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Jan HE, Tsai CS, Cia CT, Lee CC, Chen YW, Lee NY, Li CW, Li MC, Syue LS, Lo CL, Chang TC, Wu CJ, Ko WC, Chen PL. PCR-Based Microarray Enhances Diagnosis of Culture-Negative Biopsied Tissue in Patients with Invasive Mold Infections: Real-World Experience in a Tertiary Medical Center. J Fungi (Basel) 2024; 10:530. [PMID: 39194856 DOI: 10.3390/jof10080530] [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: 06/20/2024] [Revised: 07/17/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
A fungal polymerase chain reaction (PCR) amplifies conserved genes across diverse species, combined with the subsequent hybridization of amplicons using a specific oligonucleotide microarray, allowing for the rapid detection of pathogens at the species level. However, the performance of microarrays in diagnosing invasive mold infections (IMI) from infected tissue samples is rarely reported. During the 4-year study period, all biopsied tissue samples from patients with a suspected IMI sent for microarray assays were analyzed. A partial segment of the internal transcribed spacer (ITS) region was amplified by nested PCR after DNA extraction. Amplicons were hybridized with specific probes for a variety of mold species using an in-house oligonucleotide microarray. A total of 80 clinical samples from 74 patients were tested. A diagnosis of an IMI was made in 10 patients (4 proven, 1 probable, 3 possible, 2 clinical suspicion). The PCR/microarray test was positive for three out of four proven IMIs, one probable IMI, and one out of three possible IMIs. Two patients with positive PCR/microarray findings were considered to have clinical suspicion of an IMI, and their responsible physicians initiated antifungal therapy despite the absence of supporting microbiological and histological evidence. Clinical diagnoses were categorized into non-IMI and IMI groups (including proven, probable, possible, and clinical suspicion). The sensitivity and specificity of the microarray in diagnosing the IMIs were 70% and 95.7%, respectively, while the sensitivity and specificity of the culture and histological findings were 10%/96.3% and 40.0%/100%, respectively. PCR-based methods provide supportive microbiological evidence when culture results are inconclusive. The combination of a microarray with fungal culture and histology promotes the precise diagnosis of IMIs in difficult-to-diagnose patients.
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Affiliation(s)
- Hao-En Jan
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chin-Shiang Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital Douliu Branch, College of Medicine, National Cheng Kung University, Yunlin 640, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Cong-Tat Cia
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Ching-Chi Lee
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
- Clinical Medical Research Center, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Ying-Wen Chen
- Department of Internal Medicine, National Cheng Kung University Hospital Douliu Branch, College of Medicine, National Cheng Kung University, Yunlin 640, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Chia-Wen Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Ming-Chi Li
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Ling-Shan Syue
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Ching-Lung Lo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Tsung-Chain Chang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chi-Jung Wu
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan 704, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan 704, Taiwan
- Diagnostic Microbiology and Antimicrobial Resistance Laboratory, National Cheng Kung University Hospital, Tainan 704, Taiwan
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
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Morrissey CO, Kim HY, Duong TMN, Moran E, Alastruey-Izquierdo A, Denning DW, Perfect JR, Nucci M, Chakrabarti A, Rickerts V, Chiller TM, Wahyuningsih R, Hamers RL, Cassini A, Gigante V, Sati H, Alffenaar JW, Beardsley J. Aspergillus fumigatus-a systematic review to inform the World Health Organization priority list of fungal pathogens. Med Mycol 2024; 62:myad129. [PMID: 38935907 PMCID: PMC11210617 DOI: 10.1093/mmy/myad129] [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: 09/16/2023] [Revised: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 06/29/2024] Open
Abstract
Recognizing the growing global burden of fungal infections, the World Health Organization established a process to develop a priority list of fungal pathogens (FPPL). In this systematic review, we aimed to evaluate the epidemiology and impact of invasive infections caused by Aspergillus fumigatus to inform the first FPPL. The pre-specified criteria of mortality, inpatient care, complications and sequelae, antifungal susceptibility, risk factors, preventability, annual incidence, global distribution, and emergence were used to search for relevant articles between 1 January 2016 and 10 June 2021. Overall, 49 studies were eligible for inclusion. Azole antifungal susceptibility varied according to geographical regions. Voriconazole susceptibility rates of 22.2% were reported from the Netherlands, whereas in Brazil, Korea, India, China, and the UK, voriconazole susceptibility rates were 76%, 94.7%, 96.9%, 98.6%, and 99.7%, respectively. Cross-resistance was common with 85%, 92.8%, and 100% of voriconazole-resistant A. fumigatus isolates also resistant to itraconazole, posaconazole, and isavuconazole, respectively. The incidence of invasive aspergillosis (IA) in patients with acute leukemia was estimated at 5.84/100 patients. Six-week mortality rates in IA cases ranged from 31% to 36%. Azole resistance and hematological malignancy were poor prognostic factors. Twelve-week mortality rates were significantly higher in voriconazole-resistant than in voriconazole-susceptible IA cases (12/22 [54.5%] vs. 27/88 [30.7%]; P = .035), and hematology patients with IA had significantly higher mortality rates compared with solid-malignancy cases who had IA (65/217 [30%] vs. 14/78 [18%]; P = .04). Carefully designed surveillance studies linking laboratory and clinical data are required to better inform future FPPL.
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Affiliation(s)
- C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Hannah Y Kim
- The University of Sydney Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Tra-My N Duong
- The University of Sydney Infectious Diseases Institute (Sydney ID), New South Wales, Australia
| | - Eric Moran
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - David W Denning
- Global Action for Fungal Infections, Geneva, Switzerland
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - John R Perfect
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro and Grupo Oncoclinicas, Rio de Janeiro, RJ, Brazil
| | | | - Volker Rickerts
- Robert Koch Institute Berlin, FG16, Seestrasse 10, 13353 Berlin, Germany
| | - Tom M Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Parasitology, Faculty of Medicine, Universitas Kristen, Jakarta, Indonesia
| | - Raph L Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alessandro Cassini
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
- Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | - Valeria Gigante
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Hatim Sati
- AMR Division, World Health Organization, Geneva, Switzerland
| | - Jan-Willem Alffenaar
- The University of Sydney Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Justin Beardsley
- The University of Sydney Infectious Diseases Institute (Sydney ID), New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
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Tan XT, Mokhtar NNB, Hii S, Amran F. Antifungal Susceptibility and Genotypic Analysis of cyp51A Mutations in Aspergillus fumigatus Isolates in Malaysia. Infect Drug Resist 2024; 17:2159-2168. [PMID: 38828376 PMCID: PMC11144424 DOI: 10.2147/idr.s452619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/09/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Azole resistance in Aspergillus fumigatus poses a significant challenge in the management of invasive aspergillosis. This study aimed to investigate the antifungal susceptibility and cyp51A mutation profiles of A. fumigatus isolates in Malaysia. Patients and Methods Sixty clinical A. fumigatus isolates were collected and subjected to antifungal susceptibility testing (AFST) and molecular analysis. The antifungal susceptibility testing was performed according to CLSI M38 guideline. The geometric mean (GM) minimum inhibitory concentration (MIC), MIC50/MIC90 for voriconazole, itraconazole, posaconazole, amphotericin B, and isavuconazole against A. fumigatus in non-invasive cases and invasive cases were calculated. In addition, the presence of cyp51A mutations was also identified. Results The present study revealed an overall resistance rate of 6.7% among the isolates. In non-invasive cases, isavuconazole and posaconazole demonstrated the lowest GM MIC of 0.08 µg/mL. Following them were itraconazole, voriconazole, and amphotericin B with concentrations of 0.15µg/mL, 0.16µg/mL and 0.90µg/mL, respectively. Similarly, in invasive cases, isavuconazole and posaconazole exhibited the lowest GM MIC of 0.09µg/mL. Following them were itraconazole, voriconazole, and amphotericin B with concentrations of 0.14µg/mL, 0.17µg/mL and 0.80µg/mL, respectively. Genotypic analysis revealed various cyp51A mutations, including F46Y, M172V, N248K, R34L, V244A, V244S, and E427K. However, not all mutations corresponded to antifungal resistance. Conclusion The majority of clinical Aspergillus fumigatus isolates demonstrated susceptibility to the antifungal agents tested, with isavuconazole and posaconazole demonstrating the lowest MIC values. However, cyp51A mutations were discovered without a consistent correlation to antifungal resistance, emphasising the need for additional research.
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Affiliation(s)
- Xue Ting Tan
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Nurin Nazirah Binti Mokhtar
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Shirley Yi Fen Hii
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
| | - Fairuz Amran
- Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, National Institute of Health, Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia
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Mayattu K, Ghormade V. Controlled delivery of nikkomycin by PEG coated PLGA nanoparticles inhibits chitin synthase to prevent growth of Aspergillus flavus and Aspergillus fumigatus. Z NATURFORSCH C 2024; 79:155-162. [PMID: 38842117 DOI: 10.1515/znc-2023-0185] [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: 12/31/2023] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
Aspergillosis is one of the most common fungal infections that can threaten individuals with immune compromised condition. Due to the increasing resistance of pathogens to the existing antifungal drugs, it is difficult to tackle such disease conditions. Whereas, nikkomycin is an emerging safe and effective antifungal drug which causes fungal cell wall disruption by inhibiting chitin synthase. Hence, the study aims at the development of nikkomycin loaded PEG coated PLGA nanoparticles for its increased antifungal efficiency and inhibiting Aspergillus infections. The P-PLGA-Nik NPs were synthesized by w/o/w double emulsification method which resulted in a particle size of 208.3 ± 15 nm with a drug loading of 52.97 %. The NPs showed first order diffusion-controlled drug release which was sustained for 24 h. These nanoparticle's antifungal efficacy was tested using the CLSI - M61 guidelines and the MIC50 defined against Aspergillus flavus and Aspergillus fumigatus was found to be >32 μg/ml which was similar to the nikkomycin MIC. The hyphal tip bursting showed the fungal cell wall disruption. The non-cytotoxic and non-haemolytic nature highlights the drug safety profile.
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Affiliation(s)
- Kamal Mayattu
- Nanobioscience Group, 72467 Agharkar Research Institute , GG Agarkar Road, Pune 411004, Maharashtra, India
| | - Vandana Ghormade
- Nanobioscience Group, 72467 Agharkar Research Institute , GG Agarkar Road, Pune 411004, Maharashtra, India
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Montreuil N, Martinez A, Budrie L, Goyal S, Quiroz T, Vu C, Ayoade F, Sternberg CA. Aspergillus fumigatus Epidural Abscess and Postsurgical Wound Infection in an Immunocompetent Host. Case Rep Infect Dis 2024; 2024:8104167. [PMID: 38455724 PMCID: PMC10919981 DOI: 10.1155/2024/8104167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
In this case, we present an immunocompetent patient who had a wound infection secondary to Aspergillus fumigatus after undergoing a neurosurgical procedure that was complicated by an epidural abscess. The patient was treated with voriconazole and responded favorably. We highlight the need for awareness of the possibility of an Aspergillus infection in people without any obvious immunocompromise and advocate for the inclusion of this opportunistic fungus in the workup of postneurosurgical infections and dura-based collections. A brief review of relevant literature is also included.
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Affiliation(s)
| | | | - Leon Budrie
- Baylor College of Medicine, Houston, TX, USA
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Bralet T, Risco-Castillo V, Valsecchi I, Laidebeure S, Sailler A, Lécu A, Botterel F, Guillot J, Arné P, Jouvion G. Aspergillosis in a colony of Humboldt penguins (Spheniscus humboldti) in a french zoological park: evaluation of environmental exposure. Vet Res Commun 2024; 48:437-448. [PMID: 37819485 DOI: 10.1007/s11259-023-10220-z] [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: 08/02/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
Aspergillosis is a major health problem in captive penguins due to the inhalation and the development of airborne spores of opportunistic environmental molds of the genus Aspergillus. Diagnosis is often delayed and treatments, based on the use of azole antifungals, are not fully effective. This study assesses the risk of exposure to Aspergillus sp. and determines the environmental reservoirs in the direct environment of a colony of Humboldt penguins (Spheniscus humboldti) in a zoological park in Paris, and the risk of contamination with resistant isolates. Every 15 days between February and May 2022, environmental samples (air and subtract from the nests, pond water, pigeon and penguin droppings) were carried out in the penguin enclosure as well as clinical samples (one-time non-invasive sampling on chicks), and screened for Aspergillus sp. conidia. From 191 environmental samples, 264 strains of Aspergillus including 221 strains of A. fumigatus were isolated, mostly from ambient air, in the nests, and pond water. No "at risk" areas in the penguin environment have been highlighted, nor an increased risk because of the proximity with urban wild birds. However, the load of airborne Aspergillus in the nests increased significantly with outdoor temperature. Of the 221 strains isolated, we identified only one azole-resistant strain, displaying the TR34/L98H mutation in the cyp51A gene. This low prevalence of resistant strains may probably be partly explained by the urban location of the zoological park, surrounded by kilometers of urban areas without agricultural activities.
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Affiliation(s)
- Tristan Bralet
- Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Dynamyc research team, Créteil, F-94000, France
- French Food Safety Agency, Bacterial Zoonosis unit, Maisons-Alfort, F-94700, France
| | - Veronica Risco-Castillo
- Anses, INRAE, Laboratoire de Santé Animale, Ecole nationale vétérinaire d'Alfort, BIPAR, Maisons- Alfort, F-94700, France
- Ecole nationale vétérinaire d'Alfort, Centre Hospitalo-Universitaire de la Faune Sauvage, Maisons-Alfort, F-94700, France
| | - Isabel Valsecchi
- Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Dynamyc research team, Créteil, F-94000, France
| | - Sylvie Laidebeure
- Parc Zoologique de Paris, Museum national d'Histoire naturelle, Paris, F-75012, France
| | - Anaïs Sailler
- Parc Zoologique de Paris, Museum national d'Histoire naturelle, Paris, F-75012, France
| | - Alexis Lécu
- Parc Zoologique de Paris, Museum national d'Histoire naturelle, Paris, F-75012, France
| | - Françoise Botterel
- Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Dynamyc research team, Créteil, F-94000, France
| | - Jacques Guillot
- Dermatology, Parasitology and Mycology department, ONIRIS, Nantes, F-44300, France
- Université d'Angers, Université de Brest, IRF, SFR ICAT, Angers, F-49000, France
| | - Pascal Arné
- Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Dynamyc research team, Créteil, F-94000, France
- Ecole nationale vétérinaire d'Alfort, Centre Hospitalo-Universitaire de la Faune Sauvage, Maisons-Alfort, F-94700, France
| | - Grégory Jouvion
- Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC ANSES, Dynamyc research team, Créteil, F-94000, France.
- Histology and pathology unit, Ecole nationale vétérinaire d'Alfort, Maisons-Alfort, F-94700, France.
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De Francesco MA. Drug-Resistant Aspergillus spp.: A Literature Review of Its Resistance Mechanisms and Its Prevalence in Europe. Pathogens 2023; 12:1305. [PMID: 38003770 PMCID: PMC10674884 DOI: 10.3390/pathogens12111305] [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: 10/13/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Infections due to the Aspergillus species constitute an important challenge for human health. Invasive aspergillosis represents a life-threatening disease, mostly in patients with immune defects. Drugs used for fungal infections comprise amphotericin B, triazoles, and echinocandins. However, in the last decade, an increased emergence of azole-resistant Aspergillus strains has been reported, principally belonging to Aspergillus fumigatus species. Therefore, both the early diagnosis of aspergillosis and its epidemiological surveillance are very important to establish the correct antifungal therapy and to ensure a successful patient outcome. In this paper, a literature review is performed to analyze the prevalence of Aspergillus antifungal resistance in European countries. Amphotericin B resistance is observed in 2.6% and 10.8% of Aspergillus fumigatus isolates in Denmark and Greece, respectively. A prevalence of 84% of amphotericin B-resistant Aspergillus flavus isolates is reported in France, followed by 49.4%, 35.1%, 21.7%, and 20% in Spain, Portugal, Greece, and amphotericin B resistance of Aspergillus niger isolates is observed in Greece and Belgium with a prevalence of 75% and 12.8%, respectively. The prevalence of triazole resistance of Aspergillus fumigatus isolates, the most studied mold obtained from the included studies, is 0.3% in Austria, 1% in Greece, 1.2% in Switzerland, 2.1% in France, 3.9% in Portugal, 4.9% in Italy, 5.3% in Germany, 6.1% in Denmark, 7.4% in Spain, 8.3% in Belgium, 11% in the Netherlands, and 13.2% in the United Kingdom. The mechanism of resistance is mainly driven by the TR34/L98H mutation. In Europe, no in vivo resistance is reported for echinocandins. Future studies are needed to implement the knowledge on the spread of drug-resistant Aspergillus spp. with the aim of defining optimal treatment strategies.
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Affiliation(s)
- Maria Antonia De Francesco
- Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia, ASST Spedali Civili, 25123 Brescia, Italy
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Bongomin F, Morgan B, Ekeng BE, Mushi MF, Kibone W, Olum R, Meya DB, Hamer DH, Denning DW. Isolated renal and urinary tract aspergillosis: a systematic review. Ther Adv Urol 2023; 15:17562872231218621. [PMID: 38130371 PMCID: PMC10734358 DOI: 10.1177/17562872231218621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Background Aspergillosis localized to the kidneys and the urinary tract is uncommon. We conducted a comprehensive systematic review to evaluate risk factors and clinical outcomes of patients with isolated renal and genito-urinary tract aspergillosis. Methods We systematically searched Medline, CINAHL, Embase, African Journal Online, Google Scholar, and the Cochrane Library, covering the period from inception to August 2023 using the key terms 'renal' OR 'kidney*' OR 'prostate' OR 'urinary bladder' OR 'urinary tract*AND 'aspergillosis' OR 'aspergillus' OR 'aspergilloma' OR 'mycetoma'. We included single case reports or case series. Review articles, guidelines, meta-analyses, animal studies, protocols, and cases of genitourinary and /or renal aspergillosis occurring as a part of disseminated disease were excluded. Results We identified 91 renal and urinary aspergillosis cases extracted from 76 publications spanning 1925-2023. Among the participants, 79 (86.8%) were male, with a median age of 46 years. Predominantly, presentations consisted of isolated renal infections (74 instances, 81.3%), followed by prostate (5 cases, 5.5%), and bladder (7 cases, 7.7%) involvement. Aspergillus fumigatus (42.9%), Aspergillus flavus (9.9%), and Aspergillus niger/glaucus (1.1% each) were isolated. Underlying risk factors included diabetes mellitus (29.7%), HIV (12.1%), haematological malignancies (11%), and liver cirrhosis (8.8%), while common symptoms encompassed flank pain (36.3%), fever (33%), and lower urinary tract symptoms (20.9%). An autopsy was conducted in 8.8% of cases. Diagnostic work-up involved histopathology (70.5%), renal CT scans and urine microscopy and culture (52.6% each), and abdominal ultrasound (17.9%). Treatments included amphotericin B (34 cases, 37.4%) and azole-based regimens (29 cases, 31.9%). Nephrectomy was performed in 16 of 78 renal cases (20.5%). All-cause mortality was 24.4% (19 cases). No significant mortality rate difference was observed among antifungal regimens (p = 0.739) or nephrectomy status (p = 0.8). Conclusion Renal and urinary aspergillosis is an important cause of morbidity and mortality, particularly in immunocompromised and people with diabetes mellitus. While varied treatment strategies were observed, mortality rates showed no significant differences based on treatments or nephrectomy status. Further research is needed to refine diagnostics, optimize treatments, and enhance awareness among clinicians for early detection and management. PROSPERO registration number CRD42023430959.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Bethan Morgan
- Trust Library Services, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Winnie Kibone
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ronald Olum
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Emerging Infectious Disease Laboratory, Boston, MA, USA
- Center for Emerging Infectious Diseases Policy & Research, Boston University, Boston, MA, USA
| | - David W. Denning
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Abstract
The burden of fungal infections has been on the rise globally and remains a significant public health concern in Kenya. We estimated the incidence and prevalence of fungal infections using all mycology publications in Kenya up to January 2023, and from neighbouring countries where data lacked. We used deterministic modelling using populations at risk to calculate the disease burden. The total burden of serious fungal infections is estimated to affect 6,328,294 persons which translates to 11.57% of the Kenyan population. Those suffering from chronic infections such as chronic pulmonary aspergillosis are estimated to be 100,570 people (0.2% of the population) and probably nearly 200,000 with fungal asthma, all treatable with oral antifungal therapy. Serious acute fungal infections secondary to HIV (cryptococcal meningitis, disseminated histoplasmosis, pneumocystis pneumonia, and mucosal candidiasis) affect 196,543 adults and children (0.4% of the total population), while cancer-related invasive fungal infection cases probably exceed 2,299 and those in intensive care about 1,230 incident cases, including Candida auris bloodstream infection. The burden of fungal infections in Kenya is high; however, limited diagnostic test availability, low clinician awareness and inadequate laboratory capacity constrain the country's health system in responding to the syndemic of fungal disease in Kenya.
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Affiliation(s)
- Stanley N. Ratemo
- Research Department, Kisii Teaching and Referral Hospital, Kisii, Kenya
- CONTACT Stanley N. Ratemo
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Global Action for Fungal Infections (GAFFI), Geneva, Switzerland
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10
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Tan LF, Yap VL, Rajagopal M, Wiart C, Selvaraja M, Leong MY, Tan PL. Plant as an Alternative Source of Antifungals against Aspergillus Infections: A Review. PLANTS (BASEL, SWITZERLAND) 2022; 11:3009. [PMID: 36432738 PMCID: PMC9697101 DOI: 10.3390/plants11223009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Aspergillus species consists of a group of opportunistic fungi that is virulent when the immunity of the host is compromised. Among the various species, Aspergillus fumigatus is the most prevalent species. However, the prevalence of fungal infections caused by non-fumigatus Aspergillus has been increasing. Polyenes, echinocandins and azoles are the three main classes of antifungal agents being used for the treatment of aspergillosis. Nevertheless, the incidence of resistance towards these three classes has been rising over the years among several Aspergillus spp. The side effects associated with these conventional antifungal agents have also limited their usage. This urges the need for the discovery of a safe and effective antifungal agent, which presents a major challenge in medicine today. Plants present a rich source of bioactive molecules which have been proven effective against a wide range of infections and conditions. Therefore, this present review intends to examine the current literature available regarding the efficacy and mechanism of action of plant extracts and their compounds against Aspergillus spp. In addition, novel drug delivery systems of plant extracts against Aspergillus spp. were also included in this review.
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Affiliation(s)
- Lee Fang Tan
- Faculty of Pharmaceutical Sciences, UCSI University, UCSI Heights 1, Jalan Puncak Menara Gading, Taman Connaught, Cheras, Kuala Lumpur 56000, Malaysia
| | - Vi Lien Yap
- Faculty of Pharmaceutical Sciences, UCSI University, UCSI Heights 1, Jalan Puncak Menara Gading, Taman Connaught, Cheras, Kuala Lumpur 56000, Malaysia
| | - Mogana Rajagopal
- Faculty of Pharmaceutical Sciences, UCSI University, UCSI Heights 1, Jalan Puncak Menara Gading, Taman Connaught, Cheras, Kuala Lumpur 56000, Malaysia
| | - Christophe Wiart
- Institute for Tropical Biology & Conservation, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Malarvili Selvaraja
- Faculty of Pharmaceutical Sciences, UCSI University, UCSI Heights 1, Jalan Puncak Menara Gading, Taman Connaught, Cheras, Kuala Lumpur 56000, Malaysia
| | - Mun Yee Leong
- Faculty of Pharmaceutical Sciences, UCSI University, UCSI Heights 1, Jalan Puncak Menara Gading, Taman Connaught, Cheras, Kuala Lumpur 56000, Malaysia
| | - Puay Luan Tan
- Faculty of Pharmaceutical Sciences, UCSI University, UCSI Heights 1, Jalan Puncak Menara Gading, Taman Connaught, Cheras, Kuala Lumpur 56000, Malaysia
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11
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Hansanant N, Smith L. Occidiofungin: Actin Binding as a Novel Mechanism of Action in an Antifungal Agent. Antibiotics (Basel) 2022; 11:antibiotics11091143. [PMID: 36139923 PMCID: PMC9494966 DOI: 10.3390/antibiotics11091143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
The identification and development of natural products into novel antimicrobial agents is crucial to combat the rise of multidrug-resistant microorganisms. Clinical fungal isolates have been identified, which have shown resistance to all current clinical antifungals, highlighting a significant need to develop a novel antifungal agent. One of the natural products produced by the bacterium Burkholderia contaminans MS14 is the glycolipopeptide occidiofungin. Occidiofungin has demonstrated in vitro activity against a multitude of fungal species, including multidrug-resistant Candida auris strains, and in vivo effectiveness in treating vulvovaginal candidiasis. Characterization of occidiofungin revealed the mechanism of action as binding to actin to disrupt higher-order actin-mediated functions leading to the induction of apoptosis in fungal cells. Occidiofungin is the first small molecule capable of disrupting higher-order actin functions and is a first-in-class compound that is able to circumvent current antifungal resistant mechanisms by fungal species. Anticancer properties and antiparasitic activities, against Cryptosporidium parvum, have also been demonstrated in vitro. The novel mechanism of action and wide spectrum of activity highlights the potential of occidiofungin to be developed for clinical use.
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12
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Howard A, Hope W. CON: Serum biomarker monitoring should not replace primary antifungal chemoprophylaxis in patients with acute leukaemia receiving systemic anti-cancer therapy. JAC Antimicrob Resist 2022; 4:dlac081. [PMID: 35891676 PMCID: PMC9305492 DOI: 10.1093/jacamr/dlac081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Primary antifungal chemoprophylaxis (PAC) is the widespread strategy of choice for the prevention of invasive fungal disease in patients with acute leukaemia (AL). Twice-weekly monitoring of the serum biomarkers (SBM) galactomannan and 1,3-β-d-glucan has been proposed as an alternative prevention strategy to PAC for these patients. This paper outlines the arguments for why PAC should remain as the standard of care in AL, instead of switching to twice-weekly SBM. Arguments put forward in favour of PAC are the strength of evidence for its safety, cost-effectiveness and adaptability, and its adoption by multiple international guidelines as standard of care. The potential implications of PAC for drug interactions and antifungal resistance are also discussed. The drawbacks of twice-weekly SBM are appraised, including missed or delayed diagnoses, unnecessary investigations, deferral of systemic anti-cancer therapy and increased pressure on laboratory services.
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Affiliation(s)
- Alex Howard
- Liverpool University Hospitals NHS Foundation Trust , Prescot Street, Liverpool, L7 8XP , UK
| | - William Hope
- Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpool , Liverpool, L69 3BX , UK
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13
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Active Surveillance Program to Increase Awareness on Invasive Fungal Diseases: the French RESSIF Network (2012 to 2018). mBio 2022; 13:e0092022. [PMID: 35499498 PMCID: PMC9239099 DOI: 10.1128/mbio.00920-22] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The French National Reference Center for Invasive Mycoses and Antifungals leads an active and sustained nationwide surveillance program on probable and proven invasive fungal diseases (IFDs) to determine their epidemiology in France. Between 2012 and 2018, a total of 10,886 IFDs were recorded. The incidence increased slightly over time (2.16 to 2.36/10,000 hospitalization days, P = 0.0562) in relation with an increase of fungemia incidence (1.03 to 1.19/10,000, P = 0.0023), while that of other IFDs remained stable. The proportion of ≥65-year-old patients increased from 38.4% to 45.3% (P < 0.0001). Yeast fungemia (n = 5,444) was due mainly to Candida albicans (55.6%) with stable proportions of species over time. Echinocandins became the main drug prescribed (46.7% to 61.8%), but global mortality rate remained unchanged (36.3% at 1 month). Pneumocystis jirovecii pneumonia (n = 2,106) was diagnosed mostly in HIV-negative patients (80.7%) with a significantly higher mortality than in HIV-positive patients (21.9% versus 5.4% at 1 month, P < 0.0001). Invasive aspergillosis (n = 1,661) and mucormycosis (n = 314) were diagnosed mostly in hematology (>60% of the cases) with a global mortality rate of 42.5% and 59.3%, respectively, at 3 months and significant changes in diagnosis procedure over time. More concurrent infections were also diagnosed over time (from 5.4% to 9.4% for mold IFDs, P = 0.0115). In conclusion, we observed an aging of patients with IFD with a significant increase in incidence only for yeast fungemia, a trend toward more concurrent infections, which raises diagnostic and therapeutic issues. Overall, global survival associated with IFDs has not improved despite updated guidelines and new diagnostic tools.
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14
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Parente R, Possetti V, Erreni M, D'Autilia F, Bottazzi B, Garlanda C, Mantovani A, Inforzato A, Doni A. Complementary Roles of Short and Long Pentraxins in the Complement-Mediated Immune Response to Aspergillus fumigatus Infections. Front Immunol 2021; 12:785883. [PMID: 34868070 PMCID: PMC8637271 DOI: 10.3389/fimmu.2021.785883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
The ubiquitous mold Aspergillus fumigatus is the major etiologic agent of invasive aspergillosis, a life-threatening infection amongst immune compromised individuals. An increasing body of evidence indicates that effective disposal of A. fumigatus requires the coordinate action of both cellular and humoral components of the innate immune system. Early recognition of the fungal pathogen, in particular, is mediated by a set of diverse soluble pattern recognition molecules (PRMs) that act as "ancestral antibodies" inasmuch as they are endowed with opsonic, pro-phagocytic and killing properties. Pivotal is, in this respect, the contribution of the complement system, which functionally cooperates with cell-borne pattern recognition receptors (PRRs) and other soluble PRMs, including pentraxins. Indeed, complement and pentraxins form an integrated system with crosstalk, synergism, and regulation, which stands as a paradigm of the interplay between PRMs in the mounting and orchestration of antifungal immunity. Following upon our past experience with the long pentraxin PTX3, a well-established immune effector in the host response to A. fumigatus, we recently reported that this fungal pathogen is targeted in vitro and in vivo by the short pentraxin Serum Amyloid P component (SAP) too. Similar to PTX3, SAP promotes phagocytosis and disposal of the fungal pathogen via complement-dependent pathways. However, the two proteins exploit different mechanisms of complement activation and receptor-mediated phagocytosis, which further extends complexity and integration of the complement-pentraxin crosstalk in the immune response to A. fumigatus. Here we revisit this crosstalk in light of the emerging roles of SAP as a novel PRM with antifungal activity.
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Affiliation(s)
- Raffaella Parente
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Valentina Possetti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Marco Erreni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesca D'Autilia
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Barbara Bottazzi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Cecilia Garlanda
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Mantovani
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Antonio Inforzato
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Doni
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
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15
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Bastos RW, Rossato L, Goldman GH, Santos DA. Fungicide effects on human fungal pathogens: Cross-resistance to medical drugs and beyond. PLoS Pathog 2021; 17:e1010073. [PMID: 34882756 PMCID: PMC8659312 DOI: 10.1371/journal.ppat.1010073] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fungal infections are underestimated threats that affect over 1 billion people, and Candida spp., Cryptococcus spp., and Aspergillus spp. are the 3 most fatal fungi. The treatment of these infections is performed with a limited arsenal of antifungal drugs, and the class of the azoles is the most used. Although these drugs present low toxicity for the host, there is an emergence of therapeutic failure due to azole resistance. Drug resistance normally develops in patients undergoing azole long-term therapy, when the fungus in contact with the drug can adapt and survive. Conversely, several reports have been showing that resistant isolates are also recovered from patients with no prior history of azole therapy, suggesting that other routes might be driving antifungal resistance. Intriguingly, antifungal resistance also happens in the environment since resistant strains have been isolated from plant materials, soil, decomposing matter, and compost, where important human fungal pathogens live. As the resistant fungi can be isolated from the environment, in places where agrochemicals are extensively used in agriculture and wood industry, the hypothesis that fungicides could be driving and selecting resistance mechanism in nature, before the contact of the fungus with the host, has gained more attention. The effects of fungicide exposure on fungal resistance have been extensively studied in Aspergillus fumigatus and less investigated in other human fungal pathogens. Here, we discuss not only classic and recent studies showing that environmental azole exposure selects cross-resistance to medical azoles in A. fumigatus, but also how this phenomenon affects Candida and Cryptococcus, other 2 important human fungal pathogens found in the environment. We also examine data showing that fungicide exposure can select relevant changes in the morphophysiology and virulence of those pathogens, suggesting that its effect goes beyond the cross-resistance.
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Affiliation(s)
- Rafael W. Bastos
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto-SP, Brazil
| | - Luana Rossato
- Federal University of Grande Dourados, Dourados-MS, Brazil
| | - Gustavo H. Goldman
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto-SP, Brazil
| | - Daniel A. Santos
- Laboratory of Mycology, Federal University of Minas Gerais, Belo Horizonte-MG, Brazil
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16
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Simon L, Déméautis T, Dupont D, Kramer R, Garnier H, Durieu I, Sénéchal A, Reix P, Couraud S, Devouassoux G, Lina B, Rabodonirina M, Wallon M, Dannaoui E, Persat F, Menotti J. Azole resistance in Aspergillus fumigatus isolates from respiratory specimens in Lyon University Hospitals, France: prevalence and mechanisms involved. Int J Antimicrob Agents 2021; 58:106447. [PMID: 34619334 DOI: 10.1016/j.ijantimicag.2021.106447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/05/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022]
Abstract
Resistance of Aspergillus fumigatus to triazoles has been reported increasingly in Europe. As few data are available from Southern France, the objectives of this study were to assess the burden of A. fumigatus isolates with azole resistance from clinical specimens in Lyon, and explore the resistance mechanisms involved. In this retrospective cross-sectional study, 221 consecutive A. fumigatus isolates from respiratory samples were identified from an 8-month period from 195 patients attending the Pulmonary Medicine Departments of Lyon University Hospitals. Morphological identification was confirmed by sequence analysis of the β-tubulin gene. All samples were tested for susceptibilities to itraconazole, voriconazole, posaconazole and isavuconazole using concentration gradient strips, and the results were confirmed using the EUCAST broth microdilution method. Resistance mechanisms were investigated by sequencing the cyp51A gene and its promoter, and by expression analysis of cyp51 and genes encoding several efflux transporters. Four isolates exhibited azole resistance. Three isolates presented with polymorphisms in an intronic region of cyp51A, and one isolate had F46Y, M172V and E427K polymorphisms. No mutations were identified in the cyp51A promoter, but significant induction of cyp51A and cyp51B gene expression was observed for all four and three isolates, respectively. Significant induction of atrF and cdr1B gene expression was observed for two and three isolates, respectively. No significant induction of MDR1/2/3/4, MFS56 and M85 gene expression was observed. To conclude, the observed prevalence of azole resistance was 2.1%. Significant induction of expression of the cyp51 genes and two genes encoding efflux transporters was evidenced, underlying the diversity of resistance mechanisms to be explored.
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Affiliation(s)
- Loïc Simon
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Centre Hospitalier Universitaire de Nice, Service de Parasitologie-Mycologie, Université Côte d'Azur, Nice, France
| | - Tanguy Déméautis
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France
| | - Damien Dupont
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Inserm U1028, CNRS UMR5292, équipe WAKING, Lyon, France
| | - Rolf Kramer
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; European Public Health Microbiology Training Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Héloïse Garnier
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France
| | - Isabelle Durieu
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Médecine Interne et Vasculaire, Centre de Ressources et de Compétences de la Mucoviscidose Adultes, Pierre-Bénite, France
| | - Agathe Sénéchal
- Hospices Civils de Lyon, Hôpital Louis Pradel, Département de Pneumologie et de Transplantation Pulmonaire, Hospices Civils de Lyon, Bron, France
| | - Philippe Reix
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressources et de Compétences de la Mucoviscidose Enfants, Bron, France
| | - Sébastien Couraud
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Pneumologie Aiguë Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Gilles Devouassoux
- Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France; Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Pneumologie, Lyon, France
| | - Bruno Lina
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Virologie, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France
| | - Meja Rabodonirina
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France
| | - Martine Wallon
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Inserm U1028, CNRS UMR5292, équipe WAKING, Lyon, France
| | - Eric Dannaoui
- Université de Paris, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Microbiologie, Unité de Parasitologie-Mycologie, Paris, France; Université Paris-Est Créteil, Équipe Dynamyc, EA 7380, Créteil, France
| | - Florence Persat
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France
| | - Jean Menotti
- Hospices Civils de Lyon, Institut des Agents Infectieux, Service de Parasitologie et Mycologie médicale, Hôpital de la Croix-Rousse, Lyon, France; Université Claude Bernard Lyon 1, EA7426 équipe Inflammation et immunité de l'épithélium respiratoire, Oullins, France.
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17
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Rayens E, Norris KA, Cordero JF. Mortality Trends in Risk Conditions and Invasive Mycotic Disease in the United States, 1999-2018. Clin Infect Dis 2021; 74:309-318. [PMID: 33876235 DOI: 10.1093/cid/ciab336] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Invasive fungal infections (IFIs) in the United States are chronically underdiagnosed and a lack of coordinated surveillance makes the true burden of disease difficult to determine. The purpose of this analysis was to capture mortality-associated burden of risk conditions and fungal infections. METHODS We analyzed data from the National Vital Statistics System from 1999-2018 to estimate the mortality attributed to risk conditions and related fungal disease. RESULTS The number of risk conditions associated with fungal disease is steadily rising in the United States with 1,047,422 diagnoses at time of death in 2018. While fungal disease decreased substantially from 1999 to 2010, primarily due to the control of HIV infection, the number deaths with fungal diagnosis has increased in the non-HIV cohort, with significant increases in patients with diabetes, cancer, immunosuppressive disorders, or sepsis. CONCLUSION The landscape of individuals at risk for serious fungal diseases is changing, with a continued decline in HIV-associated incidence, but increased diagnoses in patients with cancer, sepsis, immunosuppressive disorders, and influenza. Additionally, there is an overall increase in the number of fungal infections in recent years, indicating a failure to control fungal disease mortality in these new immunocompromised cohorts. Improvement in prevention and management of fungal diseases is needed to control morbidity and mortality in the rising number of immunocompromised and at-risk patients in the United States.
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Affiliation(s)
- Emily Rayens
- Center for Vaccines and Immunology, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia USA.,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia USA
| | - Karen A Norris
- Center for Vaccines and Immunology, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia USA
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