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Sabadin CES, Matta DAD, Hoppe L, Fernandes FAV, Melo ASDA, Rigo L, Barbosa DA. Oral candidiasis in liver transplant patients: species identification and antifungal susceptibility profile. EINSTEIN-SAO PAULO 2024; 22:eAO0138. [PMID: 38775603 PMCID: PMC11081021 DOI: 10.31744/einstein_journal/2024ao0138] [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: 04/26/2022] [Accepted: 09/18/2023] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This study aimed to verify oral candidiasis, identify the causative species, and investigate the antifungal susceptibility of yeasts isolated from liver transplant patients. METHODS A descriptive analysis of 97 patients who underwent liver transplantation was conducted at a hospital. Two clinical examinations (Collections A and B) of the oral cavity were performed. Oral material was collected from all patients, inoculated in Sabouraud Dextrose Agar, and incubated at 35℃ for 48 hours. Samples were identified by molecular sequencing of the internal trascribed space region of rDNA. RESULTS An antifungal susceptibility test with fluconazole, amphotericin B, and micafungin was performed using the Clinical and Laboratory Standards Institute yeast broth microdilution method. Among the patients, 15 presented with oral candidiasis: eight in Collection A and seven in Collection B. The primary type of candidiasis was atrophic, followed by pseudomembranous candidiasis. The most prevalent species was Candida albicans (nine), followed by Candida glabrata (three), Candida tropicalis (two), and Candida dubliniensis (one). Regarding susceptibility to fluconazole, of the 15 samples, 11 were susceptible, three were susceptible in a dose-dependent manner, and one was resistant. CONCLUSION The most commonly identified type of candidiasis was atrophic, with C. albicans and C. glabrata being the most prevalent causative species. One fluconazole-resistant isolate each of C. tropicalis and C. albicans were identified.
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Affiliation(s)
| | - Daniel Archimedes Da Matta
- Universidade Federal de São PauloSão PauloSPBrazil Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Lísia Hoppe
- Universidade Federal de São PauloSão PauloSPBrazil Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Lilian Rigo
- Meridional CollegePasso FundoRSBrazil Meridional College, Passo Fundo, RS, Brazil.
| | - Dulce Aparecida Barbosa
- Universidade Federal de São PauloSão PauloSPBrazil Universidade Federal de São Paulo, São Paulo, SP, Brazil.
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2
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Davies GE, Thornton CR. A Lateral-Flow Device for the Rapid Detection of Scedosporium Species. Diagnostics (Basel) 2024; 14:847. [PMID: 38667492 PMCID: PMC11048963 DOI: 10.3390/diagnostics14080847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Scedosporium species are human pathogenic fungi, responsible for chronic, localised, and life-threatening disseminated infections in both immunocompetent and immunocompromised individuals. The diagnosis of Scedosporium infections currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and the time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Scedosporium-specific biomarkers. Here, we report the development of a rapid (30 min) and sensitive (pmol/L sensitivity) lateral-flow device (LFD) test, incorporating a Scedosporium-specific IgG1 monoclonal antibody (mAb), HG12, which binds to extracellular polysaccharide (EPS) antigens between ~15 kDa and 250 kDa secreted during the hyphal growth of the pathogens. The test is compatible with human serum and allows for the detection of the Scedosporium species most frequently reported as agents of human disease (Scedosporium apiospermum, Scedosporium aurantiacum, and Scedosporium boydii), with limits of detection (LODs) of the EPS biomarkers in human serum of ~0.81 ng/mL (S. apiospermum), ~0.94 ng/mL (S. aurantiacum), and ~1.95 ng/mL (S. boydii). The Scedosporium-specific LFD (ScedLFD) test therefore provides a potential novel opportunity for the detection of infections caused by different Scedosporium species.
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Affiliation(s)
- Genna E. Davies
- ISCA Diagnostics Ltd., B12A, Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
| | - Christopher R. Thornton
- ISCA Diagnostics Ltd., B12A, Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
- Biosciences, Faculty of Health and Life Sciences, Prince of Wales Road, Exeter EX4 4PS, UK
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3
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Atchade E, Desmard M, Kantor E, Genève C, Tebano G, De Tymowski C, Tran-dinh A, Zappella N, Houzé S, Mal H, Castier Y, Tanaka S, Montravers P. Fungal Isolation in Respiratory Tract After Lung Transplantation: Epidemiology, Clinical Consequences, and Associated Factors. Transplant Proc 2020; 52:326-332. [DOI: 10.1016/j.transproceed.2019.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
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4
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Cutaneous Fungal Masses From Prior Environmental Injury Following Kidney Transplant: A Case Report. Transplant Proc 2019; 51:3087-3091. [PMID: 31611114 DOI: 10.1016/j.transproceed.2019.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/28/2019] [Indexed: 01/03/2023]
Abstract
Fungus account for ∼ 5% of all cases infections following solid organ transplant. Fungal infections in the setting of immunosuppression may progress rapidly and present in an atypical pattern. Herein we describe 4 cases of environmental fungal infections acquired decades prior to transplant that developed into localized atypical cutaneous masses following kidney transplant.
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Agnelli C, Valerio M, Olmedo M, Guinea J, Zatarain‐Nicolás E, del Carmen Martínez‐Jiménez M, Alcalá L, Escribano P, Cebollero Presmanes M, Bouza E, Muñoz P, Martín‐Rabadán P. Fatal disseminated infection by
Gymnascella hyalinospora
in a heart transplant recipient. Transpl Infect Dis 2019; 21:e13128. [DOI: 10.1111/tid.13128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/30/2019] [Accepted: 06/02/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Caroline Agnelli
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - María Olmedo
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - Jesús Guinea
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058) Madrid Spain
- Department of Medicine, Facultad de Medicina Universidad Complutense de Madrid Madrid Spain
| | - Eduardo Zatarain‐Nicolás
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
- Department of Cardiology Hospital General Universitario Gregorio Marañón Madrid Spain
| | - María del Carmen Martínez‐Jiménez
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - Luis Alcalá
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - Pilar Escribano
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
| | - María Cebollero Presmanes
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
- Department of Pathology Hospital General Universitario Gregorio Marañón Madrid Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058) Madrid Spain
- Department of Medicine, Facultad de Medicina Universidad Complutense de Madrid Madrid Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058) Madrid Spain
- Department of Medicine, Facultad de Medicina Universidad Complutense de Madrid Madrid Spain
| | - Pablo Martín‐Rabadán
- Department of Clinical Microbiology and Infectious Diseases Hospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
- Department of Medicine, Facultad de Medicina Universidad Complutense de Madrid Madrid Spain
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6
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Husain S, Camargo JF. Invasive Aspergillosis in solid-organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13544. [PMID: 30900296 DOI: 10.1111/ctr.13544] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/18/2019] [Indexed: 12/13/2022]
Abstract
These updated AST-IDCOP guidelines provide information on epidemiology, diagnosis, and management of Aspergillus after organ transplantation. Aspergillus is the most common invasive mold infection in solid-organ transplant (SOT) recipients, and it is the most common invasive fungal infection among lung transplant recipients. Time from transplant to diagnosis of invasive aspergillosis (IA) is variable, but most cases present within the first year post-transplant, with shortest time to onset among liver and heart transplant recipients. The overall 12-week mortality of IA in SOT exceeds 20%; prognosis is worse among those with central nervous system involvement or disseminated disease. Bronchoalveolar lavage galactomannan is preferred for the diagnosis of IA in lung and non-lung transplant recipients, in combination with other diagnostic modalities (eg, chest CT scan, culture). Voriconazole remains the drug of choice to treat IA, with isavuconazole and lipid formulations of amphotericin B regarded as alternative agents. The role of combination antifungals for primary therapy of IA remains controversial. Either universal prophylaxis or preemptive therapy is recommended in lung transplant recipients, whereas targeted prophylaxis is favored in liver and heart transplant recipients. In these guidelines, we also discuss newer antifungals and diagnostic tests, antifungal susceptibility testing, and special patient populations.
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Affiliation(s)
- Shahid Husain
- Division of Infectious Diseases, Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jose F Camargo
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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7
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Dermatological Disorders following Liver Transplantation: An Update. Can J Gastroenterol Hepatol 2019; 2019:9780952. [PMID: 31058114 PMCID: PMC6463607 DOI: 10.1155/2019/9780952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/24/2019] [Accepted: 03/11/2019] [Indexed: 02/08/2023] Open
Abstract
Patients undergoing liver transplantation (LT) are at a high risk of dermatological complications compared to the general population as a result of long-term use of immunosuppressant. However, the risk is not as high as other solid organ transplantations (SOT), particularly for skin cancer. The liver is considered as an immune privileged organ since it has a low prevalence of humoral rejection in contrast to other SOT, and thus, LT requires a minimal amount of immunosuppressants compared to other SOT recipients. However, because of the large volume of the liver, patients with LT have higher donor lymphocytes that sometimes may trigger graft-versus-host-disease, yet it is rare. On the other hand, the vast majority of the nonspecific dermatological lesions linked with cirrhosis improve after removal of diseased liver or due to the immunosuppressant used after LT. Nevertheless, dermatological infections related to bacteria, viruses, and fungus after LT are not uncommon. Additionally, the incidence of IgE-mediated food allergies develops in 12.2% of LT patients and may present as life-threatening conditions such as urticaria and/or angioedema and hypersensitivity. Moreover, skin malignancies after LT are a matter of concern. Thus, posttransplant dermatological care should be provided to all LT patients for any suspicious dermatological lesions. Our goal is to give an outline of the dermatological manifestation associated with LT for the clinicians by collecting the published data from all archived case reports.
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8
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Ference EH, Kubak BM, Zhang P, Suh JD. Successful Treatment of Scedosporium Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management. ALLERGY & RHINOLOGY 2019; 10:2152656719827253. [PMID: 30792939 PMCID: PMC6376547 DOI: 10.1177/2152656719827253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Scedosporium fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation. Objectives To identify and evaluate treatment options. Methods This study is a retrospective review of patients treated at a tertiary academic medical center from 2007 to 2017 with positive sinonasal cultures. A review of the literature was also performed to identify additional cases. Results Two lung transplant patients had a positive culture for Scedosporium. The literature search resulted in 37 citations, which yielded only 2 prior cases of Scedosporium paranasal sinus colonization or infection in lung transplant recipients. Three of the 4 patients had cystic fibrosis. Two of the patients were colonized before initial transplant, while 1 patient was colonized before subsequent transplant. Three of the 4 patients survived, and all 3 had disease isolated to their sinuses and lungs treated with sinus surgery, while the fourth had disseminated disease and did not undergo sinus surgery. All patients were treated with multiple antifungals due to resistance patterns. One surviving patient cleared both sinus and lung cultures in less than 1 month, while the other 2 surviving patients achieved negative cultures after a minimum of 6 months. Conclusions Surgery may be especially important in patients with fungal sinus colonization or infection before or after lung transplantation. Chronic sinusitis is an important source for persistent fungal colonization and reinfection of the allograft which could be removed with surgical debridement before causing highly morbid pulmonary disease.
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Affiliation(s)
- Elisabeth H Ference
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Bernard M Kubak
- Department of Infectious Disease, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Paul Zhang
- Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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9
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Manuel O, Ison MG. Prevention and Treatment of Yeast and Endemic Fungal Infections. INFECTIOUS DISEASES IN SOLID-ORGAN TRANSPLANT RECIPIENTS 2019. [PMCID: PMC7138456 DOI: 10.1007/978-3-030-15394-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Invasive fungal infections (IFIs) remain an important complication of solid organ transplantation owing to their significant morbidity and mortality and include infections due to Candida, Cryptococcus, endemic mycosis, and other rare yeasts and molds. IFIs occur in different intervals posttransplantation and depend on a number of extrinsic and intrinsic risk factors, some of which are specific to the type of organs transplanted, surgical techniques, and type of immunosuppressive medications. Donor-derived IFIs and emergence of new multidrug-resistant yeasts have been reported in various healthcare settings. Clinical manifestations of yeast and endemic fungal infections vary in different types of organ transplants. Diagnosis of IFIs in SOT recipients is challenging due to their nonspecific signs and symptoms owing to the impaired inflammatory responses as a result of immunosuppression and the lack of highly sensitive and specific diagnostic modalities. Early diagnosis is key to successful therapy, and physicians should have a high index of suspicion based on risk factors and epidemiology of these pathogens. Antifungal treatment strategies for yeast infections have been outlined in various society guidelines. Management of complications that arise before or during antifungal therapy is critical for optimizing clinical response.
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Affiliation(s)
- Oriol Manuel
- Infectious Diseases Service and Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michael G Ison
- School of Medicine, Northwestern University Feinberg, Chicago, IL USA
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10
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Torres-Sánchez MJ, Hernández-García E, Gómez-Sánchez J, Palomares-Bayo M, Peña-Ortega M, Galindo-Sacristán P, De Gracia-Guindo C, Osuna-Ortega A. Severe Scedosporium apiospermum Infection in a Recent Renal Transplant Recipient: Case Report. Transplant Proc 2018; 50:683-684. [PMID: 29579888 DOI: 10.1016/j.transproceed.2017.09.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/21/2017] [Indexed: 10/17/2022]
Abstract
Infections in transplanted patients are still an important cause of morbidity and mortality. Among them, fungal infections with pathogens have become increasingly more prevalent in the last decade. We report the clinical course and management of disseminated Scedosporium apiospermum infection in a kidney transplant recipient, with microbiological isolation of the fungus in cerebrospinal fluid culture. S apiospermum is a fungus that is distributed worldwide and can be grown from soil samples or stagnant water. Disseminated infection is the most frequent form of infection, with cerebral involvement in most cases, which leads to a very high mortality (around 75%). Post-transplant renal infections require a thorough evaluation. Specifically, a high suspicion index is necessary, considering Scedosporium infection among the differential diagnosis of invasive fungal diseases in renal transplantation patients. It is essential to confirm the microbiological diagnosis for an adequate diagnosis and treatment.
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Affiliation(s)
- M J Torres-Sánchez
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain.
| | - E Hernández-García
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - J Gómez-Sánchez
- Department of Surgery, University Hospital of Granada, Granada, Spain
| | - M Palomares-Bayo
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - M Peña-Ortega
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - P Galindo-Sacristán
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - C De Gracia-Guindo
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
| | - A Osuna-Ortega
- Nephrology Department, University Hospital Virgen de las Nieves, Granada, Spain
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Abstract
In the ever-aging population of the world, the field of geriatrics continues to grow in importance. As human beings age, the skin undergoes a unique array of changes that predispose it to a specific set of dermatoses, infections, and neoplasms. Some of these physiologic alterations are comparable to the changes that happen in immunosuppressed individuals. Given the importance of immunosuppressive medications in treatment of many common skin conditions, we have reviewed the current literature to assist the practicing clinician in using immunosuppressive medications in the geriatric population.
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Affiliation(s)
- Artem M Sergeyenko
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - David J Rosenfeld
- Department of Dermatology, Loyola University Medical Center, Maywood, IL
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
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12
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Smita S, Sunil S, Amarjeet K, Anil B, Yatin M. Surviving a recurrent Scedosporium prolificans endocarditis: Mention if consent was taken. Indian J Med Microbiol 2016; 33:588-90. [PMID: 26470972 DOI: 10.4103/0255-0857.167322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Scedosporium prolificans have been reported to be resistant to all antifungals including the newer azoles and echinocandins. We report an unusual case of repeated S. prolificans infection of the heart valves in an immunocompetent patient.
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Affiliation(s)
- S Smita
- Department of Microbiology, Institute of Critical Care and Anaesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
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13
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Case Report of Vertebral Osteomyelitis and Mycotic Abdominal Aortic Aneurysm Caused by Scedosporium apiospermum in a Lung Transplant Patient With Cystic Fibrosis. Transplant Proc 2015; 47:204-9. [DOI: 10.1016/j.transproceed.2014.07.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022]
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Yew SM, Chan CL, Lee KW, Na SL, Tan R, Hoh CC, Yee WY, Ngeow YF, Ng KP. A five-year survey of dematiaceous fungi in a tropical hospital reveals potential opportunistic species. PLoS One 2014; 9:e104352. [PMID: 25098697 PMCID: PMC4123927 DOI: 10.1371/journal.pone.0104352] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 07/11/2014] [Indexed: 01/06/2023] Open
Abstract
Dematiaceous fungi (black fungi) are a heterogeneous group of fungi present in diverse environments worldwide. Many species in this group are known to cause allergic reactions and potentially fatal diseases in humans and animals, especially in tropical and subtropical climates. This study represents the first survey of dematiaceous fungi in Malaysia and provides observations on their diversity as well as in vitro response to antifungal drugs. Seventy-five strains isolated from various clinical specimens were identified by morphology as well as an internal transcribed spacer (ITS)-based phylogenetic analysis. The combined molecular and conventional approach enabled the identification of three classes of the Ascomycota phylum and 16 genera, the most common being Cladosporium, Cochliobolus and Neoscytalidium. Several of the species identified have not been associated before with human infections. Among 8 antifungal agents tested, the azoles posaconazole (96%), voriconazole (90.7%), ketoconazole (86.7%) and itraconazole (85.3%) showed in vitro activity (MIC ≤1 µg/mL) to the largest number of strains, followed by anidulafungin (89.3%), caspofungin (74.7%) and amphotericin B (70.7%). Fluconazole appeared to be the least effective with only 10.7% of isolates showing in vitro susceptibility. Overall, almost half (45.3%) of the isolates showed reduced susceptibility (MIC >1 µg/mL) to at least one antifungal agent, and three strains (one Pyrenochaeta unguis-hominis and two Nigrospora oryzae) showed potential multidrug resistance.
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Affiliation(s)
- Su Mei Yew
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chai Ling Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Wei Lee
- Codon Genomics SB, Jalan Bandar Lapan Belas, Pusat Bandar Puchong, Selangor Darul Ehsan, Malaysia
| | - Shiang Ling Na
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ruixin Tan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee-Choong Hoh
- Codon Genomics SB, Jalan Bandar Lapan Belas, Pusat Bandar Puchong, Selangor Darul Ehsan, Malaysia
| | - Wai-Yan Yee
- Codon Genomics SB, Jalan Bandar Lapan Belas, Pusat Bandar Puchong, Selangor Darul Ehsan, Malaysia
| | - Yun Fong Ngeow
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Peng Ng
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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Affiliation(s)
- Daire T O'Shea
- Transplant Infectious Diseases, Alberta Transplant Institute, University of Alberta, 6-030 Katz Center for Health Research, 11361-87 Ave, Edmonton, Alberta T6G 2E1, Canada
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17
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Abstract
The most important emerging and rare fungal pathogens in solid organ transplant recipients are the Zygomycetes, Scedosporium, Fusarium, and the dark molds. Factors affecting the emergence of these fungi include the combination of intensive immunosuppressive regimens with increasingly widespread use of long-term azole antifungal therapy; employment of aggressive diagnostic approaches (eg, sampling of bronchoalveolar lavage fluid); and changes in patients' interactions with the environment. This article reviews the epidemiology, microbiology, and clinical impact of emerging fungal infections in solid organ transplant recipients, and provides up-to-date recommendations on their treatment.
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Affiliation(s)
- Shmuel Shoham
- Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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18
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Utility of PCR in diagnosis of invasive fungal infections: real-life data from a multicenter study. J Clin Microbiol 2012; 51:863-8. [PMID: 23269732 DOI: 10.1128/jcm.02965-12] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Prospective studies addressing the clinical value of broad-range PCR using the internal transcribed spacer region (ITS) for diagnosis of microscopy-negative fungal infections in nonselected patient populations are lacking. We first assessed the diagnostic performance of ITS rRNA gene PCR compared with that of routine microscopic immunofluorescence examination. Second, we addressed prospectively the impact and clinical value of broad-range PCR for the diagnosis of infections using samples that tested negative by routine microscopy; the corresponding patients' data were evaluated by detailed medical record reviews. Results from 371 specimens showed a high concordance of >80% for broad-range PCR and routine conventional methods, indicating that the diagnostic performance of PCR for fungal infections is comparable to that of microscopy, which is currently considered part of the "gold standard." In this prospective study, 206 specimens with a negative result on routine microscopy were analyzed with PCR, and patients' clinical data were reviewed according to the criteria of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. We found that broad-range PCR showed a sensitivity, specificity, positive predictive value, and negative predictive value of 57.1%, 97.0%, 80%, and 91.7%, respectively, for microscopy-negative fungal infections. This study defines a possible helpful role of broad-range PCR for diagnosis of microscopy-negative fungal infections in conjunction with other tests.
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Singh N, Huprikar S, Burdette SD, Morris MI, Blair JE, Wheat LJ. Donor-derived fungal infections in organ transplant recipients: guidelines of the American Society of Transplantation, infectious diseases community of practice. Am J Transplant 2012; 12:2414-28. [PMID: 22694672 DOI: 10.1111/j.1600-6143.2012.04100.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-derived fungal infections can be associated with serious complications in transplant recipients. Most cases of donor-derived candidiasis have occurred in kidney transplant recipients in whom contaminated preservation fluid is a commonly proposed source. Donors with cryptococcal disease, including those with unrecognized cryptococcal meningoencephalitis may transmit the infection with the allograft. Active histoplasmosis or undiagnosed and presumably asymptomatic infection in the donor that had not resolved by the time of death can result in donor-derived histoplasmosis in the recipient. Potential donors from an endemic area with either active or occult infection can also transmit coccidioidomycosis. Rare instances of aspergillosis and other mycoses, including agents of mucormycosis may also be transmitted from infected donors. Appropriate diagnostic evaluation and prompt initiation of appropriate antifungal therapy are warranted if donor-derived fungal infections are a consideration. This document discusses the characteristics, evaluation and approach to the management of donor-derived fungal infections in organ transplant recipients.
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Affiliation(s)
- N Singh
- University of Pittsburgh, PA, USA.
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Shoham S, Marr KA. Invasive fungal infections in solid organ transplant recipients. Future Microbiol 2012; 7:639-55. [PMID: 22568718 DOI: 10.2217/fmb.12.28] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Invasive fungal infections are a major problem in solid organ transplant (SOT) recipients. Overall, the most common fungal infection in SOT is candidiasis, followed by aspergillosis and cryptococcosis, except in lung transplant recipients, where aspergillosis is most common. Development of invasive disease hinges on the interplay between host factors (e.g., integrity of anatomical barriers, innate and acquired immunity) and fungal factors (e.g., exposure, virulence and resistance to prophylaxis). In this article, we describe the epidemiology and clinical features of the most common fungal infections in organ transplantation. Within this context, we review recent advances in diagnostic modalities and antifungal chemotherapy, and their impact on evolving prophylaxis and treatment paradigms.
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Affiliation(s)
- Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Formas clínicas y tratamiento de las infecciones causadas por otros hongos filamentosos. Enferm Infecc Microbiol Clin 2012; 30:414-9. [DOI: 10.1016/j.eimc.2012.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/12/2012] [Indexed: 12/20/2022]
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Bourke P, Castro P, Rabagliati R, Beltran C, Verdejo H, Winter J, Bourge R. Zygomycosis over-infection during voriconazole therapy for aspergillosis in a heart transplant patient, successfully treated with liposomal amphotericin and posaconazole. Transpl Infect Dis 2012; 14:E56-9. [DOI: 10.1111/j.1399-3062.2012.00772.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/13/2012] [Accepted: 03/13/2012] [Indexed: 11/27/2022]
Affiliation(s)
- P. Bourke
- Division de Enfermedades Cardiovasculares; Escuela de Medicina; Facultad de Medicina Pontificia Universidad Católica de Chile; Santiago; Chile
| | - P. Castro
- Division de Enfermedades Cardiovasculares; Escuela de Medicina; Facultad de Medicina Pontificia Universidad Católica de Chile; Santiago; Chile
| | - R. Rabagliati
- Departamento de Medicina Interna, Escuela de Medicina; Facultad de Medicina Pontificia Universidad Católica de Chile; Santiago; Chile
| | - C. Beltran
- Departamento de Otorrinolaringología; Escuela de Medicina; Facultad de Medicina Pontificia Universidad Católica de Chile; Santiago; Chile
| | - H. Verdejo
- Division de Enfermedades Cardiovasculares; Escuela de Medicina; Facultad de Medicina Pontificia Universidad Católica de Chile; Santiago; Chile
| | - J.L. Winter
- Division de Enfermedades Cardiovasculares; Escuela de Medicina; Facultad de Medicina Pontificia Universidad Católica de Chile; Santiago; Chile
| | - R.C. Bourge
- Division of Cardiovascular Disease; Department of Medicine; University of Alabama at Birmingham; Birmingham; Alabama; USA
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Grossi PA, Gasperina DD, Barchiesi F, Biancofiore G, Carafiello G, De Gasperi A, Sganga G, Menichetti F, Montagna MT, Pea F, Venditti M, Viale P, Viscoli C, Nanni Costa A. Italian guidelines for diagnosis, prevention, and treatment of invasive fungal infections in solid organ transplant recipients. Transplant Proc 2012; 43:2463-71. [PMID: 21839295 DOI: 10.1016/j.transproceed.2011.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Use of various induction regimens, of novel immunosuppressive agents, and of newer prophylactic strategies continues to change the pattern of infections among solid organ transplant (SOT) recipients. Although invasive fungal infections (IFIs) occur at a lower incidence than bacterial and viral infections in this population, they remain a major cause of morbidity and mortality worldwide. In March 2008, a panel of Italian experts on fungal infections and organ transplantation convened in Castel Gandolfo (Rome) to develop consensus guidelines for the diagnosis, prevention, and treatment of IFIs among SOT recipients. We discussed the definitions, microbiological and radiological diagnoses, prophylaxis, empirical treatment, and therapy of established disease. Throughout the consensus document, recommendations as clinical guidelines were rated according to the standard scoring system of the Infectious Diseases Society of America and the United Stated Public Health Service.
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Affiliation(s)
- P A Grossi
- Department of Clinical Medicine, Section of Infectious Diseases, University of Insubria, Varese, Italy.
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Varettas K, Taylor P. Fungal culture of musculoskeletal tissue: what's the point? Cell Tissue Bank 2011; 13:415-20. [PMID: 22203176 DOI: 10.1007/s10561-011-9287-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/13/2011] [Indexed: 10/14/2022]
Abstract
There have not been any studies that review the prevalence of fungal isolates using selective media from samples of banked musculoskeletal tissue retrieved from living and cadaveric donors. A total of 2,036 swab and 2,621 biopsy samples of musculoskeletal tissue from tissue banks were received from the 1st August 2008 till 31st December 2010. Routine culture for fungi using selective media with a prolonged incubation period failed to demonstrate a greater prevalence of fungal isolates than by using non-selective culture media alone. Using selective culture fungi were recovered from only two Sabouraud agar plates (0.1%) but not from non-selective media. During the same period fungi were isolated from three graft samples cultured in non-selective broth media only (0.1%). There was no correlation of fungal isolates from selective or non-selective media inoculated at the same time nor from multiple graft samples collected from the same donor supporting the possibility of an exogenous source for fungal isolates rather than an endogenous source.
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Affiliation(s)
- Kerry Varettas
- Department of Microbiology, South Eastern Area Laboratory Services, St. George Hospital, Kogarah, NSW, Australia.
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Romero FA, Razonable RR. Infections in liver transplant recipients. World J Hepatol 2011; 3:83-92. [PMID: 21603030 PMCID: PMC3098392 DOI: 10.4254/wjh.v3.i4.83] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/06/2010] [Accepted: 12/13/2010] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation is a standard life-saving procedure for the treatment of many end-stage liver diseases. The success of this procedure may be limited by infectious complications. In this article, we review the contemporary state of infectious complications during the post-operative period, with particular emphasis on those that occur most commonly during the first 6 mo after liver transplantation. Bacteria, and less commonly Candida infections, remain the predominant pathogens during the immediate post-operative period, especially during the first month, and infections caused by drug-resistant strains are emerging. Infections caused by cytomegalovirus and Aspergillus sp. present clinically during the "opportunistic" period characterized by intense immunosuppression. As newer potent immunosuppressive therapies with the major aim of reducing allograft rejection are developed, one potential adverse effect is an increase in certain infections. Hence, it is essential for liver transplant centers to have an effective approach to prevention that is based on predicted infection risk, local antimicrobial resistance patterns, and surveillance. A better understanding of the common and most important infectious complications is anticipated to lead to improvements in quality of life and survival of liver transplant recipients.
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Affiliation(s)
- Fabian A Romero
- Fabian A Romero, Raymund R Razonable, Division of Infectious Diseases and the William J von Liebig Transplant Center, Mayo Clinic, Rochester, MN 55905, United States
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Binder U, Lass-Flörl C. Epidemiology of invasive fungal infections in the mediterranean area. Mediterr J Hematol Infect Dis 2011; 3:e20110016. [PMID: 21625305 PMCID: PMC3103242 DOI: 10.4084/mjhid.2011.0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/29/2011] [Indexed: 01/01/2023] Open
Abstract
Although Candida species remain the relevant cause of IFI, other fungi (especially moulds) have become increasingly prevalent. In particular, Aspergillus species are the leading cause of mould infections but also Glomeromycota (formerly Zygomycetes) and Fusarium species are increasing in frequency, and are associated with high mortality rates. Many of these emerging infections occur as breakthrough infections in patients treated with new antifungal drugs. The causative pathogens, incidence rate and severity are dependent on the underlying condition, as well as on the geographic location of the patient population. France and Italy show the highest incident rates of Fusarium infections in Europe, following the US, where numbers are still increasing. Scedosporium prolificans, which primarily is found in soil in Spain and Australia, is most frequently isolated from blood cultures in a Spanish hospital. Geotrichum capitatum represents another species predominantly found in Europe with especially high rates in Mediterranean countries. The increasing resistance to antifungal drugs especially of these new emerging pathogens is a severe problem for managing these IFIs.
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Affiliation(s)
- Ulrike Binder
- Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Austria
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Al-Sweih N, Khan ZU, Ahmad S, Devarajan L, Khan S, Joseph L, Chandy R. Kodamaea ohmeri as an emerging pathogen: a case report and review of the literature. Med Mycol 2011; 49:766-70. [PMID: 21438792 DOI: 10.3109/13693786.2011.572300] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Kodamaea (Pichia) ohmeri is a yeast-like fungus that has recently emerged as an important etiologic agent of fungemia in immunocompromised patients. We report such a case in a premature neonate born at 29 weeks of gestation. Prior to developing fungemia, she had two episodes of bacterial sepsis on day 13 and day 32 due to Enterobacter cloacae and Staphylococcus epidermidis, respectively. Kodamaea ohmeri was repeatedly isolated from blood cultures and its identity was determined by phenotypic characteristics and sequencing of the ITS and D1/D2 regions of rDNA. The neonate was successfully treated with amphotericin B. The published cases of K. ohmeri fungemia reported in pediatric patients are reviewed highlighting its increasing importance as a bloodstream pathogen.
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Affiliation(s)
- Noura Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Shuwaikh, Kuwait
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28
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Trichosporon surgical wound infection in a renal allograft recipient successfully treated with voriconazole. Transplantation 2010; 90:588-9. [PMID: 20814301 DOI: 10.1097/tp.0b013e3181ea396a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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