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Kelty MT, Miron-Ocampo A, Beattie SR. A series of pyrimidine-based antifungals with anti-mold activity disrupt ER function in Aspergillus fumigatus. Microbiol Spectr 2024:e0104524. [PMID: 38916314 DOI: 10.1128/spectrum.01045-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/23/2024] [Indexed: 06/26/2024] Open
Abstract
Fungal infections are a major contributor to morbidity and mortality among immunocompromised populations. Moreover, fungal disease caused by molds are difficult to treat and are associated with particularly high mortality. To address the need for new mold-active antifungal drugs, we performed a high-throughput screen with Aspergillus fumigatus, the most common pathogenic mold. We identified a novel, pyrimidine-based chemical scaffold with broad-spectrum antifungal activity including activity against several difficult-to-treat molds. A chemical genetics screen of Saccharomyces cerevisiae suggested that this compound may target the endoplasmic reticulum (ER) and perturb ER function and/or homeostasis. Consistent with this model, this compound induces the unfolded protein response and inhibits secretion of A. fumigatus collagenases. Initial cytotoxicity and pharmacokinetic studies show favorable features including limited mammalian cell toxicity and bioavailability in vivo. Together, these data support the further medicinal chemistry and pre-clinical development of this pyrimidine scaffold toward more effective treatments for life-threatening invasive mold infections.IMPORTANCEInvasive fungal diseases are life-threatening infections caused by fungi in immunocompromised individuals. Currently, there are only three major classes of antifungal drugs available to treat fungal infections; however, these options are becoming even more limited with the global emergence of antifungal drug resistance. To address the need for new antifungal therapies, we performed a screen of chemical compounds and identified a novel molecule with antifungal activity. Initial characterization of this compound shows drug-like features and broad-spectrum activity against medically important fungi. Together, our results support the continued development of this compound as a potential future therapy for these devastating fungal infections.
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Affiliation(s)
- Martin T Kelty
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Aracely Miron-Ocampo
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Sarah R Beattie
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Wei E, Niu J, Zhang M, Zhang Y, Yan K, Fang X, Ma W, Xie L, Jia P, Wang H. Metagenomic next-generation sequencing could play a pivotal role in validating the diagnosis of invasive mold disease of the central nervous system. Front Cell Infect Microbiol 2024; 14:1393242. [PMID: 38912204 PMCID: PMC11190073 DOI: 10.3389/fcimb.2024.1393242] [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: 02/28/2024] [Accepted: 05/10/2024] [Indexed: 06/25/2024] Open
Abstract
Background Invasive mold diseases of the central nervous (CNS IMD) system are exceedingly rare disorders, characterized by nonspecific clinical symptoms. This results in significant diagnostic challenges, often leading to delayed diagnosis and the risk of misdiagnosis for patients. Metagenomic Next-Generation Sequencing (mNGS) holds significant importance for the diagnosis of infectious diseases, especially in the rapid and accurate identification of rare and difficult-to-culture pathogens. Therefore, this study aims to explore the clinical characteristics of invasive mold disease of CNS IMD in children and assess the effectiveness of mNGS technology in diagnosing CNS IMD. Methods Three pediatric patients diagnosed with Invasive mold disease brain abscess and treated in the Pediatric Intensive Care Unit (PICU) of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2023 were selected for this study. Results Case 1, a 6-year-old girl, was admitted to the hospital with "acute liver failure." During her hospital stay, she developed fever, irritability, and seizures. CSF mNGS testing resulted in a negative outcome. Multiple brain abscesses were drained, and Aspergillus fumigatus was detected in pus culture and mNGS. The condition gradually improved after treatment with voriconazole combined with caspofungin. Case 2, a 3-year-old girl, was admitted with "acute B-lymphoblastic leukemia." During induction chemotherapy, she developed fever and seizures. Aspergillus fumigatus was detected in the intracranial abscess fluid by mNGS, and the condition gradually improved after treatment with voriconazole combined with caspofungin, followed by "right-sided brain abscess drainage surgery." Case 3, a 7-year-old girl, showed lethargy, fever, and right-sided limb weakness during the pending chemotherapy period for acute B-lymphoblastic leukemia. Rhizomucor miehei and Rhizomucor pusillus was detected in the cerebrospinal fluid by mNGS. The condition gradually improved after treatment with amphotericin B combined with posaconazole. After a six-month follow-up post-discharge, the three patients improved without residual neurological sequelae, and the primary diseases were in complete remission. Conclusion The clinical manifestations of CNS IMD lack specificity. Early mNGS can assist in identifying the pathogen, providing a basis for definitive diagnosis. Combined surgical treatment when necessary can help improve prognosis.
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Affiliation(s)
- Erhu Wei
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Walsh TJ. Meeting the Therapeutic Challenges of Emergent and Rare Invasive Fungal Diseases Through Novel Clinical Trial Designs. Open Forum Infect Dis 2024; 11:ofae257. [PMID: 38887484 PMCID: PMC11181194 DOI: 10.1093/ofid/ofae257] [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: 01/09/2024] [Indexed: 06/20/2024] Open
Abstract
Treatments for emerging and rare invasive fungal diseases (IFDs) represent a critical unmet medical need. For IFDs that occur less frequently than invasive aspergillosis, such as mucormycosis, hyalohyphomycosis, and phaeohyphomycosis, randomized controlled clinical trials are impractical and unlikely to meet urgent public health needs. Understanding regulatory approaches for approval of drugs for rare cancers and rare metabolic diseases could help meet the challenges of studying drugs for rare IFDs. A single-arm, controlled clinical trial with a high-quality external control(s), with confirmatory evidence from nonclinical studies, including pharmacokinetic/pharmacodynamic data in predictive animal models of the disease may support findings of effectiveness of new drugs and biologics. Control populations may include historical controls from published literature, patient registries, and/or contemporaneous external control groups. Continuous engagement among clinicians, industrial sponsors, and regulatory agencies to develop consensus on trial design and innovative development pathways for emergent and rare invasive fungal diseases is important.
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Affiliation(s)
- Thomas J Walsh
- Center for Innovative Therapeutics and Diagnostics, Office of the Director (citdx.org), Richmond, Virginia, USA
- Departments of Medicine and of Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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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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Choudhary H, Kaur H, Singh S, Singh R, Muthu V, Verma R, Rudramurthy SM, Agarwal R, Jain S, Bal A, Ghosh AK, Chakrabarti A. A novel indirect ELISA for serodiagnosis of mucormycosis using antigens from Rhizopus arrhizus. Mycoses 2024; 67:e13730. [PMID: 38712824 DOI: 10.1111/myc.13730] [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: 02/26/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Due to a delay in diagnosis by conventional techniques and high mortality, the development of a standardised and rapid non-culture-based technique is an unmet need in pulmonary, gastrointestinal, and disseminated forms of mucormycosis. Though limited studies have been conducted for molecular diagnosis, there are no established serologic tests for this highly fatal infection. OBJECTIVE To develop and evaluate an indirect in-house enzyme-linked immunosorbent assay (ELISA) utilising antigens of Rhizopus arrhizus for detecting anti-Rhizopus antibodies (IgG and IgM) in sera of patients with mucormycosis. METHODS We extracted both secretory and mycelial Rhizopus antigens using standardised protocols. Bradford assay was used for protein quantification. We then standardised an indirect ELISA using R. arrhizus mycelial and secretory antigens (10.0 μg/mL in bicarbonate buffer pH 9.2) for detecting anti-Rhizopus IgG and IgM antibodies in patient sera. We included patients with mucormycosis, other fungal infections, and healthy controls. Antibody index value (E-value) was calculated for each patient sample. RESULTS Asparagine broth culture filtrate utilising 85% ammonium sulphate salt fractionation and mycelial homogenate grown in yeast extract peptone dextrose (YPD) broth precipitated with trichloroacetic acid (TCA) yielded a large amount of good-quality protein for the assay. We included 55 patients with mucormycosis (rhino-orbito-cerebral mucormycosis [ROCM, n = 39], pulmonary [n = 15], gastrointestinal [n = 1]), 24 with other fungal infections (probable aspergillosis [n = 14], candidiasis [n = 10]), and healthy controls (n = 16). The sensitivity of the antibody test for diagnosing mucormycosis ranged from 83.6-92.7% for IgG and 72.7-87.3% for IgM, with a specificity of 91.7-92.5% for IgG and 80-82.5% for IgM. The sera from patients with other fungal infections and healthy individuals did not show significant cross-reactivity. CONCLUSION The detection of anti-Rhizopus IgG antibody performed significantly better in comparison to IgM-based ELISA for diagnosing both ROCM (sensitivity of 84.6% vs. 69.2%) and pulmonary cases (86.6% vs. 80.0%). More extensive studies are required to confirm our findings.
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Affiliation(s)
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, Dr. B. R. Ambedkar Institute of Medical Sciences, Mohali, Punjab, India
| | - Rachna Singh
- Department of Microbial Biotechnology, Panjab University, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Roshan Verma
- Department of Otolaryngology (ENT), Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Anup K Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Bellanger AP, Gbaguidi-Haore H, Berceanu A, Gouzien L, El Machhour C, Bichard D, Lanternier F, Scherer E, Millon L. Use of the Mucorales qPCR on blood to screen high-risk hematology patients is associated with better survival. Med Mycol 2024; 62:myae030. [PMID: 38533663 DOI: 10.1093/mmy/myae030] [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: 02/01/2024] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
Our objective was to determine whether the twice-weekly screening of high-risk hematology patients by Mucorales qPCR on serum affects the prognosis of mucormycosis. Results from all serum Mucorales qPCR tests performed on patients from the hematology unit from January 2017 to December 2022 were analyzed. Patients with positive results were classified as having proven, probable or 'PCR-only' mucormycosis. One-month mortality for the local cohort was compared with that of a national cohort of cases of mucormycosis collected by the French surveillance network for invasive fungal disease ('Réseau de surveillances des infections fongiques invasives en France' (RESSIF)) from 2012 to 2018. From 2017 to 2022, 7825 serum Mucorales qPCR tests were performed for patients from the hematology unit; 107 patients with at least one positive Mucorales qPCR (164 positive samples) were identified. Sixty patients (70 positive samples, median Cq = 40) had no radiological criteria for mucormycosis and were considered not to have invasive fungal disease (70/7825, 0.9% false positives). It was not possible to classify disease status for six patients (12 positive samples, median Cq = 38). Forty-one patients (82 positive samples, median Cq = 35) had a final diagnosis of mucormycosis. In comparison with the RESSIF cohort, the local cohort was independently associated with a 48% lower one-month all-cause mortality rate (age-, sex-, and primary disease-adjusted hazard ratio = 0.52; 95% confidence interval: 0.29-0.94; P 0.03). Proactive screening for invasive mold diseases in high-risk hematology patients, including twice-weekly Mucorales qPCR on serum, was associated with mucormycosis higher survival.
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Affiliation(s)
- Anne-Pauline Bellanger
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
| | - Houssein Gbaguidi-Haore
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
- Infection Control Department, University Hospital of Besançon, Besançon, France
| | - Ana Berceanu
- Hematological Intensive Care Unit, University Hospital of Besançon, Besançon, France
| | - Laura Gouzien
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Chaima El Machhour
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
| | - Damien Bichard
- Pharmacy Department, University Hospital of Besançon, Besançon, France
| | - Fanny Lanternier
- Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
| | - Emeline Scherer
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
| | - Laurence Millon
- Parasitology-Mycology, University Hospital of Besançon, Besançon, France
- Chrono-Environment UMR CNRS- 6249, University of Franche-Comté, Besançon, France
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Lamoth F, Prakash K, Beigelman-Aubry C, Baddley JW. Lung and sinus fungal infection imaging in immunocompromised patients. Clin Microbiol Infect 2024; 30:296-305. [PMID: 37604274 DOI: 10.1016/j.cmi.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Imaging is a key diagnostic modality for suspected invasive pulmonary or sinus fungal disease and may help to direct testing and treatment. Fungal diagnostic guidelines have been developed and emphasize the role of imaging in this setting. We review and summarize evidence regarding imaging for fungal pulmonary and sinus disease (in particular invasive aspergillosis, mucormycosis and pneumocystosis) in immunocompromised patients. OBJECTIVES We reviewed data on imaging modalities and findings used for diagnosis of invasive fungal pulmonary and sinus disease. SOURCES References for this review were identified by searches of PubMed, Google Scholar, Embase and Web of Science through 1 April 1 2023. CONTENT Computed tomography imaging is the method of choice for the evaluation of suspected lung or sinus fungal disease. Although no computed tomography radiologic pattern is pathognomonic of pulmonary invasive fungal disease (IFD) the halo sign firstly suggests an angio-invasive pulmonary aspergillosis while the Reversed Halo Sign is more suggestive of pulmonary mucormycosis in an appropriate clinical setting. The air crescent sign is uncommon, occurring in the later stages of invasive aspergillosis in neutropenic patients. In contrast, new cavitary lesions should suggest IFD in moderately immunocompromised patients. Regarding sinus site, bony erosion, peri-antral fat or septal ulceration are reasonably predictive of IFD. IMPLICATIONS Imaging assessment of the lung and sinuses is an important component of the diagnostic work-up and management of IFD in immunocompromised patients. However, radiological features signs have sensitivity and specificity that often vary according to underlying disease states. Periodic review of imaging studies and diagnostic guidelines characterizing imaging findings may help clinicians to consider fungal infections in clinical care thereby leading to an earlier confirmation and treatment of IFD.
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Affiliation(s)
- Frederic Lamoth
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratory Medicine and Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katya Prakash
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Catherine Beigelman-Aubry
- Radiodiagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John W Baddley
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
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Huang QY, Li PC, Yue JR. Diagnostic performance of serum galactomannan and β-D-glucan for invasive aspergillosis in suspected patients: A meta-analysis. Medicine (Baltimore) 2024; 103:e37067. [PMID: 38306560 PMCID: PMC10843323 DOI: 10.1097/md.0000000000037067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/04/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Serum galactomannan (GM) and β-D-glucan (BG) are known markers of invasive aspergillosis (IA). The aim of this meta-analysis was to evaluate the efficiency of serum GM and BG as diagnostic markers of symptomatic IA infection and compare the performance of the combined tests with that of either test individually. METHODS A literature search was carried out using PubMed, Web of Science, and EMBASE databases to include relevant studies published in English up to May 2023. The quality assessment was performed using Review Manager 5.3 software. A bivariate model was applied to pool diagnostic parameters using Stata 14.0 software. We used Cochrane I2 index to assess heterogeneity and identify the potential source of heterogeneity by meta-regression. Paired t tests were used to compare the value of GM and BG for IA diagnosis when used in combination or alone. RESULTS Sixteen studies were eligible for inclusion in the meta-analysis. For proven or probable IA, serum GM and BG yielded a pooled sensitivity of 0.53 (95% CI 0.40-0.66) vs 0.72 (95% CI 0.61-0.81) and a pooled specificity of 0.94 (95% CI 0.91-0.97) vs 0.82 (95% CI 0.73-0.88). The area under the curve (AUC) of ROC was 0.90 (95% CI 0.87-0.92) vs 0.83 (95% CI 0.80-0.86) for all studies. The pooled sensitivity and specificity for IA diagnosis by combined GM and BG assays (GM/BG) were 0.84 (95% CI 0.69-0.86) and 0.76 (95% CI 0.69-0.81), respectively. The sensitivity of the combined GM/BG test to diagnose IA was higher than of the GM or BG test alone. CONCLUSION Serum GM and BG tests had a relatively high accuracy for IA diagnosis in suspected patients. The diagnostic accuracy of both assays is comparable, and the diagnostic sensitivity is further improved by the combined detection of the 2 markers.
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Affiliation(s)
- Qian-Yi Huang
- Department of Transfusion, Nanchong Central Hospital Second Clinical School of North Sichuan Medical College: Nanchong Central Hospital Affiliated to North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Peng-Cheng Li
- Department of Neurosurgery, Nanchong Central Hospital Second Clinical School of North Sichuan Medical College: Nanchong Central Hospital Affiliated to North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Jin-Rui Yue
- Department of Transfusion, Nanchong Central Hospital Second Clinical School of North Sichuan Medical College: Nanchong Central Hospital Affiliated to North Sichuan Medical College, Nanchong City, Sichuan Province, China
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Xiong A, Luo W, Tang X, Cao Y, Xiang Q, Deng R, Shuai S. Risk factors for invasive fungal infections in patients with connective tissue disease: Systematic review and meta-analysis. Semin Arthritis Rheum 2023; 63:152257. [PMID: 37633041 DOI: 10.1016/j.semarthrit.2023.152257] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Invasive fungal infections (IFIs) are life-threatening opportunistic infections in patients with connective tissue disease CTD) that cause significant morbidity and mortality. We attempted to determine the potential risk factors associated with IFIs in CTD. METHODS We systematically searched PubMed, Embase, and the Cochrane Library databases for relevant articles published from the database inception to February 1, 2023. RESULTS Twenty-six studies were included in this systematic review and meta-analysis. Risk factors identified for IFIs were diabetes (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.00 to 2.64), pulmonary diseases (OR 3.43; 95% CI 2.49 to 4.73), interstitial lung disease (ILD; OR, 4.06; 95% CI, 2.22 to 7.41), renal disease (OR, 4.41; 95% CI, 1.84 to 10.59), glucocorticoid (GC) use (OR, 4.15; 95% CI, 2.74 to 6.28), especially moderate to high-dose GC, azathioprine (AZA) use (OR, 1.50; 95% CI, 1.12 to 2.01), calcineurin inhibitor (CNI) use (OR, 2.49; 95% CI, 1.59 to 3.91), mycophenolate mofetil (MMF) use (OR, 2.83; 95% CI, 1.59 to 5.03), cyclophosphamide (CYC) use (OR, 3.35; 95% CI, 2.47 to 4.54), biologics use (OR, 3.43; 95% CI, 2.36 to 4.98), and lymphopenia (OR, 4.26; 95% CI, 2.08 to 8.73). Hydroxychloroquine (HCQ) use reduced risk of IFIs (OR, 0.67; 95% CI, 0.54 to 0.84). Furthermore, 17 of the 26 studies only reported risk factors for Pneumocystis jiroveci pneumonia (PJP) in patients with CTD. Pulmonary disease; ILD; and the use of GC, CNIs, CYC, methotrexate (MTX), MMF and biologics, and lymphopenia increased the risk of PJP, whereas the use of HCQ reduced its risk. CONCLUSION Diabetes, pulmonary disease, ILD, renal disease, use of GC (especially at moderate to high dose) and immunosuppressive drugs, and lymphopenia were found to be associated with significant risk for IFIs (especially PJP) in patients with CTD. Furthermore, the use of HCQ may reduce the risk of IFIs in patients with CTD.
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Affiliation(s)
- Anji Xiong
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China; Inflammation and Immunology Key Laboratory of Nanchong, Nanchong, China.
| | - Wenxuan Luo
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiaoyu Tang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yuzi Cao
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Qilang Xiang
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ruiting Deng
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Shiquan Shuai
- Department of Rheumatology and Immunology, Nanchong Central Hospital, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China; Inflammation and Immunology Key Laboratory of Nanchong, Nanchong, China
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Yanagawa Y, Muramatsu KI, Abe M, Miyazaki Y. A Fatal Rhizopus Species Infection after Facial Injury in a Patient with Myelodysplastic Syndrome and Diabetes Mellitus. Intern Med 2023; 62:2279-2283. [PMID: 37532516 PMCID: PMC10465287 DOI: 10.2169/internalmedicine.0741-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/28/2022] [Indexed: 08/04/2023] Open
Abstract
A 73-year-old woman with myelodysplastic syndrome and diabetes mellitus, chronic renal failure and paroxysmal atrial fibrillation, received a diagnosis of facial cellulitis and was treated by antibiotics. However, her symptoms deteriorated. Facial magnetic resonance imaging (MRI) showed orbital cellulitis. She had weakness of visual acuity requiring changing the antibiotics. She also underwent steroid pulse treatment. Her symptoms temporarily improved, but she became comatose and died. Results of a molecular analysis of the residual cerebrospinal fluid indicated Rhizopus species infection. For immunocompromised hosts with refractory orbital cellulitis, mucormycosis should be considered as a differential diagnosis, and appropriate treatment should be promptly performed.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Masahiro Abe
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
| | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
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Lamoth F, Nucci M, Fernandez-Cruz A, Azoulay E, Lanternier F, Bremerich J, Einsele H, Johnson E, Lehrnbecher T, Mercier T, Porto L, Verweij PE, White L, Maertens J, Alanio A. Performance of the beta-glucan test for the diagnosis of invasive fusariosis and scedosporiosis: a meta-analysis. Med Mycol 2023; 61:myad061. [PMID: 37381179 PMCID: PMC10405209 DOI: 10.1093/mmy/myad061] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023] Open
Abstract
The (1→3)-β-D-glucan (BDG) is a component of the fungal cell wall that can be detected in serum and used as an adjunctive tool for the diagnosis of invasive mold infections (IMI) in patients with hematologic cancer or other immunosuppressive conditions. However, its use is limited by modest sensitivity/specificity, inability to differentiate between fungal pathogens, and lack of detection of mucormycosis. Data about BDG performance for other relevant IMI, such as invasive fusariosis (IF) and invasive scedosporiosis/lomentosporiosis (IS) are scarce. The objective of this study was to assess the sensitivity of BDG for the diagnosis of IF and IS through systematic literature review and meta-analysis. Immunosuppressed patients diagnosed with proven or probable IF and IS, with interpretable BDG data were eligible. A total of 73 IF and 27 IS cases were included. The sensitivity of BDG for IF and IS diagnosis was 76.7% and 81.5%, respectively. In comparison, the sensitivity of serum galactomannan for IF was 27%. Importantly, BDG positivity preceded the diagnosis by conventional methods (culture or histopathology) in 73% and 94% of IF and IS cases, respectively. Specificity was not assessed because of lacking data. In conclusion, BDG testing may be useful in patients with suspected IF or IS. Combining BDG and galactomannan testing may also help differentiating between the different types of IMI.
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Affiliation(s)
- Frederic Lamoth
- To whom correspondence should be addressed. Frederic Lamoth, Infectious Diseases Service and Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 48, 1011 Lausanne, Switzerland. Tel: +41 21 314 11 11; E-mail:
| | - Marcio Nucci
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Grupo Oncoclinicas, Brazil
| | - Ana Fernandez-Cruz
- Infectious Disease Unit, Internal Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Fundación de Investigación Puerta de Hierro-Segovia de Arana, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris Cité University, Paris, France
| | - Fanny Lanternier
- Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Groupe de recherche Mycologie Translationnelle, Département de Mycologie, Université Paris Cité, Paris, France
- Infectious Diseases Unit, Hopital Necker Enfants malades, APHP, Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Paris, France
| | - Jens Bremerich
- Cardiothoracic Imaging Section, Department of Radiology, Basel University Hospital, 4031 Basel, Switzerland
| | - Hermann Einsele
- University Hospital Würzburg, Internal Medicine II, Würzburg, Germany
| | - Elizabeth Johnson
- UK Health Security Agency (UKHSA) Mycology Reference Laboratory, Southmead Hospital, Bristol, UK and MRC Centre for Medical Mycology, Exeter University, Exeter, UK
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Toine Mercier
- Department of Oncology-Hematology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium and Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Luciana Porto
- Division of Neuroradiology, Pediatric Neuroradiology Department, University Hospital, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Center, Nijmegen, The Netherlands
| | - Lewis White
- Public Health Wales Mycology Reference Laboratory and Cardiff University Centre for Trials Research/Division of Infection and Immunity, UHW, Cardiff, UK
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium and Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Alexandre Alanio
- To whom correspondence should be addressed. Alexandre Alanio, Laboratoire de parasitologie mycologie, Hôpital Saint Louis, Université Paris Cité Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris France. Tel: +33142499501; E-mail:
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Kundu P, Gupta N, Sood N. The Fragile Patient: Considerations in the Management of Invasive Mould Infections (IMIs) in India. Cureus 2023; 15:e38085. [PMID: 37252469 PMCID: PMC10209389 DOI: 10.7759/cureus.38085] [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: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Invasive mould infections (IMIs), which are mostly caused by Aspergillus spp. and Mucormycetes, are opportunistic infections that impose a substantial threat to patients who are considered to be 'fragile'. There is no fixed definition for fragile patients; however, patients with cancer or acquired immunodeficiency syndrome (AIDS), patients who have undergone organ transplants, and patients being treated in the intensive care units (ICUs) were considered fragile. Management of IMIs in fragile patients is challenging, owing to their compromised immune status. The diagnostic challenges associated with IMIs due to insufficient sensitivity and specificity of the current diagnostic tests lead to delayed treatment. A widening demographic of at-risk patients and a broadening spectrum of pathogenic fungi have added to the challenges to ascertain a definite diagnosis. A recent surge of mucormycosis associated with SARS-CoV-2 infections and the resultant steroid usage has been reported. Liposomal amphotericin B (L-AmB) is the mainstay for treating mucormycosis while voriconazole has displaced amphotericin B as the mainstay for treating Aspergillus infection due to its better response, improved survival, and fewer severe side effects. The selection of antifungal treatment has to be subjected to more scrutiny in fragile patients owing to their comorbidities, organ impairment, and multiple ongoing treatment modalities. Isavuconazole has been documented to have a better safety profile, stable pharmacokinetics, fewer drug-drug interactions, and a broad spectrum of coverage. Isavuconazole has thus found its place in the recommendations and can be considered a suitable option for treating fragile patients with IMIs. In this review, the authors have critically appraised the challenges in ascertaining an accurate diagnosis and current management considerations and suggested an evidence-based approach to managing IMIs in fragile patients.
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Affiliation(s)
| | - Neha Gupta
- Internal Medicine, Fortis Memorial Research Institute, Gurugram, IND
- Internal Medicine, Medanta - The Medicity, Gurugram, IND
| | - Nitin Sood
- Hematology and Oncology/Stem Cell Transplant, Cancer Institute, Medanta - The Medicity, Gurugram, IND
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13
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Ankrah AO, Lawal IO, Dierckx RAJO, Sathekge MM, Glaudemans AWJM. Imaging of Invasive Fungal Infections- The Role of PET/CT. Semin Nucl Med 2023; 53:57-69. [PMID: 35933165 DOI: 10.1053/j.semnuclmed.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
Over the last decades, the population at risk for invasive fungal disease (IFD) has increased because of medical therapy advances and diseases compromising patients' immune systems. The high morbidity and mortality associated with invasive fungal disease in the immunocompromised present the challenge of early diagnosis of the IFD and the need to closely monitor the infection during treatment. The definitive diagnosis of invasive fungal disease based on culture or histopathological methods often has reduced diagnostic accuracy in the immunocompromised and may be very invasive. Less invasive and indirect evidence of the fungal infection by serology and imaging has been used for the early diagnosis of fungal infection before definitive results are available or when the definitive methods of diagnosis are suboptimal. Imaging in invasive fungal disease is a non-invasive biomarker that helps in the early diagnosis of invasive fungal disease but helps follow-up the infection during treatment. Different imaging modalities are used in the workup to evaluate fungal disease. The different imaging modalities have advantages and disadvantages at different sites in the body and may complement each other in the management of IFD. Positron emission tomography integrated with computed tomography with [18F]Fluorodeoxyglucose (FDG PET/CT) has helped manage IFD. The combined functional data from PET and anatomical data from the CT from almost the whole body allows noninvasive evaluation of IFD and provides a semiquantitative means of assessing therapy. FDG PET/CT adds value to anatomic-based only imaging modalities. The nonspecificity of FDG uptake has led to the evaluation of other tracers in the assessment of IFD. However, these are mainly still at the preclinical level and are yet to be translated to humans. FDG PET/CT remains the most widely evaluated radionuclide-based imaging modality in IFD management. The limitations of FDG PET/CT must be well understood, and more extensive prospective studies in uniform populations are needed to validate its role in the management of IFD that can be international guidelines.
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Affiliation(s)
- Alfred O Ankrah
- National Centre for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra GA, Ghana; Department of Nuclear Medicine, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa; Medical Imaging Center, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands.
| | - Ismaheel O Lawal
- Department of Nuclear Medicine, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Rudi A J O Dierckx
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Andor W J M Glaudemans
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands
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14
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Lamoth F, Calandra T. Pulmonary aspergillosis: diagnosis and treatment. Eur Respir Rev 2022; 31:31/166/220114. [DOI: 10.1183/16000617.0114-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/18/2022] [Indexed: 12/05/2022] Open
Abstract
Aspergillusspecies are the most frequent cause of fungal infections of the lungs with a broad spectrum of clinical presentations including invasive pulmonary aspergillosis (IPA) and chronic pulmonary aspergillosis (CPA). IPA affects immunocompromised populations, which are increasing in number and diversity with the advent of novel anti-cancer therapies. Moreover, IPA has emerged as a complication of severe influenza and coronavirus disease 2019 in apparently immunocompetent hosts. CPA mainly affects patients with pre-existing lung lesions and is recognised increasingly frequently among patients with long-term survival following cure of tuberculosis or lung cancer. The diagnosis of pulmonary aspergillosis is complex as it relies on the presence of clinical, radiological and microbiological criteria, which differ according to the type of pulmonary aspergillosis (IPA or CPA) and the type of patient population. The management of pulmonary aspergillosis is complicated by the limited number of treatment options, drug interactions, adverse events and the emergence of antifungal resistance.
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15
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Smith CB, Shi X, Liesman RM, Thomas LA, Bahr NC, Brownback KR. Evaluation of the Diagnostic Accuracy and Clinical Utility of Fungal Profile Plus Polymerase Chain Reaction Assay in Pulmonary Infections. Open Forum Infect Dis 2022; 9:ofac646. [PMID: 36578519 PMCID: PMC9793098 DOI: 10.1093/ofid/ofac646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background Pulmonary infections due to Aspergillus, Mucorales, and Nocardia have high morbidity and mortality, in part due to diagnostic challenges. Commercially available molecular assays on bronchoalveolar lavage fluid (BALF) may have increased sensitivity over currently available diagnostic options. Our aim was to characterize the diagnostic performance of assays for each of these pathogens in our patient population. Methods The medical records of patients whose BALF was tested by polymerase chain reaction (PCR) for Aspergillus, Mucorales, and Nocardia between 2019 and 2021 were reviewed in a cross-sectional manner. European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) definitions of "proven," "probable," and "possible" infection were used, including histopathology, serology, and culture. We used (1) "proven" or "probable" infection by EORTC criteria, (2) improvement or stabilization on targeted antimicrobial therapy, and (3) absence of a more likely diagnosis as the reference standard. Results The Aspergillus PCR assay demonstrated the highest agreement with the diagnostic reference standard, with 31.25% (10/32) sensitivity and 97.17% (206/212) specificity. Positive and negative predictive values were 62.50% (10/16) and 90.35% (206/228), respectively. No Mucorales or Nocardia infections were identified by the diagnostic reference standard, so the sensitivity could not be calculated. The specificity of Mucorales and Nocardia targets was 98.35% and 96.69%, respectively. Conclusions Our data demonstrated relatively poor clinical sensitivity for all 3 constituent PCR assays in our patient population, suggesting a limited role for this test in the diagnosis of Aspergillus, Mucorales, or Nocardia.
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Affiliation(s)
- Clarissa B Smith
- Correspondence: Clarissa Smith, MD, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66205 ()
| | - Xiaosong Shi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rachael M Liesman
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Laura A Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
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The use of the electromagnetic field in microbial process bioengineering. ADVANCES IN APPLIED MICROBIOLOGY 2022; 121:27-72. [PMID: 36328731 DOI: 10.1016/bs.aambs.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An electromagnetic field (EMF) has been shown to have various stimulatory or inhibitory effects on microorganisms. Over the years, growing interest in this topic led to numerous discoveries suggesting the potential applicability of EMF in biotechnological processes. Among these observations are stimulative effects of this physical influence resulting in intensified biomass production, modification of metabolic activity, or pigments secretion. In this review, we present the current state of the art and underline the main findings of the application of EMF in bioprocessing and their practical meaning in process engineering using examples selected from studies on bacteria, archaea, microscopic fungi and yeasts, viruses, and microalgae. All biological data are presented concerning the classification of EMF. Furthermore, we aimed to highlight missing parts of contemporary knowledge and indicate weak spots in the approaches found in the literature.
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Matthaiou EI, Chiu W, Conrad C, Hsu J. Macrophage Lysosomal Alkalinization Drives Invasive Aspergillosis in a Mouse Cystic Fibrosis Model of Airway Transplantation. J Fungi (Basel) 2022; 8:751. [PMID: 35887506 PMCID: PMC9321820 DOI: 10.3390/jof8070751] [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: 06/02/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 01/25/2023] Open
Abstract
Cystic fibrosis (CF) lung transplant recipients (LTRs) exhibit a disproportionately high rate of life-threatening invasive aspergillosis (IA). Loss of the cystic fibrosis transmembrane conductance regulator (CFTR-/-) in macrophages (mφs) has been associated with lyosomal alkalinization. We hypothesize that this alkalinization would persist in the iron-laden post-transplant microenvironment increasing the risk of IA. To investigate our hypothesis, we developed a murine CF orthotopic tracheal transplant (OTT) model. Iron levels were detected by immunofluorescence staining and colorimetric assays. Aspergillus fumigatus (Af) invasion was evaluated by Grocott methenamine silver staining. Phagocytosis and killing of Af conidia were examined by flow cytometry and confocal microscopy. pH and lysosomal acidification were measured by LysoSensorTM and LysotrackerTM, respectively. Af was more invasive in the CF airway transplant recipient compared to the WT recipient (p < 0.05). CFTR-/- mφs were alkaline at baseline, a characteristic that was increased with iron-overload. These CFTR-/- mφs were unable to phagocytose and kill Af conidia (p < 0.001). Poly(lactic-co-glycolic acid) (PLGA) nanoparticles acidified lysosomes, restoring the CFTR-/- mφs’ ability to clear conidia. Our results suggest that CFTR-/- mφs’ alkalinization interacts with the iron-loaded transplant microenvironment, decreasing the CF-mφs’ ability to kill Af conidia, which may explain the increased risk of IA. Therapeutic pH modulation after transplantation could decrease the risk of IA.
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Affiliation(s)
- Efthymia Iliana Matthaiou
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA; (E.I.M.); (W.C.)
| | - Wayland Chiu
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA; (E.I.M.); (W.C.)
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Carol Conrad
- Department of Pediatrics, Pulmonary Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA;
| | - Joe Hsu
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA; (E.I.M.); (W.C.)
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Chaturvedi CP, Hashim Z, Tripathy NK. A New and Highly Sensitive Serum Mannoprotein Lateral Flow Assay for Point-of-Care Diagnosis of Invasive Aspergillosis (Tripathy Method). Cureus 2022; 14:e26025. [PMID: 35859976 PMCID: PMC9288649 DOI: 10.7759/cureus.26025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background and objectives The mannoprotein lateral flow assay (MP-LFA) or Aspergillus-specific lateral flow device (AspLFD) is a novel rapid test for point-of-care diagnosis (PoC) of invasive aspergillosis (IA), but its routine clinical application is hampered due to low sensitivity (Sn) of the assay in serum. Therefore, this study aimed to develop a new method to enhance the Sn of the serum MP-LFA. Methodology In the new method (Tripathy method), we used direct heating of the serum without any dilution at 120°C for 15 minutes to purify the mannoprotein (MP) antigen of the Aspergillus. The MP-enriched serum supernatant obtained after centrifugation was loaded in an LFD cassette, and the results were read after 20 minutes using a digital cube reader. In parallel to our new method, AspLFD was performed according to the manufacturer’s instructions. The diagnostic performance of the two methods was evaluated using paired sera of true IA patients (IA, n=18) and healthy subjects (controls, n=20). The positivity of the two methods was also evaluated in the sera of leukemia patients with possible/probable IA (possible/probable IA; n=23). Results The Tripathy method had a significantly higher sensitivity (88.9% versus 55.5%; p<0.05) and diagnostic odds ratio (72.0 versus 23.7) than the standard AspLFD method. In receiver operating characteristic curve analysis for differentiation between IA patients and controls, although the Tripathy method (area under curve; AUC: 0.894, p<0.001) and AspLFD method (AUC: 0.753, p<0.001) were significantly associated with IA, the AUC of the Tripathy method was significantly higher than that of the AspLFD method (0.894 versus 0.753; p<0.05). In the sera of possible/probable IA, MP-LFA by the Tripathy method had a significantly higher rate of positivity than the AspLFD method (39.0% versus 21.7%; p<0.05). Conclusion Our data show that the Tripathy method is a highly sensitive method of MP-LFA for the PoC diagnosis of IA in clinical settings.
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Michallet M, Sobh M, Morisset S, Deloire A, Raffoux E, de Botton S, Caillot D, Chantepie S, Girault S, Berthon C, Bertoli S, Lepretre S, Leguay T, Castaigne S, Marolleau JP, Pautas C, Malfuson JV, Veyn N, Braun T, Gastaud L, Suarez F, Schmidt A, Gressin R, Bonmati C, Celli-Lebras K, El-Hamri M, Ribaud P, Dombret H, Thomas X, Bergeron A. Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:311-318. [PMID: 34895843 DOI: 10.1016/j.clml.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although recommended in patients with acute myeloblastic leukaemia (AML) after induction chemotherapy, real-life use of antifungal prophylaxis (AFP) is different among centres. MATERIALS AND METHODS This is an ancillary study to a randomized trial on intensive induction chemotherapy in AML patients (ALFA-0702/NCT00932412), where AFP with posaconazole was recommended. IFIs were graded by investigators and by central reviewers according to the revised EORTC definitions. Experts conclusions were compared to the investigators' ones. RESULTS A total of 677 patients were included. Four AFP strategies were reported: Group-1: no AFP (n = 203, 30%), Group-2: posaconazole (n = 241, 36%), Group-3: posaconazole with other AFP (n = 142, 21%), Group-4: other AFP (n = 91, 13%). Experts graded more IFI than investigators: proven/probable IFI, 9.0% (n = 61) versus 6.2% (n = 42). The cumulative incidence at day60 of probable/proven IFI was 13.9% (Group-1); 7.9% (Group-2); 5.6% (Group-3); and 6.6% (Group-4). IFI onset was 26 (19-31) days after induction in Groups 2-3, versus 16 (9-25) days in Group 1 and 20 (12-24) days in Group 4 (P< .001). After a median follow-up of 27.5 months (0.4-73.4), the mortality rate was 38.3%, with 5.4% attributed to IFI. In multivariate analysis, IFI occurrence was an independent risk of death (HR5.63, 95%-CI 2.62-12.08, P< .001). EORTC recommendations were applied in only 57% of patients. In patients without IFI, the rate of AML complete remission was higher. CONCLUSIONS In AML patients, AFP delayed the onset of IFI in addition of decreasing their rate. The frequent misidentification of IFI impacts their appropriate management according to recommendations. hematological remission was more frequent in patients without IFI.
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Affiliation(s)
| | - Mohamad Sobh
- Hematology department, Anticancer Centre Léon Bérard, Lyon, France
| | | | | | | | | | - Denis Caillot
- Hématologie Clinique, Dijon University Hospital, Dijon, France
| | | | | | | | - Sarah Bertoli
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse - Oncopole, CHU de Toulouse, Toulouse, France
| | - Stephane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Univ UNIROUEN, Rouen, France
| | | | | | | | | | | | - Norbert Veyn
- Hematology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Felipe Suarez
- Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | | | | | | | | | - Mohamed El-Hamri
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | | | - Herve Dombret
- Hematology Department, Saint Louis Hospital, Paris, France
| | - Xavier Thomas
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Anne Bergeron
- Pneumology department, Saint Louis Hospital, AP-HP, Paris, France
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Gold JAW, Revis A, Thomas S, Perry L, Blakney RA, Chambers T, Bentz ML, Berkow EL, Lockhart SR, Lysen C, Nunnally NS, Jordan A, Kelly HC, Montero AJ, Farley MM, Oliver NT, Pouch SM, Webster AS, Jackson BR, Beer KD. Clinical Characteristics, Healthcare Utilization, and Outcomes among Patients in a Pilot Surveillance System for Invasive Mold Disease—Georgia, United States, 2017–2019. Open Forum Infect Dis 2022; 9:ofac215. [DOI: 10.1093/ofid/ofac215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Invasive mold diseases (IMD) cause severe illness, but public health surveillance data are lacking. We describe data collected from a laboratory-based, pilot IMD surveillance system.
Methods
During 2017–2019, the Emerging Infections Program conducted active IMD surveillance at three Atlanta-area hospitals. We ascertained potential cases by reviewing histopathology, culture, and Aspergillus galactomannan results and classified patients as having an IMD case (based on European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [MSG] criteria) or a non-MSG IMD case (based on the treating clinician’s diagnosis and use of mold-active antifungal therapy). We described patient features and compared patients with MSG versus non-MSG IMD cases.
Results
Among 304 patients with potential IMD, 104 (34.2%) met an IMD case definition (41 MSG, 63 non-MSG). The most common IMD types were invasive aspergillosis (n = 66, 63.5%), mucormycosis (n = 8, 7.7%), and fusariosis (n = 4, 3.8%); the most frequently affected body sites were pulmonary (n = 66, 63.5%), otorhinolaryngologic (n = 17, 16.3%), and cutaneous/deep tissue (n = 9, 8.7%). Forty-five (43.3%) IMD patients received intensive care unit-level care, and 90-day all-cause mortality was 32.7%; these outcomes did not differ significantly between MSG and non-MSG IMD patients.
Conclusions
IMD patients had high mortality rates and a variety of clinical presentations. Comprehensive IMD surveillance is needed to assess emerging trends, and strict application of MSG criteria for surveillance might exclude > one-half of clinically significant IMD cases.
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Affiliation(s)
| | - Andrew Revis
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Stepy Thomas
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lewis Perry
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Rebekah A. Blakney
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Taylor Chambers
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | - Monica M. Farley
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nora T. Oliver
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie M. Pouch
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew S. Webster
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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21
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Liu S, Li Z, Zheng J, He N. Invasive Aspergillus outbreak in inhalation injury: a case presentation and literature review. BMC Infect Dis 2022; 22:386. [PMID: 35436864 PMCID: PMC9014600 DOI: 10.1186/s12879-022-07366-7] [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: 09/24/2021] [Accepted: 04/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Invasive pulmonary aspergillosis often occurs in patients with poor immune function, who abuse steroids or broad-spectrum antibiotics, or who use intravenous drugs. Among the Aspergillus genus of pulmonary infection, Aspergillus fumigatus is the most important pathogen, followed by Aspergillus flavus, Aspergillus niger, and Aspergillus terreus. Inhalation injury complicated by Aspergillus infection has atypical clinical manifestations. Diagnosis is difficult, and it is easy to make mistakes in treatment. Moreover, there are few cases of burn inhalation injury complicated with pulmonary Aspergillus. Case presentation We report a case of severe burns combined with severe inhalation injury, early pulmonary aspergillosis, and severe respiratory failure due to treatment discontinuation. Through analyzing the processes of diagnosis and treatment in the present case and performing a literature review, we explore feasible diagnosis and treatment plans. Conclusions Early application of a variety of diagnostic measures can be used to identify Aspergillus infection, and targeted anti-infection treatment is likely to reverse a severe adverse prognosis.
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Affiliation(s)
- Shengli Liu
- Department of Burns and Plastic Surgery, The Affiliated Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China.
| | - Zonghang Li
- School of Medicine, Xiamen University, Xiamen, China
| | - Jiansheng Zheng
- Department of Burns and Plastic Surgery, The Affiliated Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China
| | - Ning He
- Intensive Care Unit, The Affiliated Dongnan Hospital of Xiamen University, School of Medicine, Xiamen University, Zhangzhou, China
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22
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Siopi M, Karakatsanis S, Roumpakis C, Korantanis K, Eldeik E, Sambatakou H, Sipsas NV, Pagoni M, Stamouli M, Tsirigotis P, Meletiadis J. Evaluation of the Dynamiker® Fungus (1–3)-β-d-Glucan Assay for the Diagnosis of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies. Infect Dis Ther 2022; 11:1161-1175. [PMID: 35404009 PMCID: PMC9124273 DOI: 10.1007/s40121-022-00627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Stamatis Karakatsanis
- Department of Hematology and Lymphoma-Unit of Bone Marrow Transplantation, Evangelismos General Hospital, 10676, Athens, Greece
| | - Christoforos Roumpakis
- 2nd Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Konstantinos Korantanis
- Pathophysiology Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Elina Eldeik
- 2nd Department of Internal Medicine, Hippokration General Hospital, 11527, Athens, Greece
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, Hippokration General Hospital, 11527, Athens, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Maria Pagoni
- Department of Hematology and Lymphoma-Unit of Bone Marrow Transplantation, Evangelismos General Hospital, 10676, Athens, Greece
| | - Maria Stamouli
- 2nd Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Panagiotis Tsirigotis
- 2nd Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece.
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23
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Salehi M, Ghaderkhani S, Sharifian RA, Dehghan Manshadi SA, Samiee Fard E, Khodavaisy S, Pourahmad R, Foroushani AR, Rodini K, Kamali Sarvestani H. The Value of Nasal and Oral Clinical Examination in Febrile Neutropenic Patients for Initiating Antifungal Therapy as a Preemptive Method. Front Med (Lausanne) 2022; 8:803600. [PMID: 35155481 PMCID: PMC8835583 DOI: 10.3389/fmed.2021.803600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
Background Invasive fungal infections (IFIs) are complications that lead to mortality and morbidity in hematologic malignancies. The time of starting antifungal therapy is vital. Preemptive antifungal therapy has appeared recently as a new policy for the management of IFIs based on noninvasive ways in neutropenic patients. Methods We enrolled leukemia patients with neutropenia after chemotherapy in Imam Khomeini Hospital Complex, Tehran, Iran. Patients who entered the neutropenic phase were divided into two categories (empirical and preemptive) for receiving antifungal agents. The patients were clinically examined in the preemptive group every day to find IFIs. As soon as clinical evidence of IFIs was observed, antifungal was prescribed. The empirical group patients received antifungals based on the ward protocol. Based on the data in each group, the diagnostic and therapeutic results of cases are followed-up to 3 months. To compare percentages between the two groups, the chi-squared test was used. And to compare two means between the two groups, the independent t-test was used. All the statistical analyses were done in the Statistical Package for the Social Sciences (SPSS) version 24 software (IBM Corporation, Armonk, New York, USA). Results We assessed 132 leukemic patients with inclusion and exclusion criteria. Eventually, 80 patients were enrolled. The mean age was 35.52 years. Demographics data and distribution of leukemia type show no significant differences between the two groups. Despite a higher percentage of IFIs discovered in the preemptive group than the empirical group (25 vs. 18.75%, respectively), but data show no significant differences. The average days of IFIs diagnosis since the beginning of neutropenia in the empirical group were 9.5 days while in the preemptive group, the average days were 5.4 days (p < 0.05). Totally, there were 15 patients with a proven IFI in each group (40% in the empirical group and 60% in the preemptive group). Results significantly show an increase in surgical sinus debridement in the empirical groups (83.3%) vs. the preemptive groups (55.5%), (p < 0.05). The mortality rate differed significantly among the two groups; it was 7.5% in the preemptive group and 25% in the empirical group (p < 0.05). Conclusion Daily oral and nasal cavities examination to find the symptoms of IFIs and then start preemptive antifungal agents may be able to lead to accurate diagnosis, earlier treatment, and decreasing sinus surgery debridement in leukemia patients with neutropenia.
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Affiliation(s)
- Mohammadreza Salehi
- Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Ghaderkhani
- Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramezan Ali Sharifian
- Department of Internal Medicine, Imam Khomeini Hospital Complex, Hematology and Oncology Ward, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Samiee Fard
- Department of Infectious Disease, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramtin Pourahmad
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Rodini
- Department of Internal Medicine, Imam Khomeini Hospital Complex, Hematology and Oncology Ward, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasti Kamali Sarvestani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Hasti Kamali Sarvestani
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24
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Kluge S, Strauß R, Kochanek M, Weigand MA, Rohde H, Lahmer T. Aspergillosis: Emerging risk groups in critically ill patients. Med Mycol 2021; 60:6408468. [PMID: 34677613 DOI: 10.1093/mmy/myab064] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023] Open
Abstract
Information on invasive aspergillosis (IA) and other invasive filamentous fungal infections is limited in non-neutropenic patients admitted to the intensive care unit (ICU) and presenting with no classic IA risk factors. This review is based on the critical appraisal of relevant literature, on the authors' own experience and on discussions that took place at a consensus conference. It aims to review risk factors favoring aspergillosis in ICU patients, with a special emphasis on often overlooked or neglected conditions. In the ICU patients, corticosteroid use to treat underlying conditions such as chronic obstructive pulmonary disease (COPD), sepsis, or severe COVID-19, represents a cardinal risk factor for IA. Important additional host risk factors are COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia (influenza, COVID-19). Clinical observations indicate that patients admitted to the ICU because of sepsis or acute respiratory distress syndrome are more likely to develop probable or proven IA, suggesting that sepsis could also be a possible direct risk factor for IA, as could small molecule inhibitors used in oncology. There are no recommendations for prophylaxis in ICU patients; posaconazole mold-active primary prophylaxis is used in some centers according to guidelines for other patient populations and IA treatment in critically ill patients is basically the same as in other patient populations. A combined evaluation of clinical signs and imaging, classical biomarkers such as the GM assay, and fungal cultures examination, remain the best option to assess response to treatment. LAY SUMMARY The use of corticosteroids and the presence of co-morbidities such as chronic obstructive pulmonary disease, acute or chronic advanced liver disease, or severe viral pneumonia caused by influenza or Covid-19, may increase the risk of invasive aspergillosis in intensive care unit patients.
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Affiliation(s)
- Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg - Eppendorf, Hamburg, D-20246, Germany
| | - Richard Strauß
- Department of Medicine 1, Medizinische Klinik 1, University Hospital Erlangen, Erlangen, D-91054, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, D-50937, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, D-69120, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany
| | - Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität Munich, Munich, D-81675, Germany
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25
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Zhu A, Zembower T, Qi C. Molecular detection, not extended culture incubation, contributes to diagnosis of fungal infection. BMC Infect Dis 2021; 21:1159. [PMID: 34781879 PMCID: PMC8591865 DOI: 10.1186/s12879-021-06838-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/02/2021] [Indexed: 02/07/2023] Open
Abstract
Background Despite its low sensitivity, fungal culture remains one of the key methods for diagnosis and treatment of fungal infections, as it identifies the etiology at the genus and species level and affords the opportunity for susceptibility testing. The Manual of Clinical Microbiology recommends that fungal culture screening for all pathogens should routinely be held for 4 weeks to maximize the recovery of slow-growing species. Information on the optimal fungal culture time in this era of expansion of immunocompromised populations and availability of molecular diagnostics is lacking. We reviewed our experience with fungal culture to determine the optimal culture incubation time. In addition, our experience of broad-range ITS PCR for diagnosis of culture-negative fungal infections was also reviewed. Methods Fungal culture and ITS PCR results from January 1, 2013, to December 31, 2017, were reviewed. Results This study included 4234 non-duplicated positive cultures. Ninety-six percent (4058) of the positive cultures were detected in the first 7 days of incubation. During the second week of incubation, 111 (2.8%) positives were detected from day 8 to day 10, and 71 (1.7%) were detected from day 11 to day 14. Only 6 (0.1%) positive cultures were detected in the third week of incubation, and no positive culture was detected in the fourth week of incubation. No clinically significant fungal isolates were recovered after 14 days. Clinically significant pathogens were detected in 16 (0.2%) culture-negative samples by ITS PCR. Conclusion Extending culture incubation beyond 2 weeks did not generate clinically relevant results. When culture failed to make a laboratory diagnosis, broad-range internal transcribed spacer (ITS) rRNA gene PCR followed by sequencing produced clinically significant results.
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Affiliation(s)
- Alex Zhu
- Northwestern University, IL, Evanston, USA
| | - Teresa Zembower
- Department of Pathology, Clinical Microbiology Laboratory, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 303 E. Chicago Ave., Chicago, IL, 60611, USA.,Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chao Qi
- Department of Pathology, Clinical Microbiology Laboratory, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 303 E. Chicago Ave., Chicago, IL, 60611, USA.
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26
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Bhardwaj R, Sharma A, Parasher A, Gupta H, Sahu S, Pal S. Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of Covid-19: The Indian Scenario. Indian J Otolaryngol Head Neck Surg 2021; 74:3492-3497. [PMID: 34786356 PMCID: PMC8585575 DOI: 10.1007/s12070-021-02978-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022] Open
Abstract
Mucormycosis is a life threatening, opportunistic infection often seen in individuals with a weak immune system. With an upsurge of cases of Covid-19, a drastic increase in cases of Rhino-Orbito-Cerebral Mucormycosis is being witnessed at present. This article has been written with the purpose of understanding the factors responsible for it and the challenges it brings along for the Indian health-care system at present. Possible solutions for dealing with these problems have also been included in the manuscript.
Google, PubMed and ENT Cochrane databases were searched without a time limit using key words like “Mucormycosis”, “Rhino-cerebral-mucormycosis” in conjunction with “COVID-19” and “SARS CoV-2”. We found 34 articles to be relevant and hence included them to write this review. Rhino-Orbito-Cerebral Mucormycosis is being seen due to coming together of the three entities-the agent, host and environment that constitute the epidemiological triad for this disease in India. Responsible factors are uncontrolled diabetes mellitus, overzealous use of steroids and antibiotics and other environment related issues. The solutions for these problems lie in spreading awareness about prevention of these practices along with early diagnosis and treatment of mucormycosis. To deal effectively with this situation, particularly when there is an existing overload on otolaryngologists and the rest of the health-care system, a multipronged and multilevel collaborative approach is the need of the hour. With effective Standard Operating Procedures and guidelines promoting a multidisciplinary approach for early diagnosis and treatment, we can surely overcome this situation.
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Affiliation(s)
- Rohit Bhardwaj
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Akriti Sharma
- Department of Otorhinolaryngology, SGT Medical College, Hospital and Research Institute, Gurgaon, Haryana India
| | - Ankit Parasher
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Harshita Gupta
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Subhankar Sahu
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Soni Pal
- Department of General Surgery, VMMC and Safdarjung Hospital, New Delhi, India
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27
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Kimura SI, Kanda Y, Oyake T, Yamaguchi H, Fujiwara SI, Okamoto A, Fujita H, Saburi Y, Tamura K. Fungal biomarker monitoring and CT scans for early detection of invasive fungal disease in neutropenic hematological patients. J Infect 2021; 84:80-86. [PMID: 34710391 DOI: 10.1016/j.jinf.2021.10.018] [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: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES By using data from the CEDMIC trial (n = 413), we conducted a post-hoc analysis of the diagnostic value of biomarker monitoring and chest computed tomography (CT) scans for the early detection of invasive fungal disease (IFD) in neutropenic hematological patients. METHODS IFDs were defined in accordance with the EORTC/MSG definition with some modifications. Biomarkers such as Aspergillus galactomannan (GM) and (1→3)-β-D-glucan (βDG) were measured weekly. RESULTS The positive predictive value (PPV) of GM and βDG in cases of high-risk treatment were 0.70 and 0.69, while those in low-risk treatment were 0.08 and 0, respectively. All of the positive biomarkers that were measured before the development of fever in low-risk treatment were false positives. The proportion of patients who had abnormal chest CT findings was 19% in persistent fever at 4-6 days, 57% at 7 days or later and 36% in recurrent fever. Sixty-nine percent of the patients who had abnormal findings at 7 days or later did not have abnormalities at 4-6 days. CONCLUSIONS Afebrile screening of biomarkers in low-risk treatment is not useful. Chest CT should be reevaluated in persistent fever lasting for 7 days or longer even in patients who did not have abnormalities within 6 days.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan; Department of Internal Medicine, Division of Hematology, Jichi Medical University, Japan.
| | - Tatsuo Oyake
- Department of Internal Medicine, Division of Hematology and Oncology, Iwate Medical University School of Medicine, Japan
| | | | - Shin-Ichiro Fujiwara
- Department of Internal Medicine, Division of Hematology, Jichi Medical University, Japan
| | - Akinao Okamoto
- Department of Hematology, Fujita Health University School of Medicine, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Japan
| | - Yoshio Saburi
- Department of Hematology, Oita Prefectural Hospital, Japan
| | - Kazuo Tamura
- Clinical Hematology Oncology Treatment Study Group, Japan
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28
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Caudron de Coquereaumont G, Couchepin J, Perentes JY, Krueger T, Lovis A, Rotman S, Lamoth F. Limited Index of Clinical Suspicion and Underdiagnosis of Histopathologically Documented Invasive Mold Infections. Open Forum Infect Dis 2021; 8:ofab174. [PMID: 34549073 PMCID: PMC8446918 DOI: 10.1093/ofid/ofab174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 11/14/2022] Open
Abstract
Invasive mold infections (IMIs) are difficult to diagnose. This analysis of histopathologically proven IMIs at our institution (2010-2019) showed that 11/41 (27%) of them were not suspected at the time of biopsy/autopsy (9/17, 53% among autopsies). The rate of missed diagnosis was particularly high (8/16, 50%) among nonhematologic cancer patients.
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Affiliation(s)
| | - Jade Couchepin
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean Y Perentes
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alban Lovis
- Service of Pulmonology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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29
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Diagnostics for Fungal Infections in Solid Organ Transplants (SOT). CURRENT FUNGAL INFECTION REPORTS 2021. [DOI: 10.1007/s12281-021-00422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Foppiano Palacios C, Spichler Moffarah A. Diagnosis of Pneumonia Due to Invasive Molds. Diagnostics (Basel) 2021; 11:diagnostics11071226. [PMID: 34359309 PMCID: PMC8304515 DOI: 10.3390/diagnostics11071226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/20/2022] Open
Abstract
Pneumonia is the most common presentation of invasive mold infections (IMIs), and is pathogenetically characterized as angioinvasion by hyphae, resulting in tissue infarction and necrosis. Aspergillus species are the typical etiologic cause of mold pneumonia, with A. fumigatus in most cases, followed by the Mucorales species. Typical populations at risk include hematologic cancer patients on chemotherapy, bone marrow and solid organ transplant patients, and patients on immunosuppressive medications. Invasive lung disease due to molds is challenging to definitively diagnose based on clinical features and imaging findings alone, as these methods are nonspecific. Etiologic laboratory testing is limited to insensitive culture techniques, non-specific and not readily available PCR, and tissue biopsies, which are often difficult to obtain and impact on the clinical fragility of patients. Microbiologic/mycologic analysis has limited sensitivity and may not be sufficiently timely to be actionable. Due to the inadequacy of current diagnostics, clinicians should consider a combination of diagnostic modalities to prevent morbidity in patients with mold pneumonia. Diagnosis of IMIs requires improvement, and the availability of noninvasive methods such as fungal biomarkers, microbial cell-free DNA sequencing, and metabolomics-breath testing could represent a new era of timely diagnosis and early treatment of mold pneumonia.
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31
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Clinical features in maxillary sinus fungus ball in patients with malignant hematological disease. Eur Arch Otorhinolaryngol 2021; 279:1919-1927. [PMID: 34216265 DOI: 10.1007/s00405-021-06973-5] [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: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies on fungus balls have primarily focused on immunocompetent patients, and only a few studies have described the clinical characteristics of fungus balls in malignant hematological disease (MHD) patients. Therefore, we compared the clinical features of maxillary sinus fungus ball (MSFB) between immunosuppressive patients with MHD and immunocompetent patients. METHODS Twenty patients with MHD and 40 randomly selected immunocompetent patients were enrolled and divided into MHD and non-MHD groups. All patients were diagnosed with MSFB and their clinical features were retrospectively analyzed. RESULTS Patients in the MHD group had non-specific clinical symptoms and endoscopic manifestations of MSFB, similar to those in the non-MHD group. On computed tomography (CT), the MHD group showed higher Lund-Mackay scores, lesser single sinus opacifications, more multiple sinus opacifications on the affected side, and more bilateral opacifications compared to the non-MHD group. The MHD group had a lower frequency of central hyper-density and heterogeneous opacifications than the non-MHD group. There were no significant differences between the two groups in terms of the fungal-infected side, lateral sinus wall ratio, sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and nasal septum deviation. CONCLUSION The clinical symptoms and endoscopic manifestations of MSFB in patients with MHD were similar to those of immunocompetent patients. However, more atypical signs and wider mucosal inflammation were found on CT scans of MSFB patients with MHD. These results indicate that caution should be executed when excluding the possibility of fungus balls in immunosuppressive patients.
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32
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Carvalhaes CG, Rhomberg PR, Pfaller M, Castanheira M. Comparative activity of posaconazole and systemic azole agents against clinical isolates of filamentous fungi from a global surveillance programme. JAC Antimicrob Resist 2021; 3:dlab088. [PMID: 34223145 PMCID: PMC8251335 DOI: 10.1093/jacamr/dlab088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives The activity of mould-active azoles was evaluated against 397 filamentous
fungi causing invasive mould infections (IMI) worldwide. In addition, a
tentative posaconazole epidemiological cut-off value (ECV) against
Aspergillus fumigatus was investigated. Methods Isolates were susceptibility tested by the CLSI reference broth microdilution
methods. Species identification was confirmed by MALDI-TOF and/or sequencing
analysis. Results Aspergillus spp. (81.9%) remained the most common
organism causing IMI worldwide; approximately two-thirds of
Aspergillus spp. recovered were A.
fumigatus. In general, more than 90% of 220 A.
fumigatus isolates were wild type (WT) to all mould-active
azoles, except itraconazole (84.5% WT). The voriconazole
non-susceptible (NS) A. fumigatus rate was 7.7%
overall and was higher in Europe (12.9%) than in the other regions
(0%–5.8%). Posaconazole
(MIC50/MIC90, 0.25/0.5 mg/L) showed similar
or slightly higher activity than voriconazole
(MIC50/MIC90, 0.5/0.5 mg/L) and
isavuconazole (MIC50/MIC90, 0.5/1 mg/L) against
A. fumigatus. The mould-active azoles displayed similar
activity against non-fumigatus Aspergillus (WT rates
>93%), but differences were observed among the main
species/sections. Posaconazole, voriconazole, and isavuconazole inhibited at
their respective ECVs 100%, 97.0%, and 100% of
A. section Nigri; 100%,
100%, and 93.8% of A. section
Terrei; and 97.3%, 100%, and 100%
of A. section Flavi isolates. Posaconazole
displayed potency greater than or equal to the other azoles against the
Mucorales group and Scedosporium spp. Conclusions Posaconazole and other mould-active azoles showed good activity against
Aspergillus spp. causing IMI, but clinicians should be
aware of regional rates of voriconazole-NS A.
fumigatus.
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Affiliation(s)
- Cecilia G Carvalhaes
- JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA
| | - Paul R Rhomberg
- JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA
| | - Michael Pfaller
- JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA.,Department of Pathology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Mariana Castanheira
- JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA
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Sunagawa K, Nakamura S, Sato Y, Iida S, Miyazaki Y, Suzuki T, Katano H. Morphological and genetic identification of fungal genus/species in formalin-fixed, paraffin-embedded specimens obtained from patients with histologically proven fungal infection. Mycoses 2021; 64:851-859. [PMID: 34028893 DOI: 10.1111/myc.13325] [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: 02/16/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although fungi are found relatively easily by microscopic examination of pathological samples, identification of fungal genus and species in pathological samples is not easy because the morphological features of fungi are similar among genera and species. OBJECTIVES A multiple real-time PCR was developed for identification of fungal genus/species, and morphological characterizations of fungi were analysed in pathological samples. PATIENTS/METHODS Seventy-five formalin-fixed paraffin-embedded (FFPE) samples morphologically proven to contain any fungus were examined. A multiple real-time PCR system was developed to identify 25 fungal genus/species in pathological samples. Morphology of fungus in the specimens was re-reviewed retrospectively based on the results of real-time PCR. RESULTS Real-time PCR identified fungal genus/species in 56 of 75 (74.6%) specimens with histologically proven fungal infection. In 53 specimens of filamentous fungi, Aspergillus spp. (22 specimens), Cladosporium (8), Scedosporium apiospermum (4), Malassezia sympodialis (1) and Candida albicans (1) were identified. Pseudohyphae of Candida were confused with filamentous fungus in a case. Morphological observation suggested differences in the presence of septated or non-septated hyphae, the filament size, and the branch angle among genus/species of filamentous fungi; however, genus/species was not able to be determined by their morphological features. In 22 specimens of yeasts, real-time PCR allowed for the identification of Candida albicans (12 specimens), Candida glabrata (2), Cladosporium (2), Scedosporium apiospermum (2), Pichia kudriavzevii (1) and Aspergillus sydowii (1). CONCLUSIONS These data suggest that it is difficult to identify fungal genus/species by morphological features alone. Real-time PCR is useful to identify fungal genus/species in pathological samples.
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Affiliation(s)
- Keishin Sunagawa
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan.,Clinical Pathology and Laboratory Medicine, Anatomic Pathology, Saitama Cooperative Hospital, Saitama, Japan
| | - Shigeki Nakamura
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Yuko Sato
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shun Iida
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan.,Division of Infectious Diseases Pathology, Department of Global Infectious Diseases, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
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Abstract
The breadth of fungi causing human disease and the spectrum of clinical presentations associated with these infections has widened. Epidemiologic trends display dramatic shifts with expanding geographic ranges, identification of new at-risk groups, increasing prevalence of resistant infections, and emergence of novel multidrug-resistant pathogenic fungi. Certain fungi have been transmitted between patients in clinical settings. Major health events not typically associated with mycoses resulted in larger proportions of the population susceptible to secondary fungal infections. Many health care-related, environmental, and socioeconomic factors have influenced these epidemiologic shifts. This review summarizes updates to clinically significant fungal pathogens in North America.
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Affiliation(s)
- Emma E Seagle
- ASRT, Inc, 4158 Onslow Pl, Smyrna, GA 30080, USA; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329-4018, USA
| | - Samantha L Williams
- ASRT, Inc, 4158 Onslow Pl, Smyrna, GA 30080, USA; Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329-4018, USA
| | - Tom M Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329-4018, USA.
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Mercier T, Guldentops E, Lagrou K, Maertens J. Prospective Evaluation of the Turbidimetric β-D-Glucan Assay and 2 Lateral Flow Assays on Serum in Invasive Aspergillosis. Clin Infect Dis 2021; 72:1577-1584. [PMID: 32188971 DOI: 10.1093/cid/ciaa295] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/16/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) remains a potentially lethal disease and requires timely diagnosis and initiation of antifungal therapy. Recently, the IMMY lateral flow assay (LFA), the OLM Diagnostics lateral flow device (LFD), and the Wako turbidimetric β-d-glucan assay have been approved for use as a diagnostic aid. However, their performance in diagnosing IA on serum samples from at-risk patients and the added value to the existing detection of serum galactomannan remain to be investigated. METHODS We prospectively collected serum samples from 239 hematology patients and evaluated the diagnostic performance of these 3 assays while using the 2019 EORTC/MSG definitions (study number S59863/S61797, NCT03004092). RESULTS We identified 5 cases of proven IA, 36 cases of probable IA, and 188 controls. The LFA had the highest negative predictive value (NPV) and sensitivity (0.90 and 0.49, respectively) while galactomannan detection had the highest positive predictive value and specificity (0.93 and 0.99, respectively). Sensitivity was not significantly different between both tests. When used in combination, the highest NPV was seen in patients with a negative LFA and a negative β-d-glucan test. The sensitivity of the LFD was significantly lower than the LFA. After omitting serum galactomannan from the definitions to control for incorporation bias, the sensitivity of the LFA outperformed galactomannan detection (0.41 vs 0.31, P = .046). CONCLUSIONS The LFA is a fast and effective alternative to serum galactomannan detection for the diagnosis of IA and is especially useful for centers with low sample throughputs. The addition of the Wako β-D-glucan assay further improves the diagnostic performance.
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Affiliation(s)
- Toine Mercier
- Department of Microbiology, Immunology, and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Guldentops
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology, and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Hematology, University Hospitals Leuven, Leuven, Belgium
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Abstract
This article provides an overview of rare orbital diseases. Congenital
malformations, inflammatory diseases, benign and malignant neoplasias are
described. Although it represents a relatively small area of the body the
orbit contains multiple different tissues. Therefore, a great variety of
diseases can be found within the orbital space. That is the reason, why both
the completeness and the level of detail in the description of particular
diseases must be somewhat limited. Nevertheless, clinical manifestations,
important aspects of diagnosis, treatment strategies, and, when specific
data are available, the prognosis are described. The authors tried to
highlight the most characteristic aspects of the different diseases to
describe their relevant aspects in spite of the brevity of the
subsections.
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Affiliation(s)
- Ulrich Kisser
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
| | - Jens Heichel
- Universitätsklinik und Poliklinik für Augenheilkunde, Halle/S. (Klinikdirektor: Prof. Dr. med. A. Viestenz)
| | - Alexander Glien
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Halle/S. (Klinikdirektor: Prof. Dr. med. S. Plontke)
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Angelini E, Shah A. Using Artificial Intelligence in Fungal Lung Disease: CPA CT Imaging as an Example. Mycopathologia 2021; 186:733-737. [PMID: 33840005 PMCID: PMC8536566 DOI: 10.1007/s11046-021-00546-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
This positioning paper aims to discuss current challenges and opportunities for artificial intelligence (AI) in fungal lung disease, with a focus on chronic pulmonary aspergillosis and some supporting proof-of-concept results using lung imaging. Given the high uncertainty in fungal infection diagnosis and analyzing treatment response, AI could potentially have an impactful role; however, developing imaging-based machine learning raises several specific challenges. We discuss recommendations to engage the medical community in essential first steps towards fungal infection AI with gathering dedicated imaging registries, linking with non-imaging data and harmonizing image-finding annotations.
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Affiliation(s)
- Elsa Angelini
- NIHR Imperial Biomedical Research Centre, ITMAT Data Science Group, Imperial College London, London, UK.,Department of Metabolism-Digestion-Reproduction, Imperial College London, London, UK
| | - Anand Shah
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK. .,MRC Centre of Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.
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Neofytos D, Garcia-Vidal C, Lamoth F, Lichtenstern C, Perrella A, Vehreschild JJ. Invasive aspergillosis in solid organ transplant patients: diagnosis, prophylaxis, treatment, and assessment of response. BMC Infect Dis 2021; 21:296. [PMID: 33761875 PMCID: PMC7989085 DOI: 10.1186/s12879-021-05958-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is a rare complication in solid organ transplant (SOT) recipients. Although IA has significant implications on graft and patient survival, data on diagnosis and management of this infection in SOT recipients are still limited. METHODS Discussion of current practices and limitations in the diagnosis, prophylaxis, and treatment of IA and proposal of means of assessing treatment response in SOT recipients. RESULTS Liver, lung, heart or kidney transplant recipients have common as well as different risk factors to the development of IA, thus each category needs a separate evaluation. Diagnosis of IA in SOT recipients requires a high degree of awareness, because established diagnostic tools may not provide the same sensitivity and specificity observed in the neutropenic population. IA treatment relies primarily on mold-active triazoles, but potential interactions with immunosuppressants and other concomitant therapies need special attention. CONCLUSIONS Criteria to assess response have not been sufficiently evaluated in the SOT population and CT lesion dynamics, and serologic markers may be influenced by the underlying disease and type and severity of immunosuppression. There is a need for well-orchestrated efforts to study IA diagnosis and management in SOT recipients and to develop comprehensive guidelines for this population.
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Affiliation(s)
- Dionysios Neofytos
- Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
| | - Carolina Garcia-Vidal
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, FungiCLINIC Research group (AGAUR), Barcelona, Spain
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, 1011, Lausanne, Switzerland
- Department of Laboratories, Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Christoph Lichtenstern
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, Heidelberg, Germany
| | - Alessandro Perrella
- VII Department of Infectious Disease and Immunology, Hospital D. Cotugno, Naples, Italy
- CLSE-Liver Transplant Unit, Hospital A. Cardarelli, Naples, Italy
| | - Jörg Janne Vehreschild
- Medical Department II, Hematology and Oncology, University Hospital of Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, University of Cologne, Cologne, Germany
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Johnson MD, Lewis RE, Dodds Ashley ES, Ostrosky-Zeichner L, Zaoutis T, Thompson GR, Andes DR, Walsh TJ, Pappas PG, Cornely OA, Perfect JR, Kontoyiannis DP. Core Recommendations for Antifungal Stewardship: A Statement of the Mycoses Study Group Education and Research Consortium. J Infect Dis 2021; 222:S175-S198. [PMID: 32756879 DOI: 10.1093/infdis/jiaa394] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years, the global public health community has increasingly recognized the importance of antimicrobial stewardship (AMS) in the fight to improve outcomes, decrease costs, and curb increases in antimicrobial resistance around the world. However, the subject of antifungal stewardship (AFS) has received less attention. While the principles of AMS guidelines likely apply to stewarding of antifungal agents, there are additional considerations unique to AFS and the complex field of fungal infections that require specific recommendations. In this article, we review the literature on AMS best practices and discuss AFS through the lens of the global core elements of AMS. We offer recommendations for best practices in AFS based on a synthesis of this evidence by an interdisciplinary expert panel of members of the Mycoses Study Group Education and Research Consortium. We also discuss research directions in this rapidly evolving field. AFS is an emerging and important component of AMS, yet requires special considerations in certain areas such as expertise, education, interventions to optimize utilization, therapeutic drug monitoring, and data analysis and reporting.
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Affiliation(s)
- Melissa D Johnson
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Russell E Lewis
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elizabeth S Dodds Ashley
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, Laboratory of Mycology Research, McGovern Medical School, Houston, Texas, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
| | - David R Andes
- Department of Medicine and Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Peter G Pappas
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany.,CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.,Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany
| | - John R Perfect
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, Houston, Texas, USA
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Siopi M, Karakatsanis S, Roumpakis C, Korantanis K, Eldeik E, Sambatakou H, Sipsas NV, Tsirigotis P, Pagoni M, Meletiadis J. Performance, Correlation and Kinetic Profile of Circulating Serum Fungal Biomarkers of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies. J Fungi (Basel) 2021; 7:jof7030211. [PMID: 33805751 PMCID: PMC7999040 DOI: 10.3390/jof7030211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
As conventional microbiological documentation of invasive aspergillosis (IA) is difficult to obtain, serum fungal biomarkers are important adjunctive diagnostic tools. Positivity rates and the kinetic profiles of galactomannan (GM), 1,3-β-D-glucan (BDG) and Aspergillus DNA (PCR) were studied in high-risk patients with hematologic malignancies. GM, BDG and PCR data from serial serum specimens (n = 240) from 93 adult hematology patients with probable (n = 8), possible (n = 25) and no (n = 60) IA were retrospectively analyzed. Positivity rates and sensitivity/specificity/positive/negative predictive values (NPV) of each fungal biomarker alone and in combination were estimated. The three markers were compared head-to-head and correlated with various biochemical, demographic and patient characteristics. The positivity rates for patients with probable/possible/no IA were 88%/8%/0% for GM (X2 = 55, p < 0.001), 62%/46%/35% for BDG (X2 = 2.5, p = 0.29), 62%/33%/27% for PCR (X2 = 3.9, p = 0.15), 50%/4%/0% for GM + BDG and GM + PCR (X2 = 31, p < 0.001), 50%/8%/22% for BDG + PCR (X2 = 6.5, p = 0.038) and 38%/4%/0% for GM + BDG + PCR (X2 = 21, p < 0.001). Higher agreement (76%) and negative correlation (rs = −0.47, p = 0.0017) was found between GM index and PCR Ct values. The sensitivity and NPV was 45–55% and 90–92% when biomarkers assessed alone and increased to 75–90% and 93–97%, respectively when combined. Weak significant correlations were found between GM, PCR and BDG results with renal/liver function markers (r = 0.11–0.57) with most GM+ and PCR+ samples found in the first and second week of clinical assessment, respectively and BDG later on. Different positivity rates, time profiles and performances were found for the three biomarkers advocating the combination of GM with PCR for the early diagnosis of IA, whereas the high NPV of combined biomarkerscould help excluding IA.
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Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Stamatis Karakatsanis
- Unit of Bone Marrow Transplantation, Department of Hematology and Lymphoma, “Evangelismos” General Hospital, 10676 Athens, Greece; (S.K.); (M.P.)
| | - Christoforos Roumpakis
- Hematology Unit, 2nd Department of Internal Medicine, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.R.); (P.T.)
| | - Konstantinos Korantanis
- Pathophysiology Department, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.K.); (N.V.S.)
| | - Elina Eldeik
- 2nd Department of Internal Medicine, “Hippokration” General Hospital, 11527 Athens, Greece; (E.E.); (H.S.)
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, “Hippokration” General Hospital, 11527 Athens, Greece; (E.E.); (H.S.)
| | - Nikolaos V. Sipsas
- Pathophysiology Department, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.K.); (N.V.S.)
| | - Panagiotis Tsirigotis
- Hematology Unit, 2nd Department of Internal Medicine, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.R.); (P.T.)
| | - Maria Pagoni
- Unit of Bone Marrow Transplantation, Department of Hematology and Lymphoma, “Evangelismos” General Hospital, 10676 Athens, Greece; (S.K.); (M.P.)
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Correspondence: ; Tel.: +30-210-583-1909; Fax: +30-210-532-6421
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41
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The values of (1,3)-β-D-glucan and galactomannan in cases of invasive fungal rhinosinusitis. Am J Otolaryngol 2021; 42:102871. [PMID: 33412381 DOI: 10.1016/j.amjoto.2020.102871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the values of the serum (1,3)-β-D-glucan test (G test) alone, the galactomannan test (GM test) alone, and their combination in the diagnosis of invasive fungal rhinosinusitis (IFRS). METHODS The present study retrospectively analysed the clinical data of 98 patients who were preliminarily diagnosed with "space-occupying lesions in nose". Of these 98 patients, 88 received the G test, 55 received the GM test, and 45 received both. A pathology analysis was used as the gold standard to diagnose IFRS. All data were analysed using SPSS 19.0. RESULTS The sensitivities (Se) of the G and GM tests alone were 60.0% and 28.6%, respectively, whereas the specificities (Sp) were 92.3% and 93.8%, respectively. Moreover, the positive predictive values (PPV) of the G and GM tests alone were 50.0% and 40.0%, respectively, and the negative predictive values (NPV) were 94.7% and 90.0%, respectively. In addition, the diagnostic odds ratios (DOR) were 18.0 and 6.0, respectively, and the Kappa values were 0.48 (P < 0.05) and 0.25 (P > 0.05), respectively. When the G and GM tests were parallel combined, the Se was 66.7%, the Sp was 92.3%, the PPV was 57.1%, the NPV was 94.7%, the DOR was 24.0, and the Kappa value was 0.55 (P < 0.05). The present study was unable to evaluate the serial diagnosis due to the lack of patients testing positive. CONCLUSIONS The G/GM tests exhibited low Se and PPV when used to diagnose IFRS, while high Sp and NPV. Parallel diagnosis improved the diagnostic Se and DOR values.
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Suwatanapongched T, Visoottiviseth Y, Watcharananan SP, Kanoksil W, Muntham D, Pornsuriyasak P. Clinical characteristics and CT manifestations of invasive pulmonary aspergillosis in hospitalised patients with systemic lupus erythematosus. Clin Radiol 2021; 76:548.e13-548.e23. [PMID: 33610288 DOI: 10.1016/j.crad.2021.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/13/2021] [Indexed: 11/17/2022]
Abstract
AIM To investigate clinical and computed tomography (CT) findings of invasive pulmonary aspergillosis (IPA) in patients with systemic lupus erythematosus (SLE) and to explore the relationships of CT findings with clinical characteristics and outcomes. MATERIALS AND METHODS Clinical and CT findings of 14 SLE patients with proven (n=4) and probable (n=10) IPA between January 2006 and April 2013 were reviewed retrospectively and related to patients' outcomes. RESULTS All patients (mean age, 42.3 ± 15.1 years; 11 women, three men) had active SLE, prior corticosteroid, and/or immunosuppressive therapy. Dominant CT findings performed within 10 days of the clinical onset consisted of nodules/masses (100%, 14/14), consolidations (92.9%, 13/14), and ground-glass opacity (85.7%, 12/14). Bilateral, multilobar, and upper-lobe involvement was common. Regardless of dominant patterns, the halo, reversed halo, air-crescent, hypodense, and feeding vessel signs were found in 12 (85.7%), one (7.1%), three (21.3%), seven (50%), and seven (50%) patients, respectively. There was no significant difference in CT findings between the IPA alone (n=5) and co-infection (n=9) groups and between survived (n=4) and non-survived (n=10) patients. The IPA-alone group more frequently had alcohol consumption (p=0.018), haemoptysis (p=0.023), and disseminated aspergillosis (p=0.027) than did the co-infection group. Non-survived patients tended to be older and have a history of recent hospitalisation. CONCLUSIONS IPA is a rare, life-threatening disease affecting SLE patients in the early course of disease with high disease activity requiring corticosteroid and/or immunosuppressive therapy. Dominant CT findings are characteristics of angio-invasive form with a high frequency of the halo sign and bilateral, multilobar, and upper-lobe involvement.
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Affiliation(s)
- T Suwatanapongched
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Y Visoottiviseth
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S P Watcharananan
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W Kanoksil
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - D Muntham
- Section for Mathematics, Faculty of Science and Technology, Rajamangala University of Technology, Phranakhon Si Ayutthaya Province, Thailand
| | - P Pornsuriyasak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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43
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Shi B, Xia Z, Tang W, Qin C, Cheng Y, Huang T, Li Y, Xu H. Rapid Diagnosis of IPA Relied on Calcofluor White Fluorescence Staining: Two Cases Report. J Trop Pediatr 2021; 67:6024572. [PMID: 33277907 DOI: 10.1093/tropej/fmaa115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Invasive pulmonary aspergillosis (IPA) is a serious infectious disease with high mortality. However, the rapid diagnosis of IPA remains difficult since the microbiological evidence is difficult to obtain or time-consuming. Thus, we attempted to rapidly diagnose two pediatric cases with respiratory failure due to IPA via bronchoalveolar lavage fluid with Calcofluor White fluorescence staining, which has rarely been used before.
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Affiliation(s)
- Buyun Shi
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
| | - Zhi Xia
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
| | - Chenguang Qin
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
| | - Ying Cheng
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
| | - Tao Huang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
| | - Yong Li
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
| | - Hui Xu
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), Wuhan City, Hubei Province 430070, China
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Mercier T, Dunbar A, Veldhuizen V, Holtappels M, Schauwvlieghe A, Maertens J, Rijnders B, Wauters J. Point of care aspergillus testing in intensive care patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:642. [PMID: 33168049 PMCID: PMC7652676 DOI: 10.1186/s13054-020-03367-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/29/2020] [Indexed: 01/05/2023]
Abstract
Background Invasive pulmonary aspergillosis (IPA) is an increasingly recognized complication in intensive care unit (ICU) patients, especially those with influenza, cirrhosis, chronic obstructive pulmonary disease, and other diseases. The diagnosis can be challenging, especially in the ICU, where clinical symptoms as well as imaging are mostly nonspecific. Recently, Aspergillus lateral flow tests were developed to decrease the time to diagnosis of IPA. Several studies have shown promising results in bronchoalveolar lavage fluid (BALf) from hematology patients. We therefore evaluated a new lateral flow test for IPA in ICU patients. Methods Using left-over BALf from adult ICU patients in two university hospitals, we studied the performance of the Aspergillus galactomannan lateral flow assay (LFA) by IMMY (Norman, OK, USA). Patients were classified according to the 2008 EORTC-MSG definitions, the AspICU criteria, and the modified AspICU criteria, which incorporate galactomannan results. These internationally recognized consensus definitions for the diagnosis of IPA incorporate patient characteristics, microbiology and radiology. The LFA was read out visually and with a digital reader by researchers blinded to the final clinical diagnosis and IPA classification. Results We included 178 patients, of which 55 were classified as cases (6 cases of proven and 26 cases of probable IPA according to the EORTC-MSG definitions, and an additional 23 cases according to the modified AspICU criteria). Depending on the definitions used, the sensitivity of the LFA was 0.88–0.94, the specificity was 0.81, and the area under the ROC curve 0.90–0.94, indicating good overall test performance. Conclusions In ICU patients, the LFA performed well on BALf and can be used as a rapid screening test while waiting for other microbiological results.
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Affiliation(s)
- Toine Mercier
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium. .,Department of Hematology, University Hospitals Leuven, Leuven, Belgium.
| | - Albert Dunbar
- Department of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent Veldhuizen
- Department of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michelle Holtappels
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Alexander Schauwvlieghe
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Hematology, University Hospitals Ghent, Ghent, Belgium
| | - Johan Maertens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Rijnders
- Department of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Wauters
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
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Stanford FA, Voigt K. Iron Assimilation during Emerging Infections Caused by Opportunistic Fungi with emphasis on Mucorales and the Development of Antifungal Resistance. Genes (Basel) 2020; 11:genes11111296. [PMID: 33143139 PMCID: PMC7693903 DOI: 10.3390/genes11111296] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
Iron is a key transition metal required by most microorganisms and is prominently utilised in the transfer of electrons during metabolic reactions. The acquisition of iron is essential and becomes a crucial pathogenic event for opportunistic fungi. Iron is not readily available in the natural environment as it exists in its insoluble ferric form, i.e., in oxides and hydroxides. During infection, the host iron is bound to proteins such as transferrin, ferritin, and haemoglobin. As such, access to iron is one of the major hurdles that fungal pathogens must overcome in an immunocompromised host. Thus, these opportunistic fungi utilise three major iron acquisition systems to overcome this limiting factor for growth and proliferation. To date, numerous iron acquisition pathways have been fully characterised, with key components of these systems having major roles in virulence. Most recently, proteins involved in these pathways have been linked to the development of antifungal resistance. Here, we provide a detailed review of our current knowledge of iron acquisition in opportunistic fungi, and the role iron may have on the development of resistance to antifungals with emphasis on species of the fungal basal lineage order Mucorales, the causative agents of mucormycosis.
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Affiliation(s)
- Felicia Adelina Stanford
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research, and Infection Biology–Hans Knöll Institute, Jena, Adolf-Reichwein-Straße 23, 07745 Jena, Germany;
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich-Schiller University Jena, Neugasse 25, 07743 Jena, Germany
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research, and Infection Biology–Hans Knöll Institute, Jena, Adolf-Reichwein-Straße 23, 07745 Jena, Germany;
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich-Schiller University Jena, Neugasse 25, 07743 Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology–Hans Knöll Institute, Jena Microbial Resource Collection Adolf-Reichwein-Straße 23, 07745 Jena, Germany
- Correspondence: ; Tel.: +49-3641-532-1395; Fax: +49-3641-532-2395
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Keng LT, Lee CF. Ultrasound-guided Transthoracic Needle Aspiration to Diagnose Invasive Pulmonary Aspergillosis. Am J Respir Crit Care Med 2020; 201:1451-1452. [PMID: 32078784 PMCID: PMC7258635 DOI: 10.1164/rccm.202001-0008le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Li-Ta Keng
- Nation Taiwan University Hospital Hsin-Chu BranchHsin-Chu, Taiwan
| | - Chien-Feng Lee
- Nation Taiwan University Hospital Hsin-Chu BranchHsin-Chu, Taiwan
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47
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Hepburn K, Kim D, Darbar A, Pollock C. Unusual cause of headache following renal transplantation. Nephrology (Carlton) 2020; 25:873-874. [PMID: 32666657 DOI: 10.1111/nep.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kirsten Hepburn
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Dana Kim
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Archie Darbar
- Department of Infectious Diseases, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Carol Pollock
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia
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48
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Hoshal SG, Timbang M, Harris BN, Darrow MA, Bewley AF. Endotracheal Tube Bridle Associated With Full-Thickness Facial Necrosis and Parotid Gland Mucormycosis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP18-NP20. [PMID: 32627585 DOI: 10.1177/0145561320936489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Steven G Hoshal
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Maryroz Timbang
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Brianna N Harris
- Department of Head and Neck Microvascular and Reconstructive Surgery, SENTA Clinic, San Diego, CA, USA
| | - Morgan A Darrow
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA
| | - Arnaud F Bewley
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
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49
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In Vitro Evaluation of Radiolabeled Amphotericin B for Molecular Imaging of Mold Infections. Antimicrob Agents Chemother 2020; 64:AAC.02377-19. [PMID: 32393491 DOI: 10.1128/aac.02377-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/02/2020] [Indexed: 12/17/2022] Open
Abstract
Invasive pulmonary aspergillosis and mucormycosis are life-threatening complications in immunocompromised patients. A rapid diagnosis followed by early antifungal treatment is essential for patient survival. Given the limited spectrum of biomarkers for invasive mold infections, recent studies have proposed the use of radiolabeled siderophores or antibodies as molecular probes to increase the specificity of radiological findings by nuclear imaging modalities. While holding enormous diagnostic potential, most of the currently available molecular probes are tailored to the detection of Aspergillus species, and their cost-intensive and sophisticated implementation restricts their accessibility at less specialized centers. In order to develop cost-efficient and broadly applicable tracers for pulmonary mold infections, this study established streamlined and high-yielding protocols to radiolabel amphotericin B (AMB) with the gamma emitter technetium-99m (99mTc-AMB) and the positron emitter gallium-68 (68Ga-AMB). The radiochemical purity of the resulting tracers consistently exceeded 99%, and both probes displayed excellent stability in human serum (>98% after 60 to 240 min at 37°C). The uptake kinetics by representative mold pathogens were assessed in an in vitro Transwell assay using infected endothelial cell layers. Both tracers accumulated intensively and specifically in Transwell inserts infected with Aspergillus fumigatus, Rhizopus arrhizus, and other clinically relevant mold pathogens compared with their accumulation in uninfected inserts and inserts infected with bacterial controls. Inoculum-dependent enrichment was confirmed by gamma counting and autoradiographic imaging. Taken together, this pilot in vitro study proposes 99mTc-AMB and 68Ga-AMB to be facile, stable, and specific probes, meriting further preclinical in vivo evaluation of radiolabeled amphotericin B for molecular imaging in invasive mycoses.
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Bassetti M, Giacobbe DR, Grecchi C, Rebuffi C, Zuccaro V, Scudeller L. Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, adult patients: A systematic review with qualitative evidence synthesis. J Infect 2020; 81:131-146. [PMID: 32330523 DOI: 10.1016/j.jinf.2020.03.065] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To summarize the available evidence on the diagnostic performance for invasive aspergillosis (IA) in non-hematological, non-solid organ transplantation critically ill patients of the following: (i) existing definitions of IA (developed either for classical immunocompromised populations or for non-immunocompromised critically ill patients); (ii) laboratory tests; (iii) radiology tests. METHODS A systematic review was performed by evaluating studies assessing the diagnostic performance for IA of a definition/s and/or laboratory/radiology test/s vs. a reference standard (histology) or a reference definition. RESULTS Sufficient data for evaluating the performance of existing definitions and laboratory tests for the diagnosis of IA in critically ill patients is available only for invasive pulmonary aspergillosis. Against histology/autopsy as reference, the AspICU definition showed a promising diagnostic performance but based on small samples and applicable only to patients with positive respiratory cultures. Studies on laboratory tests consistently indicated a better diagnostic performance of bronchoalveolar lavage fluid (BALF) galactomannan (GM) than serum GM, and a suboptimal specificity of BALF and serum (1,3)-β-D-glucan. CONCLUSIONS Evidence stemming from this systematic review will guide the discussion for defining invasive aspergillosis within the FUNDICU project. The project aims to develop a standard set of definitions for invasive fungal diseases in critically ill, adult patients.
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Affiliation(s)
- M Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132 Genoa, Italy.
| | - D R Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132 Genoa, Italy
| | - C Grecchi
- Infectious Diseases Unit, IRCCS San Matteo, Pavia, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | - C Rebuffi
- Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Zuccaro
- Infectious Diseases Unit, IRCCS San Matteo, Pavia, Italy
| | - L Scudeller
- Scientific Direction, Clinical Epidemiology and Biostatistics, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Foundation, Milan, Italy
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