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Akuri MC, Bencardino JT, Peixoto JB, Sato VN, Miyahara LK, Kase DT, Dell'Aquila AM, do Amaral E Castro A, Fernandes ARC, Aihara AY. Fungal Musculoskeletal Infections: Comprehensive Approach to Proper Diagnosis. Radiographics 2024; 44:e230176. [PMID: 38900682 DOI: 10.1148/rg.230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Fungal musculoskeletal infections often have subacute or indolent manifestations, making it difficult to distinguish them from other diseases and infections, given that they are relatively uncommon. Fungal infections occur by hematogenous spread, direct inoculation, or contiguous extension and may be related to different risk factors, including immunosuppression and occupational activity. The infection can manifest in isolation in the musculoskeletal system or as part of a systemic process. The fungi may be endemic to certain regions or may be found throughout the world, and this can help to narrow the diagnosis of the etiologic agent. Infections such as candidiasis, cryptococcosis, aspergillosis, and mucormycosis are often related to immunosuppression. On the other hand, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, and blastomycosis can occur in healthy patients in geographic areas where these infections are endemic. Furthermore, infections can be classified on the basis of the site of infection in the body. Some subcutaneous infections that can have osteoarticular involvement include mycetoma, sporotrichosis, and phaeohyphomycosis. Different fungi affect specific bones and joints with greater prevalence. Imaging has a critical role in the evaluation of these diseases. Imaging findings include nonspecific features such as osteomyelitis and arthritis, with bone destruction, osseous erosion, mixed lytic and sclerotic lesions, and joint space narrowing. Multifocal osteomyelitis and chronic arthritis with joint effusion and synovial thickening may also occur. Although imaging findings are often nonspecific, some fungal infections may show findings that aid in narrowing the differential diagnosis, especially when they are associated with the patient's clinical condition and history, the site of osteoarticular involvement, and the geographic location. ©RSNA, 2024.
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Affiliation(s)
- Marina C Akuri
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Jenny T Bencardino
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Júlia B Peixoto
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Vitor N Sato
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Lucas K Miyahara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adriana M Dell'Aquila
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Adham do Amaral E Castro
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.)
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Giusiano G, Tracogna F, Messina F, Sosa V, Rojas F, Chacón Y, Vásquez A, de Los Ángeles Sosa M, Formosa P, Fernández M, Cattana ME, Mussin J, Fernández N, Piedrabuena M, Romero M, Miranda C, Posse G, Davalos F, Valdez R, Acuña A, Aguilera A, Andreni M, Serrano J, Álvarez C, Aguirre D, Pineda G, Effron GG, Santiso G. Impact of COVID-19 on paracoccidioidomycosis. Which was the most influential: The pandemic or the virus? Mycoses 2024; 67:e13761. [PMID: 38946016 DOI: 10.1111/myc.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Abstract
The impact of COVID-19 on paracoccidioidomycosis (PCM) in Argentina and the consequences generated by the pandemic are discussed. From 2018 to 3 years after the pandemic declaration, 285 proven PCM patients were registered. No association between both diseases was documented. PCM frequency decreased to extremely low levels in 2020. Mandatory social isolation and the emotional and psychological effects generated under pandemic circumstances led to delays in diagnosis, severe disseminated cases, and other challenges for diagnosis in subsequent years. Probable underdiagnosis should be considered due to the overlap of clinical manifestations, the low index of suspicion and the lack of sensitive diagnostic tools.
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Affiliation(s)
- Gustavo Giusiano
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia, Chaco, Argentina
- Hospital Pediátrico Juan Pablo II, Corrientes, Argentina
| | | | - Fernando Messina
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Vanesa Sosa
- Servicio de Micología, Hospital Ramon Madariaga, Posadas, Misiones, Argentina
| | - Florencia Rojas
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia, Chaco, Argentina
| | - Yone Chacón
- Hospital Señor del Milagro, Salta, Argentina
| | - Andrea Vásquez
- Servicio de Microbiología, Hospital 4 de Junio Ramón Carrillo, Presidencia Roque Sáenz Peña, Chaco, Argentina
| | - Maria de Los Ángeles Sosa
- Laboratorio Central de Redes y Programas, Facultad de Ciencias Exactas y Naturales y Agrimensura, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Corrientes, Argentina
| | - Patricia Formosa
- Hospital de Alta Complejidad Pte. J. D. Perón, Formosa, Argentina
| | | | | | - Javier Mussin
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia, Chaco, Argentina
| | - Norma Fernández
- Laboratorio de Micología, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - Milagros Piedrabuena
- Laboratorio de Microbiología, Hospital San Martín, Paraná, Entre Ríos, Argentina
| | - Mercedes Romero
- CEMAR Microbiología, Dir. Bioquímica, Secretaría de Salud Pública, Rosario, Argentina
| | | | - Gladys Posse
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | | | - Ruth Valdez
- Hospital Señor del Milagro, Salta, Argentina
| | | | | | - Mariana Andreni
- Sección Microbiología, Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina
| | - Julian Serrano
- Sección Micología, Hospital Independencia, Santiago del Estero, Argentina
| | - Christian Álvarez
- División Micología-Laboratorio de Salud Pública de Tucumán, Tucumán, Argentina
| | - Diana Aguirre
- Hospital Pediátrico Avelino Castelán, Resistencia, Chaco, Argentina
| | - Gloria Pineda
- Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
- Hospital de Pediatría S.A.M.I.C. Juan P. Garraham, Buenos Aires, Argentina
| | - Guillermo Garcia Effron
- Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, CONICET, Santa Fe, Argentina
| | - Gabriela Santiso
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
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Sepúlveda VE, Goldman WE, Matute DR. Genotypic diversity, virulence, and molecular genetic tools in Histoplasma. Microbiol Mol Biol Rev 2024; 88:e0007623. [PMID: 38819148 DOI: 10.1128/mmbr.00076-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
SUMMARYHistoplasmosis is arguably the most common fungal respiratory infection worldwide, with hundreds of thousands of new infections occurring annually in the United States alone. The infection can progress in the lung or disseminate to visceral organs and can be difficult to treat with antifungal drugs. Histoplasma, the causative agent of the disease, is a pathogenic fungus that causes life-threatening lung infections and is globally distributed. The fungus has the ability to germinate from conidia into either hyphal (mold) or yeast form, depending on the environmental temperature. This transition also regulates virulence. Histoplasma and histoplasmosis have been classified as being of emergent importance, and in 2022, the World Health Organization included Histoplasma as 1 of the 19 most concerning human fungal pathogens. In this review, we synthesize the current understanding of the ecological niche, evolutionary history, and virulence strategies of Histoplasma. We also describe general patterns of the symptomatology and epidemiology of histoplasmosis. We underscore areas where research is sorely needed and highlight research avenues that have been productive.
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Affiliation(s)
- Victoria E Sepúlveda
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William E Goldman
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel R Matute
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Dao A, Kim HY, Halliday CL, Oladele R, Rickerts V, Govender MMed NP, Shin JH, Heim J, Ford NP, Nahrgang SA, Gigante V, Beardsley J, Sati H, Morrissey CO, Alffenaar JW, Alastruey-Izquierdo A. Histoplasmosis: A systematic review to inform the World Health Organization of a fungal priority pathogens list. Med Mycol 2024; 62:myae039. [PMID: 38935903 PMCID: PMC11210611 DOI: 10.1093/mmy/myae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/30/2023] [Accepted: 04/29/2024] [Indexed: 06/29/2024] Open
Abstract
Histoplasmosis, a significant mycosis primarily prevalent in Africa, North and South America, with emerging reports globally, poses notable health challenges, particularly in immunocompromised individuals such as people living with HIV/AIDS and organ transplant recipients. This systematic review, aimed at informing the World Health Organization's Fungal Priority Pathogens List, critically examines literature from 2011 to 2021 using PubMed and Web of Science, focusing on the incidence, mortality, morbidity, antifungal resistance, preventability, and distribution of Histoplasma. We also found a high prevalence (22%-44%) in people living with HIV, with mortality rates ranging from 21% to 53%. Despite limited data, the prevalence of histoplasmosis seems stable, with lower estimates in Europe. Complications such as central nervous system disease, pulmonary issues, and lymphoedema due to granuloma or sclerosis are noted, though their burden remains uncertain. Antifungal susceptibility varies, particularly against fluconazole (MIC: ≥32 mg/l) and caspofungin (MICs: 4-32 mg/l), while resistance to amphotericin B (MIC: 0.125-0.16 mg/l), itraconazole (MICs: 0.004-0.125 mg/l), and voriconazole (MICs: 0.004-0.125 mg/l) remains low. This review identifies critical knowledge gaps, underlining the need for robust, globally representative surveillance systems to better understand and combat this fungal threat.
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Affiliation(s)
- Aiken Dao
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Westmead Clinical School, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hannah Yejin Kim
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Nelesh P Govender MMed
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Infection and Immunity, St George’s University of London, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Jong-Hee Shin
- Department of Laboratory Medicine, Chonnam National University School of Medicine, Gwangju, South Korea
| | - Jutta Heim
- Scientific Advisory Committee, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Nathan Paul Ford
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Saskia Andrea Nahrgang
- Antimicrobial Resistance Programme, World Health Organization European Office, Copenhagen, Denmark
| | - Valeria Gigante
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Justin Beardsley
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Westmead Clinical School, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hatim Sati
- AMR Division, World Health Organization, Geneva, Switzerland
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jan-Willem Alffenaar
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, New South Wales, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Pharmacy, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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Brown GD, Ballou ER, Bates S, Bignell EM, Borman AM, Brand AC, Brown AJP, Coelho C, Cook PC, Farrer RA, Govender NP, Gow NAR, Hope W, Hoving JC, Dangarembizi R, Harrison TS, Johnson EM, Mukaremera L, Ramsdale M, Thornton CR, Usher J, Warris A, Wilson D. The pathobiology of human fungal infections. Nat Rev Microbiol 2024:10.1038/s41579-024-01062-w. [PMID: 38918447 DOI: 10.1038/s41579-024-01062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/27/2024]
Abstract
Human fungal infections are a historically neglected area of disease research, yet they cause more than 1.5 million deaths every year. Our understanding of the pathophysiology of these infections has increased considerably over the past decade, through major insights into both the host and pathogen factors that contribute to the phenotype and severity of these diseases. Recent studies are revealing multiple mechanisms by which fungi modify and manipulate the host, escape immune surveillance and generate complex comorbidities. Although the emergence of fungal strains that are less susceptible to antifungal drugs or that rapidly evolve drug resistance is posing new threats, greater understanding of immune mechanisms and host susceptibility factors is beginning to offer novel immunotherapeutic options for the future. In this Review, we provide a broad and comprehensive overview of the pathobiology of human fungal infections, focusing specifically on pathogens that can cause invasive life-threatening infections, highlighting recent discoveries from the pathogen, host and clinical perspectives. We conclude by discussing key future challenges including antifungal drug resistance, the emergence of new pathogens and new developments in modern medicine that are promoting susceptibility to infection.
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Affiliation(s)
- Gordon D Brown
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK.
| | - Elizabeth R Ballou
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Steven Bates
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Elaine M Bignell
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Andrew M Borman
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Alexandra C Brand
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Alistair J P Brown
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Carolina Coelho
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Peter C Cook
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Rhys A Farrer
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Nelesh P Govender
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Neil A R Gow
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - William Hope
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - J Claire Hoving
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Rachael Dangarembizi
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Thomas S Harrison
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Elizabeth M Johnson
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Liliane Mukaremera
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Mark Ramsdale
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | | | - Jane Usher
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Duncan Wilson
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
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6
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Dan J, Wei W, Ou W, Gao G, Song W, Ye L, Liang H, Guo X, Tan L, Jiang J. Excavation of Biomarker Candidates for the Diagnosis of Talaromyces marneffei Infection via Genome-Wide Prediction and Functional Annotation of Secreted Proteins. ACS OMEGA 2024; 9:27093-27103. [PMID: 38947822 PMCID: PMC11209904 DOI: 10.1021/acsomega.4c00571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 07/02/2024]
Abstract
Talaromyces marneffei is the third most common infectious pathogen in AIDS patients and leads to the highest death rate in Guangxi, China. The lack of reliable biomarkers is one of the major obstacles in current clinical diagnosis, which largely contributes to this high mortality. Here, we present a study that aimed at identifying diagnostic biomarker candidates through genome-wide prediction and functional annotation of Talaromyces marneffei secreted proteins. A total of 584 secreted proteins then emerged, including 382 classical and 202 nonclassical ones. Among them, there were 87 newly obtained functional annotations in this study. The annotated proteins were further evaluated by combining RNA profiling and a homology comparison. Three proteins were ultimately highlighted as biomarker candidates with robust expression and remarkable specificity. The predicted phosphoinositide phospholipase C and the galactomannoprotein were suggested to play an interactive immune game through metabolism of arachidonic acid. Therefore, they hold promise in developing new tools for clinical diagnosis of Talaromyces marneffei and also possibly serve as molecular targets for future therapy.
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Affiliation(s)
- Jing Dan
- Collaborative
Innovation Centre of Regenerative Medicine and Medical BioResource
Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi 530021, China
- Guangxi
Key Laboratory of AIDS Prevention and Treatment & Biosafety III
Laboratory, Guangxi Medical University, Nanning, Guangxi 530021, China
- Center
for Energy Metabolism and Reproduction, Institute of Biomedicine and
Biotechnology, Shenzhen Institute of Advanced
Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Wudi Wei
- Guangxi
Key Laboratory of AIDS Prevention and Treatment & Biosafety III
Laboratory, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Weijie Ou
- Center
for Energy Metabolism and Reproduction, Institute of Biomedicine and
Biotechnology, Shenzhen Institute of Advanced
Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Guangshi Gao
- Geekgene
Technology Co. Ltd., Beijing 100091, China
| | - Wanjun Song
- Geekgene
Technology Co. Ltd., Beijing 100091, China
| | - Li Ye
- Guangxi
Key Laboratory of AIDS Prevention and Treatment & Biosafety III
Laboratory, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Hao Liang
- Collaborative
Innovation Centre of Regenerative Medicine and Medical BioResource
Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi 530021, China
- Guangxi
Key Laboratory of AIDS Prevention and Treatment & Biosafety III
Laboratory, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Xuzhen Guo
- Center
for Energy Metabolism and Reproduction, Institute of Biomedicine and
Biotechnology, Shenzhen Institute of Advanced
Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Lei Tan
- Center
for Energy Metabolism and Reproduction, Institute of Biomedicine and
Biotechnology, Shenzhen Institute of Advanced
Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- College
of Life Sciences, University of Chinese
Academy of Sciences, Beijing 100049, China
- Department
of Cardiology, Shenzhen Guangming District
People’s Hospital, Shenzhen 518055, China
| | - Junjun Jiang
- Collaborative
Innovation Centre of Regenerative Medicine and Medical BioResource
Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi 530021, China
- Guangxi
Key Laboratory of AIDS Prevention and Treatment & Biosafety III
Laboratory, Guangxi Medical University, Nanning, Guangxi 530021, China
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7
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Gandhi P, Hebert B, Yun A, Bradley J, Moldoveanu B. Histoplasmosis around the world: A global perspective on the presentation, virulence factors, and treatment of histoplasmosis. Am J Med Sci 2024:S0002-9629(24)01283-7. [PMID: 38885929 DOI: 10.1016/j.amjms.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/29/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
Histoplasmosis is a systemic infection caused by an endemic dimorphic fungus, Histoplasma capsulatum. Though prevalent in the eastern United States of America, near the Ohio and Mississippi River Valleys, the evidence underlying the global prevalence of histoplasmosis, especially in immunocompromised populations, is underappreciated. This article highlights the global epidemiology, risk factors, microbiology and pathophysiological characteristics, pulmonary and extrapulmonary manifestations, prevention measures, radiographic patterns, diagnostic techniques, and antifungal treatment approaches for Histoplasma capsulatum.
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Affiliation(s)
- Pooja Gandhi
- Division of General Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Brandon Hebert
- Division of General Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Angelica Yun
- Division of General Internal Medicine, University of Louisville, Louisville, Kentucky, USA
| | - James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky, USA.
| | - Bogdan Moldoveanu
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky, USA
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8
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Hoenigl M, Arastehfar A, Arendrup MC, Brüggemann R, Carvalho A, Chiller T, Chen S, Egger M, Feys S, Gangneux JP, Gold JAW, Groll AH, Heylen J, Jenks JD, Krause R, Lagrou K, Lamoth F, Prattes J, Sedik S, Wauters J, Wiederhold NP, Thompson GR. Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease. Clin Microbiol Rev 2024; 37:e0007423. [PMID: 38602408 DOI: 10.1128/cmr.00074-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
SUMMARYFungal infections are on the rise, driven by a growing population at risk and climate change. Currently available antifungals include only five classes, and their utility and efficacy in antifungal treatment are limited by one or more of innate or acquired resistance in some fungi, poor penetration into "sequestered" sites, and agent-specific side effect which require frequent patient reassessment and monitoring. Agents with novel mechanisms, favorable pharmacokinetic (PK) profiles including good oral bioavailability, and fungicidal mechanism(s) are urgently needed. Here, we provide a comprehensive review of novel antifungal agents, with both improved known mechanisms of actions and new antifungal classes, currently in clinical development for treating invasive yeast, mold (filamentous fungi), Pneumocystis jirovecii infections, and dimorphic fungi (endemic mycoses). We further focus on inhaled antifungals and the role of immunotherapy in tackling fungal infections, and the specific PK/pharmacodynamic profiles, tissue distributions as well as drug-drug interactions of novel antifungals. Finally, we review antifungal resistance mechanisms, the role of use of antifungal pesticides in agriculture as drivers of drug resistance, and detail detection methods for antifungal resistance.
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Affiliation(s)
- Martin Hoenigl
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Amir Arastehfar
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Roger Brüggemann
- Department of Pharmacy and Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc-CWZ Center of Expertise in Mycology, Nijmegen, The Netherlands
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW South Wales Health Pathology, Westmead Hospital, Westmead, Australia
- The University of Sydney, Sydney, Australia
| | - Matthias Egger
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Simon Feys
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jean-Pierre Gangneux
- Centre National de Référence des Mycoses et Antifongiques LA-AspC Aspergilloses chroniques, European Excellence Center for Medical Mycology (ECMM EC), Centre hospitalier Universitaire de Rennes, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S 1085, Rennes, France
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology and Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
| | - Jannes Heylen
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jeffrey D Jenks
- Department of Public Health, Durham County, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Robert Krause
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Juergen Prattes
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Sarah Sedik
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Joost Wauters
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
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9
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Hayes JF. The Relationship Between Endemic Mycoses and Antimicrobial Resistance. Am J Med 2024:S0002-9343(24)00353-X. [PMID: 38866302 DOI: 10.1016/j.amjmed.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Justin F Hayes
- Division of Infectious Diseases, University of Arizona, Tucson, Arizona; Valley Fever Center for Excellence, University of Arizona, Tucson, Arizona.
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10
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Salmanton-García J, Simon M, Groll AH, Kurzai O, Lahmer T, Lehrnbecher T, Schroeder M, Cornely OA, Stemler J. Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany. JAC Antimicrob Resist 2024; 6:dlae083. [PMID: 38812581 PMCID: PMC11135635 DOI: 10.1093/jacamr/dlae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/12/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction In Germany, the growing incidence of invasive fungal infections (IFIs) is a significant health concern, particularly impacting individuals with compromised immune systems due to factors like increasing transplant recipients, an ageing population, and heightened use of immunosuppressive medications. Diagnosing IFI remains challenging, and the integration of biomarker assays into clinical practice is difficult. Antifungal resistance, exemplified by pan-antifungal-resistant Candida auris cases, adds complexity to treatment. This study aims to provide a concise overview of the diagnostic and treatment landscape for IFI in Germany, identifying areas for improvement and paving the way for targeted interventions. Methods Data were collected using an online electronic case report form from October 2021 to February 2023. The survey included questions about institutional practices related to fungal infection diagnosis and treatment, with invitations extended to researchers nationwide. Results The study surveyed 58 hospitals across Germany. Notably, 77.6% managed high-risk patients for IFI. While 86% had onsite microbiology labs, a significant difference was noted for high-risk patients (93% in specialized hospitals versus 62% in others). Microscopy services had 96% coverage, while overall access to culture was 96%. Antigen tests had 96% coverage, and antibody access was reported at 98%. PCR testing was available at 98%. Imaging access showed no significant access differences. Variability existed in amphotericin B formulations based on patient profiles. Therapeutic drug monitoring was more common in high-risk patient institutions (89.5% versus 50.0%). All analysed institutions reported access to surgery (100%). Conclusions Addressing identified disparities in diagnostic and therapeutic resources for IFI is crucial to improving patient outcomes. The study calls for ongoing research and collaboration to optimize strategies for the prevention and treatment of IFI, emphasizing the importance of equitable access to resources, especially in high-risk patient populations.
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Affiliation(s)
- Jon Salmanton-García
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, University Hospital Cologne, Institute of Translational Research, Herderstraße 52, 50931 Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Michaela Simon
- Institute for Medical Microbiology, Immunology, and Hygiene, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Andreas H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, Children’s University Hospital Münster, Münster, Germany
| | - Oliver Kurzai
- National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Jena, Germany
| | - Tobias Lahmer
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, Munich, Germany
| | - Thomas Lehrnbecher
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria Schroeder
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, University Hospital Cologne, Institute of Translational Research, Herderstraße 52, 50931 Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Jannik Stemler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, University Hospital Cologne, Institute of Translational Research, Herderstraße 52, 50931 Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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11
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Kriegl L, Hatzl S, Schilcher G, Zollner-Schwetz I, Boyer J, Geiger C, Hoenigl M, Krause R. Antifungals in Patients With Extracorporeal Membrane Oxygenation: Clinical Implications. Open Forum Infect Dis 2024; 11:ofae270. [PMID: 38887481 PMCID: PMC11181180 DOI: 10.1093/ofid/ofae270] [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: 12/31/2023] [Accepted: 05/05/2024] [Indexed: 06/20/2024] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique used in critical care medicine for patients with severe respiratory or cardiac failure. This review examines the treatment and prophylaxis of fungal infections in ECMO patients, proposing specific regimens based on available data for different antifungals (azoles, echinocandins, amphotericin B/liposomal amphotericin B) and invasive fungal infections. Currently, isavuconazole and posaconazole have the most supported data, while modified dosages of isavuconazole are recommended in ECMO. Echinocandins are preferred for invasive candidiasis. However, choosing echinocandins is challenging due to limited and varied data on concentration loss in the ECMO circuit. Caution is likewise advised when using liposomal amphotericin B due to uncertain concentrations and potential ECMO dysfunction based on scarce data. We further conclude with the importance of further research on the impact of ECMO on antifungal drug concentrations to optimize dosing regimens in critically ill patients.
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Affiliation(s)
- Lisa Kriegl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Stefan Hatzl
- BioTechMed-Graz, Graz, Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Ines Zollner-Schwetz
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Boyer
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christina Geiger
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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12
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Sousa YV, Santiago MG, de Souza BM, Keller KM, Oliveira CSF, Mendoza L, Vilela RVR, Goulart GAC. Itraconazole in human medicine and veterinary practice. J Mycol Med 2024; 34:101473. [PMID: 38493607 DOI: 10.1016/j.mycmed.2024.101473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/03/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
Diagnosis and management of fungal infections are challenging in both animals and humans, especially in immunologically weakened hosts. Due to its broad spectrum and safety profile when compared to other antifungals, itraconazole (ITZ) has been widely used in the treatment and prophylaxis of fungal infections, both in human and veterinary medicine. The dose and duration of management depend on factors such as the type of fungal pathogen, the site of infection, sensitivity to ITZ, chronic stages of the disease, the health status of the hosts, pharmacological interactions with other medications and the therapeutic protocol used. In veterinary practice, ITZ doses generally vary between 3 mg/kg and 50 mg/kg, once or twice a day. In humans, doses usually vary between 100 and 400 mg/day. As human and veterinary fungal infections are increasingly associated, and ITZ is one of the main medications used, this review addresses relevant aspects related to the use of this drug in both clinics, including case reports and different clinical aspects available in the literature.
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Affiliation(s)
- Yamara V Sousa
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av Antônio Carlos, 6627, Belo Horizonte, MG 31270-901, Brazil
| | - Marie G Santiago
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av Antônio Carlos, 6627, Belo Horizonte, MG 31270-901, Brazil
| | - Bianca M de Souza
- Department of Preventive Veterinary Medicine, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Kelly M Keller
- Department of Preventive Veterinary Medicine, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Camila S F Oliveira
- Department of Preventive Veterinary Medicine, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Leonel Mendoza
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI 48824, United States
| | - Raquel V R Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, MI 48824, United States; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil
| | - Gisele A C Goulart
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av Antônio Carlos, 6627, Belo Horizonte, MG 31270-901, Brazil.
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13
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Zuniga-Moya JC, Papadopoulos B, Mansoor AER, Mazi PB, Rauseo AM, Spec A. Incidence and Mortality of COVID-19-Associated Invasive Fungal Infections Among Critically Ill Intubated Patients: A Multicenter Retrospective Cohort Analysis. Open Forum Infect Dis 2024; 11:ofae108. [PMID: 38567199 PMCID: PMC10986750 DOI: 10.1093/ofid/ofae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Background An association between coronavirus disease 2019 (COVID-19)-associated invasive fungal infections (CAIFIs) and high mortality among intubated patients has been suggested in previous research. However, some of the current evidence was derived from small case series and multicenter studies conducted during different waves of the COVID-19 pandemic. We examined the incidence of CAIFIs and their associated mortality using a large, multicenter COVID-19 database built throughout the pandemic. Methods We conducted a retrospective analysis of the National COVID Cohort Collaborative (N3C) database collected from 76 medical centers in the United States between January 2020 and August 2022. Patients were 18 years or older and intubated after severe acute respiratory syndrome coronavirus 2 infection. The primary outcomes were incidence and all-cause mortality at 90 days. To assess all-cause mortality, we fitted Cox proportional hazard models after adjusting for confounders via inverse probability weighting. Results Out of the 4 916 229 patients with COVID-19 diagnosed during the study period, 68 383 (1.4%) met our cohort definition. The overall incidence of CAIFI was 2.80% (n = 1934/68 383). Aspergillus (48.2%; n = 933/1934) and Candida (41.0%; n = 793/1934) were the most common causative organisms. The incidence of CAIFIs associated with Aspergillus among patients who underwent BAL was 6.2% (n = 83/1328). Following inverse probability weighting, CAIFIs caused by Aspergillus (hazard ratio [HR], 2.0; 95% CI, 1.8-2.2) and Candida (HR, 1.7; 95% CI, 1.5-1.9) were associated with increased all-cause mortality. Systemic antifungals reduced mortality in 17% of patients with CAIFI with Aspergillus and 24% of patients with CAIFI with Candida. Conclusions The incidence of CAIFI was modest but associated with higher 90-day all-cause mortality among intubated patients. Systemic antifungals modified mortality.
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Affiliation(s)
| | | | | | - Patrick B Mazi
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
| | - Adriana M Rauseo
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
| | - Andrej Spec
- St Louis School of Medicine, Washington University, St Louis, Missouri, USA
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14
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Cavassin FB, Magri MMC, Vidal JE, de Moraes Costa Carlesse FA, Falci DR, Baú-Carneiro JL, Breda GL, de Araújo Motta F, de Miranda Godoy CS, de Bastos Ascenço Soares R, De Oliveira CS, Mendes AVA, Morales HP, Montes PS, Taborda M, Rego CM, Félix MA, Katopodis PP, da Silva do Ó JR, Abrão MPL, Pereira TTT, Queiroz-Telles F. Effectiveness, Tolerability, and Safety of Different Amphotericin B Formulations in Invasive Fungal Infections: A Multicenter, Retrospective, Observational Study. Clin Ther 2024; 46:322-337. [PMID: 38403508 DOI: 10.1016/j.clinthera.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Data on the real-life use of amphotericin B lipid complex (ABLC) compared with other available formulations are limited. This study aimed to evaluate the effectiveness, tolerability, and safety of different amphotericin B (AMB) intravenously administered in the context of hospital practice for the treatment of invasive fungal infections (IFI) and to provide new insights into the profile of ABLC. METHODS This is a multicenter, retrospective, observational study conducted at 10 tertiary Brazilian hospitals. Patients first exposed to any formulation of AMB for treating endemic and opportunistic IFI who had received at least 2 intravenous doses were screened. Retrospective data (from January 2014 to December 2019) were extracted from the patients' medical records. Clinical parameters were examined pre- and post-treatment to determine effectiveness; acute infusion-related side effects (IRSE) and drug interruption to determine tolerability; and adverse events, toxicity, and treatment interruption were stated to analyze safety. FINDINGS Overall, 1879 medical records of patients were identified. The median (interquartile rate) duration of treatment was 14 (7-21) days. The overall success rate (95% confidence interval [CI]) was 65% (95% CI 60-65). ABLC proved to be effective among AMB formulations with 59% (95% CI 55.6-62.5) within complete response. This was significantly higher in patients who received the drug for a longer period, ≥4 weeks compared to <1 week treatment (P < 0.001). IRSE was observed in 446 (23.7%) patients. Eight cases (1.4%) of severe IRSE in pediatrics and 14 (1.1%) in adults resulted in treatment discontinuation. Regarding safety, 637 (33.9%) patients presented some alteration in creatinine levels during AMB exposure, and 89 (4.74%) had to interrupt or discontinue the drug within the first 14 days of therapy because of renal dysfunction. Overall mortality was 34%. IMPLICATIONS ABLC is an effective formulation for the treatment of invasive fungal infections, with few adverse events leading to drug discontinuation or lethal outcomes. Furthermore, this real-life study confirmed the comparative safety of AMB lipid formulations versus AMB deoxycholate.
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Affiliation(s)
| | | | | | | | | | | | - Giovanni Luís Breda
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, Brazil
| | | | | | | | | | | | | | - Patrícia Silva Montes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FAMUSP), São Paulo, Brazil
| | - Mariane Taborda
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FAMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | - Flávio Queiroz-Telles
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, Brazil
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Salmanton-García J, Koehler P, Grothe JH, Mellinghoff SC, Sal E, Simon M, Stemler J, Cornely OA, Sprute R. The Cologne ECMM Excellence Center: A Two-Year Analysis of External Consultation Service for Invasive Fungal Infections. Mycopathologia 2024; 189:25. [PMID: 38466469 PMCID: PMC10927858 DOI: 10.1007/s11046-023-00822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/11/2023] [Indexed: 03/13/2024]
Abstract
The European Confederation of Medical Mycology (ECMM), formed due to the surge in invasive fungal infections (IFI), initiated the Excellence Centers program in 2016 to guide stakeholders to leading medical mycology sites. This report focuses on the Cologne ECMM Excellence Center, recognized with Diamond status for active global involvement in 2017. The center offers free consultation via email and phone, responding within 24 h for life-threatening IFI, collecting data on origin, pathogens, infection details, and more. Over two years, 189 requests were received globally, predominantly from Germany (85%), mainly involving Aspergillus spp., Mucorales, and Candida spp. Fungal mixed infections occurred in 4% of cases. The center's service effectively addresses IFI challenges, advocating for a comprehensive study encompassing all ECMM Excellence Centers to enhance global mycological care. Proactive expansion of consultancy platforms is crucial, with future analyses needed to assess expert advice's impact on patient outcomes.
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Affiliation(s)
- Jon Salmanton-García
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Philipp Koehler
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jan-Hendrik Grothe
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - Sibylle C Mellinghoff
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Ertan Sal
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - Michaela Simon
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - Jannik Stemler
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany.
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany.
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Herderstraße 52, 50931, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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Qiang L, Deng X, Yang Y, Wang Z, Gai W. Disseminated Histoplasmosis Infection Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report. Infect Drug Resist 2024; 17:865-873. [PMID: 38468846 PMCID: PMC10926916 DOI: 10.2147/idr.s451564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/25/2024] [Indexed: 03/13/2024] Open
Abstract
Histoplasmosis is an endemic disease caused by Histoplasma capsulatum. This systemic disease can affect various organs beyond the lungs, such as the liver, spleen, adrenal gland, and lymph nodes. The clinical symptoms can range from asymptomatic to severe, life-threatening conditions, depending on the state of the patient's immune system. This report describes a 40-year-old male who presented with reports of weight loss, low back pain, and progressively worsening movement disorder of the bilateral lower extremities for months. Computed tomography (CT) examination showed multiple lytic lesions of vertebral bodies, bilateral ribs, and pelvic bone, histopathological examination and tumor-related serum markers exclude tumors. mNGS was employed to identify H. capsulatum var. capsulatum as the etiological agent of the lesions in the bone biopsy. Through phylogenetic tree analysis, Histoplasma capsulatum var. Capsulatum (Hcc) was the main responsible pathogen, rarely reported in bone lesions. The patient underwent spinal surgery and was successfully treated with liposomal amphotericin B and itraconazole. Based on the diagnosis and treatment of this case, we discuss the epidemiologic status, clinical presentations, diagnostic criteria, and treatment guidelines of histoplasmosis to provide additional information about this disease. mNGS is utilized in this case, and it appears to be a reliable method for early and accurate diagnosis of this disease.
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Affiliation(s)
- Lei Qiang
- Department of Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People’s Republic of China
| | - Xianghui Deng
- Department of Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People’s Republic of China
| | - Yong Yang
- Department of Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People’s Republic of China
| | - Zhigan Wang
- Department of Pathology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People’s Republic of China
| | - Wei Gai
- WillingMed Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China
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Spec A, Thompson GR, Miceli MH, Hayes J, Proia L, McKinsey D, Arauz AB, Mullane K, Young JA, McGwin G, McMullen R, Plumley T, Moore MK, McDowell LA, Jones C, Pappas PG. MSG-15: Super-Bioavailability Itraconazole Versus Conventional Itraconazole in the Treatment of Endemic Mycoses-A Multicenter, Open-Label, Randomized Comparative Trial. Open Forum Infect Dis 2024; 11:ofae010. [PMID: 38440302 PMCID: PMC10911225 DOI: 10.1093/ofid/ofae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 03/06/2024] Open
Abstract
Background Invasive fungal disease caused by dimorphic fungi is associated with significant morbidity and mortality. Super-bioavailability itraconazole (SUBA-itra) is a novel antifungal agent with pharmacokinetic advantages over currently available formulations. In this prospective comparative study, we report the outcomes of patients with endemic fungal infections (histoplasmosis, blastomycosis, coccidioidomycosis, and sporotrichosis). Methods This open-label randomized trial evaluated the efficacy, safety, and pharmacokinetics SUBA-itra compared with conventional itraconazole (c-itra) treatment for endemic fungal infections. An independent data review committee determined responses on treatment days 42 and 180. Results Eighty-eight patients were enrolled for IFD (SUBA-itra, n = 42; c-itra, n = 46) caused by Histoplasma (n = 51), Blastomyces (n = 18), Coccidioides (n = 13), or Sporothrix (n = 6). On day 42, clinical success was observed with SUBA-itra and c-itra on day 42 (in 69% and 67%, respectively, and on day 180 (in 60% and 65%). Patients treated with SUBA-itra exhibited less drug-level variability at days 7 (P = .03) and 14 (P = .06) of randomized treatment. The concentrations of itraconazole and hydroxyitraconazole were comparable between the 2 medications (P = .77 and P = .80, respectively). There was a trend for fewer adverse events (AEs; 74% vs 87%, respectively; P = .18) and serious AEs (10% vs 26%; P = .06) in the SUBA-itra-treated patients than in those receiving c-itra. Serious treatment-emergent AEs were less common in SUBA-itra-treated patients (12% vs 50%, respectively; P < .001). Conclusions SUBA-itra was bioequivalent, well tolerated, and efficacious in treating endemic fungi, with a more favorable safety profile than c-itra. Clinical Trials Registration NCT03572049.
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Affiliation(s)
- Andrej Spec
- Division of Infectious Disease, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, University of California Davis Medical Center, Sacramento, California, USA
| | - Marisa H Miceli
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan, Ann Arbor, Michigan, USA
| | - Justin Hayes
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Laurie Proia
- Department of Medicine, Rochester Regional Health, Rochester, New York, USA
| | - David McKinsey
- Metro Infectious Disease Consultants, Kansas City, Missouri, USA
| | - Ana Belen Arauz
- Department of Medicine, University of Panama and Hospital Santo Tomas, Panama City, Panama
| | - Kathleen Mullane
- Department of Medicine/Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
| | - Jo-Ann Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Adult Transplant Infectious Disease, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gerald McGwin
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rachel McMullen
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Mycoses Study Group Education and Research Consortium, Birmingham, Alabama, USA
| | - Tyler Plumley
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mary K Moore
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Carolynn Jones
- College of Nursing, The Ohio State University College of Nursing, Columbus, Ohio, USA
- Mycoses Study Group Education and Research Consortium, Birmingham, Alabama, USA
| | - Peter G Pappas
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Mycoses Study Group Education and Research Consortium, Birmingham, Alabama, USA
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18
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Fernandez NB, Spruijtenburg B, Tiraboschi IN, Meis JF, Lugo A, López Joffre MC, Meijer EF. Genotyping and clonal origin of Sporothrix brasiliensis in human sporotrichosis cases in Argentina. Med Mycol Case Rep 2024; 43:100633. [PMID: 38420181 PMCID: PMC10899009 DOI: 10.1016/j.mmcr.2024.100633] [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: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
Sporothrix brasiliensis is considered a highly virulent emerging pathogen that causes sporotrichosis in humans, mainly after zoonotic transmission from infected cats. The epidemic of this zoonosis that originated from Brazil has spread in the last decades, generating hyperendemic regions in Latin America. We present two cases of human sporotrichosis causes by S. brasiliensis in Buenos Aires, Argentina, with good clinical response to differing treatments after contact with sick cats. Using Short tandem repeat (STR) genotyping, the two S. brasiliensis cases appear to be introduced from Brazil and likely originate from the same source.
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Affiliation(s)
- Norma B. Fernandez
- Sección Micología, División Infectología, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Av. Córdoba 2351, Ciudad Autónoma de Buenos Aires, C1121ABJ, Argentina
| | - Bram Spruijtenburg
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, Nijmegen, the Netherlands
| | - Iris N. Tiraboschi
- División Infectología, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Av. Córdoba 2351, Ciudad Autónoma de Buenos Aires, C1121ABJ, Argentina
| | - Jacques F. Meis
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Ana Lugo
- División Infectología, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Av. Córdoba 2351, Ciudad Autónoma de Buenos Aires, C1121ABJ, Argentina
| | - María Cecilia López Joffre
- Departamento Micología, Instituto Nacional de Enfermedades Infecciosas INEI-ANLIS “Dr. Carlos G. Malbrán” Av. VélezSarsfield563, Ciudad Autónoma de Buenos Aires, C1282AFF, Argentina
| | - Eelco F.J. Meijer
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
- Canisius-Wilhelmina Hospital (CWZ)/Dicoon, Nijmegen, the Netherlands
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19
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Gudisa R, Harchand R, Rudramurthy SM. Nucleic-Acid-Based Molecular Fungal Diagnostics: A Way to a Better Future. Diagnostics (Basel) 2024; 14:520. [PMID: 38472992 DOI: 10.3390/diagnostics14050520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The world has seen a tremendous increase in the number of fungal infections during the past two decades. Recently, the World Health Organisation released the pathogen priority list for fungal infections, signifying the importance of these infections in the fields of research and public health. Microbiology laboratories demand an upgrade in the diagnostic system to keep up with the increased burden of these infections. Diagnosis of fungal infections using conventional techniques has always faced limitations in terms of specificity, sensitivity, and turnaround time. Although these methods are the core pillars of the diagnosis, there is an increased need for molecular approaches. Molecular techniques have revolutionised the field of fungal diagnostics. The diverse array of molecular techniques, including techniques like Polymerase Chain Reaction (PCR), have emerged as a cornerstone in fungal diagnostics. Molecular techniques have transformed fungal diagnostics, providing powerful tools for the rapid and accurate identification of pathogens. As these technologies continue to evolve, their integration into routine clinical practice holds the promise of improving patient outcomes through timely and targeted antifungal interventions. This review will cover the molecular approaches involved in fungal diagnostics, moving from the basic techniques to the advanced-level nucleic-acid-based molecular approaches providing a high throughput and decreased turnaround time for the diagnosis of serious fungal infections.
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Affiliation(s)
- Rajendra Gudisa
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ritika Harchand
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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20
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de Oliveira VF, Petrucci JF, Taborda M, Brener PZ, Kremer PGDBB, Randi BA, Magri ASGK, Magri MMC, Levin AS, Silva GD. Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta-analysis. Mycoses 2024; 67:e13697. [PMID: 38374494 DOI: 10.1111/myc.13697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The clinical features of central nervous system (CNS) sporotrichosis are derived from case reports and a limited series of cases. Our objective was to carry out a systematic review and meta-analysis of CNS sporotrichosis. METHODS We searched PubMed/MEDLINE, Embase, Scopus, and LILACS on 9 September 2023. Our inclusion criteria were documentation of Sporothrix and demonstrated CNS involvement. A metaproportion or metamean analysis was performed to estimate a summary proportion with 95% confidence intervals. RESULTS We included 52 cases of CNS sporotrichosis published from 1966 to 2023. Forty-six patients were male (88%, 95% CI: 77-95), and the mean age was 39 years (95% CI: 36-43). Close contact with cats was reported in 55% of cases (95% CI: 37-72). Thirty-two (61.5%) patients were from Brazil, 18 patients from the United State of America (34.6%). Only two Sporothrix species were reported: S. schenckii (26/41, 63%), and S. brasiliensis (15/41, 37%). The most common neurological symptom was headache. Meningitis was chronic in approximately 80% of cases. A significant majority of the patients were immunocompromised. HIV infection was the primary cause of immunosuppression (85%, 95% CI: 61-95). Overall mortality was 56% (22/39). The comparison of Kaplan-Meier survival curve showed a higher mortality with a statistically significant difference in immunosuppressed patients (p = .019). CONCLUSION CNS sporotrichosis represents a notable cause of chronic meningitis, especially in individuals living in the Americas with HIV infection and concurrent skin lesions.
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Affiliation(s)
- Vítor Falcão de Oliveira
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Júlia Figueiredo Petrucci
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mariane Taborda
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Bruno Azevedo Randi
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Satie Gonçalves Kono Magri
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcello Mihailenko Chaves Magri
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Diogo Silva
- Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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21
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Heidari A, Kaur S, Pearson SJ, Munoz A, Sandhu H, Mann G, Schivo M, Zeki AA, Bays DJ, Wilson M, Albertson TE, Johnson R, Thompson GR. Hypoxemic Respiratory Failure and Coccidioidomycosis-Associated Acute Respiratory Distress Syndrome. Open Forum Infect Dis 2024; 11:ofad679. [PMID: 38370292 PMCID: PMC10873137 DOI: 10.1093/ofid/ofad679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Background Severe coccidioidomycosis presenting with respiratory failure is an uncommon manifestation of disease. Current knowledge of this condition is limited to case reports and small case series. Methods A retrospective multicenter review of patients with coccidioidomycosis-associated acute respiratory distress syndrome (CA-ARDS) was conducted. It assessed clinical and laboratory variables at the time of presentation, reviewed the treatment course, and compared this cohort with a national database of patients with noncoccidioidomycosis ARDS. Survivors and nonsurvivors of coccidioidomycosis were also compared to determine prognostic factors. Results In this study, CA-ARDS (n = 54) was most common in males, those of Hispanic ethnicity, and those with concurrent diabetes mellitus. As compared with the PETAL network database (Prevention and Early Treatment of Acute Lung Injury; n = 1006), patients with coccidioidomycosis were younger, had fewer comorbid conditions, and were less acidemic. The 90-day mortality was 15.4% for patients with coccidioidomycosis, as opposed to 42.6% (P < .0001) for patients with noncoccidioidomycosis ARDS. Patients with coccidioidomycosis who died, as compared with those who survived, were older, had higher APACHE II scores (Acute Physiology and Chronic Health Evaluation), and did not receive corticosteroid therapy. Conclusions CA-ARDS is an uncommon but morbid manifestation of infection. When compared with a national database, the overall mortality appears favorable vs other causes of ARDS. Patients with CA-ARDS had a low overall mortality but required prolonged antifungal therapy. The utility of corticosteroids in this condition remains unconfirmed.
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Affiliation(s)
- Arash Heidari
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Bakersfield, California, USA
- Dignity Health, Bakersfield Memorial Hospital, Bakersfield, California, USA
- Valley Fever Institute, Bakersfield, California, USA
| | - Simmer Kaur
- Valley Fever Institute, Bakersfield, California, USA
- Division of Infectious Diseases, Department of Internal Medicine, Kern Medical, Bakersfield, California, USA
| | - Skyler J Pearson
- University of California–Davis Medical Center, Sacramento, CA, USA
| | - Augustine Munoz
- Valley Fever Institute, Bakersfield, California, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kern Medical, Bakersfield, California, USA
| | - Harleen Sandhu
- Division of Infectious Diseases, Department of Internal Medicine, Kern Medical, Bakersfield, California, USA
| | - Gursimran Mann
- University of California–Davis Medical Center, Sacramento, CA, USA
| | - Michael Schivo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UC Davis Lung Center, University of California Davis Medical Center, Sacramento, CA, USA
| | - Amir A Zeki
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UC Davis Lung Center, University of California Davis Medical Center, Sacramento, CA, USA
| | - Derek J Bays
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Machelle Wilson
- Department of Public Health Sciences, University of California–Davis, Davis, California, USA
| | - Timothy E Albertson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UC Davis Lung Center, University of California Davis Medical Center, Sacramento, CA, USA
| | - Royce Johnson
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Bakersfield, California, USA
- Valley Fever Institute, Bakersfield, California, USA
- Division of Infectious Diseases, Department of Internal Medicine, Kern Medical, Bakersfield, California, USA
| | - George R Thompson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, UC Davis Lung Center, University of California Davis Medical Center, Sacramento, CA, USA
- Department of Medical Microbiology and Immunology, University of California–Davis Medical Center, Davis, California, USA
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22
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Bryan AW, Sykes J, Crucillo K, Zhang K, Bays DJ, Cohen SH, Wilson MD, Thompson GR. Comparison of coccidioidal complement fixation and quantitative immunodiffusion serology at a reference laboratory. Med Mycol 2024; 62:myad121. [PMID: 38061838 DOI: 10.1093/mmy/myad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
The incidence of coccidioidomycosis continues to increase. The diagnosis frequently relies on non-invasive diagnostic testing with immunodiffusion and complement fixation (CF) testing the current gold standard. A direct comparison of quantitative immunodiffusion and CF for IgG antibodies has not been previously reported. In a comparison of 368 samples, there was close concordance observed (360/368 = 97.8%) (P-value < .001). These tests can be considerably interchangeable in the reference laboratory setting.
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Affiliation(s)
- Allen W Bryan
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Jane Sykes
- University of California, Davis, School of Veterinary Medicine, Davis, CA, USA
| | - Kelly Crucillo
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Kaihua Zhang
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Derek J Bays
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
| | - Stuart H Cohen
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
| | - Machelle D Wilson
- University of California, Davis, Department of Public Health Sciences, Division of Biostatistics, Clinical and Translational Science Center, Sacramento, CA, USA
| | - George R Thompson
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
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23
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Wilson MJ, Harding I, Borman AM, Johnson E, Miller R. Pulmonary endemic mycoses. Clin Med (Lond) 2024; 24:100014. [PMID: 38382182 PMCID: PMC11024832 DOI: 10.1016/j.clinme.2024.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
While rare, the likelihood of encountering a case of a pulmonary endemic mycosis (PEM) in the UK is increasing. Diagnosis may be challenging, often leading to considerable delay to appropriate treatment. Clinical suspicion must be present for respiratory disease, particularly in the immunocompromised or in those not responding to empiric treatment approaches, and an extended travel history should be obtained. This article summarises the epidemiology of PEM, key clinical features, diagnostic strategies and management.
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Affiliation(s)
- Michael J Wilson
- SpR in infectious diseases and microbiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Irasha Harding
- consultant microbiologist, National Infection Service, Bristol, UK
| | - Andrew M Borman
- deputy director, UKHSA National Mycology Reference Laboratory, Bristol, UK; honorary professor of medical mycology, University of Exeter, Exeter, UK
| | - Elizabeth Johnson
- honorary professor of medical mycology, University of Exeter, Exeter, UK; director, UKHSA National Mycology Reference Laboratory, Bristol, UK
| | - Robert Miller
- Associate Professor of Clinical Infection, Institute for Global Health, University College London
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24
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Höft MA, Duvenage L, Salie S, Keeton R, Botha A, Schwartz IS, Govender NP, Brown GD, Hoving JC. The pathogenesis of experimental Emergomycosis in mice. PLoS Negl Trop Dis 2024; 18:e0011850. [PMID: 38198478 PMCID: PMC10805315 DOI: 10.1371/journal.pntd.0011850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/23/2024] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Emergomyces africanus is a recently identified thermally-dimorphic fungal pathogen that causes disseminated infection in people living with advanced HIV disease. Known as emergomycosis, this disseminated disease is associated with very high case fatality rates. Over the last decade, improved diagnostics and fungal identification in South Africa resulted in a dramatic increase in the number of reported cases. Although the true burden of disease is still unknown, emergomycosis is among the most frequently diagnosed dimorphic fungal infections in Southern Africa; and additional species in the genus have been identified on four continents. Little is known about the pathogenesis and the host's immune response to this emerging pathogen. Therefore, we established a murine model of pulmonary infection using a clinical isolate, E. africanus (CBS 136260). Both conidia and yeast forms caused pulmonary and disseminated infection in mice with organisms isolated in culture from lung, spleen, liver, and kidney. Wild-type C57BL/6 mice demonstrated a drop in body weight at two weeks post-infection, corresponding to a peak in fungal burden in the lung, spleen, liver, and kidney. An increase in pro-inflammatory cytokine production was detected in homogenized lung supernatants including IFN-γ, IL-1β, IL-6, IL12-p40 and IL-17 at three- and four-weeks post-infection. No significant differences in TNF, IL-12p70 and IL-10 were observed in wild-type mice between one and four-weeks post-infection. Rag-1-deficient mice, lacking mature T-and B-cells, had an increased fungal burden associated with reduced IFN-γ production. Together our data support a protective T-helper type-1 immune response to E. africanus infection. This may provide a possible explanation for the susceptibility of only a subset of people living with advanced HIV disease despite hypothesized widespread environmental exposure. In summary, we have established a novel murine model of E. africanus disease providing critical insights into the host immune components required for eliminating the infection.
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Affiliation(s)
- Maxine A. Höft
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucian Duvenage
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sumayah Salie
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roanne Keeton
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Stellenbosch, South Africa
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nelesh P. Govender
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
| | - Gordon D. Brown
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
| | - Jennifer Claire Hoving
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
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25
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Bombassaro A, Figueiredo JM, Taborda CP, Joosten LAB, Vicente VA, Queiroz-Telles F, Meis JF, Kischkel B. Skin innate immune response against fungal infections and the potential role of trained immunity. Mycoses 2024; 67. [PMID: 38282360 DOI: 10.1111/myc.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/30/2024]
Abstract
Fungal skin infections are distributed worldwide and can be associated with economic and social traits. The immune response related to skin cells is complex and its understanding is essential to the comprehension of each cell's role and the discovery of treatment alternatives. The first studies of trained immunity (TI) described the ability of monocytes, macrophages and natural killer (NK) cells to develop a memory-like response. However, the duration of TI does not reflect the shorter lifespan of these cells. These conclusions supported later studies showing that TI can be observed in stem and haematopoietic cells and, more recently, also in non-immune skin cells such as fibroblasts, highlighting the importance of resident cells in response to skin disorders. Besides, the participation of less studied proinflammatory cytokines in the skin immune response, such as IL-36γ, shed light into a new possibility of inflammatory pathway blockade by drugs. In this review, we will discuss the skin immune response associated with fungal infections, the role of TI in skin and clinical evidence supporting opportunities and challenges of TI and other inflammatory responses in the pathogenesis of fungal skin infections.
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Affiliation(s)
- Amanda Bombassaro
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Julia Marcondes Figueiredo
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Carlos P Taborda
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Department of Dermatology, LIM53, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vania A Vicente
- Program in Microbiology, Parasitology and Pathology, Biological Sciences, Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
- Engineering Bioprocess and Biotechnology Post-graduation Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, Brazil
| | - Flavio Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Engineering Bioprocess and Biotechnology Post-graduation Program, Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, Brazil
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Brenda Kischkel
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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26
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Nzimande SP, Govender NP, Maphanga TG. In vitro manogepix susceptibility testing of South African Emergomyces africanus, Emergomyces pasteurianus, and Blastomyces emzantsi clinical isolates. Antimicrob Agents Chemother 2023; 67:e0110423. [PMID: 37971237 PMCID: PMC10720492 DOI: 10.1128/aac.01104-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023] Open
Abstract
We performed in vitro antifungal susceptibility testing of manogepix against the yeast phase of 78 Emergomyces africanus, 2 Emergomyces pasteurianus, and 5 Blastomyces emzantsi isolates using a reference broth microdilution method following Clinical and Laboratory Standards Institute recommendations. All three pathogens had low minimum inhibitory concentrations ranging from <0.0005 to 0.008 mg/L. Manogepix should be investigated in animal models and potentially in future human clinical trials for endemic mycoses.
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Affiliation(s)
- Silondiwe P. Nzimande
- National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nelesh P. Govender
- National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tsidiso G. Maphanga
- National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service, Johannesburg, South Africa
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27
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Puerta-Arias JD, Isaza Agudelo JP, Naranjo Preciado TW. Identification and production of novel potential pathogen-specific biomarkers for diagnosis of histoplasmosis. Microbiol Spectr 2023; 11:e0093923. [PMID: 37882565 PMCID: PMC10714873 DOI: 10.1128/spectrum.00939-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
IMPORTANCE Histoplasmosis is considered one of the most important mycoses due to the increasing number of individuals susceptible to develop severe clinical forms, particularly those with HIV/AIDS or receiving immunosuppressive biological therapies, the high mortality rates reported when antifungal treatment is not initiated in a timely manner, and the limitations of conventional diagnostic methods. In this context, there is a clear need to improve the capacity of diagnostic tools to specifically detect the fungal pathogen, regardless of the patient's clinical condition or the presence of other co-infections. The proposed novel pathogen-specific biomarkers have the potential to be used in immunodiagnostic platforms and antifungal treatment monitoring in histoplasmosis. In addition, the bioinformatics strategy used in this study could be applied to identify potential diagnostic biomarkers in other models of fungal infection of public health importance.
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Affiliation(s)
- Juan David Puerta-Arias
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB-UdeA-UPB-UDES), Medellín, Colombia
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
- Universidad de Santander (UDES), Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Colombia
| | | | - Tonny Williams Naranjo Preciado
- Medical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB-UdeA-UPB-UDES), Medellín, Colombia
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
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28
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Elalouf A, Elalouf H, Rosenfeld A. Modulatory immune responses in fungal infection associated with organ transplant - advancements, management, and challenges. Front Immunol 2023; 14:1292625. [PMID: 38143753 PMCID: PMC10748506 DOI: 10.3389/fimmu.2023.1292625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Organ transplantation stands as a pivotal achievement in modern medicine, offering hope to individuals with end-stage organ diseases. Advancements in immunology led to improved organ transplant survival through the development of immunosuppressants, but this heightened susceptibility to fungal infections with nonspecific symptoms in recipients. This review aims to establish an intricate balance between immune responses and fungal infections in organ transplant recipients. It explores the fundamental immune mechanisms, recent advances in immune response dynamics, and strategies for immune modulation, encompassing responses to fungal infections, immunomodulatory approaches, diagnostics, treatment challenges, and management. Early diagnosis of fungal infections in transplant patients is emphasized with the understanding that innate immune responses could potentially reduce immunosuppression and promise efficient and safe immuno-modulating treatments. Advances in fungal research and genetic influences on immune-fungal interactions are underscored, as well as the potential of single-cell technologies integrated with machine learning for biomarker discovery. This review provides a snapshot of the complex interplay between immune responses and fungal infections in organ transplantation and underscores key research directions.
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Affiliation(s)
- Amir Elalouf
- Department of Management, Bar-Ilan University, Ramat Gan, Israel
| | - Hadas Elalouf
- Information Science Department, Bar-Ilan University, Ramat Gan, Israel
| | - Ariel Rosenfeld
- Information Science Department, Bar-Ilan University, Ramat Gan, Israel
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29
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Bahr NC, Thompson GR. Endemic mycoses - are we making progress in management? Curr Opin Infect Dis 2023; 36:436-442. [PMID: 37755392 PMCID: PMC10840811 DOI: 10.1097/qco.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW The endemic fungi are a significant cause of morbidity and mortality in effected patients. The range of endemicity for these are expanding with infections observed outside of traditional locations. Enhanced diagnostic and treatment practices may significantly alter patient outcomes. RECENT FINDINGS Recently completed clinical trials have focused on an assessment of improving efficacy while minimizing patient toxicity. Practice changing trials have been completed in histoplasmosis showing the utility of a single up-front liposomal amphotericin B dose followed by standard itraconazole dosing. The recent evaluation of several antifungal options including isauvconazole in the treatment of coccidioidomycosis also show promise for additional therapeutic agents. A recently conducted trial has also shown the superiority of amphotericin B therapy over itraconazole in the treatment of talaromycosis. SUMMARY The increased range of endemic mycoses coupled with the growing immunocompromised patient population mandates continued investigation of improved diagnostic and therapeutic options. Advances in these areas have led to more rapid diagnosis and more efficacious antifungal therapy.
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Affiliation(s)
- Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, California, USA
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30
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Jenks JD, Prattes J, Wurster S, Sprute R, Seidel D, Oliverio M, Egger M, Del Rio C, Sati H, Cornely OA, Thompson GR, Kontoyiannis DP, Hoenigl M. Social determinants of health as drivers of fungal disease. EClinicalMedicine 2023; 66:102325. [PMID: 38053535 PMCID: PMC10694587 DOI: 10.1016/j.eclinm.2023.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Disparities in social determinants of health (SDOH) play a significant role in causing health inequities globally. The physical environment, including housing and workplace environment, can increase the prevalence and spread of fungal infections. A number of professions are associated with increased fungal infection risk and are associated with low pay, which may be linked to crowded and sub-optimal living conditions, exposure to fungal organisms, lack of access to quality health care, and risk for fungal infection. Those involved and displaced from areas of armed conflict have an increased risk of invasive fungal infections. Lastly, a number of fungal plant pathogens already threaten food security, which will become more problematic with global climate change. Taken together, disparities in SDOH are associated with increased risk for contracting fungal infections. More emphasis needs to be placed on systematic approaches to better understand the impact and reducing the health inequities associated with these disparities.
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Affiliation(s)
- Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, NC, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, United States of America
| | - Juergen Prattes
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Sebastian Wurster
- Division of Internal Medicine, Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, University of Texas, Houston, TX, United States of America
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Danila Seidel
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
| | - Matteo Oliverio
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Carlos Del Rio
- Emory Center for AIDS Research, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Hatim Sati
- Department of Global Coordination and Partnership on Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
| | - Oliver A. Cornely
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Koln), University of Cologne, Cologne, Germany
| | - George R. Thompson
- University of California Davis Center for Valley Fever, Sacramento, CA, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, United States of America
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, United States of America
| | - Dimitrios P. Kontoyiannis
- Division of Internal Medicine, Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, University of Texas, Houston, TX, United States of America
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
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31
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Salmanton-García J, Hoenigl M, Salzer HJF, Lackner M, Prattes J, Dichtl K, Winkler-Zamani M, Krause R, Stemler J, Lass-Flörl C, Cornely OA, Willinger B. The Austrian landscape of diagnostic capacity and access to treatment for invasive fungal infections. Mycoses 2023; 66:1056-1063. [PMID: 37592370 DOI: 10.1111/myc.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Immunosuppression after chemotherapy, stem cell transplantation or solid organ transplantation are the main risk factors for invasive fungal infections in Austria. Here, we aim to describe the status of laboratory mycology and the access to antifungal treatment in Austria. METHODS Between October and November 2021, hospitals were contacted to participate in our online survey: www.clinicalsurveys.net/uc/IFI_management_capacity/. Centres were required to provide information on their institutional profile; self-assessment of burden of invasive fungal infections; access to microscopy, culture, serology, antigen detection and molecular testing; and availability of antifungal agents and therapeutic drug monitoring. RESULTS Responses were collected from university hospitals and laboratories in Graz, Innsbruck, Linz and Vienna. The four hospitals can provide tertiary care and were highly specialised, including management of patients with severe immunosuppression. All sites consider the incidence of invasive fungal infections to be moderate. Access to microscopy, culture, serology, antigen detection and molecular testing is provided regardless of laboratory. The maximum capacity to identify fungi varies from institution to institution. All currently marketed antifungal agents are available at the four sites. CONCLUSION Austria is currently well equipped to deal with the emerging threat of invasive fungal infections. However, hospitals may consider preparing for the potential endemicity of certain infections in the near future.
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Affiliation(s)
- Jon Salmanton-García
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Martin Hoenigl
- Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz, Austria
- BioTechMed, Austria
| | - Helmut J F Salzer
- Department of Internal Medicine 4 - Pneumology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Michaela Lackner
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, European Confederation of Medical Mycology Excellence Centre in Fungal Infections, Innsbruck, Austria
| | - Juergen Prattes
- Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz, Austria
- BioTechMed, Austria
| | - Karl Dichtl
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Markus Winkler-Zamani
- Institute of Clinical Pathology and Molecular Pathology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - Robert Krause
- Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz, Austria
- BioTechMed, Austria
| | - Jannik Stemler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, European Confederation of Medical Mycology Excellence Centre in Fungal Infections, Innsbruck, Austria
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
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Gong D, Lin W, Zhang H, Ou X, Li L, Guo P, He Y, Liu C, Cai W, Tang X, Li L. An evaluation of Mp1p antigen screening for talaromycosis in HIV-infected antiretroviral therapy-naïve population in Guangdong, China. PLoS Negl Trop Dis 2023; 17:e0011785. [PMID: 38011216 PMCID: PMC10703259 DOI: 10.1371/journal.pntd.0011785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/07/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Talaromycosis is one of the most common opportunistic infections in human immunodeficiency virus (HIV) infected patients. However, few researches have explored the prevalence in Southern China and fully assessed the value of the Mp1p antigen screening for the diagnosis of talaromycosis. METHODOLOGY/PRINCIPAL FINDINGS We performed a cross-sectional study of HIV-infected antiretroviral therapy (ART)-naïve adult patients who were seen in 2018 at Guangzhou Eighth People's Hospital, Guangzhou Medical University. Serum samples collected from all the 784 enrolled patients were tested for Mp1p antigen using double-antibody sandwich enzyme-linked immunosorbent assay. A culture of pathogen was conducted in 350 clinically suspected patients to confirm talaromycosis. The overall prevalence of talaromycosis based on the Mp1p antigen detection was 11.4% (89/784) and peaked at 32.2% (75/233) in patients with CD4+ ≤50 Nr/μl. Logistic regression analysis found Mp1p antigen positive rate decreased with the increase in CD4+ counts (OR 0.982, 95% CI 0.977-0.987, P<0.01). The optimal cut-off point of the CD4+ count was 50 Nr/μl or less. Among the 350 patients received both fungal culture and Mp1p antigen detection, 95/350 (27.1%) patients were culture-positive for a Talaromyces marneffei, 75/350 (21.4%) patients were Mp1p antigen positive. The Mp1p antigen assay showed a good agreement to the culture of pathogen, and the sensitivity, specificity, positive predictive value, negative predictive value and kappa value was 71.6% (68/95), 97.3% (248/255), 90.7% (68/75), 90.2% (248/275), and 0.737, respectively. The screening accuracy of the Mp1p antigen assay in patients with CD4+ counts of ≤50 Nr/μl was superior to that in those with higher CD4+ counts. CONCLUSIONS/SIGNIFICANCE Mp1p antigen screening can be an effective tool for more efficient diagnosis of Talaromycosis, especially in HIV/AIDS patients with low CD4+ counts. Future validation studies are needed.
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Affiliation(s)
- Dandan Gong
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weiyin Lin
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huihua Zhang
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xu Ou
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liya Li
- Research Institute, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pengle Guo
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yaozu He
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Cong Liu
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weiping Cai
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoping Tang
- Research Institute, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
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Bongomin F, Ekeng BE, Kwizera R, Salmanton-García J, Kibone W, van Rhijn N, Govender NP, Meya DB, Osaigbovo II, Hamer DH, Oladele R, Denning DW. Fungal diseases in Africa: Closing the gaps in diagnosis and treatment through implementation research and advocacy. J Mycol Med 2023; 33:101438. [PMID: 38358796 PMCID: PMC11103624 DOI: 10.1016/j.mycmed.2023.101438] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 02/16/2024]
Abstract
Fungal diseases impose an escalating burden on public health in Africa, exacerbated by issues such as delayed diagnosis, inadequate therapy, and limited access to healthcare resources, resulting in significant morbidity and mortality. Effectively tackling these challenges demands a comprehensive approach encompassing research, training, and advocacy initiatives. Recent clinical mycology surveys conducted by Global Action for Fungal Infection (GAFFI) and the European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) have underscored gaps in fungal diagnostics and the availability and accessibility of antifungal therapy in Africa. The World Health Organization (WHO) Fungal Priority Pathogens List (FPPL) identifies fungi of critical or high importance to human health, providing a roadmap for action and highlighting the urgent need for prioritizing fungal diseases and developing targeted interventions within the African context. To enhance diagnosis and treatment, it is imperative to invest in comprehensive training programs for healthcare workers across all levels and disciplines. Equipping them with the necessary knowledge and skills will facilitate early detection, accurate diagnosis, and appropriate management of fungal infections. Moreover, implementation science research in medical mycology assumes a pivotal role in bridging the gap between knowledge and practice. By identifying the barriers and facilitators that influence the adoption of diagnostic techniques and public health interventions, tailored strategies can be formulated to improve their implementation within healthcare settings. Advocacy plays a critical role in raising awareness regarding the profound impact of fungal diseases on public health in Africa. Engaging policymakers, healthcare providers, researchers, industry experts and communities underscore the importance of addressing these diseases and galvanize efforts for change. Substantial investment in surveillance, research and development specifically focused on fungal diseases is indispensable for advancing our understanding of local epidemiology, developing effective interventions, and ultimately improving patient outcomes. In conclusion, closing the gaps in diagnosing and treating fungal diseases in Africa demands concerted research and advocacy initiatives to ensure better healthcare delivery, reduced mortality rates, and improved public health outcomes.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda; Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
| | - Bassey E Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Norman van Rhijn
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Nelesh P Govender
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David B Meya
- Infectious Diseases Institute, Department of medicine, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda
| | - Iriagbonse I Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin 300213, Nigeria
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, United States; Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, United States of America; National Emerging Infectious Disease Laboratory, Boston, United States; Center for Emerging Infectious Diseases Policy & Research, Boston University, Boston, MA, United States
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos 101017, Nigeria
| | - David W Denning
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Almeida-Silva F, Coelho RA, Bernardes-Engemann AR, Fichman V, Freitas DF, Galhardo MC, Corrêa-Junior D, Frases S, Zancopé-Oliveira RM, Almeida-Paes R. In vitro isavuconazole activity against Sporothrix brasiliensis suggests its efficacy in some severe sporotrichosis cases. Future Microbiol 2023; 18:1041-1048. [PMID: 37721514 DOI: 10.2217/fmb-2023-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background: Sporothrix brasiliensis causes sporotrichosis, an important infection in some groups of patients. Aims: This work was designed to investigate the effects of isavuconazole against this species. Methods: An antifungal susceptibility test was performed to compare MIC values with other antifungal drugs used to treat sporotrichosis. A checkerboard assay was performed to understand isavuconazole interactions. Furthermore, isavuconazole growth inhibition on an itraconazole-resistant strain was tested. Results: Isavuconazole had similar MICs to other azoles against S. brasiliensis, presenting fungistatic activity. Isavuconazole did not interact in vitro with antifungals or immunosuppressive drugs and inhibited the growth of an itraconazole-resistant strain. Conclusion: Isavuconazole inhibits S. brasiliensis, its pharmacologic characteristics make it a candidate for patients with sporotrichosis and it may be useful to combat sporotrichosis caused by resistant isolates.
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Affiliation(s)
- Fernando Almeida-Silva
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rowena A Coelho
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andréa R Bernardes-Engemann
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Vivian Fichman
- Departamento de Dermatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayvison Fs Freitas
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria Cg Galhardo
- Laboratório de Pesquisa Clínica em Dermatologia Infecciosa, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Dario Corrêa-Junior
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susana Frases
- Laboratório de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Rede Micologia RJ, FAPERJ, Rio de Janeiro, Brazil
| | - Rosely M Zancopé-Oliveira
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rodrigo Almeida-Paes
- Laboratório de Micologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Rede Micologia RJ, FAPERJ, Rio de Janeiro, Brazil
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35
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Douglas AP, Stewart AG, Halliday CL, Chen SCA. Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management. J Fungi (Basel) 2023; 9:1059. [PMID: 37998865 PMCID: PMC10672668 DOI: 10.3390/jof9111059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Nosocomial clusters of fungal infections, whilst uncommon, cannot be predicted and are associated with significant morbidity and mortality. Here, we review reports of nosocomial outbreaks of invasive fungal disease to glean insight into their epidemiology, risks for infection, methods employed in outbreak detection including genomic testing to confirm the outbreak, and approaches to clinical and infection control management. Both yeasts and filamentous fungi cause outbreaks, with each having general and specific risks. The early detection and confirmation of the outbreak are essential for diagnosis, treatment of affected patients, and termination of the outbreak. Environmental sampling, including the air in mould outbreaks, for the pathogen may be indicated. The genetic analysis of epidemiologically linked isolates is strongly recommended through a sufficiently discriminatory approach such as whole genome sequencing or a method that is acceptably discriminatory for that pathogen. An analysis of both linked isolates and epidemiologically unrelated strains is required to enable genetic similarity comparisons. The management of the outbreak encompasses input from a multi-disciplinary team with epidemiological investigation and infection control measures, including screening for additional cases, patient cohorting, and strict hygiene and cleaning procedures. Automated methods for fungal infection surveillance would greatly aid earlier outbreak detection and should be a focus of research.
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Affiliation(s)
- Abby P. Douglas
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC 3084, Australia
| | - Adam G. Stewart
- Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, The University of Queensland, Herston, QLD 4006, Australia;
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
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36
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Zangeneh TT, Lainhart WD, Wiederhold NP, Al-Obaidi MM. Coccidioides species antifungal susceptibility testing: Experience from a large healthcare system in the endemic region. Med Mycol 2023; 61:myad104. [PMID: 37804176 DOI: 10.1093/mmy/myad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023] Open
Abstract
The clinical utility of Coccidioides species antifungal susceptibility testing (AST) remains unclear. This study describes the clinical course of eight patients with severe or chronic coccidioidomycosis and subsequent Coccidioides AST. We present the clinical manifestations, antifungal treatment regimens, and clinical outcomes for these patients.
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Affiliation(s)
- Tirdad T Zangeneh
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Valley Fever Center for Excellence, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - William D Lainhart
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Mohanad M Al-Obaidi
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Valley Fever Center for Excellence, University of Arizona College of Medicine, Tucson, Arizona, USA
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37
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Chen L, Hu D, Zhang C, Wu T, Cheng X, Hagen F, Zhu H, Deng S. Histoplasmosis: An epidemiological and clinical update in China, review and a case report. Mycology 2023; 15:101-109. [PMID: 38558846 PMCID: PMC10976997 DOI: 10.1080/21501203.2023.2259934] [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: 05/17/2023] [Accepted: 09/11/2023] [Indexed: 04/04/2024] Open
Abstract
Histoplasmosis is a systemic mycosis caused by the dimorphic fungus in the genus Histoplasma. Histoplasmosis is overlooked in China. This study aims to provide an epidemiological and clinical update on histoplasmosis in China by literature review. We reviewed cases of histoplasmosis reported in recent 11 years and described a case of histoplasmosis-triggered hemophagocytic lymphohistiocytosis (HLH) in an immunocompetent patient. A total of 225 cases of histoplasmosis diagnosed in China between 2012 and 2022 were involved in this study, compared with 300 cases reviewed from 1990 to 2011, an increasing number of cases of histoplasmosis have been diagnosed in the last 11 years. The majority of cases of histoplasmosis were autochthonous cases, mainly from provinces Sichuan (56/225, 24.9%), Hunan (50/225, 22.2%), Guangdong (31/225, 13.8%), and Yunnan (24/225, 10.7%). Higher incidence (52.5%, 53/99) of histoplasmosis occurred in immunocompetent patients which is similar to those from the previous 21 years, and the prevalence of the disease did not vary highly over time. Of note, the number of histoplasmosis cases is increasing, and the geographic distribution is shifting southwards over time. Improved awareness is critically important for informing clinical practice in China.
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Affiliation(s)
- Lihua Chen
- Department of Medicine Laboratory, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Danyang Hu
- Life Science College, University of Essex, Colchester, UK
| | - Congming Zhang
- Department of hematology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Tianrui Wu
- Department of Medicine Laboratory, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiangning Cheng
- Department of Medicine Laboratory, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - Hui Zhu
- Department of Gynaecology and Obstetrics, The First Hospital of Suzhou University, Suzhou, China
| | - Shuwen Deng
- Medical Center in The People’s Hospital of SND, Suzhou, China
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38
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Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
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Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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39
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Braman BC, Amin K, Khaja SF. Disseminated Blastomycosis Mimicking Metastatic Head and Neck Cancer in a 70-year-Old Man. Laryngoscope 2023; 133:2237-2239. [PMID: 36856153 DOI: 10.1002/lary.30631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
Blastomycosis is a fungal infection known to mimic many disease processes, including malignancy. A 70-year-old man presented with an enlarging neck mass and, incidentally found on preliminary imaging, a lung mass. The initial biopsy of the neck mass demonstrating cytologic atypia and mitotic figures was suggestive of malignancy. Whole body positron emission tomography (PET)/CT revealed hypermetabolic lesions in multiple sites, including the neck, lung, and soft tissue, raising concern for metastatic disease. Repeat sampling from multiple lesions, however, demonstrated granuloma. Microbiological studies were collected, and Blastomyces dermatitidis was isolated in culture. The diagnosis of disseminated blastomycosis was made, and the patient received antifungal therapy with good response. A high degree of suspicion for blastomycosis in endemic areas is required to ensure patients receive appropriate and timely treatment. Laryngoscope, 133:2237-2239, 2023.
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Affiliation(s)
- Brooke C Braman
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Khalid Amin
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Sobia F Khaja
- Department of Otolaryngology- Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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40
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Ariza Y, Cubides CL, Cubillos DA, Roa CL, Álvarez JC, Cuervo-Maldonado SI. Make the diagnosis - Second part. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:312-322. [PMID: 37721895 PMCID: PMC10586880 DOI: 10.7705/biomedica.7219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 07/07/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Yenny Ariza
- Grupo de Medicina Interna e Infectología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
| | - Cristian Leonardo Cubides
- Grupo de Medicina Interna e Infectología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia; Grupo de Investigación en Enfermedades Infecciosas en Cáncer y Alteraciones Hematológicas, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
| | - Daniel Alejandro Cubillos
- Grupo de Investigación en Enfermedades Infecciosas en Cáncer y Alteraciones Hematológicas, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia; Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
| | - Carmen Lucía Roa
- Grupo de Medicina Interna e Infectología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
| | - José Camilo Álvarez
- Grupo de Medicina Interna e Infectología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia; Grupo de Investigación en Enfermedades Infecciosas en Cáncer y Alteraciones Hematológicas, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia.
| | - Sonia Isabel Cuervo-Maldonado
- Grupo de Medicina Interna e Infectología, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia; Grupo de Investigación en Enfermedades Infecciosas en Cáncer y Alteraciones Hematológicas, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia; Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
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41
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Calvopiña M, Toro M, Bastidas-Caldes C, Vasco-Julio D, Muñoz G. A Fatal Case of Disseminated Histoplasmosis by Histoplasma capsulatum var. capsulatum Misdiagnosed as Visceral Leishmaniasis-Molecular Diagnosis and Identification. Pathogens 2023; 12:1112. [PMID: 37764920 PMCID: PMC10538155 DOI: 10.3390/pathogens12091112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/29/2023] Open
Abstract
Histoplasmosis is an endemic mycosis in the Americas. However, its diagnosis is challenging due to the complexity and limited availability of conventional laboratory techniques-antigen tests, culture, and staining. Microscopic preparations often confuse with other pathogens, such as Leishmania spp. The genus Histoplasma capsulatum comprises three varieties: var. capsulatum, var. duboissi, and var. farciminosum, which cannot be distinguished using conventional techniques. An infant from a tropical region of Ecuador was hospitalized for fever, bloody diarrhea, and anemia persisting for two months. Upon admission, he received antibiotics and immunosuppressants. Histopathological examination of the lymph nodes, intestines, and bone marrow aspirate reported the presence of Leishmania-like amastigotes, and treatment was initiated with meglumine antimoniate and conventional amphotericin B. However, subsequent analysis of samples using PCR and DNA sequencing identified H. capsulatum var. capsulatum but not Leishmania. Despite fluconazole and amphotericin B, the infant succumbed to the disease. The delay in clinical and laboratory diagnosis of histoplasmosis and the use of nonspecific and ineffective drugs such as fluconazole led to disease dissemination and, ultimately, death. Implementing molecular diagnosis and antigen tests in laboratories located in endemic regions and reference hospitals is crucial.
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Affiliation(s)
- Manuel Calvopiña
- One Health Research Group, Universidad de Las Américas (UDLA), Quito 170124, Ecuador;
| | - Marcelo Toro
- Hospital Pediátrico “Baca Ortiz”, Quito 170523, Ecuador; (M.T.); (G.M.)
| | | | - David Vasco-Julio
- Programa de Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca 62050, Mexico
| | - Greta Muñoz
- Hospital Pediátrico “Baca Ortiz”, Quito 170523, Ecuador; (M.T.); (G.M.)
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Zerbato V, Di Bella S, Pol R, D’Aleo F, Angheben A, Farina C, Conte M, Luzzaro F, Luzzati R, Principe L. Endemic Systemic Mycoses in Italy: A Systematic Review of Literature and a Practical Update. Mycopathologia 2023; 188:307-334. [PMID: 37294504 PMCID: PMC10386973 DOI: 10.1007/s11046-023-00735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/02/2023] [Indexed: 06/10/2023]
Abstract
Endemic systemic mycoses such as blastomycosis, coccidioidomycosis, histoplasmosis, talaromycosis, paracoccidioidomycosis are emerging as an important cause of morbidity and mortality worldwide. We conducted a systematic review on endemic systemic mycoses reported in Italy from 1914 to nowadays. We found out: 105 cases of histoplasmosis, 15 of paracoccidioidomycosis, 10 of coccidioidomycosis, 10 of blastomycosis and 3 of talaromycosis. Most cases have been reported in returning travelers and expatriates or immigrants. Thirtytwo patients did not have a story of traveling to an endemic area. Fortysix subjects had HIV/AIDS. Immunosuppression was the major risk factor for getting these infections and for severe outcomes. We provided an overview on microbiological characteristics and clinical management principles of systemic endemic mycoses with a focus on the cases reported in Italy.
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Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Riccardo Pol
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Francesco D’Aleo
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, 37024 Negrar di Valpolicella, Verona, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST “Papa Giovanni XXIII”, 24127 Bergamo, Italy
| | - Marco Conte
- Microbiology and Virology Unit, Great Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy
| | - Francesco Luzzaro
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
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Franconi I, Rizzato C, Poma N, Tavanti A, Lupetti A. Candida parapsilosis sensu stricto Antifungal Resistance Mechanisms and Associated Epidemiology. J Fungi (Basel) 2023; 9:798. [PMID: 37623569 PMCID: PMC10456088 DOI: 10.3390/jof9080798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Fungal diseases cause millions of deaths per year worldwide. Antifungal resistance has become a matter of great concern in public health. In recent years rates of non-albicans species have risen dramatically. Candida parapsilosis is now reported to be the second most frequent species causing candidemia in several countries in Europe, Latin America, South Africa and Asia. Rates of acquired azole resistance are reaching a worrisome threshold from multiple reports as in vitro susceptibility testing is now starting also to explore tolerance and heteroresistance to antifungal compounds. With this review, the authors seek to evaluate known antifungal resistance mechanisms and their worldwide distribution in Candida species infections with a specific focus on C. parapsilosis.
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Affiliation(s)
- Iacopo Franconi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno, 37, 56127 Pisa, Italy; (I.F.); (C.R.)
| | - Cosmeri Rizzato
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno, 37, 56127 Pisa, Italy; (I.F.); (C.R.)
| | - Noemi Poma
- Department of Biology, University of Pisa, Via San Zeno, 37, 56127 Pisa, Italy; (N.P.); (A.T.)
| | - Arianna Tavanti
- Department of Biology, University of Pisa, Via San Zeno, 37, 56127 Pisa, Italy; (N.P.); (A.T.)
| | - Antonella Lupetti
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno, 37, 56127 Pisa, Italy; (I.F.); (C.R.)
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Jenks JD, White PL, Kidd SE, Goshia T, Fraley SI, Hoenigl M, Thompson GR. An update on current and novel molecular diagnostics for the diagnosis of invasive fungal infections. Expert Rev Mol Diagn 2023; 23:1135-1152. [PMID: 37801397 PMCID: PMC10842420 DOI: 10.1080/14737159.2023.2267977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Invasive fungal infections cause millions of infections annually, but diagnosis remains challenging. There is an increased need for low-cost, easy to use, highly sensitive and specific molecular assays that can differentiate between colonized and pathogenic organisms from different clinical specimens. AREAS COVERED We reviewed the literature evaluating the current state of molecular diagnostics for invasive fungal infections, focusing on current and novel molecular tests such as polymerase chain reaction (PCR), digital PCR, high-resolution melt (HRM), and metagenomics/next generation sequencing (mNGS). EXPERT OPINION PCR is highly sensitive and specific, although performance can be impacted by prior/concurrent antifungal use. PCR assays can identify mutations associated with antifungal resistance, non-Aspergillus mold infections, and infections from endemic fungi. HRM is a rapid and highly sensitive diagnostic modality that can identify a wide range of fungal pathogens, including down to the species level, but multiplex assays are limited and HRM is currently unavailable in most healthcare settings, although universal HRM is working to overcome this limitation. mNGS offers a promising approach for rapid and hypothesis-free diagnosis of a wide range of fungal pathogens, although some drawbacks include limited access, variable performance across platforms, the expertise and costs associated with this method, and long turnaround times in real-world settings.
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Affiliation(s)
- Jeffrey D Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, UHW, United Kingdom and Centre for trials research/Division of Infection/Immunity, Cardiff University, Cardiff, UK
| | - Sarah E Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
- School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Tyler Goshia
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Stephanie I Fraley
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - George R Thompson
- University of California Davis Center for Valley Fever, Sacramento, CA, USA
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, USA
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Schwartz IS, Marek C, Sandhu H, Abdelmonem A, Petersen G, Dishner E, Heidari A, Thompson GR. Multicentric Case Series and Literature Review of Coccidioidal Otomastoiditis. Emerg Infect Dis 2023; 29:1297-1301. [PMID: 37347877 PMCID: PMC10310367 DOI: 10.3201/eid2907.230129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Coccidioidomycosis involving the ear, mastoid bone, or both is uncommon. We describe 5 new cases from the United States and review 4 cases reported in the literature of otomycosis and mastoiditis caused by Coccidioides. Of the 9 cases, 8 were linked to residence in or travel to California. Two patients had poorly controlled diabetes mellitus, 7 had otomastoiditis, 1 had otitis externa without mastoid involvement, and 1 had mastoiditis without otic involvement. Four patients had concurrent or prior pulmonary coccidioidomycosis. Ipsilateral facial nerve palsies developed in 2 patients. All patients received antifungal treatment for varying durations, and 8 of the 9 patients underwent surgical debridement. Clinicians should consider coccidioidomycosis as a differential diagnosis for otomastoiditis in patients with geographic risks.
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Milani B, Dagne DA, Choi HL, Schito M, Stone HA. Diagnostic capacities and treatment practices on implantation mycoses: Results from the 2022 WHO global online survey. PLoS Negl Trop Dis 2023; 17:e0011443. [PMID: 37379338 PMCID: PMC10335693 DOI: 10.1371/journal.pntd.0011443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
Between January and March 2022, WHO conducted a global online survey to collect data on diagnostic capacities and treatment practices in different settings for four implantation mycoses: eumycetoma, actinomycetoma, cutaneous sporotrichosis and chromoblastomycosis. The survey investigated the type of diagnostic methods available in countries at various health system levels (tertiary, secondary, primary level) and the medicines used to treat implantation mycoses, with a view to understanding the level of drug repurposing for treatment of these diseases. 142 respondents from 47 countries, including all continents, contributed data: 60% were from middle-income countries, with 59% working at the tertiary level of the health system and 30% at the secondary level. The results presented in this article provide information on the current diagnostic capacity and treatment trends for both pharmacological and non-pharmacological interventions. In addition, the survey provides insight on refractory case rates, as well as other challenges, such as availability and affordability of medicines, especially in middle-income countries. Although the study has limitations, the survey-collected data confirms that drug repurposing is occurring for all four surveyed implantation mycoses. The implementation of an openly accessible global and/or a national treatment registry for implantation mycoses could contribute to address the gaps in epidemiological information and collect valuable observational data to inform treatment guidelines and clinical research.
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Affiliation(s)
- Barbara Milani
- WHO consultant, World Health Organization, Geneva, Switzeland
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
| | - Hye Lynn Choi
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
- Department of Regulation and Prequalification [WHO/RPQ], World Health Organization, Geneva, Switzeland
| | - Marco Schito
- CURE Drug Repurposing Collaboratory, Critical Path Institute, Tucson, Arizona, United States of America
| | - Heather Anne Stone
- Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
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Huang XW, Lu S, Pan W, Zhong MZ, Chai JW, Liu YH, Zeng K, Xi LY. Autophagy benefits the in vitro and in vivo clearance of Talaromyces marneffei. Microb Pathog 2023; 180:106146. [PMID: 37150309 DOI: 10.1016/j.micpath.2023.106146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
Talaromycosis, namely Talaromyces marneffei infection, is increasing gradually and has a high mortality rate even under antifungal therapy. Although autophagy acts differently on different pathogens, it is a promising therapeutic strategy. However, information on autophagy in macrophages and animals upon infection by T. marneffei is still limited. Therefore, several models were employed here to investigate the role of autophagy in host defense against T. marneffei, including RAW264.7 macrophages as in vitro models, different types of Caenorhabditis elegans and BALB/c mice as in vivo models. We applied the clinical T. marneffei isolate SUMS0152 in this study. T. marneffei-infected macrophages exhibit increased formation of autophagosomes. Further, macrophage autophagy promoted by rapamycin or Earle's balanced salt solution (EBSS) inhibited the viability of intracellular T. marneffei. In vivo, compared with uninfected Caenorhabditis elegans, the wild-type nematodes upregulated the expression of the autophagy-related gene lgg-1 and atg-18, and nematodes carrying GFP reporter were induced to form autophagosomes (GFP::LGG-1) after T. marneffei infection. Furthermore, the knockdown of lgg-1 significantly reduced the survival rate of T. marneffei-infected nematodes. Likewise, the autophagy activator rapamycin reduced the fungal burden and suppressed lung inflammation in a mouse model of infection. In conclusion, autophagy is essential for host defense against T. marneffei in vitro and in vivo. Therefore, autophagy may be an attractive target for developing new therapeutics to treat talaromycosis.
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Affiliation(s)
- Xiao-Wen Huang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Sha Lu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Rd., Guangzhou, 510120, China
| | - Wen Pan
- Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Mei-Zhen Zhong
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jin-Wei Chai
- Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Ying-Hui Liu
- Dermatology Department, Dermatology Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Li-Yan Xi
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Rd., Guangzhou, 510120, China; Dermatology Department, Dermatology Hospital, Southern Medical University, Guangzhou, 510515, China.
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Gonzalez HC, Gordon SC. Hepatic Manifestations of Systemic Diseases. Med Clin North Am 2023; 107:465-489. [PMID: 37001948 DOI: 10.1016/j.mcna.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
In addition to being the primary target of infections such as viral hepatitis, the liver may also be affected by systemic disease. These include bacterial, mycotic, and viral infections, as well as autoimmune and infiltrative diseases. These conditions generally manifest as abnormal liver biochemistries, often with a cholestatic profile, and may present with additional signs/symptoms such as jaundice and fever. A high index of suspicion and familiarity with potential causal entities is necessary to guide appropriate testing, diagnosis, and treatment.
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Affiliation(s)
- Humberto C Gonzalez
- Division of Gastroenterology and Hepatology, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA.
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA
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Giusiano G, Tracogna F, Santiso G, Rojas F, Messina F, Sosa V, Chacón Y, Sosa MDLÁ, Mussin J, Cattana ME, Vazquez A, Formosa P, Fernández N, Piedrabuena M, Valdez R, Davalos F, Fernández M, Acuña A, Aguilera A, Guelfand L, Afeltra J, Garcia Effron G, Posse G, Amigot S, Serrano J, Sellares O, Álvarez C, Pineda G, Carnovale S, Zalazar L, Canteros C. Clinical and Demographic Features of Paracoccidioidomycosis in Argentina: A Multicenter Study Analysis of 466 Cases. J Fungi (Basel) 2023; 9:jof9040482. [PMID: 37108936 PMCID: PMC10145406 DOI: 10.3390/jof9040482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/01/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Information on paracoccidioidomycosis (PCM) in Argentina is fragmented and has historically been based on estimates, supported only by a series of a few reported cases. Considering the lack of global information, a national multicentric study in order to carry out a more comprehensive analysis was warranted. We present a data analysis including demographic and clinical aspects of a historical series of 466 cases recorded over 10 years (2012-2021). Patients were aged from 1 to 89 years. The general male: female (M:F) ratio was 9.5:1 with significant variation according to the age group. Interestingly, the age range 21-30 shows an M:F ratio of 2:1. Most of the cases (86%) were registered in northeast Argentina (NEA), showing hyperendemic areas in Chaco province with more than 2 cases per 10,000 inhabitants. The chronic clinical form occurred in 85.6% of cases and the acute/subacute form occurred in 14.4% of cases, but most of these juvenile type cases occurred in northwestern Argentina (NWA). In NEA, the incidence of the chronic form was 90.6%; in NWA, the acute/subacute form exceeded 37%. Diagnosis by microscopy showed 96% positivity but antibody detection displays 17% of false negatives. Tuberculosis was the most frequent comorbidity, but a diverse spectrum of bacterial, fungal, viral, parasitic, and other non-infectious comorbidities was recorded. This national multicenter registry was launched in order to better understand the current status of PCM in Argentina and shows the two endemic zones with a highly diverse epidemiology.
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Affiliation(s)
- Gustavo Giusiano
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
- Hospital Pediátrico Juan Pablo II, Corrientes 3400, Argentina
| | | | - Gabriela Santiso
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Uspallata, Buenos Aires 2272, Argentina
| | - Florencia Rojas
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
| | - Fernando Messina
- Unidad de Micología, Hospital de Enfermedades Infecciosas F. J. Muñiz, Uspallata, Buenos Aires 2272, Argentina
| | - Vanesa Sosa
- Servicio de Micología, Hospital Dr. Ramon Madariaga, Av. Marconi 3736, Posadas N3300, Argentina
| | - Yone Chacón
- Hospital Señor del Milagro, Salta 4400, Argentina
| | - Maria de Los Ángeles Sosa
- Laboratorio Central de Redes y Programas, Facultad de Ciencias Exactas y Naturales y Agrimensura, Instituto de Medicina Regional, Universidad Nacional del Nordeste, Placido Martínez, Corrientes 1044, Argentina
| | - Javier Mussin
- Departamento Micología, Instituto de Medicina Regional, Universidad Nacional de Nordeste, CONICET, Resistencia 3500, Argentina
| | | | - Andrea Vazquez
- Servicio de Microbiología, Hospital 4 de Junio Ramón Carrillo, Roque Sáenz Peña, Av. Malvinas Argentinas 1350, Sáenz Peña H3700, Argentina
| | - Patricia Formosa
- Hospital de Alta Complejidad Pte. J. D. Perón, Av. Pantaleón Gómez & Av. Dr. Nestor Kirchner, Formosa 3600, Argentina
| | - Norma Fernández
- Laboratorio de Micología, Hospital de Clínicas, José de San Martin, Buenos Aires 2351, Argentina
| | - Milagros Piedrabuena
- Laboratorio de Microbiología, Hospital San Martín, Pres. Juan Domingo Perón 450, Paraná 3100, Argentina
| | - Ruth Valdez
- Hospital Señor del Milagro, Salta 4400, Argentina
| | - Florencia Davalos
- Servicio de Microbiología, Hospital San Bernardo, Av. José Tobias 69, Salta 4400, Argentina
| | | | | | | | - Liliana Guelfand
- Sección Microbiología, Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires 1425, Argentina
| | - Javier Afeltra
- Unidad de Parasitología y Micología, Hospital General de Agudos José María Ramos Mejía, Ciudad Autónoma de Buenos Aires 1221, Argentina
| | - Guillermo Garcia Effron
- Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, CONICET, Santa Fe 2750, Argentina
| | - Gladys Posse
- Hospital Nacional Prof. Dr. A. Posadas, Buenos Aires 1684, Argentina
| | - Susana Amigot
- CEMAR Microbiología, Dir. Bioquímica, Secretaría de Salud Pública, Rosario 2020, Argentina
| | - Julian Serrano
- Sección Micología, Hospital Independencia, Av. Belgrano Nte. 660, Santiago del Estero 4200, Argentina
| | | | - Christian Álvarez
- División Micología-Laboratorio de Salud Pública de Tucumán, Tucumán 4000, Argentina
| | - Gloria Pineda
- Hospital Universitario Austral, Pilar, Buenos Aires 1500, Argentina
| | - Susana Carnovale
- Hospital de Pediatría S.A.M.I.C. Prof. Juan P. Garraham, Pichincha 1890, Buenos Aires 1245, Argentina
| | - Laura Zalazar
- Facultad de Humanidades, Universidad Nacional del Nordeste, Las Heras 727, Resistencia H3500COI, Argentina
| | - Cristina Canteros
- Departamento de Micología, INEI-ANLIS "Dr. Carlos G. Malbrán", Buenos Aires 1281, Argentina
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Munhoz LS, Poester VR, Benelli JL, Melo AM, Trápaga MR, Nogueira CW, Zeni G, Flores MM, Stevens DA, Xavier MO. Effectiveness of diphenyl diselenide against experimental sporotrichosis caused by Sporothrix brasiliensis. Med Mycol 2023; 61:myad035. [PMID: 36977574 DOI: 10.1093/mmy/myad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Diphenyl diselenide (PhSe)2 is a stable organoselenium compound with promising in vitro antifungal activity against several fungi, including Sporothrix brasiliensis. This species is associated with feline and zoonotic sporotrichosis, an emergent mycosis in Latin America. We evaluated the activity of (PhSe)2, alone and in association with itraconazole, in the treatment of sporotrichosis caused by S. brasiliensis, in a murine model. Sixty mice were subcutaneously infected with S. brasiliensis in the footpad and treated by gavage for 30 consecutive days. The six treatment groups received: no active treatment, itraconazole (50 mg/kg), (PhSe)2 at 1, 5, and 10 mg/kg dosages, or itraconazole (50 mg/kg) + (PhSe)2 1 mg/kg, once a day, starting seven days post-inoculation. A significant reduction in the fungal burden of internal organs was achieved in the groups treated with (PhSe)2 1 mg/kg or itraconazole alone in comparison with the untreated group. Higher dosages (5 and 10 mg/kg) of (PhSe)2 increased the clinical manifestation of sporotrichosis and mortality rate. Treatment with both itraconazole and (PhSe)2 1 mg/kg was better than their activities alone (P < .001). This is the first demonstration of the potential use of (PhSe)2, alone or with the present drug of choice, in the treatment of sporotrichosis.
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Affiliation(s)
- Lívia Silveira Munhoz
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
| | - Vanice Rodrigues Poester
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - Jéssica Louise Benelli
- Hospital Universitário Dr. Miguel Riet Corrêa Jr. (HU-FURG), vinculado à Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio Grande city, Rio Grande do Sul state, 96200-190, Brazil
| | - Aryse Martins Melo
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, 1600-609, Portugal
| | - Mariana Rodrigues Trápaga
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
| | - Cristina Wayne Nogueira
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - Gilson Zeni
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - Mariana Martins Flores
- Universidade Federal de Santa Maria (UFSM), Santa Maria city, Rio Grande do Sul state, 97105-900, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, California 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, California 94305, USA
| | - Melissa Orzechowski Xavier
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande (FURG), Rio Grande city, Rio Grande do Sul state, 96203-900, Brazil
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