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Teng Q, Ye X, Wang B, Zhang X, Tao Z, Yin X, Yang Q. Case report: Successful combination therapy with isavuconazole and amphotericin B in treatment of disseminated Candida tropicalis infection. Front Med (Lausanne) 2024; 11:1397539. [PMID: 38978781 PMCID: PMC11228301 DOI: 10.3389/fmed.2024.1397539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Disseminated candidiasis is a severe complication in patients with hematological malignancies who have undergone chemotherapy or hematopoietic stem cell transplantation. It has a high mortality rate. When disseminated candidiasis caused by Candida tropicalis involves either the brain or heart, the prognosis is extremely poor. Traditional methods such as cultures are limited in diagnosing disseminated candidiasis. We describe a case report of a 55-year-old man with acute myeloid leukemia who developed candidemia caused by Candida tropicalis after chemotherapy, which disseminated extensively to the heart, brain, skin, liver, spleen and kidneys. In this instance, the patient was rapidly diagnosed with candida infection by metagenomic next generation sequencing, and successfully treated with combination therapy of isavuconazole and amphotericin B. The patient continued with treatment of leukemia while simultaneously receiving antifungal therapy, and both leukemia and disseminated candidiasis were effectively controlled. This case report provides real-world experience for treatment of patients with leukemia complicated by disseminated candidiasis.
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Affiliation(s)
- Qibei Teng
- Department of Hematology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xueshi Ye
- Department of Hematology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bei Wang
- Department of Ultrasound in Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyue Zhang
- Department of Traditional Chinese Medicine, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhizhi Tao
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiufeng Yin
- Department of Hematology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Yang
- Department of Hematology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Jeantin L, Leclercq D, Tran S, Maillart E, Reina V, Fekkar A, Lanternier F, Marois C, Celier A. Longitudinally extensive posterolateral myelitis revealing invasive CNS aspergillosis in an immunocompetent patient. Mult Scler 2024; 30:755-758. [PMID: 38247156 DOI: 10.1177/13524585231221680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Fungal infections of the central nervous system usually affect immunocompromised patients. Primary Aspergillus myelitis has never been described. REPORT A 45-year-old immunocompetent male with subacute paraplegia was treated for inflammatory myelitis before clinical deterioration requiring mechanical ventilation. Purulent meningitis preceded the formation of a paraspinal nodule biopsied by neurosurgery. Histopathological analysis revealed the presence of fungal hyphae, and polymerase chain reaction was positive for Aspergillus fumigatus. No cause of immunodeficiency was identified in this patient. DISCUSSION Primary Aspergillus myelitis may be confused with inflammatory myelitis and should be considered even in the absence of apparent immunosuppression.
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Affiliation(s)
- Lina Jeantin
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Department of Neurology, Neuro-ICU, Paris, France
| | - Delphine Leclercq
- Department of Neuroradiology, Pitié-Salpétrière University Hospital, Paris, France
| | - Suzanne Tran
- Sorbonne Université, Groupe Hospitalier Universitaire Pitié-Salpêtrière, Department of Neuropathology, APHP, Paris, France/Paris Brain Institute-ICM, Inserm, CNRS, UMRS 1127, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Elisabeth Maillart
- Department of Neurology, Pitié-Salpétrière University Hospital, Paris, France
| | - Vincent Reina
- Department of Neurosurgery, Pitié-Salpétrière University Hospital, Paris, France
| | - Arnaud Fekkar
- AP-HP, Groupe Hospitalier La Pitié-Salpêtrière, Parasitologie Mycologie, Paris, France/Sorbonne Université, Inserm, CNRS, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, Paris, France
| | - Fanny Lanternier
- Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Paris, France/Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Department of Mycology, Paris, France
| | - Clémence Marois
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Department of Neurology, Neuro-ICU, Paris, France
| | - Adam Celier
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Department of Neurology, Neuro-ICU, Paris, France
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Kuenzli AB, Müller MD, Z`Graggen WJ, Walti LN, Martin Y, Lazarevic V, Schrenzel J, Oberli A. Case report: Chronic Candida albicans meningitis: a rare entity diagnosed by metagenomic next-generation sequencing. Front Cell Infect Microbiol 2024; 14:1322847. [PMID: 38707513 PMCID: PMC11066203 DOI: 10.3389/fcimb.2024.1322847] [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: 10/16/2023] [Accepted: 02/07/2024] [Indexed: 05/07/2024] Open
Abstract
The aetiology of chronic aseptic meningitis is difficult to establish. Candida meningitis in particular is often diagnosed late, as cerebrospinal fluid (CSF) work-up and imaging findings are nonspecific. A 35-year-old patient with chronic aseptic meningitis, for which repeated microbiological testing of CSF was unrevealing, was finally diagnosed with Candida albicans (C. albicans) meningitis with cauda equina involvement using metagenomic next-generation sequencing (mNGS). This report highlights the diagnostic challenges and the difficulties of treating shunt-associated fungal meningitis.
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Affiliation(s)
- Andrea B. Kuenzli
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Service d’Infectiologie, Department of Internal Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
| | - Mandy D. Müller
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner J. Z`Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura N. Walti
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yonas Martin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals (HUG) and University of Geneva, Geneva, Switzerland
| | - Jacques Schrenzel
- Genomic Research Laboratory, Geneva University Hospitals (HUG) and University of Geneva, Geneva, Switzerland
| | - Alexander Oberli
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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4
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Fletcher AM, Bhattacharyya S. Infectious Myelopathies. Continuum (Minneap Minn) 2024; 30:133-159. [PMID: 38330476 DOI: 10.1212/con.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Infectious myelopathy of any stage and etiology carries the potential for significant morbidity and mortality. This article details the clinical presentation, risk factors, and key diagnostic components of infectious myelopathies with the goal of improving the recognition of these disorders and guiding subsequent management. LATEST DEVELOPMENTS Despite our era of advanced multimodal imaging and laboratory diagnostic technology, a causative organism often remains unidentified in suspected infectious and parainfectious myelopathy cases. To improve diagnostic capability, newer technologies such as metagenomics are being harnessed to develop diagnostic assays with a greater breadth of data from each specimen and improvements in infection identification. Conventional assays have been optimized for improved sensitivity and specificity. ESSENTIAL POINTS Prompt recognition and treatment of infectious myelopathy decreases morbidity and mortality. The key diagnostic tools include serologies, CSF analysis, and imaging; however clinical presentation, epidemiologic risk factors, and history of recent illness are all vital to making the proper diagnosis because current laboratory and imaging modalities are often inconclusive. The cornerstone of recommended treatment is targeted antimicrobials with appropriate immune modulation, surgical intervention, supportive care, and interdisciplinary involvement, all of which further improve outcomes for patients with infectious myelopathy.
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5
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Walsh TJ, Zhang SX. Emerging Roles of (1→3)-β-D-Glucan in Cerebrospinal Fluid for Detection and Therapeutic Monitoring of Invasive Fungal Diseases of the Central Nervous System. Clin Infect Dis 2024; 78:11-14. [PMID: 37650506 DOI: 10.1093/cid/ciad520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Thomas J Walsh
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sean X Zhang
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bigot J, Leroy J, Chouaki T, Cholley L, Bigé N, Tabone MD, Brissot E, Thorez S, Maizel J, Dupont H, Sendid B, Hennequin C, Guitard J. ß-D-Glucan Assay in the Cerebrospinal Fluid for the Diagnosis of Non-cryptococcal Fungal Infection of the Central Nervous System: A Retrospective Multicentric Analysis and a Comprehensive Review of the Literature. Clin Infect Dis 2023; 77:711-720. [PMID: 37132362 DOI: 10.1093/cid/ciad274] [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: 11/08/2022] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Except for cryptococcosis, fungal infection of the central nervous system (FI-CNS) is a rare but severe complication. Clinical and radiological signs are non-specific, and the value of conventional mycological diagnosis is very low. This study aimed to assess the value of β1,3-D-glucan (BDG) detection in the cerebrospinal fluid (CSF) of non-neonatal non-cryptococcosis patients. METHODS Cases associated with BDG assay in the CSF performed in 3 French University Hospitals over 5 years were included. Clinical, radiological, and mycological results were used to classify the episodes as proven/highly probable, probable, excluded, and unclassified FI-CNS. Sensitivity and specificity were compared to that calculated from an exhaustive review of the literature. RESULTS In total, 228 episodes consisting of 4, 7, 177, and 40 proven/highly probable, probable, excluded, and unclassified FI-CNS, respectively, were analysed. The sensitivity of BDG assay in CSF to diagnose proven/highly probable/probable FI-CNS ranged from 72.7% [95% confidence interval {CI}: 43.4%‒90.2%] to 100% [95% CI: 51%‒100%] in our study and was 82% in the literature. For the first time, specificity could be calculated over a large panel of pertinent controls and was found at 81.8% [95% CI: 75.3%‒86.8%]. Bacterial neurologic infections were associated with several false positive results. CONCLUSIONS Despite its sub-optimal performance, BDG assay in the CSF should be added to the diagnostic armamentarium for FI-CNS.
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Affiliation(s)
- Jeanne Bigot
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Jordan Leroy
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Univ. Lille, Glycobiology in Fungal Pathogenesis & Clinical Applications, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Taieb Chouaki
- Mycology Laboratory, University Hospital of Amiens, Amiens, France
| | - Laurence Cholley
- Sorbonne Université, APHP, Hôpital Saint Antoine, Service de Radiologie Générale, Paris, France
| | - Naïke Bigé
- Sorbonne Université, APHP, Hôpital Saint Antoine, Service de Réanimation Médicale, Paris, France
- Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Marie-Dominique Tabone
- Département d'Hématologie et d'Oncologie Pédiatrique, Sorbonne Université, APHP, Hôpital Armand Trousseau, Paris, France
| | - Eolia Brissot
- Sorbonne Université, INSERM U938, APHP, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France
| | - Sophie Thorez
- Sorbonne Université, APHP, Hôpital St Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Julien Maizel
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Surgical ICU, University Hospital of Amiens Picardy, Amiens, France
- Université de Picardie Jules Verne, Unité de recherche 7518 SSPC, CHU Amiens Picardie, Service d'Anesthésie et de Réanimation Polyvalente, Amiens, France
| | - Boualem Sendid
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Univ. Lille, Glycobiology in Fungal Pathogenesis & Clinical Applications, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Christophe Hennequin
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Juliette Guitard
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
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7
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Soriano A, Honore PM, Puerta-Alcalde P, Garcia-Vidal C, Pagotto A, Gonçalves-Bradley DC, Verweij PE. Invasive candidiasis: current clinical challenges and unmet needs in adult populations. J Antimicrob Chemother 2023:7176280. [PMID: 37220664 DOI: 10.1093/jac/dkad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Invasive candidiasis (IC) is a serious infection caused by several Candida species, and the most common fungal disease in hospitals in high-income countries. Despite overall improvements in health systems and ICU care in the last few decades, as well as the development of different antifungals and microbiological techniques, mortality rates in IC have not substantially improved. The aim of this review is to summarize the main issues underlying the management of adults affected by IC, focusing on specific forms of the infection: IC developed by ICU patients, IC observed in haematological patients, breakthrough candidaemia, sanctuary site candidiasis, intra-abdominal infections and other challenging infections. Several key challenges need to be tackled to improve the clinical management and outcomes of IC patients. These include the lack of global epidemiological data for IC, the limitations of the diagnostic tests and risk scoring tools currently available, the absence of standardized effectiveness outcomes and long-term data for IC, the timing for the initiation of antifungal therapy and the limited recommendations on the optimal step-down therapy from echinocandins to azoles or the total duration of therapy. The availability of new compounds may overcome some of the challenges identified and increase the existing options for management of chronic Candida infections and ambulant patient treatments. However, early identification of patients that require antifungal therapy and treatment of sanctuary site infections remain a challenge and will require further innovations.
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Affiliation(s)
- Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Patrick M Honore
- CHU UCL Godinne Namur, UCL Louvain Medical School, Namur, Belgium
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, CIBERINF, University of Barcelona, Barcelona, Spain
| | | | | | - Paul E Verweij
- Radboudumc-CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
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8
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Imaging of Uncommon Bacterial, Rickettsia, Spirochete, and Fungal Infections. Neuroimaging Clin N Am 2023; 33:83-103. [DOI: 10.1016/j.nic.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Marra CM, Rohatgi S, Bloom AK, Kahle KT, Haj AK. Case 25-2022: A 25-Year-Old Woman with Headache and Blurred Vision. N Engl J Med 2022; 387:641-650. [PMID: 36070713 DOI: 10.1056/nejmcpc2201241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christina M Marra
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Saurabh Rohatgi
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Allyson K Bloom
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Kristopher T Kahle
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Amelia K Haj
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
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Jeantin L, Plu I, Amador MDM, Maillart E, Lanternier F, Pourcher V, Davy V. Pearls & Oy-Sters: Spinal Cord Candidiasis Linked to CARD9 Deficiency Masquerading as a Longitudinally Extensive Transverse Myelitis. Neurology 2022; 99:475-479. [PMID: 35794021 DOI: 10.1212/wnl.0000000000200992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lina Jeantin
- Department of neurology, Pitie Salpetriere University Hospital, AP-HP, 47-83 bd de l'hopital, 75013 Paris, France
| | - Isabelle Plu
- Department of pathology, Pitie Salpetriere University Hospital, AP-HP, 47-83 bd de l'hopital, 75013 Paris, France
| | - Maria Del Mar Amador
- Department of neurology, Pitie Salpetriere University Hospital, AP-HP, 47-83 bd de l'hopital, 75013 Paris, France
| | - Elisabeth Maillart
- Department of neurology, Pitie Salpetriere University Hospital, AP-HP, 47-83 bd de l'hopital, 75013 Paris, France
| | - Fanny Lanternier
- Universite de Paris, Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Imagine Institute, Paris, France.,Institut Pasteur, Centre National de Reference Mycoses invasives et Antifongiques, unité de mycologie moleculaire, CNRS, Paris, France
| | - Valérie Pourcher
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Service des Maladies infectieuses et tropicales, Paris, France
| | - Vincent Davy
- Department of neurology, Pitie Salpetriere University Hospital, AP-HP, 47-83 bd de l'hopital, 75013 Paris, France
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Forster J, Hoenigl M, Suerbaum S, Wagener J, Dichtl K. Serologic biomarkers in Candida and Aspergillus infections of the central nervous system: a comparison of galactomannan, mannan, and β-1,3-D-gucan testing from serum and cerebrospinal fluid. Mycoses 2022; 65:709-714. [PMID: 35506957 DOI: 10.1111/myc.13451] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of Aspergillus and Candida CNS infection, which are characterized by high mortality rates, is underestimated. This underdiagnosis presumably results from the limitations of available diagnostic tools and the need for invasive sampling. Little is known about the role of serologic biomarkers in the setting of CNS aspergillosis and candidiasis. PATIENTS, MATERIALS, METHODS Serum (19) and cerebrospinal fluid (CSF; 10) samples of 19 patients, whose CNS specimens yielded growth of Aspergillus or Candida, were analyzed for different biomarkers for fungal infection, i.e., galactomannan (GM), galactomannoprotein (GP), mannan, anti-mannan-antibodies, and β-1,3-D-glucan (BDG). Serum and CSF specimens of time-matched patients (two each for every case of fungal CNS infection) were included as controls. RESULTS GM, GP, and BDG seropositivity was found in one, two, and three of five cases of CNS aspergillosis. BDG and mannan / anti-mannan-antibody sensitivity in proven CNS candidiasis was 40 % and 20 %, respectively. Applying the serum cut off, sensitivity in CSF testing was 100 % for GM and BDG, and 50 % for mannans. While serum specificity for all assays ranged from 89 - 97 %, specificity for CSF BDG was only 70 %. No false positive GM results from CSF were obtained. CONCLUSION Sensitivity for diagnosing CNS aspergillosis and CNS candidiasis from serum is mediocre for all serological biomarkers. GM testing in CSF proved excellent performance. With a sensitivity of 100 % but a specificity of only 70 %, CSF BDG might be most useful when used in patients with a high pre-test probability.
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Affiliation(s)
- Johannes Forster
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, United States
| | - Sebastian Suerbaum
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany
| | - Johannes Wagener
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.,Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland.,Department of Clinical Microbiology, School of Medicine, Trinity College Dublin, The University of Dublin, St. James's Hospital Campus, Dublin, Ireland
| | - Karl Dichtl
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, LMU München, Munich, Germany.,Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
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12
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Central Nervous System Fungal Infections in Paediatric Patients. CURRENT FUNGAL INFECTION REPORTS 2022. [DOI: 10.1007/s12281-021-00427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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14
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Xu L, Zhao H, Zhou M, Lang G, Lou H. Single and Repeated Episodes of Candida Species Isolated From Cerebrospinal Fluid for Diagnosing Probable Candida meningitis. Front Microbiol 2021; 12:742931. [PMID: 34721340 PMCID: PMC8554295 DOI: 10.3389/fmicb.2021.742931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical relevance of single or repeated episodes of Candida spp. in cerebrospinal fluid (CSF) in adult patients is debatable. Methods: Forty-two patients with positive Candida episodes in CSF were enrolled in this retrospective study. Results: A total of 42.9% (18/42) were determined to have probable Candida meningitis (PCM). Neurosurgery [odds ratio (OR) (95% confidence interval), OR: 14.4 (1.6–126.1), P = 0.004], lumbar drainage [OR: 5.8 (1.5–23.3), P = 0.009], VP shunt [(OR: 5.6 (1.2–25.8), P = 0.020)], external ventricular drainage [OR: 4.7 (1.3–17.7), P = 0.018], CRP ≥ 10.0 mg/L [OR: 4.9 (1.3–18.1), P = 0.034], and postsurgical broad-spectrum antibiotics [OR: 9.5 (1.8–50.5), P = 0.004] were risk factors associated with PCM. A single CSF Candida episode for the diagnosis of PCM had 7.7% (0.4–37.9%) sensitivity and 20.7% (8.7–40.3%) specificity, whereas repeated episodes of Candida had 66.7% (41.2–85.6%) sensitivity and 95.8% (76.9–99.8%) specificity. No significant difference was found in radiological imaging or CSF profiles between PCM and non-PCM patients. A total of 37.5% (9/24) of patients without PCM received empirical antifungal treatment, and 88.9% (16/18) of patients with PCM received preemptive antifungal treatment. PCM patients had hospitalized mortality rates of 50.0% (9/18). The odds ratio of mortality was 23.0 (2.5–208.6) for PCM patients compared with non-PCM patients (P = 0.001). Conclusion: Both single and repeated positive CSF samples have low validity for the diagnosis of PCM, suggesting that novel strategies for diagnosis algorithms of PCM are urgently needed. Empirical antifungal treatment should be started immediately for suspicious patients with risk factors.
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Affiliation(s)
- Lijun Xu
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Handan Zhao
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Minghan Zhou
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Guanjing Lang
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Haiyan Lou
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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15
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Demir KK, Butler-Laporte G, Del Corpo O, Ekmekjian T, Sheppard DC, Lee TC, Cheng MP. Comparative effectiveness of amphotericin B, azoles and echinocandins in the treatment of candidemia and invasive candidiasis: A systematic review and network meta-analysis. Mycoses 2021; 64:1098-1110. [PMID: 33894072 DOI: 10.1111/myc.13290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND + OBJECTIVES: The echinocandins, amphotericin B preparations, voriconazole and fluconazole are approved for the treatment of invasive candidiasis, though it remains unclear which agent is most effective. In order to answer this question, we performed a systematic review and network meta-analysis of the randomised controlled trials (RCTs) which evaluated these agents in comparison. METHODS Four electronic databases were searched from database inception to 8 October 2020. RCTs comparing triazoles, echinocandins or amphotericin B for the treatment of invasive candidiasis or candidemia were included. Random effect Bayesian network meta-analysis methods were used to compare treatment outcomes. RESULTS Thirteen RCTs met inclusion criteria. Of the 3528 patients included from these trials, 1531 were randomised to receive an echinocandin, 944 to amphotericin B and 1053 to a triazole. For all forms of invasive candidiasis, echinocandins were associated with the highest rate of treatment success when compared to amphotericin B (OR 1.41, 95% CI 1.04-1.92) and the triazoles (OR 1.82, 95% CI 1.35-2.51). Rank probability analysis favoured echinocandins as the most effective choice 98% of the time. Overall survival did not significantly differ between groups. CONCLUSIONS Among patients with invasive candidiasis, echinocandins had the best clinical outcomes and should remain the first-line agents in the treatment of invasive candidiasis.
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Affiliation(s)
- Koray K Demir
- Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Guillaume Butler-Laporte
- Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,Division of Medical Microbiology, Department of Laboratory Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Olivier Del Corpo
- Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Centre, Montréal, QC, Canada
| | - Donald C Sheppard
- Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,Division of Medical Microbiology, Department of Laboratory Medicine, McGill University Health Centre, Montréal, QC, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, Montréal, QC, Canada
| | - Todd C Lee
- Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, Montréal, QC, Canada.,Clinical Practice Assessment Unit, McGill University Health Centre, Montréal, QC, Canada
| | - Matthew P Cheng
- Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.,Division of Medical Microbiology, Department of Laboratory Medicine, McGill University Health Centre, Montréal, QC, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity, Montréal, QC, Canada
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