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Lipovy B, Hladik M, Vyklicka K, Kocmanova I, Lengerova M, Kren L, Srnik M, Bohm J, Andrla P, Borilova Linhartova P. Rare multi-fungal sepsis: a case of triple-impact immunoparalysis. Folia Microbiol (Praha) 2024; 69:903-911. [PMID: 38647991 DOI: 10.1007/s12223-024-01165-0] [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: 09/05/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.
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Affiliation(s)
- Bretislav Lipovy
- Department of Burns and Plastic Surgery, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
- CEITEC - Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, Brno, Czech Republic
| | - Martin Hladik
- Department of Burns and Plastic Surgery, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Katerina Vyklicka
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Iva Kocmanova
- Department of Clinical Microbiology and Immunology, University Hospital Brno, Jihlavska 20, Brno, Czech Republic
| | - Martina Lengerova
- Department of Internal Medicine - Haematology and Oncology, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Leos Kren
- Department of Pathology, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Michal Srnik
- Department of Forensic Medicine, Institutions Shared With St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Pekarska 664/53, Brno, Czech Republic
| | - Jan Bohm
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Petr Andrla
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
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Sakai Y, Taniguchi T, Herai Y, Yahaba M, Watanabe A, Kamei K, Igari H. Fungemia With Wickerhamomyces anomalus: A Case Report and Literature Review. Cureus 2024; 16:e53550. [PMID: 38445156 PMCID: PMC10912825 DOI: 10.7759/cureus.53550] [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] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
We report the case of an 84-year-old man with a history of IgG4-related sclerosing cholangitis who was diagnosed with advanced esophageal cancer and underwent radiation and chemotherapy. An implantable central venous access port was placed for chemotherapy and total parenteral nutrition. The patient presented with a fever and received antimicrobial therapy for acute cholangitis but remained febrile, and subsequently, yeast was detected in the aerobic bottle of blood culture obtained from the central venous line. The yeast was identified as Wickerhamomyces anomalus. Liposomal amphotericin B was administered, and the central line access port was removed. After confirmation of negative blood cultures and 14 days post treatment, he underwent reinsertion of the central line access port. Due to persistent pain at the insertion site, fluconazole was added for an additional 14 days, and the patient was discharged and transferred to another hospital. Wickerhamomyces anomalus is a rare fungal infection with other synonyms including Pichia anomala, Hansenula anomala, and Candida pelliculosa. A literature review of 53 case reports of Wickerhamomyces anomalus, Pichia anomala, Hansenula anomala, and Candida pelliculosa was conducted, with a total of 211 cases reviewed. Fungemia was reported in 94% of cases, with central venous catheterization, parental feeding, low birth weight, and immunocompromised status identified as major risk factors. The majority of cases were pediatric, particularly neonatal, and there were reports of nosocomial infections causing outbreaks, with some cases involving the eye such as endophthalmitis or keratitis.
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Affiliation(s)
- Yui Sakai
- Infectious Diseases, Chiba University School of Medicine, Chiba, JPN
| | | | - Yoriko Herai
- Infectious Diseases, Chiba University Hospital, Chiba, JPN
- Respiratory Medicine, Misato Central General Hospital, Misato, JPN
| | - Misuzu Yahaba
- Infectious Diseases, Chiba University Hospital, Chiba, JPN
| | - Akira Watanabe
- Clinical Research, Chiba University Medical Mycology Research Centre, Chiba, JPN
| | - Katsuhiko Kamei
- Clinical Research, Chiba University Medical Mycology Research Centre, Chiba, JPN
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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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Zhang L, Xiao M, Arastehfar A, Ilkit M, Zou J, Deng Y, Xu Y, Liao W, Zhao J, Fang W, Pan W. Investigation of the Emerging Nosocomial Wickerhamomyces anomalus Infections at a Chinese Tertiary Teaching Hospital and a Systemic Review: Clinical Manifestations, Risk Factors, Treatment, Outcomes, and Anti-fungal Susceptibility. Front Microbiol 2021; 12:744502. [PMID: 34690991 PMCID: PMC8527005 DOI: 10.3389/fmicb.2021.744502] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 12/12/2022] Open
Abstract
Wickerhamomyces anomalus is an emerging pathogen, which has been associated with clonal outbreaks and poor clinical outcomes. Despite being an important emerging yeasts species, our understanding concerning the microbiological and clinical characteristics of infections due to this species is limited. Herein, we are reporting a retrospective analysis of fungemia patients with W. anomalus from a 2,100-bed hospital in Shanghai during 2014–2016. Moreover, we conducted an extensive literature review to gain a deeper clinical and microbiological insights. Detailed clinical data were recorded. Antifungal susceptibility testing (AFST) followed CLSI M27-A3, and isolates were identified using MALDI-TOF MS. In total, 13 patients were identified with a mortality rate of 38.5% (5/13). Central venous catheter (CVC), broad-spectrum antibiotic therapy, total parenteral nutrition (TPN), surgery, and mechanical ventilation were the most frequently observed risk factors. Eight patients (61.5%) experienced mixed bacterial/Candida bloodstream infections, and four patients developed mixed candidemia (MC). W. anomalus isolates showed high minimum inhibitory concentrations (MICs) against all azoles tested and flucytosine, while AMB showed the highest in vitro activity. Azoles were used for 84.6% (11/13) of the cases, while 36.4% (4/11) of them died. When combining with the AFST data and the literature review, our study highlights the poor efficacy of azoles and optimal efficacy of AMB and LAMB against infections caused by W. anomalus. In conclusion, our study highlights the emerging threat of W. anomalus affecting both neonates and adults. Furthermore, our results advocate the use of AMB formulations rather than azoles among patients infected with W. anomalus. Future studies are warranted to reach a definitive consensus regarding the utility of echinocandins among such patients.
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Affiliation(s)
- Li Zhang
- Department of Dermatology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meng Xiao
- Peking Union Medical College Hospital, Beijing, China
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States
| | - Macit Ilkit
- Division of Mycology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Jun Zou
- The Fourth People's Hospital of Nanning, Nanning, China
| | - Yuchen Deng
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Yingchun Xu
- Peking Union Medical College Hospital, Beijing, China
| | - Wanqing Liao
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jingjun Zhao
- Department of Dermatology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenjie Fang
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Weihua Pan
- Shanghai Key Laboratory of Molecular Medical Mycology, Department of Dermatology, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Zhang Z, Cao Y, Li Y, Chen X, Ding C, Liu Y. Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit. BMC Infect Dis 2021; 21:620. [PMID: 34187390 PMCID: PMC8244135 DOI: 10.1186/s12879-021-06295-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background Candida pelliculosa is an ecological fungal species that can cause infections in immunocompromised individuals. Numerous studies globally have shown that C. pelliculosa infects neonates. An outbreak recently occurred in our neonatal intensive care unit; therefore, we aimed to evaluate the risk factors in this hospital-acquired fungal infection. Methods We performed a case-control study, analysing the potential risk factors for neonatal infections of C. pelliculosa so that infection prevention and control could be implemented in our units. Isolated strains were tested for drug resistance and biofilm formation, important factors for fungal transmission that give rise to hospital-acquired infections. Results The use of three or more broad-spectrum antimicrobials or long hospital stays were associated with higher likelihoods of infection with C. pelliculosa. The fungus was not identified on the hands of healthcare workers or in the environment. All fungal isolates were susceptible to anti-fungal medications, and after anti-fungal treatment, all infected patients recovered. Strict infection prevention and control procedures efficiently suppressed infection transmission. Intact adhesin-encoding genes, shown by genome analysis, indicated possible routes for fungal transmission. Conclusions The use of three or more broad-spectrum antimicrobials or a lengthy hospital stay is theoretically associated with the risk of infection with C. pelliculosa. Strains that we isolated are susceptible to anti-fungal medications, and these were eliminated by treating all patients with an antifungal. Transmission is likely via adhesion to the cell surface and biofilm formation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06295-1.
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Affiliation(s)
- Zhijie Zhang
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China
| | - Yu Cao
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China
| | - Yanjian Li
- College of Life and Health Sciences, Northeastern University, 195, Chuangxin Road, Hunnan District, Shenyang, China
| | - Xufang Chen
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China
| | - Chen Ding
- College of Life and Health Sciences, Northeastern University, 195, Chuangxin Road, Hunnan District, Shenyang, China
| | - Yong Liu
- Department of Laboratory Medicine of Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, China.
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Dutra VR, Silva LF, Oliveira ANM, Beirigo EF, Arthur VM, Bernardes da Silva R, Ferreira TB, Andrade-Silva L, Silva MV, Fonseca FM, Silva-Vergara ML, Ferreira-Paim K. Fatal Case of Fungemia by Wickerhamomyces anomalus in a Pediatric Patient Diagnosed in a Teaching Hospital from Brazil. J Fungi (Basel) 2020; 6:jof6030147. [PMID: 32854208 PMCID: PMC7558373 DOI: 10.3390/jof6030147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
In recent decades, emerging fungal infections have changed the clinical mycology scenario as a consequence of the advances in medical diagnostics and therapeutic procedures, long hospitalization times, and the growing number of individuals with debilitating chronic diseases and impaired immune systems. This report presents a 19 months old Brazilian female patient who developed a severe fungal sepsis by an uncommon yeast. She was admitted at the intensive care unit with severe pneumonia, bronchopulmonary dysplasia, and weight-for-age z score of less than −2. She remained more than 30 days in the intensive care unit where she had a femoral venous catheter placement, enteral nutrition, broad-spectrum antibiotic therapy, and prophylaxis with fluconazole. Moreover, pericardiocentesis was performed due to cardiac tamponade. She had a previous history of prematurity, cardiac surgery due to patent ductus arteriosus, and a long period of hospital stay. Despite the antifungal prophylaxis, two yeast isolates were recovered from blood and then identified by classical mycological methods and internal transcribed spacer (ITS) sequencing as Wickerhamomyces anomalus. Both isolates exhibited susceptibility to amphotericin B, ketoconazole, itraconazole, voriconazole, and fluconazole. Her clinical state worsened, presenting anasarca, epistaxis, and hemorrhagic suffusions in the mouth, sclera, oliguria, and bradycardia. Two days after the first positive culture, she presented a gradual reduction of the white blood cells count, with severe leukopenia and neutropenia. She died five days after.
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Affiliation(s)
- Vitor Rodrigues Dutra
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Leonardo Francisco Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | | | - Emília Freitas Beirigo
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Vanessa Mello Arthur
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Raíssa Bernardes da Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | - Thatiana Bragine Ferreira
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
| | - Leonardo Andrade-Silva
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
| | - Marcos Vinícius Silva
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
| | | | - Mario León Silva-Vergara
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
| | - Kennio Ferreira-Paim
- Department of Microbiology, Immunology and Parasitology, Federal University of Triangulo Mineiro, Uberaba 38015-050, Brazil; (V.R.D.); (L.F.S.); (E.F.B.); (V.M.A.); (R.B.d.S.); (M.V.S.)
- Department of Infectious Diseases, Federal University of Triangulo Mineiro, Uberaba 38025-440, Brazil; (T.B.F.); (L.A.-S.); (M.L.S.-V.)
- Correspondence: ; Tel.: +55-34-3700-6480
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7
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Investigation of a nosocomial outbreak of fungemia caused by Candida pelliculosa (Pichia anomala) in a Korean tertiary care center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:794-801. [DOI: 10.1016/j.jmii.2017.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/11/2017] [Accepted: 05/07/2017] [Indexed: 01/05/2023]
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Fernández-Ruiz M, Guinea J, Puig-Asensio M, Zaragoza Ó, Almirante B, Cuenca-Estrella M, Aguado JM. Fungemia due to rare opportunistic yeasts: data from a population-based surveillance in Spain. Med Mycol 2016; 55:125-136. [DOI: 10.1093/mmy/myw055] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 02/22/2016] [Accepted: 05/15/2016] [Indexed: 12/18/2022] Open
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Pasqualotto AC, Sukiennik TCT, Severo LC, de Amorim CS, Colombo AL. An Outbreak ofPichia anomalaFungemia in a Brazilian Pediatric Intensive Care Unit. Infect Control Hosp Epidemiol 2016; 26:553-8. [PMID: 16018431 DOI: 10.1086/502583] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To report an outbreak ofPichia anomalafungemia that occurred in a Brazilian pediatric intensive care unit (ICU) from October 2002 to January 2004.Design:Unmatched case-control study.Methods:We randomly selected four control-patients for each case-patient from a list of all patients admitted to the ICU for at least 48 hours during the outbreak. A second control group was composed of all consecutive patients with nosocomial candidemia in the ICU during the outbreak. An environmental study was performed, and genetic relatedness among the clinical isolates was characterized by randomly amplified polymorphic DNA assay.Results:During the study period, 1,046 children were admitted to the pediatric ICU, 17 of whom developedP. anomalafungemia (attack rate, 1.6%). The median age was 1.1 years, and the main underlying conditions were congenital malformations (35.3%) and neoplastic diseases (11.8%). The overall mortality rate was 41.2%. Two patients received no antifungal treatment; all of the others were treated with amphotericin B. On multivariate analysis, only the presence of a central venous catheter was significantly associated withP. anomalafungemia. The yeast was not found on healthcare workers' hands or in the environment. Molecular studies showed that the outbreak was caused by a single strain. The distribution of risk factors was similar between patients withP. anomalafungemia and control-patients with candidemia.Conclusions:This study highlights the importance ofP. anomalaas an emerging nosocomial fungal pathogen. Patients withP. anomalafungemia seem to have risk factors in common with those who have candidemia.
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Kamoshita M, Matsumoto Y, Nishimura K, Katono Y, Murata M, Ozawa Y, Shimmura S, Tsubota K. Wickerhamomyces anomalus fungal keratitis responds to topical treatment with antifungal micafungin. J Infect Chemother 2014; 21:141-3. [PMID: 25239058 DOI: 10.1016/j.jiac.2014.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/29/2014] [Accepted: 08/18/2014] [Indexed: 11/17/2022]
Abstract
We describe a 91-year-old woman who suffered from fungal keratitis after corneal transplantation. The causative organism was identified as Wickerhamomyces anomalus (formerly Pichia anomala or Hansenula anomala) on the basis of morphological characteristics and the sequence of the internal transcribed spacer region of the ribosomal RNA gene. The patient was successfully treated with topical micafungin (MCFG) only. We present the first report of a case of W. anomalus fungal keratitis that responded to topical treatment with the antifungal MCFG.
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Affiliation(s)
- Mamoru Kamoshita
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | | | | | - Yasuhiro Katono
- Department of Microbiology, Central Clinical Laboratory, Keio University Hospital, Japan
| | - Mitsuru Murata
- Department of Microbiology, Central Clinical Laboratory, Keio University Hospital, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Japan
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11
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Lin HC, Lin HY, Su BH, Ho MW, Ho CM, Lee CY, Lin MH, Hsieh HY, Lin HC, Li TC, Hwang KP, Lu JJ. Reporting an outbreak of Candida pelliculosa fungemia in a neonatal intensive care unit. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 46:456-62. [DOI: 10.1016/j.jmii.2012.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/13/2012] [Accepted: 07/20/2012] [Indexed: 10/27/2022]
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13
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Pemán J, Salavert M, Cantón E, Jarque I, Romá E, Zaragoza R, Viudes Á, Gobernado M. Voriconazole in the management of nosocomial invasive fungal infections. Ther Clin Risk Manag 2011; 2:129-58. [PMID: 18360588 PMCID: PMC1661660 DOI: 10.2147/tcrm.2006.2.2.129] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Voriconazole is a new triazole developed for the treatment of life-threatening fungal infections. The drug is available for both oral and intravenous administration; the oral formulation has excellent bioavailability. The side-effect profile of voriconazole presents an acceptable safety and tolerability spectrum: transient visual disturbances, liver enzyme abnormalities, and skin rashes are the most frequently reported side effects but rarely lead to discontinuation. The potential for drug–drug interactions is high, because of its extensive hepatic metabolism. Careful attention to dosage is required, and serum levels and the effects of interacting drugs should be monitored. Review of 25 470 isolates of yeasts and 3216 isolates of filamentous fungi showed voriconazole to have broad-spectrum activity against pathogenic yeasts including intrinsically fluconazole-resistant isolates such as Candida krusei, dimorphic fungi, and opportunistic moulds like Aspergillus spp, amphotericin-B-resistant Aspergillus terreus, Fusarium spp, and Scedosporium apiospermum. It displays excellent clinical efficacy in patients with fluconazole-resistant and -susceptible Candida infections, invasive bone and central nervous system aspergillosis, and various refractory fungal infections. Voriconazole has been approved by the US Food and Drug Administration and by the European Medicines Agency for the treatment of invasive aspergillosis, serious infections caused by Fusarium and S. apiospermum, fluconazole-resistant invasive Candida infections, and candidemia in nonneutropenic patients.
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Affiliation(s)
- Javier Pemán
- Microbiology Department, Hospital Universitario La FeValencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario La FeValencia, Spain
| | - Emilia Cantón
- Experimental Microbiology Unit, Hospital Universitario La FeValencia, Spain
| | - Isidro Jarque
- Hematology Department, Hospital Universitario La FeValencia, Spain
| | - Eva Romá
- Pharmacy Department, Hospital Universitario La FeValencia, Spain
| | - Rafael Zaragoza
- Intensive Care Unit, Hospital Universitario Dr. PesetValencia, Spain
| | | | - Miguel Gobernado
- Microbiology Department, Hospital Universitario La FeValencia, Spain
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15
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Miceli MH, Díaz JA, Lee SA. Emerging opportunistic yeast infections. THE LANCET. INFECTIOUS DISEASES 2011; 11:142-51. [PMID: 21272794 DOI: 10.1016/s1473-3099(10)70218-8] [Citation(s) in RCA: 547] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Marisa H Miceli
- Department of Internal Medicine, Oakwood Hospital and Medical Center, Dearborn, MI, USA
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van Saene HK, Silvestri L, de la Cal MA, Gullo A. Outbreaks of Infection in the ICU: What’s up at the Beginning of the Twenty-First Century? INFECTION CONTROL IN THE INTENSIVE CARE UNIT 2011. [PMCID: PMC7120292 DOI: 10.1007/978-88-470-1601-9_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Hendrick K.F. van Saene
- , Institute of Aging and Chronic Diseases, University Liverpool, Daulby Street, Liverpool, L69 3GA United Kingdom
| | - Luciano Silvestri
- , Dept. Emergency, Hospital Gorizia, Via Vittorio Veneto 171, Gorizia, 34170 Italy
| | - Miguel A. de la Cal
- , Department of Intensive Care Medicine, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, 28045 Spain
| | - Antonino Gullo
- Policlinico di Catania, UCO di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria, Via Santa Sofia 78, Catania, 95100 Italy
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17
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Ricci I, Mosca M, Valzano M, Damiani C, Scuppa P, Rossi P, Crotti E, Cappelli A, Ulissi U, Capone A, Esposito F, Alma A, Mandrioli M, Sacchi L, Bandi C, Daffonchio D, Favia G. Different mosquito species host Wickerhamomyces anomalus (Pichia anomala): perspectives on vector-borne diseases symbiotic control. Antonie van Leeuwenhoek 2010; 99:43-50. [PMID: 21113816 DOI: 10.1007/s10482-010-9532-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 11/15/2010] [Indexed: 11/30/2022]
Abstract
The genetic manipulation of the microbial community associated with hematophagus insects is particularly relevant for public health applications. Within mosquito populations, this relationship has been overlooked until recently. New advances in molecular biotechnology propose the genetic manipulation of mosquito symbionts to prevent the transmission of pathogens to humans by interfering with the obligatory life cycle stages within the insect through the use of effector molecules. This approach, defined as 'paratransgenesis', has opened the way for the investigation and characterization of microbes residing in the mosquito body, particularly those localised within the gut. Some interesting bacteria have been identified as candidates for genetic modification, however, endosymbiotic yeasts remain largely unexplored with little information on the symbiotic relationships to date. Here we review the recent report of symbiotic relationship between Wickerhamomyces anomalus (Pichia anomala) and several mosquito vector species as promising methods to implement control of mosquito-borne diseases.
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Affiliation(s)
- Irene Ricci
- Scuola di Bioscienze e Biotecnologie, Università degli Studi di Camerino, 62032 Camerino, Italy
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18
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Wickerhamomyces anomalus in the sourdough microbial ecosystem. Antonie van Leeuwenhoek 2010; 99:63-73. [DOI: 10.1007/s10482-010-9517-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/30/2010] [Indexed: 11/30/2022]
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19
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Diekema DJ, Messer SA, Boyken LB, Hollis RJ, Kroeger J, Tendolkar S, Pfaller MA. In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods. J Clin Microbiol 2009; 47:3170-7. [PMID: 19710283 PMCID: PMC2756931 DOI: 10.1128/jcm.00942-09] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 06/22/2009] [Accepted: 08/12/2009] [Indexed: 01/09/2023] Open
Abstract
Five Candida species (C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei) account for over 95% of invasive candidiasis cases. Some less common Candida species have emerged as causes of nosocomial candidiasis, but there is little information about their in vitro susceptibilities to antifungals. We determined the in vitro activities of fluconazole, voriconazole, posaconazole, amphotericin B, anidulafungin, caspofungin, and micafungin against invasive, unique patient isolates of Candida collected from 100 centers worldwide between January 2001 and December 2007. Antifungal susceptibility testing was performed by the CLSI M27-A3 method. CLSI breakpoints for susceptibility were used for fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin, while a provisional susceptibility breakpoint of < or = 1 microg/ml was used for amphotericin and posaconazole. Of 14,007 Candida isolates tested, 658 (4.7%) were among the less common species. Against all 658 isolates combined, the activity of each agent, expressed as the MIC50/MIC90 ratio (and the percentage of susceptible isolates) was as follows: fluconazole, 1/4 (94.8%); voriconazole, 0.03/0.12 (98.6%); posaconazole, 0.12/0.5 (95.9%); amphotericin, 0.5/2 (88.3%); anidulafungin, 0.5/2 (97.4%); caspofungin, 0.12/0.5 (98.0%); and micafungin, 0.25/1 (99.2%). Among the isolates not susceptible to one or more of the echinocandins, most (68%) were C. guilliermondii. All isolates of the less common species within the C. parapsilosis complex (C. orthopsilosis and C. metapsilosis) were susceptible to voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin. Over 95% of clinical isolates of the rare Candida species were susceptible to the available antifungals. However, activity did vary by drug-species combination, with some species (e.g., C. rugosa and C. guilliermondii) demonstrating reduced susceptibilities to commonly used agents such as fluconazole and echinocandins.
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Affiliation(s)
- D J Diekema
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA
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20
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Chakrabarti A, Chatterjee SS, Rao KLN, Zameer MM, Shivaprakash MR, Singhi S, Singh R, Varma SC. Recent experience with fungaemia: change in species distribution and azole resistance. ACTA ACUST UNITED AC 2009; 41:275-84. [PMID: 19229762 DOI: 10.1080/00365540902777105] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Owing to a rise in frequency and change in pattern of cases with fungaemia at our tertiary care centre, we conducted a prospective study for 4 months to understand the epidemiology and outcome of this infection. Detailed case histories including management protocol and outcomes were noted. Records of 140 cases with fungaemia (27.1% adult and 72.9% paediatric patients) were analysed. Although C. tropicalis was the most common yeast isolated, significantly higher isolation of C. guilliermondii (30.4%) and C. pelliculosa (17.6%) was noted in paediatric patients; and C. albicans (26.3%) and C. glabrata (10.5%) in adult patients. Rare species isolated included C. ustus (0.7%) and Trichosporon asahii (2.1%). Mortality was high (56.9% and 47.4%, respectively), in both groups of patients. Resistance to azoles (fluconazole, itraconazole, voriconazole) emerged in C. albicans (12.5-18.8%) and C. tropicalis (10.2-13.6%). Antifungal susceptibility testing report modified the therapy from fluconazole to amphotericin B in 8 patients; 5 survived. In conclusion, the study highlighted the rise of non-albicans Candida species in our hospital with differential distribution in paediatric and adult wards and emergence of azole resistance.
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Affiliation(s)
- Arunaloke Chakrabarti
- Departments of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012,India.
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22
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Bhardwaj S, Sutar R, Bachhawat AK, Singhi S, Chakrabarti A. PCR-based identification and strain typing of Pichia anomala using the ribosomal intergenic spacer region IGS1. J Med Microbiol 2007; 56:185-189. [PMID: 17244798 DOI: 10.1099/jmm.0.46790-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Frequent outbreaks of Pichia anomala fungaemia in paediatric patients have warranted the development of a rapid identification system for this organism. This study describes a specific PCR-based method targeting the rRNA gene intergenic spacer region 1 (IGS1) for rapid identification of Pichia anomala isolates and characterization at the strain level. These methods of species identification and strain typing were used on 106 isolates of Pichia anomala (77 from a previously described outbreak and 29 isolated post-outbreak from the same hospital). Using conventional morphological and biochemical methods, 11 strains isolated during the outbreak were misidentified as P. anomala. blast analysis of sequences of internal transcribed spacer (ITS) regions of rRNA genes confirmed that they were Pichia guilliermondii (eight isolates) and Debaryomyces hansenii (three isolates). Strain typing of Pichia anomala isolates confirmed the previous finding of a point-source outbreak. The results suggest that IGS sequences and their polymorphisms could be exploited for similar typing methods in other organisms.
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Affiliation(s)
- Sonia Bhardwaj
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajeshwari Sutar
- Institute of Microbial Technology, Sector 39-A, Chandigarh 160036, India
| | - Anand K Bachhawat
- Institute of Microbial Technology, Sector 39-A, Chandigarh 160036, India
| | - Sunit Singhi
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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23
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Paula CR, Krebs VLJ, Auler ME, Ruiz LS, Matsumoto FE, Silva EH, Diniz EMA, Vaz FAC. Nosocomial infection in newborns by Pichia anomala in a Brazilian intensive care unit. Med Mycol 2006; 44:479-84. [PMID: 16882616 DOI: 10.1080/13693780600561809] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Disseminated candidiasis is the most common nosocomial fungal infection, and Candida albicans has been reported to account for 50% to more than 70% of cases of invasive candidiasis. However, recent reports have also suggested the emergence of infections caused by non-albicans species. In addition, less-common pathogenic yeasts (Malassezia, Trichosporon, Rhodotorula, Debaryomyces and Pichia) have recently been reported, with increased frequency, as causes of nosocomial infections with high mortality. This article describes two cases of fungemia caused by Pichia anomala in newborns that occurred in an intensive care unit (ICU), in November 2004 at the Instituto da Criança (Pediatric Institute) of the Hospital das Clínicas of the School of Medicine, São Paulo University, Brazil. The principal factors related to virulence (proteinase and phospholipase) and the susceptibility of the isolated strains to antifungal agents were also evaluated, and the biotype of each strain was determined through the use of an epidemiological marker (killer biotype).
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MESH Headings
- Antifungal Agents/pharmacology
- Brazil/epidemiology
- Catheterization/adverse effects
- Cross Infection/epidemiology
- Cross Infection/microbiology
- DNA, Fungal/genetics
- Drug Therapy, Combination
- Fatal Outcome
- Female
- Fungemia/epidemiology
- Fungemia/microbiology
- Gestational Age
- Hospitals, University
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/microbiology
- Intensive Care Units, Pediatric
- Killer Factors, Yeast
- Microbial Sensitivity Tests
- Molecular Epidemiology
- Mycoses/epidemiology
- Mycoses/microbiology
- Mycotoxins/pharmacology
- Peptide Hydrolases/metabolism
- Phospholipases/metabolism
- Pichia/classification
- Pichia/drug effects
- Pichia/isolation & purification
- Pichia/physiology
- Polymerase Chain Reaction
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Affiliation(s)
- Claudete R Paula
- Departamento de Microbiologia, Instituto de Ciências Biomédicas II, Universidade de São Paulo, São Paulo, Brasil.
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24
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Zaragoza R, Pemán J. Infección fúngica invasora en el paciente crítico: diferentes opciones terapéuticas y una misma estrategia. Rev Iberoam Micol 2006; 23:59-63. [PMID: 16854178 DOI: 10.1016/s1130-1406(06)70014-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The high morbidity, mortality, and healthcare costs associated with the invasive fungal infections, especially in the critical care setting, is of importance since the prophylactic, empiric, and pre-emptive therapy interventions, based on early identification of risk factors, is of common occurrence. In the last years alone there have been important developments in antifungal pharmacotherapy. Evidence-based studies using new antifungal agents are now emerging as important players in the pharmacotherapy of invasive fungal infections in seriously ill and difficult patients. However, data on critically ill patients are more limited and usually recovered from general studies. This study shows the benefits obtained by the new antifungal agents on different clinical situations in critical care units. The increasing number of non-C. albicans species and the high mortality rates in these settings suggest that the application of early de-escalation therapy in critically ill patients with fungal infection should be mandatory. The possibility of using antifungal combination therapy in these types of patients should be considered.
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Affiliation(s)
- Rafael Zaragoza
- Intensive Care Unit, Hospital Universitario Peset, Av. Gaspar Aguilar 90, 46017 Valencia, Spain.
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25
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Sutar R, David JK, Ganesan K, Ghosh AK, Singhi S, Chakrabarti A, Bachhawat AK. Comparison of ITS and IGS1 regions for strain typing of clinical and non-clinical isolates of Pichia anomala. J Med Microbiol 2004; 53:119-123. [PMID: 14729932 DOI: 10.1099/jmm.0.05436-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pichia anomalais an emerging nosocomial pathogen and there is a need for methods that distinguish between differentP. anomalastrains. In the typing of several clinical as well as non-clinicalP. anomalastrains, the sequence variation of the internal transcribed spacer (ITS) was found to be inadequate for typing purposes. The intergenic spacer 1 (IGS1) region of the rDNA of severalP. anomalastrains was therefore investigated in detail. The IGS1 region (which varied from 1213 to 1231 bp in length) was interspersed with repeats and had more variation than the ITS regions. Comparative analysis in cases where analysis by the ITS was ambiguous clearly revealed the IGS1 region to be a more discriminatory tool in the typing ofP. anomalastrains.
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Affiliation(s)
- Rajeshwari Sutar
- Institute of Microbial Technology, Sector 39-A, Chandigarh, India 160 036 2Postgraduate Institute of Medical Education and Research, Chandigarh, India 160 012
| | - Joseph K David
- Institute of Microbial Technology, Sector 39-A, Chandigarh, India 160 036 2Postgraduate Institute of Medical Education and Research, Chandigarh, India 160 012
| | - K Ganesan
- Institute of Microbial Technology, Sector 39-A, Chandigarh, India 160 036 2Postgraduate Institute of Medical Education and Research, Chandigarh, India 160 012
| | - Anup K Ghosh
- Institute of Microbial Technology, Sector 39-A, Chandigarh, India 160 036 2Postgraduate Institute of Medical Education and Research, Chandigarh, India 160 012
| | - Sunit Singhi
- Institute of Microbial Technology, Sector 39-A, Chandigarh, India 160 036 2Postgraduate Institute of Medical Education and Research, Chandigarh, India 160 012
| | - Arunaloke Chakrabarti
- Institute of Microbial Technology, Sector 39-A, Chandigarh, India 160 036 2Postgraduate Institute of Medical Education and Research, Chandigarh, India 160 012
| | - Anand K Bachhawat
- Institute of Microbial Technology, Sector 39-A, Chandigarh, India 160 036 2Postgraduate Institute of Medical Education and Research, Chandigarh, India 160 012
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