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Neoh CF, Chen SCA, Lanternier F, Tio SY, Halliday CL, Kidd SE, Kong DCM, Meyer W, Hoenigl M, Slavin MA. Scedosporiosis and lomentosporiosis: modern perspectives on these difficult-to-treat rare mold infections. Clin Microbiol Rev 2024; 37:e0000423. [PMID: 38551323 DOI: 10.1128/cmr.00004-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYAlthough Scedosporium species and Lomentospora prolificans are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different Scedosporium species. L. prolificans is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.
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Affiliation(s)
- Chin Fen Neoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- The University of Sydney, Sydney, Australia
- Department of Infectious Diseases, Westmead Hospital, Sydney, Australia
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital universitaire Necker-Enfants malades, Paris, France
- National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology research group, Mycology Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Shio Yen Tio
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Sarah E Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
- School of Biological Sciences, Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - David C M Kong
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Melbourne, Australia
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Medicine, Deakin University, Waurn Ponds, Geelong, Australia
| | - Wieland Meyer
- The University of Sydney, Sydney, Australia
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Group, ECMM Excellence Center for Clinical Mycology, Medical University of Graz, Graz, Austria
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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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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Thornton CR, Davies GE, Dougherty L. Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker. Front Cell Infect Microbiol 2023; 13:1305662. [PMID: 38145040 PMCID: PMC10739493 DOI: 10.3389/fcimb.2023.1305662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Mucoromycosis is a highly aggressive angio-invasive disease of humans caused by fungi in the zygomycete order, Mucorales. While Rhizopus arrhizus is the principal agent of mucoromycosis, other Mucorales fungi including Apophysomyces, Cunninghamella, Lichtheimia, Mucor, Rhizomucor and Syncephalastrum are able to cause life-threatening rhino-orbital-cerebral, pulmonary, gastro-intestinal and necrotising cutaneous infections in humans. Diagnosis of the disease currently relies on non-specific CT, lengthy and insensitive culture from invasive biopsy, and time-consuming histopathology of tissue samples. At present, there are no rapid antigen tests that detect Mucorales-specific biomarkers of infection, and which allow point-of-care diagnosis of mucoromycosis. Here, we report the development of an IgG2b monoclonal antibody (mAb), TG11, which binds to extracellular polysaccharide (EPS) antigens of between 20 kDa and 250 kDa secreted during hyphal growth of Mucorales fungi. The mAb is Mucorales-specific and does not cross-react with other yeasts and molds of clinical importance including Aspergillus, Candida, Cryptococcus, Fusarium, Lomentospora and Scedosporium species. Using the mAb, we have developed a Competitive lateral-flow device that allows rapid (30 min) detection of the EPS biomarker in human serum and bronchoalveolar lavage (BAL), with a limit of detection (LOD) in human serum of ~100 ng/mL serum (~224.7 pmol/L serum). The LFD therefore provides a potential novel opportunity for detection of mucoromycosis caused by different Mucorales species.
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Affiliation(s)
- Christopher R. Thornton
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Genna E. Davies
- ISCA Diagnostics Ltd., Hatherly Laboratories, Exeter, United Kingdom
| | - Laura Dougherty
- Biosciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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Marinovic DA, Bhaimia E, Forrest GN, LaRue R, Nathan S, Ustun C, Ward A. Scedosporium infection disseminated "from toe to head" in allogeneic stem cell transplant recipient: a case report. BMC Infect Dis 2023; 23:353. [PMID: 37231339 DOI: 10.1186/s12879-023-08345-2] [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: 03/04/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Scedosporium is a lesser-known non-Aspergillus genus of mold that can present in unsuspecting ways. If overlooked, it may disseminate and cause high mortality in high-risk allogeneic stem cell transplant recipients. CASE PRESENTATION This case report describes a 65-year-old patient with Acute Myeloid Leukemia who underwent an allogeneic hematopoietic stem cell transplant after a period of prolonged neutropenia with fluconazole prophylaxis. She suffered severe debility with altered mentation from a S. apiospermum infection which likely disseminated from a toe wound to the lung and central nervous system. She was successfully treated with liposomal amphotericin B and voriconazole, but faced a prolonged recovery from physical and neurologic sequela. CONCLUSIONS The case highlights the importance of adequate anti-mold prophylaxis in high-risk patients, and the value of a thorough physical examination in this patient population, with particular attention to skin and soft tissue findings.
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Affiliation(s)
- Debra A Marinovic
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, 1725 W Harrison St Suite 809, IL, 1725 W Harrison St Suite 809, Chicago, USA.
| | - Eric Bhaimia
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, 1725 W Harrison St Suite 809, IL, 1725 W Harrison St Suite 809, Chicago, USA
| | - Graeme N Forrest
- Division of Infectious Disease, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Rebecca LaRue
- Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA
| | - Sunita Nathan
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, 1725 W Harrison St Suite 809, IL, 1725 W Harrison St Suite 809, Chicago, USA
| | - Celalettin Ustun
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, 1725 W Harrison St Suite 809, IL, 1725 W Harrison St Suite 809, Chicago, USA
| | - Anna Ward
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, 1725 W Harrison St Suite 809, IL, 1725 W Harrison St Suite 809, Chicago, USA
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Rahi MS, Jindal V, Pednekar P, Parekh J, Gunasekaran K, Sharma S, Stender M, Jaiyesimi IA. Fungal infections in hematopoietic stem-cell transplant patients: a review of epidemiology, diagnosis, and management. Ther Adv Infect Dis 2021; 8:20499361211039050. [PMID: 34434551 PMCID: PMC8381463 DOI: 10.1177/20499361211039050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/24/2021] [Indexed: 12/18/2022] Open
Abstract
The advent of bone marrow transplant has opened doors to a different approach and
offered a new treatment modality for various hematopoietic stem-cell-related
disorders. Since the first bone marrow transplant in 1957, there has been
significant progress in managing patients who undergo bone marrow transplants.
Plasma-cell disorders, lymphoproliferative disorders, and myelodysplastic
syndrome are the most common indications for hematopoietic stem-cell transplant.
Despite the advances, invasive fungal infections remain a significant cause of
morbidity and mortality in this high-risk population. The overall incidence of
invasive fungal infection in patients with hematopoietic stem-cell transplant is
around 4%, but the mortality in patients with allogeneic stem-cell transplant is
as high as 13% in one study. Type of stem-cell transplant, conditioning regimen,
and development of graft-versus-host disease are some of the
risk factors that impact the risk and outcomes in patients with invasive fungal
infections. Aspergillus and candida remain the two most common organisms causing
invasive fungal infections. Molecular diagnostic methods have replaced some
traditional methods due to their simplicity of use and rapid turnaround time.
Primary prophylaxis has undoubtedly shown to improve outcomes even though
breakthrough infection rates remain high. The directed treatment has seen a
significant shift from amphotericin B to itraconazole, voriconazole, and
echinocandins, which have shown better efficacy and fewer adverse effects. In
this comprehensive review, we aim to detail epidemiology, risk factors,
diagnosis, and management, including prophylaxis, empiric and directed
management of invasive fungal infections in patients with hematopoietic
stem-cell transplant.
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Affiliation(s)
- Mandeep Singh Rahi
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA
| | - Vishal Jindal
- Division of Hematology and Oncology, Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Prachi Pednekar
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Jay Parekh
- Department of Internal Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Kulothungan Gunasekaran
- Division of Pulmonary Diseases and Critical Care Medicine, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Sorabh Sharma
- Department of Internal Medicine, Banner University Medical Center, Tucson, AZ, USA
| | - Michael Stender
- Division of Hematology and Oncology, Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Ishmael A Jaiyesimi
- Division of Hematology and Oncology, Oakland University-William Beaumont School of Medicine, Royal Oak, MI, USA
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Longhitano A, Alipour R, Khot A, Bajel A, Antippa P, Slavin M, Thursky K. The role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in assessment of complex invasive fungal disease and opportunistic co-infections in patients with acute leukemia prior to allogeneic hematopoietic cell transplant. Transpl Infect Dis 2020; 23:e13547. [PMID: 33338319 DOI: 10.1111/tid.13547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Individuals diagnosed with acute lymphoid and myeloid malignancies are at significant risk of invasive fungal and bacterial infections secondary to their marked immunocompromised states with a significant high risk of mortality. The role of metabolic imaging with 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) has been increasingly recognized in optimizing the diagnosis of invasive infection, monitoring the response to therapy and guiding the duration of antimicrobial therapy or need to escalate to surgical intervention. METHODS Two distinct cases of pulmonary co-infection of rare fungal and bacterial pathogens are explored in severely immunocompromised individuals where FDG PET/CT aided both patients to make a full recovery and transition to HCT. The first case explores mixed Scedosporium apiospermum and Rhizomucor pulmonary infection on a background of T cell/myeloid mixed phenotype acute leukemia ultimately warranting long-term antifungal therapy and lobectomy prior to HCT. The second case explores Fusarium and Nocardia pulmonary infection on a background of relapsed AML also warranting surgical resection with lobectomy and long-term antimicrobials prior to transition to HCT. DISCUSSION The cases highlight the utility of FDG PET/CT to support the diagnosis of infections, including the presence or absence of disseminated infection, and to provide highly sensitive monitoring of the infection over time. FDG PET/CT played a key role in directing therapy duration decisions and prompted the necessity for surgical intervention. Ultimately, the use of FDG PET/CT allowed for a successful transition to HCT highlighting its value in this clinical setting. CONCLUSION FDG PET/CT has an emerging role in the diagnostic and monitoring pathway for complex infections in high-risk immunocompromised patients.
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Affiliation(s)
- Anthony Longhitano
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Ramin Alipour
- Sir Peter MacCallum Department of Oncology, University of Melbourne Parkville, Melbourne, Vic., Australia.,Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Vic., Australia.,Lung Cancer Service, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne Parkville, Melbourne, Vic., Australia.,National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,National Centre for Antimicrobial Stewardship (NCAS), The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.,Department of Medicine, University of Melbourne, Parkville, Vic., Australia
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7
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Seidel D, Hassler A, Salmanton-García J, Koehler P, Mellinghoff SC, Carlesse F, Cheng MP, Falces-Romero I, Herbrecht R, Jover Sáenz A, Klimko N, Mareş M, Lass-Flörl C, Soler-Palacín P, Wisplinghoff H, Cornely OA, Pana Z, Lehrnbecher T. Invasive Scedosporium spp. and Lomentospora prolificans infections in pediatric patients: Analysis of 55 cases from FungiScope® and the literature. Int J Infect Dis 2019; 92:114-122. [PMID: 31863876 DOI: 10.1016/j.ijid.2019.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Current knowledge on infections caused by Scedosporium spp. and Lomentospora prolificans in children is scarce. We therefore aim to provide an overview of risk groups, clinical manifestation and treatment strategies of these infections. METHODS Pediatric patients (age ≤18 years) with proven/probable Scedosporium spp. or L. prolificans infection were identified in PubMed and the FungiScope® registry. Data on diagnosis, treatment and outcome were collected. RESULTS Fifty-five children (median age 9 years [IQR: 5-14]) with invasive Scedosporium spp. (n = 33) or L. prolificans (n = 22) infection were identified between 1990 and 2019. Malignancy, trauma and near drowning were the most common risk factors. Infections were frequently disseminated. Most patients received systemic antifungal therapy, mainly voriconazole and amphotericin B, plus surgical treatment. Overall, day 42 mortality was 31%, higher for L. prolificans (50%) compared to Scedosporium spp. (18%). L. prolificans infection was associated with a shorter median survival time compared to Scedosporium spp. (6 days [IQR: 3-28] versus 61 days [IQR: 16-148]). Treatment for malignancy and severe disseminated infection were associated with particularly poor outcome (HR 8.33 [95% CI 1.35-51.40] and HR 6.12 [95% CI 1.52-24.66], respectively). Voriconazole use at any time and surgery for antifungal treatment were associated with improved clinical outcome (HR 0.33 [95% CI 0.11-0.99] and HR 0.09 [95% CI 0.02-0.40], respectively). CONCLUSIONS Scedosporium spp. and L. prolificans infections in children are associated with high mortality despite comprehensive antifungal therapy. Voriconazole usage and surgical intervention are associated with successful outcome.
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Affiliation(s)
- Danila Seidel
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany.
| | - Angela Hassler
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany
| | - Jon Salmanton-García
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Philipp Koehler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Sibylle C Mellinghoff
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Fabianne Carlesse
- Instituto de Oncologia Pediátrica - GRAACC/UNIFESP, São Paulo, SP, Brazil
| | - Matthew P Cheng
- Montreal, McGill University, Department Microbiology and Immunology, Montreal, Canada
| | - Iker Falces-Romero
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Raoul Herbrecht
- University Hospital of Strasbourg, Hôpital de Hautepierre, Department of Oncology and Hematology, Strasbourg, France
| | - Alfredo Jover Sáenz
- Territorial Unit of Nosocomial Infection and antibiotic policy (TUNI). University Hospital Arnau de Vilanova, Lleida, Spain
| | - Nikolai Klimko
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Mihai Mareş
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iași, Romania
| | - Cornelia Lass-Flörl
- Medical University of Innsbruck, Institute of Hygiene und Medical Microbiology (HMM), Innsbruck, Austria
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Hilmar Wisplinghoff
- Wisplinghoff Laboratories, Cologne, Germany; Institute for Virology and Microbiology, University Witten/Herdecke, Witten, Germany; Institute for Medical Microbiology, University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine, Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), Cologne, Germany; Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Zoi Pana
- Department of Medicine, European University of Cyprus (EUC), Cyprus
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt, Germany
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9
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Mind the gap: Management of an emergent and threatening invasive fungal infection-a case report of rhino-orbital-cerebral and pulmonary mucormycosis. Med Mycol Case Rep 2013; 2:79-84. [PMID: 24432223 DOI: 10.1016/j.mmcr.2013.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/22/2013] [Accepted: 02/27/2013] [Indexed: 11/20/2022] Open
Abstract
Mucormycosis is an emergent and threatening invasive fungal invasion underdiagnosed by clinicians due to lack of awareness and aspecific clinical picture. The authors describe a clinical case of a diabetic and cirrhotic patient who developed rhino-orbital-cerebral and pulmonary mucormycosis, non-responsive to treatment. Typical gaps in the management of this deadly disease are addressed. There is a strong need for novel therapies and an expectation that sponsors will recognize the critical need for randomized clinical trials.
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10
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Chakrabarti A, Singh R. The emerging epidemiology of mould infections in developing countries. Curr Opin Infect Dis 2012; 24:521-6. [PMID: 21799406 DOI: 10.1097/qco.0b013e32834ab21e] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The present review describes the emerging trends of mould infections in developing countries, and highlights the major epidemiological differences from the developed countries. RECENT FINDINGS The limited data available from developing countries suggest an alarming increase in invasive mould infections, especially aspergillosis and mucormycosis, and also a difference in risk factors and causative agents between the developed and developing world. Sino-orbital, cerebral and ophthalmic infections due to Aspergillus flavus are the major clinical types in aspergillosis, after pulmonary aspergillosis. Aspergillus and Fusarium spp. are frequent causes of trauma-associated keratitis in agricultural workers. Rhino-orbito-cerebral presentation associated with uncontrolled diabetes is the predominant mucormycosis. Isolated renal mucormycosis has emerged as a new clinical entity. Apophysomyces elegans and Mucor irregularis are emerging species in these regions and uncommon agents such as Rhizopus homothallicus have also been reported. Many pathogens are geographically restricted, with Pythium insidionum, Rhinocladiella mackenziei and M. irregularis being described almost exclusively from Thailand, Middle East and China, respectively. SUMMARY Despite limited studies, certain peculiarities have been observed in invasive mould infections in developing countries, including a high incidence of ophthalmic lesions, mucormycosis and aspergillosis; few different clinical presentations; and a varied spectrum of pathogens involved in such lesions.
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Affiliation(s)
- Arunaloke Chakrabarti
- Division of Mycology, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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