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Chen X, Chen C, Wu M, Wang S, Jiang H, Li Z, Yu Y, Li B. Causal relationship between type 1 diabetes mellitus and mycoses: a Mendelian randomization study. Front Med (Lausanne) 2024; 11:1408297. [PMID: 38947239 PMCID: PMC11211379 DOI: 10.3389/fmed.2024.1408297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is frequently associated with various infections, including mycoses; however, the direct link between T1DM and fungal infections remains under-researched. This study utilizes a Mendelian randomization (MR) approach to investigate the potential causal relationship between T1DM and mycoses. Methods Genetic variants associated with T1DM were sourced from the European Bioinformatics Institute database, while those related to fungal infections such as candidiasis, pneumocystosis, and aspergillosis were obtained from the Finngen database, focusing on European populations. The primary analysis was conducted using the inverse variance weighted (IVW) method, with additional insight from Mendelian randomization Egger regression (MR-Egger). Extensive sensitivity analyses assessed the robustness, diversity, and potential horizontal pleiotropy of our findings. Multivariable Mendelian randomization (MVMR) was employed to adjust for confounders, using both MVMR-IVW and MVMR-Egger to evaluate heterogeneity and pleiotropy. Results Genetically, the odds of developing candidiasis increased by 5% in individuals with T1DM, as determined by the IVW method (OR = 1.05; 95% CI 1.02-1.07, p = 0.0001), with a Bonferroni-adjusted p-value of 0.008. Sensitivity analyses indicated no significant issues with heterogeneity or pleiotropy. Adjustments for confounders such as body mass index, glycated hemoglobin levels, and white blood cell counts further supported these findings (OR = 1.08; 95% CI:1.03-1.13, p = 0.0006). Additional adjustments for immune cell counts, including CD4 and CD8 T cells and natural killer cells, also demonstrated significant results (OR = 1.04; 95% CI: 1.02-1.06, p = 0.0002). No causal associations were found between T1DM and other fungal infections like aspergillosis or pneumocystosis. Conclusion This MR study suggests a genetic predisposition for increased susceptibility to candidiasis in individuals with T1DM. However, no causal links were established between T1DM and other mycoses, including aspergillosis and pneumocystosis.
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Affiliation(s)
- Xiaolan Chen
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chen Chen
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingyan Wu
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shanmei Wang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hongbin Jiang
- Department of Emergency, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhe Li
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing Li
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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2
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Shekhova E, Salazar F, Da Silva Dantas A, Chakraborty T, Wooding EL, White PL, Warris A. Age difference of patients with and without invasive aspergillosis: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:220. [PMID: 38373908 PMCID: PMC10875810 DOI: 10.1186/s12879-024-09109-2] [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: 07/19/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Invasive Aspergillosis (IA) is a life-threatening fungal disease with significant mortality rates. Timely diagnosis and treatment greatly enhance patient outcomes. This study aimed to explore the association between patient age and the development of IA, as well as the potential implications for risk stratification strategies. METHODS We searched National Center for Biotechnology Information (NCBI) databases for publications until October 2023 containing age characteristics of patients with and without IA. A random-effects model with the application of inverse-variance weighting was used to pool reported estimates from each study, and meta-regression and subgroup analyses were utilized to assess sources of heterogeneity. RESULTS A systematic review was conducted, resulting in the inclusion of 55 retrospective observational studies with a total of 13,983 patients. Meta-analysis revealed that, on average, patients with IA were approximately two and a half years older (95% Confidence Interval [CI] 1.84-3.31 years; I2 = 26.1%) than those without the disease (p < 0.0001). No significant moderators could explain the observed heterogeneity in age difference. However, subgroup analysis revealed that age differences were more pronounced within particular patient groups compared to others. For example, patients with and without IA who had primary severe lung infections exhibited a greater difference in mean age than other patient cohorts. CONCLUSIONS Further research, such as individual patient data meta-analysis, is necessary to better understand the potential relationship between increasing age and the likelihood of IA. Improved risk stratification strategies based on patient age could potentially enhance the early detection and treatment of IA, ultimately improving patient outcomes.
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Affiliation(s)
- Elena Shekhova
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK.
| | - Fabián Salazar
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | | | - Tanmoy Chakraborty
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | - Eva L Wooding
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, Cardiff University, UHW, Cardiff, UK
- Centre for Trials Research, Division of Infection and Immunity, Cardiff University, UHW, Cardiff, UK
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
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3
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Khan S, Bilal H, Shafiq M, Zhang D, Awais M, Chen C, Khan MN, Wang Q, Cai L, Islam R, Zeng Y. Distribution of Aspergillus species and risk factors for aspergillosis in mainland China: a systematic review. Ther Adv Infect Dis 2024; 11:20499361241252537. [PMID: 38835831 PMCID: PMC11149451 DOI: 10.1177/20499361241252537] [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: 09/25/2023] [Accepted: 04/17/2024] [Indexed: 06/06/2024] Open
Abstract
Background Aspergillus, a widespread fungus in the natural environment, poses a significant threat to human health by entering the human body via the airways and causing a disease called aspergillosis. This study comprehensively analyzed data on aspergillosis in published articles from mainland China to investigate the prevalence of Aspergillus, and risk factors, mortality rate, and underlying condition associated with aspergillosis. Methods Published articles were retrieved from Google Scholar, PubMed, and Science Direct online search engines. In the 101 analyzed studies, 3558 Aspergillus isolates were meticulously collected and classified. GraphPad Prism 8 was used to statistically examine the epidemiology and clinical characteristics of aspergillosis. Results Aspergillus fumigatus was prominently reported (n = 2679, 75.14%), followed by A. flavus (n = 437, 12.25%), A. niger (n = 219, 6.14%), and A. terreus (n = 119, 3.33%). Of a total of 9810 patients, 7513 probable cases accounted for the highest number, followed by confirmed cases (n = 1956) and possible cases (n = 341). In patients, cough emerged as the most common complaint (n = 1819, 18.54%), followed by asthma (n = 1029, 10.48%) and fever (1024, 10.44%). Of total studies, invasive pulmonary aspergillosis (IPA) was reported in 47 (45.53%) studies, exhibiting an increased prevalence in Beijing (n = 12, 25.53%), Guangdong (n = 7, 14.89%), and Shanghai (n = 6, 12.76%). Chronic pulmonary aspergillosis (CPA) was reported in 14 (13.86%) studies. Among the total of 14 studies, the occurrence of CPA was 5 (35.71%) in Beijing and 3 (21.42%) in Shanghai. Allergic bronchopulmonary aspergillosis (ABPA), was reported at a lower frequency (n = 8, 7.92%), Guangdong recorded a relatively high number (n = 3, 37.5%), followed by Beijing (n = 2, 25.0%), and Shanghai (n = 1, 12.5%). Percentage of death reported: IPA had the highest rate (n = 447, 68.87%), followed by CPA (n = 181, 27.88%) and ABPA (n = 14, 2.15%). Among the aspergillosis patients, 6220 had underlying conditions, including chronic lung disease (n = 3765, 60.53%), previous tuberculosis (n = 416, 6.68%), and organ transplant or organ failure (n = 648, 10.41%). Aspergillosis was also found in patients using corticosteroid therapy (n = 622, 10.0%). Conclusion This review sheds light on the prevalence patterns of Aspergillus species, risk factors of aspergillosis, and gaps in surveillance that could be helpful for the control and treatment of aspergillosis and guide the researchers in future studies. Registration This systematic review was prospectively registered on PROSPERO: Registration ID CRD42023476870.
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Affiliation(s)
- Sabir Khan
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hazrat Bilal
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Muhammad Shafiq
- Department of Pharmacology, Shantou University Medical College, Shantou, China
| | - Dongxing Zhang
- Department of Dermatology, Meizhou Dongshan Hospital, Meizhou, Guangdong, China
- Department of Dermatology, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Muhammad Awais
- Department of Environmental Science, Kunming University of Science and Technology, Yunnan, China
| | - Canhua Chen
- Clinical Laboratory, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Muhammad Nadeem Khan
- Faculty of Biological Sciences, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Qian Wang
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Medical-Surgical and Experimental Sciences, University of Sassari - Neurology Unit, Azienza Ospedaliera Universitaria (AOU) Sassari, Sassari, Italy
| | - Lin Cai
- Department of Dermatology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Rehmat Islam
- Key Laboratory of Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | - Yuebin Zeng
- Department of Dermatology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610021, China
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4
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Han G, Xu Q, Lv Q, Li X, Shi X. Pharmacoeconomic evaluation of isavuconazole, posaconazole, and voriconazole for the treatment of invasive mold diseases in hematological patients: initial therapy prior to pathogen differential diagnosis in China. Front Public Health 2023; 11:1292162. [PMID: 38179563 PMCID: PMC10766362 DOI: 10.3389/fpubh.2023.1292162] [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: 09/11/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background Invasive mold diseases (IMD) is associated with high mortality and a substantial economic burden. For high-risk patients, fever drive or diagnostic drive therapy is usually initiated prior to the differential diagnosis of the pathogen. This study evaluated the cost-effectiveness of isavuconazole, posaconazole, vs. voriconazole in the treatment of IMD from the perspective of the Chinese healthcare system, informing healthcare decision-making and resource allocation. Methods A decision analytic model was constructed using TreeAge Pro 2011 software to evaluate the cost-effectiveness of the entire disease course. We assumed that the prevalence of mucormycosis in the patients entering the model was 7.8%. Efficacy, cost, adverse events, and other data included in the model were mainly derived from clinical studies, published literature, and publicly available databases. The primary outcomes of the model output were total cost, quality-adjusted life years (QALYs), life years (Lys), and incremental cost-effectiveness ratio (ICER). The willing-to-pay (WTP) threshold was defined as one to three times China's GDP per capita in 2022. One-way sensitivity analysis and probability sensitivity analysis were used to determine the robustness of the model. At the same time, the cost-effectiveness of three triazole antifungal agents under a broader range of mucormycosis prevalence, when voriconazole was covered by medical insurance reimbursement, and after the price reduction of posaconazole was discussed. Results Compared with voriconazole, isavuconazole provided an additional 0.38 Lys (9.29 vs. 8.91 LYs) and 0.31 QALYs (7.62 vs. 7.31 QALYs); ICER was $15,702.46/QALY, well-below the WTP threshold ($38,223/QALY). However, posaconazole did not provide a significant economic advantage over voriconazole (9.40 vs. 9.36 Lys; 7.71 vs. 7.68 QALYs; ICER $64,466.57/QALY). One-way sensitivity analysis found that ICER was highly sensitive to the mortality of patients with invasive aspergillus infection. In the probabilistic sensitivity analysis, when the WTP threshold was $38,223/QALY, the probability of isavuconazole being cost-effective was 72.9%. The scenario analysis results indicated that posaconazole would become cost-effective when the price was reduced by 15% or the prevalence of mucormycosis was 14%. Conclusions Isavuconazole represents a cost-effective initial option for treating IMD in high-risk hematological patients prior to the differential diagnosis of pathogens. It will also be economical when a 15% reduction in posaconazole cost is achieved.
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Affiliation(s)
- Guangxin Han
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Qing Xu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoping Shi
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
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Casutt A, Lamoth F, Lortholary O, Prior JO, Tonglet A, Manuel O, Bergeron A, Beigelman-Aubry C. Atypical imaging patterns during lung invasive mould diseases: lessons for clinicians. Eur Respir Rev 2023; 32:230086. [PMID: 37758271 PMCID: PMC10523149 DOI: 10.1183/16000617.0086-2023] [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] [Received: 04/29/2023] [Accepted: 07/13/2023] [Indexed: 09/30/2023] Open
Abstract
Imaging of pulmonary invasive mould diseases (IMDs), which represents a cornerstone in their work-up, is mainly based on computed tomography (CT). The purpose of this review is to discuss their CT features, mainly those related to aspergillosis and mucormycosis. We will especially focus on atypical radiological presentations that are increasingly observed among non-neutropenic emerging populations of patients at risk, such as those receiving novel anticancer therapies or those in the intensive care unit. We will also discuss the interest of other available imaging techniques, mainly positron emission tomography/CT, that may play a role in the diagnosis as well as evaluation of disease extent and follow-up. We will show that any new airway-centred abnormality or caveated lesion should evoke IMDs in mildly immunocompromised hosts. Limitations in their recognition may be due to potential underlying abnormalities that increase the complexity of interpretation of lung imaging, as well as the non-specificity of imaging features. In this way, the differentials of all morphological/metabolic aspects must be kept in mind for the optimal management of patients, as well as the benefit of evaluation of the vascular status.
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Affiliation(s)
- Alessio Casutt
- Division of Pulmonology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Division of Pulmonology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Olivier Lortholary
- University Paris Cité, Necker Enfants Malades University Hospital, AP-HP, IHU Imagine, Paris, France
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Paris, France
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andrea Tonglet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anne Bergeron
- Department of Pulmonology, Geneva University Hospital, University of Geneva, Geneva, Switzerland
- A. Bergeron and C. Beigelman-Aubry contributed equally to this work
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- A. Bergeron and C. Beigelman-Aubry contributed equally to this work
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6
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Ahmed SA, Ismail M, Albirair M, Nail AMA, Denning DW. Fungal infections in Sudan: An underestimated health problem. PLoS Negl Trop Dis 2023; 17:e0011464. [PMID: 37656764 PMCID: PMC10501601 DOI: 10.1371/journal.pntd.0011464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/14/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.
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Affiliation(s)
- Sarah A. Ahmed
- Center of Expertise in Mycology Radboudumc / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Mawahib Ismail
- Mycology Reference laboratory, faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed Albirair
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington State, United States of America
| | - Abdelsalam Mohamed Ahmed Nail
- Tropical Diseases Teaching Hospital, Khartoum, Sudan
- Department of Internal Medicine, Faculty of Medicine and Health Sciences (OIU), Khartoum, Sudan
| | - David W. Denning
- Manchester Fungal Infection Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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7
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Duong TN, Le M, Beardsley J, Denning DW, Le N, Nguyen BT. Updated estimation of the burden of fungal disease in Vietnam. Mycoses 2023; 66:346-353. [PMID: 36564981 PMCID: PMC10953305 DOI: 10.1111/myc.13559] [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: 08/12/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Anecdotally, the burden of fungal diseases in Vietnam is rapidly rising, but there has been no updated estimate on this issue since a previous report in 2015. OBJECTIVES In this study, we aimed at estimating the incidence and prevalence of serious fungal infections for the year 2020. METHODS We made estimates with a previously described methodology, using reports on the incidence and prevalence of various established risk factors for fungal infections from local, regional or global sources. RESULTS We estimated 2,389,661 cases of serious fungal infection occurred in Vietnam in 2020. The most common condition was recurrent vaginal candidiasis (4047/100,000 women annually). Among people living with HIV, we estimated 451 cases of cryptococcal meningitis, 1030 of pneumocystis pneumonia, 166 of histoplasmosis and 1612 of talaromycosis annually. Candidaemia incidence was estimated at 12/100,000 population each year. Owing to its high burden of tuberculosis and respiratory diseases, Vietnam had high rates of severe infections caused by Aspergillus species. Incidence of invasive aspergillosis is 24/100,000 population, allergic bronchopulmonary aspergillosis 78/100,000 and severe asthma with fungal sensitisation 102/100,000. Five-year period prevalence of chronic pulmonary aspergillosis is 120/100,000 population /5-year period. Mucormycosis, fungal keratitis and tinea capitis were estimated at 192, 14,431 and 201 episodes each year, respectively. CONCLUSIONS The number of patients with mycoses in Vietnam is likely underestimated due to a lack of local data and limited diagnostic capacity, but at least 2.5% of the population might have some form of serious fungal disease.
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Affiliation(s)
- Tra‐My N. Duong
- Sydney Infectious Diseases InstituteThe University of SydneySydneyNew South WalesAustralia
- Woolcock Institute of Medical ResearchHanoiVietnam
| | - Minh‐Hang Le
- Sydney Infectious Diseases InstituteThe University of SydneySydneyNew South WalesAustralia
- Woolcock Institute of Medical ResearchHanoiVietnam
| | - Justin Beardsley
- Sydney Infectious Diseases InstituteThe University of SydneySydneyNew South WalesAustralia
- Westmead Institute for Medical ResearchWestmeadNew South WalesAustralia
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and HealthUniversity of Manchester and Manchester Academic Health Science CentreManchesterUK
- Global Action for Fungal InfectionsManchesterSwitzerland
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Ashby T, Green K, Burcher KM, Louis M. Role of COPD in a case of fatal Aspergillus niger tracheobronchitis. BMJ Case Rep 2023; 16:e251807. [PMID: 36948520 PMCID: PMC10039985 DOI: 10.1136/bcr-2022-251807] [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: 03/24/2023] Open
Abstract
A man with chronic obstructive pulmonary disease (COPD) in his mid-60s was admitted for respiratory failure due to multifocal, necrotising pneumonia. Despite initial improvement with antimicrobial therapy, the patient developed hemoptysis and progressive infiltrates. Subsequent fungal cultures from his bronchoalveolar lavage were positive for Aspergillus niger and treatment with voriconazole was added for suspected invasive pulmonary aspergillosis (IPA). A repeat bronchoscopy revealed cobblestone lesions with mucosal friability throughout the lower trachea and bilateral mainstem bronchi. Endobronchial biopsy showed septated hyphae confirming the diagnosis of IPA. Despite appropriate therapy, the patient declined further and passed away on hospital day 11. Invasive infections with A. niger are infrequent, with a paucity of data on clinical course and outcomes. Our case adds to the current body of literature regarding the potential virulence of this species in patients with COPD.
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Affiliation(s)
- Tracy Ashby
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville, FL, USA
| | - Kevin Green
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville, FL, USA
| | - Kimberly Marie Burcher
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Mariam Louis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville, FL, USA
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9
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Otu A, Kosmidis C, Mathioudakis AG, Ibe C, Denning DW. The clinical spectrum of aspergillosis in chronic obstructive pulmonary disease. Infection 2023:10.1007/s15010-022-01960-2. [PMID: 36662439 PMCID: PMC9857914 DOI: 10.1007/s15010-022-01960-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/15/2022] [Indexed: 01/21/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. In this review, we present the clinical spectrum and pathogenesis of syndromes caused by Aspergillus in COPD namely invasive aspergillosis (IA), community-acquired Aspergillus pneumonia, chronic pulmonary Aspergillosis and Aspergillus sensitisation. Some of these entities are clearly linked to COPD, while others may coexist, but are less clearly liked directly to COPD. We discuss current uncertainties as these pertain to IA in COPD cohorts and explore areas for future research in this field.
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Affiliation(s)
- Akaninyene Otu
- grid.418161.b0000 0001 0097 2705Department of Microbiology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX UK
| | - Chris Kosmidis
- grid.5379.80000000121662407Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M23 9LT UK
| | - Alexander G. Mathioudakis
- grid.5379.80000000121662407Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK ,grid.498924.a0000 0004 0430 9101North West Lung Centre, Wythenshawe Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Chibuike Ibe
- grid.442675.60000 0000 9756 5366Department of Microbiology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria
| | - David W. Denning
- grid.5379.80000000121662407Manchester Fungal Infection Group, University of Manchester, Manchester, UK
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10
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Ray A, Aayilliath K A, Banerjee S, Chakrabarti A, Denning DW. Burden of Serious Fungal Infections in India. Open Forum Infect Dis 2022; 9:ofac603. [PMID: 36589484 PMCID: PMC9792086 DOI: 10.1093/ofid/ofac603] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/08/2022] [Indexed: 12/27/2022] Open
Abstract
Background Fungal disease is frequent in India, but its incidence and prevalence are unclear. This review aims at defining the frequency or burden of various fungal infections in India. Methods A systematic review of the literature on the PubMed, Embase, and Web of Science (WOS) databases was conducted using appropriate search strings. Deterministic modeling determined annual incidence and prevalence estimates for multiple life- and sight-threatening infections with significant morbidity. Results Literature searches yielded >2900 papers; 434 papers with incidence/prevalence/proportion data were analyzed. An estimated 57 251 328 of the 1 393 400 000 people in India (4.1%) suffer from a serious fungal disease. The prevalence (in millions) of recurrent vulvovaginal candidiasis is 24.3, allergic bronchopulmonary aspergillosis is 2.0, tinea capitis in school-age children is 25, severe asthma with fungal sensitization is 1.36, chronic pulmonary aspergillosis is 1.74, and chronic fungal rhinosinusitis is 1.52. The annual incidence rates of Pneumocystis pneumonia (58 400), invasive aspergillosis (250 900), mucormycosis (195 000), esophageal candidiasis in HIV (266 600), candidemia (188 000), fungal keratitis (1 017 100), and cryptococcal meningitis (11 500) were also determined. Histoplasmosis, talaromycosis, mycetoma, and chromoblastomycosis were less frequent. Conclusions India's fungal burden is high and underappreciated in clinical practice.
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Affiliation(s)
- Animesh Ray
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - David W Denning
- Correspondence: David W. Denning FRCP, FRCPath, FMedSci, Professor of Infectious Diseases in Global Health, Manchester Fungal Infection Group, CTF building, Grafton Street, Manchester M13 9NT, United Kingdom ()
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11
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Li C, Sun L, Liu Y, Zhou H, Chen J, She M, Wang Y. Diagnostic value of bronchoalveolar lavage fluid galactomannan assay for invasive pulmonary aspergillosis in adults: A meta-analysis. J Clin Pharm Ther 2022; 47:1913-1922. [PMID: 36324286 DOI: 10.1111/jcpt.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/31/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE To analyse the diagnostic accuracy of bronchoalveolar lavage fluid galactomannan (BALF-GM) assay for invasive pulmonary aspergillosis (IPA) in adults to determine the optimal diagnostic cut-off by meta-analysis. METHODS PubMed, Embase, Web of Science, Cochrane Library, China national knowledge infrastructure (CNKI), and China Wanfang databases were searched to collect relevant studies on the diagnostic value of BALF-GM for IPA from inception to March 2022. The summary receiver operating characteristic (SROC) curve was drawn to determine the optimal diagnostic cut-off. RESULTS AND DISCUSSION Nineteen articles (56 data sets) were included. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.79 (95% CI: 0.72-0.84), 0.92 (95% CI: 0.88-0.94), 9.25 (95% CI: 6.84-12.52), 0.23 (95% CI: 0.18-0.30), 39.44 (95% CI: 29.55-52.65), and 0.92 (95% CI: 0.90-0.94), respectively. The area under the curves (AUCs) were 0.92, 0.86, 0.93, 0.89, 0.88, and 0.94 when the cut-off values were 0.5, 0.8, 1.0, 1.5, 2.0, and 3.0, respectively. Sixteen studies were included in the combined analysis when the cut-off value was 0.5. The results showed that the pooled sensitivity, specificity, PLR, NLR and DOR of BALF-GM (cut-off 0.5) for the diagnosis of IPA were 0.89 (95% CI: 0.83-0.93), 0.79 (95% CI: 0.71-0.86), 4.33 (95% CI: 3.04-6.16), 0.14 (95% CI: 0.09-0.22), and 31.51 (95% CI: 17.43-56.98). The AUC was 0.92 (95% CI: 0.89-0.94). WHAT IS NEW AND CONCLUSIONS BALF-GM has excellent diagnostic accuracy for adult IPA, which can be diagnosed early and treated early to reduce the mortality rate. Considering the sensitivity, specificity, PLR and NLR, the recommended diagnostic cut-off of BALF-GM for adult IPA is 0.5.
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Affiliation(s)
- Chang Li
- Department of Pulmonary and Critical Care Medicine, Chongzhou People's Hospital, Chengdu, Sichuan, China
| | - Lin Sun
- Department of Pulmonary and Critical Care Medicine, Chongzhou People's Hospital, Chengdu, Sichuan, China
| | - Yin Liu
- Department of Pulmonary and Critical Care Medicine, Chongzhou People's Hospital, Chengdu, Sichuan, China
| | - Hongbing Zhou
- Department of Pulmonary and Critical Care Medicine, Chongzhou People's Hospital, Chengdu, Sichuan, China
| | - Jianguo Chen
- Department of Pulmonary and Critical Care Medicine, Chongzhou People's Hospital, Chengdu, Sichuan, China
| | - Min She
- Department of Pulmonary and Critical Care Medicine, Chongzhou People's Hospital, Chengdu, Sichuan, China
| | - Yong Wang
- Department of Pulmonary and Critical Care Medicine, Chongzhou People's Hospital, Chengdu, Sichuan, China
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12
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Claverias L, Daniel X, Martín-Loeches I, Vidal-Cortez P, Gómez-Bertomeu F, Trefler S, Zaragoza R, Borges-Sa M, Reyes LF, Quindós G, Peman J, Bodí M, Díaz E, Sarvisé C, Pico E, Papiol E, Solé-Violan J, Marín-Corral J, Guardiola JJ, Rodríguez A. Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia. Med Intensiva 2022; 46:426-435. [PMID: 35868719 DOI: 10.1016/j.medine.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/05/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the incidence and impact of Aspergillus spp. isolation (AI) on ICU mortality in critically ill patients with severe influenza pneumonia during the first 24h of admission. DESIGN Secondary analysis of an observational and prospective cohort study. SETTING ICUs voluntary participating in the Spanish severe Influenza pneumonia registry, between June 2009 and June 2019. PATIENTS Consecutive patients admitted to the ICU with diagnosis of severe influenza pneumonia, confirmed by real-time polymerase chain reaction. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Incidence of AI in respiratory samples. Demographic variables, comorbidities, need for mechanical ventilation and the presence of shock according at admission. Acute Physiology and Chronic Health Evaluation II (APACHE II) scale calculated on ICU admission. RESULTS 3702 patients were analyzed in this study. AI incidence was 1.13% (n=42). Hematological malignancies (OR 4.39, 95% CI 1.92-10.04); HIV (OR 3.83, 95% CI 1.08-13.63), and other immunosuppression situations (OR 4.87, 95% CI 1.99-11.87) were factors independently associated with the presence of Aspergillus spp. The automatic CHAID decision tree showed that hematologic disease with an incidence of 3.3% was the most closely AI related variable. Hematological disease (OR 2.62 95% CI 1.95-3.51), immunosuppression (OR 2.05 95% CI 1.46-2.88) and AI (OR 3.24, 95% CI 1.60-6.53) were variables independently associated with ICU mortality. CONCLUSIONS Empirical antifungal treatment in our population may only be justified in immunocompromised patients. In moderate-high risk cases, active search for Aspergillus spp. should be implemented.
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Affiliation(s)
- L Claverias
- Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain; Institut d'Investigació Sanitaria Pere Virgili, Reus, Spain.
| | - X Daniel
- Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - I Martín-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St James's University Hospital, Dublin, Ireland
| | - P Vidal-Cortez
- Critical Care Department, Complejo Hospitalario Universitario Ourense, Spain
| | - F Gómez-Bertomeu
- Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - S Trefler
- Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain; Institut d'Investigació Sanitaria Pere Virgili, Reus, Spain
| | - R Zaragoza
- Critical Care Department, Hospital Dr Peset, Valencia, Spain
| | - M Borges-Sa
- Multidisciplinar Sepsis Unit, Critical Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - L F Reyes
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia; Critical Care Department, Clinica Universidad de La Sabana, Chía, Colombia
| | - G Quindós
- Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - J Peman
- Institute of Sanitary Investigation La Fe, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - M Bodí
- Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII Tarragona, Spain
| | - E Díaz
- Critical Care Department, Hospital Parc Taulí, Sabadell, Spain
| | - C Sarvisé
- Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - E Pico
- Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - E Papiol
- Critical Care Department, Hospital Valle Hebrón, Barcelona, Spain
| | - J Solé-Violan
- Critical Care Department Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - J Marín-Corral
- Critical Care Department, Hospital del Mar, Barcelona, Spain
| | - J J Guardiola
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, USA
| | - A Rodríguez
- Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII Tarragona, Spain
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13
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Xiao W, Du L, Cai L, Miao T, Mao B, Wen F, Gibson PG, Gong D, Zeng Y, Kang M, Du X, Qu J, Wang Y, Liu X, Feng R, Fu J. Existing tests vs. novel non-invasive assays for detection of invasive aspergillosis in patients with respiratory diseases. Chin Med J (Engl) 2022; 135:00029330-990000000-00075. [PMID: 35861304 PMCID: PMC9532040 DOI: 10.1097/cm9.0000000000002050] [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: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays. METHODS Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed. RESULTS The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) ( χ2 = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) ( χ2 = 24.65, P < 0.001), and fungal culture (33% [84/253]) ( χ2 = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher's exact P = 1.000) to and slightly lower specificity (87% [77/89]) ( χ2 = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) ( P = 0.734). Sputum LFD had similar specificity (91% [81/89]) ( χ2 = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) ( χ2 = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) ( χ2 = 6.95, P = 0.008), BDG ( χ2 = 10.43, P = 0.001), and fungal culture ( χ2 = 12.70, P < 0.001). CONCLUSIONS Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.
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Affiliation(s)
- Wei Xiao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Divison of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
| | - Longyi Du
- West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, China
| | - Linli Cai
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Tiwei Miao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Bing Mao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Fuqiang Wen
- Divison of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Peter Gerard Gibson
- Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW 2305, Australia
- Priority Research Centre for Asthma and Respiratory Diseases, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Deying Gong
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
| | - Yan Zeng
- Department of Pneumology, Pidu District of Traditional Chinese Medicine, The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, China
| | - Mei Kang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Xinmiao Du
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Junyan Qu
- Center of Infectious Disease, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan Wang
- Research Core Facility, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
| | - Xuemei Liu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Ruizhi Feng
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Juanjuan Fu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Divison of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan 610093, China
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González-García P, Alonso-Sardón M, Rodríguez-Alonso B, Almeida H, Romero-Alegría Á, Vega-Rodríguez VJ, López-Bernús A, Muñoz-Bellido JL, Muro A, Pardo-Lledías J, Belhassen-García M. How Has the Aspergillosis Case Fatality Rate Changed over the Last Two Decades in Spain? J Fungi (Basel) 2022; 8:jof8060576. [PMID: 35736059 PMCID: PMC9225319 DOI: 10.3390/jof8060576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Aspergillus produces high morbidity and mortality, especially in at-risk populations. In Spain, the evolution of mortality in recent years due to this fungus is not well established. The aim of this study was to estimate the case fatality rate of aspergillosis in inpatients from 1997 to 2017 in Spain. (2) Methodology: A retrospective descriptive study was conducted with records of inpatients admitted to the National Health System with a diagnosis of aspergillosis. (3) Principal findings: Of 32,960 aspergillosis inpatients, 24.5% of deaths were registered, and 71% of the patients who died were men. The percentage of deaths increased progressively with age. The case fatality rate progressively decreased over the period, from 25.4 and 27.8% in 1997–1998 to values of 20.6 and 20.8% in 2016 and 2017. Influenza and pneumonia occurrence/association significantly increased case fatality rates in all cases. (4) Conclusions: Our study shows that lethality significantly decreased in the last two decades despite the increase in cases. This highlights the fact that patients with solid and/or hematological cancer do not have a much higher mortality rate than the group of patients with pneumonia or influenza alone, these two factors being the ones that cause the highest CFRs. We also need studies that analyze the causes of mortality to decrease it and studies that evaluate the impact of COVID-19.
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Affiliation(s)
- Pablo González-García
- Servicio de Medicina Interna, Hospital Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, 39008 Santander, Spain; (P.G.-G.); (J.P.-L.)
| | - Montserrat Alonso-Sardón
- Área de Medicina Preventiva, Epidemiología y Salud Pública, IBSAL, CIETUS, Universidad de Salamanca, 37007 Salamanca, Spain;
| | - Beatriz Rodríguez-Alonso
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas CAUSA, IBSAL, CIETUS, 37007 Salamanca, Spain; (B.R.-A.); (Á.R.-A.); (A.L.-B.)
| | - Hugo Almeida
- Serviçio de Medicina Interna, Unidade Local de Saúde de Guarda, 6300 Guarda, Portugal;
| | - Ángela Romero-Alegría
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas CAUSA, IBSAL, CIETUS, 37007 Salamanca, Spain; (B.R.-A.); (Á.R.-A.); (A.L.-B.)
| | | | - Amparo López-Bernús
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas CAUSA, IBSAL, CIETUS, 37007 Salamanca, Spain; (B.R.-A.); (Á.R.-A.); (A.L.-B.)
| | - Juan Luis Muñoz-Bellido
- Servicio de Microbiología y Parasitología, CAUSA, CIETUS, IBSAL, Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, CSIC, 37007 Salamanca, Spain;
| | - Antonio Muro
- Infectious and Tropical Diseases Group (e-INTRO), IBSAL-CIETUS, Faculty of Pharmacy, University of Salamanca, 37007 Salamanca, Spain;
| | - Javier Pardo-Lledías
- Servicio de Medicina Interna, Hospital Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, 39008 Santander, Spain; (P.G.-G.); (J.P.-L.)
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas CAUSA, IBSAL, CIETUS, 37007 Salamanca, Spain; (B.R.-A.); (Á.R.-A.); (A.L.-B.)
- Correspondence: ; Tel.: +34-923291100 (ext. 306)
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15
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Inoue K, Muramatsu K, Nishimura T, Fujino Y, Matsuda S, Fushimi K, Kamochi M. Association between early diagnosis of and inpatient mortality from invasive pulmonary aspergillosis among patients without immunocompromised host factors: a nationwide observational study. Int J Infect Dis 2022; 122:279-284. [PMID: 35643307 DOI: 10.1016/j.ijid.2022.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The incidence of invasive pulmonary aspergillosis (IPA) among patients without immunocompromised host factors (ICHF) has been described extensively. However, its diagnosis remains challenging. To date, no study has statistically confirmed the efficacy of early IPA diagnosis in patients without ICHF. METHODS We conducted a cross-sectional study on mortality from IPA among patients without ICHF, using the Japanese Diagnosis Procedure Combination National Inpatient Database (April 2014-March 2018). The early diagnosis group was defined according to antifungal therapy initiation within 7 days of hospital admission. The delayed diagnosis group was defined according to antifungal therapy initiation between 8 and 28 days of the hospitalization. Associations were estimated using multivariate logistic regression. RESULTS A total of 423 patients were registered (early diagnosis group, n = 262, 62%). The early diagnosis group had a lower mortality rate (30%) than the delayed diagnosis group (42%). The early diagnosis group that was treated with voriconazole was associated with lower odds of mortality (odds ratio 0.55, 95% confidence interval 0.31-0.99, P = 0.047). An age of ≥65 years and mechanical ventilation were associated with a higher mortality rate. CONCLUSION Early diagnosis along with optimal antifungal treatment are crucial for achieving favorable outcomes among patients with IPA without ICHF.
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Affiliation(s)
- Katsuhiro Inoue
- Intensive Care Unit, Hospital of University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan.
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi,, 8078555, Japan
| | - Takehiro Nishimura
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi,, 8078555, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of industrial Ecological Sciences, University of Occupational and Environmental Health, 11 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi,, 8078555, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1 5-45 Yushima, Bunkyo-ku, Tokyo, 1138510, Japan
| | - Masayuki Kamochi
- Intensive Care Unit, Hospital of University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan
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16
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Claverias L, Daniel X, Martín-Loeches I, Vidal-Cortez P, Gómez-Bertomeu F, Trefler S, Zaragoza R, Borges-Sa M, Reyes L, Quindós G, Peman J, Bodí M, Díaz E, Sarvisé C, Pico E, Papiol E, Solé-Violan J, Marín-Corral J, Guardiola J, Rodríguez A. Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia. Med Intensiva 2022. [DOI: 10.1016/j.medin.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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17
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Mir T, Uddin M, Khalil A, Lohia P, Porter L, Regmi N, Weinberger J, Koul PA, Soubani AO. Mortality outcomes associated with invasive aspergillosis among acute exacerbation of chronic obstructive pulmonary disease patient population. Respir Med 2021; 191:106720. [PMID: 34959147 DOI: 10.1016/j.rmed.2021.106720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Literature regarding trends of mortality, and complications of aspergillosis infection among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is limited. METHODS Data from the National Readmissions Database (NRD) that constitutes 49.1% of the stratified sample of all hospitals in the United States (US), representing more than 95% of the national population were analyzed for hospitalizations with aspergillosis among AECOPD. Predictors and trends related to aspergillosis in AECOPD were evaluated. A Linear p-trend was used to assess the trends. RESULTS Out of the total 7,282,644 index hospitalizations for AECOPD (mean age 69.17 ± 12.04years, 55.3% females), 8209 (11.2/10,000) with primary diagnosis of invasive aspergillosis were recorded in the NRD for 2013-2018. Invasive aspergillosis was strongly associated with mortality (OR 4.47, 95%CI 4.02-4.97, p < 0.001) among AECOPD patients. Malignancy and organ transplant status were predominant predictors of developing aspergillosis among AECOPD patients. The IA-AECOPD group had higher rates of multi-organ manifestations including ACS (3.7% vs 0.44%; p-value0.001), AF (20% vs 18.4%; p-value0.001), PE (4.79% vs1.87%; p-value0.001), AKI (22.3% vs17.5%; p-value0.001), ICU admission (16.5% vs11.9%; p-value0.001), and MV (22.3% vs7.31%; p-value0.001) than the AECOPD group. The absolute yearly trend for mortality of aspergillosis was steady (linear p-trend 0.22) while the yearly rate of IA-AECOPD had decreased from 15/10,000 in 2013 to 9/10,000 in 2018 (linear p-trend 0.02). INTERPRETATION Aspergillosis was related with high mortality among AECOD hospitalizations. There has been a significant improvement in the yearly rates of aspergillosis while the mortality trend was steady among aspergillosis subgroups. Improved risk factor management through goal-directed approach may improve clinical outcomes.
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Affiliation(s)
- Tanveer Mir
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Mohammed Uddin
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Amir Khalil
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Prateek Lohia
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Lekiesha Porter
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Neelambuj Regmi
- Division of Pulmonary and Critical Care and Sleep Medicine, Wayne State University, Detroit, MI, USA
| | - Jarrett Weinberger
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Parvaiz A Koul
- Department of Internal Medicine, Sheri-Kashmir University SKIMS Srinagar, India
| | - Ayman O Soubani
- Division of Pulmonary and Critical Care and Sleep Medicine, Wayne State University, Detroit, MI, USA.
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Zhou LH, Jiang YK, Li RY, Huang LP, Yip CW, Denning DW, Zhu LP. Risk-Based Estimate of Human Fungal Disease Burden, China. Emerg Infect Dis 2021; 26:2137-2147. [PMID: 32818410 PMCID: PMC7454105 DOI: 10.3201/eid2609.200016] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We conducted a systematic literature review to obtain risk population–based fungal disease incidence or prevalence data from China. Data were categorized by risk factors and extrapolated by using most recent demographic figures. A total of 71,316,101 cases (5.0% of the population) were attributed to 12 risk factors and 17 fungal diseases. Excluding recurrent Candida vaginitis (4,057/100,000 women) and onychomycosis (2,600/100,000 persons), aspergillosis (317/100,000 persons) was the most common problem; prevalence exceeded that in most other countries. Cryptococcal meningitis, an opportunistic infection, occurs in immunocompetent persons almost twice as often as AIDS. The pattern of fungal infections also varies geographically; Talaromyces marneffei is distributed mainly in the Pearl River Basin, and the Yangtze River bears the greatest histoplasmosis burden. New host populations, new endemic patterns, and high fungal burdens in China, which caused a huge impact on public health, underscore the urgent need for building diagnostic and therapeutic capacity.
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19
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Gu Y, Ye X, Liu Y, Wang Y, Shen K, Zhong J, Chen B, Su X. A risk-predictive model for invasive pulmonary aspergillosis in patients with acute exacerbation of chronic obstructive pulmonary disease. Respir Res 2021; 22:176. [PMID: 34107968 PMCID: PMC8188951 DOI: 10.1186/s12931-021-01771-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/06/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives Invasive pulmonary aspergillosis (IPA) is increasingly reported in chronic obstructive pulmonary disease (COPD) patients. These patients often have poor clinical outcomes. Early recognition of IPA in COPD is always challenging. We aimed to develop and validate a risk model using readily available clinical parameters to predict IPA for acute exacerbation of COPD (AECOPD) patients. Methods We performed a retrospective cohort study. AECOPD patients who were admitted to Jinling Hospital between January 2012 and December 2017 were included. 880 AECOPD patients were randomly divided into the training set (70%, n = 616) and validation set (30%, n = 264). A nomogram model was developed using multivariate logistic regression from training set. The discrimination and calibration of model were validated internally. Decision curve analyses assessed the clinical utility of the nomogram. Results The incidence of IPA in hospitalized AECOPD patients was 9.6% in the training set (59 cases of IPA) and 9.1% in the validation set (24 cases of IPA), respectively. The nomogram model consisted of independent factors associated with IPA included lung function GOLD III–IV, use of broad-spectrum antibiotic over 10 days in the last month, oral or intravenous corticosteroids (prednisone) over 265 mg in the last 3 months and serum albumin < 30 g/L. The model performed good discrimination and calibration in validation set (c-statistic, 0.79 [95%CI 0.68–0.90]). The 95%CI region of calibration belt did not cross the 45-degree diagonal bisector line (P = 0.887). Conclusion The simple risk predictive model for earlier recognition of IPA is useful in hospitalized AECOPD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01771-3.
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Affiliation(s)
- Yu Gu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Xianping Ye
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Yuxiu Liu
- Department of Medical Statistics, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China
| | - Yu Wang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Kunlu Shen
- Department of Respiratory and Critical Care Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China
| | - Jinjin Zhong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Bilin Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China. .,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China. .,Department of Respiratory and Critical Care Medicine, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China.
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20
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Chen F, Zhong Y, Li N, Wang H, Tan Y, Zhang H, Hua W, Mao Y, Huang H. Dynamic monitor of CT scan within short interval in invasive pulmonary aspergillosis for nonneutropenic patients: a retrospective analysis in two centers. BMC Pulm Med 2021; 21:142. [PMID: 33941132 PMCID: PMC8091757 DOI: 10.1186/s12890-021-01512-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background In nonneutropenic patients with underlying respiratory diseases (URD), invasive pulmonary aspergillosis (IPA) is a life-threatening disease. Yet establishing early diagnosis in those patients remains quite a challenge. Methods A retrospective series of nonneutropenic patients with probable or proven IPA were reviewed from January 2014 to May 2018 in Department of Respiratory Medicine of two Chinese hospitals. Those patients were suspected of IPA and underwent lung computed tomography (CT) scans twice within 5–21 days. The items required for IPA diagnosis were assessed by their host factors, mycological findings and CT scans according to the European Organization for Research and Treatment of Cancer (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) criteria (EORTC/MSG criteria). Results Together with the risk factors, mycological findings and nonspecific radiological signs on first CT, ten patients were suspected of IPA. With the appearance of cavities on second CT scan in the following days, all patients met the criteria of probable or possible IPA. Except one patient who refused antifungal treatment, nine patients received timely antifungal treatment and recovered well. One of the nine treated IPA cases was further confirmed by pathology, one was confirmed by biopsy. Conclusions Dynamic monitor of CT scan provided specific image evidences for IPA diagnosis. This novel finding might provide a noninvasive and efficient strategy in IPA diagnosis with URD.
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Affiliation(s)
- Fei Chen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yonghong Zhong
- Yuhang Branch, the Second Affiliated Hospital, Zhejiang University School of medicine, Zhejiang, Hangzhou, China
| | - Na Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huijie Wang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanbin Tan
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hao Zhang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wen Hua
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanxiong Mao
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Huaqiong Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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21
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Respiratory Mycoses in COPD and Bronchiectasis. Mycopathologia 2021; 186:623-638. [PMID: 33709335 DOI: 10.1007/s11046-021-00539-z] [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: 12/18/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and bronchiectasis represent chronic airway diseases associated with significant morbidity and mortality. Bacteria and viruses are commonly implicated in acute exacerbations; however the significance of fungi in these airways remains poorly defined. While COPD and bronchiectasis remain recognized risk factors for the occurrence of Aspergillus-associated disease including chronic and invasive aspergillosis, underlying mechanisms that lead to the progression from colonization to invasive disease remain uncertain. Nonetheless, advances in molecular technologies have improved our detection, identification and understanding of resident fungi characterizing these airways. Mycobiome sequencing has revealed the complex varied and myriad profile of airway fungi in COPD and bronchiectasis, including their association with disease presentation, progression, and mortality. In this review, we outline the emerging evidence for the clinical importance of fungi in COPD and bronchiectasis, available diagnostic modalities, mycobiome sequencing approaches and association with clinical outcomes.
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Banerjee S, Denning DW, Chakrabarti A. One Health aspects & priority roadmap for fungal diseases : A mini-review. Indian J Med Res 2021; 153:311-319. [PMID: 33906993 PMCID: PMC8204821 DOI: 10.4103/ijmr.ijmr_768_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 11/29/2022] Open
Abstract
Fungal diseases have not been taken seriously in public health agendas as well as research priorities, despite of globally causing an estimated two million deaths every year, and the emergence of many troublesome fungal pathogens like Candida auris, azole resistant Aspergillus fumigatus, terbinafine and azole resistant dermatophytes, and zoonotic sporotrichosis in humans. Fungi are also responsible for huge losses of agricultural products and stored crops as well as recent massive and unexpected mortality in animals caused by white-nose syndrome in the bats and Chytridiomycosis in amphibians. This review aims to underscore the need for collaborative, multisectoral, and trans-disciplinary approach to include the One Health approach as an essential component of surveillance, prevention, and control of globally emerging fungal diseases. Rigorous evidence based surveillance of the environment as well as strengthening rapid and quality diagnosis of fungal diseases can save millions of lives and reduce significant morbidity.
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Affiliation(s)
- Sayantan Banerjee
- Department of Infectious Diseases, Beleghata Infectious Diseases & BG Hospitals, Beleghata, Kolkata, West Bengal, India
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- Center of Advanced Research in Medical Mycology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Gu Y, Ye X, Wang Y, Shen K, Zhong J, Chen B, Su X. Clinical features and prognostic analysis of patients with Aspergillus isolation during acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2021; 21:69. [PMID: 33637057 PMCID: PMC7908687 DOI: 10.1186/s12890-021-01427-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background Lower respiratory tract (LRT) specimen culture is widely performed for the identification of Aspergillus. We investigated the clinical features and prognosis of patients with Aspergillus isolation from LRT specimens during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This is a 6-year single-center, real-world study. 75 cases out of 1131 hospitalized AECOPD patients were positive for Aspergillus. These patients were carefully evaluated and finally diagnosed of pulmonary aspergillosis (PA, 60 cases, 80%) or colonization (15 cases, 20%). Comparisons of clinical data were performed between these two groups. A cox regression model was used to confirm prognostic factors of Aspergillus infection. Results The PA group had worse lung function and higher rates of systemic corticosteroid use and broad-spectrum antibiotic use before admission than the colonization group. The PA group had significantly higher in-hospital mortality and 180-day mortality than the colonization group (45% (27/60) vs. 0% (0/15), p = 0.001, and 52.5% (31/59) vs. 6.7% (1/15), p < 0.001, respectively). By multivariable analysis among Aspergillus infection patients, antifungal therapy (HR 0.383, 95% CI 0.163–0.899, p = 0.027) was associated with improved survival, whereas accumulated dose of systemic steroids > 700 mg (HR 2.452, 95% CI 1.134–5.300, p = 0.023) and respiratory failure at admission (HR 5.983, 95% CI 2.487–14.397, p < 0.001) were independently associated with increased mortality. Significant survival differential was observed among PA patients without antifungals and antifungals initiated before and after Aspergillus positive culture (p = 0.001). Conclusions Aspergillus isolation in hospitalized AECOPD patients largely indicated PA. AECOPD patients with PA had worse prognosis than those with Aspergillus colonization. Empirical antifungal therapy is warranted to improve the prognosis for Aspergillus infection.
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Affiliation(s)
- Yu Gu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, China
| | - Xianping Ye
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, China
| | - Yu Wang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Kunlu Shen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 210002, China
| | - Jinjin Zhong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Bilin Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Xuanwu District, Nanjing, 210002, China. .,Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China. .,Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 210002, China.
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Zhang J, Zhang Y, Wu D, Cao G, Hamed K, Desai A, Aram JA, Guo X, Fayyad R, Cornely OA. Clinical experience with isavuconazole in healthy volunteers and patients with invasive aspergillosis in China, and the results from an exposure-response analysis. Mycoses 2021; 64:445-456. [PMID: 33355949 DOI: 10.1111/myc.13233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Isavuconazole is a broad-spectrum triazole for the treatment of invasive fungal disease (IFD). OBJECTIVE To investigate the clinical experience with isavuconazole in Chinese individuals. PATIENTS/METHODS Participants were Chinese healthy volunteers from a Phase I pharmacokinetics (PK) and safety study of single/multiple doses of isavuconazole (n = 36) and Chinese patients from the global Phase III SECURE study that assessed safety and efficacy of isavuconazole vs voriconazole for IFD treatment (n = 26). RESULTS No clinically relevant differences in PK were found between Chinese and Western participants, although exposure was increased in Chinese volunteers. Treatment-emergent adverse events (TEAEs) were reported in 75.0% of healthy volunteers, many of which were infusion-related. No serious AEs were reported. In SECURE, findings in Chinese patients (n = 26) were similar to the global population. For patients who received ≥1 dose of study drug, allcause mortality from first dose to Day 42 was 10.0% (1/10) with isavuconazole and 25.0% (4/16) with voriconazole (treatment difference [95% confidence interval, CI]: -15.0% [-43.2%, 13.2%]). Overall response at the end of treatment for patients with proven/probable IFD was 25.0% and 16.7% with isavuconazole and voriconazole, respectively (treatment difference [95% CI] -8.3% [-60.2%, 43.5%]). Isavuconazole was associated with lower incidence of hepatobiliary, eye, skin, subcutaneous tissue and psychiatric disorders compared with voriconazole and lower incidence of treatment-related TEAEs, serious TEAES or death overall. CONCLUSIONS Although further research is required, this study demonstrated a favourable risk-benefit profile of isavuconazole in Chinese patients.
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Affiliation(s)
- Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yingyuan Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Depei Wu
- Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoying Cao
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Kamal Hamed
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Amit Desai
- Astellas Pharma Inc, Northbrook, IL, USA
| | | | | | | | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
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Huseynov RM, Javadov SS, Osmanov A, Khasiyev S, Valiyeva SR, Almammadova E, Denning DW. The burden of serious fungal infections in Azerbaijan. Ther Adv Infect Dis 2021; 8:20499361211043969. [PMID: 34497715 PMCID: PMC8419541 DOI: 10.1177/20499361211043969] [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: 01/14/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Azerbaijan is an upper middle-income country in South Caucasus with an area of 86,600 km2 and a total population of 10 million people and gross domestic product of US $4480 per capita. The aim of this research is to estimate fungal infection burden and highlight the problem at national and international levels. METHODS Fungal infection burden was estimated using data from epidemiological papers and population at risk and LIFE (Leading International Fungal Education) modelling. RESULTS The number of people living with human immunodeficiency virus (PLHIV) in 2018 was 6193, 29% of them not receiving antiretroviral therapy. Based on 90% and 20% rates of oral and oesophageal candidiasis in patients with CD4 cell count <200 µl-1 we estimate 808 and 579 patients with oral and oesophageal candidiasis, respectively. The annual incidences of cryptococcal meningitis and Pneumocystis pneumonia are 5 and 55 cases, respectively. We estimated 2307 cases of chronic pulmonary aspergillosis (CPA), 4927 patients with allergic bronchopulmonary aspergillosis (ABPA), and 6504 with severe asthma with fungal sensitization (SAFS). Using data on chronic obstructive pulmonary diseases (COPD), lung cancer, acute myeloid leukaemia rates, and number of transplantations, we estimated 693 cases of invasive aspergillosis following these conditions. Using a low-European rate for invasive candidiasis, we estimated 499 and 75 patients with candidemia and intra-abdominal candidiasis respectively. The number of adult women (15-55 years) in Azerbaijan is ~2,658,000, so it was estimated that 159,490 women suffer from recurrent vulvovaginal candidiasis (rVVC). DISCUSSION In total, the estimated number of people suffering from fungal diseases in Azerbaijan is 225,974 (2.3% of the population). However, the fungal rate is underestimated due to lack of epidemiological data. The most imminent need is improvement in diagnostic capabilities. This aim should be achieved via establishing a reference laboratory and equipping major clinical centers with essential diagnostics assays.
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Affiliation(s)
- Ravil M. Huseynov
- The Department of Medical Microbiology and Immunology, Azerbaijan Medical University, Mardanov Qardashlari 98, Baku, Azerbaijan
| | - Samir S. Javadov
- The Department of Medical Microbiology and Immunology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Ali Osmanov
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Shahin Khasiyev
- The Department of Informatics and Statistics, Ministry of Health of Azerbaijan Republic, Baku, Azerbaijan
| | - Samira R. Valiyeva
- Republican Centre for Combating AIDS, Ministry of Health of Azerbaijan Republic, Baku, Azerbaijan
| | - Esmira Almammadova
- Republican Centre for Combating AIDS, Ministry of Health of Azerbaijan Republic, Baku, Azerbaijan
| | - David W. Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Waqas S, Dunne K, Talento AF, Wilson G, Martin-Loeches I, Keane J, Rogers TR. Prospective observational study of respiratory Aspergillus colonization or disease in patients with various stages of chronic obstructive pulmonary disease utilizing culture versus nonculture techniques. Med Mycol 2020; 59:myaa077. [PMID: 32926151 DOI: 10.1093/mmy/myaa077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) patients have been recognized to be at increased risk of Aspergillus spp. colonization, which may progress to invasive pulmonary aspergillosis (IPA). The objective of this study was to determine the frequency of Aspergillus colonization, or disease, in a cohort of COPD patients. A prospective observational study was undertaken to determine Aspergillus colonization, or disease, in consecutive COPD patients undergoing bronchoscopy. Fungal culture as well as galactomannan antigen (GM) and Aspergillus nucleic acid detection (PCR) were performed on bronchoalveolar lavage fluid (BAL) samples. One hundred and fifty patients were recruited. One hundred and twelve (74.7%) were outpatients, 38 (25.33%) were inpatients, of whom 6 (4%) were in the intensive care unit. Most patients (N = 122, 81.3%) were either COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 1 or 2. Nine (6%) patients were on systemic steroids, 64 (42.7%) on inhaled steroids, and 9 (6%) on both. Seventeen patients (11.3%) had at least one positive test for Aspergillus detection (culture ± galactomannan ± polymerase chain reaction [PCR]), 13 (76.4%) of whom were COPD GOLD stages 1 or 2. Five patients had probable or putative IPA. Aspergillus sp. was detected in five patients (3.3%) by culture, but detection increased to 17 (11.3%) by the additional testing for GM or Aspergillus DNA. The frequency of Aspergillus detection in this cohort of COPD patients may reflect the predominance of early GOLD stages among the study population but deserves further investigation to determine its relevance as a predictive risk factor for IPA. LAY SUMMARY COPD is a risk factor for Aspergillus spp. colonization. Bronchoalveolar lavage samples of 150 COPD patients were tested for presence of Aspergillus fumigatus, which was detected in five patients (3.3%) by culture, but detection of Aspergillus increased to 17 (11.3%) by additional GM and PCR testing.
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Affiliation(s)
- Sarmad Waqas
- Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Katie Dunne
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
| | - Alida Fe Talento
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
- Department of Microbiology, St. James's Hospital, Dublin 8, Ireland
| | - Graham Wilson
- Department of Radiology, St. James's Hospital, Dublin 8, Ireland
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, Trinity College Dublin, Ireland
- Department of Intensive Care Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Joseph Keane
- Department of Clinical Medicine, Trinity College Dublin, Ireland
- Department of Respiratory Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Thomas R Rogers
- Department of Clinical Microbiology, Trinity College Dublin, Ireland
- Department of Microbiology, St. James's Hospital, Dublin 8, Ireland
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27
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Hammond EE, McDonald CS, Vestbo J, Denning DW. The global impact of Aspergillus infection on COPD. BMC Pulm Med 2020; 20:241. [PMID: 32912168 PMCID: PMC7488557 DOI: 10.1186/s12890-020-01259-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 02/10/2023] Open
Abstract
Background Advanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication. Aspergillus sensitisation may worsen symptoms in COPD. Methods We identified published papers between January 2000 and May 2019 with > 50 subjects and GOLD criteria for grade II, III or IV (FEV1/FVC < 70% and FEV1 < 80%) using standardised criteria in multiple countries, to re-estimate the prevalence of COPD. Hospitalised COPD patients develop IA in 1.3–3.9%, based on positive cultures of Aspergillus spp. and radiological findings. Given limited data on per-patient annual hospitalisation rates, we assumed a conservative 10.5% estimate. Annual IA mortality in COPD was estimated using the literature rates of 43–72%. A separate literature search assessed the impact of Aspergillus sensitisation on severity of COPD (by FEV1). Results We re-estimated the global prevalence of COPD GOLD stages II-IV at 552,300,599 people (7.39% of the population) with 339,206,893 (8.58%) in Asia, 85,278,783 (8.52%) in the Americas, 64,298,051 (5.37%) in Africa, 59,484,329 (7.77%) in Europe and 4,032,543 (10.86%) in Oceania. An estimated 57,991,563 (10.5%) people with COPD are admitted to hospital annually and of these 753,073 (1.3%) – 2,272,322 (3.9%) develop IA and 540,451–977,082 deaths are predicted annually. Aspergillus sensitisation prevalence in COPD was 13.6% (7.0–18.3%) and not related to lower predicted FEV1% (P > 0.05). Conclusions The prevalence of COPD is much higher than previously estimated. Overall COPD mortality may be higher than estimated and IA probably contributes to many deaths. Improved rapid diagnosis of IA using culture and non-culture based techniques is required in COPD hospital admissions to reduce mortality.
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Affiliation(s)
- Emily E Hammond
- School of Medicine, University of Manchester, Manchester, UK
| | | | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK. .,National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
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Liu Z, Li Y, Tian X, Liu Q, Li E, Gu X, Liu M, Xu J, He Z, Huang Y, Xu S, Lai G, Chen Y, Zhang X, Zhang T, Xu J, Zhu L, Qu J, Cao B. Airway-invasion-associated pulmonary computed tomography presentations characteristic of invasive pulmonary Aspergillosis in non-immunocompromised adults: a National Multicenter Retrospective Survey in China. Respir Res 2020; 21:173. [PMID: 32635916 PMCID: PMC7341597 DOI: 10.1186/s12931-020-01424-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
Background The European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria are widely used in the diagnosis of invasive pulmonary aspergillosis (IPA), but they only apply to immunocompromised patients. We here aimed to identify clinical characteristics helpful to the diagnosis of IPA in non-immunocompromised patients. Methods This is a multicenter retrospective study. Data were collected from adult patients with IPA admitted to 15 tertiary hospitals in China from 2010 to 2016. Results We included 254 patients in the study, of whom 66 (26.0%) were immunocompromised, and 188 (74.0%) were not. Airway-invasion-associated computed tomography (CT) signs including patchy exudation along the airway (67.6% vs. 45.5%, P = 0.001) and thickened airway wall (42.0% vs. 16.7%, P < 0.001) were more common in non-immunocompromised patients than in immunocompromised ones, and angio-invasive CT signs were more common in immunocompromised patients (55.3% vs.72.7%, P = 0.013). Typical angio-invasive CT signs were delayed in non-immunocompromised IPA patients, whereas airway-invasive signs appear earlier. Host immunocompromised condition was associated with ICU admission and/or intubation (OR 1.095; 95% CI 1.461–6.122; P = 0.003). Poor prognosis (35.5% vs. 21.1%, P = 0.005) was more common in immunocompromised patients. Conclusion Airway-invasion-associated CT presentations at early stages of the disease are characteristic of IPA in non-immunocompromised hosts.
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Affiliation(s)
- Zhibo Liu
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yuping Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinlun Tian
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghua Liu
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Erran Li
- Institute of Respiratory Disease, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoying Gu
- Department of Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- The department of radiology, China-Japan Friendship Hospital, Beijing, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Zhiyi He
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Shuyun Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxiang Lai
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Fuzhou, China
| | - Yusheng Chen
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xiangyan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lanyan Zhu
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central-South University, Changsha, China
| | - Jieming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, Beijing, 100029, China.
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Moin S, Farooqi J, Jabeen K, Laiq S, Zafar A. Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan. Antimicrob Resist Infect Control 2020; 9:62. [PMID: 32393344 PMCID: PMC7216335 DOI: 10.1186/s13756-020-00731-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Burden of aspergillosis is reported to be significant from developing countries including those in South Asia. The estimated burden in Pakistan is also high on the background of tuberculosis and chronic lung diseases. There is concern for management of aspergillosis with the emergence of azole resistant Aspergillus species in neighbouring countries in Central and South Asia. Hence the aim of this study was to screen significant Aspergillus species isolates at the Microbiology Section of Aga Khan Clinical Laboratories, Pakistan, for triazole resistance. Methods A descriptive cross-sectional study, conducted at the Aga Khan University Laboratories, Karachi, from September 2016–May 2019. One hundred and fourteen, clinically significant Aspergillus isolates [A. fumigatus (38; 33.3%), A. flavus (64; 56.1%), A. niger (9; 7.9%) A. terreus (3; 2.6%)] were included. The clinical spectrum ranged from invasive aspergillosis (IA) (n = 25; 21.9%), chronic pulmonary aspergillosis (CPA) (n = 58; 50.9%), allergic bronchopulmonary aspergillosis (ABPA) (n = 4; 3.5%), severe asthma with fungal sensitization (SAFS) (n = 4; 3.5%), saprophytic tracheobronchial aspergillosis (n = 23; 20.2%). Screening for triazole resistance was performed by antifungal agar screening method. The minimum inhibitory concentration (MIC) of 41 representative isolates were tested and interpreted according to the Clinical and Laboratory Standards Institute broth microdilution method. Results All the isolates were triazole-susceptible on agar screening. MICs of three azole antifungals for 41 tested isolates were found to be ≤1 ml/L; all isolates tested were categorized as triazole-susceptible, including 4 isolates from patients previously on triazole therapy for more than 2 weeks. The minimum inhibitory concentration required to inhibit the growth of 90% organisms (MIC90) of itraconazole, voriconazole and posaconazole of the representative Aspergillus isolates was 1 mg/L, 1 mg/L and 0.5 mg/L, respectively. Conclusion Triazole resistance could not be detected amongst clinical Aspergillus isolates from the South of Pakistan. However, environmental strains remain to be tested for a holistic assessment of the situation. This study will set precedence for future periodic antifungal resistance surveillance in our region on Aspergillus isolates.
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Affiliation(s)
- Safia Moin
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Joveria Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.
| | - Kauser Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sidra Laiq
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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30
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Buil JB, Meijer EFJ, Denning DW, Verweij PE, Meis JF. Burden of serious fungal infections in the Netherlands. Mycoses 2020; 63:625-631. [PMID: 32297377 PMCID: PMC7318641 DOI: 10.1111/myc.13089] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022]
Abstract
Background Fungal diseases have an ever‐increasing global disease burden, although regional estimates for specific fungal diseases are often unavailable or dispersed. Objectives Here, we report the current annual burden of life‐threatening and debilitating fungal diseases in the Netherlands. Methods The most recent available epidemiological data, reported incidence and prevalence of fungal diseases were used for calculations. Results Overall, we estimate that the annual burden of serious invasive fungal infections in the Netherlands totals 3 185 patients, including extrapulmonary or disseminated cryptococcosis (n = 9), pneumocystis pneumonia (n = 740), invasive aspergillosis (n = 1 283), chronic pulmonary aspergillosis (n = 257), invasive Candida infections (n = 684), mucormycosis (n = 15) and Fusarium keratitis (n = 8). Adding the prevalence of recurrent vulvo‐vaginal candidiasis (n = 220 043), allergic bronchopulmonary aspergillosis (n = 13 568) and severe asthma with fungal sensitisation (n = 17 695), the total debilitating burden of fungal disease in the Netherlands is 254 491 patients yearly, approximately 1.5% of the country's population. Conclusion We estimated the annual burden of serious fungal infections in the Netherlands at 1.5% of the population based on previously reported modelling of fungal rates for specific populations at risk. With emerging new risk groups and increasing reports on antifungal resistance, surveillance programmes are warranted to obtain more accurate estimates of fungal disease epidemiology and associated morbidity and mortality.
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Affiliation(s)
- Jochem B Buil
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands
| | - Eelco F J Meijer
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - David W Denning
- The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Global Action Fund for Fungal Infections, Geneva, Switzerland.,Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester, UK
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Center for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil
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31
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Factores clínicos asociados a enfermedad pulmonar por Aspergillus spp. en pacientes con enfermedad pulmonar obstructiva crónica. Enferm Infecc Microbiol Clin 2020; 38:4-10. [DOI: 10.1016/j.eimc.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022]
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32
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Huang YS, Denning DW, Shih SM, Hsiung CA, Wu UI, Sun HY, Chen PY, Chen YC, Chang SC. Fungal Diseases in Taiwan-National Insurance Data and Estimation. J Fungi (Basel) 2019; 5:jof5030078. [PMID: 31438643 PMCID: PMC6787579 DOI: 10.3390/jof5030078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/09/2019] [Accepted: 08/16/2019] [Indexed: 12/16/2022] Open
Abstract
The burden of fungal diseases based on the real-world national data is limited. This study aimed to estimate the Taiwan incident cases with selected fungal diseases in 2013 using the National Health Insurance Research Database (NHIRD) which covered 99.6% of the 23.4 million population. Over 80,000 incident cases were found and the majority were superficial infections including vulvovaginal candidiasis (477 per 100,000 adult women) and oral candidiasis (90 cases per 100,000 population). Common potentially life-threating fungal diseases were Pneumocystis pneumonia (5.35 cases per 100,000 population), candidemia (3.68), aspergillosis (2.43) and cryptococcal meningitis (1.04). Of the aforementioned cases cancer patients contributed 30.2%, 42.9%, 38.6% and 22.2%, respectively. Of 22,270 HIV-infected persons in NHIRD in 2013, four common diseases were Pneumocystis pneumonia (28.3 cases per 1000 HIV-infected patients), oral candidiasis (17.6), esophageal candidiasis (6.06) and cryptococcal meningitis (2.29). Of pulmonary aspergillosis 32.9% occurred in patients with chronic pulmonary diseases and 26.3% had a prior diagnosis of tuberculosis. There are some notable gaps related to insurance claim data. Cutaneous, urinary tract and eye fungal infections were not captured.
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Affiliation(s)
- Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - David W Denning
- National Aspergillosis Center, Wythenshawe Hospital, Manchester M23 9LT, UK
- The University of Manchester and Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Shu-Man Shih
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County 35053, Taiwan
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County 35053, Taiwan
| | - Un-In Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Pao-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan.
- Department of Medicine, National Taiwan University College of Medicine, Taipei 10051, Taiwan.
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County 35053, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
- Department of Medicine, National Taiwan University College of Medicine, Taipei 10051, Taiwan
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33
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Bobokhojaev OI, Osmanov A, Aliev SP, Radjabzoda AS, Avgonov ZT, Manonov ST, Denning DW. The Burden of Serious Fungal Infections in Tajikistan. J Fungi (Basel) 2019; 5:jof5030068. [PMID: 31330914 PMCID: PMC6787594 DOI: 10.3390/jof5030068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022] Open
Abstract
Tajikistan is a low-income country in Middle Asia with a population of 8.9 million people. Five percent of the population lives on less than 1.9 USD a day and 54% live on less than 5.5 USD a day. We have estimated the burden of serious fungal infections in Tajikistan. It was estimated that 168,834 Tajik women develop recurrent vulvovaginal candidiasis. Among HIV-positive patients, we estimate 490 patients with oesophageal candidiasis and 1260 patients with oral candidiasis, 41 cases of cryptococcal meningitis and 210 cases of Pneumocystis pneumonia annually. According to our estimations there are 774 cases of chronic pulmonary aspergillosis (CPA) as a sequel of tuberculosis; CPA may occur as a consequence of multiple pulmonary conditions and the total prevalence of 4161 cases was estimated. We have estimated 6008 cased of allergic bronchopulmonary aspergillosis (ABPA) and 7930 cases of severe asthma with fungal sensitisation (SAFS), and 137 fungal asthma deaths annually. We have estimated 445 cases of candidemia a year applying a low European rate. There are approximately 283 cases of invasive aspergillosis annually. There are 189,662 (2.1% of the population) people suffering from serious fungal infections in Tajikistan. Hence, improving diagnostics is the first step of understanding a scale of the fungal burden.
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Affiliation(s)
- Oktam I Bobokhojaev
- Department of Phthisiopneumology, Tajik State Medical University, 734003 Dushanbe, Tajikistan
| | - Ali Osmanov
- Global Action Fund for Fungal Infections, 1208 Geneva, Switzerland.
| | - Samariddin P Aliev
- Research Scientific Institute of Preventive Medicine, Ministry of Health and Social Protection of the population, 734025 Dushanbe, Tajikistan
| | - Asliddin S Radjabzoda
- Republican Center of the Protection Population from Tuberculosis Ministry of Health and Social Protection of the Population, 734000 Dushanbe, Tajikistan
| | - Ziyovuddin T Avgonov
- Secretariat of the National Coordination Committee to Fight AIDS, TB and Malaria, 734018 Dushanbe, Tajikistan
| | - Safarbek T Manonov
- Republican Center of Medical Statistics, Ministry of Health and Social Protection of the Population, 734025 Dushanbe, Tajikistan
| | - David W Denning
- Global Action Fund for Fungal Infections, 1208 Geneva, Switzerland
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, UK
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Southmoor Road, Manchester M23 9LT, UK
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The Burden of Serious Fungal Infections in Kyrgyzstan. J Fungi (Basel) 2019; 5:jof5030066. [PMID: 31331088 PMCID: PMC6787754 DOI: 10.3390/jof5030066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/23/2022] Open
Abstract
Kyrgyzstan in Central Asia has a population of 6 million people who have high mortality rates for chronic lung diseases. The mountainous geography, widespread use of biomass fuels for cooking and indoor heating, and high rates of smoking are the major contributing factors. We have estimated the number of serious fungal infections in order to define the burden of these diseases in Kyrgyzstan. We estimated 774 cases of chronic pulmonary aspergillosis (CPA) as a sequel of tuberculosis (TB); CPA occurs as a sequel of multiple conditions, so a total prevalence of 3097 cases was estimated, which is among the highest rates in the world. An estimated 2205 patients have allergic bronchopulmonary aspergillosis (ABPA) and 2911 have severe asthma with fungal sensitization (SAFS), which may be an underestimate. There are approximately 292 cases of invasive aspergillosis annually. The number of adult women who get recurrent vulvovaginal candidiasis is 175,949. We approximated 787 cases of oral and 294 cases of esophageal candidiasis, 25 cases of cryptococcal meningitis, and 101 cases of Pneumocystis pneumonia annually in HIV-positive patients. The incidence of candidemia was estimated at 300. We have estimated that a total of 185,961 people (3% of the population) have serious fungal infection in Kyrgyzstan. Given this burden, diagnostic improvements are necessary.
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Hilmioğlu-Polat S, Seyedmousavi S, Ilkit M, Hedayati MT, Inci R, Tumbay E, Denning DW. Estimated burden of serious human fungal diseases in Turkey. Mycoses 2018; 62:22-31. [PMID: 30107069 DOI: 10.1111/myc.12842] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 02/05/2023]
Abstract
The current number of fungal infections occurring each year in Turkey is unknown. We estimated the burden of serious human fungal diseases based on the population at risk, existing epidemiological data from 1920 to 2017 and modelling previously described by the LIFE program (http://www.LIFE-worldwide.org). Among the population of Turkey (80.8 million in 2017), approximately 1 785 811 (2.21%) people are estimated to suffer from a serious fungal infection each year. The model used predicts high prevalences of allergic fungal rhinosinusitis episodes (312 994 cases) (392/100 000), of severe asthma with fungal sensitisation (42 989 cases) (53.20 cases/100 000 adults per year), of allergic bronchopulmonary aspergillosis (32 594 cases) (40.33/100 000), of fungal keratitis (26 671 cases) (33/100 000) and of chronic pulmonary aspergillosis (5890 cases) (7.29/100 000). The estimated annual incidence for invasive aspergillosis is lower (3911 cases) (4.84/100 000 annually). Among about 22.5 million women aged 15-50 years, recurrent vulvovaginal candidiasis is estimated to occur in 1 350 371 (3342/100 000) females. The burden of three superficial fungal infections was also estimated: tinea pedis (1.79 million), tinea capitis (43 900) and onychomycosis (1.73 million). Given that the modelling estimates reported in the current study might be substantially under- or overestimated, formal epidemiological and comprehensive surveillance studies are required to validate or modify these estimates.
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Affiliation(s)
| | - Seyedmojtaba Seyedmousavi
- Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States of America.,Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology and Parasitology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ramazan Inci
- Department of Microbiology, Faculty of Medicine, University of Ege, Izmir, Turkey
| | - Emel Tumbay
- Department of Microbiology, Faculty of Medicine, University of Ege, Izmir, Turkey
| | - David W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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36
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Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case report and review of the literature. Oncotarget 2018; 8:38069-38074. [PMID: 28445159 PMCID: PMC5513717 DOI: 10.18632/oncotarget.16971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/13/2017] [Indexed: 11/25/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is an infection that often occurs in immunocompromised patients and has a high mortality rate. In recent years, the reported incidence of IPA in the context of chronic obstructive pulmonary disease (COPD) has seemingly increased. The combination of factors such as long-term corticosteroid use, increasing rate of bacterial exacerbations over time, lung immune imbalance, and malnutrition are responsible for the emergence of IPA in COPD patients. A diagnosis of IPA in COPD patients is difficult to make, which explains the delay in antifungal therapy and the high mortality rate. The purpose of this study is to increase the recognition and improve the outcomes associated with this situation through the description of our case. In patients in which IPA is suspected, comprehensive analysis of their clinical manifestations, imaging, microbiology and serological examination results are effective means of increasing the rate of reliable diagnosis. If the patient’s condition permits, a pathological specimen should be obtained as soon as possible.
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37
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Kemaykin VM, Tabinbaev NB, Khudaibergenova MS, Olifirovich AA, Abdrakhmanova LM, Denning DW, Klimko N. An Estimate of Severe and Chronic Fungal Diseases in the Republic of Kazakhstan. J Fungi (Basel) 2018. [PMID: 29518045 PMCID: PMC5872337 DOI: 10.3390/jof4010034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Our work aimed to generate a preliminary estimation of severe and chronic fungal diseases in the Republic of Kazakhstan with a model proposed by LIFE (Leading International Fungal Education). Calculations were carried out on data from 2015. Published results of studies of mycoses in Kazakhstan were identified; in the absence of national data from the scientific literature, the frequency of life-threatening and serious mycoses in defined groups of patients at risk from other countries were taken into account. We also used analogous estimations of mycoses in the Russian Federation. We estimate that 300,824 patients (1.7% of the population) were affected by severe and chronic mycotic diseases. There were an estimated 15,172 cases of acute mycoses, notably tinea capitis in children (11,847), Pneumocystis pneumonia and invasive candidiasis, and 285,652 of chronic fungal diseases. The most frequent were chronic recurrent vulvovaginal candidiasis (273,258 cases) and chronic pulmonary aspergillosis (6231). There is uncertainty about the prevalence of asthma in adults; the official number is 12,478 patients, but a prevalence estimate of 1.47% from a WHO consortium yields a prevalence of ~170,000 affected. We have used the official figures to generate the prevalence of fungal asthma, but it is likely to be a significant underestimate. CONCLUSION Results of investigation indicate significant prevalence of severe and chronic mycoses in the Republic of Kazakhstan.
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Affiliation(s)
- Vadim M Kemaykin
- National Scientific Center for Oncology and Transplantology, Astana 020000, Kazakhstan.
| | - Nariman B Tabinbaev
- National Scientific Center for Oncology and Transplantology, Astana 020000, Kazakhstan.
| | | | | | | | - David W Denning
- The National Aspergillosis Centre, Wythenshave Hospital, The University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK.
- Leading International Fungal Education (LIFE), Cheshire SK10 9AR, UK.
| | - Nikolai Klimko
- Department of Clinical Mycology, Allergy and Immunology, I. Metchnikov North Western State Medical University, St. Petersburg 191015, Russia.
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38
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Dauchy C, Bautin N, Nseir S, Reboux G, Wintjens R, Le Rouzic O, Sendid B, Viscogliosi E, Le Pape P, Arendrup MC, Gosset P, Fry S, Fréalle E. Emergence of Aspergillus fumigatus azole resistance in azole-naïve patients with chronic obstructive pulmonary disease and their homes. INDOOR AIR 2018; 28:298-306. [PMID: 29082624 DOI: 10.1111/ina.12436] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
Azole-resistant Aspergillus fumigatus (ARAF) has been reported in patients with chronic obstructive pulmonary disease (COPD) but has not been specifically assessed so far. Here, we evaluated ARAF prevalence in azole-naïve COPD patients and their homes, and assessed whether CYP51A mutations were similar in clinical and environmental reservoirs. Sixty respiratory samples from 41 COPD patients with acute exacerbation and environmental samples from 36 of these patient's homes were prospectively collected. A. fumigatus was detected in respiratory samples from 11 of 41 patients (27%) and in 15 of 36 domiciles (42%). Cyp51A sequencing and selection on itraconazole medium of clinical (n = 68) and environmental (n = 48) isolates yielded ARAF detection in 1 of 11 A. fumigatus colonized patients with COPD (9%) and 2 of 15 A. fumigatus-positive patient's homes (13%). The clinical isolate had no CYP51A mutation. Two environmental isolates from two patients harbored TR34 /L98H mutation, and one had an H285Y mutation. Coexistence of different cyp51A genotypes and/or azole resistance profiles was detected in 3 of 8 respiratory and 2 of 10 environmental samples with more than one isolate, confirming the need for a systematic screening of all clinically relevant isolates. The high prevalence of ARAF in patients with COPD and their homes supports the need for further studies to assess the prevalence of azole resistance in patients with Aspergillus diseases in Northern France.
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Affiliation(s)
- C Dauchy
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille, France
| | - N Bautin
- CHU Lille, Department of Respiratory Diseases, Lille, France
| | - S Nseir
- CHU Lille, Critical Care Center, Lille, France
| | - G Reboux
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Laboratoire de Parasitologie-Mycologie, CHU de Besançon, Hôpital Jean-Minjoz, Besançon, France
| | - R Wintjens
- Research in Drug Development, Faculté de Pharmacie, Université Libre de Bruxelles, Bruxelles, Belgium
| | - O Le Rouzic
- CHU Lille, Department of Respiratory Diseases, Lille, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - B Sendid
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille, France
- Inserm U995, Université de Lille, Lille, France
| | - E Viscogliosi
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - P Le Pape
- EA1155-IICiMed, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - M C Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P Gosset
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - S Fry
- CHU Lille, Department of Respiratory Diseases, Lille, France
| | - E Fréalle
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
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González-Senac NM, Romero Estarlich V, Marañón Fernández E, Serra-Rexach JA. [Invasive pulmonary aspergillosis in an elderly patient with a cerebral abscess of odontogenic origin]. Rev Esp Geriatr Gerontol 2018; 53:237-239. [PMID: 29463424 DOI: 10.1016/j.regg.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
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Bongomin F, Gago S, Oladele RO, Denning DW. Global and Multi-National Prevalence of Fungal Diseases-Estimate Precision. J Fungi (Basel) 2017; 3:E57. [PMID: 29371573 PMCID: PMC5753159 DOI: 10.3390/jof3040057] [Citation(s) in RCA: 1397] [Impact Index Per Article: 199.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 02/07/2023] Open
Abstract
Fungal diseases kill more than 1.5 million and affect over a billion people. However, they are still a neglected topic by public health authorities even though most deaths from fungal diseases are avoidable. Serious fungal infections occur as a consequence of other health problems including asthma, AIDS, cancer, organ transplantation and corticosteroid therapies. Early accurate diagnosis allows prompt antifungal therapy; however this is often delayed or unavailable leading to death, serious chronic illness or blindness. Recent global estimates have found 3,000,000 cases of chronic pulmonary aspergillosis, ~223,100 cases of cryptococcal meningitis complicating HIV/AIDS, ~700,000 cases of invasive candidiasis, ~500,000 cases of Pneumocystis jirovecii pneumonia, ~250,000 cases of invasive aspergillosis, ~100,000 cases of disseminated histoplasmosis, over 10,000,000 cases of fungal asthma and ~1,000,000 cases of fungal keratitis occur annually. Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious fungal infections country by country for over 5.7 billion people (>80% of the world's population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations. Here we interrogate the accuracy of these fungal infection burden estimates in the 43 published papers within the LIFE initiative.
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Affiliation(s)
- Felix Bongomin
- The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
| | - Sara Gago
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester M13, 9PL, UK.
| | - Rita O Oladele
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
| | - David W Denning
- The National Aspergillosis Center, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
- Global Action Fund for Fungal Infections, 1211 Geneva 1, Switzerland.
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester M13, 9PL, UK.
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Wu Y, Xu H, Li L, Yuan W, Zhang D, Huang W. Susceptibility to Aspergillus Infections in Rats with Chronic Obstructive Pulmonary Disease via Deficiency Function of Alveolar Macrophages and Impaired Activation of TLR2. Inflammation 2017; 39:1310-8. [PMID: 27312383 PMCID: PMC4951508 DOI: 10.1007/s10753-016-0363-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Clinical evidence indicates that patients with severe chronic obstructive pulmonary disease (COPD) are more susceptible to Aspergillus. However, the exact mechanisms underlying this effect are not known. In this study, we used cigarette smoke exposure to generate COPD rat model. colony-forming units (CFU) count assessment and phagocytosis were applied to evaluate the defense function of COPD rats against Aspergillus challenge. ELISA, western blotting, and GST-Rac1 pull-down assays were conducted to determine the expressions of cytokines and TLR2-associated signaling pathway. Our data showed that Aspergillus burdens increased, phagocytosis of Aspergillus as well as the expressions of inflammatory cytokines from alveolar macrophages (AMs) were impaired in COPD rats compared with normal rats. Though TLR2 signaling-related proteins were induced in response to the stimulation of Aspergillus or Pam3csk4 (TLR2 agonist), the activation of TLR2-associated signaling pathway was apparently interfered in rats with COPD, compared to that in normal rats. Taken together, our study demonstrated that COPD caused the deficiency of AMs function and impaired the activation of TLR2/PI3K/Rac 1 signaling pathway, leading to invasion of Aspergillus infection, which also provides a future basis for the infection control in COPD patients.
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Affiliation(s)
- Yuting Wu
- Graduate School, Southern Medical University, No1023, Shatai South Street, Guangzhou, Guangdong, 510515, China
| | - Hong Xu
- Respiratory Center of PLA, General Hospital of Guangzhou Command of PLA, Gangzhou, Guangdong, 510010, China
| | - Li Li
- Respiratory Center of PLA, General Hospital of Guangzhou Command of PLA, Gangzhou, Guangdong, 510010, China
| | - Weifeng Yuan
- Respiratory Center of PLA, General Hospital of Guangzhou Command of PLA, Gangzhou, Guangdong, 510010, China
| | - Deming Zhang
- Department of elderly Respiratory, General Hospital of Guangzhou Command of PLA, Guangzhou, Guangdong, 510010, China
| | - Wenjie Huang
- Graduate School, Southern Medical University, No1023, Shatai South Street, Guangzhou, Guangdong, 510515, China. .,Respiratory Center of PLA, General Hospital of Guangzhou Command of PLA, Gangzhou, Guangdong, 510010, China.
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Tilavberdiev SA, Denning DW, Klimko NN. Serious fungal diseases in the Republic of Uzbekistan. Eur J Clin Microbiol Infect Dis 2017; 36:925-929. [PMID: 28293759 DOI: 10.1007/s10096-017-2926-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
Abstract
We have undertaken the first and preliminary estimation of severe and chronic mycotic diseases in the Republic of Uzbekistan, using a model proposed by LIFE (Leading International Fungal Education). Calculation was carried out based on data from 2014. Published results describing mycoses in Uzbekistan were identified. In the absence of published or official data, information about the frequency of mycoses from scientific literature elsewhere in groups at risk of development of fungal infections were taken into account. We also utilized methodology used in analogous estimations of mycoses in the Russian Federation. We estimate that of the 30.8 million population, 536,978 people (1.8% of the population) were affected by severe and chronic mycotic diseases. In 2014, there were 12,351 cases of acute invasive fungal diseases and 524,627 cases of chronic fungal diseases, including 1,941 cases of chronic pulmonary aspergillosis. The most frequent problems were recurrent vulvovaginal candidiasis (513,600 cases), trichophytosis of the scalp (6,414), and relapsed oral candidiasis (4,950). Results of the investigation indicate a significant prevalence of mycoses in the Republic of Uzbekistan.
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Affiliation(s)
| | - D W Denning
- The University of Manchester, Manchester, UK
| | - N N Klimko
- I. Metchnikov North-Western State Medical University, 1/28 Santiago-de-Cuba str., St.-Petersburg, 194291, Russia.
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43
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Serious fungal infections in Egypt. Eur J Clin Microbiol Infect Dis 2017; 36:971-974. [PMID: 28213689 DOI: 10.1007/s10096-017-2929-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/26/2022]
Abstract
We aimed to estimate the burden of serious fungal infections in Egypt, currently unknown, based on the size of the populations at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports with clearcut denominators. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. The population of Egypt in 2011 was ∼82,500,000; 31% children, and 8% women >60 years of age. Amongst about 21.8 million women aged 15-50 years, recurrent vulvovaginal candidiasis (≥4 episodes/year) is estimated to occur in 1.3 million (3,169/100,000 females). Using a low international average rate of 5/100,000, we estimate 4,127 cases of candidaemia, and 619 patients with intra-abdominal candidiasis. Amongst the survivors of pulmonary tuberculosis (TB) in Egypt in 2012, 319 new cases of chronic pulmonary aspergillosis (CPA) are likely, a prevalence of 1,005 post-TB and a total prevalence estimate of 3,015 CPA patients in all. Asthma is common in Egypt, affecting 9.4% of adults, 5.35 million, and so ABPA and SAFS were estimated in around 162/100,000 and 214/100,000 respectively. Invasive aspergillosis is estimated to affect 495 patients following leukaemia therapy, there are an estimated 37 cases in renal and liver transplant recipients, and an estimated 132 patients develop IA in the context of lung cancer. Amongst 641,000 COPD admissions to hospital each year, 8,337 patients develop IA. The total HIV-infected population is small, with an estimated 6,500 patients, 2,500 not on antiretroviral therapy. Amongst HIV-infected patients, 38 (0.6%) cases of cryptococcal meningitis and 125 (1.9%) cases of Pneumocystis pneumonia are estimated each year. Fungal keratitis is common, with 28-55% (mean 40%) of corneal infections being fungal, an estimated total of 11,550 cases. The present study indicates that 2% of the Egyptian population is affected by fungal infections. The estimates are certainly incomplete, and need further epidemiological and diagnostic studies.
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44
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Serious fungal infections in Pakistan. Eur J Clin Microbiol Infect Dis 2017; 36:949-956. [PMID: 28161741 DOI: 10.1007/s10096-017-2919-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/25/2022]
Abstract
The true burden of fungal infection in Pakistan is unknown. High-risk populations for fungal infections [tuberculosis (TB), diabetes, chronic respiratory diseases, asthma, cancer, transplant and human immunodeficiency virus (HIV) infection] are numerous. Here, we estimate the burden of fungal infections to highlight their public health significance. Whole and at-risk population estimates were obtained from the WHO (TB), BREATHE study (COPD), UNAIDS (HIV), GLOBOCAN (cancer) and Heartfile (diabetes). Published data from Pakistan reporting fungal infections rates in general and specific populations were reviewed and used when applicable. Estimates were made for the whole population or specific populations at risk, as previously described in the LIFE methodology. Of the 184,500,000 people in Pakistan, an estimated 3,280,549 (1.78%) are affected by a serious fungal infection, omitting all cutaneous infection, oral candidiasis and allergic fungal sinusitis, which we could not estimate. Compared with other countries, the rates of candidaemia (21/100,000) and mucormycosis (14/100,000) are estimated to be very high, and are based on data from India. Chronic pulmonary aspergillosis rates are estimated to be high (39/100,000) because of the high TB burden. Invasive aspergillosis was estimated to be around 5.9/100,000. Fungal keratitis is also problematic in Pakistan, with an estimated rate of 44/100,000. Pakistan probably has a high rate of certain life- or sight-threatening fungal infections.
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Denning DW, Perlin DS, Muldoon EG, Colombo AL, Chakrabarti A, Richardson MD, Sorrell TC. Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Fungal Diagnostic Capabilities. Emerg Infect Dis 2017; 23:177-183. [PMID: 27997332 PMCID: PMC5324810 DOI: 10.3201/eid2302.152042] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Antimicrobial resistance, a major public health concern, largely arises from excess use of antibiotic and antifungal drugs. Lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. In support of this contention, we cite 4 common clinical situations that illustrate this problem: 1) inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis; 2) failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis; 3) misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease; and 4) overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients. All communities should have access to nonculture fungal diagnostics, which can substantially benefit clinical outcome, antimicrobial stewardship, and control of antimicrobial resistance.
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Liang S, Jiang R, Lu HW, Mao B, Li MH, Li CW, Gu SY, Bai JW, Xu JF. Immunity status of invasive pulmonary aspergillosis patients with structural lung diseases in Chinese adults. J Thorac Dis 2017; 9:247-253. [PMID: 28275471 DOI: 10.21037/jtd.2017.02.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Invasive pulmonary aspergillosis (IPA) is a fungal infection frequently observed in patients with immune dysfunction, such as those suffering from structural lung diseases. Nevertheless, studies assessing IPA combined with other common respiratory diseases remain scarce, particularly those regarding the immune status of its patients. Different structural lung diseases are known to differently affect patient immune status; however, the mechanisms by which this is conferred have yet to be determined. Thus, our study aims to compare the immune status of IPA patients with the structural lung diseases chronic obstructive pulmonary diseases (COPD), interstitial lung disease (ILD) and non-cystic fibrosis bronchiectasis (NCFB). METHODS This study was performed retrospectively with data collected over the years 2004 to 2013 at Shanghai Pulmonary Hospital, Tongji University, and included 77 patients whose lower respiratory tract (LRT) samples tested positive for. Our analysis considered blood examinations of CD3+, CD4+, CD8+, CD4+/CD8+, IgG, IgA and IgM levels. RESULTS CD4+/CD8+ double positive cells, representing cell-mediated immunity, were less abundant in IPA patients with COPD than those with ILD and NCFB (0.81±0.09 vs. 1.39±0.25 and 0.81±0.09 vs. 1.57±0.06, respectively, P<0.001). In agreement with this result, corticosteroid and broad-spectrum antibiotic use were most common in individuals with COPD (57%). IgA levels, which indicate humoral immunity, were lower in IPA patients with NCFB than those with COPD or ILD (0.95±0.28 vs. 1.64±0.40 g/L and 0.95±0.28 vs. 3.16±0.83 g/L, respectively, P<0.001). CONCLUSIONS Immunity status differs between IPA patients with different structural lung diseases. Among IPA patients with COPD, ILD and NCFB, those with COPD have the lowest cell-mediated immunity, while those with NCFB have the lowest humoral immunity.
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Affiliation(s)
- Shuo Liang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Rong Jiang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Hai-Wen Lu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Bei Mao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Man-Hui Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Cheng-Wei Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Shu-Yi Gu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jiu-Wu Bai
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jin-Fu Xu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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47
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Pegorie M, Denning DW, Welfare W. Estimating the burden of invasive and serious fungal disease in the United Kingdom. J Infect 2017; 74:60-71. [DOI: 10.1016/j.jinf.2016.10.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 01/07/2023]
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48
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Enoch DA, Yang H, Aliyu SH, Micallef C. The Changing Epidemiology of Invasive Fungal Infections. Methods Mol Biol 2017; 1508:17-65. [PMID: 27837497 DOI: 10.1007/978-1-4939-6515-1_2] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.
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Affiliation(s)
- David A Enoch
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK.
| | - Huina Yang
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Sani H Aliyu
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
| | - Christianne Micallef
- National Infection Service, Public Health England, Cambridge Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Box 236, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QW, UK
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López-Medrano F, Fernández-Ruiz M, Silva JT, Carver PL, van Delden C, Merino E, Pérez-Saez MJ, Montero M, Coussement J, de Abreu Mazzolin M, Cervera C, Santos L, Sabé N, Scemla A, Cordero E, Cruzado-Vega L, Martín-Moreno PL, Len Ó, Rudas E, de León AP, Arriola M, Lauzurica R, David M, González-Rico C, Henríquez-Palop F, Fortún J, Nucci M, Manuel O, Paño-Pardo JR, Montejo M, Muñoz P, Sánchez-Sobrino B, Mazuecos A, Pascual J, Horcajada JP, Lecompte T, Moreno A, Carratalà J, Blanes M, Hernández D, Fariñas MC, Andrés A, Aguado JM. Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study. Am J Transplant 2016; 16:3220-3234. [PMID: 27105907 DOI: 10.1111/ajt.13837] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/24/2016] [Accepted: 04/17/2016] [Indexed: 01/25/2023]
Abstract
The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; p-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J T Silva
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P L Carver
- University of Michigan Health System, Ann Harbor, MI
| | - C van Delden
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - E Merino
- Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain
| | - M J Pérez-Saez
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Montero
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Coussement
- Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M de Abreu Mazzolin
- Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - C Cervera
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - L Santos
- Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - N Sabé
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - A Scemla
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France
| | - E Cordero
- Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - L Cruzado-Vega
- Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain
| | - P L Martín-Moreno
- Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ó Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - E Rudas
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - A P de León
- Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - R Lauzurica
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M David
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - F Henríquez-Palop
- Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain
| | - J Fortún
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain
| | - M Nucci
- Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - O Manuel
- Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - J R Paño-Pardo
- Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain
| | - P Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - B Sánchez-Sobrino
- Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Mazuecos
- Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain
| | - J Pascual
- Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - T Lecompte
- Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland
| | - A Moreno
- Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - M Blanes
- Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain
| | - D Hernández
- Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain
| | - M C Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Corzo-León DE, Armstrong-James D, Denning DW. Burden of serious fungal infections in Mexico. Mycoses 2016; 58 Suppl 5:34-44. [PMID: 26449505 DOI: 10.1111/myc.12395] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/15/2015] [Accepted: 08/17/2015] [Indexed: 12/29/2022]
Abstract
Serious fungal infections (SFIs) could be more frequent than are recognised. Estimates of the incidence and prevalence of SFIs are essential in order to identify public health problems. We estimated the rates of SFIs in Mexico, following a methodology similar to that used in prior studies. We obtained information about the general population and populations at risk. A systematic literature search was undertaken to identify epidemiological reports of SFIs in Mexico. When Mexican reports were unavailable, we based our estimates on international literature. The most prevalent SFIs in Mexico are recurrent vulvovaginal candidiasis (5999 per 100,000) followed by allergic bronchopulmonary aspergillosis (60 per 100,000), chronic pulmonary aspergillosis (15.9 per 100,000), fungal keratitis (10.4 per 100,000), invasive candidiasis (8.6 per 100,000) and SFIs in HIV (8.2 per 100,000); coccidioidomycosis (7.6 per 100,000), IA (4.56 per 100,000). These correspond to 2,749,159 people affected in any year (2.45% of the population), probably >10,000 deaths and 7000 blind eyes. SFIs affect immunocompromised and healthy populations. Most are associated with high morbidity and mortality rates. Validation of these estimates with epidemiological studies is required. The burdens indicate that an urgent need to improve medical skills, surveillance, diagnosis, and management of SFIs exists.
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Affiliation(s)
- D E Corzo-León
- Infectious Diseases and Epidemiology Department, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - D Armstrong-James
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,The NIHR Respiratory Rare Diseases Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - D W Denning
- National Aspergillosis Centre, The University Hospital of South Manchester, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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