatment efficacy and safety in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT). We aimed to describe the intra- and interindividual variation of VRC Cmin throughout the course of VRC therapy and to identify the determinants of this variation. Clinical data, medications, and VRC Cmin (n = 308) of 33 AHSCT patients were retrospectively collected. Cytochrome P450 (CYP450) genotypes of CYP2C19, CYP3A4, and CYP3A5 patients were retrospectively determined before allografting, and a combined genetic score was calculated for each patient. The higher the genetic score, the faster the metabolism of the patient. The VRC Cmin inter- and intraindividual coefficients of variation were 84% and 68%, respectively. The VRC dose (D) was correlated to VRC Cmin (r = 0.412, P < 0.0001) only for oral administration. The administration route and the genetic score significantly affected the initial VRC Cmin. Considering oral therapy, patients with a genetic score of <2 had higher initial VRC Cmin/D than patients with a genetic score of >2 (P = 0.009). Subsequent VRC Cmin remained influenced by the genetic score (P = 0.004) but were also affected by pump proton inhibitor comedication (P < 0.0001). The high variability of VRC Cmin in AHSCT patients is partially explained by the route of administration, treatment with pump proton inhibitors, and the combined genetic score. This study suggests the interest in combined genetic score determination to individualize a priori the VRC dose and underlines the need for longitudinal therapeutic drug monitoring to adapt subsequent doses to maintain the VRC Cmin within the therapeutic range.
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197
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Loschi M, Thill C, Gray C, David M, Bagatha MF, Chamseddine A, Contentin N, Jardin F, Lanic H, Lemasle E, Lenain P, Stamatoullas A, Tilly H, Lepretre S. Invasive aspergillosis in neutropenic patients during hospital renovation: effectiveness of mechanical preventive measures in a prospective cohort of 438 patients. Mycopathologia 2015; 179:337-45. [PMID: 25637199 DOI: 10.1007/s11046-015-9865-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aspergillus species are the main cause of invasive fungal disease for patients with severe and prolonged neutropenia. Building or renovation works have been shown as one of the major causes of outbreaks of aspergillosis. OBJECTIVES This study aimed to assess the effectiveness of introduction and adaptation by air sampling of mechanical preventive measures on the incidence of invasive pulmonary aspergillosis in neutropenic patients during hospital renovation. PATIENTS All of the patients admitted for prolonged and severe neutropenia during a renovation period from 2003 to 2008 were prospectively enrolled. Invasive pulmonary aspergillosis (IPA) cases were classified as possible, probable, and proven, according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group criteria. The effectiveness of preventive measures was determined by air sampling. RESULTS We recorded 705 hospitalizations for neutropenia concerning 438 patients. The majority of hospitalized neutropenic patients was treated for acute leukemia (38.3 %), followed by patients suffering from non-Hodgkin and Hodgkin lymphomas (33 %). The total cumulative incidence of probable and proven IPA was 4.1 %. Risk factors for developing IPA were underlying disease, treatment course at the time of hospitalization, and the mean duration of hospitalization and of neutropenia. CONCLUSIONS In this prospective study, the incidence of invasive pulmonary aspergillosis did not increase in neutropenic patients during a renovation period because of efficient mechanical preventive measures systematically adjusted using the results of air sampling.
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Affiliation(s)
- Michael Loschi
- Department of Hematology, Centre Henri Becquerel, 1 rue d'Amiens, 76000, Rouen, France
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198
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Dorgan E, Denning DW, McMullan R. Burden of fungal disease in Ireland. J Med Microbiol 2015; 64:423-426. [PMID: 25596121 DOI: 10.1099/jmm.0.000020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/31/2014] [Indexed: 12/23/2022] Open
Abstract
Our objective was to estimate the burden of fungal disease on the island of Ireland, as part of a coordinated project estimating the global burden. Published epidemiology data describing fungal infection in Ireland were identified. Population and underlying disease data were collected for 2010 and a structured set of assumptions were applied to estimate burden of fungal disease based on immunosuppression, chronic disease, and other demographic information indicating predisposition to fungal infection. From Ireland's population of 6.4 million, we estimate 117, 000 patients develop significant fungal disease each year. By far the most common fungal disease is recurrent Candida vaginitis, with an estimated 95, 000 episodes annually (3000 per 100 000 women). Other fungal diseases which may be less well recognized are severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis, with estimated episodes per year of 11, 700 and 9000, respectively (182 and 140 per 100, 000 population, respectively). The model also estimates 450 episodes of invasive aspergillosis, 200 of chronic pulmonary aspergillosis, 600 of oesophageal candidiasis and 450 of candidaemia per year (7, 3, 9 and 6 episodes per 100, 000 population, respectively). This is, we believe, the first attempt to estimate the burden of fungal disease in our population and provides a basis for estimating its impact on human health and resource use.
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Affiliation(s)
- Eileen Dorgan
- Department of Medical Microbiology, Belfast HSC Trust, Belfast, UK
| | - David W Denning
- University of Manchester, Education and Research Centre, Southmoor Road Manchester M23 9LT
| | - Ronan McMullan
- Centre for Infection and Immunity, Queens University Belfast, UK.,Department of Medical Microbiology, Belfast HSC Trust, Belfast, UK
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199
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Castagnola E, Mikulska M, Viscoli C. Prophylaxis and Empirical Therapy of Infection in Cancer Patients. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7173426 DOI: 10.1016/b978-1-4557-4801-3.00310-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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200
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Desjardins A, Parize P, Angebault C, Lécuyer H, Lortholary O, Bougnoux ME. Lack of 1-3-B-D-glucan detection in adults with bacteraemia. Med Mycol 2014; 53:405-8. [DOI: 10.1093/mmy/myu067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/04/2014] [Indexed: 11/13/2022] Open
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