1
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Filigheddu MT, Leonelli M, Varando G, Gómez-Bermejo MÁ, Ventura-Díaz S, Gorospe L, Fortún J. Using staged tree models for health data: Investigating invasive fungal infections by aspergillus and other filamentous fungi. Comput Struct Biotechnol J 2024; 24:12-22. [PMID: 38144574 PMCID: PMC10746417 DOI: 10.1016/j.csbj.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Machine learning models are increasingly used in the medical domain to study the association between risk factors and diseases to support practitioners in understanding health outcomes. In this paper, we showcase the use of machine-learned staged tree models for investigating complex asymmetric dependence structures in health data. Staged trees are a specific class of generative, probabilistic graphical models that formally model asymmetric conditional independence and non-regular sample spaces. An investigation of the risk factors in invasive fungal infections demonstrates the insights staged trees provide to support medical decision-making.
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Affiliation(s)
- Maria Teresa Filigheddu
- Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS (Instituto Ramón y Cajal de Investigación Sanitaria); Universidad de Alcalá, Madrid, Spain
| | | | - Gherardo Varando
- Image Processing Laboratory (IPL), Universitat de València, Valencia, Spain
| | | | - Sofía Ventura-Díaz
- Radiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis Gorospe
- Radiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesús Fortún
- Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS (Instituto Ramón y Cajal de Investigación Sanitaria); Universidad de Alcalá, Madrid, Spain
- Microbiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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2
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Wolfgruber S, Sedik S, Klingspor L, Tortorano A, Gow NAR, Lagrou K, Gangneux JP, Maertens J, Meis JF, Lass-Flörl C, Arikan-Akdagli S, Cornely OA, Hoenigl M. Insights from Three Pan-European Multicentre Studies on Invasive Candida Infections and Outlook to ECMM Candida IV. Mycopathologia 2024; 189:70. [PMID: 39088098 DOI: 10.1007/s11046-024-00871-0] [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: 04/11/2024] [Accepted: 06/20/2024] [Indexed: 08/02/2024]
Abstract
Invasive candidiasis and candidemia remain a significant public health concern. The European Confederation of Medical Mycology (ECMM) conducted three pan-European multicentre studies from 1997 to 2022 to investigate various aspects of invasive Candida infections. These studies revealed shifting trends in Candida species distribution, with an increase of non-albicans Candida species as causative pathogens, increasing rates of antifungal resistance, and persistently high mortality rates. Despite advancements in antifungal treatment, the persistently high mortality rate and increasing drug resistance, as well as limited drug access in low-income countries, underscore the need for continued research and development in the treatment of Candida infections. This review aims to summarize the findings of the three completed ECMM Candida studies and emphasize the importance of continued research efforts. Additionally, it introduces the upcoming ECMM Candida IV study, which will focus on assessing candidemia caused by non-albicans Candida species, including Candida auris, investigating antifungal resistance and tolerance, and evaluating novel treatment modalities on a global scale.
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Affiliation(s)
- Stella Wolfgruber
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Sarah Sedik
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Lena Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annamaria Tortorano
- Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Neil A R Gow
- Medical Research Council Centre for Medical Mycology, Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, UK
| | - Katrien Lagrou
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, UZ Leuven, Leuven, Belgium
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, 35000, Rennes, France
- Laboratory of Mycology, Centre Hospitalier Universitaire de Rennes, Centre National de référence pour les mycoses et antifongiques - LA AspC, ECMM Excellence Center for Medical Mycology, Rennes, France
| | - Johan Maertens
- Department of Haematology and ECMM Excellence Center for Medical Mycology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Jacques F Meis
- Department of Medical Microbiology, Excellence Center for Medical Mycology (ECMM), Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology Medical University of Innsbruck, Excellence Center for Medical Mycology (ECMM), Innsbruck, Austria
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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3
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Nakamura Y, Zaimoku Y, Yamaguchi H, Yamazaki H, Kanaya M, Uchida N, Doki N, Sakurai M, Hiramoto N, Kako S, Onizuka M, Onodera K, Maruyama Y, Ohigashi H, Nishida T, Yoshihara S, Matsuoka KI, Eto T, Kanda Y, Fukuda T, Atsuta Y, Onishi Y. Significance of absolute neutrophil count before allogeneic hematopoietic stem cell transplantation in adult patients with aplastic anemia. Ann Hematol 2024; 103:3121-3133. [PMID: 38750374 DOI: 10.1007/s00277-024-05800-1] [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: 01/27/2024] [Accepted: 05/10/2024] [Indexed: 07/28/2024]
Abstract
The impact of absolute neutrophil count (ANC) before allogenic hematopoietic stem cell transplantation (HSCT) on the outcomes for patients with aplastic anemia (AA) remains unclear. We retrospectively evaluated the relationship between ANC before transplantation and patient outcomes, involving 883 adult Japanese patients with AA who underwent allogeneic HSCT as their first transplantation between 2008 and 2020. Patients were divided into three groups based on ANC: 0/µL (n = 116); 1-199 (n = 210); and ≥ 200 (n = 557). In the low ANC groups (ANC < 200), patient age was higher, previous anti-thymocyte globulin (ATG) treatments were infrequent, duration from diagnosis to transplantation was shorter, hematopoietic cell transplantation-comorbidity index (HCT-CI) was higher, ATG-based conditioning was used infrequently, and peripheral blood stem cell from related donor and cord blood were used frequently. In multivariate analysis, patient age, previous ATG treatment, HCT-CI, stem cell source, and ANC before transplantation were significantly associated with 5-year overall survival (OS) ("ANC ≥ 200": 80.3% vs. "ANC 1-199": 71.7% vs. "ANC 0": 64.4%). The cumulative incidence of bacterial infection, invasive fungal disease, and early death before engraftment were significantly higher in the low ANC groups. Among patients with ANC of zero before transplantation, younger patient age, shorter duration from diagnosis to transplantation, HCT-CI of 0, and bone marrow from related donor as stem cell source were significantly associated with better OS. Consequently, ANC before allogeneic HSCT was found to be a significant prognostic factor in adult patients with AA. Physicians should pay attention to ANC before transplantation.
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Affiliation(s)
- Yukinori Nakamura
- Third Department of Internal Medicine, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Yoshitaka Zaimoku
- Department of Infection Control and Prevention, Kanazawa University Hospital, Ishikawa, Japan
| | | | - Hirohito Yamazaki
- Division of Transfusion Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Minoru Kanaya
- Blood Disorders Center, Aiiku Hospital, Hokkaido, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Makoto Onizuka
- Department of Hematology/Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Koichi Onodera
- Department of Hematology, Tohoku University Hospital, Miyagi, Japan
| | - Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Hiroyuki Ohigashi
- Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan
| | - Tetsuya Nishida
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Satoshi Yoshihara
- Department of Hematology, Hyogo Medical University Hospital, Hyogo, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
- Division of Hematology, Jichi Medical University, Tochigi, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan
- Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan
| | - Yasushi Onishi
- Department of Hematology, Tohoku University Hospital, Miyagi, Japan
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4
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Bassetti M, Vena A, Bavastro M, Giacobbe DR. Optimizing Antifungal Treatment Strategies to Prevent Invasive Pulmonary Aspergillosis Infection-Related Deaths in Intensive Care Unit Patients: The Need for Standardization of Research Definitions. Mycopathologia 2024; 189:69. [PMID: 39066809 PMCID: PMC11283379 DOI: 10.1007/s11046-024-00879-6] [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: 05/31/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
The clinical spectrum of invasive pulmonary aspergillosis (IPA) has expanded in recent decades. A large group of patients admitted to intensive care units (ICU) is indeed susceptible to the development of IPA. Although timely diagnosis and antifungal therapy of IPA in this expanding population is crucial to prevent IPA-related deaths, the magnitude of the favorable prognostic impact of antifungal therapy is difficult to measure precisely. In our opinion, the development of standardized research definitions could have favorable implications for further improving our ability both to measure the favorable effect of antifungal treatment and to prevent IPA-related death in ICU patients.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | - Martina Bavastro
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy.
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Paw Cho Sing E, Tomlinson GA, Schechter T, Ali M, Phelan R, Rassekh SR, McKinnon K, Bier GA, van de Wetering M, Gomez S, Sung L, Dupuis LL. Impact of dexamethasone on transplant-related mortality in pediatric patients: a multi-site, propensity score-weighted, retrospective assessment. Support Care Cancer 2024; 32:552. [PMID: 39052128 DOI: 10.1007/s00520-024-08732-8] [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: 12/13/2023] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
Dexamethasone use during hematopoietic cell transplant (HCT) conditioning varies between pediatric centers. This study aimed to estimate the difference in 1-year treatment-related mortality (TRM) between patients who did or did not receive dexamethasone during HCT conditioning. Secondary objectives were to estimate the difference between dexamethasone-exposed and dexamethasone-unexposed groups in 1-year event-free survival (EFS), time to neutrophil engraftment, acute graft-versus-host disease (aGVHD), and invasive fungal disease (IFD) at day + 100. This was a seven-site, international, retrospective cohort study. Patients < 18 years old undergoing their first allogeneic or autologous myeloablative HCT for hematologic malignancy or aplastic anemia between January 1, 2012, and July 31, 2017, were included. To control for potential confounders, propensity score weighting was used to calculate the standardized mean difference for all endpoints. Among 242 patients, 140 received dexamethasone during HCT conditioning and 102 did not. TRM was unaffected by dexamethasone exposure (1.7%; 95% CI - 7.4, 10.2%). Between-group differences in secondary outcomes were small. However, dexamethasone exposure significantly increased possible, probable, and proven IFD incidence (9.0%, 95% CI 0.8, 17.3%). TRM is not increased in pediatric patients who receive dexamethasone during HCT conditioning. Clinicians should consider potential IFD risk when selecting chemotherapy-induced vomiting prophylaxis for pediatric HCT patients.
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Affiliation(s)
- Edric Paw Cho Sing
- Neonatal and Pediatric Pharmacy, Surrey Memorial Hospital, Surrey, BC, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Muhammad Ali
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Rachel Phelan
- Division of Hematology and Oncology, Department of Pediatrics, Medical College of Wisconsin, Madison, USA
| | - S Rod Rassekh
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Krista McKinnon
- Pharmacy Services, Alberta Children's Hospital, Calgary, AB, Canada
| | - Gefen Aldouby Bier
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem and Department of Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marianne van de Wetering
- Paediatric Oncology Department, Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Sergio Gomez
- Stem Cell Transplantation Unit, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - L Lee Dupuis
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Pharmacy, Leslie Dan Faculty of Pharmacy, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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6
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Wang H, Yu D, Chen X, Zhou Y, Qian X, Liu D, Wang L, Tang Y, Wang M. Performance of rapid on-site evaluation of touch imprints of bronchoscopic biopsies or lung tissue biopsies for the diagnosis of invasive pulmonary filamentous fungi infections in non-neutropenic patients. J Clin Microbiol 2024; 62:e0047924. [PMID: 38856218 PMCID: PMC11250116 DOI: 10.1128/jcm.00479-24] [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: 04/03/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
The diagnosis of invasive pulmonary fungal disease depends on histopathology and mycological culture; there are few studies on touch imprints of bronchoscopic biopsies or lung tissue biopsies for the diagnosis of pulmonary filamentous fungi infections. The purpose of the present study was to explore the detection accuracy of rapid on-site evaluation of touch imprints of bronchoscopic biopsies or lung tissue biopsies for the filamentous fungi, and it aims to provide a basis for initiating antifungal therapy before obtaining microbiological evidence. We retrospectively analyzed the diagnosis and treatment of 44 non-neutropenic patients with invasive pulmonary filamentous fungi confirmed by glactomannan assay, histopathology, and culture from February 2017 to December 2023. The diagnostic positive rate and sensitivity of rapid on-site evaluation for these filamentous fungi identification, including diagnostic turnaround time, were calculated. Compared with the final diagnosis, the sensitivity of rapid on-site evaluation was 81.8%, and the sensitivity of histopathology, culture of bronchoalveolar lavage fluid, and glactomannan assay of bronchoalveolar lavage fluid was 86.4%, 52.3%, and 68.2%, respectively. The average turnaround time of detecting filamentous fungi by rapid on-site evaluation was 0.17 ± 0.03 hours, which was significantly faster than histopathology, glactomannan assay, and mycological culture. A total of 29 (76.3%) patients received earlier antifungal therapy based on ROSE diagnosis and demonstrated clinical improvement. Rapid on-site evaluation showed good sensitivity and accuracy that can be comparable to histopathology in identification of pulmonary filamentous fungi. Importantly, it contributed to the triage of biopsies for further microbial culture or molecular detection based on the preliminary diagnosis, and the decision on early antifungal therapy before microbiological evidence is available.
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Affiliation(s)
- Hansheng Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Dan Yu
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xiao Chen
- Department of Laboratory, Shiyan Maternal and Child Health Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yanhui Zhou
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xin Qian
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Lei Wang
- Department of Laboratory, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yijun Tang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Meifang Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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7
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Carelli S, Posteraro B, Torelli R, De Carolis E, Vallecoccia MS, Xhemalaj R, Cutuli SL, Tanzarella ES, Dell'Anna AM, Lombardi G, Cammarota F, Caroli A, Grieco DL, Sanguinetti M, Antonelli M, De Pascale G. Prognostic value of serial (1,3)-β-D-glucan measurements in ICU patients with invasive candidiasis. Crit Care 2024; 28:236. [PMID: 38997712 PMCID: PMC11241937 DOI: 10.1186/s13054-024-05022-x] [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: 05/06/2024] [Accepted: 07/06/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND To determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis. METHODS Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered. RESULTS In the study population of 103 patients (age 47 [35-62] years, SAPS II score 67 [52-77]) 68 bloodstream and 35 intrabdominal infections were recorded. Serial measurements showed that in 54 patients BDG decreased over time (BDG downslope group) while in 49 did not (N-BDG downslope group). Candida albicans was the pathogen most frequently isolated (61%) followed by C. parapsilosis (17%) and C. glabrata (12%), in absence of any inter-group difference. Invasive candidiasis related mortality was lower in BDG downslope than in N-BDG downslope group (17% vs 53%, p < 0.01). The multivariate Cox regression analysis showed the association of septic shock at infection occurrence and chronic liver disease with invasive candidiasis mortality (HR [95% CI] 3.24 [1.25-8.44] p = 0.02 and 7.27 [2.33-22.66] p < 0.01, respectively) while a BDG downslope was the only predictor of survival (HR [95% CI] 0.19 [0.09-0.43] p < 0.01). The area under the receiver operator characteristic curve for the performance of BDG downslope as predictor of good clinical outcome was 0.74 (p = 0.02) and our model showed that a BDG downslope > 70% predicted survival with both specificity and positive predictive value of 100%. CONCLUSIONS A decrease in serum BDG was associated with reduced mortality and a steep downslope predicted survival with high specificity in invasive candidiasis.
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Affiliation(s)
- Simone Carelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Brunella Posteraro
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena De Carolis
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Sole Vallecoccia
- Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care, Santa Maria Nuova Hospital, Florence, Italy
| | - Rikardo Xhemalaj
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Lucio Cutuli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloisa Sofia Tanzarella
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Maria Dell'Anna
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianmarco Lombardi
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabiola Cammarota
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Caroli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Luca Grieco
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Marjańska A, Pogorzała M, Dziedzic M, Czyżewski K, Richert-Przygońska M, Dębski R, Bogiel T, Styczyński J. Impact of prophylaxis with rituximab on EBV-related complications after allogeneic hematopoietic cell transplantation in children. Front Immunol 2024; 15:1427637. [PMID: 39055711 PMCID: PMC11269116 DOI: 10.3389/fimmu.2024.1427637] [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: 05/04/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Background Children undergoing allo-HCT are at high risk of EBV-related complications. The objective of the study was to analyze the impact of prophylactic post-transplant rituximab on EBV infection and EBV-PTLD in children after allo-HCT, to determine the risk factors for the development of EBV infection and EBV-PTLD and to determine their outcomes. Additionally, the impact of EBV-driven complications on transplant outcomes was analyzed. Methods Single center retrospective analysis of EBV-related complications in pediatric population undergoing allo-HCT, based on strategy of prophylaxis with rituximab. Overall 276 consecutive children, including 122 on prophylaxis, were analyzed for EBV-driven complications and transplant outcomes. Results Prophylaxis with rituximab resulted in significant reduction of EBV infection (from 35.1% to 20.5%; HR=2.7; p<0.0001), and EBV-PTLD (from 13.0% to 3.3%; HR=0.23; p=0.0045). A trend for improved survival was also observed (HR=0.66; p=0.068), while non-relapse mortality was comparable in both cohorts. The peak value of viral load was a risk factor in the development of EBV-PTLD: 10-fold higher peak viral load in comparison to the baseline 104 copies/mL, caused a 3-fold (HR=3.36; p<0.001) increase in the risk of EBV-PTLD. Rituximab treatment was effective as a preemptive therapy in 91.1%, and in 70.9% in EBV-PTLD. Patients who developed PTLD had dismal 5-year overall survival (29% vs 60%; p<0.001), and an increased risk of relapse (72% vs 35%; p=0.024). Conclusions Rituximab for prophylaxis of EBV infection and EBV-PTLD was highly effective in pediatric population. Treatment of EBV-PTLD was successful in 70%, however the occurrence of EBV-PTLD was associated with an increased risk of relapse of primary malignant disease.
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Affiliation(s)
- Agata Marjańska
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Monika Pogorzała
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Monika Richert-Przygońska
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Robert Dębski
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - Tomasz Bogiel
- Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
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9
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Bettelli F, Vallerini D, Lagreca I, Barozzi P, Riva G, Nasillo V, Paolini A, D'Amico R, Forghieri F, Morselli M, Pioli V, Gilioli A, Giusti D, Messerotti A, Bresciani P, Cuoghi A, Colaci E, Marasca R, Pagano L, Candoni A, Maertens J, Viale P, Mussini C, Manfredini R, Tagliafico E, Sarti M, Trenti T, Lewis R, Comoli P, Eccher A, Luppi M, Potenza L. Identification and validation of diagnostic cut-offs of the ELISpot assay for the diagnosis of invasive aspergillosis in high-risk patients. PLoS One 2024; 19:e0306728. [PMID: 38980880 PMCID: PMC11233002 DOI: 10.1371/journal.pone.0306728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/21/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE We investigated the performance of enzyme linked immunospot (ELISpot) assay for the diagnosis of invasive aspergillosis (IA) in high-risk patients with hematologic malignancies. METHODS We prospectively enrolled two cohorts of patients undergoing intensive myelosuppressive or immunosuppressive treatments at high risk for IA. ELISpot was performed to detect Aspergillus-specific T cells producing Interleukin-10. RESULTS In the discovery cohort, a derived cut-off of 40 spot forming cells (SFCs)/106 PBMCs has shown to correctly classify IA cases with a sensitivity and specificity of 89.5% and 88.6%, respectively. This cut-off is lowered to 25 SFC when considering the subset of possible IA patients, with sensitivity and specificity of 76% and 93%, respectively. The application of the 40 SFCs cut-off to the validation cohort resulted in a positivity rate of 83.3% in proven/probable cases and a negativity rate of 92.5% in possible/non-IA cases. Adopting the 25 SCFs cut-off, the assay resulted positive in 83.3% of proven/probable cases while it resulted negative in 66.7% of possible/non-IA cases. CONCLUSIONS ELISpot shows promises in the diagnosis of IA and the possibility to use two distinct cut-offs with similar diagnostic performances according to patients' different pre-test probability of infection can widen its use in patients at risk.
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Affiliation(s)
- Francesca Bettelli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Daniela Vallerini
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Ivana Lagreca
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Patrizia Barozzi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Giovanni Riva
- Diagnostic Hematology and Clinical Genomics, Department of Laboratory Medicine and Pathology, AUSL/AOU Modena, Modena, Italy
| | - Vincenzo Nasillo
- Diagnostic Hematology and Clinical Genomics, Department of Laboratory Medicine and Pathology, AUSL/AOU Modena, Modena, Italy
| | - Ambra Paolini
- Diagnostic Hematology and Clinical Genomics, Department of Laboratory Medicine and Pathology, AUSL/AOU Modena, Modena, Italy
| | - Roberto D'Amico
- Statistic Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Fabio Forghieri
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Monica Morselli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Valeria Pioli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Andrea Gilioli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Davide Giusti
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Andrea Messerotti
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Paola Bresciani
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Angela Cuoghi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Elisabetta Colaci
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Roberto Marasca
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Livio Pagano
- Hematology Division, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Candoni
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Johan Maertens
- Department of Hematology, University Hospital UZ Leuven, Leuven, Belgium
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, IRCCS-AOU Policlinico Santorsola, Bologna, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Rossella Manfredini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Tagliafico
- Diagnostic Hematology and Clinical Genomics, Department of Laboratory Medicine and Pathology, AUSL/AOU Modena, Modena, Italy
| | - Mario Sarti
- Diagnostic Hematology and Clinical Genomics, Department of Laboratory Medicine and Pathology, AUSL/AOU Modena, Modena, Italy
| | - Tommaso Trenti
- Diagnostic Hematology and Clinical Genomics, Department of Laboratory Medicine and Pathology, AUSL/AOU Modena, Modena, Italy
| | - Russell Lewis
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Patrizia Comoli
- Pediatric Hematology/Oncology Unit and Cell Factory, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Mario Luppi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
| | - Leonardo Potenza
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, AOU Modena, Modena, Italy
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Schnetzke U, Fischer M, Röllig C, Scherag A, Altmann H, Stölzel F, Alakel N, Bornhäuser M, Hochhaus A, Scholl S. Validating genetic variants in innate immunity linked to infectious events in acute myeloid leukemia post-induction chemotherapy. Genes Immun 2024:10.1038/s41435-024-00285-4. [PMID: 38982248 DOI: 10.1038/s41435-024-00285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
Infectious events, such as sepsis and invasive fungal disease (IFD), pose significant risks in patients with acute myeloid leukemia (AML). Previous studies, including our own, have suggested a potential role of single nucleotide polymorphisms (SNPs) within the innate immune system in influencing individual infection susceptibility. However, many of these associations lack validation in independent cohorts. This study sought to validate the impact of 11 candidate SNPs across 6 genes (TLR2, TLR4, Dectin-1, DC-SIGN, PTX3, L-Ficolin) in an independent cohort of patients. Two cohorts with newly diagnosed AML patients receiving intensive induction chemotherapy were analyzed: a stratification cohort comprising 186 patients and a validation cohort consisting of 138 patients. Multiple SNPs in each cohort were found to be associated to infectious complications, notably the DC-SIGN SNP rs4804800 demonstrated a significant association with sepsis in both cohorts. SNPs within the PTX3 and Dectin-1 genes were linked to IFD development in one cohort each. This study represents the first validation study of candidate genes associated with infectious events in AML patients after intensive induction chemotherapy. Identifying genetic predispositions to infections could significantly impact the management of antimicrobial prophylaxis and treatment in AML patients.
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Affiliation(s)
- Ulf Schnetzke
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Comprehensive Cancer Center Central Germany - Campus Jena, Universitätsklinikum Jena, Jena, Germany.
| | - Mike Fischer
- Institut für Humangenetik, Universitätsklinikum Jena, Jena, Germany
| | - Christoph Röllig
- Medizinische Klinik I, Universitätsklinikum der Technischen Universität Dresden, Dresden, Germany
| | - André Scherag
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, Jena, Germany
| | - Heidi Altmann
- Medizinische Klinik I, Universitätsklinikum der Technischen Universität Dresden, Dresden, Germany
| | - Friedrich Stölzel
- Medizinische Klinik I, Universitätsklinikum der Technischen Universität Dresden, Dresden, Germany
- Sektion für Stammzelltransplantation und zelluläre Immuntherapie, Klinik für Innere Medizin II, Abteilung für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Nael Alakel
- Medizinische Klinik I, Universitätsklinikum der Technischen Universität Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Medizinische Klinik I, Universitätsklinikum der Technischen Universität Dresden, Dresden, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Comprehensive Cancer Center Central Germany - Campus Jena, Universitätsklinikum Jena, Jena, Germany
| | - Sebastian Scholl
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Comprehensive Cancer Center Central Germany - Campus Jena, Universitätsklinikum Jena, Jena, Germany
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11
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Wu Y, Sun G, Tang B, Song K, Cheng Y, Tu M, Zhu X. Ruxolitinib Plus Basiliximab Therapy for Steroid-Refractory Acute Graft-Versus-Host Disease in Unrelated Cord Blood Transplantation: A Large-Scale Study. Transplant Cell Ther 2024:S2666-6367(24)00488-3. [PMID: 38971463 DOI: 10.1016/j.jtct.2024.06.026] [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: 05/18/2024] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 07/08/2024]
Abstract
Steroid-refractory (SR) acute graft-versus-host disease (aGVHD) is a major cause of mortality after allogeneic hematopoietic stem cell transplantation. We aimed to evaluate the effectiveness and safety of ruxolitinib plus basiliximab for treating SR-aGVHD after unrelated cord blood transplantation (UCBT). Among the 1154 patients with hematological malignancies who underwent UCBT between February 2014 and May 2022, 198 patients with grade II to IV SR-aGVHD were enrolled, 112 of whom were treated with basiliximab alone (basiliximab group) and 86 of whom received basiliximab plus ruxolitinib (combined therapy group). The combined therapy group demonstrated a significantly higher complete response rate (CRR) on day 28 (36.0%) than did the basiliximab group (12.5%, P < .001). SR-aGVHD patients were further stratified into standard-risk and high-risk groups using the refined Minnesota aGVHD risk score. For standard-risk patients, combined therapy significantly improved the CRR (51.1% versus 13.6%, P < .001) and 3-year overall survival (74.5% versus 52.4%, P = .033). However, high-risk patients did not exhibit the same benefits. Compared with basiliximab monotherapy, ruxolitinib plus basiliximab therapy was an effective therapy for patients with standard-risk SR-aGVHD following UCBT. The effectiveness of combined therapy in high-risk patients was not apparent, indicating the need for other treatments.
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Affiliation(s)
- Yue Wu
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei, China; Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Guangyu Sun
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Baolin Tang
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei, China; Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Kaidi Song
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yaxin Cheng
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Meijuan Tu
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiaoyu Zhu
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei, China; Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
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12
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Kim DH, Hong J, Shin DY, Kim I, Yoon SS, Bang SM, Lee JO, Lee JY, Kim SA, Byun JM, Koh Y. Phase II trial of posaconazole prophylaxis during anti-thymocyte globulin treatment for aplastic anaemia and hypoplastic myelodysplastic syndrome. Br J Haematol 2024; 205:356-359. [PMID: 38699798 DOI: 10.1111/bjh.19500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Dong Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
| | - Soo Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ji Yun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Sang-A Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Center for Medical Innovation, Seoul National University Hospital, Seoul, Korea
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13
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Monzó-Gallo P, Lopera C, Badía-Tejero AM, Machado M, García-Rodríguez J, Vidal-Cortés P, Merino E, Calderón J, Fortún J, Palacios-Baena ZR, Pemán J, Sanchis JR, Aguilar-Guisado M, Gudiol C, Ramos JC, Sánchez-Romero I, Martin-Davila P, López-Cortés LE, Salavert M, Ruiz-Camps I, Chumbita M, Aiello TF, Peyrony O, Puerta-Alcalde P, Soriano A, Marco F, Garcia-Vidal C. Safety and effectiveness of isavuconazole in real-life non-neutropenic patients. Int J Infect Dis 2024; 144:107070. [PMID: 38663477 DOI: 10.1016/j.ijid.2024.107070] [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: 01/29/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life. METHODS A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG. RESULTS A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients. CONCLUSION Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported.
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Affiliation(s)
- Patricia Monzó-Gallo
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
| | - Carlos Lopera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
| | - Ana M Badía-Tejero
- Department of Infectious Diseases, Hospital of Bellvitge, Barcelona, Spain
| | - Marina Machado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid - Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Julio García-Rodríguez
- Infectious Diseases Unit, University Hospital La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | | | - Esperanza Merino
- Department of Infectious Diseases, Hospital General Universitario Dr. Balmis - Instituto, Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Jorge Calderón
- Department of Infectious Diseases, University Hospital Puerta de Hierro, Madrid, Spain
| | - Jesús Fortún
- Department of Infectious Diseases, University Hospital Ramon y Cajal, Madrid, Spain
| | - Zaira R Palacios-Baena
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Institute of Biomedicine of Seville (IBiS) and CSIC, Seville, Spain; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Javier Pemán
- Infectious Diseases Unit (Medical Clinical Department), University and Polytechnic Hospital La Fe, La Fe Health Research Institute (IIS-La Fe), Valencia, Spain
| | - Joan Roig Sanchis
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Manuela Aguilar-Guisado
- Unit of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Carlota Gudiol
- Department of Infectious Diseases, Hospital of Bellvitge, Barcelona, Spain; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Juan C Ramos
- Infectious Diseases Unit, University Hospital La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Isabel Sánchez-Romero
- Department of Infectious Diseases, University Hospital Puerta de Hierro, Madrid, Spain
| | - Pilar Martin-Davila
- Department of Infectious Diseases, University Hospital Ramon y Cajal, Madrid, Spain
| | - Luis E López-Cortés
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Institute of Biomedicine of Seville (IBiS) and CSIC, Seville, Spain; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Miguel Salavert
- Infectious Diseases Unit (Medical Clinical Department), University and Polytechnic Hospital La Fe, La Fe Health Research Institute (IIS-La Fe), Valencia, Spain
| | - Isabel Ruiz-Camps
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
| | - Tommaso Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
| | - Olivier Peyrony
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain; Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain.; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Francesc Marco
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain.; Department of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain.; CIBER Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain.
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14
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Jain N, Ryan AL, Haeusler GM, McMullan BJ, Moore AS, Bartlett AW, Blyth CC, Kotecha RS, Yeoh DK, Clark JE. Invasive fungal disease in children with solid tumors: An Australian multicenter 10-year review. Pediatr Blood Cancer 2024; 71:e31031. [PMID: 38679843 DOI: 10.1002/pbc.31031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/09/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
Invasive fungal disease (IFD) occurs less frequently during treatment for solid compared to hematological malignancies in children, and risk groups are poorly defined. Retrospective national multicenter cohort data (2004-2013) were analyzed to document prevalence, clinical characteristics, and microbiology of IFD. Amongst 2067 children treated for solid malignancy, IFD prevalence was 1.9% overall and 1.4% for proven/probable IFD. Of all IFD episodes, 42.5% occurred in patients with neuroblastoma (prevalence 7.0%). Candida species comprised 54.8% of implicated pathogens in proven/probable IFD. In children with solid tumors, IFD is rare, and predominantly caused by yeasts.Routine prophylaxis may not be warranted.
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Affiliation(s)
- Neha Jain
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Anne L Ryan
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Gabrielle M Haeusler
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia
- The Paediatric Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Brendan J McMullan
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Andrew S Moore
- Oncology Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Adam W Bartlett
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
- Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Julia E Clark
- Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
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15
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Umemura T, Kakizaki H, Mutoh Y, Mizuno T, Ito Y, Hioki T, Kato H, Hagihara M, Yamada T, Ikeda Y, Mikamo H, Ichihara T, Hamada Y. Effectiveness and safety of the simulation-based first-dose design of voriconazole. J Infect Chemother 2024:S1341-321X(24)00170-3. [PMID: 38944383 DOI: 10.1016/j.jiac.2024.06.016] [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: 02/25/2024] [Revised: 06/17/2024] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND We investigated whether the initial voriconazole (VRCZ) dosing design, as determined using simulation software with a population pharmacokinetic model of Japanese patients, impacts the effectiveness and safety when compared with VRCZ initiation according to the package insert. METHODS In this single-center retrospective observational study, we employed records from Tosei General Hospital (a 633-bed hospital), dated April 2017 to September 2023. Eligible patients were divided into the software-based simulation group, comprising patients administered initial VRCZ dosage adjustment by pharmacists using software-based simulation, and the standard therapy group, whose dosage was administered by a physician following the package insert recommendations without simulation. The primary objective of this study was to determine the efficacy of VRCZ first-dose design in reducing the incidence of hepatotoxicity and visual symptoms. RESULTS The median ages of enrolled participants (n = 93) were 75 (68-79) and 72 (65-78) years in the software-based simulation and standard therapy groups, respectively. Regardless of formulation, initial trough concentrations were lower in the VRCZ software-based first dosage adjustment group and higher rate within the appropriate range (1-4 μg/mL). The incidence of all-grade hepatotoxicity or visual symptoms was significantly lower in the software-based simulation group. The log-rank test revealed a significant impact on the occurrence of ≥grade 2 hepatotoxicity in the software-based first dosage adjustment group compared to that in the standard therapy group. CONCLUSIONS The initial VRCZ dosing design using simulation software improved the achievement of appropriate initial trough concentrations and resulted in fewer occurrences of hepatotoxicity (≥grade 2) when compared with the standard therapy.
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Affiliation(s)
- Takumi Umemura
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan; Department of Clinical Infectious Diseases, Tosei General Hospital, Seto, Aichi, Japan; Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Aichi, Japan; College of Pharmacy, Kinjo Gakuin University, Nagoya, Aichi, Japan.
| | - Hiromi Kakizaki
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yoshikazu Mutoh
- Department of Clinical Infectious Diseases, Tosei General Hospital, Seto, Aichi, Japan
| | - Takahito Mizuno
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yuki Ito
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan
| | - Tatsuya Hioki
- Department of Clinical Infectious Diseases, Tosei General Hospital, Seto, Aichi, Japan
| | - Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pharmacy, Mie University Hospital, Tsu, Mie, Japan
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tetsuya Yamada
- Department of Pharmacy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yoshiaki Ikeda
- College of Pharmacy, Kinjo Gakuin University, Nagoya, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Aichi, Japan
| | | | - Yukihiro Hamada
- Department of Pharmacy, Kochi Medical School Hospital, Nankoku, Kochi, Japan
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16
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Seybold B, Funk T, Dreger P, Egerer G, Brandt J, Mueller-Tidow C, Giesen N, Merle U. Microbiological risk factors, ICU survival, and 1-year survival in hematological patients with pneumonia requiring invasive mechanical ventilation. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04883-y. [PMID: 38922376 DOI: 10.1007/s10096-024-04883-y] [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: 01/28/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To identify pathogenic microorganisms and microbiological risk factors causing high morbidity and mortality in immunocompromised patients requiring invasive mechanical ventilation due to pneumonia. METHODS A retrospective single-center study was performed at the intensive care unit (ICU) of the Department of Internal Medicine at Heidelberg University Hospital (Germany) including 246 consecutive patients with hematological malignancies requiring invasive mechanical ventilation due to pneumonia from 08/2004 to 07/2016. Microbiological and radiological data were collected and statistically analyzed for risk factors for ICU and 1-year mortality. RESULTS ICU and 1-year mortality were 63.0% (155/246) and 81.0% (196/242), respectively. Pneumonia causing pathogens were identified in 143 (58.1%) patients, multimicrobial infections were present in 51 (20.7%) patients. Fungal, bacterial and viral pathogens were detected in 89 (36.2%), 55 (22.4%) and 41 (16.7%) patients, respectively. Human herpesviruses were concomitantly reactivated in 85 (34.6%) patients. As significant microbiological risk factors for ICU mortality probable invasive Aspergillus disease with positive serum-Galactomannan (odds ratio 3.1 (1.2-8.0), p = 0.021,) and pulmonary Cytomegalovirus reactivation at intubation (odds ratio 5.3 (1.1-26.8), p = 0.043,) were identified. 1-year mortality was not significantly associated with type of infection. Of interest, 19 patients had infections with various respiratory viruses and Aspergillus spp. superinfections and experienced high ICU and 1-year mortality of 78.9% (15/19) and 89.5% (17/19), respectively. CONCLUSIONS Patients with hematological malignancies requiring invasive mechanical ventilation due to pneumonia showed high ICU and 1-year mortality. Pulmonary Aspergillosis and pulmonary reactivation of Cytomegalovirus at intubation were significantly associated with negative outcome.
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Affiliation(s)
- Benjamin Seybold
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Timo Funk
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Peter Dreger
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerlinde Egerer
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Brandt
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Mueller-Tidow
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicola Giesen
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Hematology, Oncology and Palliative Care, Robert Bosch Hospital, Stuttgart, Germany
| | - Uta Merle
- Department of Internal Medicine IV, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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17
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Grijalva JAG, de Oliveira VF, de Carvalho VC, de Oliveira PR, Lima ALL. Analysis of epidemiological and clinical aspects in cases of fungal osteomyelitis caused by non-Candida species. Braz J Microbiol 2024:10.1007/s42770-024-01418-7. [PMID: 38896342 DOI: 10.1007/s42770-024-01418-7] [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: 02/18/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Osteomyelitis caused by non-Candida species is rare and often neglected, and current recommendations are based on primarily clinical experience and expert opinion. The objective of this study was to describe a case series of non-Candida fungal osteomyelitis. This retrospective study included 10 patients with non-Candida fungal osteomyelitis. Patients with osteomyelitis and microbiologically confirmed non-Candida species from bone fragment cultures were selected from the institution Infection Control Board database. Fusarium spp. were the most commonly isolated fungus from bone fragment cultures in five patients (50%). The majority did not present immunosuppression. The most common etiology was post-traumatic (n = 7, 70%), particularly open fractures. All patients were treated with antifungals associated with surgery. The antifungals used were itraconazole in five patients (50%), and voriconazole in another five patients (50%), with a median duration of antifungal therapy of four weeks (range: 3-25). There were no observed deaths within 30 days and one year. An antifungal approach combined with surgical treatment demonstrated favorable clinical outcomes, including low mortality rates and effective remission.
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Affiliation(s)
- Jorge Andrés González Grijalva
- Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vítor Falcão de Oliveira
- Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Vladimir Cordeiro de Carvalho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Rosalba de Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Lúcia L Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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18
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Chen X, Chen C, Wu M, Wang S, Jiang H, Li Z, Yu Y, Li B. Causal relationship between type 1 diabetes mellitus and mycoses: a Mendelian randomization study. Front Med (Lausanne) 2024; 11:1408297. [PMID: 38947239 PMCID: PMC11211379 DOI: 10.3389/fmed.2024.1408297] [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: 03/28/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is frequently associated with various infections, including mycoses; however, the direct link between T1DM and fungal infections remains under-researched. This study utilizes a Mendelian randomization (MR) approach to investigate the potential causal relationship between T1DM and mycoses. Methods Genetic variants associated with T1DM were sourced from the European Bioinformatics Institute database, while those related to fungal infections such as candidiasis, pneumocystosis, and aspergillosis were obtained from the Finngen database, focusing on European populations. The primary analysis was conducted using the inverse variance weighted (IVW) method, with additional insight from Mendelian randomization Egger regression (MR-Egger). Extensive sensitivity analyses assessed the robustness, diversity, and potential horizontal pleiotropy of our findings. Multivariable Mendelian randomization (MVMR) was employed to adjust for confounders, using both MVMR-IVW and MVMR-Egger to evaluate heterogeneity and pleiotropy. Results Genetically, the odds of developing candidiasis increased by 5% in individuals with T1DM, as determined by the IVW method (OR = 1.05; 95% CI 1.02-1.07, p = 0.0001), with a Bonferroni-adjusted p-value of 0.008. Sensitivity analyses indicated no significant issues with heterogeneity or pleiotropy. Adjustments for confounders such as body mass index, glycated hemoglobin levels, and white blood cell counts further supported these findings (OR = 1.08; 95% CI:1.03-1.13, p = 0.0006). Additional adjustments for immune cell counts, including CD4 and CD8 T cells and natural killer cells, also demonstrated significant results (OR = 1.04; 95% CI: 1.02-1.06, p = 0.0002). No causal associations were found between T1DM and other fungal infections like aspergillosis or pneumocystosis. Conclusion This MR study suggests a genetic predisposition for increased susceptibility to candidiasis in individuals with T1DM. However, no causal links were established between T1DM and other mycoses, including aspergillosis and pneumocystosis.
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Affiliation(s)
- Xiaolan Chen
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chen Chen
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingyan Wu
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shanmei Wang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hongbin Jiang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhe Li
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing Li
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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19
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Koulenti D, Paramythiotou E, Almyroudi MP, Karvouniaris M, Markou N, Paranos P, Routsi C, Meletiadis J, Blot S. Severe mold fungal infections in critically ill patients with COVID-19. Future Microbiol 2024; 19:825-840. [PMID: 38700287 PMCID: PMC11290760 DOI: 10.2217/fmb-2023-0261] [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: 11/21/2023] [Accepted: 02/20/2024] [Indexed: 05/05/2024] Open
Abstract
The SARS-CoV-2 pandemic put an unprecedented strain on modern societies and healthcare systems. A significantly higher incidence of invasive fungal co-infections was noted compared with the pre-COVID-19 era, adding new diagnostic and therapeutic challenges in the critical care setting. In the current narrative review, we focus on invasive mold infections caused by Aspergillus and Mucor species in critically ill COVID-19 patients. We discuss up-to-date information on the incidence, pathogenesis, diagnosis and treatment of these mold-COVID-19 co-infections, as well as recommendations on preventive and prophylactic interventions. Traditional risk factors were often not recognized in COVID-19-associated aspergillosis and mucormycosis, highlighting the role of other determinant risk factors. The associated patient outcomes were worse compared with COVID-19 patients without mold co-infection.
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Affiliation(s)
- Despoina Koulenti
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Maria Panagiota Almyroudi
- Emergency Department, Attikon University Hospital, National & Kapodistrian University of Athens, Greece
| | | | - Nikolaos Markou
- Intensive Care Unit of Latseio Burns Centre, Thriasio General Hospital of Elefsina, Greece
| | - Paschalis Paranos
- Clinical Microbiology Laboratory, Attikon University Hospital, National & Kapodistrian Uni-versity of Athens, Greece
| | - Christina Routsi
- First Department of Intensive Care, School of Medicine, National & Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, National & Kapodistrian Uni-versity of Athens, Greece
| | - Stijn Blot
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
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20
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Kwon M, Gómez-Centurión I, Oarbeascoa G, Torres M, Martinez AP, Suarez-Lledó M, Chinea A, Cascón MJP, Vazquez L, Espigado I, Izquierdo I, Parody R, Cadenas IG, Calbacho M, Sierra PG, Heras I, Yañez L, Torrent A, Bautista G, Gonzalez S, Roldan E, Vallejo JC, Bailen R, Borrero A, Lopez-Jiménez J, Casas MAC, Solano C. Real-World Experience with Isavuconazole in Allogeneic Stem Cell Transplantation in Spain. Transplant Cell Ther 2024:S2666-6367(24)00467-6. [PMID: 38871055 DOI: 10.1016/j.jtct.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
Invasive fungal infections (IFI) pose a significant complication after hematopoietic stem cell transplantation (HSCT). Isavuconazole (ISV) is a new generation azole with a favourable adverse effect and interaction profile approved for the treatment of invasive aspergillosis and mucormycosis. We analyzed the indications, effectiveness, adverse event profile and drug interaction management of ISV in the real-world setting in adults who received allogeneic-HSCT (allo-HSCT) within the Spanish Group of HSCT and Cell Therapy (GETH-TC). We conducted a multicenter retrospective study of all consecutive adult allo-HSCT recipients (≥18 years) who received ISV either for IFI treatment or prophylaxis, from December 2017 to August 2021, in 20 centers within the Spanish Group of Hematopoietic Stem Cell Transplantation and Cell Therapy (GETH-TC). A total of 166 adult allografted patients who received ISV from 2017 to 2021 were included. Median age was 48 years with 43% females. In 81 (49%) patients, ISV was used for treatment of IFI, and in 85 (51%) for prophylaxis. Median duration of ISV administration for IFI treatment was 57 days (range 31-126) and 86 days (range 33-196) for prophylaxis. Most frequent indication for treatment was invasive aspergillosis (78%), followed by mucormycosis (6%). Therapeutic success (45%) was the most frequent reason for ISV withdrawal. In the prophylaxis group, the resolution of IFI risk factors was the most frequent reason for withdrawal (62%). Six (7%) breakthrough IFI were reported. The majority of patients (80%) presented pharmacologic interactions. Twenty-one patients (13%) reported adverse events related to ISV, mainly liver biochemistry abnormalities, which led to ISV withdrawal in 7 patients (4%). ISV was effective and well tolerated for IFI treatment and prophylaxis, with a manageable interaction profile.
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Affiliation(s)
- Mi Kwon
- Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.
| | - Ignacio Gómez-Centurión
- Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Gillen Oarbeascoa
- Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Melissa Torres
- Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | - Ildefonso Espigado
- Department of Medicine, University of Seville, HUV Macarena-HUV Rocío, IBiS/CSIC, Sevilla, Spain
| | | | - Rocio Parody
- Institut Català Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | | | | | | | | | - Lucrecia Yañez
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Anna Torrent
- Institut Català d'oncologia, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Guiomar Bautista
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elisa Roldan
- Vall d'Hebron Instituto de Oncología, Barcelona, Spain
| | | | - Rebeca Bailen
- Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Asunción Borrero
- Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Carlos Solano
- Hospital Clínico Universitario de Valencia, Valencia, Spain
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21
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Trápaga MR, Poester VR, Basso RP, Blan BDS, Munhoz LS, Pasqualotto AC, Werner TDF, Figurelli ML, Stevens DA, von Groll A, Xavier MO. Aspergillosis in Critically Ill Patients with and Without COVID-19 in a Tertiary Hospital in Southern Brazil. Mycopathologia 2024; 189:48. [PMID: 38847987 DOI: 10.1007/s11046-024-00862-1] [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: 03/25/2024] [Accepted: 05/18/2024] [Indexed: 06/20/2024]
Abstract
The impact of invasive pulmonary aspergillosis (IPA) on non-neutropenic critically ill patients in intensive care units (ICU) has been demonstrated in recent decades. Furthermore, after the start of the COVID-19 pandemic, COVID-19 associated with pulmonary aspergillosis (CAPA) has become a major concern in ICUs. However, epidemiological data from different regions are scarce. We evaluated the prevalence and clinical-epidemiological data of IPA in patients with COVID-19 requiring mechanical ventilation (MV) in the ICU ("severe COVID-19") and non-COVID ICU patients in MV of a tertiary hospital in the southern region of Brazil. Eighty-seven patients admitted between June 2020 and August 2022 were included; 31 with severe COVID-19. For the diagnosis of IPA or CAPA, algorithms including host factors and mycological criteria (positive culture for Aspergillus spp., immunoassay for galactomannan detection, and/or qPCR) were utilized. The overall incidence of IPA and CAPA in our ICU was 73 cases/1000 ICU hospitalizations. Aspergillosis occurred in 13% (4/31) of the COVID-19 patients, and in 16% (9/56) of the critically ill patients without COVID-19, with mortality rates of 75% (3/4) and 67% (6/9), respectively. Our results highlight the need for physicians enrolled in ICU care to be aware of aspergillosis and for more access of the patients to sensitive and robust diagnostic tests by biomarkers detection.
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Affiliation(s)
- Mariana Rodrigues Trápaga
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Vanice Rodrigues Poester
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Rossana Patrícia Basso
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
- Hospital Universitário Dr. Miguel Riet Correa Jr., Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Bianca Dos Santos Blan
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Lívia Silveira Munhoz
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Alessandro C Pasqualotto
- Laboratório de Biologia Molecular, Santa Casa de Misericórdia, Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Talita da Fontoura Werner
- Hospital Universitário Dr. Miguel Riet Correa Jr., Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Maria Letícia Figurelli
- Hospital Universitário Dr. Miguel Riet Correa Jr., Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - David A Stevens
- California Institute for Medical Research, San Jose, CA, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA, USA
| | - Andrea von Groll
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
- Núcleo de Pesquisa em Microbiologia Médica, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Melissa Orzechowski Xavier
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil.
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil.
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Heldman MR, Alexander BD, Perfect JR, Schwartz IS, Maziarz EK. Explaining the "Unexpectedly High" Frequency of Invasive Fungal Disease in a Cohort Study of Solid Organ Transplant Recipients Treated With Belatacept. Open Forum Infect Dis 2024; 11:ofae291. [PMID: 38854396 PMCID: PMC11161895 DOI: 10.1093/ofid/ofae291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Madeleine R Heldman
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Barbara D Alexander
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - John R Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen K Maziarz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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23
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Little JS, Kampouri E, Friedman DZ, McCarty T, Thompson GR, Kontoyiannis DP, Vazquez J, Baddley JW, Hammond SP. The Burden of Invasive Fungal Disease Following Chimeric Antigen Receptor T-Cell Therapy and Strategies for Prevention. Open Forum Infect Dis 2024; 11:ofae133. [PMID: 38887472 PMCID: PMC11181190 DOI: 10.1093/ofid/ofae133] [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: 12/01/2023] [Accepted: 03/05/2024] [Indexed: 06/20/2024] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a novel immunotherapy approved for the treatment of hematologic malignancies. This therapy leads to a variety of immunologic deficits that could place patients at risk for invasive fungal disease (IFD). Studies assessing IFD in this setting are limited by inconsistent definitions and heterogeneity in prophylaxis use, although the incidence of IFD after CAR T-cell therapy, particularly for lymphoma and myeloma, appears to be low. This review evaluates the incidence of IFD after CAR T-cell therapy, and discusses optimal approaches to prevention, highlighting areas that require further study as well as future applications of cellular therapy that may impact IFD risk. As the use of CAR T-cell therapy continues to expand for hematologic malignancies, solid tumors, and most recently to include non-oncologic diseases, understanding the risk for IFD in this uniquely immunosuppressed population is imperative to prevent morbidity and mortality.
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Affiliation(s)
- Jessica S Little
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleftheria Kampouri
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Daniel Z Friedman
- Section of Infectious Diseases and Global Health, The University of Chicago, Chicago, Illinois, USA
| | - Todd McCarty
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - George R Thompson
- Division of Infectious Diseases, University of California-Davis, Sacramento, California, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jose Vazquez
- Division of Infectious Diseases, Medical College of Georgia/Augusta University, Augusta, Georgia, USA
| | - John W Baddley
- Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sarah P Hammond
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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24
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Bell E, Pisano J, Brown M, Friedman D. An Unexpectedly High Incidence of Invasive Fungal Diseases in Solid Organ Transplant Recipients Taking Belatacept for Organ Rejection Prophylaxis: A Single-Center Retrospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae158. [PMID: 38887477 PMCID: PMC11181179 DOI: 10.1093/ofid/ofae158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/14/2024] [Indexed: 06/20/2024] Open
Abstract
Among solid organ transplant recipients taking belatacept, 15% developed invasive fungal diseases. The most common invasive fungal diseases were aspergillosis (56%) and candidiasis (22%). The infected cohort was more likely to receive basiliximab, undergo lung transplantation, or identify as White. Higher rates of aspergillosis were seen in this lung cohort than previously reported.
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Affiliation(s)
- Elizabeth Bell
- Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jennifer Pisano
- Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Manasa Brown
- Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Daniel Friedman
- Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois, USA
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25
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Vergidis P, Sendi P, Alkhateeb HB, Nguyen MH. How do I manage refractory invasive pulmonary aspergillosis. Clin Microbiol Infect 2024; 30:755-761. [PMID: 38286175 DOI: 10.1016/j.cmi.2024.01.015] [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: 08/11/2023] [Revised: 11/06/2023] [Accepted: 01/20/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Invasive aspergillosis is associated with significant morbidity and mortality in patients with haematologic malignancies and haematopoietic cell transplant recipients. The prognosis is worse among patients who have failed primary antifungal treatment. OBJECTIVES We aim to provide guidance on the diagnosis and management of refractory invasive pulmonary aspergillosis. SOURCES Using PubMed, we performed a review of original articles, meta-analyses, and systematic reviews. CONTENT We discuss the diagnostic criteria for invasive pulmonary aspergillosis and the evidence on the treatment of primary infection. We outline our diagnostic approach to refractory disease. We propose a treatment algorithm for refractory disease and discuss the role of experimental antifungal agents. IMPLICATIONS For patients with worsening disease while on antifungal therapy, a thorough diagnostic evaluation is required to confirm the diagnosis of aspergillosis and exclude another concomitant infection. Treatment should be individualized. Current options include switching to another triazole, transitioning to a lipid formulation of amphotericin B, or using combination antifungal therapy.
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Affiliation(s)
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | | | - M Hong Nguyen
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Gupta C, Dogra P, Jain V, Kaur R, Sharma JB. HIV-associated disseminated cryptococcosis-An unusual clinical and diagnostic picture with successful cure by single dose liposomal amphotericin B treatment. Diagn Microbiol Infect Dis 2024; 109:116217. [PMID: 38513558 DOI: 10.1016/j.diagmicrobio.2024.116217] [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: 10/12/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Cryptococcosis is an invasive, opportunistic fungal infection seen especially in human immunodeficiency virus (HIV) infected patients. Cryptococcal meningitis (CM) is the second leading cause of mortality in HIV patients. We report a case of disseminated cryptococcosis presenting with altered mental status in a newly diagnosed HIV infection. METHODS AND RESULTS A 50-year-old with a short history of altered mental sensorium and a history of low-grade fever and weight loss for few months presented at a tertiary care hospital in North India. He was detected positive for HIV-1. Cryptococcal antigen (CRAG) was positive in Cerebrospinal fluid (CSF), and negative in serum. The fungal culture in CSF was sterile while the fungal blood culture grew Cryptococcus neoformans. The patient was treated with single high-dose Liposomal Amphotericin B (LAmB) therapy followed by Fluconazole and Flucytosine for the next two weeks followed by fluconazole daily for consolidation and maintenance therapy. Antiretroviral therapy (ART) was started 4 weeks after induction therapy. After 6 months, the patient is doing fine. CONCLUSION Single dose LAmB along with the backbone of fluconazole and flucytosine appears promising in disseminated cryptococcal infection in HIV-infected individuals.
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Affiliation(s)
- Chhavi Gupta
- Infectious disease, Yashoda Superpseciality Hospital, Kaushambi, India.
| | | | - Varun Jain
- Neuroanaesthesia and Critical Care, Fortis Hospital, Noida, India
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27
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Sano H, Fukushima K, Yano M, Osone S, Kato Y, Hasegawa D, Miyamura T, Iwamoto S, Takahashi H, Terui K, Tawa A, Tomizawa D. Analysis of overweight/obese pediatric patients with acute myeloid leukemia: a report from the Japanese Pediatric Leukemia/Lymphoma Study Group AML-05 study. Int J Hematol 2024; 119:745-754. [PMID: 38460081 DOI: 10.1007/s12185-024-03745-9] [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: 09/15/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
The dosage of chemotherapy drugs for overweight/obese children with acute myeloid leukemia (AML) has been empirically reduced based on ideal body weight (BW) in Japan to reduce the risk of adverse events. We investigated the associations between pre-therapeutic body mass index (BMI) and clinical outcomes among children with AML. A total of 280 children were divided into two groups based on the World Health Organization Child Growth Standards: a healthy-weight group (n = 254), and an overweight/obese group (n = 26). If BW exceeded 1.2 times the standard BW of Japanese children, the dosage of chemotherapy drugs was calculated using 1.2 times the standard BW. The dosage of chemotherapy drugs was reduced during at least one chemotherapy cycle in 24 of 26 patients (92.3%) in the overweight/obese group, compared with zero patients in the healthy-weight group. Overall/event-free survival, cumulative incidence of relapse, and treatment-related mortality (TRM) did not differ between the overweight/obese and healthy weight groups. However, the frequency of bacteremia was higher in the overweight/obese group (80.8 vs. 52.4%, P = 0.006). This indicates that TRM may increase when chemotherapy drug dosage is not corrected in overweight/obese patients. Drug reduction is a potential treatment strategy.
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Affiliation(s)
- Hirozumi Sano
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishi-ku, Sapporo, 003-0006, Japan.
| | | | - Michihiro Yano
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinya Osone
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoko Kato
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Daiichiro Hasegawa
- Department of Hematology/Oncology, Kobe Children's Hospital, Kobe, Japan
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | - Kiminori Terui
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akio Tawa
- Higashiosaka Aramoto Heiwa Clinic, Higashiosaka, Japan
| | - Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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28
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Ellis GC, Shaikh F, Carson ML, Sercy E, Stewart L, Andrews JM, Campbell WR, Mende K, Yabes JM, Tribble DR, Bialek R, Wickes BL, Ganesan A. A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured. Open Forum Infect Dis 2024; 11:ofae078. [PMID: 38887475 PMCID: PMC11181181 DOI: 10.1093/ofid/ofae078] [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: 11/13/2023] [Accepted: 02/09/2024] [Indexed: 06/20/2024] Open
Abstract
Background Among combat injured, invasive fungal infections (IFIs) result in significant morbidity. Cultures and histopathology are the primary diagnostic methods for IFIs, but they have limitations. We previously evaluated a panfungal polymerase chain reaction assay, which was 83% sensitive and 99% specific for angioinvasive IFIs. Here, we evaluated 3 less resource-intensive seminested assays targeting clinically relevant fungi in the order Mucorales and genera Aspergillus and Fusarium. Methods Formalin-fixed paraffin-embedded tissue specimens from a multicenter trauma IFI cohort (2009-2014) were used. Cases were US military personnel injured in Afghanistan with histopathologic IFI evidence. Controls were patients with similar injury patterns and no laboratory IFI evidence (negative culture and histopathology). Seminested assays specific to Mucorales (V4/V5 regions of 18S rDNA), Aspergillus (mitochondrial tRNA), and Fusarium (internal transcribed spacer [ITS]/28A regions of DNA) were compared with a panfungal assay amplifying the internal transcribed spacer 2 region of rDNA and to histopathology. Results Specimens from 92 injury sites (62 subjects) were compared with control specimens from 117 injuries (101 subjects). We observed substantial agreement between the seminested and panfungal assays overall, especially for the order Mucorales. Moderate agreement was observed at the genus level for Aspergillus and Fusarium. When compared with histopathology, sensitivity and specificity of seminested assays were 67.4% and 96.6%, respectively (sensitivity increased to 91.7% when restricted to sites with angioinvasion). Conclusions Prior studies of seminested molecular diagnostics have focused on culture-negative samples from immunocompromised patients. Our findings underscore the utility of the seminested approach in diagnosing soft-tissue IFIs using formalin-fixed paraffin-embedded tissue samples, especially with angioinvasion.
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Affiliation(s)
- Graham C Ellis
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Faraz Shaikh
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - M Leigh Carson
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Erica Sercy
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Laveta Stewart
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | | | - Wesley R Campbell
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Katrin Mende
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, Houston, Texas, USA
| | - Joseph M Yabes
- Brooke Army Medical Center, JBSA Fort Sam Houston, Houston, Texas, USA
| | - David R Tribble
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ralf Bialek
- LADR GmbH MVZ Dr, Kramer & Kollegen, Geesthacht, Germany
| | - Brian L Wickes
- The Department of Microbiology, Immunology, and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Anuradha Ganesan
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
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29
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Palomba E, Colaneri M, Azzarà C, Fava M, Maccaro A, Renisi G, Viero G, Kaur H, Chakrabarti A, Gori A, Lombardi A, Bandera A. Epidemiology, Clinical Manifestations, and Outcome of Mucormycosis in Solid Organ Transplant Recipients: A Systematic Review of Reported Cases. Open Forum Infect Dis 2024; 11:ofae043. [PMID: 38887489 PMCID: PMC11181195 DOI: 10.1093/ofid/ofae043] [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: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 06/20/2024] Open
Abstract
Mucormycosis is an emerging disease primarily affecting the immunocompromised host, but scarce evidence is available for solid organ transplant recipients (SOTRs). We systematically reviewed 183 cases occurring in SOTRs, exploring epidemiology, clinical characteristics, causative pathogens, therapeutic approaches, and outcomes. Kidney transplants accounted for half of the cases, followed by heart (18.6%), liver (16.9%), and lung (10.4%). Diagnosis showed a dichotomous distribution, with 63.7% of cases reported within 100 days of transplantation and 20.6% occurring at least 1 year after transplant. The 90-day and 1-year mortality rates were 36.3% and 63.4%, respectively. Disseminated disease had the highest mortality at both time points (75% and 93%). Treatment with >3 immunosuppressive drugs showed a significant impact on 90-day mortality (odds ratio [OR], 2.33; 95% CI, 1.02-5.66; P = .0493), as did a disseminated disease manifestation (OR, 8.23; 95% CI, 2.20-36.71; P = .0027) and the presence of diabetes (OR, 2.35; 95% CI, 1.01-5.65; P = .0497). Notably, prophylaxis was administered to 12 cases with amphotericin B. Further investigations are needed to validate these findings and to evaluate the potential implementation of prophylactic regimens in SOTRs at high risk.
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Affiliation(s)
- Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Cecilia Azzarà
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Fava
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Renisi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Viero
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Institution and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Infectious Disease and Microbiology, Doodhadhari Burfani Hospital and Research Institute, Haridwar, India
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
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30
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Komorowski AS, Hall CW, Atwal S, Johnstone R, Walker R, Mertz D, Piessens EA, Yamamura D, Kasper EM. Cerebrospinal fluid galactomannan detection for the diagnosis of central nervous system aspergillosis: a diagnostic test accuracy systematic review and meta-analysis. Clin Microbiol Infect 2024:S1198-743X(24)00250-7. [PMID: 38810927 DOI: 10.1016/j.cmi.2024.05.013] [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: 01/02/2024] [Revised: 03/28/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) galactomannan is an adjunctive test for central nervous system (CNS) aspergillosis diagnosis with unclear diagnostic test characteristics. OBJECTIVES To evaluate the diagnostic test characteristics of CSF galactomannan in CNS aspergillosis. METHODS Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, Web of Science, and Scopus, from inception to 24 February 2023. STUDY ELIGIBILITY CRITERIA Prospective and retrospective studies with 1-group and 2-group designs using any galactomannan assay on CSF to diagnose CNS aspergillosis. PARTICIPANTS Adult and/or paediatric patients with CNS aspergillosis. TEST(S) Galactomannan testing on CSF specimens. REFERENCE STANDARD European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) diagnostic criteria, or equivalent. ASSESSMENT OF RISK OF BIAS QUADAS-2 assessment in duplicate. METHODS OF DATA SYNTHESIS Bivariate restricted maximum likelihood estimation random-effects meta-analysis, summarized using forest and summary receiver operating characteristic plots; bivariate meta-regression models to investigate heterogeneity; and subgroup and sensitivity analyses to explore subgroup effects and methodologic choices (PROSPERO registration: CRD42022296331; funding: none). RESULTS We included eight studies (n = 342 participants). The summary estimates of CSF galactomannan sensitivity and specificity were 69.0% (95% CI, 57.2-78.7%) and 94.4% (95% CI, 82.8-98.3%), respectively. Using meta-regression, galactomannan cut-off (p = 0.38), EORTC/MSGERC criteria version (p = 0.48), or whether the reference standard was defined as both proven and probable or only proven aspergillosis (p = 0.48) did not explain observed heterogeneity. No subgroup effects were demonstrated by analysing the EORTC/MSGERC criteria reference standard used (e.g. 2002 vs. 2008 definitions) or whether paediatric patients were included. Diagnostic sensitivity was improved using a galactomannan cut-off of 1.0, and by excluding high risk of bias and 1-group design studies. DISCUSSION CSF galactomannan is a highly specific but insensitive test for use as a component of CNS aspergillosis diagnosis. Few included studies, no prospective studies, and a high risk of bias are study limitations.
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Affiliation(s)
- Adam S Komorowski
- Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences and St. Joseph's Healthcare, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Clayton W Hall
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sukhreet Atwal
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rochelle Johnstone
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert Walker
- Department of Neurosurgery, Boston University, Boston, MA, United States
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eva A Piessens
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Deborah Yamamura
- Microbiology Department, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences and St. Joseph's Healthcare, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ekkehard M Kasper
- Department of Neurosurgery, Boston University, Boston, MA, United States; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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31
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Kimura M, Rinaldi M, Kothari S, Giannella M, Anjan S, Natori Y, Phoompoung P, Gault E, Hand J, D'Asaro M, Neofytos D, Mueller NJ, Kremer AE, Rojko T, Ribnikar M, Silveira FP, Kohl J, Cano A, Torre-Cisneros J, San-Juan R, Aguado JM, Mansoor AER, George IA, Mularoni A, Russelli G, Luong ML, AlJishi YA, AlJishi MN, Hamandi B, Selzner N, Husain S. Invasive Aspergillosis in Liver Transplant Recipients in The Current Era. Am J Transplant 2024:S1600-6135(24)00344-7. [PMID: 38801991 DOI: 10.1016/j.ajt.2024.05.016] [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: 12/11/2023] [Revised: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multi-center 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in eight cases (13%). 12-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotics usage (adjusted odds ratio [aOR], 4.74; p=0.03) and history of pneumonia (aOR, 48.7; p=0.01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; p=0.01), systemic antibiotics usage (aOR, 5.03; p=0.04), and anti-mold prophylaxis (aOR, 11.9; p=0.02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ration [aHR], 86.9; p<0.001), ICU stay (aHR, 3.67; p=0.02), disseminated IA (aHR, 8.98; p<0.001), and dialysis (aHR, 2.93; p=0.001) were identified as independent risk factors associated with 12-week all-cause mortality; while recent receipt of tacrolimus (aHR, 0.11; p=0.001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted anti-mold prophylactic and appropriate treatment strategies against IA.
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Affiliation(s)
- Muneyoshi Kimura
- Transplant Infectious Diseases, Ajmera Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Matteo Rinaldi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sagar Kothari
- Transplant Infectious Diseases, Ajmera Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Maddalena Giannella
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Shweta Anjan
- Miami Transplant Institute, Jackson Health System, Miami, Florida; Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Yoichiro Natori
- Miami Transplant Institute, Jackson Health System, Miami, Florida; Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Pakpoom Phoompoung
- Transplant Infectious Diseases, Ajmera Transplant Program, University Health Network, Toronto, Ontario, Canada; Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Emily Gault
- University of Queensland School of Medicine, Ochsner Clinical School, Louisiana
| | - Jonathan Hand
- Ochsner Health, University of Queensland School of Medicine, Ochsner Clinical School
| | - Matilde D'Asaro
- Transplant Infectious Diseases Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland, Swiss Transplant Cohort Study
| | - Andreas E Kremer
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Tereza Rojko
- Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Slovenia
| | - Marija Ribnikar
- Department of Gastroenterology, University Medical Centre Ljubljana, Slovenia
| | - Fernanda P Silveira
- University of Pittsburgh, School of Medicine, Department of Medicine, Division of Infectious Diseases, Pennsylvania
| | - Joshua Kohl
- University of Pittsburgh, Clinical and Translational Science Institute, Pennsylvania
| | - Angela Cano
- Service of Infectious Diseases, Hospital Universitario Reina Sofia-IMIBIC-UCO. CIBERINFEC (CB21/13/00049). Córdoba, Spain
| | - Julian Torre-Cisneros
- Service of Infectious Diseases, Hospital Universitario Reina Sofia-IMIBIC-UCO. CIBERINFEC (CB21/13/00049). Córdoba, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain. CIBER-INFEC
| | - Jose Maria Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain. CIBER-INFEC
| | - Armaghan-E-Rehman Mansoor
- Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, Missouri
| | - Ige Abraham George
- Division of Infectious Diseases, Department of Medicine, Washington University in St. Louis, Missouri
| | - Alessandra Mularoni
- Department of Infectious Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - Giovanna Russelli
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS ISMETT), Palermo, Italy
| | - Me-Linh Luong
- Department of Medicine, Division of Infectious Diseases, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Yamama A AlJishi
- Section of Infectious diseases at King Fahad Specialist Hospital Dammam, Saudi Arabia
| | - Maram N AlJishi
- Department of Medicine at King Fahad Specialist Hospital Dammam, Saudi Arabia
| | - Bassem Hamandi
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada
| | - Shahid Husain
- Transplant Infectious Diseases, Ajmera Transplant Program, University Health Network, Toronto, Ontario, Canada.
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Han T, Qiu M, Niu X, Wang S, Wang F, Cao J, Tang S, Cheng L, Mei Y, Liang H, Feng Z, Chen G, Li Q. End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China. BMC Infect Dis 2024; 24:521. [PMID: 38783182 PMCID: PMC11119303 DOI: 10.1186/s12879-024-09360-7] [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: 01/03/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Invasive fungal infection (IFI) has become an increasing problem in NICU neonates, and end-organ damage (EOD) from IFI is one of the leading causes of morbidity and mortality in neonates. This study was conducted to summarize clinical data on epidemiology, risk factors, causative pathogens, and clinical outcomes of IFI-associated EOD among neonates in a center in China for the sake of providing references for prevention and treatment of fungal infections in neonates in future. METHODS The clinical data of IFI neonates who received treatment in a tertiary NICU of China from January 2009 to December 2022 were retrospectively analyzed, including causative pathogens and the incidence of EOD. The neonates were divided into EOD group and non-EOD (NEOD) group. The general characteristics, risk factors and clinical outcomes of the two groups were compared. RESULTS Included in this study were 223 IFI neonates (137 male and 86 female) with a median gestational age (GA) of 30.71 (29,35) weeks and a median birth weight (BW) of 1470 (1120,2150) g. Of them, 79.4% were preterm infants and 50.2% were born at a GA of ≥ 28, <32 weeks, and 37.7% with BW of 1000-1499 g. Candida albicans (C. albicans) was the most common Candida spp. in these neonates, accounting for 41.3% of all cases, followed by C. parapsilosis (30.5%) and C. glabrata (7.2%). EOD occurred in 40 (17.9%) of the 223 cases. Fungal meningitis was the most common EOD, accounting for 13.5% of the 40 EOD cases. There was no significant difference in the premature birth rate, delivery mode, GA and BW between EOD and NEOD groups, but the proportion of male infants with EOD was higher than that without. There was no significant difference in antenatal corticosteroid use, endotracheal intubation, invasive procedures, use of antibiotics, total parenteral nutrition, blood transfusion, postnatal corticosteroid use, fungal prophylaxis and the incidence of necrotizing enterocolitis between the two groups, but the proportion of C. albicans infection cases in EOD group was higher than that in NEOD group (57.5% vs. 37.7%). Compared with NEOD group, the proportion of cured or improved infants in EOD group was significantly lower (P < 0.05), and the number of infants who died or withdrew from treatment was larger (P < 0.05). CONCLUSIONS Our retrospective study showed that preterm infants were prone to fungal infection, especially very preterm infants. C. albicans was the most common Candida spp. for IFI, and was a high-risk factor for EOD. EOD can occur in both full-term and premature infants, so the possibility of EOD should be considered in all infants with IFI.
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Affiliation(s)
- Tao Han
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Meng Qiu
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Xinxin Niu
- Department of Organ Transplantation, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shumei Wang
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Feng Wang
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Jingke Cao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shanghong Tang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liping Cheng
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Yabo Mei
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Huayu Liang
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Zhichun Feng
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China.
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China.
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China.
| | - Geyu Chen
- Department of clinical medicine, Nan Fang Hospital affiliated to Southern Medical University, 1838 North Guangzhou Avenue, Baiyun District, Guangzhou, 510515, China.
| | - Qiuping Li
- Department of Neonatology, Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, NO.5 Nanmencang, Dongcheng District, Beijing, 100007, China.
- National Engineering Laboratory for Birth defects prevention and control of key technology, Beijing, China.
- Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China.
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Chen X, Lin S, Jin Q, Zhang L, Jiang W, Lu X, Wang G, Ge Y. Prevalence, Risk Factors, and Mortality of Invasive Pulmonary Aspergillosis in Patients with Anti-MDA5+ Dermatomyositis: A Retrospective Study in China. J Inflamm Res 2024; 17:3247-3257. [PMID: 38800596 PMCID: PMC11122320 DOI: 10.2147/jir.s460702] [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: 01/21/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To investigate the prevalence, risk factors and prognosis of invasive pulmonary aspergillosis (IPA) in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM). Methods A retrospective analysis was conducted in anti-MDA5+ DM patients diagnosed between January 2016 and March 2023. Patients with lower respiratory tract specimens were categorized into IPA+ and IPA- groups based on the presence of IPA and their clinical characteristics and prognoses then compared. Results Of the 415 patients diagnosed with anti-MDA5+ DM, 28 cases had IPA (prevalence rate of 6.7%) with Aspergillus fumigatus being the most common species. The patients were categorized into IPA+ (n=28) and IPA- (n=98) groups, with no significant age or gender-related differences (P>0.05). The IPA+ group had a lower lymphocyte count, particularly the CD4+ T-cell count, and reduced serum albumin and higher serum ferritin levels (P all<0.05). An elevated bronchoalveolar lavage fluid (BALF) galactomannan level was found to be the sole independent risk factor for the occurrence of IPA (adjusted OR=2.191, P=0.029) with a cut-off value of 0.585 and area under the curve of 0.779. The mortality rate in the IPA+ group was 25%. Compared to survivors, non-survivors in this group exhibited a higher incidence of rapidly progressive interstitial lung disease, lower lymphocyte counts, and increased co-infection with Pneumocystis jirovecii (P all<0.05). Conclusion IPA was not rare in patients with anti-MDA5+ DM, with elevated BALF galactomannan levels being an independent risk factor for IPA occurrence. Clinicians must exercise vigilance to identify patients exhibiting the aforementioned risk factors.
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Affiliation(s)
- Xixia Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Sang Lin
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qiwen Jin
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Lu Zhang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Wei Jiang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Xin Lu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Yongpeng Ge
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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Zhang W, Nie W, Li B, Wang H. Ultrasonography is an effective method for evaluating hepatosplenic fungal infections in pediatric onco-hematological patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38761012 DOI: 10.1002/jcu.23730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE This prospective study assessed the value of ultrasonography (US) in the evaluation of hepatosplenic fungal infections (HSFI). METHODS Thirty-two pediatric participants with confirmed onco-hematological diseases and HSFI were included. Lesions in the liver and/or spleen were detected by US, magnetic resonance imaging (MRI), or computed tomography (CT). RESULTS Of the participants, 11 (34%) had confirmed HSFI, while 21 (66%) had highly suspected HSFI. The US, CT, MRI, and fungal blood cultures demonstrated positive results in 31, 19, 25, and 7 patients, respectively. US had a significantly higher detection rate than CT, MRI, and fungal blood cultures (p < 0.05). The "bull's eye" phenomenon was a distinctive US feature of HSFI. Follow-up examinations indicated that after a mean of 7.7 (1-15) months, liver and/or spleen lesions disappeared in five patients. The lesion was significantly smaller in 10 patients. Residual calcifications were detected in 15 patients. Two patients died. CONCLUSION Conclusively, the US may substitute for tissue biopsy, other imaging modalities, or fungal blood culture for the confirmation of HSFI, and may guide better antifungal treatment, thus achieving better outcomes.
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Affiliation(s)
- Wenhua Zhang
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Wei Nie
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Bin Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan, Shandong, China
| | - Hui Wang
- Department of Special Examination, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Shi J, Chen J, Hu L, Song Q, Qian G. Clinical, radiological, and laboratory features of HIV-negative pulmonary cryptococcosis with regard to serum lateral flow assay. Front Med (Lausanne) 2024; 11:1234474. [PMID: 38818403 PMCID: PMC11138259 DOI: 10.3389/fmed.2024.1234474] [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: 06/04/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Cryptococcosis is the second most common invasive yeast infection in China. Pulmonary cryptococcosis (PC) is difficult to diagnose due to the lack of specific clinical features and the limitation of diagnostic techniques. Although lateral flow assay was very useful in diagnosing cryptococcal infection, quite a few patients with PC presented negative serum lateral flow assay (sLFA). Methods We conducted a retrospective study of HIV-negative patients who were diagnosed with PC in our hospital over the past decade to explore the potential relationship between the clinical profiles and sLFA in PC. Results In total, 112 patients with sLFA tested were enrolled in this study, of which 58.93% were male. The positivity rate of sLFA for PC was 91.07%. The extent of pulmonary lesions was positively correlated with sLFA grade (Spearman r = 0.268, p < 0.01). Solitary nodule (SN) and pneumonia were the most common imaging findings in PC with negative and positive sLFA respectively. Among 65 symptomatic PC patients, 14 presented with fever and had higher hypersensitive C-reactive protein (hsCRP) level and more extensive pulmonary involvement (Mann-Whitney U test, p < 0.05) than those without fever. Symptomatic PC patients were more likely to have positive results of sLFA (Mann-Whitney U test, p = 0.05) compared against asymptomatic ones. Discussion In conclusion, negative sLFA cannot exclude PC in patients with a solitary nodule in lung. Positive sLFA is more reliable in diagnosing PC in symptomatic patients with diffused lesions in lung who generally experience a more severe systemic inflammatory reaction.
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Affiliation(s)
- Jiejun Shi
- Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Jianhua Chen
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Liqing Hu
- Department of Clinical Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qifa Song
- Medical Data Research Center, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Guoqing Qian
- Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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Zhao YS, Lai QP, Tang H, Luo RJ, He ZW, Huang W, Wang LY, Zhang ZT, Lin SH, Qin WJ, Xu F. Identifying the risk factors of ICU-acquired fungal infections: clinical evidence from using machine learning. Front Med (Lausanne) 2024; 11:1386161. [PMID: 38784232 PMCID: PMC11112035 DOI: 10.3389/fmed.2024.1386161] [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: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Background Fungal infections are associated with high morbidity and mortality in the intensive care unit (ICU), but their diagnosis is difficult. In this study, machine learning was applied to design and define the predictive model of ICU-acquired fungi (ICU-AF) in the early stage of fungal infections using Random Forest. Objectives This study aimed to provide evidence for the early warning and management of fungal infections. Methods We analyzed the data of patients with culture-positive fungi during their admission to seven ICUs of the First Affiliated Hospital of Chongqing Medical University from January 1, 2015, to December 31, 2019. Patients whose first culture was positive for fungi longer than 48 h after ICU admission were included in the ICU-AF cohort. A predictive model of ICU-AF was obtained using the Least Absolute Shrinkage and Selection Operator and machine learning, and the relationship between the features within the model and the disease severity and mortality of patients was analyzed. Finally, the relationships between the ICU-AF model, antifungal therapy and empirical antifungal therapy were analyzed. Results A total of 1,434 cases were included finally. We used lasso dimensionality reduction for all features and selected six features with importance ≥0.05 in the optimal model, namely, times of arterial catheter, enteral nutrition, corticosteroids, broadspectrum antibiotics, urinary catheter, and invasive mechanical ventilation. The area under the curve of the model for predicting ICU-AF was 0.981 in the test set, with a sensitivity of 0.960 and specificity of 0.990. The times of arterial catheter (p = 0.011, OR = 1.057, 95% CI = 1.053-1.104) and invasive mechanical ventilation (p = 0.007, OR = 1.056, 95%CI = 1.015-1.098) were independent risk factors for antifungal therapy in ICU-AF. The times of arterial catheter (p = 0.004, OR = 1.098, 95%CI = 0.855-0.970) were an independent risk factor for empirical antifungal therapy. Conclusion The most important risk factors for ICU-AF are the six time-related features of clinical parameters (arterial catheter, enteral nutrition, corticosteroids, broadspectrum antibiotics, urinary catheter, and invasive mechanical ventilation), which provide early warning for the occurrence of fungal infection. Furthermore, this model can help ICU physicians to assess whether empiric antifungal therapy should be administered to ICU patients who are susceptible to fungal infections.
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Affiliation(s)
- Yi-Si Zhao
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Qing-Pei Lai
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hong Tang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ren-Jie Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Wei He
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liu-Yang Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Tao Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shi-Hui Lin
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Jian Qin
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fang Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Miwa T, Okamoto K, Ikeuchi K, Yamamoto S, Okugawa S, Ichida A, Akamatsu N, Hasegawa K, Tsutsumi T. The Role of Frequent Screening or Diagnostic Testing of Serum Cryptococcal Antigen in Liver Transplant Recipients: A Descriptive Epidemiology. Open Forum Infect Dis 2024; 11:ofae255. [PMID: 38774792 PMCID: PMC11108085 DOI: 10.1093/ofid/ofae255] [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: 03/06/2024] [Indexed: 05/24/2024] Open
Abstract
Background Cryptococcosis is a notable infectious complication of liver transplantation. Currently, there is no recommendation for screening serum cryptococcal antigen (CrAg) levels in solid organ transplant recipients. We aimed to explore the role of serum CrAg in liver transplant recipients at an institution where posttransplant serum CrAg has been widely tested. Methods This retrospective study was conducted at a tertiary care center in Japan. All liver transplant recipients with serum CrAg measured either for screening or for diagnostic testing at least once after transplantation between April 2005 and March 2022 were included. For participants with either a positive CrAg test result or positive culture for Cryptococcus, we manually reviewed clinical manifestations, management, and prognosis from the medical records. Results During the study period, 12 885 serum CrAg tests (median, 16 tests per patient) were performed in 468 liver transplant recipients. The 1-year posttransplant incidence of positive serum CrAg test results and culture-proven cryptococcosis was 1.9% (9/468) and 0.6% (3/468), respectively. No patient with persistently negative serum CrAg test results showed growth of Cryptococcus in culture. Four patients had clinical manifestations consistent with cryptococcosis, of whom 2 (50.0%) started antifungal therapy promptly based on a positive serum CrAg test result. In contrast, 5 patients had no clinical manifestations. Three of the 5 (60.0%) patients did not receive antifungal therapy and remained free of clinical manifestations. Conclusions Serum CrAg test was more sensitive than culture among liver transplant recipients and prompted early diagnosis and antifungal therapy in symptomatic patients. However, serial screening of serum CrAg in asymptomatic patients may be of little value, with the potential for false-positive results.
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Affiliation(s)
- Toshiki Miwa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiko Ikeuchi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiko Ichida
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
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Biyun L, Yahui H, Yuanfang L, Xifeng G, Dao W. Risk factors for invasive fungal infections after haematopoietic stem cell transplantation: a systematic review and meta-analysis. Clin Microbiol Infect 2024; 30:601-610. [PMID: 38280518 DOI: 10.1016/j.cmi.2024.01.005] [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: 07/12/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Invasive fungal infections (IFIs) are common infectious complications after haematopoietic stem cell transplantation (HSCT), seriously threatening the survival of patients. OBJECTIVES This systematic review aimed to investigate risk factors associated with IFIs following HSCT. METHODS Two authors independently conducted the selection of studies and extraction of data. Risk factors for IFIs, invasive aspergillosis or invasive mould infections and invasive candida infection after HSCT were compiled separately by meta-analysis using RevMan 5.4 and R language 4.1.2. DATA SOURCES Pubmed, EMBASE, Web of Science, and the Cochrane Library until April 2023. STUDY ELIGIBILITY CRITERIA Case-control or cohort studies that assessed risk factors for IFIs among HSCT recipients were included. PARTICIPANTS Patients experiencing HSCT. TEST/S None. REFERENCE STANDARD The IFIs were defined according to the European Organisation for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria, or a similar definition. ASSESSMENT OF RISK OF BIAS A modified version of the Newcastle-Ottawa Scale was used. METHODS OF DATA SYNTHESIS A random-effects model with the Mantel-Haenszel method was used to pool results from primary studies. RESULTS Out of 1637 studies screened, 51 studies involving 109 155 patients were included, with 45 studies providing adequate data for meta-analysis. Identified risk factors for IFIs included prolonged neutropenia, intensified therapy for graft-versus-host disease (GVHD), previous transplantation, previous proven or probable IFI, acute GVHD ≥ grade II, extensive or severe chronic GVHD, use of anti-thymocyte globulin during transplantation, haploidentical transplantation, high-dose glucocorticoids, Epstein-Barr virus infection, cytomegalovirus infection or reactivation, and lower albumin. Conversely, antifungal prophylaxis emerged as the sole preventive factor. For invasive aspergillosis or invasive mould infections, the top risk factors were extensive or severe chronic GVHD, respiratory viral infection, high-dose glucocorticoids, acute GVHD ≥ grade II, and human leukocyte antigen mismatch. Cord blood transplantation was the sole significant risk factor for invasive candidiasis. However, there was likely a high degree of interdependence among various risk factors. DISCUSSION This meta-analysis provides a thorough review of risk factors for IFIs infection after HSCT. The achieved insights can aid in stratifying patients who are at an elevated risk of IFIs and promoting antifungal preventive strategies.
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Affiliation(s)
- Li Biyun
- Department of Pediatric Hematology and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Han Yahui
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Yuanfang
- Department of Pediatric Hematology and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guo Xifeng
- Department of Pediatric Hematology and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wang Dao
- Department of Pediatric Hematology and Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Alsalman J, Althaqafi A, Alsaeed A, Subhi A, Mady AF, AlHejazi A, Francis B, Alturkistani HH, Ayas M, Bilbisi M, Alsharidah S. Middle Eastern Expert Opinion: Strategies for Successful Antifungal Stewardship Program Implementation in Invasive Fungal Infections. Cureus 2024; 16:e61127. [PMID: 38919246 PMCID: PMC11198984 DOI: 10.7759/cureus.61127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
In recent years, global public health efforts have increasingly emphasized the critical role of antimicrobial stewardship (AMS) in improving outcomes, reducing costs, and combating the growing threat of antimicrobial resistance. However, antifungal stewardship (AFS) has remained relatively overlooked despite the staggering impact of invasive fungal infections (IFIs). This burden is particularly pronounced in hospitals worldwide, with the Middle East facing significant unmet needs. The rising population of immunocompromised individuals vulnerable to IFI has prompted an increased reliance on antifungal agents for both prevention and treatment. Given the considerable mortality associated with IFIs and the emergence of antifungal resistance, implementing AFS programs in hospital settings is becoming increasingly urgent. In this article, we offer expert insights into the strategies that can be used for successful antifungal stewardship program implementation in IFI. Drawing upon the extensive clinical experience of a multinational and multidisciplinary panel, we present recommendations for optimizing AFS practices. We delve into the challenges and practical considerations of tailoring local AFS initiatives to the evolving landscape of fungal infections. Additionally, we provide actionable recommendations and position statements for the effective implementation of AFS programs, informed by the collective clinical experiences of panel members across their respective countries of practice.
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Affiliation(s)
| | - Abdulhakeem Althaqafi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Medicine/Infectious Diseases, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Ahmad Alsaeed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Adult Hematology and Stem Cell Transplantation, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Jeddah, SAU
| | - Ahmad Subhi
- Adult Infectious Diseases, Department of Medicine, Al-Qassimi Hospital, Emirates Health Services, Sharjah, ARE
| | - Ahmed F Mady
- Critical Care Medicine, King Saud Medical City, Riyadh, SAU
| | - Ayman AlHejazi
- Department of Oncology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Bassam Francis
- Hematology, Hematology and Bone Marrow Transplant Center, Baghdad, IRQ
| | | | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Montaser Bilbisi
- Department of Infectious Diseases, Abdali Medical Center, Amman, JOR
| | - Sondus Alsharidah
- Pediatric Stem Cell Transplant Unit, Department of Pediatric Hematology/Oncology, National Bank of Kuwait (NBK) Children's Specialized Hospital, Sabah Central Health Region, KWT
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Kohli A, Rifai ZJ, Foray N. Exploring a Rare Pulmonary Coinfection: Cryptococcal Pneumonia and Exophiala dermatitidis in an Immunocompetent Host. Cureus 2024; 16:e61085. [PMID: 38919216 PMCID: PMC11197632 DOI: 10.7759/cureus.61085] [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: 05/25/2024] [Indexed: 06/27/2024] Open
Abstract
Pulmonary cryptococcosis is becoming increasingly common in immunocompetent hosts, manifesting with variable clinical presentations ranging from asymptomatic colonization to severe pneumonia. Radiological findings are non-specific, such as nodular infiltrates, mass-like lesions, and mediastinal lymphadenopathy. We present a case of a 61-year-old woman with Cryptococcus neoformans pneumonia coinfected with Exophiala dermatitidis, an unusual occurrence in an immunocompetent host and the first of its kind. This coinfection posed significant diagnostic challenges due to the rare occurrence of each individual organism in immunocompetent patients as well as the difficulty of their laboratory diagnosis. Treatment regimens, particularly in coinfections, warrant careful consideration to mitigate mortality risk. This case underscores the importance of comprehensive diagnostic strategies and optimized treatment regimens for rare fungal coinfections in immunocompetent hosts.
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Affiliation(s)
- Akshay Kohli
- Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Zeyad J Rifai
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Nathalie Foray
- Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, Springfield, USA
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Pandey M, Xess I, Sachdev J, Sharad N, Gupta S, Singh G, Yadav RK, Rana B, Raj S, Ahmad MN, Nityadarshini N, Baitha U, Soneja M, Shalimar, Prakash B, Sikka K, Mathur P, Jyotsna VP, Kumar R, Wig N, Gourav S, Biswas A, Thakar A. Utility of an in-house real-time PCR in whole blood samples as a minimally invasive method for early and accurate diagnosis of invasive mould infections. J Infect 2024; 88:106147. [PMID: 38555035 DOI: 10.1016/j.jinf.2024.106147] [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: 09/20/2023] [Revised: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Invasive mould infections (IMIs) are a leading cause of death in patients with compromised immune systems. Proven invasive mould infection requires detection of a fungus by histopathological analysis of a biopsied specimen, sterile culture, or fungal DNA amplification by PCR in tissue. However, the clinical performance of a PCR assay on blood samples taken from patients suspected of invasive mould disease has not been fully evaluated, particularly for the differential diagnosis of invasive aspergillosis (IA) and invasive Mucormycosis (IM). OBJECTIVES To assess the diagnostic utility of our previously validated in-house real-time PCR in blood samples for diagnosis of invasive aspergillosis and mucormycosis in patients with suspected invasive mould infection. METHODS All patients with suspected invasive mould infection were prospectively enrolled from May 2021 to July 2021. Conventional fungal diagnosis was performed using tissue and respiratory samples. In-house PCR was performed on blood samples and its diagnostic performance evaluated. RESULTS A total of 158 cases of suspected invasive mould infection were enrolled in the study. The sensitivity and specificity of in-house PCR performed on blood samples was found to be 92.5% and 81.4% respectively for diagnosis of probable IA, and 65% and 84.62% respectively for diagnosis of proven and probable IM. It was also able to detect 3 out of 5 cases of possible IM where no other microbiological evidence of IM was obtained. CONCLUSIONS This assay could be helpful in minimally invasive diagnosis of IMIs for patients in whom invasive sampling is not feasible, especially as a preliminary or screening test. It can help in early diagnosis, anticipating conventional laboratory confirmation by days or weeks. Possible correlation between fungal load and mortality can help in initiating aggressive treatment for patients with high initial fungal load.
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Affiliation(s)
- Mragnayani Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Janya Sachdev
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Sharad
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sonakshi Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Renu Kumari Yadav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Rana
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Stephen Raj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - M Nizam Ahmad
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Nityadarshini
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu Prakash
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sudesh Gourav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
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Liu J, Li Y, Liu Y, Yu R, Yin Y, Lai X, Xu B, Cao J. Elevated serum level of progranulin is associated with increased mortality in critically ill patients with candidemia. Microbes Infect 2024; 26:105302. [PMID: 38246573 DOI: 10.1016/j.micinf.2024.105302] [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: 10/03/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
Candidemia is a severe disease with high mortality in both intensive care unit (ICU) and non-ICU settings. Considering that progranulin (PGRN) is a potential therapeutic target for the candidemia caused by Candida albicans, we determined the serum level of PGRN after candidemia and evaluated its association with mortality. A retrospective discovery cohort (62 patients) and a validation cohort (70 patients) were enrolled. Blood was collected on day of first blood culture positivity for C. albicans, and serum PGRN levels were then measured. In the discovery cohort, all serum PGRN studied were expressed at higher levels in candidemia patients than in bacteremia patients and healthy volunteers, non-survivors presented with significantly higher serum PGRN concentrations when compared with survivors. Serum PGRN concentration was associated with 30-day mortality and patients at a higher risk of death showed higher serum PGRN levels. These results were confirmed in the independent validation cohort. Interestingly, in vitro study demonstrated that macrophages, neutrophils and lymphocytes may be the major source of PGRN production after C. albicans infection instead of epithelial cells. Our findings highlight that serum PGRN appears as a biomarker in candidemia patients and as a promising tool for mortality risk stratification in managing candidemia.
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Affiliation(s)
- Jiayu Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Key Laboratory of Laboratory Medical Diagnostics Designated by the Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Yue Li
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuhan Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Renlin Yu
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yibing Yin
- Key Laboratory of Laboratory Medical Diagnostics Designated by the Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Xiaofei Lai
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Banglao Xu
- Department of Laboratory Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Ju Cao
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Flanagan EP. Aspergillus myelitis: Breaking the mold to make a diagnosis. Mult Scler 2024; 30:758-759. [PMID: 38450617 DOI: 10.1177/13524585241237385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
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Jeantin L, Leclercq D, Tran S, Maillart E, Reina V, Fekkar A, Lanternier F, Marois C, Celier A. Longitudinally extensive posterolateral myelitis revealing invasive CNS aspergillosis in an immunocompetent patient. Mult Scler 2024; 30:755-758. [PMID: 38247156 DOI: 10.1177/13524585231221680] [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: 01/23/2024]
Abstract
BACKGROUND Fungal infections of the central nervous system usually affect immunocompromised patients. Primary Aspergillus myelitis has never been described. REPORT A 45-year-old immunocompetent male with subacute paraplegia was treated for inflammatory myelitis before clinical deterioration requiring mechanical ventilation. Purulent meningitis preceded the formation of a paraspinal nodule biopsied by neurosurgery. Histopathological analysis revealed the presence of fungal hyphae, and polymerase chain reaction was positive for Aspergillus fumigatus. No cause of immunodeficiency was identified in this patient. DISCUSSION Primary Aspergillus myelitis may be confused with inflammatory myelitis and should be considered even in the absence of apparent immunosuppression.
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Affiliation(s)
- Lina Jeantin
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Department of Neurology, Neuro-ICU, Paris, France
| | - Delphine Leclercq
- Department of Neuroradiology, Pitié-Salpétrière University Hospital, Paris, France
| | - Suzanne Tran
- Sorbonne Université, Groupe Hospitalier Universitaire Pitié-Salpêtrière, Department of Neuropathology, APHP, Paris, France/Paris Brain Institute-ICM, Inserm, CNRS, UMRS 1127, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Elisabeth Maillart
- Department of Neurology, Pitié-Salpétrière University Hospital, Paris, France
| | - Vincent Reina
- Department of Neurosurgery, Pitié-Salpétrière University Hospital, Paris, France
| | - Arnaud Fekkar
- AP-HP, Groupe Hospitalier La Pitié-Salpêtrière, Parasitologie Mycologie, Paris, France/Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, Paris, France
| | - Fanny Lanternier
- Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Paris, France/Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Department of Mycology, Paris, France
| | - Clémence Marois
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Department of Neurology, Neuro-ICU, Paris, France
| | - Adam Celier
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Department of Neurology, Neuro-ICU, Paris, France
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Wu X, Cao Z, Chen Z, Wang Y, He H, Xiao P, Hu S, Lu J, Li B. Infectious complications in pediatric patients undergoing CD19+CD22+ chimeric antigen receptor T-cell therapy for relapsed/refractory B-lymphoblastic leukemia. Clin Exp Med 2024; 24:87. [PMID: 38662121 PMCID: PMC11045589 DOI: 10.1007/s10238-024-01339-7] [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: 12/25/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy is effective in the treatment of relapsed/refractory acute B-lymphoblastic leukemia (R/R B-ALL); however, patients who receive CAR-T therapy are predisposed to infections, with considerable detrimental effects on long-term survival rates and the quality of life of patients. This study retrospectively analyzed infectious complications in 79 pediatric patients with R/R B-ALL treated with CAR-T cells at our institution. Overall, 53 patients developed 88 infections. Nine patients experienced nine infections during lymphodepletion chemotherapy, 35 experienced 41 infections during the early phase (days 0-+ 30 after infusion), and 29 experienced 38 infections during the late phase (day + 31-+ 90 after infusion). Pathogens were identified in 31 infections, including 23 bacteria, seven viruses, and one fungus. Four patients were admitted to the intensive care unit for infection and one died. In a univariate analysis, there were ten factors associated with infection, including tumor load, lymphodepleting chemotherapy, neutrophil deficiency and lymphocyte reduction, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), etc. In a multivariate analysis, CRS ≥ grade 3 was identified as a risk factor for infection (hazard ratio = 2.41, 95% confidence interval: 1.08-5.36, P = 0.031). Therefore, actively reducing the CRS grade may decrease the risk of infection and improve the long-term quality of life of these patients.
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Affiliation(s)
- Xiaochen Wu
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China
| | - Zhanmeng Cao
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China
| | - Zihan Chen
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China
| | - Yi Wang
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China
| | - Hailong He
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China
| | - Peifang Xiao
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China
| | - Shaoyan Hu
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China.
| | - Jun Lu
- Department of Hematology, Children's Hospital of Soochow University, Suzhou, 215002, Jiangsu, China.
| | - Benshang Li
- Key Laboratory of Pediatric Hematology and Oncology, Department of Hematology and Oncology, Shanghai Children's Medical Center, Ministry of Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Zheng G, Cai J, Deng H, Yang H, Xiong W, Chen E, Bai H, He J. Development of a risk prediction model for subsequent infection after colonization with carbapenem-resistant Enterobacterales: a retrospective cohort study. Antimicrob Resist Infect Control 2024; 13:46. [PMID: 38659068 PMCID: PMC11044304 DOI: 10.1186/s13756-024-01394-5] [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: 05/18/2023] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Colonization of carbapenem-resistant Enterobacterale (CRE) is considered as one of vital preconditions for infection, with corresponding high morbidity and mortality. It is important to construct a reliable prediction model for those CRE carriers with high risk of infection. METHODS A retrospective cohort study was conducted in two Chinese tertiary hospitals for patients with CRE colonization from 2011 to 2021. Univariable analysis and the Fine-Gray sub-distribution hazard model were utilized to identify potential predictors for CRE-colonized infection, while death was the competing event. A nomogram was established to predict 30-day and 60-day risk of CRE-colonized infection. RESULTS 879 eligible patients were enrolled in our study and divided into training (n = 761) and validation (n = 118) group, respectively. There were 196 (25.8%) patients suffered from subsequent CRE infection. The median duration of subsequent infection after identification of CRE colonization was 20 (interquartile range [IQR], 14-32) days. Multisite colonization, polymicrobial colonization, catheterization and receiving albumin after colonization, concomitant respiratory diseases, receiving carbapenems and antimicrobial combination therapy before CRE colonization within 90 days were included in final model. Model discrimination and calibration were acceptable for predicting the probability of 60-day CRE-colonized infection in both training (area under the curve [AUC], 74.7) and validation dataset (AUC, 81.1). Decision-curve analysis revealed a significantly better net benefit in current model. Our prediction model is freely available online at https://ken-zheng.shinyapps.io/PredictingModelofCREcolonizedInfection/ . CONCLUSIONS Our nomogram has a good predictive performance and could contribute to early identification of CRE carriers with a high-risk of subsequent infection, although external validation would be required.
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Affiliation(s)
- Guanhao Zheng
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Jiaqi Cai
- Department of Clinical Laboratory, Kunshan Hospital, Nanjing University of Chinese Medicine, Kunshan, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Han Deng
- Department of International Medical Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Haoyu Yang
- Department of Pharmacy, Handan First Hospital, Handan, China
| | - Wenling Xiong
- Department of Infection Management, Chongqing University Cancer Hospital, Chongqing, China
| | - Erzhen Chen
- Department of Emergency Intensive Care Unit, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hao Bai
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China.
| | - Juan He
- Department of Pharmacy, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Winchell G, de Greef R, Ouerdani A, Fauchet F, Wrishko RE, Mangin E, Bruno C, Waskin H. A population pharmacokinetic model for posaconazole intravenous solution and oral powder for suspension formulations in pediatric patients with neutropenia. Antimicrob Agents Chemother 2024; 68:e0119723. [PMID: 38376229 PMCID: PMC10994819 DOI: 10.1128/aac.01197-23] [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: 09/18/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024] Open
Abstract
The objective of this study was to support posaconazole dose regimens in pediatric patients aged ≥2 years, using a population pharmacokinetic (PK) approach with data from a phase 1b study (NCT02452034). A one-compartment model with first-order absorption was fit to pharmacokinetic data from 144 participants aged 2 to 17 years, who were administered posaconazole as intravenous (IV) and powder for oral suspension (PFS) formulations, or IV only, at dosing regimens of 3.5, 4.5, and 6 mg/kg. The influence of demographic and clinical factors on pharmacokinetic parameters was evaluated using a stepwise forward inclusion/backward exclusion procedure. The final model simulated posaconazole exposure in patients aged 2 to <7 and 7 to 17 years at dosing regimens of 4.5, 6, and 7.5 mg/kg. Plasma concentration data following IV and PFS administration were well-described by a one-compartment model with first-order absorption and estimated bioavailability, where clearance and volume were subject to allometric scaling by body weight. The 6-mg/kg dosing regimen achieved the pharmacokinetic target (90% of the pediatric population having an average steady-state plasma concentration of ≥500 and <2,000 ng/mL) for both age groups, regardless of whether patients received IV and PFS or IV only. In a virtual adolescent population (body weight >40 kg), the 300 mg/day posaconazole tablet was also predicted to achieve the pharmacokinetic target and remain within a safe range of exposure. These data informed a weight-based nomogram for PFS dosing to maximize the number of pediatric patients achieving the pharmacokinetic target across weight bands, while also maintaining a favorable benefit/risk profile.
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Zhang J, Gao XL, Wu J, Chen JJ. Clinical characteristics and outcomes of pleural aspergillosis: a review of 13 cases. Microbiol Spectr 2024; 12:e0385223. [PMID: 38411055 PMCID: PMC10986553 DOI: 10.1128/spectrum.03852-23] [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: 11/03/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
Aspergillus pleurisy is a rare complication of invasive pulmonary aspergillosis (IPA), which mostly occurs in the immunocompromised host. The clinical condition is critical, especially to those who develop bronchopleural fistula. This study aimed to assess the characteristics and the prognosis of aspergillus pleurisy. Clinical data from 13 patients diagnosed with aspergillus pleurisy in our hospital from January 2000 to December 2022 were retrospectively studied. Thirteen patients with Aspergillus pleurisy were included. There were 10 males and 3 females, with a median age of 65 (range: 18-79) years. Bronchopleural fistula was present in eight patients. A proven diagnosis of Aspergillus pleurisy was based on positive pleural fluid culture in seven cases and histopathological examination of pleural biopsies in six cases. Four patients refused further treatment and were discharged from the hospital against medical advice. Nine cases recovered and were discharged after multiple antifungal treatments (systemic and topical antifungal therapies, pleural drainage and irrigation, and surgical repair). During follow-up, one patient, who suffered underlying bronchiectasis, died of massive hemoptysis 2 years after discharge. The remaining eight cases are still under close follow-up, with a median follow-up of 5.4 (range: 1.3-18.9) years. The prognosis of aspergillus pleurisy complicated with bronchopleural fistula is poor. Thoracic surgery, especially lung resection, is a risk factor associated with the incidence of Aspergillus pleurisy. Systemic antifungal therapy and adequate pleural irrigation could improve the prognosis. IMPORTANCE Aspergillus pleurisy is a rare complication of invasive pulmonary aspergillosis (IPA), associated with a poor prognosis. The morbidity and mortality of this condition have not been thoroughly studied, and recent research on this topic is limited. The current study included 13 patients diagnosed with Aspergillus pleurisy, with the majority presenting concomitantly with a bronchopleural fistula. Among these patients, nine had a history of thoracic surgery, including lung transplantation and lobectomy. Four patients refused further treatment and were discharged against medical advice, while one patient succumbed to massive hemoptysis 2 years after discharge. This case series provides essential insights into Aspergillus pleurisy and evaluates the therapeutic strategy based on a limited cohort.
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Affiliation(s)
- Jing Zhang
- Second Department of Geriatrics Respiratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Xing-Lin Gao
- Second Department of Geriatrics Respiratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Jian Wu
- Second Department of Geriatrics Respiratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Jing-Jing Chen
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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Boppana M, Sengar M, Jain H, Gurjar M, Ambotkar M, Gota V, Bonda A, Bagal B, Thorat J, Gokarn A, Nayak L, Shetty N, Baheti A, Mokal S, Kannan S, Shetty A, Eipe T. A Prospective Study to Evaluate the Effect of Therapeutic Drug Monitoring-Based Posaconazole Prophylaxis on Invasive Fungal Infection Rate During Acute Myeloid Leukemia Induction Therapy. Indian J Hematol Blood Transfus 2024; 40:204-212. [PMID: 38708158 PMCID: PMC11065854 DOI: 10.1007/s12288-023-01709-3] [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: 05/13/2023] [Accepted: 10/04/2023] [Indexed: 05/07/2024] Open
Abstract
Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality in de-novo acute myeloid leukemia patients receiving induction chemotherapy. Despite using posaconazole, a broad-spectrum antifungal, for IFI prophylaxis, the breakthrough IFI rate is high in the real-world setting. One of the reasons could be frequent suboptimal plasma posaconazole levels. In the present study, we evaluated if therapeutic drug monitoring (TDM) guided posaconazole prophylaxis can reduce the IFI rates in comparison to a historical cohort. We enrolled 90 patients, > / = 16 years of age, without baseline IFIs, planned for remission induction therapy. All patients were started on posaconazole suspension 200 mg TDS and the dose was increased in a stepwise manner if trough levels were found to be suboptimal (< 350 ng/ml for day 2 or < 700 ng/ml subsequently). The TDM based approach resulted in a significant decline in breakthrough IFI rates (18% versus 52%, P < 0.0001) A total of 69 patients (78%) required dose escalation. Thirty-one patients required change in antifungals due to either suboptimal levels, persistent fever, diarrhoea or vomiting. We could not demonstrate an exposure-response relationship but the difference in IFI rates in patients with a median posaconazole level > / = 700 ng/ml (0%) and < 700 ng/ml (21.6%) was clinically meaningful. Posaconazole levels were found to be significantly lower in patients on antacids and prokinetics. The incidence of posaconazole-related grade 3 toxicity was low (2.3%). Thus TDM-based dosing of posaconazole helps reduce breakthrough IFI rate and should be a part of posaconazole prophylaxis. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01709-3.
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Affiliation(s)
- Mounika Boppana
- Department of Medical Oncology, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
- Present Address: Department of Medical Oncology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, Telangana 500003, India
| | - Manju Sengar
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, Earnest Borges Road, Parel, Mumbai 400012 India
| | - Hasmukh Jain
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Murari Gurjar
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Madhavi Ambotkar
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Avinash Bonda
- Department of Medical Oncology, Asian Institute of Gastroenterology (AIG) Hospitals, Mindspace Road, P Janardhan Reddy Nagar, Gachibowli, Hyderabad, Telangana 500032, India
| | - Bhausaheb Bagal
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Jayashree Thorat
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Anant Gokarn
- Adult Hematolymphoid Unit, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Lingaraj Nayak
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Nitin Shetty
- Department of Radiodiagnosis, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Akshay Baheti
- Department of Radiodiagnosis, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Smruti Mokal
- Clinical Research Secretariat, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Sadhana Kannan
- Clinical Research Secretariat, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Alok Shetty
- Department of Medical Oncology, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Thomas Eipe
- Department of Medical Oncology, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
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Barnbrock A, Salmanton-García J, Lankes F, Bochennek K, Schöning S, Lehrnbecher T. No Impact of Dietary Restrictions on the Risk for Infection in Pediatric Patients With Cancer: A Monocenter Analysis. JCO Oncol Pract 2024; 20:503-508. [PMID: 38261984 DOI: 10.1200/op.23.00553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
PURPOSE Prophylactic anti-infective strategies are used in patients with cancer to decrease the risk for infection. Dietary restrictions do not allow raw vegetables and fresh fruits to limit the introduction of potentially harmful pathogens in the gastrointestinal tract, but the efficacy is unclear. PATIENTS AND METHODS In this study analyzing the impact of the dietary restrictions on infectious complications, all children treated between April 2014 and March 2018 for ALL and AML or non-Hodgkin lymphoma (NHL) were included. Dietary restrictions were standard until March 2016, but were stopped in April 2016. Patients with dietary restrictions (treated April 2014-March 2016) and patients not advised for dietary restrictions (treated April 2016-March 2018) were compared regarding infectious complications, including bloodstream infection, pneumonia, diarrhea, and fever of unknown origin (FUO). RESULTS Eighty-six patients (25 female; 62 ALL; nine AML, 15 NHL) experienced 223 infections. The 46 patients with dietary restrictions and the 40 patients without food restrictions did not significantly differ regarding the number of infections per patient, bloodstream infections, pneumonia, diarrhea, FUO, admission to intensive care, and death. CONCLUSION Our data suggest that dietary restrictions do not affect the risk for infectious complications. Therefore, the indication of dietary restrictions should be reconsidered in pediatric patients with cancer.
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Affiliation(s)
- Anke Barnbrock
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - 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, 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
| | - Franziska Lankes
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Konrad Bochennek
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Stefan Schöning
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Thomas Lehrnbecher
- Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany
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