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Colson JD, Kendall JA, Yamamoto T, Mizusawa M. A Diagnostic Stewardship Intervention to Improve Utilization of 1,3 β-D-Glucan Testing at a Single Academic Center: Five-Year Experience. Open Forum Infect Dis 2024; 11:ofae358. [PMID: 39035574 PMCID: PMC11259134 DOI: 10.1093/ofid/ofae358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
Background (1,3)- β-D-glucan (BDG) testing is one of the noninvasive tests to aid diagnosis of invasive fungal infections (IFIs). The study results have been heterogenous, and diagnostic performance varies depending on the risks for IFI. Thus, it is important to select appropriate patients for BDG testing to prevent false-positive results. An algorithmic diagnostic stewardship intervention was instituted at a single academic medical center to improve BDG test utilization. Methods The BDG test order in the electronic health record was replaced with the BDG test request order, which required approval to process the actual test order. The approval criteria were (1) immunocompromised or intensive care unit patient and (2) on empiric antifungal therapy, or inability to undergo invasive diagnostic procedures. A retrospective observational study was conducted to evaluate the efficacy of the intervention by comparing the number of BDG tests performed between 1 year pre- and post-intervention. Safety was assessed by chart review of the patients for whom BDG test requests were deemed inappropriate and rejected. Results The number of BDG tests performed per year decreased by 85% from 156 in the pre-intervention period to 24 in the post-intervention period. The average monthly number of BDG tests performed was significantly lower between those periods (P = .002). There was no delay in IFI diagnosis or IFI-related deaths in the patients whose BDG test requests were rejected. The sustained effectiveness of the intervention was observed for 5 years. Conclusions Institution of the diagnostic stewardship intervention successfully and safely improved BDG test utilization.
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Affiliation(s)
- Jordan D Colson
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan A Kendall
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Takeru Yamamoto
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
- Department of Pathology and Laboratory Medicine, Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Pathology and Laboratory Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
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Lee R, Yoo IY, Oh EJ, Choi AR, Nho D, Cho SY, Lee J, Ahn HL, Park YJ, Lee DG. Dextrose-containing fluids causing false-positive serum galactomannan: a case-control study and interrupted time series analysis. Clin Microbiol Infect 2024; 30:682.e1-682.e4. [PMID: 38309324 DOI: 10.1016/j.cmi.2024.01.019] [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: 10/20/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES This study aimed to identify the cause of false-positive serum Aspergillus antigen galactomannan (GM) results in our centre. METHODS We performed a case-control study aiming to elucidate the factors associated with false-positive GM results. Independent risk factors for false-positive GM were evaluated through a multivariable regression analysis. An interrupted time series analysis was used to evaluate the effectiveness of an intervention removing the identified factors. RESULTS Among 568 patients tested, GM was positive in 130 patients of whom 97 had false-positive GM (cases). These were compared with 427 patients with true-negative GM (controls). Administration of dextrose-containing fluids within 6 days before GM testing was an independent predictor for false-positive GM results (adjusted odds ratio [aOR], 18.60; 95% CI, 8.95-38.66. An analysis of GM presence in different dextrose-containing fluids revealed positivity in 34.8% (8 of 23) (manufacturer A) and 33.3% (5 of 15) (manufacturer B) of the samples. Investigation of the manufacturing process revealed that the saccharification process employed enzymes derived from Aspergillus niger. After identifying the root cause of false positivity, GM-containing dextrose fluid use was restricted. Interrupted time series analysis showed an immediate reduction of GM false-positivity (-6.5% per week, p = 0.045) and a declining trend (-0.33% per week, p = 0.005) postintervention. CONCLUSIONS Administering dextrose-containing fluids was the primary factor causing false-positive serum Aspergillus antigen GM assay results. Our investigation led to a modification of the manufacturing process of the dextrose-containing fluids.
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Affiliation(s)
- Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Young Yoo
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Jee Oh
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ae Ran Choi
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dukhee Nho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jongin Lee
- Department of Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Lim Ahn
- Department of Pharmacy, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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3
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Foglia F, Greco G, Zannella C, Chianese A, Ambrosino A, Conzo A, Conzo G, De Filippis A, Finamore E, Docimo L, Galdiero M. A case of Magnusiomyces capitatus isolated during monitoring in an antimicrobial diagnostic stewardship context. IDCases 2024; 36:e01959. [PMID: 38681078 PMCID: PMC11046207 DOI: 10.1016/j.idcr.2024.e01959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/12/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
Magnusiomyces capitatus (M. capitatus) is an emerging opportunistic yeast in the Mediterranean region typically isolated from immunocompromised patients, usually affected by blood malignancies. We reported a rare case of M. capitatus infection, isolated from a drainage fluid in a patient affected by lung cancer recovered in the University Hospital of Campania "Luigi Vanvitelli", Naples, Italy. The isolate was identified by phenotypic methods, i.e., Gram and Lactophenol cotton blue (LCB) staining, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis. We identified M. capitatus on the third day from Sabouraud Dextrose Agar supplemented with chloramphenicol and gentamicin. Antifungal susceptibility test revealed that 5-fluorocytosine was the most active drug against M. capitatus, followed by itraconazole and voriconazole, micafungin, amphotericin B and fluconazole, posaconazole, anidulafungin, and caspofungin. Our data showed the importance of an early cultural and fast microbiology diagnosis based on the characteristic morphologic features observed in Gram-stained smears of blood culture positive bottles, and the validation via MALDI-TOF MS. This dual approach has significant impact in the clinical management of infectious diseases and antibiotic stewardship, by integrating sample processing, fluid handling, and detection for rapid bacterial diagnosis.
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Affiliation(s)
- Francesco Foglia
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Giuseppe Greco
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Carla Zannella
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Annalisa Chianese
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Annalisa Ambrosino
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Alessandra Conzo
- Division of General and Oncologic Surgery, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 1, 80131 Naples, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 1, 80131 Naples, Italy
| | - Anna De Filippis
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Emiliana Finamore
- Complex Operative Unity of Virology and Microbiology, University Hospital of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Ludovico Docimo
- Division of General and Oncologic Surgery, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 1, 80131 Naples, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
- Complex Operative Unity of Virology and Microbiology, University Hospital of Campania "Luigi Vanvitelli", 80138 Naples, Italy
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Gal Etzioni TR, Fainshtain N, Nitzan-Luques A, Goldstein G, Weinreb S, Temper V, Korem M, Averbuch D. Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome. Microorganisms 2024; 12:145. [PMID: 38257971 PMCID: PMC10820110 DOI: 10.3390/microorganisms12010145] [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: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Invasive fungal infections (IFI) cause morbidity and mortality in children with acute leukemia (AL). We retrospectively collected data on febrile neutropenic episodes (FNE) in AL children (2016-2021) and assessed factors associated with proven/probable IFI. Ninety-three children developed 339 FNE. Seventeen (18.3%) children developed 19 proven/probable IFI (11 yeast; eight molds). The proven/probable yeast IFI rate was 6/52 (11.5%) in children who belong to the high risk for IFI category (HR-IFI-AL: high-risk acute lymphocytic leukemia (ALL), acute myeloid leukemia, relapse); and 5/41 (12.2%) in the non-HR-IFI-AL category (standard/intermediate risk ALL). The proven/probable mold IFI rate was 7/52 (13.5%) in HR-IFI-AL children and 1/41 (2.4%) in the non-HR-IFI-AL category. In the multivariable analysis, underlying genetic syndrome, oral mucositis, and older age were significantly associated with proven/probable IFI, while a longer time since AL diagnosis was protective. Two of 13 (15.4%) HR-IFI-AL children died because of IFI. The elevated risks of proven/probable mold IFI and the associated mortality in HR-IFI-AL children, and high risk of invasive candidiasis in the non-HR-IFI-AL group, emphasize the need for the close monitoring of local epidemiology and the adjustment of practices accordingly.
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Affiliation(s)
- Tamar Ruth Gal Etzioni
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Nurit Fainshtain
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Adi Nitzan-Luques
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Gal Goldstein
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Sigal Weinreb
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Violeta Temper
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Department of Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Maya Korem
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Department of Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
| | - Dina Averbuch
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (T.R.G.E.); (N.F.); (A.N.-L.); (G.G.); (S.W.); (V.T.); (M.K.)
- Pediatric Division, Hadassah Medical Center, Jerusalem 91120, Israel
- Pediatric Infectious Diseases, Hadassah Medical Center, Jerusalem 91120, Israel
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Yoo IY, Park YJ. Culture-independent diagnostic approaches for invasive aspergillosis in solid organ transplant recipients. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:155-164. [PMID: 37751964 PMCID: PMC10583980 DOI: 10.4285/kjt.23.0043] [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: 07/31/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Prompt and accurate diagnosis of invasive aspergillosis (IA) is crucial for immunocompromised patients, including those who have received a solid organ transplant (SOT). Despite their low sensitivity, microscopic detection and conventional culture are considered the 'gold standard' methods. In conjunction with conventional culture, culture-independent assays such as serum galactomannan testing and Aspergillus polymerase chain reaction (PCR) have been incorporated into the diagnostic process for IA. The recently revised consensus definitions from the European Organization for Research and Treatment of Cancer and the Mycosis Study Group have adjusted the threshold for positive galactomannan testing based on the sample type, and have excluded 1,3-β-D-glucan testing as a mycological criterion. Following extensive standardization efforts, positive Aspergillus PCR tests using serum, plasma, or bronchoalveolar lavage fluid have been added. However, there are limited studies evaluating the clinical utility of these culture-independent assays for the early diagnosis of IA in SOT recipients. Therefore, further research is required to determine whether these assays could aid in the early diagnosis of IA in SOT recipients, particularly in relation to the organ transplanted. In this review, we examine the culture-independent diagnostic methods for IA in SOT recipients, as well as the clinical utility of these assays.
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Affiliation(s)
- In Young Yoo
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon-Joon Park
- Department of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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6
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Selby PR, Warner MS, Peake SL, Bardy P, Hiwase D, Singhal D, Beligaswatte A, Hahn U, Roberts JA, Yeung D, Shakib S. Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches. Transpl Infect Dis 2022; 24:e13988. [PMID: 36349869 PMCID: PMC10909427 DOI: 10.1111/tid.13988] [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: 07/10/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limited consensus exists on the optimal use of antifungal agents to prevent invasive fungal infection in the early post allogeneic hematopoietic stem cell transplant (alloHCT) period, particularly when patients cannot tolerate oral medication administration. METHODS We undertook a retrospective observational cohort study to assess the tolerability, efficacy, and cost of a new antifungal prophylaxis pathway at a major tertiary alloHCT centre. Patients aged ≥16 years who underwent alloHCT between February 2018 and October 2019 (cohort 1) or between April 2020 and November 2021 (cohort 2) were included. In both cohorts, first line prophylactic therapy was oral posaconazole. The second line drugs where oral therapy was unable to be administered were intravenous voriconazole (cohort 1) versus intravenous posaconazole (cohort 2). RESULTS There were 142 patients enrolled in the study, 71 in each cohort. The proportion of patients remaining on first-line prophylaxis or progressing to second-, third-, and fourth-line options was 22.5%, 39.4%, 29.6%, and 8.5% in cohort 1 and 39.4%, 59.2%, 1.4%, and 0% in cohort 2, respectively. The frequency of neuropsychiatric adverse events was significantly higher in cohort 1 compared to cohort 2 (49.3% vs. 19.8%, p = .0004). Occurrence of proven and probable fungal infections was not significantly different between cohorts. Antifungal drug expenditure was $359 935 (AUD) more in cohort 1 ($830 486 AUD) compared to cohort 2 ($477 149 AUD). CONCLUSION The antifungal prophylaxis pathway used in cohort 2 resulted in reduced antifungal-associated adverse effects, less patients requiring progression to 3rd and 4th line prophylaxis and reduced antifungal drug costs.
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Affiliation(s)
- Philip R. Selby
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Pharmacy DepartmentRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Morgyn S. Warner
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Infectious Diseases UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
| | - Sandra L. Peake
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Intensive Care MedicineThe Queen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - Peter Bardy
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Devendra Hiwase
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Cancer ThemeSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Deepak Singhal
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Cancer ThemeSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Ashanka Beligaswatte
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Uwe Hahn
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Herston Infectious Diseases Institute (HeIDI)Metro North HealthBrisbaneQueenslandAustralia
- Department of Pharmacy and Intensive Care MedicineRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
- Division of Anaesthesiology Critical Care Emergency and Pain MedicineNîmes University Hospital, University of MontpellierNîmesFrance
| | - David Yeung
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- SA PathologyAdelaideSouth AustraliaAustralia
- Haematology UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Cancer ThemeSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Sepehr Shakib
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Department of Clinical PharmacologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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Piatek M, O'Beirne C, Beato Z, Tacke M, Kavanagh K. Exposure of Candida parapsilosis to the silver(I) compound SBC3 induces alterations in the proteome and reduced virulence. Metallomics 2022; 14:6617997. [PMID: 35751649 PMCID: PMC9348618 DOI: 10.1093/mtomcs/mfac046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/23/2022] [Indexed: 11/14/2022]
Abstract
The antimicrobial properties of silver have been exploited for many centuries and continue to gain interest in the fight against antimicrobial drug resistance. The broad-spectrum activity and low toxicity of silver have led to its incorporation into a wide range of novel antimicrobial agents, including N-heterocyclic carbene (NHC) complexes. The antimicrobial activity and in vivo efficacy of the NHC silver(I) acetate complex SBC3, derived from 1,3-dibenzyl-4,5-diphenylimidazol-2-ylidene (NHC*), have previously been demonstrated, although the mode(s) of action of SBC3 remains to be fully elucidated. Label-free quantitative proteomics was applied to analyse changes in protein abundance in the pathogenic yeast Candida parapsilosis in response to SBC3 treatment. An increased abundance of proteins associated with detoxification and drug efflux were indicative of a cell stress response, whilst significant decreases in proteins required for protein and amino acid biosynthesis offer potential insight into the growth-inhibitory mechanisms of SBC3. Guided by the proteomic findings and the prolific biofilm and adherence capabilities of C. parapsilosis, our studies have shown the potential of SBC3 in reducing adherence to epithelial cells and biofilm formation and hence decrease fungal virulence.
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Affiliation(s)
- Magdalena Piatek
- SSPC Pharma Research Centre, Department of Biology, Maynooth University, Maynooth, Co. Kildare, Ireland
| | - Cillian O'Beirne
- School of School of Chemistry, University College Dublin, Belfield, Stillorgan, Dublin 4, Ireland
| | - Zoe Beato
- School of School of Chemistry, University College Dublin, Belfield, Stillorgan, Dublin 4, Ireland
| | - Matthias Tacke
- School of School of Chemistry, University College Dublin, Belfield, Stillorgan, Dublin 4, Ireland
| | - Kevin Kavanagh
- SSPC Pharma Research Centre, Department of Biology, Maynooth University, Maynooth, Co. Kildare, Ireland
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8
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Scott AP, Choptiany M, Dwyer J, McCarthy KL. Case report: Ganoderma weberianum invasive fungal disease (IFD) during allogeneic hematopoietic stem cell transplantation (HSCT). Transpl Infect Dis 2021; 23:e13647. [PMID: 34028924 DOI: 10.1111/tid.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ashleigh P Scott
- Department of Haematology and Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Markian Choptiany
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Department of Microbiology, Pathology Queensland, Brisbane, QLD, Australia
| | - Jennifer Dwyer
- Department of Microbiology, Pathology Queensland, Brisbane, QLD, Australia
| | - Kate L McCarthy
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Department of Microbiology, Pathology Queensland, Brisbane, QLD, Australia
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9
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Gabriel M, Hoeben BAW, Uhlving HH, Zajac-Spychala O, Lawitschka A, Bresters D, Ifversen M. A Review of Acute and Long-Term Neurological Complications Following Haematopoietic Stem Cell Transplant for Paediatric Acute Lymphoblastic Leukaemia. Front Pediatr 2021; 9:774853. [PMID: 35004543 PMCID: PMC8734594 DOI: 10.3389/fped.2021.774853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Despite advances in haematopoietic stem cell transplant (HSCT) techniques, the risk of serious side effects and complications still exists. Neurological complications, both acute and long term, are common following HSCT and contribute to significant morbidity and mortality. The aetiology of neurotoxicity includes infections and a wide variety of non-infectious causes such as drug toxicities, metabolic abnormalities, irradiation, vascular and immunologic events and the leukaemia itself. The majority of the literature on this subject is focussed on adults. The impact of the combination of neurotoxic drugs given before and during HSCT, radiotherapy and neurological complications on the developing and vulnerable paediatric and adolescent brain remains unclear. Moreover, the age-related sensitivity of the nervous system to toxic insults is still being investigated. In this article, we review current evidence regarding neurotoxicity following HSCT for acute lymphoblastic leukaemia in childhood. We focus on acute and long-term impacts. Understanding the aetiology and long-term sequelae of neurological complications in children is particularly important in the current era of immunotherapy for acute lymphoblastic leukaemia (such as chimeric antigen receptor T cells and bi-specific T-cell engager antibodies), which have well-known and common neurological side effects and may represent a future treatment modality for at least a fraction of HSCT-recipients.
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Affiliation(s)
- Melissa Gabriel
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bianca A W Hoeben
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Hilde Hylland Uhlving
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Olga Zajac-Spychala
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznań, Poland
| | - Anita Lawitschka
- Haematopoietic Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Marianne Ifversen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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10
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Zubkowicz M, Held J, Baier M, Pletz MW, Kesselmeier M, Hagel S, Bahrs C. Clinical evaluation of two different (1,3)-ß-d-glucan assays for diagnosis of invasive fungal diseases: A retrospective cohort study. Mycoses 2020; 64:212-219. [PMID: 33156525 DOI: 10.1111/myc.13207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Early diagnosis of invasive fungal diseases (IFDs) remains a major challenge in routine clinical practice. OBJECTIVES The aim of this retrospective cohort study was to evaluate the diagnostic performance of the fungal biomarker (1,3)-ß-d-glucan (BDG) using the β-Glucan test (GT) and the well-established Fungitell assay® (FA) in real-life clinical practice. PATIENTS/METHODS We included 109 patients with clinical suspicion of IFD who were treated at Jena University Hospital, Germany, between November 2018 and March 2019. The patients were classified according to the latest update of the EORTC/MSG consensus definitions of IFD. The first serum sample of every patient was analysed for BDG using the FA and the GT, respectively. RESULTS Fifty-six patients (51.4%) had at least one host factor for IFD. In patients with proven (n = 11) or probable IFDs (n = 20), median BDG concentrations were 145.0 pg/ml for the FA and 5.1 pg/ml for the GT, respectively. A positive test result of both BDG assays at manufacturer's cut-offs predicted 89.5%-98.3% of proven or probable IFD, but the sensitivity of both assays was limited: The FA identified 60.7% of IFDs (cut-off: 80 pg/ml). Reducing the GT cut-off value from 11.0 to 4.1 pg/ml increased the detection rate of IFDs from 35.5% to 54.8%. CONCLUSIONS A positive test result of both BDG assays at manufacturer's cut-off was highly predictive for IFD, but except for Pneumocystis jirovecii pneumonia sensitivities were limited. Adjustment of the GT cut-off value equalised sensitivities of GT and FA.
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Affiliation(s)
- Marta Zubkowicz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Jürgen Held
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Baier
- Institute of Medical Microbiology, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Miriam Kesselmeier
- Research Group Clinical Epidemiology, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.,Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Christina Bahrs
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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11
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Evaluation of Commercially Available Real-Time Polymerase Chain Reaction Assays for the Diagnosis of Invasive Aspergillosis in Patients with Haematological Malignancies. Mycopathologia 2020; 185:269-277. [PMID: 31950340 DOI: 10.1007/s11046-020-00424-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
Early diagnosis of invasive aspergillosis (IA) is a challenge. Non-specific clinical and radiologic findings, as well as difficulties in conventional diagnostic method application, may delay correct diagnosis. Nowadays, nucleic acid-based assays have reduced the need for conventional antigen detection and culture-based methods and provided new opportunities for patient care. Aspergillus PCR is now included in the latest European Cancer Research and Treatment Organization/Mycosis Study Group definition updates. We evaluated the performance of commercial real-time polymerase chain reaction (PCR) MycAssay Aspergillus PCR and Artus Aspergillus RG PCR assays and compared the results with galactomannan enzyme immunoassay. During 41 febrile neutropenic episodes, 168 serum samples were collected from 32 patients with haematological malignancies. IA diagnosis was established according to the revised guidelines of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. Twenty-one probable episodes were identified. There were no proven IA cases in the study. In 20 episodes, patients did not fulfil the established criteria for the IA diagnosis. Artus Aspergillus RG PCR assay had a sensitivity of 47.6% and specificity of 100%, while those of MycAssay Aspergillus PCR were 61.9% and 100%, respectively. Two different PCR assays were used in this study. Although there are many studies that evaluated MycAssay Aspergillus PCR, data regarding Artus Aspergillus RG PCR assay are scarce. We found moderate sensitivity and high specificity in the diagnosis of IA in patients with haematological malignancy in both PCR methods. Our results demonstrated that commercial PCR assays can be applied for the early diagnosis and pre-emptive treatment of IA.
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12
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Demiraslan H, Atalay MA, Eren E, Demir K, Kaynar L, Koc AN, Doganay M. Assessing the risk of false positive serum galactomannan among patients receiving piperacillin/tazobactam for febrile neutropenia. Med Mycol 2018; 55:535-540. [PMID: 27915301 DOI: 10.1093/mmy/myw129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 10/27/2016] [Indexed: 12/11/2022] Open
Abstract
Galactomannan (GM) assay is commonly used as an early diagnostic tool for invasive fungal infection (IFI) in high-risk hematology patients. False positivity is frequently observed in GM with the use of piperacillin/tazobactam. The usage of generic drugs over the original brand has a significant cost advantage. The aim of this study was to assess the performance of GM test among patients receiving original and generic piperacillin/tazobactam formulations. The study included 85 adult patients; 62.4% were male with hematological malignancy currently receiving piperacillin/tazobactam. The study group was divided into two groups: patients receiving original and generic piperacillin/tazobactam. Serum GM index was positive in one of 35 patients receiving original piperacillin/tazobactam, whereas it was positive in 46 out of 50 patients receiving generic piperacillin/tazobactam (P < .001). However, the patients receiving generic piperacillin/tazobactam underwent computed tomography (CT) scans more frequently than those receiving original piperacillin/tazobactam (P = .047). In addition, in vitro analysis of GM was performed in two generics and one original piperacillin/tazobactam vials. One generic piperacillin/tazobactam vial included high GM level. False positivity of serum GM with generic formulations of piperacillin/tazobactam is still an ongoing issue in hematology patients. A high rate of serum GM index false positivity may unexpectedly lead to a higher rate of CT scan. Selected piperacillin/tazobactam vials in each batch should be checked for GM to identify a false positivity of GM before purchase.
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Affiliation(s)
| | | | - Esma Eren
- Department of Infectious Diseases and Clinical Microbiology
| | - Koray Demir
- Hematology, Erciyes University, Kayseri, Turkey
| | | | | | - Mehmet Doganay
- Department of Infectious Diseases and Clinical Microbiology
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13
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Vidal-García M, Redrado S, Domingo MP, Marquina P, Colmenarejo C, Meis JF, Rezusta A, Pardo J, Galvez EM. Production of the Invasive Aspergillosis Biomarker Bis(methylthio)gliotoxin Within the Genus Aspergillus: In Vitro and in Vivo Metabolite Quantification and Genomic Analysis. Front Microbiol 2018; 9:1246. [PMID: 29946309 PMCID: PMC6006755 DOI: 10.3389/fmicb.2018.01246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/23/2018] [Indexed: 01/12/2023] Open
Abstract
Gliotoxin (GT) is a fungal secondary metabolite that has attracted great interest due to its high biological activity since it was discovered by the 1930s. An inactive derivative of this molecule, bis(methylthio)gliotoxin (bmGT), has been proposed as an invasive aspergillosis (IA) biomarker. Nevertheless, studies regarding bmGT production among common opportunistic fungi, including the Aspergillus genus, are scarce and sometimes discordant. As previously reported, bmGT is produced from GT by a methyl-transferase, named as GtmA, as a negative feedback regulatory system of GT production. In order to analyze the potential of bmGT detection to enable identification of infections caused by different members of the Aspergillus genus we have assessed bmGT production within the genus Aspergillus, including A, fumigatus, A. niger, A. nidulans, and A. flavus, and its correlation with gtmA presence. In order to validate the relevance of our in vitro findings, we compared bmGT during in vitro culture with the presence of bmGT in sera of patients from whom the Aspergillus spp. were isolated. Our results indicate that most A. fumigatus isolates produce GT and bmGT both in vitro and in vivo. In contrast, A. niger and A. nidulans were not able to produce GT or bmGT, although A. niger produced bmGT from a exogenous GT source. The frequency and amount of bmGT production in A. terreus and A. flavus isolates in vitro was lower than in A. fumigatus. Our results suggest that this defect could be related to the in vitro culture conditions, since isolates that did not produce bmGT in vitro were able to synthetize it in vivo. In summary, our study indicates that bmGT could be very useful to specifically detect the presence of A. fumigatus, the most prevalent agent causing IA. Concerning A. terreus and A. flavus a higher number of analyses from sera from infected patients will be required to reach a useful conclusion.
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Affiliation(s)
- Matxalen Vidal-García
- Centro de Investigación Biomédica de Aragón, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | | | - Jacques F Meis
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Antonio Rezusta
- Hospital Universitario Miguel Servet, Zaragoza, Spain.,Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
| | - Julian Pardo
- Centro de Investigación Biomédica de Aragón, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Fundacion Agencia Aragonesa para la Investigacion y el Desarrollo, Zaragoza, Spain.,Departamento de Bioquímica y Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Nanociencia de Aragón, Zaragoza, Spain
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14
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Yu WL, Liu WL, Chan KS, Yang CC, Tan CK, Tsai CL, Chen CM, Chuang YC. High-level ambient particulate matter before influenza attack with increased incidence of Aspergillus antigenemia in Southern Taiwan, 2016. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:141-147. [DOI: 10.1016/j.jmii.2016.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/11/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
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15
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Association of mannose-binding lectin levels and invasive fungal disease in hematologic malignancy patients receiving myelosuppressive chemotherapy or allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2016; 51:1228-32. [PMID: 27088382 DOI: 10.1038/bmt.2016.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 02/29/2016] [Accepted: 03/04/2016] [Indexed: 12/17/2022]
Abstract
Several studies have suggested an association of mannose-binding lectin (MBL) deficiency with infections. In this study, we investigated the association between MBL deficiency and invasive fungal disease (IFD) in hematologic malignancy patients receiving myelosuppressive chemotherapy or hematopoietic stem cell transplant. MBL levels were quantified at the start of treatment in 152 patients who were followed for 6 months and scored as developing IFD or not. Forty-five patients (29.6%) developed IFD, of which 21 (46.7% of IFD cases and 13.8% of patients) were proven or probable IFD. Fifty-nine (38.8%) had MBL levels <1000 ng/mL. The rates of all IFD in patients with MBL levels below and above 1000 ng/mL were 33.9% and 26.9%, respectively (P=0.356). The rates of proven or probable IFD in patients with MBL levels below and above 1000 ng/mL were 11.9% and 15.1%, respectively (P=0.579). MBL levels <1000 ng/mL were not predictors of death (P=0.233). As expected, IFD was associated with death (P<0.0001). Our findings indicate that MBL levels <1000 ng/mL were not associated with an increased risk of developing IFD or overall survival.
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16
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Deo SS, Gottlieb DJ. Adoptive T-cell therapy for fungal infections in haematology patients. Clin Transl Immunology 2015; 4:e40. [PMID: 26366286 PMCID: PMC4558438 DOI: 10.1038/cti.2015.16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 02/01/2023] Open
Abstract
The prolonged immune deficiency resulting from haematopoietic stem cell transplant and chemotherapy predisposes to a high risk of invasive fungal infections. Despite the recent advances in molecular diagnostic testing, early initiation of pre-emptive antifungal therapy and the use of combination pharmacotherapy, mortality from invasive mould infections remain high among recipients of allogeneic stem cell transplant. The increasing incidences of previously rare and drug-resistant strains of fungi present a further clinical challenge. Therefore, there is a need for novel strategies to combat fungal infections in the immunocompromised. Adoptive therapy using in vitro-expanded fungus-specific CD4 cells of the Th-1 type has shown clinical efficacy in murine studies and in a small human clinical study. Several techniques for the isolation and expansion of fungus-specific T cells have been successfully applied. Here we discuss the incidence and changing patterns of invasive fungal diseases, clinical evidence supporting the role of T cells in fungal immunity, methods to expand fungus-specific T cells in the laboratory and considerations surrounding the use of T cells for fungal immunotherapy.
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Affiliation(s)
- Shivashni S Deo
- Centre for Cancer Research, Westmead Millennium Institute for Medical Research , Westmead, NSW, Australia ; Sydney Medical School, University of Sydney , Sydney, NSW, Australia
| | - David J Gottlieb
- Centre for Cancer Research, Westmead Millennium Institute for Medical Research , Westmead, NSW, Australia ; Sydney Medical School, University of Sydney , Sydney, NSW, Australia ; Blood and Marrow Transplant Unit, Department of Haematology, Westmead Hospital , Westmead, NSW, Australia ; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital , Westmead, NSW, Australia
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17
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Ansari S, Shirzadi E, Elahi M. The Prevalence of fungal infections in children with hematologic malignancy in Ali-Asghar Children Hospital between 2005 and 2010. IRANIAN JOURNAL OF PEDIATRIC HEMATOLOGY AND ONCOLOGY 2015; 5:1-10. [PMID: 25914797 PMCID: PMC4402151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 01/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND A fungal infection represents a growing problem in children with hematologic malignancies, during chemotherapy induced neutropenia. Fungal colonization is considered a major risk factor for subsequent fungal infections. The aim of this retrospective study was to evaluate prevalence of fungal infection among children admitted to hospital between 2005 and 2010 in Tehran, Iran. MATERIALS AND METHODS 617 hematological patients in the age range of neoteric to 19 years old were enrolled and 87 cases with invasive fungal infections were extracted from patients' files and documented. Diagnosis of fungal infections was based on the local biopsy and pathology for mucormycosis, blood culture, urine culture and clinical examination for candidasis and galactomannan for aspergillus. RESULTS the mean age of cancer diagnosis was 6.33 years old and the mean age of fungal infection was 7.95 years old. The majority of the infections was caused by candidia spp (74.7%), followed by aspergillus spp (17.2%) and zygomycetes (11.5%). Among candidiasis patients, oral infection had the highest manifestation (92.3%) whereas in 10 of 15 patients with aspergillus, the infectious site was the lung. There was a significant association between mortality and the type of fungal infection (p <0.0001). CONCLUSION Our finding suggests that there is a high rate of fungal infections in children receiving remission therapy for onco-hematology. These results help improve the management of these patients, however Further studies are needed.
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Affiliation(s)
- Sh Ansari
- Assistant professor of Pediatrician, Oncologist, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - E Shirzadi
- General practitioner, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Elahi
- General practitioner, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author: Morvarid Elahi MD, General practitioner, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran.
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18
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Zarrinfar H, Mirhendi H, Fata A, Khodadadi H, Kordbacheh P. Detection of Aspergillus flavus and A. fumigatus in Bronchoalveolar Lavage Specimens of Hematopoietic Stem Cell Transplants and Hematological Malignancies Patients by Real-Time Polymerase Chain Reaction, Nested PCR and Mycological Assays. Jundishapur J Microbiol 2014; 8:e13744. [PMID: 25763133 PMCID: PMC4344768 DOI: 10.5812/jjm.13744] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 10/15/2013] [Accepted: 11/10/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pulmonary aspergillosis (PA) is one of the most serious complications in immunocompromised patients, in particular among hematopoietic stem cell transplants (HSCT) and patients with hematological malignancies. OBJECTIVES The current study aimed to evaluate the incidence of PA and utility of molecular methods in HSCT and patients with hematological malignancies, four methods including direct examination, culture, nested polymerase chain reaction (PCR) and real-time PCR were performed on bronchoalveolar lavage (BAL) specimens in Tehran, Iran. PATIENTS AND METHODS During 16 months, 46 BAL specimens were obtained from individuals with allogeneic HSCT (n = 18) and patients with hematological malignancies (n = 28). Direct wet mounts with 20% potassium hydroxide (KOH) and culture on mycological media were performed. The molecular detection of Aspergillus fumigatus and A. flavus was done by amplifying the conserved sequences of internal transcribed spacer 1 (ITS1) ribosomal DNA by nested-PCR and the β-tubulin gene by TaqMan real-time PCR. RESULTS Seven (15.2%) out of 46 specimens were positive in direct examination and showed branched septate hyphae; 11 (23.9%) had positive culture including eight (72.7%) A. flavus and three (27.3%) A. fumigatus; 22 (47.8%) had positive nested-PCR and eight (17.4%) had positive real-time PCR. The incidence of invasive pulmonary aspergillosis (IPA) in these patients included proven IPA in 1 (2.2%), probable IPA in 10 (21.7%), possible IPA in 19 (41.3%) and not IPA in 16 cases (34.8%). CONCLUSIONS The incidence of IPA in allogeneic HSCT and patients with hematological malignancies was relatively high and A. flavus was the most common cause of PA. As molecular methods had higher sensitivity, it may be useful as screening methods in HSCT and patients with hematological malignancies, or to determine when empirical antifungal therapy can be withheld.
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Affiliation(s)
- Hossein Zarrinfar
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Department of Parasitology and Mycology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abdolmajid Fata
- Research Center for Skin Diseases and Cutaneous Leishmaniasis, Department of Parasitology and Mycology, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Abdolmajid Fata, Research Center for Skin Diseases and Cutaneous Leishmaniasis, Department of Parasitology and Mycology, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118547255, Fax: +98-5118002385, E-mail:
| | - Hossein Khodadadi
- Department of Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Parivash Kordbacheh
- Department of Medical Parasitology and Mycology, Tehran University of Medical Sciences, Tehran, IR Iran
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