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Beltran-Reyes P, Ostrosky-Zeichner L, Gonzalez-Lara MF. Update on diagnosis and treatment of fungal meningitis: lessons from recent outbreaks. Curr Opin Infect Dis 2024:00001432-990000000-00182. [PMID: 39259683 DOI: 10.1097/qco.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
PURPOSE OF REVIEW Recently, fungal meningitis outbreaks have occurred in association with neuraxial and epidural anesthesia in immunocompetent patients. Herein, we describe the course of those outbreaks, their diagnosis, treatment, prognosis, and lessons learned. RECENT FINDINGS Two outbreaks of Fusarium solani meningitis during 2022-2023 were associated with epidural anesthesia in two distant cities in Mexico (Durango and Matamoros). The initial etiological agent identification was delayed due to insensitivity of cultures. A Fusarium solani qPCR was validated and positive in 38% cerebrospinal fluid (CSF) samples from Durango, while BD-Glucan allowed early diagnosis of the index case in Matamoros. Antifungal treatment with voriconazole and liposomal amphotericin B (L-AmB) was recommended. Overall mortality was 51%. Once the cause was confirmed, some patients received fosmanogepix. SUMMARY Fungal meningitis outbreaks due to filamentous fungi are usually associated with direct epidural inoculation. They result in severe presentations and high mortality. Early diagnosis should be suspected, BD-Glucan CSF testing screening is recommended. Aggressive antifungal treatment based on antifungal susceptibility testing should be administered as early as possible. The advent of molecular diagnostic methods and new antifungal drugs may allow for timely diagnosis and treatment, increasing the chances of survival.
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Affiliation(s)
- Paula Beltran-Reyes
- Clinical Microbiology Department, Infectious Diseases Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Maria F Gonzalez-Lara
- Clinical Microbiology Department, Infectious Diseases Department, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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2
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Griffin IS, Smith DJ, Annambhotla P, Gold JAW, Ostrosky-Zeichner L, Kauffman CA, Gade L, Litvintseva A, Friedman DZ, Nishio Lucar AG, Parpia TC, Lieberman J, Bujan J, Corkrean J, Divatia MK, Grimes K, Lin J, Mobley C, Schwartz MR, Hannawi B, Malilay A, O'Boye A, Lysne J, Subramani MV, Heckmann H, Servellita V, Chiu C, Basavaraju SV. Outcomes in solid organ transplant recipients receiving organs from a donor with Fusarium solani species complex meningitis. Transpl Infect Dis 2024:e14331. [PMID: 39012471 DOI: 10.1111/tid.14331] [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: 04/18/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Five organs (heart, right lung, liver, right, and left kidneys) from a deceased patient were transplanted into five recipients in four US states; the deceased patient was identified as part of a healthcare-associated fungal meningitis outbreak among patients who underwent epidural anesthesia in Matamoros, Mexico. METHODS After transplant surgeries occurred, Fusarium solani species complex, a fungal pathogen with a high case-mortality rate, was identified in cerebrospinal fluid from the organ donor by metagenomic next-generation sequencing (mNGS) and fungal-specific polymerase chain reaction and in plasma by mNGS. RESULTS Four of five transplant recipients received recommended voriconazole prophylaxis; four were monitored weekly by serum (1-3)-β-d-glucan testing. All five were monitored for signs of infection for at least 3 months following transplantation. The liver recipient had graft failure, which was attributed to an etiology unrelated to fungal infection. No fungal DNA was identified in sections of the explanted liver, suggesting that F. solani species complex did not contribute to graft failure. The remaining recipients experienced no signs or symptoms suggestive of fusariosis. CONCLUSION Antifungal prophylaxis may be useful in preventing donor-derived infections in recipients of organs from donors that are found to have Fusarium meningitis.
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Affiliation(s)
- Isabel S Griffin
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dallas J Smith
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pallavi Annambhotla
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Carol A Kauffman
- Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anastasia Litvintseva
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel Zp Friedman
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Angie G Nishio Lucar
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Tarina C Parpia
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Janet Bujan
- Houston Methodist Hospital, Houston, Texas, USA
| | | | - Mukul K Divatia
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Jiejian Lin
- Houston Methodist Hospital, Houston, Texas, USA
| | | | - Mary R Schwartz
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Bashar Hannawi
- Transplant Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anne Malilay
- Transplant Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anne O'Boye
- Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Jeffrey Lysne
- Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | | | | | - Venice Servellita
- Department of Laboratory Medicine and Medicine, Division of Infectious Diseases and UCSF Clinical Microbiology Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Charles Chiu
- Department of Laboratory Medicine and Medicine, Division of Infectious Diseases and UCSF Clinical Microbiology Laboratory, University of California San Francisco, San Francisco, California, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Hoenigl M, Arastehfar A, Arendrup MC, Brüggemann R, Carvalho A, Chiller T, Chen S, Egger M, Feys S, Gangneux JP, Gold JAW, Groll AH, Heylen J, Jenks JD, Krause R, Lagrou K, Lamoth F, Prattes J, Sedik S, Wauters J, Wiederhold NP, Thompson GR. Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease. Clin Microbiol Rev 2024; 37:e0007423. [PMID: 38602408 PMCID: PMC11237431 DOI: 10.1128/cmr.00074-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
SUMMARYFungal infections are on the rise, driven by a growing population at risk and climate change. Currently available antifungals include only five classes, and their utility and efficacy in antifungal treatment are limited by one or more of innate or acquired resistance in some fungi, poor penetration into "sequestered" sites, and agent-specific side effect which require frequent patient reassessment and monitoring. Agents with novel mechanisms, favorable pharmacokinetic (PK) profiles including good oral bioavailability, and fungicidal mechanism(s) are urgently needed. Here, we provide a comprehensive review of novel antifungal agents, with both improved known mechanisms of actions and new antifungal classes, currently in clinical development for treating invasive yeast, mold (filamentous fungi), Pneumocystis jirovecii infections, and dimorphic fungi (endemic mycoses). We further focus on inhaled antifungals and the role of immunotherapy in tackling fungal infections, and the specific PK/pharmacodynamic profiles, tissue distributions as well as drug-drug interactions of novel antifungals. Finally, we review antifungal resistance mechanisms, the role of use of antifungal pesticides in agriculture as drivers of drug resistance, and detail detection methods for antifungal resistance.
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Affiliation(s)
- Martin Hoenigl
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Amir Arastehfar
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Roger Brüggemann
- Department of Pharmacy and Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc-CWZ Center of Expertise in Mycology, Nijmegen, The Netherlands
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW South Wales Health Pathology, Westmead Hospital, Westmead, Australia
- The University of Sydney, Sydney, Australia
| | - Matthias Egger
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Simon Feys
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jean-Pierre Gangneux
- Centre National de Référence des Mycoses et Antifongiques LA-AspC Aspergilloses chroniques, European Excellence Center for Medical Mycology (ECMM EC), Centre hospitalier Universitaire de Rennes, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S 1085, Rennes, France
| | - Jeremy A. W. Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H. Groll
- Department of Pediatric Hematology/Oncology and Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children’s Hospital, Muenster, Germany
| | - Jannes Heylen
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jeffrey D. Jenks
- Department of Public Health, Durham County, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Robert Krause
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Juergen Prattes
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Sarah Sedik
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Joost Wauters
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Nathan P. Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
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Strong N, Ostrosky-Zeichner L. Fusarium species central nervous system infection. Curr Opin Infect Dis 2024; 37:185-191. [PMID: 38518108 DOI: 10.1097/qco.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW Fusarium species are an increasingly important cause of meningitis and invasive disease in immunocompromised patients as well as in otherwise healthy patients as observed in two recent healthcare-associated outbreaks. This review summarizes recently published information on treatment and diagnosis of this infection. RECENT FINDINGS Incidence of Fusarium species meningitis and invasive fusariosis are increasing. Molecular techniques are improving the speed of diagnosis. New antifungal agents in development show good in vitro activity against some Fusarium species. New technologies, including cerebrospinal fluid (CSF) filtration, may play a role in treatment of central nervous system (CNS) disease. Due to the continued prime importance of the host immune system in recovery, immunomodulatory treatments may play a role in treatment. SUMMARY The overall incidence of CNS fusariosis is increasing with a continued poor prognosis, but new diagnostic and treatment modalities are in development which may offer improvements.
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Affiliation(s)
- Nora Strong
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Bailey H. Advances in emergency management of the critically Ill and injured. Curr Opin Crit Care 2024; 30:193-194. [PMID: 38690951 DOI: 10.1097/mcc.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Heatherlee Bailey
- Department of Emergency Medicine, VA Medical Center, 508 Fulton Street, Durham
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6
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Maltezou HC, Pavli A. Challenges with medical tourism. Curr Opin Crit Care 2024; 30:224-230. [PMID: 38441086 DOI: 10.1097/mcc.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months. RECENT FINDINGS There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years. SUMMARY Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.
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Affiliation(s)
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
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Freiberg JA, Wright PW. What's Hot This Year in Infectious Diseases Clinical Science. Clin Infect Dis 2024; 78:1170-1174. [PMID: 38170287 PMCID: PMC11093670 DOI: 10.1093/cid/ciad789] [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: 11/28/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
The field of infectious diseases saw numerous exciting advances in 2023. Trials of new antibiotics and treatment regimens sought to address rising rates of antimicrobial resistance. Other studies focused on the most appropriate use of currently available treatments, balancing the dual goals of providing effective treatment and impactful antimicrobial stewardship. Improvements in disease prevention were made through trials of both new vaccines and new chemoprophylaxis approaches. Concerning trends this year included increasing rates of invasive group A streptococcal infections, medical tourism-associated cases of fungal meningitis, and the return of locally acquired malaria to the United States. This review covers some of these notable trials and clinical developments in infectious diseases in the past year.
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Affiliation(s)
- Jeffrey A Freiberg
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patty W Wright
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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8
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Nailor MD, Goodlet KJ, Gonzalez O, Haller JT. Early Experiences with Intrathecal Administration of Amphotericin B Liposomal Formulation at a Neurosurgical Center. CNS Drugs 2024; 38:225-229. [PMID: 38270786 DOI: 10.1007/s40263-024-01065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Intrathecal administration of amphotericin B represents an important adjunctive therapy for management of severe fungal meningitis. Intrathecal preparations have traditionally used amphotericin B deoxycholate. Liposomal amphotericin B is an alternative formulation with good clinical outcomes as systemic therapy, but scant data exist investigating intrathecal use. OBJECTIVE The aim of this exploratory study was to evaluate outcomes following intrathecal administration of liposomal amphotericin B for treatment of severe fungal meningitis. METHODS A national shortage of amphotericin B deoxycholate necessitated revision of institutional protocols at a southwestern neurosurgical center in Spring 2023. A starting intrathecal daily dose of 0.125-0.5 mg liposomal amphotericin B was recommended (dependent on insertion device), with 0.125-0.25 mg slow titration every 48 h and up to a 2 mg maximum daily dose. RESULTS Four cases of fungal meningitis treated with adjunctive intrathecal amphotericin B liposomal formulation were reviewed. This included three cases of coccidioidal meningitis and one case of presumed Fusarium solani meningitis following an outbreak. All patients had initial disease improvement following initiation of intrathecal amphotericin B and were able to tolerate long-term therapy. One coccidioidal meningitis patient expired of neurologic complications shortly after being moved from the intensive care unit (ICU) to a floor unit. All other patients were successfully discharged from the hospital. New headache was the only reported adverse effect, which was managed with dose reduction and did not require therapy discontinuation. CONCLUSIONS Liposomal amphotericin B may be feasibly administered intrathecally for the adjunctive treatment of severe fungal meningitis.
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Affiliation(s)
- Michael D Nailor
- Department of Pharmacy Services, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA.
| | - Kellie J Goodlet
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, AZ, USA
| | - Omar Gonzalez
- Infectious Disease Division, Arizona Pulmonary Specialists, Phoenix, AZ, USA
- Barrow Neurological Institute, St. Joseph Hospital and Medical Center, Phoenix, AZ, USA
| | - J Tyler Haller
- Department of Pharmacy Services, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd, Phoenix, AZ, 85013, USA
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Strong N, Meeks G, Sheth SA, McCullough L, Villalba JA, Tan C, Barreto A, Wanger A, McDonald M, Kan P, Shaltoni H, Campo Maldonado J, Parada V, Hassan AE, Reagan-Steiner S, Chiller T, Gold JAW, Smith DJ, Ostrosky-Zeichner L. Neurovascular Complications of Iatrogenic Fusarium solani Meningitis. N Engl J Med 2024; 390:522-529. [PMID: 38324485 DOI: 10.1056/nejmoa2308192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
A multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in Mexico. The pathogen involved had a high predilection for the brain stem and vertebrobasilar arterial system and was associated with high mortality from vessel injury. Effective treatment options remain limited; in vitro susceptibility testing of the organism suggested that it is resistant to all currently approved antifungal medications in the United States. To highlight the severe complications associated with fusarium infection acquired in this manner, we report data, clinical courses, and outcomes from 13 patients in the outbreak who presented with symptoms after a median delay of 39 days.
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Affiliation(s)
- Nora Strong
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Grant Meeks
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Sunil A Sheth
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Louise McCullough
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Julian A Villalba
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Chunfeng Tan
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Andrew Barreto
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Audrey Wanger
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Michelle McDonald
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Peter Kan
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Hashem Shaltoni
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Jose Campo Maldonado
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Victoria Parada
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Ameer E Hassan
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Sarah Reagan-Steiner
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Tom Chiller
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Jeremy A W Gold
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Dallas J Smith
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
| | - Luis Ostrosky-Zeichner
- From McGovern Medical School, University of Texas Health Science Center at Houston, Houston (N.S., G.M., S.A.S., L.M., C.T., A.B., A.W., M.M., L.O.-Z.), the University of Texas Medical Branch, Galveston (P.K., H.S.), and the University of Texas Rio Grande Valley-Harlingen, Harlingen (J.C.M., V.P., A.E.H.) - all in Texas; and the Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (J.A.V., S.R.-S.), and the Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases (T.C., J.A.W.G., D.J.S.), Centers for Disease Control and Prevention, Atlanta
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10
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García-Rodríguez G, Duque-Molina C, Kondo-Padilla I, Zaragoza-Jiménez CA, González-Cortés VB, Flores-Antonio R, Villa-Reyes T, Vargas-Rubalcava A, Ruano-Calderon LÁ, Tinoco-Favila JC, Sánchez-Salazar HC, Rivas-Ruiz R, Castro-Escamilla O, Martínez-Gamboa RA, González-Lara F, López-Martínez I, Chiller TM, Pelayo R, Bonifaz LC, Robledo-Aburto Z, Alcocer-Varela J. Outbreak of Fusarium solani Meningitis in Immunocompetent Persons Associated With Neuraxial Blockade in Durango, Mexico, 2022-2023. Open Forum Infect Dis 2024; 11:ofad690. [PMID: 38370296 PMCID: PMC10873708 DOI: 10.1093/ofid/ofad690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024] Open
Abstract
Background Fungal meningitis can be associated with epidural anesthesia procedures. Fusariosis is a rare infection typically affecting immunocompromised patients and rarely causes meningitis. During 2022-2023, public health officials responded to a large outbreak of Fusarium solani meningitis associated with epidural anesthesia in Durango, Mexico. Methods The public health response and epidemiological and clinical features of patients affected by this outbreak were described. Coordinated actions were addressed to identify the etiological agent, determine its drug susceptibility, develop diagnostic tests, and implement clinical and epidemiological protocols. Retrospective analyses of clinical variables and outcomes were performed to determine association with better patient survival. Results A total of 1801 persons exposed to epidural anesthesia were identified, of whom 80 developed meningitis. Fusarium solani was found in 3 brain biopsies and showed susceptibility to voriconazole and amphotericin B. After F solani polymerase chain reaction (PCR) implementation, 57 patients with meningitis were PCR-screened, and 31 (38.8%) had a positive result. Most patients were female (95%), and cesarean section was the most common surgical procedure (76.3%). The case fatality rate was 51.3% (41 patients) and the median hospitalization duration was 39.5 days (interquartile range, 18-86 days). Seventy-one patients (88.8%) received voriconazole/amphotericin B and 64 subjects (80%) additionally received steroids. Cox regression analysis showed an increased lethality risk in patients who received antifungal treatment after 5 days (hazard ratio, 2.1 [95% confidence interval, 1.01-4.48], P < .05). Conclusions The F solani meningitis outbreak in Durango was an unprecedented medical challenge. Timely treatment and effective healthcare management were associated with better survival outcomes.
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Affiliation(s)
| | - Célida Duque-Molina
- Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Irasema Kondo-Padilla
- Dirección de los Servicios de Salud del Estado de Durango, Secretaría de Salud, Durango, Mexico
| | | | - Vladimir Brian González-Cortés
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Rocio Flores-Antonio
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Tania Villa-Reyes
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Adriana Vargas-Rubalcava
- Coordinación de la Red Hospitalaria de Vigilancia Epidemiológica, Dirección de Información Epidemiológica, Secretaría de Salud, Mexico City, Mexico
| | - Luis Ángel Ruano-Calderon
- Servicio de Neurología, Hospital General 450, Servicios de Salud del Estado de Durango, Secretaría de Salud, Durango, Mexico
| | - Juan Carlos Tinoco-Favila
- Clínica de Infectología, Hospital General 450, Servicios de Salud del Estado de Durango, Secretaría de Salud, Durango, Mexico
| | | | - Rodolfo Rivas-Ruiz
- División de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Octavio Castro-Escamilla
- División de Investigación Clínica, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rosa Areli Martínez-Gamboa
- Laboratorio de Microbiología Clínica, Servicio de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernanda González-Lara
- Laboratorio de Microbiología Clínica, Servicio de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irma López-Martínez
- Dirección de Diagnóstico y Referencia, Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaría de Salud, Mexico City, Mexico
| | - Tom M Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rosana Pelayo
- Unidad de Educación e Investigación, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Laura C Bonifaz
- Coordinación de Investigación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Zoe Robledo-Aburto
- Dirección General, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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11
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Valaparla VL, Banerjee P, Elnaeem A, Sharma T, Bhatt S, Memon Z, Shaltoni H, Dabi A, Rodríguez-Fernández JM. Cerebral vasospasm due to Fusarium solani meningitis: A complication from medical tourism. Case report and literature review. J Stroke Cerebrovasc Dis 2024; 33:107432. [PMID: 37966093 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Medical tourism is expanding globally, with patients seeking cosmetic procedures abroad. To date, little information is known regarding the risks and outcomes of cosmetic tourism, especially potential stroke complications. Here, we present a case of fungal meningitis in the setting of medical tourism leading to ischemic strokes and vasospasm. MATERIAL AND METHODS We describe an immunocompetent 29-year-old female patient who initially presented with intractable headaches and an abnormal cerebrospinal fluid (CSF) profile who was eventually diagnosed with Fusarium solani meningitis as a part of a common source outbreak in Matamoros, Mexico. These patients were part of a cohort who underwent cosmetic procedures requiring spinal anesthesia. This report also highlights the unusual clinical course leading to poor outcomes in such conditions. RESULTS The patient initially presented with headaches, papilledema, elevated opening pressure on the spinal tap, abnormal CSF studies, and eventually developed ischemic strokes and hydrocephalus. CSF showed positive beta D-Glucan with repeated negative CSF fungal cultures. A cerebral angiogram revealed extensive basilar artery vasospasm that led to ischemic strokes. Continued clinical worsening and lack of response to antifungal treatment prompted further imaging that revealed significant non-obstructive hydrocephalus subsequently complicated by spontaneous intracranial hemorrhage. CSF PCR for Fusarium solani species was positive days after her passing. CONCLUSION This novel case highlights fungal meningitis caused by Fusarium solani complicated by bilateral ischemic strokes stemming from basilar artery vasospasm. Complications from medical tourism impact not only individual patients but also the health systems of both countries. Professional and regulatory entities for cosmetic surgeries must highlight and educate patients on the risks and complications of cosmetic surgeries happening abroad. Physicians should be aware of ongoing outbreaks and possible complications of these procedures.
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Affiliation(s)
| | - Pankhuri Banerjee
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Awab Elnaeem
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Tripti Sharma
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Sandeep Bhatt
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Zeeshan Memon
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Hashem Shaltoni
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Alok Dabi
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
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12
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Jenks JD, Prattes J, Wurster S, Sprute R, Seidel D, Oliverio M, Egger M, Del Rio C, Sati H, Cornely OA, Thompson GR, Kontoyiannis DP, Hoenigl M. Social determinants of health as drivers of fungal disease. EClinicalMedicine 2023; 66:102325. [PMID: 38053535 PMCID: PMC10694587 DOI: 10.1016/j.eclinm.2023.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Disparities in social determinants of health (SDOH) play a significant role in causing health inequities globally. The physical environment, including housing and workplace environment, can increase the prevalence and spread of fungal infections. A number of professions are associated with increased fungal infection risk and are associated with low pay, which may be linked to crowded and sub-optimal living conditions, exposure to fungal organisms, lack of access to quality health care, and risk for fungal infection. Those involved and displaced from areas of armed conflict have an increased risk of invasive fungal infections. Lastly, a number of fungal plant pathogens already threaten food security, which will become more problematic with global climate change. Taken together, disparities in SDOH are associated with increased risk for contracting fungal infections. More emphasis needs to be placed on systematic approaches to better understand the impact and reducing the health inequities associated with these disparities.
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Affiliation(s)
- Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, NC, United States of America
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, United States of America
| | - Juergen Prattes
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Sebastian Wurster
- Division of Internal Medicine, Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, University of Texas, Houston, TX, United States of America
| | - Rosanne Sprute
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Danila Seidel
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
| | - Matteo Oliverio
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Carlos Del Rio
- Emory Center for AIDS Research, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Hatim Sati
- Department of Global Coordination and Partnership on Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
| | - Oliver A. Cornely
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging – Associated Diseases (CECAD), Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center of Medical Mycology (ECMM), Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Koln), University of Cologne, Cologne, Germany
| | - George R. Thompson
- University of California Davis Center for Valley Fever, Sacramento, CA, United States of America
- Division of Infectious Diseases, Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, United States of America
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, United States of America
| | - Dimitrios P. Kontoyiannis
- Division of Internal Medicine, Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, University of Texas, Houston, TX, United States of America
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
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13
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Nucci M, Nouér SA. Practical issues related to non-Aspergillus invasive mold infections. Mol Aspects Med 2023; 94:101230. [PMID: 38011770 DOI: 10.1016/j.mam.2023.101230] [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: 01/04/2023] [Revised: 11/04/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Abstract
Infection by non-Aspergillus molds has been increasingly reported. The management of such infections is challenging both for diagnosis and treatment, including the need of well-trained mycologists to properly identify rare fungi, difficulties in distinguishing between contamination, colonization and infection, the lack of randomized studies comparing different drugs or regimens, poor activity of available antifungal agents, lack of correlation between in vitro antifungal susceptibility tests and clinical outcome, and poor prognosis. Mucormycosis and fusariosis are the most frequent non-Aspergillus mold infections. Mucormycosis occurs more frequently in four major groups of patients: solid organ transplant recipients, patients with hematologic malignancies receiving chemotherapy or hematopoietic cell transplantation, diabetic patients, and immunocompetent individuals who suffer various types of skin and soft tissue trauma. Invasive fusariosis occurs almost exclusively in patients with hematologic malignancies. In this review we discuss practical issues related to the management of these and other non-Aspergillus mold infections.
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Affiliation(s)
- Marcio Nucci
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Grupo Oncoclínicas, Rio de Janeiro, Brazil.
| | - Simone A Nouér
- Department of Infectious Diseases, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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14
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Douglas AP, Stewart AG, Halliday CL, Chen SCA. Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management. J Fungi (Basel) 2023; 9:1059. [PMID: 37998865 PMCID: PMC10672668 DOI: 10.3390/jof9111059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Nosocomial clusters of fungal infections, whilst uncommon, cannot be predicted and are associated with significant morbidity and mortality. Here, we review reports of nosocomial outbreaks of invasive fungal disease to glean insight into their epidemiology, risks for infection, methods employed in outbreak detection including genomic testing to confirm the outbreak, and approaches to clinical and infection control management. Both yeasts and filamentous fungi cause outbreaks, with each having general and specific risks. The early detection and confirmation of the outbreak are essential for diagnosis, treatment of affected patients, and termination of the outbreak. Environmental sampling, including the air in mould outbreaks, for the pathogen may be indicated. The genetic analysis of epidemiologically linked isolates is strongly recommended through a sufficiently discriminatory approach such as whole genome sequencing or a method that is acceptably discriminatory for that pathogen. An analysis of both linked isolates and epidemiologically unrelated strains is required to enable genetic similarity comparisons. The management of the outbreak encompasses input from a multi-disciplinary team with epidemiological investigation and infection control measures, including screening for additional cases, patient cohorting, and strict hygiene and cleaning procedures. Automated methods for fungal infection surveillance would greatly aid earlier outbreak detection and should be a focus of research.
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Affiliation(s)
- Abby P. Douglas
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC 3084, Australia
| | - Adam G. Stewart
- Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women’s Hospital Campus, The University of Queensland, Herston, QLD 4006, Australia;
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW 2145, Australia; (C.L.H.); (S.C.-A.C.)
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
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