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Devi KS, R A, Kizhakkoottu S. Clinico-Demographic Parameters of Oral Fungal Infections: An Institutional Retrospective Study. Cureus 2024; 16:e55386. [PMID: 38562320 PMCID: PMC10983061 DOI: 10.7759/cureus.55386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Most fungal infections are responsive to antifungal therapy. However, failure to diagnose the same can significantly affect the quality of lives of patients. Timely identification of fungal infections and their association with varied demographic and clinical parameters will help in improving the prognosis of the patient. The present study aims to evaluate the prevalence of fungal infections among various age groups and genders and also to evaluate the association of fungal infections with demographic parameters. Methods This study included a sample size of n = 600. The demographic and clinical details were compiled and transferred to IBM SPSS Version 23 software (IBM Corp., Armonk, NY) for statistical analysis. Descriptive and Pearson chi-square tests were used to analyze the association of the type of fungal infection with gender, age, and comorbidities. A p-value of less than 0.05 is considered statistically significant. Results Angular cheilitis (40%, 240), followed by denture stomatitis (37.5%, 225), were the most common type of fungal infection among the sample population, and the elderly age group (51-72 years) was the most affected. Angular cheilitis was the most common infection among both males (21.4%, 128) and females (18.6%, 112), but candidiasis was reported more in females (18%, 108) than males (3%, 18) (p = 0.00). Angular cheilitis (32%, 192) and candidiasis (18%, 108) were more observed in association with anemia; however, denture stomatitis (34%, 204) was significantly higher among diabetics (p = 0.00). Conclusion The identification of associated systemic and demographic factors is as important as the treatment of fungal infection itself. The recognition of fungal infections and the role of parameters like age, gender, and systemic comorbidities in the development of fungal infections will have valuable implications for public health. Future research is required for a clear understanding of the same.
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Affiliation(s)
- Kamala S Devi
- Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Abilasha R
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Suvarna Kizhakkoottu
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Khsiba A, Moalla M, Nechi S, Bani A, Elloumi A, Jemal S, Azouz MM, Medhioub M, Hamzaoui L. Fatal invasive gastric mucormycosis: Two case reports. Clin Case Rep 2022; 10:e6330. [PMID: 36172336 PMCID: PMC9468655 DOI: 10.1002/ccr3.6330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
Mucormycosis is a fungal infection affecting most commonly immunocompromised patients. Hereby, we report two cases: the first one is about a 61-year-old female with diabetes who presented with vomiting. The upper gastrointestinal endoscopy showed a budding grayish process which corresponded to an invasive mucormycosis in histology. As laboratory tests showed renal dysfunction, conventional amphotericin B was started at low doses since liposomal form was unavailable in Tunisia. Evolution was marked by a worsening of renal function leading to drug therapy withdrawal. Total gastrectomy was delayed because of a pulmonary embolism and was practiced 2 months later. The patient passed away 10 days after surgery. The second patient was a 59-year-old man who presented with vomiting and fast worsening of general state. At admission, he had a septic shock. Explorations revealed an invasive gastric mucormycosis. He died few days after admission. Thus, prompt diagnosis of mucormycosis and rapid initiation of treatment based on amphotericin B and surgical debridement is necessary to improve prognosis.
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Affiliation(s)
- Amal Khsiba
- Department of GastroenterologyMohamed Taher Maamouri HospitalNabeulTunisia
| | - Manel Moalla
- Department of GastroenterologyMohamed Taher Maamouri HospitalNabeulTunisia
| | - Salwa Nechi
- Department of CytologyMohamed Taher Maamouri HospitalNabeulTunisia
| | - Amina Bani
- Department of CytologyMohamed Taher Maamouri HospitalNabeulTunisia
| | - Aicha Elloumi
- Parasitology and Entomology LaboratoryLa Rabta HospitalTunisTunisia
| | - Sana Jemal
- Parasitology and Entomology LaboratoryLa Rabta HospitalTunisTunisia
| | | | - Mouna Medhioub
- Department of GastroenterologyMohamed Taher Maamouri HospitalNabeulTunisia
| | - Lamine Hamzaoui
- Department of GastroenterologyMohamed Taher Maamouri HospitalNabeulTunisia
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3
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Haupt-Jorgensen M, Groule V, Reibel J, Buschard K, Pedersen AML. Gluten-free diet modulates inflammation in salivary glands and pancreatic islets. Oral Dis 2021; 28:639-647. [PMID: 33432638 DOI: 10.1111/odi.13775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES A lifelong gluten-free (GF) diet ameliorates autoimmune diabetes in non-obese diabetic (NOD) mice and most likely in humans. Besides diabetes, NOD mice develop focal sialadenitis, as seen in Sjögren's syndrome (SS). In humans, type 1 diabetes (T1D) is also linked to SS. Here, we investigated whether a lifelong GF diet influences the immune cell infiltration in the salivary glands and pancreatic islets in NOD mice. METHODS NOD mice were fed a lifelong (i.e. 13 weeks) GF or gluten-containing standard (STD) diet. Insulitis and sialadenitis were scored on H&E-stained paraffin-embedded sections of pancreas and submandibular glands. Immune cell specificity and distribution were investigated immunohistochemically. RESULTS There were fewer CD68+ and CD4+ cells in submandibular gland areas with focal sialadenitis as well as reduced insulitis and fewer VEGFR2+ cells in pancreatic islets in mice on GF versus STD diet. The degree of sialadenitis was not significantly lower in GF mice, but sialadenitis and insulitis correlated strongly. Lung weight was lower in GF mice. CONCLUSION In NOD mice, a lifelong GF diet reduces infiltration of monocytes/macrophages and T cells in salivary glands and inflammation in pancreatic islets, possibly by reducing VEGFR2, indicating that the linked autoimmune diseases, T1D and SS, may be alleviated by a GF diet.
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Affiliation(s)
| | - Vibeke Groule
- Department of Odontology, Section for Oral Biology and Immunopathology, Oral Medicine and Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Jesper Reibel
- Department of Odontology, Section for Oral Biology and Immunopathology, Oral Medicine and Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Karsten Buschard
- Department of Pathology, The Bartholin Institute, Rigshospitalet, Copenhagen N, Denmark
| | - Anne Marie Lynge Pedersen
- Department of Odontology, Section for Oral Biology and Immunopathology, Oral Medicine and Pathology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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Babatzia A, Papaioannou W, Stavropoulou A, Pandis N, Kanaka-Gantenbein C, Papagiannoulis L, Gizani S. Clinical and microbial oral health status in children and adolescents with type 1 diabetes mellitus. Int Dent J 2019; 70:136-144. [PMID: 31872438 DOI: 10.1111/idj.12530] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To study the oral health of young individuals with controlled and uncontrolled type 1 diabetes mellitus (T1DM) and compare the results with those for healthy counterparts. MATERIALS AND METHODS One-hundred and forty-four youngsters (6-15 years of age) were assigned, according to glycaemic control, to three study groups: (i) diabetic patients with poor glycaemic control [glycated haemoglobin (HbA1c ≥7.5%)] (n = 35); (ii) diabetic patients with good glycaemic control (HbA1c <7.5%) (n = 39); and (iii) healthy individuals (n = 70). Plaque, gingival inflammation, calculus and decayed, missing and filled surfaces (DMFS) indices were recorded. Salivary parameters were determined, and stimulated saliva was collected to allow detection and determination of the levels of oral Candida albicans and Streptococcus mutans by real-time polymerase chain reaction (PCR). RESULTS Significantly different amounts of plaque were found among the study groups (P = 0.024): youngsters with poor glycaemic control had significantly more plaque than youngsters in the other two groups. The gingival, calculus and DMFS indices were not significantly different among groups (P > 0.05). Candida albicans levels were not statistically significant different among groups, but the group with poor glycemic control showed an elevated frequency of detection. Streptococcus mutans was isolated from the oral cavity of 96 of the 144 individuals. A statistically significant difference in the level of S. mutans was found between the group with poor glycaemic control and the healthy control group (P = 0.032). CONCLUSIONS The results imply that youngsters with T1DM have a lower level of oral hygiene and are potentially at a higher risk of future oral disease, particularly when their metabolic disorder is uncontrolled. However, factors outside the oral cavity may also have a considerable impact on the initiation and progression of oral diseases.
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Affiliation(s)
- Anastasia Babatzia
- Department of Paediatric Dentistry, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - William Papaioannou
- Department of Preventive and Community Dentistry, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Stavropoulou
- Virology Unit, Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Bern, Switzerland.,Private Practice, Corfu, Greece
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Liza Papagiannoulis
- Department of Paediatric Dentistry, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiria Gizani
- Department of Paediatric Dentistry, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Tsai WC, Lee CH, Wu WM, Lin SH, Yang YC, Cheng YW, Ho JC, Liu KL. Cutaneous manifestations of subcutaneous and systemic fungal infections in tropical regions: a retrospective study from a referral center in southern Taiwan. Int J Dermatol 2017; 56:623-629. [PMID: 28295235 DOI: 10.1111/ijd.13497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep cutaneous fungal infections, including subcutaneous mycoses and systemic fungal infection with cutaneous involvement, cause significant morbidity and mortality in light of increasing immunocompromised patients and global warming. Although a few studies reviewed deep fungal infections in temperate regions, a relevant study in tropical regions is lacking. We evaluated features of deep cutaneous fungal infections in southern Taiwan among the tropical regions. METHODS We retrospectively reviewed all histopathological specimens with deep cutaneous fungal infections in a single referral center from 2001 to 2014 and successfully identified 23 cases. Medical chart review revealed patient demographic data, clinical presentation, underlying disease, microbiological culture reports, and treatment outcomes. RESULTS The average patient age was 52 years. Fourteen cases had primary subcutaneous mycoses, and nine had systemic mycoses. Fifteen patients were immunocompromised, including hematological malignancies. Acquired immune deficiency syndrome (AIDS) and long-term steroid use were most commonly associated with deep fungal infections. The positive culture growth rate was 63%. Fonsecaea sp. was most frequently identified by tissue culture. Aspergillosis, mucormycosis, and disseminated cryptococcosis were particularly fatal. CONCLUSIONS Diabetes and long-term steroid use appear as major risk factors for advanced mycoses in this region. Rapid diagnosis with skin biopsy and tissue culture along with appropriate treatment of deep cutaneous fungal infection are necessary.
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Affiliation(s)
- Wen-Chien Tsai
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Shang-Hung Lin
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chien Yang
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Wen Cheng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ji-Chen Ho
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kwei-Lan Liu
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Radowsky JS, Brown TS, Lisboa FA, Rodriguez CJ, Forsberg JA, Elster EA. Serum Inflammatory Cytokine Markers of Invasive Fungal Infection in Previously Immunocompetent Battle Casualties. Surg Infect (Larchmt) 2015; 16:526-32. [PMID: 26110227 DOI: 10.1089/sur.2013.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Invasive fungal infection (IFI) is described increasingly in individuals experiencing high-energy military trauma. Hallmarks of successful treatment involve aggressive surgical debridement and early initiation of systemic antimicrobial therapy. Currently, intravenous anti-fungal therapy commences based on appearance of wounds and patient's clinical course. Whereas some clinical protocols exist to predict which critically injured patients should receive anti-fungal therapies, there are no established serum markers associated with IFI. Our hypothesis is that serum inflammatory cytokines exist that can assist in identifying individuals at risk for IFI. METHODS This is a retrospective case control study at a single institution. Nine patients with IFI (Saksenaea vasiformis, Fusarium sp., Graphium sp., Scedosporium sp., Aspergillus sp., Mucor sp., and Alternaria sp.) after battlefield trauma were matched to nine individuals with similar injury patterns whose laboratory results were negative for IFI. The combination of serum inflammatory cytokines from the first and second debridements was examined with multiplex platform proteomic analysis. We defined statistical significance as a two-tailed α<0.05 after adjusting for multiple comparisons using the false discovery rate method. This model was refined further with correlation-based filter selection and the area under the curve of the receiver operating characteristics (AUROC) was tested. RESULTS Both groups had similar Injury Severity Scores (ISS) (mean±standard deviation [SD]) (26.8±15.5 vs. 29.2±16.8, p=0.766). Elevated RANTES (regulated on activation, normal T cell expressed and secreted) alone (10,492.8±4,450.1 vs. 5,333.3±4,162.2, p=0.006) correlated with IFI. Also, the combination of persistent elevations in RANTES, interleukin (IL)-2R, and IL-15 was a robust model for predicting IFI with the AUROC being 0.9. CONCLUSIONS Elevation in serum cytokines, particularly RANTES, correlated with IFI in this small group of patients. This demonstrates the potential of future rapid serum testing for early initiation and guidance of anti-fungal therapies.
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Affiliation(s)
- Jason S Radowsky
- 1 Department of General Surgery, Walter Reed National Military Medical Center, Bethesda , Maryland.,2 Naval Medical Research Center , Regenerative Medicine Department, Silver Spring, Maryland.,4 Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Trevor S Brown
- 2 Naval Medical Research Center , Regenerative Medicine Department, Silver Spring, Maryland.,5 Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences , Department of Surgery, Bethesda, Maryland
| | - Felipe A Lisboa
- 2 Naval Medical Research Center , Regenerative Medicine Department, Silver Spring, Maryland.,4 Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,5 Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences , Department of Surgery, Bethesda, Maryland
| | - Carlos J Rodriguez
- 1 Department of General Surgery, Walter Reed National Military Medical Center, Bethesda , Maryland.,4 Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Jonathan A Forsberg
- 2 Naval Medical Research Center , Regenerative Medicine Department, Silver Spring, Maryland.,3 Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda , Maryland.,5 Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences , Department of Surgery, Bethesda, Maryland
| | - Eric A Elster
- 1 Department of General Surgery, Walter Reed National Military Medical Center, Bethesda , Maryland.,2 Naval Medical Research Center , Regenerative Medicine Department, Silver Spring, Maryland.,4 Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences , Bethesda, Maryland.,5 Surgical Critical Care Initiative (SC2i), Uniformed Services University of the Health Sciences , Department of Surgery, Bethesda, Maryland
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7
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Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers. Case Rep Med 2015; 2015:509827. [PMID: 26064128 PMCID: PMC4443939 DOI: 10.1155/2015/509827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 01/07/2023] Open
Abstract
Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.
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8
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Abstract
Even at a time when HIV/AIDS and immunosuppressive therapy have increased the number of individuals living with significant immunocompromise, diabetes mellitus (DM) remains a major comorbid disorder for several rare but potentially lethal infections, including rhino-orbital-cerebral mucormycosis and malignant external otitis. DM is also a commonly associated condition in patients with nontropical pyomyositis, pyogenic spinal infections, Listeria meningitis, and blastomycosis. As West Nile virus spread to and across North America over a decade ago, DM appeared in many series as a risk factor for death or neuroinvasive disease. More recently, in several large international population-based studies, DM was identified as a risk factor for herpes zoster. The relationships among infection, DM, and the nervous system are multidirectional. Viral infections have been implicated in the pathogenesis of type 1 and type 2 DM, while parasitic infections have been hypothesized to protect against autoimmune disorders, including type 1 DM. DM-related neurologic disease can predispose to systemic infection - polyneuropathy is the predominant risk factor for diabetic foot infection. Because prognosis for many neurologic infections depends on timely institution of antimicrobial and sometimes surgical therapy, neurologists caring for diabetic patients should be familiar with the clinical features of the neuroinfectious syndromes associated with DM.
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Affiliation(s)
- Cheryl A Jay
- Department of Neurology, University of California San Francisco and Neurology Service, San Francisco General Hospital, San Francisco, CA, USA.
| | - Marylou V Solbrig
- Departments of Internal Medicine (Neurology) and Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Stanzani M, Lewis RE, Fiacchini M, Ricci P, Tumietto F, Viale P, Ambretti S, Baccarani M, Cavo M, Vianelli N. A risk prediction score for invasive mold disease in patients with hematological malignancies. PLoS One 2013; 8:e75531. [PMID: 24086555 PMCID: PMC3784450 DOI: 10.1371/journal.pone.0075531] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/14/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A risk score for invasive mold disease (IMD) in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis. METHODS We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008) to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012. RESULTS Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD) were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of < 6 discriminated patients with low (< 1%) versus higher incidence rates (> 5%) of IMD, with a negative predictive value (NPV) of 0.99, (95% CI 0.98-0.99). During 2009-2012, patients with a calculated risk score at admission of < 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores > 6 (0.9% vs. 10.6%, P <0.001). CONCLUSION An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate "screening-out" of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.
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Affiliation(s)
- Marta Stanzani
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- * E-mail:
| | - Russell E. Lewis
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Fiacchini
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Ricci
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Tumietto
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Ambretti
- Operative Unit of Microbiology, Department of Hematology, Oncology and Laboratory Medicine, S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Michele Baccarani
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Michele Cavo
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicola Vianelli
- Institute of Hematology, Department of Hematology and Clinical Oncology, “Lorenzo e Ariosto Seràgnoli” S’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Nair S, James E, Awasthi S, Nambiar S, Goyal S. A review of the clinicopathological and radiological features of unilateral nasal mass. Indian J Otolaryngol Head Neck Surg 2013; 65:199-204. [PMID: 24427646 PMCID: PMC3738805 DOI: 10.1007/s12070-011-0288-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 08/12/2011] [Indexed: 10/17/2022] Open
Abstract
Unilateral sinonasal pathology are common presentations but are regarded with caution as neoplastic conditions during their early stages may mimic an inflammatory pathology. The aim of the review was to analyse the varied presentations of patients with unilateral nasal mass and to identify features suggestive of neoplastic pathology. A retrospective review of all cases of unilateral nasal mass/polyp from Jan 09 to Jan 10 presenting at a tertiary care hospital were analysed. The patients were grouped as per their histopathological diagnosis as inflammatory and neoplastic. The demographic data, presenting symptoms, radiological and histopathological findings were compared between the two groups. Out of the 53 patients of unilateral nasal mass, 44 (83.1%) had inflammatory conditions and 9 (16.9%) had neoplastic conditions. Benign nasal polyp and inverted papilloma were the commonest inflammatory and neoplastic condition. Neoplastic conditions were significantly commoner in males (P = 0.0315) and in the age group above 50 years (P = 0.0046). Epistaxis and extranasal symptoms like facial pain, dental and orbital complaints were found to be significantly higher in neoplastic conditions. Neoplastic lesions of nose and paranasal sinus are one of the most challenging conditions that otolaryngologists have to diagnose and treat due to their hidden nature and late presentations. In our review neoplastic conditions were found to be higher in elderly male with epistaxis, extranasal symptoms and presence of extensive soft tissue involvement and bony destruction on CT scan. The clinician should have a high index of suspicion to rule out a neoplastic aetiology in all cases of unilateral nasal mass.
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Affiliation(s)
- Satish Nair
- Army Hospital Research and Referral, New Delhi, India
| | - E. James
- Army Hospital Research and Referral, New Delhi, India
| | - S. Awasthi
- Army Hospital Research and Referral, New Delhi, India
| | - Sapna Nambiar
- Army Hospital Research and Referral, New Delhi, India
| | - Sunil Goyal
- Army Hospital Research and Referral, New Delhi, India
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Abstract
The chronic metabolic disorder diabetes mellitus is a fast-growing global problem with huge social, health, and economic consequences. It is estimated that in 2010 there were globally 285 million people (approximately 6.4% of the adult population) suffering from this disease. This number is estimated to increase to 430 million in the absence of better control or cure. An ageing population and obesity are two main reasons for the increase. Furthermore it has been shown that almost 50% of the putative diabetics are not diagnosed until 10 years after onset of the disease, hence the real prevalence of global diabetes must be astronomically high. This chapter introduces the types of diabetes and diabetic complications such as impairment of immune system, periodontal disease, retinopathy, nephropathy, somatic and autonomic neuropathy, cardiovascular diseases and diabetic foot. Also included are the current management and treatments, and emerging therapies.
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Abstract
With the rising incidence of diabetes mellitus (DM) in the US, it is of paramount importance that practitioners understand the complications of DM and how best to manage them. Diabetes affects every organ system and the skin is no exception. There are numerous cutaneous manifestations of DM that have similar etiologies and result from the same pathologic mechanisms as the internal complications of this disease state. In addition, skin manifestations may precede the diagnosis of diabetes. The present article reviews both the common and less common cutaneous manifestations of DM, including presenting lesions, pathogenesis, and management.
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Affiliation(s)
- Lauren Levy
- Mt Sinai Medical Center, New York, New York 10029, USA
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Özcan D, Seçkin D, Demirbilek M. In vitro antifungal susceptibility of dermatophyte strains causing tinea pedis and onychomycosis in patients with non-insulin-dependent diabetes mellitus: a case-control study. J Eur Acad Dermatol Venereol 2010; 24:1442-6. [DOI: 10.1111/j.1468-3083.2010.03666.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Saini R, Al-Maweri SA, Saini D, Ismail NM, Ismail AR. Oral mucosal lesions in non oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions. Diabetes Res Clin Pract 2010; 89:320-6. [PMID: 20488573 DOI: 10.1016/j.diabres.2010.04.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 04/09/2010] [Accepted: 04/20/2010] [Indexed: 12/29/2022]
Abstract
AIMS This study was aimed to determine the prevalence of oral mucosal lesions (OML) in patients with diabetes mellitus (DM) and non-diabetic subjects without any oral habits and to investigate the association of DM with oral precancerous lesions. METHODS This cross-sectional study involved 420 diabetic and 420 non-diabetic control subjects without any oral habits. Detailed oral examination was performed based on international criteria. RESULTS A significantly greater proportion of subjects with DM (45%) had one or more OML in comparison to non-diabetics (38.3%). Patients with DM showed a significantly greater prevalence of geographic tongue, denture stomatitis and angular cheilitis than non-diabetics (p<0.05). The results also showed an association between occurrence of one or more OML and metabolic control of diabetic patients (p<0.05). For precancerous lesions, lichen planus was found in two diabetic patients while none of controls had any precancerous lesion (p>0.05). CONCLUSIONS Prevalence of OML was significantly higher in diabetic patients than non-diabetics and this prevalence was associated with the metabolic control of the patients. However, no association was observed between DM and oral precancerous lesions.
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Affiliation(s)
- Rajan Saini
- Department of Oral Pathology and Medicine, School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kelantan, Malaysia.
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15
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Kothavade RJ, Kura MM, Valand AG, Panthaki MH. Candida tropicalis: its prevalence, pathogenicity and increasing resistance to fluconazole. J Med Microbiol 2010; 59:873-880. [PMID: 20413622 DOI: 10.1099/jmm.0.013227-0] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Candida tropicalis has been identified as the most prevalent pathogenic yeast species of the Candida-non-albicans group. Historically, Candida albicans has been the major species responsible for causing candidiasis in immunocompromised and immunocompetent patients. However, infections (candidiasis) due to C. tropicalis have increased dramatically on a global scale thus proclaiming this organism to be an emerging pathogenic yeast. The reasons for this organism's dominance and its resistance to fluconazole have been difficult to elucidate. In addition, the mechanism of this organism's pathogenicity and the consequent immune response remain to be clarified. This paper describes certain predisposing factors potentially responsible for these characteristics and presents a 'root cause analysis' to explain the increasing prevalence of C. tropicalis in developed and undeveloped countries, as well as the organism's acquired drug resistance. Control measures against fluconazole resistance in clinical management have also been discussed.
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Affiliation(s)
- Rajendra J Kothavade
- Microbiology Section, WQA Laboratory, EPCOR, 9469 Rossdale Rd NW, Edmonton, AB T5K 0S5, Canada
| | - M M Kura
- Department of Dermatology, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai 400 008, India
| | - Arvind G Valand
- Department of Pathology, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai 400 008, India
| | - M H Panthaki
- Department of Immunocytobiology and Pathology, Sir H. N. Hospital and Medical Research Centre, Mumbai 400 004, India
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16
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Naggie S, Perfect JR. Molds: hyalohyphomycosis, phaeohyphomycosis, and zygomycosis. Clin Chest Med 2009; 30:337-53, vii-viii. [PMID: 19375639 DOI: 10.1016/j.ccm.2009.02.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Emerging fungi previously thought to be nonpathogenic are now recognized as playing a significant role in the increased incidence of invasive fungal disease. This change in the epidemiology of invasive fungal infections (IFIs) has occurred in the era of aggressive new therapies for hematopoietic stem cell transplantation and other malignancies that lead to profound immunosuppression for longer durations and has extended the survival of these critically ill patients. The significant morbidity and mortality associated with these infections is not only related to the host populations but to delayed recognition and diagnosis and high rates of resistance in some of these emerging pathogens to standard antifungal therapies.
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Affiliation(s)
- Susanna Naggie
- Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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17
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Peters E, Seaton A. Candidemia in patients with diabetes mellitus: epidemiology and predictors of mortality. ACTA ACUST UNITED AC 2009; 37:312-3. [PMID: 15804671 DOI: 10.1080/00365540410021126] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Candidemia is the fourth most frequent nosocomial bloodstream infection in the US. The clinical characteristics and outcome of candidemia in adult patients with diabetes mellitus (DM) have not been reported in the literature. The objective of the study was to determine the epidemiology and determinants of mortality in diabetic patients with candidemia. A retrospective cohort study among diabetic patients with candidemia was carried out at 2 medical centers. The primary outcome was death from any cause after the onset of candidemia until discharge from the hospital. A stepwise logistic regression analysis was performed to determine the predictors of mortality. From June 1995 to June 2003, 87 patients with both DM and candidemia were studied. Candida albicans was the most common (48/87, 55%) and Candida glabrata the second most common isolate of candidemia (18/87, 21%). Overall hospital mortality was 39% (34/87). Logistic regression analysis identified 3 independent determinants of death; Apache II score > or =23 (OR 8.3, 95% CI{2.7, 25.4}, p =0.0002), nosocomial candidemia (OR 10.2, 95% CI{1.1, 97.9}, p = 0.04), and mechanical ventilation (OR 3.6, 95% CI{1.1, 11.2}, p = 0.03). The study demonstrates the emergence of non-albicans species of Candida as major causes of candidemia among diabetic patients. The severity of illness reflected by Apache II was the most significant predictor of mortality among diabetic patients with candidemia.
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Affiliation(s)
- Erica Peters
- The Infection, Tropical Medicine and Counselling Service, The Brownlee Centre, Gartnavel General Hospital, Glasgow, UK
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18
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19
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Factors affecting the prevalence of yeasts in the oral cavity of patients with diabetes mellitus. J Mycol Med 2008. [DOI: 10.1016/j.mycmed.2008.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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A Patient With an Unusual Surgical Site Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e318165434d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Rodríguez-Pichardo A, García-Bravo B. Candidiasis cutaneomucosas. Manifestaciones clínicas. Med Clin (Barc) 2006. [DOI: 10.1157/13097521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41:634-53. [PMID: 16080086 DOI: 10.1086/432579] [Citation(s) in RCA: 1887] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 04/18/2005] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. METHODS We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. RESULTS The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). CONCLUSIONS Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
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Affiliation(s)
- Maureen M Roden
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA
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23
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Thajeb P, Thajeb T, Dai D. Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy. ACTA ACUST UNITED AC 2004; 36:643-8. [PMID: 15370650 DOI: 10.1080/00365540410020794] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Within a 10-y period, fatal strokes occurred during parenteral administration of amphotericin B and surgical debridement of paranasal sinuses in 6 pathologically verified cases of rhino-orbito-cerebral mucormycosis (ROCM). All patients had unnoticed type-2 diabetes mellitus without ketoacidosis. They presented with unilateral orbital cellulitis and cavernous sinus syndrome. Fatal malignant cerebral infarctions occurred in the carotid system in 5 patients, and in the basilar artery or its major branches in 2 patients. Accelerated thrombotic occlusion of the cavernous portion of the carotid artery or the basilar artery was likely to be due to mucormycosis associated-vasculopathy and diabetic vasculopathy. One patient died of massive subarachnoid hemorrhage following rupture of the mycotic aneurysm. Despite parenteral administration of amphotericin B, fatal outcome of ROCM in patients with unnoticed diabetes mellitus occurs due to mucormycosis-associated malignant strokes. To improve outcome, a combination of early radical debridement, ocular exenteration, parenteral and local administration of amphotericin B, and decompression craniotomy should be considered.
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Affiliation(s)
- Peterus Thajeb
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
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24
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Manfredi M, McCullough MJ, Vescovi P, Al-Kaarawi ZM, Porter SR. Update on diabetes mellitus and related oral diseases. Oral Dis 2004; 10:187-200. [PMID: 15196139 DOI: 10.1111/j.1601-0825.2004.01019.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycaemia of diabetes is associated with long-term systemic dysfunction. The present article summarizes current knowledge of DM and details the oral and dental implications of this common endocrine disorder.
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Affiliation(s)
- M Manfredi
- Oral Medicine Department, Eastman Dental Institute, UCL, London, UK.
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25
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Bouguerra R, Essaïs O, Sebaï N, Ben Salem L, Amari H, Kammoun MR, Chaker E, Zidi B, Ben Slama C. Prévalence et aspects cliniques des mycoses superficielles chez le diabétique tunisien en milieu hospitalier. Med Mal Infect 2004; 34:201-5. [PMID: 16235595 DOI: 10.1016/j.medmal.2004.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The prevalence of mycotic infection seems to be higher among diabetic patients than in the non-diabetic population. The aims of this study were to determine the frequency of mycosis and to compare clinical and fungal results. PATIENTS AND METHODS This transversal study included 307 type 1 and 2 diabetic patients admitted between January 1998 and January 2000. A dermatologist examined all patients. The mean age was 44 +/- 17 years and the duration of diabetes 8 +/- 6 years. Patients with suspected lesions underwent mycological examination. RESULTS Clinical signs of presumed fungal infection were found in 61% of patients, but mycosis was confirmed only in 30%. Fungal foot infection accounted 38% of the patients, mostly due to dermatophytes (94%). The commonest localizations of dermatophytes were interdigital (60%) followed by onychomycosis (30%). The main fungal agent was Trichophyton rubrum. The main risk factors for fungal infections were the age of patients (P = 0.0003) and duration of diabetes (P < 0.05). Interdigital foot localization of dermatophytes was correlated to age (P < 0.0001) and to the male gender (P < 0.01). The frequency of dermatophytes in nails was higher in type 2 diabetic patients (P < 0.01). Vulvovaginal candidosis and interdigital dermatophytes were more frequent in obese than in non-obese patients. The accuracy and specificity of direct examination were respectively 85% and 79%. CONCLUSION The high frequency of mycosis in diabetic patients at hospital is demonstrated. The main risk factors were age, male gender and obesity.
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Affiliation(s)
- R Bouguerra
- Service d'endocrinologie-diabétologie, institut national de nutrition, Bab-Saadoun, Tunisie
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26
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Eibl N, Spatz M, Fischer GF, Mayr WR, Samstag A, Wolf HM, Schernthaner G, Eibl MM. Impaired primary immune response in type-1 diabetes: results from a controlled vaccination study. Clin Immunol 2002; 103:249-59. [PMID: 12173299 DOI: 10.1006/clim.2002.5220] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with diabetes have an increased risk for infections, but information on their adoptive immunity is incomplete and contradictory. Twenty patients with diabetes type-1 and 20 patients with type-2 diabetes were vaccinated with T-cell-dependent primary protein antigens (hepatitis A viral antigen, HAV; diphtheria toxoid) and a T-cell-independent polysaccharide antigen (pneumococcal polysaccharide). In parallel, the proliferative response of CD4+ T-cells to the primary protein antigens keyhole limpet hemocyanin (KLH) and sperm whale myoglobin (SWM) was measured in vitro using monocyte-derived dendritic cells (MDDC) as antigen-presenting cells. Compared to healthy controls, type-1 diabetes patients mounted a significantly impaired primary antibody response to hepatitis A vaccine (median HAV antibody titer after the first vaccination, 53 IU/L in diabetic patients vs 212 IU/L in the controls, P = 0.017) and diphtheria toxoid (median serum antibodies after vaccination, patients, 0.94 IU/ml, controls, 6.38 IU/ml, P = 0.004), while the response to pneumococcal polysaccharide was normal. Type-2 diabetes patients had a comparable metabolic dysregulation but showed a normal antibody response following vaccination, demonstrating that the effect was not due to hyperglycemia. Antigen-induced interferon-gamma and interleukin-13 release was reduced in type-1 diabetes patients, localizing the impairment to the level of antigen-presenting cell-T-cell interaction. In addition, the proliferative response of CD4+ T-cells derived from type-1 diabetes patients to KLH and SWM was significantly reduced (P < or = 0.01). FACS analysis of CD80 (B7.1), CD86 (B7.2), and HLA-DR expression on MDDC could not demonstrate significant differences in the expression of these molecules between type-1 and type-2 diabetes patients and healthy controls. An association of low HAV antibody response with HLA-DR3,4 expression in the patients was shown. Our results indicate that the primary antibody response to T-cell dependent antigens as well as the T-cell response to primary protein antigens is reduced in type-1 diabetes patients and that additional booster immunization can overcome the defect.
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Affiliation(s)
- Nicole Eibl
- Krankenanstalt Rudolfstiftung, 1. Medizinische Abteilung, Juchgasse 25, A-1030 Vienna, Austria
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Abstract
OBJECTIVE To describe a case of gastric mucormycosis in conjunction with severe bleeding in a young woman, which occurred after an episode of ketoacidosis and had a fatal outcome. METHODS We present a case report, including detailed clinical and pathologic findings in a woman with gastric mucormycosis associated with severe bleeding. RESULTS A 17-year-old woman sought medical assistance for diabetic ketoacidosis and severe epigastric pain. Chest radiography showed normal findings, and blood and urine cultures were negative for bacterial growth. Endoscopy disclosed an extensive ulcerated lesion involving the greater curvature and posterior wall of the stomach. Biopsy specimens demonstrated the presence of invasive mucormycosis. Treatment with amphotericin B was initiated, but severe persistent gastrointestinal bleeding resulted in the patient's demise. CONCLUSION In conjunction with diabetic ketoacidosis, severe infection by Mucor has been reported mainly in the rhino-orbital area. Although uncommon, the gastrointestinal tract can also be involved. In the case described, severe hemorrhage ensued and caused the patient's death.
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Affiliation(s)
- José Egídio Paulo De Oliveira
- Department of Internal Medicine, Medical School, and Diabetes and Nutrition Division of Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
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28
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Ueta E, Tanida T, Yoneda K, Yamamoto T, Osaki T. Increase of Candida cell virulence by anticancer drugs and irradiation. ORAL MICROBIOLOGY AND IMMUNOLOGY 2001; 16:243-9. [PMID: 11442850 DOI: 10.1034/j.1399-302x.2001.160408.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The influence of anticancer drugs and irradiation on Candida cell proliferation, adherence to HeLa cells and susceptibility to antifungal drugs (amphotericin B and miconazole) and neutrophils were examined using two Candida albicans strains. After treatment with 5-fluorouracil (25 microg/ml to 250 microg/ml), cis-diammine-dichloroplatinum (10 microg/ml to 100 microg/ml), peplomycin (0.5 microg/ml to 5 microg/ml) or 137Cs (20 Gy to 40 Gy) for 3 days or more, surviving Candida cells proliferated more rapidly than did untreated control cells. Anticancer agent-pretreated Candida cells revealed an increased adhesion to HeLa cells corresponding to an increase of binding to the lectins. The concentration of half limited colony formation (IC50) of amphotericin B and miconazole was increased to near two-fold that of the control by pretreatment of Candida cells with the anticancer agents, except peplomycin, which only weakly increased IC50. In addition, the enolase and Candida acid proteinase activities in the culture supernatants were increased by pretreatment with the drugs and irradiation. Correspondingly, surviving Candida cells after these treatments were resistant to neutrophils, with a reduction to half of the killing. These results indicate that anti-cancer drugs and irradiation potentiate the virulence of Candida cells, or they eliminate Candida cells with low virulence, thereby enhancing the risk of oral and systemic candidiasis.
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Affiliation(s)
- E Ueta
- Department of Oral Surgery, Kochi Medical School, Kochi, Japan
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29
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Lyke KE, Miller NS, Towne L, Merz WG. A case of cutaneous ulcerative alternariosis: rare association with diabetes mellitus and unusual failure of itraconazole treatment. Clin Infect Dis 2001; 32:1178-87. [PMID: 11283807 DOI: 10.1086/319751] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2000] [Revised: 08/22/2000] [Indexed: 11/03/2022] Open
Abstract
Alternaria species are ubiquitous dematiaceous fungi that are increasingly recognized as pathogens in immunocompromised patients or those with significant underlying disease, but they are also pathogens in otherwise healthy hosts. We describe a case of dermal cutaneous ulcerative alternariosis in a frail 83-year-old patient with diet-controlled diabetes mellitus. Histological analysis revealed hyphal morphology in tissue sections that was initially confused with that of a zygomycetous fungus, and multiple positive culture results were necessary to identify the organism. Treatment with oral itraconazole and surgical debridement were ineffective; clinical improvement was achieved by means of treatment with intravenous amphotericin B lipid complex. We review the literature regarding the role of diabetes mellitus in cutaneous alternariosis and regarding the efficacy of treatment with itraconazole, which has been used very successfully. To our knowledge, this is only the second case report noting diabetes mellitus uncomplicated by steroid administration as a possible predisposing factor for cutaneous infection.
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Affiliation(s)
- K E Lyke
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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Guggenheimer J, Moore PA, Rossie K, Myers D, Mongelluzzo MB, Block HM, Weyant R, Orchard T. Insulin-dependent diabetes mellitus and oral soft tissue pathologies: II. Prevalence and characteristics of Candida and Candidal lesions. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 89:570-6. [PMID: 10807713 DOI: 10.1067/moe.2000.104477] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prevalence of Candida albicans and oral infection with Candida in patients with insulin-dependent diabetes mellitus (IDDM). STUDY DESIGN This cross-sectional study compared the prevalence of candidiasis in 405 subjects with IDDM and 268 nondiabetic control subjects. Assessments included evidence of clinical manifestations of candidiasis and a quantitative measure of Candida pseudohyphae in a cytologic smear from the midline posterior dorsal tongue. RESULTS More subjects with IDDM than control subjects without IDDM (15.1% vs 3.0%) were found to have clinical manifestations of candidiasis, including median rhomboid glossitis, denture stomatitis, and angular cheilitis. IDDM subjects were also more likely to have any Candida pseudohyphae in their cytologic smears (23.0% vs 5.7%; P <.0001), as well as pseudohyphae counts of >10/cm(2) (7.1% vs 0.8%; P <.0001). Diabetic subjects with median rhomboid glossitis were more likely to have a longer duration of IDDM and complications of nephropathy and retinopathy. Denture stomatitis was associated with smoking, retinopathy, higher Candida counts, poor glycemic control, and longer duration of IDDM. A multivariate regression analysis found 3 factors to be significantly associated with the presence of Candida pseudohyphae in the subjects with IDDM: current use of cigarettes (odds ratio, 2:4), use of dentures (odds ratio, 2:3), and elevated levels of glycosylated hemoglobin (odds ratio, 1:9). The use of antimicrobials, immunosuppressants, or drugs with xerostomic side effects was not related to the presence of Candida. CONCLUSIONS Candida pseudohyphae and oral soft tissue manifestations of candidiasis were more prevalent in subjects with IDDM than in control subjects without diabetes. The presence of Candida pseudohyphae was significantly associated with cigarette smoking, use of dentures, and poor glycemic control.
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Affiliation(s)
- J Guggenheimer
- University of Pittsburgh School of Dental Medicine, Departments of Restorative Dentistry and Oral Medicine and Pathology, Pennsylvania, USA
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31
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Affiliation(s)
- N Joshi
- Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033, USA
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32
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Sivalingam P, Tully AM. Acute meningococcal epiglottitis and septicaemia in a 65-y-old man. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 30:196-8. [PMID: 9730313 DOI: 10.1080/003655498750003654] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report a case of acute meningococcal epiglottitis in a 65-y-old man. He was noted to have stridor of acute onset. We highlight the importance of the diagnosis of acute epiglottitis, early establishment of an airway and appropriate antibiotic therapy. This case report mainly concerns the association of unusual pathogen Neisseria meningitidis and adult acute epiglottitis.
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Affiliation(s)
- P Sivalingam
- Department of Anaesthesia, Vale of Leven District General Hospital, Alexandria, UK
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Lee SS, Sun JH, Chang LY, Ueng SW, Shih CH. Limb-threatening necrotizing alternariosis salvaged by adjunctive hyperbaric oxygen therapy. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 30:194-6. [PMID: 9730312 DOI: 10.1080/003655498750003645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We describe, to our knowledge, the first case of limb-threatening necrotizing alternariosis whose limbs were successfully salvaged by adjunctive hyperbaric oxygen therapy (HBO2). This 58-y-old patient was immunocompromised with both diabetes and Cushing's syndrome. She suffered from necrotizing soft tissue infection of both legs caused by Alternaria. It was impossible to halt the progression of the invasive infection with standard anti-fungal treatment and aggressive surgical debridement. After the use of HBO2, the wound was stabilized and eventually healed. Adjunctive HBO2 in this case has demonstrated its role in the treatment of complicating necrotizing soft tissue infection caused by invasive fungal infection. The possible mechanisms may be the potentiation of immune responses and the enhancement of fibroblast proliferation.
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Affiliation(s)
- S S Lee
- Department of Orthopaedic Surgery, Hyperbaric Oxygen Therapy Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
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Khanna SK, Soumekh B, Bradley JS, Billman G, Kearns DB, Spear RM, Peterson BM. A case of fatal rhinocerebral mucormycosis with new onset diabetic keto-acidosis. J Diabetes Complications 1998; 12:224-7. [PMID: 9647341 DOI: 10.1016/s1056-8727(97)00078-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S K Khanna
- Children's Hospital, San Diego, Califonia, USA
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35
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Cunha BA. Infections in nonleukopenic compromised hosts (diabetes mellitus, SLE, steroids, and asplenia) in critical care. Crit Care Clin 1998; 14:263-82. [PMID: 9561817 DOI: 10.1016/s0749-0704(05)70395-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acutely ill patients who are immunocompromised but not neutropenic most commonly are: (1) diabetic; (2) on chronic high-dose steroid therapy; (3) have lupus; or (4) have impaired or absent splenic function. These patients often present in the CCU because of the severity of their infection. Differential diagnosis may be approached by first considering the patient's underlying disease, i.e., SLE. The next step in the diagnostic process is to appreciate the immune defect associated with these disorders. The nature of the immune defect determines which clinical pathogens are related to the immune defect. Pathogens are associated with a sterotyped pattern of organ involvement. The object of the diagnostic analysis is to determine the most likely organism affecting a particular organ system, given the defect in host defenses associated with the patient's underlying illness. In this way, a useful clinical diagnosis can be made rapidly, and appropriate clinical specimens obtained for diagnostic testing. Often empiric therapy must be started pending the results of diagnostic testing. In such situations, empiric therapy ordinarily is directed against the bacterial pathogens most likely to cause disease relevant to the patient's impaired defenses. Specific therapy for unusual or exotic pathogens should not be empiric and should be based on demonstration of a pathogenic role by the microorganism. In the case of miliary tuberculosis or invasive fungal disease, a case may be made for early empiric therapy to cover these organisms if there is sufficient clinical suspicion based on the presenting signs and symptoms as well as the pattern of organ involvement. As with all infections, but particularly in immunocompromised patients, the early initiation of appropriate antimicrobial therapy is essential and often life-saving.
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Affiliation(s)
- B A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA
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Vella A, Farrugia G. 90-year-old man with fever and melena. Mayo Clin Proc 1996; 71:1205-8. [PMID: 8945497 DOI: 10.4065/71.12.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Vella
- Mayo Graduate School of Medicine, Mayo Clinic Rochester, MN 55905, USA
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