Cardiothoracic surgical site phaeohyphomycosis caused by Bipolaris mould, multiple US states, 2008-2013: a clinical description

Dematiaceous fungal infections in solid organ transplantation: systematic review and bayesian meta-analysis

BACKGROUND

Dematiaceous fungi cause a number of infectious syndromes referred to as phaeohyphomycosis among both immunocompetent and immunocompromised hosts. We performed a systematic review to characterize these infections in solid organ transplant recipients (SOTR).

METHODS

We searched PubMed database (last searched 1/6/2022) for English-language reports on dematiaceous fungal infections in SOTR. Included reports needed individualized demographic, treatment, and outcome data; pediatric reports were excluded. A universally applicable bias assessment was performed on reports. Models for infection type and outcome were created using the Bayesian paradigm.

RESULTS

We included 149 reports on 201 cases of dematiaceous fungal infections in SOTR. The mean age was 54 years, 72% were men, and kidney recipients accounted for 61% of cases. Skin and soft tissue infection (SSTI) was the most common infectious syndrome (73%). Death from infection occurred in 7% of cases (14/201), with disseminated (32%) cases having the highest mortality. Our model for infection type predicted the relative probability of central nervous system infection to be highest in liver recipients. Across all transplant types, higher relative probabilities of disseminated and pulmonary infections occur in the early post-transplant period, and the predicted probabilities for these infection types decreased after 100 months post-transplantation.

DISCUSSION

We identified SSTI as the most common dematiaceous fungal infections in SOTR. Disseminated infections carried the worst prognosis. The evidence in this review is limited by the heterogeneity of included cases. No funding source was used, and this review's protocol was not registered. This article is protected by copyright. All rights reserved.

Adhesion of filamentous fungi isolated from drinking water under different process conditions

Filamentous fungi (ff) are consistently recognized as drinking water (DW) inhabitants, typically harboured in biofilms. Their sessile behaviour is still poorly understood. This study aimed the evaluation of the influence of several abiotic factors (substratum, hydrodynamic conditions and nutrient availability) on biofilm formation by Penicillium brevicompactum and P. expansum isolated from DW. Fungal adhesion was quantified on high density polyethylene (HDPE) and polyvinyl chloride (PVC) surfaces using synthetic tap water (STW) and R2A broth, under stagnant or agitated (25 and 150 rpm) conditions. Fungal spore numbers were assessed after staining with Calcofluor White MR2 and epifluorescence microscopy. The surface charge and physicochemical properties of spores were characterized for a mechanistic understanding on the adhesion process. The adhesion kinetics of spores was represented accurately by the Logistic model, in which adhesion increased with time until a maximum level attained before spore germination (8 h after incubation). In general, P. brevicompactum demonstrated to adhere in a higher extent than P. expansum (12 × 10⁴ spores/cm²vs 1.7 × 10⁴ spores/cm²). Moreover, fungal adhesion was potentiated under stagnation and using R2A broth. HDPE and PVC allowed spore adhesion at similar extents. Adhesion predictions based on the extended Derjaguin, Landau, Verwey and Overbeek (XDLVO) theory corroborated the experimental results, highlighting the role of physicochemical surface properties on the adhesion of spores. These results allowed to refine a model for ff biofilm formation. The overall results help to understand key aspects determining the presence of P. brevicompactum and P. expansum biofilms in DW, where stagnant conditions and the presence of nutrients should be avoided to prevent ff biofilm formation.

Subcutaneous phaeohyphomycosis caused by Amesia atrobrunnea in Kuwait

The recently described genus Amesia encompasses four species but only Amesia atrobrunnea (=Chaetomium atrobrunneum) is known to be pathogenic to humans. Here, we describe a case of subcutaneous phaeohyphomycosis in Kuwait in an apparently immunocompetent patient diagnosed by direct microscopy of the infected tissue and culture. The identity of A. atrobrunnea was established by typical morphological characteristics and by sequencing of internally transcribed spacer (ITS) region and D1/D2 domains of rDNA. To the best of our knowledge, this is the first report documenting etiologic role of this species in causing a locally invasive subcutaneous infection.

Catastrophic Prosthetic Valve Endocarditis Caused by Rare Black Fungi

Fungal infection of prosthetic heart valves is rare and can lead to severe complications including death. Dematiaceous mold, also known as "black fungi," are an extremely rare cause of endocarditis that usually affect immunocompromised hosts. The infection is usually chronic and can lead to heart failure and embolic complications. These fungi have limited antifungal treatment modalities. We present a rare case of prosthetic aortic valve, root, and graft infection in an immunocompetent host that revealed itself through renal, mesenteric, and cerebral embolic phenomenon. The patient underwent removal and replacement of the aortic graft followed by small bowel resection for mesenteric infarction. Patient had a successful postoperative course and underwent a long-term antifungal treatment with amphotericin B and voriconazole.

Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks

Several high-profile outbreaks have drawn attention to invasive fungal infections (IFIs) as an increasingly important public health problem. IFI outbreaks are caused by many different fungal pathogens and are associated with numerous settings and sources. In the community, IFI outbreaks often occur among people without predisposing medical conditions and are frequently precipitated by environmental disruption. Health-care-associated IFI outbreaks have been linked to suboptimal hospital environmental conditions, transmission via health-care workers' hands, contaminated medical products, and transplantation of infected organs. Outbreak investigations provide important insights into the epidemiology of IFIs, uncover risk factors for infection, and identify opportunities for preventing similar events in the future. Well recognised challenges with IFI outbreak recognition, response, and prevention include the need for improved rapid diagnostic methods, the absence of routine surveillance for most IFIs, adherence to infection control practices, and health-care provider awareness. Additionally, IFI outbreak investigations have revealed several emerging issues, including new populations at risk because of travel or relocation, occupation, or immunosuppression; fungal pathogens appearing in geographical areas in which they have not been previously recognised; and contaminated compounded medications. This report highlights notable IFI outbreaks in the past decade, with an emphasis on these emerging challenges in the USA.