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Construction of a Recyclable Genetic Marker and Serial Gene Deletions in the Human Pathogenic Mucorales Mucor circinelloides. G3-GENES GENOMES GENETICS 2017; 7:2047-2054. [PMID: 28476909 PMCID: PMC5499115 DOI: 10.1534/g3.117.041095] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mucor circinelloides is a human pathogen, biofuel producer, and model system that belongs to a basal fungal lineage; however, the genetics of this fungus are limited. In contrast to ascomycetes and basidiomycetes, basal fungal lineages have been understudied. This may be caused by a lack of attention given to these fungi, as well as limited tools for genetic analysis. Nonetheless, the importance of these fungi as pathogens and model systems has increased. M. circinelloides is one of a few genetically tractable organisms in the basal fungi, but it is far from a robust genetic system when compared to model fungi in the subkingdom Dikarya. One problem is the organism is resistant to drugs utilized to select for dominant markers in other fungal transformation systems. Thus, we developed a blaster recyclable marker system by using the pyrG gene (encoding an orotidine-5'-phosphate decarboxylase, ortholog of URA3 in Saccharomyces cerevisiae). A 237-bp fragment downstream of the pyrG gene was tandemly incorporated into the upstream region of the gene, resulting in construction of a pyrG-dpl237 marker. To test the functionality of the pyrG-dpl237 marker, we disrupted the carRP gene that is involved in carotenoid synthesis in pyrG- mutant background. The resulting carRP::pyrG-dpl237 mutants exhibit a white colony phenotype due to lack of carotene, whereas wild type displays yellowish colonies. The pyrG marker was then successfully excised, generating carRP-dpl237 on 5-FOA medium. The mutants became auxotrophic and required uridine for growth. We then disrupted the calcineurin B regulatory subunit cnbR gene in the carRP::dpl237 strain, generating mutants with the alleles carRP::dpl237 and cnbR::pyrG These results demonstrate that the recyclable marker system is fully functional, and therefore the pyrG-dpl237 marker can be used for sequential gene deletions in M. circinelloides.
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202
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Increasing incidence of mucormycosis in a large Spanish hospital from 2007 to 2015: Epidemiology and microbiological characterization of the isolates. PLoS One 2017; 12:e0179136. [PMID: 28591186 PMCID: PMC5462442 DOI: 10.1371/journal.pone.0179136] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/24/2017] [Indexed: 11/19/2022] Open
Abstract
We studied 19 cases of proven/probable mucormycosis diagnosed from 2007 to 2015 in our hospital and assessed the microbiological characteristics of the isolates. We recorded the incidence of mucormycosis and clinical and microbiological data of infected patients. Isolates were identified to molecular level and tested for their antifungal susceptibility to azoles, amphotericin B, and liposomal amphotericin B according to the CLSI M-38 A2 procedure. The incidence of mucormycosis in cases/100,000 hospital admissions during 2007–2015 increased significantly with respect to that reported in 1988–2006 (3.3 vs. 1.2; P<0.05). Patients mainly had hematological malignancies (52.6%) and/or trauma/surgical wounds (52.6%) and had received antifungal agents before the diagnosis of mucormycosis in 68% of cases. Diagnosis was by isolation (n = 17/19) and/or direct staining (n = 17/18) of Mucorales fungi in clinical samples. Identification was by panfungal PCR in patients with negative results in culture and in direct staining. The microorganisms identified were Lichtheimia spp. (42%), Rhizopus spp. (21%), Cunninghamella bertholletiae (16%), and others (21%). Liposomal amphotericin B was always more active than the other drugs against all the microorganisms except C. bertholletiae. All patients received antifungal treatment with 1 or more antifungal agents, mainly liposomal amphotericin B (17/19). Mortality was 47.4%, although this was significantly lower in the 11 patients in whom debridement was performed (18% vs. 87.5%) (P = 0.015). The incidence of mucormycosis has risen in recent years. The proportion of cases with soft tissue involvement was high, and Lichtheimia was the most frequently involved species. The highest antifungal activity was observed with liposomal amphotericin B.
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203
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Compain F, Aït-Ammar N, Botterel F, Gibault L, Le Pimpec Barthes F, Dannaoui E. Fatal Pulmonary Mucormycosis due to Rhizopus homothallicus. Mycopathologia 2017; 182:907-913. [PMID: 28580534 DOI: 10.1007/s11046-017-0151-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
We report here a case of cavitary pneumonia due to Rhizopus homothallicus in a diabetic patient. This is the first proven case of R. homothallicus infection in Western countries and the third case described worldwide. The organism was isolated from lung biopsy and identified after amplification and sequencing of the internal transcribed spacer region.
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Affiliation(s)
- Fabrice Compain
- Unité de Parasitologie-Mycologie, Service de Microbiologie, Université Paris-Descartes, Faculté de Médecine, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Nawel Aït-Ammar
- Unité de Mycologie-Parasitologie, Département de Bactériologie Virologie Hygiène Parasitologie Mycologie, DHU VIC, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Dynamyc Research Group, Université Paris-Est Créteil, Faculté de Médecine, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Françoise Botterel
- Unité de Mycologie-Parasitologie, Département de Bactériologie Virologie Hygiène Parasitologie Mycologie, DHU VIC, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Dynamyc Research Group, Université Paris-Est Créteil, Faculté de Médecine, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Laure Gibault
- Department of Pathology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Francoise Le Pimpec Barthes
- Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Eric Dannaoui
- Unité de Parasitologie-Mycologie, Service de Microbiologie, Université Paris-Descartes, Faculté de Médecine, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France. .,Dynamyc Research Group, Université Paris-Est Créteil, Faculté de Médecine, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.
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204
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Abstract
Immunocompromised patients are at high risk for invasive fungal infections (IFIs); although Aspergillus remains the most common IFI caused by molds, other fungi, such as Mucorales, dematiaceous molds, and Fusarium spp, are being seen with increasing frequency. Presentations can vary, but sinopulmonary and disseminated infections are common. Our understanding of the pathogenesis of these infections is rudimentary. Fungal cultures and histopathology remain the backbone of diagnostics, as no good serologic markers are available. Polymerase chain reaction tests are being developed but currently remain investigational. Management of these infections is usually multidisciplinary, requiring surgical debridement along with antifungal therapy.
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205
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Abstract
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare fulminant opportunistic fungal infection that despite relevant treatment has high mortality. We present a case of a 3-year-old girl with acute lymphoblastic leukemia and ROCM, who was treated successfully with excessive surgery, systemic antifungal treatment with amphotericin B (AmB), posaconazole, and terbinafine as well as hyperbaric oxygen. Surgery included, beside extracranial and intracranial removal of infected areas, endoscopic sinus and skull base surgery with local AmB installation and in addition placement of an Ommaya reservoir for 114 intrathecal administrations of AmB. In addition, we review the literature of ROCM in pediatric patients with hematological diseases.
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206
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Prophylaxis with Isavuconazole or Posaconazole Protects Immunosuppressed Mice from Pulmonary Mucormycosis. Antimicrob Agents Chemother 2017; 61:AAC.02589-16. [PMID: 28264840 PMCID: PMC5404573 DOI: 10.1128/aac.02589-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/25/2017] [Indexed: 01/26/2023] Open
Abstract
We assessed prophylactic or continuous therapy of isavuconazole, posaconazole, or voriconazole in treating pulmonary murine mucormycosis. In the prophylaxis studies, only isavuconazole treatment resulted in significantly improved survival and lowered tissue fungal burden of immunosuppressed mice infected with Rhizopus delemar. In the continuous treatment studies, isavuconazole and posaconazole, but not voriconazole, equally prolonged survival time and lowered tissue fungal burden compared to placebo-treated mice. These results support the use of isavuconazole and posaconazole in prophylaxis treatment.
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207
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Bourcier J, Heudes PM, Morio F, Gastinne T, Chevallier P, Rialland-Battisti F, Garandeau C, Danner-Boucher I, Le Pape P, Frampas E, Moreau P, Defrance C, Peterlin P. Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016). Mycoses 2017; 60:526-533. [DOI: 10.1111/myc.12624] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/23/2017] [Accepted: 03/15/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Jessie Bourcier
- Service d'Hématologie Clinique; Centre d'Investigation Clinique en Cancérologie (CI2C); Centre Hospitalier et Universitaire (CHU) de Nantes; Nantes France
| | - Pierre-Marie Heudes
- Central Department of Radiology and Medical Imaging; University Hospital; Nantes France
| | - Florent Morio
- Laboratoire de Parasitologie-Mycologie; CHU de Nantes; Nantes France
- Département de Parasitologie et Mycologie Médicale; EA1155-IICiMed; Institut de Recherche en Santé 2; Université de Nantes; Nantes Atlantique Universités; Nantes France
| | - Thomas Gastinne
- Service d'Hématologie Clinique; Centre d'Investigation Clinique en Cancérologie (CI2C); Centre Hospitalier et Universitaire (CHU) de Nantes; Nantes France
| | - Patrice Chevallier
- Service d'Hématologie Clinique; Centre d'Investigation Clinique en Cancérologie (CI2C); Centre Hospitalier et Universitaire (CHU) de Nantes; Nantes France
| | | | - Claire Garandeau
- Service de Néphrologie-Immunologie Clinique; Centre Hospitalier et Universitaire (CHU) de Nantes; Nantes France
| | - Isabelle Danner-Boucher
- Service de Pneumologie et de Transplantation Thoracique; Centre Hospitalier et Universitaire (CHU) de Nantes; Nantes France
| | - Patrice Le Pape
- Laboratoire de Parasitologie-Mycologie; CHU de Nantes; Nantes France
- Département de Parasitologie et Mycologie Médicale; EA1155-IICiMed; Institut de Recherche en Santé 2; Université de Nantes; Nantes Atlantique Universités; Nantes France
| | - Eric Frampas
- Central Department of Radiology and Medical Imaging; University Hospital; Nantes France
| | - Philippe Moreau
- Service d'Hématologie Clinique; Centre d'Investigation Clinique en Cancérologie (CI2C); Centre Hospitalier et Universitaire (CHU) de Nantes; Nantes France
| | - Claire Defrance
- Central Department of Radiology and Medical Imaging; University Hospital; Nantes France
| | - Pierre Peterlin
- Service d'Hématologie Clinique; Centre d'Investigation Clinique en Cancérologie (CI2C); Centre Hospitalier et Universitaire (CHU) de Nantes; Nantes France
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208
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Narayanan S, Panarkandy G, Subramaniam G, Radhakrishnan C, Thulaseedharan NK, Manikath N, Ramaswamy S, Radhakrishnan S, Ekkalayil D. The "black evil" affecting patients with diabetes: a case of rhino orbito cerebral mucormycosis causing Garcin syndrome. Infect Drug Resist 2017; 10:103-108. [PMID: 28405168 PMCID: PMC5378458 DOI: 10.2147/idr.s130926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinvasive disease often resistant to treatment with a debilitating course and high mortality. Here, we report a case of a 45 year old woman with type 2 diabetes mellitus who presented to us with history of right-sided ptosis and facial palsy, and subsequently developed loss of vision and palatal palsy. She was in diabetic ketoacidosis. Nervous system examination revealed involvement of right second, third, fourth, sixth, seventh, ninth, and tenth cranial nerves, suggestive of Garcin syndrome. The hard palate had been eroded with formation of black eschar. Computed tomography of paranasal sinuses revealed right maxillary and ethmoid sinusitis, with spread of inflammation to infratemporal fossa and parapharynygeal neck spaces. Debridement of sinus mucosa was done, and culture of the same yielded growth of rhizopus species. Histopathological examination of the tissue showed angioinvasion and fungal hyphae suggestive of mucormycosis. She was treated with amphotericin B, posaconazole, and periodic nasal sinus debridement, but her general condition worsened after 8 weeks due to secondary sepsis and she succumbed to death.
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Affiliation(s)
| | | | | | | | | | | | | | - Suma Radhakrishnan
- Department of Otorhinolaryngology, Government Medical College, Kozhikode, Kerala, India
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209
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Samarei R, Gharebaghi N, Zayer S. Evaluation of 30 cases of mucormycosis at a university hospital in Iran. Mycoses 2017; 60:426-432. [PMID: 28321926 DOI: 10.1111/myc.12614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/17/2016] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
Mucormycosis is a deadly invasive fungal infection and mainly affects immunocompromised patients. To investigate the clinical features of patients who developed mucormycosis and to determine the parameters, which influenced the outcome following mycotic infection. The current investigation retrospectively evaluated the demographic characteristics, clinical features, therapeutic data, as well as the outcomes of treatment in all cases of proven and probable mucormycosis diagnosed from 2002 until 2016 in our hospital. A total of thirty cases were recorded. Rhizopus spp. was the predominant pathogen among the identified Mucorales (26.7%). Diabetes mellitus (46.7%) and haematological malignancy (40%), were the most common underlying diseases. With regard to predisposing factors, neutropenia (43.3%) and chemotherapy (40%) were the leading concomitant parameters. The most frequent sites of infection were lung (30%) and sinus (26.7%), whereas disseminated infection was also found in nine of 30 patients (30%). Neutropenia remained the only independent factor associated with mortality (Relative Risk=3.557, 95% CI=1.365-9.271, P=.009). Diagnostic delay -either due to delayed presentation of patients to our centre or insufficient awareness about invasive fungal infection among our clinicians- is a likely explanation for such a high mortality rate in our series.
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Affiliation(s)
- Reza Samarei
- Department of Otolaryngology, Faculty of Medicine, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Gharebaghi
- Department of Infectious Diseases, Urmia University of Medical Sciences, Urmia, Iran
| | - Salar Zayer
- Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran
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210
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Bagshaw E, Kuessner D, Posthumus J, Escrig C, Blackney M, Heimann SM, Cornely OA. The cost of treating mucormycosis with isavuconazole compared with standard therapy in the UK. Future Microbiol 2017; 12:515-525. [PMID: 28191796 DOI: 10.2217/fmb-2016-0231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM Mucormycosis is a fungal infection associated with high mortality. Until recently, the only licensed treatments were amphotericin B (AMB) formulations. Isavuconazole (ISAV) is a new mucormycosis treatment. A UK-based economic model explored treatment costs with ISAV versus liposomal AMB followed by posaconazole. MATERIALS & METHODS As a matched case-control analysis showed similar efficacy for ISAV and AMB, a cost-minimization approach was taken. Direct costs - drug acquisition, monitoring and administration, and hospitalization costs - were estimated from the National Health Service perspective. RESULTS Per-patient costs for ISAV and liposomal AMB + posaconazole were UK£26,810 and UK£41,855, respectively, with savings primarily driven by drug acquisition and hospitalization costs. CONCLUSION ISAV may reduce costs compared with standard mucormycosis therapy.
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Affiliation(s)
| | - Daniel Kuessner
- Global Market Access and Health Economics, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Jan Posthumus
- Global Market Access and Health Economics, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Cesar Escrig
- Global Medical Affairs, Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | | | - Oliver Andreas Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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211
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Echenique IA, Angarone MP, Gordon RA, Rich J, Anderson AS, McGee EC, Abicht TO, Kang J, Stosor V. Invasive fungal infection after heart transplantation: A 7-year, single-center experience. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 07/19/2016] [Accepted: 09/12/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Ignacio A. Echenique
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Michael P. Angarone
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Robert A. Gordon
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Jonathan Rich
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Allen S. Anderson
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Edwin C. McGee
- Division of Cardiac Surgery; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Travis O. Abicht
- Division of Cardiac Surgery; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Joseph Kang
- Division of Biostatistics; Department of Preventative Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Valentina Stosor
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Organ Transplantation; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
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212
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Kudo K, Hasegawa H, Sato E, Kaneko T, Ishida D, Kanno C, Endo M. A case of rhinocerebral mucormycosis extending into the skull. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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213
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Suzuki Y, Kume H, Togano T, Ohto H. Epidemiology of Zygomycosis: Analysis of National Data from Pathological Autopsy Cases in Japan. Med Mycol J 2017; 58:E89-E95. [DOI: 10.3314/mmj.16-00028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yuhko Suzuki
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, School of Medicine
- Both authors contributed equally to this work
| | - Hikaru Kume
- Department of Pathology, Kitasato University, School of Medicine
- Both authors contributed equally to this work
| | - Tomiteru Togano
- Department of Hematology, Kitasato University, School of Medicine
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, School of Medicine
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214
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Hyperglycemia as a possible risk factor for mold infections-the potential preventative role of intensified glucose control in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2016; 52:657-662. [PMID: 27941771 DOI: 10.1038/bmt.2016.306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/04/2016] [Accepted: 10/12/2016] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus (DM) is well-known as a disorder that increases the risk of infectious diseases. Various reports have shown that innate immunity is impaired in patients with DM, which is considered to be a major cause of increased risk of infectious diseases. However, there is a paucity of data about the actual risk of mold infections in patients with DM. Several treatment procedures, such as solid organ transplantation and hematopoietic stem cell transplantation (HSCT), are intrinsically associated with a high risk of mold infections and also correlated with an increased risk of post-transplant DM. Therefore, we could assume that organ transplant recipients or HSCT recipients with DM are at quite high risk of mold infections. Here, we aim to summarize the information about the increased risk of mold infections in patients with DM, and propose possible interventions such as intensive glucose control to reduce this risk in patients with DM.
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215
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Abdollahi A, Shokohi T, Amirrajab N, Poormosa R, Kasiri AM, Motahari SJ, Ghoreyshi SM, Madani SA, Nikkhah M, Ghasemi M, Vahedi Larijani L, Didehdar M, Seifi Z, Gholinejad N, Ilkit M. Clinical features, diagnosis, and outcomes of rhino-orbito-cerebral mucormycosis- A retrospective analysis. Curr Med Mycol 2016; 2:15-23. [PMID: 28959791 PMCID: PMC5611692 DOI: 10.18869/acadpub.cmm.2.4.15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Rhino-orbito-cerebral mucormycosis (ROCM) is a rare disease with acute and fulminant manifestation. This infection is associated with high morbidity and mortality rates. Herein, we reviewed the manifestations, underlying conditions, medical treatments, and surgical interventions in ROCM patients admitted to a tertiary referral center in northern Iran over a seven-year period. Materials and Methods: In a retrospective analysis, 15 cases of ROCM were identified from 2007 to 2013 in Bu Ali Sina Hospital, Sari, Iran. All the ROCM cases were clinically diagnosed and confirmed by histopathological and/or mycological examination. The relevant demographic data, clinical, ophthalmic, and neurologic manifestations, underlying conditions, medical treatments, and surgical interventions were recorded and analyzed. Results: The mean age of the patients was 54±11 years (age range: 28–70 years); 26.7% of the patients were male and 73.3% female (male: female ratio of 1: 2.7). Uncontrolled diabetes was noted in at least 86.7% (13/15) of the cases. The maxillary sinuses were the most frequently involved sites (66.7% of the cases) followed by the ethmoid sinus. Amphotericin B in combination with surgical debridement was used in the treatment of 80% of the cases. Furthermore, 73.3% of the patients who were diagnosed early and underwent medical and extensive surgical debridement of the infected tissues survived. Conclusion: Uncontrolled diabetes mellitus is considered to be the main predisposing factor for ROCM. To prevent and reduce mortality rate of this acute disease, early diagnosis based on clinical findings and biopsy is recommended.
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Affiliation(s)
- A Abdollahi
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - T Shokohi
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center (IFRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - N Amirrajab
- Department of Medical Laboratory Sciences, School of Paramedicine/Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - R Poormosa
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - A M Kasiri
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - S J Motahari
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - S M Ghoreyshi
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - S A Madani
- Department of Otolaryngology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Nikkhah
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Ghasemi
- Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - L Vahedi Larijani
- Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Didehdar
- Department of Medical Mycology and Parasitology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Z Seifi
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - N Gholinejad
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - M Ilkit
- Division of Mycology, Department of Microbiology, School of Medicine, University of Çukurova, Adana, Turkey
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216
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Pana ZD, Seidel D, Skiada A, Groll AH, Petrikkos G, Cornely OA, Roilides E. Invasive mucormycosis in children: an epidemiologic study in European and non-European countries based on two registries. BMC Infect Dis 2016; 16:667. [PMID: 27832748 PMCID: PMC5105268 DOI: 10.1186/s12879-016-2005-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/29/2016] [Indexed: 01/23/2023] Open
Abstract
Background Mucormycosis has emerged as a rare but frequently fatal invasive fungal disease. Current knowledge on paediatric mucormycosis is based on case reports and small series reported over several decades. Contemporary data on a large cohort of patients is lacking. Methods Two large international registries (Zygomyco.net and FungiScope™) were searched for mucormycosis cases in ≤19 year-old patients. Cases enrolled between 2005 and 2014 were extracted, and dual entries in the two databases merged. Epidemiology, clinical characteristics, diagnostic procedures, therapeutic management and final outcome were recorded and analysed with SPSS v.12. Results Sixty-three unique cases (44 proven and 19 probable) were enrolled from 15 countries (54 in European and 9 in non-European countries). Median age was 13 years [Interquartile Range (IQR) 7.7] with a slight predominance (54.1 %) of females. Underlying conditions were haematological malignancies (46 %), other malignancies (6.3 %), haematopoietic stem cell transplantation (15.9 %), solid organ transplantation, trauma/surgery and diabetes mellitus (4.8 % each) and a variety of other diseases (7.9 %); in 9.5%, no underlying medical condition was found. Neutropenia was recorded in 46 % of the patients. The main sites of infection were lungs (19 %), skin and soft tissues (19 %), paranasal sinus/sino-orbital region (15.8 %) and rhino-cerebral region (7.9 %). Disseminated infection was present in 38.1 %. Mucormycosis diagnosis was based on several combinations of methods; culture combined with histology was performed in 31 cases (49.2 %). Fungal isolates included Rhizopus spp. (39.7 %), Lichtheimia spp. (17.5 %), Mucor spp. (12.7 %), Cunninghamella bertholletiae (6.3 %) and unspecified (23.8 %). Treatment comprised amphotericin B (AmB) monotherapy in 31.7 % or AmB in combination with other antifungals in 47.7 % of the cases, while 14.3 % received no antifungals. Surgery alone was performed in 6.3 %, and combined with antifungal therapy in 47.6 %. Crude mortality at last contact of follow-up was 33.3 %. In regression analysis, disseminated disease and prior haematopoietic stem cell transplantation were associated with increased odds of death, whereas the combination of systemic antifungal therapy with surgery was associated with improved survival. Conclusion Paediatric mucormycosis mainly affects children with malignancies, presents as pulmonary, soft tissue, paranasal sinus or disseminated disease and is highly lethal. Outcome is improved when active antifungal therapy and surgery are combined. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2005-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zoi Dorothea Pana
- 3rd Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece
| | - Danila Seidel
- 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
| | - Anna Skiada
- 1st Department of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Paediatric Hematology and Oncology, Infectious Disease Research Program, University Children's Hospital, Muenster, Germany
| | | | - 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
| | - Emmanuel Roilides
- 3rd Department of Paediatrics, Infectious Diseases Unit, Aristotle University School of Medicine, Hippokration General Hospital, Konstantinoupoleos 49, GR-546 42, Thessaloniki, Greece.
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Jacob NB, Chaney S. Rhino Orbito Cerebral Mucormycosis: A Fatal Acute Invasive Fungal Infection in Uncontrolled Diabetes. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Springer J, Lackner M, Ensinger C, Risslegger B, Morton CO, Nachbaur D, Lass-Flörl C, Einsele H, Heinz WJ, Loeffler J. Clinical evaluation of a Mucorales-specific real-time PCR assay in tissue and serum samples. J Med Microbiol 2016; 65:1414-1421. [PMID: 27902424 DOI: 10.1099/jmm.0.000375] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Molecular diagnostic assays can accelerate the diagnosis of fungal infections and subsequently improve patient outcomes. In particular, the detection of infections due to Mucorales is still challenging for laboratories and physicians. The aim of this study was to evaluate a probe-based Mucorales-specific real-time PCR assay (Muc18S) using tissue and serum samples from patients suffering from invasive mucormycosis (IMM). This assay can detect a broad range of clinically relevant Mucorales species and can be used to complement existing diagnostic tests or to screen high-risk patients. An advantage of the Muc18S assay is that it exclusively detects Mucorales species allowing the diagnosis of Mucorales DNA without sequencing within a few hours. In paraffin-embedded tissue samples this PCR-based method allowed rapid identification of Mucorales in comparison with standard methods and showed 91 % sensitivity in the IMM tissue samples. We also evaluated serum samples, an easily accessible material, from patients at risk from IMM. Mucorales DNA was detected in all patients with probable/proven IMM (100 %) and in 29 % of the possible cases. Detection of IMM in serum could enable an earlier diagnosis (up to 21 days) than current methods including tissue samples, which were gained mainly post-mortem. A screening strategy for high-risk patients, which would enable targeted treatment to improve patient outcomes, is therefore possible.
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Affiliation(s)
- Jan Springer
- Department for Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria
| | - Christian Ensinger
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria
| | - Brigitte Risslegger
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria
| | | | - David Nachbaur
- University Hospital of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Austria
| | - Hermann Einsele
- Department for Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Werner J Heinz
- Department for Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Juergen Loeffler
- Department for Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
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220
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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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Chowdhary A, Masih A, Sharma C. Azole Resistance in Moulds—Approach to Detection in a Clinical Laboratory. CURRENT FUNGAL INFECTION REPORTS 2016. [DOI: 10.1007/s12281-016-0265-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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222
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Trenker C, Dohse M, Metzelder SK, Rexin P, Mariss J, Goerg C. 71-Year-Old Patient with Chronic Lymphocytic Leukemia (CLL) and Hypoechoic Nodular Spleen and Liver Lesions with Fatal Outcome: Presentation of Mucormycosis in B-Mode Imaging and Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open 2016; 2:E100-1. [PMID: 27689177 DOI: 10.1055/s-0042-106394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/12/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- C Trenker
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - M Dohse
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - S K Metzelder
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - P Rexin
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - J Mariss
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - C Goerg
- UKGM, Klinik für Innere Medizin, Schwerpunkt Hämatologie, Onkologie und Immunologie, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
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223
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Moreira J, Varon A, Galhardo MC, Santos F, Lyra M, Castro R, Oliveira R, Lamas CC. The burden of mucormycosis in HIV-infected patients: A systematic review. J Infect 2016; 73:181-8. [PMID: 27394402 DOI: 10.1016/j.jinf.2016.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Mucormycosis is an invasive fungal infection afflicting immunocompromised patients, causing a significant degree of morbidity and mortality. The purpose of the study was to provide a comprehensive analysis describing the epidemiology and outcome of mucormycosis in the scenario of HIV infection. METHODS We systematically searched PubMed for reports about mucormycosis associated with HIV. Eligible studies describe the predisposing factor, clinical form, treatment, and survival outcome. RESULTS We included 61 articles from 212 reviewed abstracts, corresponding to 67 cases. Patients were mostly men (68.2%) with a median CD4(+) count of 47 [IQR 17-100] cells/mm(3). Intravenous drug use (50%), neutropenia (29.7%) and corticosteroid use (25%) were the predominant associated factors. The main clinical forms were disseminated (20.9%), renal (19.4%), and rhino-cerebral (17.9%). Rhizopus (45.5%) and Lichtheimia spp (30.3%) were the main fungal isolates. Treatment consisted of antifungal therapy and surgery in 38.8%. Overall mortality rate was 52.2%, and varied with the site of infection: 92.9% for disseminated disease, 62.5% for cerebral disease, 60% for pulmonary infection, and 36.4% for cutaneous infection. Survival was worse for those who did not initiate antifungals (p = .04), who were antiretroviral naïve (p = .01), who were admitted to ICU (p = .003) or had disseminated disease (p = .007). CONCLUSIONS Mucormycosis is a life-threatening infection in HIV patients and clinician should be aware of this co-infection in the differential diagnosis of HIV opportunistic infections.
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Affiliation(s)
- José Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
| | - Andrea Varon
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Clara Galhardo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Fabio Santos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Marcelo Lyra
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Rodolfo Castro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Raquel Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Cristiane C Lamas
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Unigranrio, Infectious Disease Department, Rio de Janeiro, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
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Heaton SM, Weintrob AC, Downing K, Keenan B, Aggarwal D, Shaikh F, Tribble DR, Wells J. Histopathological techniques for the diagnosis of combat-related invasive fungal wound infections. BMC Clin Pathol 2016; 16:11. [PMID: 27398067 PMCID: PMC4937573 DOI: 10.1186/s12907-016-0033-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective management of trauma-related invasive fungal wound infections (IFIs) depends on early diagnosis and timely initiation of treatment. We evaluated the utility of routine staining, histochemical stains and frozen section for fungal element identification. METHODS A total of 383 histopathological specimens collected from 66 combat-injured United States military personnel with IFIs were independently reviewed by two pathologists. Both periodic acid-Schiff (PAS) and Gomori methenamine silver (GMS) stains were used on 74 specimens. The performance of the two special stains was compared against the finding of fungal elements via any histopathological method (ie, special stains or hematoxylin and eosin). In addition, the findings from frozen sections were compared against permanent sections. RESULTS The GMS and PAS results were 84 % concordant (95 % confidence interval: 70 to 97 %). The false negative rate of fungal detection was 15 % for GMS and 44 % for PAS, suggesting that GMS was more sensitive; however, neither stain was statistically significantly superior for identifying fungal elements (p = 0.38). Moreover, 147 specimens had frozen sections performed, of which there was 87 % correlation with permanent sections (60 % sensitivity and 98 % specificity). In 27 permanent sections, corresponding cultures were available for comparison and 85 % concordance in general species identification was reported. CONCLUSIONS The use of both stains does not have an added benefit for identifying fungal elements. Furthermore, while the high specificity of frozen section may aid in timely IFI diagnoses, it should not be used as a stand-alone method to guide therapy due to its low sensitivity.
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Affiliation(s)
- Sarah M Heaton
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Amy C Weintrob
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA ; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Kevin Downing
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Bryan Keenan
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
| | - Deepak Aggarwal
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Justin Wells
- Department of Pathology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814 USA
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Ruhnke M, Schwartz S. Recent developments in the management of invasive fungal infections in patients with oncohematological diseases. Ther Adv Hematol 2016; 7:345-359. [PMID: 27904738 DOI: 10.1177/2040620716656381] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Patients with hematological cancer have a high risk of invasive fungal diseases (IFDs). These infections are mostly life threatening and an early diagnosis and initiation of appropriate antifungal therapy are essential for the clinical outcome. Most commonly, Aspergillus and Candida species are involved. However, other non-Aspergillus molds are increasingly be identified in cases of documented IFDs. Important risk factors are long lasting granulocytopenia with neutrophil counts below 500/μl for more than 10 days or graft-versus-host disease resulting from allogeneic stem-cell transplantation. For definite diagnosis of IFD, various diagnostic tools have to be applied, including conventional mycological culture and nonconventional microbiological tests such as antibody/antigen and molecular tests, as well as histopathology and radiology. In the last few years, various laboratory methods, like the Aspergillus GM immunoassay (Aspergillus GM EIA), 1,3-ß-D-glucan (BG) assay or polymerase chain reaction (PCR) techniques have been developed for better diagnosis. Since no single indirect test, including radiological methods, provides the definite diagnosis of an invasive fungal infection, the combination of different diagnostic procedures, which include microbiological cultures, histological, serological and molecular methods like PCR together with the pattern of clinical presentation, may currently be the best strategy for the prompt diagnosis, initiation and monitoring of IFDs. Early start of antifungal therapy is mandatory, but clinical diagnostics often do not provide clear evidence of IFD. Integrated care pathways have been proposed for management and therapy of IFDs with either the diagnostic driven strategy using the preemptive antifungal therapy as opposed to the clinical or empirical driven strategy using the 'traditional' empirical antifungal therapy. Antifungal agents preferentially used for systemic therapy of invasive fungal infections are amphotericin B preparations, fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, and most recently isavuconazole. Clinical decision making must consider licensing status, local experience and availability, pharmacological and economic aspects.
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Affiliation(s)
- Markus Ruhnke
- Department of Hematology and Oncology, Paracelsus-Kliniken Osnabrück, Am Natruper Holz 69, 49090 Osnabrück, Germany
| | - Stefan Schwartz
- Department of Internal Medicine, Division of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Benjamin Franklin, Berlin
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Marty FM, Ostrosky-Zeichner L, Cornely OA, Mullane KM, Perfect JR, Thompson GR, Alangaden GJ, Brown JM, Fredricks DN, Heinz WJ, Herbrecht R, Klimko N, Klyasova G, Maertens JA, Melinkeri SR, Oren I, Pappas PG, Ráčil Z, Rahav G, Santos R, Schwartz S, Vehreschild JJ, Young JAH, Chetchotisakd P, Jaruratanasirikul S, Kanj SS, Engelhardt M, Kaufhold A, Ito M, Lee M, Sasse C, Maher RM, Zeiher B, Vehreschild MJGT. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:828-837. [DOI: 10.1016/s1473-3099(16)00071-2] [Citation(s) in RCA: 440] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 11/26/2022]
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Chermetz M, Gobbo M, Rupel K, Ottaviani G, Tirelli G, Bussani R, Luzzati R, Di Lenarda R, Biasotto M. Combined Orofacial Aspergillosis and Mucormycosis: Fatal Complication of a Recurrent Paediatric Glioma-Case Report and Review of Literature. Mycopathologia 2016; 181:723-33. [PMID: 27350324 DOI: 10.1007/s11046-016-0021-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
Abstract
Mucormycosis and aspergillosis are two opportunistic fungal infections, which can evolve into life-threatening complications. They generally affect patients with relevant risk factors such as immunocompromisation or long-term use of antibiotics or corticosteroids. Treatment usually combines medical and surgical approaches, often including extended necrosectomies, although the prognosis of generalized fungal infections is very poor. In this paper, we present the case of a 17-year-old girl affected by combined aspergillosis and mucormycosis, following treatment of a recurrent glioma. The patient was hospitalized for a suspected cellulitis of the right hemi-face, involving frontal maxillary area and the upper airways and was immediately put on intravenous antibiotic therapies; after performing nasal septum and maxillary biopsies, concomitant mucormycosis and aspergillosis were diagnosed and antimycotic therapy with liposomal B-amphotericin was administered. After evaluation by the oral surgeon and otolaryngologist, surgical cranio-facial necrosectomy was suggested, but refused by the parents of the patient. The girl died only few days later, due to a respiratory arrest. Awareness of this pathology with prompt diagnosis and early treatment may improve the outcome of these infections and reduce the mortality.
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Affiliation(s)
- Maddalena Chermetz
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Margherita Gobbo
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Katia Rupel
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Giulia Ottaviani
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy
| | - Rossana Bussani
- UCO Pathological Anatomy and Histopathology Unit, Cattinara Hospital, Strada di Fiume 447, 34149, Trieste, Italy
| | - Roberto Luzzati
- Infectious Diseases Unit, University Hospital, Trieste, Italy
| | - Roberto Di Lenarda
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy
| | - Matteo Biasotto
- Division of Oral Medicine, Dental Science Department, University of Trieste, Piazza dell'Ospitale 2, 34125, Trieste, Italy.
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Tribble DR, Rodriguez CJ, Weintrob AC, Shaikh F, Aggarwal D, Carson ML, Murray CK, Masuoka P. Environmental Factors Related to Fungal Wound Contamination after Combat Trauma in Afghanistan, 2009-2011. Emerg Infect Dis 2016; 21:1759-69. [PMID: 26401897 PMCID: PMC4593427 DOI: 10.3201/eid2110.141759] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Environmental characteristics, along with known risk factors, may help predict likelihood of mold contamination after injury. During the recent war in Afghanistan (2001–2014), invasive fungal wound infections (IFIs) among US combat casualties were associated with risk factors related to the mechanism and pattern of injury. Although previous studies recognized that IFI patients primarily sustained injuries in southern Afghanistan, environmental data were not examined. We compared environmental conditions of this region with those of an area in eastern Afghanistan that was not associated with observed IFIs after injury. A larger proportion of personnel injured in the south (61%) grew mold from wound cultures than those injured in the east (20%). In a multivariable analysis, the southern location, characterized by lower elevation, warmer temperatures, and greater isothermality, was independently associated with mold contamination of wounds. These environmental characteristics, along with known risk factors related to injury characteristics, may be useful in modeling the risk for IFIs after traumatic injury in other regions.
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Schmidt-Hieber M, Silling G, Schalk E, Heinz W, Panse J, Penack O, Christopeit M, Buchheidt D, Meyding-Lamadé U, Hähnel S, Wolf HH, Ruhnke M, Schwartz S, Maschmeyer G. CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 2016; 27:1207-25. [PMID: 27052648 PMCID: PMC4922317 DOI: 10.1093/annonc/mdw155] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/24/2016] [Indexed: 12/22/2022] Open
Abstract
Diagnosis of CNS infections remains a great challenge in patients with hematological disorders since symptoms might both be masked and be mimicked by other conditions such as metabolic disturbances or consequences from antineoplastic treatment. Thus, awareness of this complication is crucial and any suspicion of a CNS infection should lead to timely and adequate diagnostics and treatment to improve the outcome in this population. Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients. However, identification of CNS infections in immunocompromised patients could represent a major challenge since metabolic disturbances, side-effects of antineoplastic or immunosuppressive drugs and CNS involvement of the underlying hematological disorder may mimic symptoms of a CNS infection. The prognosis of CNS infections is generally poor in these patients, albeit the introduction of novel substances (e.g. voriconazole) has improved the outcome in distinct patient subgroups. This guideline has been developed by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) with the contribution of a panel of 14 experts certified in internal medicine, hematology/oncology, infectious diseases, intensive care, neurology and neuroradiology. Grades of recommendation and levels of evidence were categorized by using novel criteria, as recently published by the European Society of Clinical Microbiology and Infectious Diseases.
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Affiliation(s)
- M Schmidt-Hieber
- Department of Hematology, Oncology and Tumor Immunology, HELIOS Clinic Berlin-Buch, Berlin
| | - G Silling
- Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen
| | - E Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg
| | - W Heinz
- Department of Internal Medicine II, University Hospital Würzburg, Center of Internal Medicine, Würzburg
| | - J Panse
- Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen
| | - O Penack
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow Clinic, Berlin
| | - M Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Hamburg
| | - D Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim
| | - U Meyding-Lamadé
- Department of Neurology, Hospital Nordwest Frankfurt, Frankfurt/M., Germany Brunei Neuroscience Stroke and Rehabilitation Centre, Jerudong, Brunei Darussalam Department of Neuroinfectiology, Otto-Meyerhof-Centre, University of Heidelberg, Heidelberg
| | - S Hähnel
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg
| | - H H Wolf
- Department of Hematology and Oncology, University Hospital Halle, Halle
| | - M Ruhnke
- Paracelsus Clinic Osnabrück, Osnabrück
| | - S Schwartz
- Department of Hematology and Oncology, Charité University Medicine, Campus Benjamin Franklin, Berlin
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst von Bergmann Clinic, Potsdam, Germany
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Using free flaps for reconstruction during infections by mucormycosis: A case report and a structured review of the literature. ANN CHIR PLAST ESTH 2016; 61:153-61. [DOI: 10.1016/j.anplas.2015.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/20/2015] [Indexed: 01/08/2023]
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231
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Lichtheimia ramosa: A Fatal Case of Mucormycosis. Can Respir J 2016; 2016:2178218. [PMID: 27445521 PMCID: PMC4904553 DOI: 10.1155/2016/2178218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/17/2015] [Indexed: 11/17/2022] Open
Abstract
Mucormycosis due to Lichtheimia ramosa is an infrequent opportunistic infection that can potentially be angioinvasive when affecting inmunocompromised hosts. We present a fatal case of mucormycosis, affecting a 56-year-old male with diabetes mellitus and siderosis, initially admitted to our hospital due to an H1N1 infection. The subject's clinical condition worsened and he finally died because of a necrotizing bilateral pneumonia with disseminated mycotic thromboses due to Lichtheimia ramosa, which is an emerging Mucoralean fungus. This is an infrequent case because of the extent to which it affected a subject without overt immunocompromise. This case underlines the importance of an early premortem diagnosis and treatment in order to prevent rapid progression of this disease, as well as the need of considering mucormycosis when facing subjects with multiple emboli and fever unresponsive to usual antimicrobials.
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232
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Role of Antifungal Susceptibility Testing in Non-Aspergillus Invasive Mold Infections. J Clin Microbiol 2016; 54:1638-1640. [PMID: 27008871 DOI: 10.1128/jcm.00318-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/15/2016] [Indexed: 12/26/2022] Open
Abstract
No clinical breakpoints are available to delineate antifungal drug efficacy in non-Aspergillus invasive mold infections (NAIMIs). In this analysis of 39 NAIMI episodes, the MIC of the first-line antifungal drug was the most important predictor of therapeutic response. For amphotericin B, an MIC of ≤0.5 μg/ml was significantly associated with better 6-week outcomes.
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233
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Pedemonte-Sarrias G, Gras-Cabrerizo JR, Rodríguez-Álvarez F, Montserrat-Gili JR. Rhinocerebral mucormycosis in a 5-month heart transplant recipient. J Oral Maxillofac Pathol 2016; 19:375-8. [PMID: 26980968 PMCID: PMC4774293 DOI: 10.4103/0973-029x.174635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mucormycosis is an opportunistic acute fungal infection with a high mortality rate seen in immunocompromised patients. It is extremely rare in heart transplant recipients. Rhinocerebral mucormycosis (RM) is the most frequently observed presentation. We report a case of RM in a heart transplant recipient 5-month after the procedure, with a fatal outcome.
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Affiliation(s)
- Gabriel Pedemonte-Sarrias
- Department of Otorhinolaryngology/Head and Neck Surgery, Santa Creu and Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Ramon Gras-Cabrerizo
- Department of Otorhinolaryngology/Head and Neck Surgery, Santa Creu and Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Rodríguez-Álvarez
- Department of Ophthalmology, Santa Creu and Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Ramon Montserrat-Gili
- Department of Otorhinolaryngology/Head and Neck Surgery, Santa Creu and Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain
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234
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Kaerger K, Schwartze VU, Dolatabadi S, Nyilasi I, Kovács SA, Binder U, Papp T, Hoog SD, Jacobsen ID, Voigt K. Adaptation to thermotolerance in Rhizopus coincides with virulence as revealed by avian and invertebrate infection models, phylogeny, physiological and metabolic flexibility. Virulence 2016; 6:395-403. [PMID: 26065324 DOI: 10.1080/21505594.2015.1029219] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Mucormycoses are fungal infections caused by the ancient Mucorales. They are rare, but increasingly reported. Predisposing conditions supporting and favoring mucormycoses in humans and animals include diabetic ketoacidosis, immunosuppression and haematological malignancies. However, comprehensive surveys to elucidate fungal virulence in ancient fungi are limited and so far focused on Lichtheimia and Mucor. The presented study focused on one of the most important causative agent of mucormycoses, the genus Rhizopus (Rhizopodaceae). All known clinically-relevant species are thermotolerant and are monophyletic. They are more virulent compared to non-clinically, mesophilic species. Although adaptation to elevated temperatures correlated with the virulence of the species, mesophilic strains showed also lower virulence in Galleria mellonella incubated at permissive temperatures indicating the existence of additional factors involved in the pathogenesis of clinical Rhizopus species. However, neither specific adaptation to nutritional requirements nor stress resistance correlated with virulence, supporting the idea that Mucorales are predominantly saprotrophs without a specific adaptation to warm blooded hosts.
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235
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Lewandowski LR, Weintrob AC, Tribble DR, Rodriguez CJ, Petfield J, Lloyd BA, Murray CK, Stinner D, Aggarwal D, Shaikh F, Potter BK. Early Complications and Outcomes in Combat Injury-Related Invasive Fungal Wound Infections: A Case-Control Analysis. J Orthop Trauma 2016; 30:e93-9. [PMID: 26360542 PMCID: PMC4761299 DOI: 10.1097/bot.0000000000000447] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures before initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure. DESIGN Retrospective review and case-control analysis. SETTING Military hospitals. PATIENTS/PARTICIPANTS US military personnel injured during combat operations (2009-2011). The IFI cases were identified based on the presence of recurrent, necrotic extremity wounds with mold growth in culture, and/or histopathologic fungal evidence. Non-IFI controls were matched on injury pattern and severity. In a supplemental matching analysis, non-IFI controls were also matched by blood volume transfused within 24 hours of injury. INTERVENTION None. MAIN OUTCOME MEASUREMENTS Amputation revision rate and loss of functional levels. RESULTS Seventy-one IFI cases (112 fungal-infected extremity wounds) were identified and matched to 160 control patients (315 non-IFI extremity wounds). The IFI wounds resulted in significantly more changes in amputation level (P < 0.001). Additionally, significantly (P < 0.001) higher number of operative procedures and longer duration to initial wound closure were associated with IFI. A shorter duration to initial wound closure was significantly associated with wounds lacking IFIs (Hazard ratio: 1.53; 95% confidence interval, 1.17-2.01). The supplemental matching analysis found similar results. CONCLUSIONS Our analysis indicates that IFIs adversely impact wound healing and patient recovery, requiring more frequent proximal amputation revisions and leading to higher early complication rates. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Louis R. Lewandowski
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Amy C. Weintrob
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20814
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, MD 20817
| | - David R. Tribble
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Carlos J. Rodriguez
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Joseph Petfield
- Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX 78234
| | | | - Clinton K. Murray
- Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive #3600, JBSA Fort Sam Houston, TX 78234
| | - Daniel Stinner
- Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX 78234
| | - Deepak Aggarwal
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, MD 20817
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, MD 20817
| | - Benjamin K. Potter
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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236
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Vaezi A, Moazeni M, Rahimi MT, de Hoog S, Badali H. Mucormycosis in Iran: a systematic review. Mycoses 2016; 59:402-15. [PMID: 26906121 DOI: 10.1111/myc.12474] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/06/2015] [Accepted: 01/04/2016] [Indexed: 12/27/2022]
Abstract
Fungi in the order Mucorales cause acute, invasive and frequently fatal infections in susceptible patients. This study aimed to perform a systematic review of all reported mucormycosis cases during the last 25 years in Iran. After a comprehensive literature search, we identified 98 cases in Iran from 1990-2015. The mean patient age was 39.8 ± 19.2 years. Diabetes was the most common underlying condition (47.9%), and 22.4% of the patients underwent solid organ or bone marrow transplantation. The most common clinical forms of mucormycosis were rhinocerebral (48.9%), pulmonary (9.2%) and cutaneous (9.2%). Eight cases of disseminated disease were identified. Overall mortality in the identified cases was 40.8%, with the highest mortality rate in patients diagnosed with disseminated infection (75%). The mortality rate in rhinocerebral infection patients was significantly lower (45.8%). Rhinocerebral infection was the most common clinical manifestation in diabetes patients (72.9%). Patients were diagnosed using various methods including histopathology (85.7%), microscopy (12.3%) and culture (2.0%). Rhizopus species were the most prevalent (51.7%), followed by Mucor species (17.2%). Sixty-nine patients were treated with a combination of surgery and antifungal therapy (resulting survival rate, 66.7%). Owing to the high mortality rate of advanced mucormycosis, early diagnosis and treatment may significantly improve survival rates. Therefore, increased monitoring and awareness of this life-threatening disease is critical.
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Affiliation(s)
- Afsane Vaezi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Moazeni
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Rahimi
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands
| | - Hamid Badali
- Department of Medical Mycology and Parasitology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Molecular and Cell Biology Research Center (MCBRC), Mazandaran University of Medical Sciences, Sari, Iran
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237
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Douglas AP, Chen SCA, Slavin MA. Emerging infections caused by non-Aspergillus filamentous fungi. Clin Microbiol Infect 2016; 22:670-80. [PMID: 26812445 DOI: 10.1016/j.cmi.2016.01.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/02/2016] [Accepted: 01/09/2016] [Indexed: 12/25/2022]
Abstract
There are three broad groups of non-Aspergillus moulds: the mucormycetes, the hyalohyphomycetes and the phaeohyphomycetes. Infections with these pathogens are increasingly reported, particularly in the context of increasing use of immunosuppressant agents and improved diagnostics. The epidemiology of non-Aspergillus mould infections varies with geography, climate and level of immunosuppression. Skin and soft-tissue infections are the predominant presentation in the immunocompetent host and pulmonary and other invasive infections in the immunocompromised host. The more common non-Aspergillus moulds include Rhizopus, Mucor, Fusarium and Scedosporium species; however, other emerging pathogens are Rasamsonia and Verruconis species, which are discussed in this article. Outbreaks of non-Aspergillus mould infections have been increasingly reported, with contaminated medical supplies and natural disasters as common sources. Currently culture and other conventional diagnostic methods are the cornerstone of diagnosis. Molecular methods to directly detect and identify mould pathogens in tissue and body fluids are increasingly used.
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Affiliation(s)
- A P Douglas
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, University of Sydney, New South Wales, Australia
| | - M A Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
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238
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Kennedy KJ, Daveson K, Slavin MA, van Hal SJ, Sorrell TC, Lee A, Marriott DJ, Chapman B, Halliday CL, Hajkowicz K, Athan E, Bak N, Cheong E, Heath CH, Morrissey CO, Kidd S, Beresford R, Blyth C, Korman TM, Robinson JO, Meyer W, Chen SCA. Mucormycosis in Australia: contemporary epidemiology and outcomes. Clin Microbiol Infect 2016; 22:775-781. [PMID: 26806139 DOI: 10.1016/j.cmi.2016.01.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/30/2015] [Accepted: 01/09/2016] [Indexed: 11/27/2022]
Abstract
Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1-42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% versus 10/66; 15.2%; p <0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2-481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3-25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3-13.8). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.
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Affiliation(s)
- K J Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
| | - K Daveson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - S J van Hal
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - T C Sorrell
- Centre for Infectious Diseases and Microbiology, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - A Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - D J Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - B Chapman
- The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - C L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - K Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - E Athan
- Department of Infectious Diseases, Barwon Health, Deakin University, Geelong, Australia
| | - N Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia
| | - E Cheong
- Department of Infectious Diseases and Microbiology, Concord Hospital, Sydney, Australia
| | - C H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - C O Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - S Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
| | - R Beresford
- Department of Infectious Diseases and Microbiology, Liverpool Hospital, Sydney, Australia
| | - C Blyth
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, Australia
| | - T M Korman
- Monash Infectious Diseases and Monash University, Melbourne, Australia
| | - J O Robinson
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Australian Collaborating Centre for Enterococcus and Staphylococcus Species Typing and Research, School of Biomedical Sciences, Curtin University, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - W Meyer
- The Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology, The University of Sydney, Sydney, Australia
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239
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Springer J, Goldenberger D, Schmidt F, Weisser M, Wehrle-Wieland E, Einsele H, Frei R, Löffler J. Development and application of two independent real-time PCR assays to detect clinically relevant Mucorales species. J Med Microbiol 2016; 65:227-234. [PMID: 26743820 DOI: 10.1099/jmm.0.000218] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PCR-based detection of Mucorales species could improve diagnosis of suspected invasive fungal infection, leading to a better patient outcome. This study describes two independent probe-based real-time PCR tests for detection of clinically relevant Mucorales, targeting specific fragments of the 18S and the 28S rRNA genes. Both assays have a short turnaround time, allow fast, specific and very sensitive detection of clinically relevant Mucorales and have the potential to be used as quantitative tests. They were validated on various clinical samples (fresh and formalin-fixed paraffin-embedded specimens, mainly biopsies, n = 17). The assays should be used as add-on tools to complement standard techniques; a combined approach of both real-time PCR assays has 100 % sensitivity. Genus identification by subsequent sequencing is possible for amplicons of the 18S PCR assay. In conclusion, combination of the two independent Mucorales assays described in this study, 18S and 28S, detected all clinical samples associated with proven Mucorales infection (n = 10). Reliable and specific identification of Mucorales is a prerequisite for successful antifungal therapy as these fungi show intrinsic resistance to voriconazole and caspofungin.
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Affiliation(s)
- Jan Springer
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Daniel Goldenberger
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Friderike Schmidt
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Maja Weisser
- Clinic of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Elisabeth Wehrle-Wieland
- Clinic of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Hermann Einsele
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Reno Frei
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Jürgen Löffler
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
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240
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Kömür S, İnal AS, Kurtaran B, Ulu A, Uğuz A, Aksu HSZ, Taşova Y. Mucormycosis: a 10-year experience at a tertiary care center in Turkey. Turk J Med Sci 2016; 46:58-62. [PMID: 27511334 DOI: 10.3906/sag-1409-137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/18/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Mucormycosis is a rare invasive fungal infection most commonly encountered in the immunocompromised host. We analyzed 51 adult patients treated for mucormycosis between 2003 and 2013 and recorded at a tertiary university hospital in Turkey. MATERIALS AND METHODS We examined the following data for all patients: age, sex, predisposing disease, symptoms, treatment, surgical procedure, concomitant infections, intensive care requirement, and outcomes. RESULTS During the study period 51 cases of mucormycosis were documented; 54.9% of the patients were female. The mean age was 44.2 ± 18.2 years. Rhinocerebral presentation was reported in 94.1% of patients. Almost all patients (88.2%) had at least one risk factor. The common predisposing factors were hematologic malignancies (52.9%), diabetes mellitus (25.5%), and solid malignancies (5.8%). The most common initial symptoms were fever, cellulitis, and facial pain. The primary medication used was liposomal amphotericin B or conventional amphotericin B. Surgery was performed in 94.1% of patients. Mortality was 52.9%. CONCLUSION Our study revealed that mucormycosis continues to be a mortal disease in about half of the cases. Our findings indicate that treatment with L-AMB is associated with a favorable response. Also, in the case of facial pain, the low mortality rate may indicate the importance of early diagnosis.
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Affiliation(s)
- Süheyla Kömür
- Department of Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ayşe Seza İnal
- Department of Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Aslıhan Ulu
- Department of Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Aysun Uğuz
- Department of Pathology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hasan Salih Zeki Aksu
- Department of Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Yeşim Taşova
- Department of Infectious Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
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Asano-Mori Y. Diagnosis and Treatment of Mucormycosis in Patients with Hematological Malignancies. Med Mycol J 2016; 57:J155-J162. [DOI: 10.3314/mmj.16.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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242
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Saul SR, Aleksic S, Magnotti M. A Patient with Newly Diagnosed Diabetes Presenting with Sino-Orbital Mucormycosis. AACE Clin Case Rep 2016. [DOI: 10.4158/ep14559.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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243
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Millon L, Herbrecht R, Grenouillet F, Morio F, Alanio A, Letscher-Bru V, Cassaing S, Chouaki T, Kauffmann-Lacroix C, Poirier P, Toubas D, Augereau O, Rocchi S, Garcia-Hermoso D, Bretagne S. Early diagnosis and monitoring of mucormycosis by detection of circulating DNA in serum: retrospective analysis of 44 cases collected through the French Surveillance Network of Invasive Fungal Infections (RESSIF). Clin Microbiol Infect 2015; 22:810.e1-810.e8. [PMID: 26706615 DOI: 10.1016/j.cmi.2015.12.006] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/02/2015] [Accepted: 12/06/2015] [Indexed: 11/26/2022]
Abstract
The main objective of this study was to assess the diagnostic performance of a set of three Mucorales quantitative PCR assays in a retrospective multicentre study. Mucormycosis cases were recorded thanks to the French prospective surveillance programme (RESSIF network). The day of sampling of the first histological or mycological positive specimen was defined as day 0 (D0). Detection of circulating DNA was performed on frozen serum samples collected from D-30 to D30, using quantitative PCR assays targeting Rhizomucor, Lichtheimia, Mucor/Rhizopus. Forty-four patients diagnosed with probable (n = 19) or proven (n = 25) mucormycosis were included. Thirty-six of the 44 patients (81%) had at least one PCR-positive serum. The first PCR-positive sample was observed 9 days (range 0-28 days) before diagnosis was made using mycological criteria and at least 2 days (range 0-24 days) before imaging. The identifications provided with the quantitative PCR assays were all concordant with culture and/or PCR-based identification of the causal species. Survival rate at D84 was significantly higher for patients with an initially positive PCR that became negative after treatment initiation than for patients whose PCR remained positive (48% and 4%, respectively; p <10-6). The median time for complete negativity of PCR was 7 days (range 3-19 days) after initiation of l-AmB treatment. Despite some limitations due to the retrospective design of the study, we showed that Mucorales quantitative PCR could not only confirm the mucormycosis diagnosis when other mycological arguments were present but could also anticipate this diagnosis. Quantification of DNA loads may also be a useful adjunct to treatment monitoring.
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Affiliation(s)
- L Millon
- Laboratoire de Parasitologie Mycologie, Centre Hospitalier Régional Universitaire, Besançon, France; Laboratoire Chrono-environnement UMR6249, Université Bourgogne Franche-Comté/CNRS, Besançon, France.
| | - R Herbrecht
- Département d'Oncologie et Hématologie, Hôpitaux Universitaires de Strasbourg, France
| | - F Grenouillet
- Laboratoire de Parasitologie Mycologie, Centre Hospitalier Régional Universitaire, Besançon, France; Laboratoire Chrono-environnement UMR6249, Université Bourgogne Franche-Comté/CNRS, Besançon, France
| | - F Morio
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France
| | - A Alanio
- Centre Hospitalier Universitaire APHP-Saint Louis Paris, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France; CNRS URA3012, Institut Pasteur, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - V Letscher-Bru
- Laboratoire de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, France; Institut de Parasitologie et de Pathologie Tropicale, EA7292, Fédération de Médecine Translationnelle, Université de Strasbourg, France
| | - S Cassaing
- Laboratoire de Parasitologie-Mycologie Centre Hospitalier Universitaire Toulouse, France
| | - T Chouaki
- Centre Hospitalier Universitaire Amiens, France; EA 4666-Centre Universitaire de Recherche en Santé CURS, CAP-Santé (FED 4231), Université de Picardie Jules Verne, France
| | | | - P Poirier
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - D Toubas
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Reims, France; Unité MEDyC, CNRS UMR7369, Université Reims Champagne-Ardenne, Reims, France
| | - O Augereau
- Centre Hospitalier Régional Orléans, France
| | - S Rocchi
- Laboratoire Chrono-environnement UMR6249, Université Bourgogne Franche-Comté/CNRS, Besançon, France
| | - D Garcia-Hermoso
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France; CNRS URA3012, Institut Pasteur, Paris, France
| | - S Bretagne
- Centre Hospitalier Universitaire APHP-Saint Louis Paris, France; Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France; CNRS URA3012, Institut Pasteur, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Leclercq A, Cinotti E, Labeille B, Perrot JL, Cambazard F. Ex vivoconfocal microscopy: a new diagnostic technique for mucormycosis. Skin Res Technol 2015; 22:203-7. [DOI: 10.1111/srt.12251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Leclercq
- Department of Dermatology; University Hospital of Saint Etienne; Saint-Etienne France
| | - E. Cinotti
- Department of Dermatology; University Hospital of Saint Etienne; Saint-Etienne France
| | - B. Labeille
- Department of Dermatology; University Hospital of Saint Etienne; Saint-Etienne France
| | - J. L. Perrot
- Department of Dermatology; University Hospital of Saint Etienne; Saint-Etienne France
| | - F. Cambazard
- Department of Dermatology; University Hospital of Saint Etienne; Saint-Etienne France
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245
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Hagihara M, Yamagishi Y, Hirai J, Koizumi Y, Kato H, Hamada Y, Matsuura K, Mikamo H. Drug-induced hypersensitivity syndrome by liposomal amphotericin-B: a case report. BMC Res Notes 2015; 8:510. [PMID: 26420570 PMCID: PMC4589069 DOI: 10.1186/s13104-015-1486-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Liposomal amphotericin-B (Ambisome(®)) is widely used antifungal drug for treatments of invasive fungal infections. The use of liposomal amphotericin-B is increasing in medical setting because of its tolerability and potent antifungal activity. CASE PRESENTATION In a case of a 76 year-old Japanese female was admitted with subarachnoid hemorrhage, the ethnicity of the patient is Asian, we experienced that liposomal amphotericin-B was the culprit drug for Drug-induced hypersensitivity syndrome, also known as drug rash with eosinophilia and systemic symptoms in view of a clear temporal relationship between liposomal amphotericin-B administration and the onset of symptoms, the remission of the symptomatological pattern after liposomal amphotericin-B withdrawal. CONCLUSION The present case report shows that prolonged liposomal amphotericin-B treatment can be associated with drug rash with eosinophilia and systemic symptoms. We recommend careful monitoring of neutrophil counts in a prolonged treatment course with liposomal amphotericin-B.
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Affiliation(s)
- Mao Hagihara
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. .,Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan.
| | - Yuka Yamagishi
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Jun Hirai
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Yusuke Koizumi
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Hideo Kato
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. .,Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan.
| | - Yukihiro Hamada
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. .,Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan.
| | - Katsuhiko Matsuura
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. .,Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan.
| | - Hiroshige Mikamo
- Department of Infection Control and Prevention, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
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246
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Tyll T, Lyskova P, Hubka V, Muller M, Zelenka L, Curdova M, Tuckova I, Kolarik M, Hamal P. Early Diagnosis of Cutaneous Mucormycosis Due to Lichtheimia corymbifera After a Traffic Accident. Mycopathologia 2015; 181:119-24. [PMID: 26363921 DOI: 10.1007/s11046-015-9943-9] [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] [Received: 08/12/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
A case report of cutaneous mucormycosis and obstacles to early diagnosis is presented. A 38-year-old male was involved in a car accident that led to amputation of both lower limbs. Subsequently, he developed fungal wound infection of the left lower limb stump. The infection was detected very early, although the diagnosis was difficult because only a small area was affected and histopathological examination was initially negative. The infection was proven by microscopy, culture and histopathology. The isolate was identified by sequencing of the rDNA ITS region gene (internal transcribed spacer region of ribosomal DNA) as Lichtheimia corymbifera. Liposomal amphotericin B and surgery were successful in management of the disease.
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Affiliation(s)
- Tomas Tyll
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and the Military University Hospital Prague, U Vojenske Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Pavlina Lyskova
- Laboratory of Medical Mycology, Department of Parasitology, Mycology and Mycobacteriology Prague, Public Health Institute in Usti nad Labem, Sokolovska 60, 186 00, Prague 8, Czech Republic. .,Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Hnevotinska 3, 77515, Olomouc, Czech Republic.
| | - Vit Hubka
- Department of Botany, Faculty of Science, Charles University in Prague, Benatska 2, 128 01, Praha 2, Czech Republic.,Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the AS CR, Videnska 1083, 142 20, Praha 4, Czech Republic.,First Faculty of Medicine, Charles University in Prague, Katerinska 32, 121 08, Prague 2, Czech Republic
| | - Martin Muller
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and the Military University Hospital Prague, U Vojenske Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Lubomir Zelenka
- Department of Orthopaedics, First Faculty of Medicine, Charles University in Prague and the Military University Hospital Prague, U Vojenske Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Martina Curdova
- Department of Clinical Microbiology, Military University Hospital Prague, U Vojenske Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Inna Tuckova
- Department of Pathology, Military University Hospital Prague, U Vojenske Nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Miroslav Kolarik
- Department of Botany, Faculty of Science, Charles University in Prague, Benatska 2, 128 01, Praha 2, Czech Republic.,Laboratory of Fungal Genetics and Metabolism, Institute of Microbiology of the AS CR, Videnska 1083, 142 20, Praha 4, Czech Republic
| | - Petr Hamal
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Hnevotinska 3, 77515, Olomouc, Czech Republic
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Abstract
PURPOSE OF REVIEW This study focuses on the epidemiology and management of mucormycosis in hematopoietic stem cell transplant patients, a life-threatening mold infection whose incidence has increased over the past decades. RECENT FINDINGS Mucormycosis may occur in hematopoietic stem cell transplant recipients with severe graft-versus-host disease, steroids, neutropenia, iron overload, diabetes, and malnutrition, or those who received antifungals not active against Mucorales. Its incidence in allogeneic hematopoietic stem cell transplant is around 0.3%. As Mucorales are not susceptible to voriconazole and candins, and as mucormycosis often mimics aspergillosis, it is extremely important to have a precise diagnostic to correctly manage the patient. The reversed halo sign on chest computed tomography has been associated to mucormycosis in neutropenic patients, but is not pathognomonic. Direct fungal identification is crucial. Molecular approaches are developed that may be extremely useful for early diagnosis. SUMMARY Although randomized trials are quite impossible to run, due to the rarity of the disease, the recent numerous data have allowed the elaboration of European guidelines for the management of mucormycosis. Lipid formulations of amphotericin B, and especially liposomal amphotericin B at high doses (5-10 mg/kg/day), are the standard treatment, combined with surgery and control of favoring factors. The prognosis is poor, and any delay in the initiation of therapy may impact on outcome.
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248
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Lanternier F, Poiree S, Elie C, Garcia-Hermoso D, Bakouboula P, Sitbon K, Herbrecht R, Wolff M, Ribaud P, Lortholary O. Prospective pilot study of high-dose (10 mg/kg/day) liposomal amphotericin B (L-AMB) for the initial treatment of mucormycosis. J Antimicrob Chemother 2015; 70:3116-23. [PMID: 26316385 DOI: 10.1093/jac/dkv236] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/09/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mucormycosis incidence is increasing and is associated with a high rate of mortality. Although lipid-based formulations of amphotericin B are the recommended first-line treatment, only one prospective trial in a limited number of patients has been performed to evaluate this regimen. METHODS Patients with proven or probable mucormycosis were included between June 2007 and March 2011. Patients were scheduled to receive 10 mg/kg/day liposomal amphotericin B (L-AMB) monotherapy for 1 month and surgery was performed when appropriate. The primary outcome was response rate at week 4 or at the end of treatment (EOT) if before week 4, evaluated by an independent committee. ClinicalTrials.gov Identifier: NCT00467883. RESULTS Forty patients were enrolled. Response was analysed in 33 patients at week 4. Most patients had a haematological malignancy as their primary underlying disease (53%). Seventy-one percent of patients underwent therapeutic surgery. The response rate at week 4 or at EOT was 36%, with 18% partial responses and 18% complete responses. The response rate at week 12 was 45%, with 13% partial responses and 32% complete responses. Overall mortality was 38% at week 12 and 53% at week 24. Serum creatinine doubled in 16 (40%) patients and returned to normal levels within 12 weeks in 10/16 (63%). CONCLUSIONS High-dose L-AMB for mucormycosis, in combination with surgery in 71% of cases, was associated with an overall response rate of 36% at week 4 and 45% at week 12 and creatinine level doubling in 40% of patients (transient in 63%). These results may serve as the basis for future clinical trials.
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Affiliation(s)
- F Lanternier
- Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker Enfants Malades, AP-HP, IHU Imagine, 149 rue de Sèvres, 75015 Paris, France Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - S Poiree
- Service de Radiologie, Hôpital Universitaire Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - C Elie
- Unité de Recherche Clinique/Centre d'Investigation Clinique, Hôpital Universitaire Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - D Garcia-Hermoso
- Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Paris, France
| | - P Bakouboula
- Unité de Recherche Clinique/Centre d'Investigation Clinique, Hôpital Universitaire Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - K Sitbon
- Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Paris, France
| | - R Herbrecht
- Service d'Onco-Hématologie, Hôpital d'Hautepierre, Strasbourg, France
| | - M Wolff
- Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Paris, France
| | - P Ribaud
- Université Paris Diderot, Sorbonne Paris-Cité, Service d'Hématologie-Greffe de Moelle, AP-HP, Hôpital Saint-Louis, Paris, France
| | - O Lortholary
- Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker Enfants Malades, AP-HP, IHU Imagine, 149 rue de Sèvres, 75015 Paris, France Université Paris Descartes, Sorbonne Paris-Cité, Paris, France Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Paris, France
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249
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Girard D, Antoine D, Che D. Epidemiology of pulmonary tuberculosis in France. Can the hospital discharge database be a reliable source of information? Med Mal Infect 2015; 44:509-14. [PMID: 25455077 DOI: 10.1016/j.medmal.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/05/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In France, tuberculosis surveillance is based on mandatory notification (MN) of cases. However, the MN does not allow the full description of cases, and underreporting limits data interpretation. Aiming at better describing the cases of tuberculosis, the hospital record database (PMSI) was analyzed. PATIENTS AND METHOD Incident cases of active pulmonary tuberculosis identified in 2010 in France in the PMSI were included and their characteristics were compared with those of the cases identified through the MN. RESULTS In 2010, 5158 incident cases of pulmonary tuberculosis were identified in the PMSI. The mean duration of hospitalization was higher for cases considered contagious — at least one positive test result on pulmonary sample — (22 vs 13 days, P < 0.001). Among all cases, 5% were infected by HIV. Death was reported for 4% of cases. The number of pulmonary TB cases reported in the MN was 3781 in 2010. PMSI data by sex, region of residence and month of diagnosis were similar with those of the MN but patients were older in the PMSI (52 vs 47 years, P < 0.001). Considering the PMSI as exhaustive, sensitivity of the MN was estimated at 73.3% in 2010. CONCLUSION PMSI data were compatible with those of the MN and the estimation of the sensitivity was close to other French studies. PMSI can be considered as an interesting tool aiming at improving our knowledge about tuberculosis (TB) cases and strengthening awareness where the sensitivity of the MN is low.
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Affiliation(s)
- D Girard
- Institut de veille sanitaire, 12, rue du Val-d’Osne, 94415 Saint Maurice cedex, France
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250
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Miceli MH, Kauffman CA. Isavuconazole: A New Broad-Spectrum Triazole Antifungal Agent. Clin Infect Dis 2015; 61:1558-65. [PMID: 26179012 DOI: 10.1093/cid/civ571] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/01/2015] [Indexed: 11/14/2022] Open
Abstract
Isavuconazole is a new extended-spectrum triazole with activity against yeasts, molds, and dimorphic fungi. It is approved for the treatment of invasive aspergillosis and mucormycosis. Advantages of this triazole include the availability of a water-soluble intravenous formulation, excellent bioavailability of the oral formulation, and predictable pharmacokinetics in adults. A randomized, double-blind comparison clinical trial for treatment of invasive aspergillosis found that the efficacy of isavuconazole was noninferior to that of voriconazole. An open-label trial that studied primary as well as salvage therapy of invasive mucormycosis showed efficacy with isavuconazole that was similar to that reported for amphotericin B and posaconazole. In patients in these studies, as well as in normal volunteers, isavuconazole was well tolerated, appeared to have few serious adverse effects, and had fewer drug-drug interactions than those noted with voriconazole. As clinical experience increases, the role of this new triazole in the treatment of invasive fungal infections will be better defined.
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Affiliation(s)
- Marisa H Miceli
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System
| | - Carol A Kauffman
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System Veterans Affairs Ann Arbor Healthcare System, Michigan
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