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Hoenigl M, Arastehfar A, Arendrup MC, Brüggemann R, Carvalho A, Chiller T, Chen S, Egger M, Feys S, Gangneux JP, Gold JAW, Groll AH, Heylen J, Jenks JD, Krause R, Lagrou K, Lamoth F, Prattes J, Sedik S, Wauters J, Wiederhold NP, Thompson GR. Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease. Clin Microbiol Rev 2024; 37:e0007423. [PMID: 38602408 DOI: 10.1128/cmr.00074-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
SUMMARYFungal infections are on the rise, driven by a growing population at risk and climate change. Currently available antifungals include only five classes, and their utility and efficacy in antifungal treatment are limited by one or more of innate or acquired resistance in some fungi, poor penetration into "sequestered" sites, and agent-specific side effect which require frequent patient reassessment and monitoring. Agents with novel mechanisms, favorable pharmacokinetic (PK) profiles including good oral bioavailability, and fungicidal mechanism(s) are urgently needed. Here, we provide a comprehensive review of novel antifungal agents, with both improved known mechanisms of actions and new antifungal classes, currently in clinical development for treating invasive yeast, mold (filamentous fungi), Pneumocystis jirovecii infections, and dimorphic fungi (endemic mycoses). We further focus on inhaled antifungals and the role of immunotherapy in tackling fungal infections, and the specific PK/pharmacodynamic profiles, tissue distributions as well as drug-drug interactions of novel antifungals. Finally, we review antifungal resistance mechanisms, the role of use of antifungal pesticides in agriculture as drivers of drug resistance, and detail detection methods for antifungal resistance.
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Affiliation(s)
- Martin Hoenigl
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Amir Arastehfar
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Maiken Cavling Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Roger Brüggemann
- Department of Pharmacy and Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc-CWZ Center of Expertise in Mycology, Nijmegen, The Netherlands
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW South Wales Health Pathology, Westmead Hospital, Westmead, Australia
- The University of Sydney, Sydney, Australia
| | - Matthias Egger
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Simon Feys
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jean-Pierre Gangneux
- Centre National de Référence des Mycoses et Antifongiques LA-AspC Aspergilloses chroniques, European Excellence Center for Medical Mycology (ECMM EC), Centre hospitalier Universitaire de Rennes, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S 1085, Rennes, France
| | - Jeremy A W Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology and Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital, Muenster, Germany
| | - Jannes Heylen
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jeffrey D Jenks
- Department of Public Health, Durham County, Durham, North Carolina, USA
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Robert Krause
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Frédéric Lamoth
- Department of Laboratory Medicine and Pathology, Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Juergen Prattes
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- BiotechMed-Graz, Graz, Austria
| | - Sarah Sedik
- Department of Internal Medicine, Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
| | - Joost Wauters
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
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Qureshi HUH, Absar M, Nasser W, Yacoubi MT. A rare case of cerebral phaeohyphomycosis caused by Fonsecaea species in a renal transplant patient. Med Mycol Case Rep 2024; 43:100621. [PMID: 38187996 PMCID: PMC10771888 DOI: 10.1016/j.mmcr.2023.100621] [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: 10/04/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024] Open
Abstract
Cerebral phaeohyphomycosis (CP) is a serious form of phaeohyphomycosis. We report a case of CP caused by Fonsecaea species in a 66-year-old immunocompromised renal transplant recipient female. Craniotomy was performed on an irregularly enhancing right cerebellar hemisphere lesion and abscess and tissue samples collected for microbiological and histological evaluation, showing fungal elements and Fonsecaea species was isolated. Antifungal treatment with voriconazole & liposomal amphotericin B was initiated with a temporary improvement in the patient's condition. Deep vein thrombosis jeopardized patient's prognosis. Despite aggressive surgical and medical intervention, our patient succumbed to the disease. Historically, CP has been linked with fatality rates as high as 65 %, despite surgical intervention and systemic antifungal medication.
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Affiliation(s)
- Hammad Ul Haq Qureshi
- Department of Neurosurgery, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, AlAhsa, Saudi Arabia
| | - Muhammad Absar
- Department of Pathology and Laboratory Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, AlAhsa, Saudi Arabia
| | - Wafa Nasser
- Infection Prevention & Control Program, Imam Abdulrahman Bin Faisal Hospital, Al-Dammam, Saudi Arabia
| | - Mohamed Tahar Yacoubi
- Department of Pathology and Laboratory Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, AlAhsa, Saudi Arabia
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Bigot J, Leroy J, Chouaki T, Cholley L, Bigé N, Tabone MD, Brissot E, Thorez S, Maizel J, Dupont H, Sendid B, Hennequin C, Guitard J. ß-D-Glucan Assay in the Cerebrospinal Fluid for the Diagnosis of Non-cryptococcal Fungal Infection of the Central Nervous System: A Retrospective Multicentric Analysis and a Comprehensive Review of the Literature. Clin Infect Dis 2023; 77:711-720. [PMID: 37132362 DOI: 10.1093/cid/ciad274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Except for cryptococcosis, fungal infection of the central nervous system (FI-CNS) is a rare but severe complication. Clinical and radiological signs are non-specific, and the value of conventional mycological diagnosis is very low. This study aimed to assess the value of β1,3-D-glucan (BDG) detection in the cerebrospinal fluid (CSF) of non-neonatal non-cryptococcosis patients. METHODS Cases associated with BDG assay in the CSF performed in 3 French University Hospitals over 5 years were included. Clinical, radiological, and mycological results were used to classify the episodes as proven/highly probable, probable, excluded, and unclassified FI-CNS. Sensitivity and specificity were compared to that calculated from an exhaustive review of the literature. RESULTS In total, 228 episodes consisting of 4, 7, 177, and 40 proven/highly probable, probable, excluded, and unclassified FI-CNS, respectively, were analysed. The sensitivity of BDG assay in CSF to diagnose proven/highly probable/probable FI-CNS ranged from 72.7% [95% confidence interval {CI}: 43.4%‒90.2%] to 100% [95% CI: 51%‒100%] in our study and was 82% in the literature. For the first time, specificity could be calculated over a large panel of pertinent controls and was found at 81.8% [95% CI: 75.3%‒86.8%]. Bacterial neurologic infections were associated with several false positive results. CONCLUSIONS Despite its sub-optimal performance, BDG assay in the CSF should be added to the diagnostic armamentarium for FI-CNS.
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Affiliation(s)
- Jeanne Bigot
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Jordan Leroy
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Univ. Lille, Glycobiology in Fungal Pathogenesis & Clinical Applications, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Taieb Chouaki
- Mycology Laboratory, University Hospital of Amiens, Amiens, France
| | - Laurence Cholley
- Sorbonne Université, APHP, Hôpital Saint Antoine, Service de Radiologie Générale, Paris, France
| | - Naïke Bigé
- Sorbonne Université, APHP, Hôpital Saint Antoine, Service de Réanimation Médicale, Paris, France
- Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Marie-Dominique Tabone
- Département d'Hématologie et d'Oncologie Pédiatrique, Sorbonne Université, APHP, Hôpital Armand Trousseau, Paris, France
| | - Eolia Brissot
- Sorbonne Université, INSERM U938, APHP, Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, Paris, France
| | - Sophie Thorez
- Sorbonne Université, APHP, Hôpital St Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Julien Maizel
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Surgical ICU, University Hospital of Amiens Picardy, Amiens, France
- Université de Picardie Jules Verne, Unité de recherche 7518 SSPC, CHU Amiens Picardie, Service d'Anesthésie et de Réanimation Polyvalente, Amiens, France
| | - Boualem Sendid
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Univ. Lille, Glycobiology in Fungal Pathogenesis & Clinical Applications, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Christophe Hennequin
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Juliette Guitard
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
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Kucukkaya IC, Gulsever CI, Dolas I, Genc GE, Kuskucu MA, Sabanci PA, Erturan Z. First case of Rhinocladiella mackenziei brain abscess in Turkey: Case report and review of the literature. Mycoses 2023; 66:755-766. [PMID: 37165906 DOI: 10.1111/myc.13601] [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: 03/08/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023]
Abstract
Rhinocladiella mackenziei is a highly neurotropic fungus, mainly reported from the Middle East. However, in recent years, there have been some cases from outside this region. We described an additional fatal case of R. mackenziei cerebral infection for the first time from Turkey and made a literature review of all previously reported cases. During 34 years (1988-2022), there have been 42 R. mackenziei brain abscess cases. Most patients have been reported from Saudi Arabia (n = 14, 33.3%). It is noteworthy that 40.5% of patients, including our case, were immunocompetent at initial diagnosis and mostly presented with a single lesion (n = 10, 23.8%). The most frequent comorbidities were solid organ transplant (n = 9, 21.4%), diabetes mellitus (n = 6, 14.3%), malignancy (n = 6, 14.3%) and prior surgery (n = 3, 7.1%). The most commonly used initial antifungal regimen were amphotericin B together with itraconazole (n = 9, 21.4%), combinations of lipid preparations of amphotericin B, voriconazole and/or posaconazole (n = 9, 21.4%) and amphotericin B alone (n = 8, 19%). Although both surgical procedures and antifungal medication in the majority of patients were performed, mortality rates remained high (90.4%). The area at risk of R. mackenziei cerebral abscess cases extends to other countries. Clinicians should be aware of this emerging disease and take a detailed travel history in patients with atypical and undocumented brain abscesses. Our case confirms the hypothesis that this fungus might spread more widely than previously predicted regions.
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Affiliation(s)
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gonca Erkose Genc
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mert Ahmet Kuskucu
- Department of Medical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
- İş-Bank Center for Infectious Diseases, Department of Medical Microbiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zayre Erturan
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Rodrigues ML, Nosanchuk JD. Recognition of fungal priority pathogens: What next? PLoS Negl Trop Dis 2023; 17:e0011136. [PMID: 36893096 PMCID: PMC9997940 DOI: 10.1371/journal.pntd.0011136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Marcio L. Rodrigues
- Instituto Carlos Chagas, Fundação Oswaldo Cruz (Fiocruz), Curitiba, Brazil
- Instituto de Microbiologia Paulo de Góes (IMPG), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (MLR); (JDN)
| | - Joshua D. Nosanchuk
- Department of Medicine (Division of Infectious Diseases) and Department of Microbiology and Immunology, Albert Einstein College of Medicine, New York, New York, United States of America
- * E-mail: (MLR); (JDN)
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Juravel E, Polacheck I, Isaacson B, Dagan A, Korem M. The Distinction between Dematiaceous Molds and Non-Dematiaceous Fungi in Clinical and Spiked Samples Treated with Hydrogen Peroxide Using Direct Fluorescence Microscopy. J Fungi (Basel) 2023; 9:jof9020227. [PMID: 36836341 PMCID: PMC9967646 DOI: 10.3390/jof9020227] [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: 01/12/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Dematiaceous fungi are pigmented molds with a high content of melanin in their cell walls that can cause fatal infections in immunocompromised hosts. Direct microscopy is the main method for the rapid diagnosis of dematiaceous fungi in clinical specimens. However, it is often difficult to distinguish their hyphae from non-dematiaceous hyphae and yeast pseudohyphae. Our aim was to develop a fluorescence staining method that targets melanin for the detection of dematiaceous molds in clinical specimens. Glass slide smears of clinical samples and sterile bronchoalveolar lavage spiked with dematiaceous and non-dematiaceous fungi were treated with hydrogen peroxide, and digital images were recorded using direct microscopy with different fluorescent filters. The images of fungi were compared for their fluorescence intensity using the NIS-Elements software. The fluorescent signal between dematiaceous and non-dematiaceous fungi demonstrated a markedly increased mean intensity for dematiaceous molds following hydrogen peroxide treatment (7510.3 ± 10,427.6 vs. 0.3 ± 3.1, respectively, p < 0.0001). No fluorescent signal was detected in the absence of hydrogen peroxide. "Staining" fungal clinical specimens with hydrogen peroxide, followed by fluorescence microscopy examination, can differentiate between dematiaceous and non-dematiaceous fungi. This finding can be used for the detection of dematiaceous molds in clinical specimens and enables the early and appropriate treatment of infections.
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Affiliation(s)
- Elchanan Juravel
- Department of Internal Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112101, Israel
| | - Itzhack Polacheck
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112101, Israel
| | - Batya Isaacson
- The Concern Foundation Laboratories at the Lautenberg Center for Immunology and Cancer Research, The Hebrew University Medical School, IMRIC, Jerusalem 9112102, Israel
| | - Arie Dagan
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, The Hebrew University Medical School, Jerusalem 9112102, Israel
| | - Maya Korem
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112101, Israel
- Correspondence: ; Tel.: +972-50-8573173; Fax: +972-2-6419545
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Rao S, Boreddy V, Zameer MM, D'Cruz A. Cladophialophora bantiana brain abscess after pediatric liver transplant: A report of a long-term survivor. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_23_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Bono B, Olei S, Rossini Z, Fernandes B, Valeri M, Pessina F. Primary brain necrotizing granulomas caused by. Infect Dis Now 2022; 52:381-383. [DOI: 10.1016/j.idnow.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
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Affiliation(s)
- Yohann Le Govic
- Infectious Agents, Resistance and Chemotherapy (AGIR), University of Picardy Jules Verne, Amiens, France
- Parasitology-Mycology Department, Center for Human Biology, University Hospital of Amiens-Picardie, Amiens, France
| | - Baptiste Demey
- Infectious Agents, Resistance and Chemotherapy (AGIR), University of Picardy Jules Verne, Amiens, France
- Virology Department, Center for Human Biology, University Hospital of Amiens-Picardie, Amiens, France
| | - Julien Cassereau
- Department of Neurology, Angers University Hospital, Angers, France
- Univ Angers, Inserm, CNRS, MITOVASC, SFR ICAT, Angers, France
| | - Yong-Sun Bahn
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
- * E-mail: (Y-SB); (NP)
| | - Nicolas Papon
- Univ Angers, Univ Brest, IRF, SFR ICAT, Angers, France
- * E-mail: (Y-SB); (NP)
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Mody P, Wada P, Bloch KC, Lionakis MS, White KD, Maris AS, Snyder T, Steinhauer J, Humphries R. Gram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old. BMC Infect Dis 2022; 22:13. [PMID: 34983414 PMCID: PMC8725554 DOI: 10.1186/s12879-021-07008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/22/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fungal brain abscesses in immunocompetent patients are exceedingly rare. Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis, a dematiaceous mold. Radiological presentation can mimic other disease states, with diagnosis through surgical aspiration and growth of melanized fungi in culture. Exposure is often unknown, with delayed presentation and diagnosis. CASE PRESENTATION We present a case of cerebral phaeohyphomycosis in a 24-year-old with no underlying conditions or risk factors for disease. He developed upper respiratory symptoms, fevers, and headaches over the course of 2 months. On admission, he underwent brain MRI which demonstrated three parietotemporal rim-enhancing lesions. Stereotactic aspiration revealed a dematiaceous mold on staining and the patient was treated with liposomal amphotericin B, 5-flucytosine, and posaconazole prior to culture confirmation. He ultimately required surgical excision of the brain abscesses and prolonged course of antifungal therapy, with clinical improvement. CONCLUSIONS Culture remains the gold standard for diagnosis of infection. Distinct microbiologic findings can aid in identification and guide antimicrobial therapy. While little guidance exists on treatment, patients have had favorable outcomes with surgery and combination antifungal therapy. In improving awareness, clinicians may accurately diagnose disease and initiate appropriate therapy in a more timely manner.
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Affiliation(s)
- Perceus Mody
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA.
| | - Paul Wada
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen C Bloch
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Annapolis, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Annapolis, MD, USA
| | - Katie D White
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander S Maris
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
| | - Tonya Snyder
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
| | - Jennifer Steinhauer
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
| | - Romney Humphries
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, Nashville, TN, 37232, USA
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Dong L, Bai N, Wang T, Cai Y. Development and validation of a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the quantification of voriconazole in human cerebrospinal fluid. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2021; 13:4585-4593. [PMID: 34532726 DOI: 10.1039/d1ay01103k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: A liquid chromatography-tandem mass spectrometry (LC-MS/MS). Method: For the quantification of voriconazole in human cerebrospinal fluid (CSF) was developed and validated, to guide the clinical use of voriconazole in the treatment of central nervous system infections. CSF samples were treated by protein precipitation with methanol containing fluconazole as the internal standard (IS). The supernatant was analyzed by LC-MS/MS using an Agilent EclipsePlus C18 column eluted with a methanol and water mobile phase at a flow rate of 0.4 mL min-1. Quantification was performed by multiple-reaction monitoring using the precursor and product ion pair 350/280.9 for voriconazole and 307/219.9 for fluconazole. Results: The calibration curve was linear over the range of 0.1-10.0 μg mL-1 (R2 = 0.9991). The inter-day and intra-day precisions were <4.20% and <9.97%, respectively. The recoveries for the three concentrations (0.2, 1.0, and 8.0 μg mL-1) were 99.96%, 107.00%, and 99.85%, and the matrix effects were 99.35%, 103.41%, and 99.64%, respectively. The stability under various conditions was also acceptable. The study also demonstrated that the CSF matrix could be replaced by plasma and artificial CSF. Conclusion: A simple and accurate method for the determination of voriconazole concentrations in human CSF was developed and validated, which can be used for drug monitoring in the treatment of central nervous system infections.
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Affiliation(s)
- Liuhan Dong
- Center of Medicine Clinical Research, Department of Pharmacy, Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China.
- Medical School of Chinese PLA, Beijing 100853, China
| | - Nan Bai
- Center of Medicine Clinical Research, Department of Pharmacy, Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China.
| | - Tianlin Wang
- Office of Clinical Pharmacy, Department of Pharmacy, Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China.
| | - Yun Cai
- Center of Medicine Clinical Research, Department of Pharmacy, Chinese PLA General Hospital, 28 Fu Xing Road, Beijing 100853, China.
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Anversa L, Lara BR, Romani CD, Saeki EK, Nogueira Nascentes GA, Bonfietti LX, Melhem MDSC, da Silva Ruiz L, Camargo CH, Pereira VBR. Fungi in dialysis water and dialysate: occurrence, susceptibility to antifungal agents and biofilm production capacity. JOURNAL OF WATER AND HEALTH 2021; 19:724-735. [PMID: 34665766 DOI: 10.2166/wh.2021.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of this study was to investigate the occurrence of fungi in dialysis water and dialysate, in addition to evaluating the susceptibility to antifungals and the biofilm production capacity of isolated microorganisms. The samples were collected in three hemodialysis units in Bauru (Brazil), every 15 days (July 2017-June 2018) at post-reverse osmosis, reuse, and dialysate points. The fungi were isolated by spread plate on Sabouraud dextrose agar. Filamentous fungi were phenotypically identified and yeasts were subjected to molecular evaluation of the ITS region. Susceptibility test to antifungals was carried out by the broth microdilution method and biofilm production capacity was evaluated in microtiter plates using crystal violet staining. Fungi were isolated in 52/216 (24.1%) samples, with an average count of 16.3 (10-40) CFU/mL. Overall, 61 microorganisms were identified, with 54 (88.5%) filamentous fungi and 7 (11.5%) yeasts. The main genera included were Penicillium, Cladosporium, Scedosporium, Rhinocladiella, Fusarium, and Emmonsia. Most isolates showed high values of minimum inhibitory concentration for 5-flucytosine and fluconazole and 35/45 (77.8%) isolates were classified as strong producers of biofilm. In order to increase the safety of the dialysis process, the adoption of control measures and monitoring of fungi in hemodialysis fluids is suggested.
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Affiliation(s)
- Laís Anversa
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | - Bruna Rossini Lara
- Regional Laboratories Center Bauru, Adolfo Lutz Institute, Bauru, Brazil E-mail:
| | | | - Erika Kushikawa Saeki
- Regional Laboratories Center Presidente Prudente, Adolfo Lutz Institute, Presidente Prudente, Brazil
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13
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AlOtaibi TM, Gheith OA, Alobaid K, Nair P, Eldein SMZ, Mahmoud TS, Halim MA, Aboatya HH, Balaha MA, Atea KA, Nagib AM, Al-Hatmi AMS, Sadon A, Meis JF, Zahab M. Disseminated Rhinocladiella mackenziei infection in a kidney transplant recipient: A case report and literature review. J Mycol Med 2021; 31:101196. [PMID: 34418686 DOI: 10.1016/j.mycmed.2021.101196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 12/11/2022]
Abstract
Rhinocladiella mackenziei is a rare fungal pathogen which belongs to a large group of pigmented fungi causing phaeohyphomycosis. R. mackenziei primarily infects the brain and leads to high fatality rates among both immunocompetent and immunocompromised individuals. Among solid organ transplant recipients, the infection may disseminate to extra-neuronal sites, necessitating comprehensive radiologic imaging. Here we describe a new case of R. mackenziei infection in a renal transplant patient involving the brain and renal allograft. She received liposomal amphotericin B and voriconazole but no surgical intervention. Ultimately, the patient died after two months of hospital stay. A review of all reported cases of transplant patients infected with R. mackenziei is also presented.
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Affiliation(s)
| | - Osama A Gheith
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait; Urology and Nephrology Center, Mansoura University, Egypt
| | - Khaled Alobaid
- Mycology Reference Laboratory, Mubarak Al-Kabeer hospital, Jabriya 46307, Kuwait.
| | - Prasad Nair
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
| | | | | | | | | | | | - Khalid A Atea
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
| | - Ayman Maher Nagib
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait; Urology and Nephrology Center, Mansoura University, Egypt
| | - Abdullah M S Al-Hatmi
- Natural and Medical Sciences Research Center, University of Nizwa, 616 Nizwa, Oman; Department of Biological Sciences and Chemistry, College of Arts and Sciences, University of Nizwa, Nizwa 616, Oman; Centre of Expertise in Mycology Radboud University Medical Centre/ Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Amal Sadon
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Mohamed Zahab
- Hamed Alessa Organ Transplant Center, Shuwaikh, Kuwait
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14
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Hobson CA, Desoubeaux G, Carvalho-Schneider C, Destrieux C, Cottier JP, Garot D, Le Brun C, Maakaroun Z, Lemaignen A, Bailly É, Bernard L. Challenging diagnosis of chronic cerebral fungal infection: Value of (1→3)-ß-D-glucan and mannan antigen testing in cerebrospinal fluid and of cerebral ventricle puncture. Med Mycol 2021; 59:74-80. [PMID: 32470986 DOI: 10.1093/mmy/myaa035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Primary fungal infection of the central nervous system (CNS) is rare but often associated with severe prognosis. Diagnosis is complicated since cerebrospinal fluid (CSF) samples obtained from lumbar puncture usually remain sterile. Testing for fungal antigens in CSF could be a complementary diagnostic tool. We conducted such measurements in CSF from patients with CNS fungal infection and now discuss the usefulness of ventricular puncture. Mannan and (1→3)ß-D-glucan (BDG) testing were retrospectively performed in CSF samples from three patients with proven chronic CNS fungal infection (excluding Cryptococcus), and subsequently compared to 16 controls. Results from lumbar punctures and those from cerebral ventricles were confronted. BDG detection was positive in all the CSF samples (from lumbar and/or ventricular puncture) from the three confirmed cases. In case of Candida infection, mannan antigen measurement was positive in 75% of the CSF samples. In the control group, all antigen detections were negative (n = 15), except for one false positive. Faced with suspected chronic CNS fungal infection, measurement of BDG levels appears to be a complementary diagnostic tool to circumvent the limitations of mycological cultures from lumbar punctures. In the event of negative results, more invasive procedures should be considered, such as ventricular puncture.
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Affiliation(s)
- Claire A Hobson
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Guillaume Desoubeaux
- Department of Parasitology and Mycology, University Hospital of Tours, France.,CEPR INSERM U1100 / Team 3
| | | | - Christophe Destrieux
- Department of Neuro-surgery, University Hospital of Tours, France.,UMR1253, iBrain, INSERM, Tours, France
| | - Jean-Philippe Cottier
- UMR1253, iBrain, INSERM, Tours, France.,Department of Neuro-imaging, University Hospital of Tours, France
| | - Denis Garot
- Intensive Care Unit, University Hospital of Tours, France
| | - Cécile Le Brun
- Department of Microbiology, University Hospital of Tours, France
| | - Zoha Maakaroun
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Adrien Lemaignen
- Department of Infectious Diseases, University Hospital of Tours, France
| | - Éric Bailly
- Department of Parasitology and Mycology, University Hospital of Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, University Hospital of Tours, France
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15
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Vitale RG, Giudicessi SL, Romero SM, Al-Hatmi AMS, Li Q, de Hoog GS. Recent developments in less known and multi-resistant fungal opportunists. Crit Rev Microbiol 2021; 47:762-780. [PMID: 34096817 DOI: 10.1080/1040841x.2021.1927978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Fungal infections have increased in recent years due to host factors, such as oncohaematological and transplant-related disorders, immunosuppressive therapy, and AIDS. Additionally, molecular and proteomic facilities have become available to identify previously unrecognizable opportunists. For these reasons, reports on less-known and recalcitrant mycoses, such as those caused by black fungi, hyaline filamentous fungi, coelomycetes, Mucorales, and non-Candida yeasts have emerged. In this review, novel taxonomy in these groups, which often are multi-resistant to one or several classes of antifungals, is discussed. Clinical presentations, diagnosis and current treatment of some major groups are summarised.
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Affiliation(s)
- Roxana G Vitale
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.,Unidad de Parasitología, Sector Micología, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Silvana L Giudicessi
- Facultad de Farmacia y Bioquímica, Cátedra de Biotecnología, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Nanobiotecnología (NANOBIOTEC), UBA-CONICET, Buenos Aires, Argentina
| | - Stella M Romero
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.,Instituto Multidisciplinario de Biología Vegetal (IMBIV), CONICET, FCEFyN, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Abdullah M S Al-Hatmi
- Center of Expertise in Mycology of Radboud, University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Natural & Medical Science Research Center, University of Nizwa, Nizwa, Omán
| | - Qirui Li
- Department of Pharmacy, Guiyang Medical University, Guiyang, PR China
| | - G Sybren de Hoog
- Center of Expertise in Mycology of Radboud, University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Key Laboratory of Environmental Pollution Monitoring and Disease Control, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, PR China.,Department of Medical Microbiology, People's Hospital of Suzhou, National New & Hi-Tech Industrial Development Zone, Suzhou, PR China
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16
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Rohilla R, Meena S, Goyal N, Kaistha N. A rare case of fatal cerebral phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent individual in India. Curr Med Mycol 2021; 6:69-72. [PMID: 33834147 PMCID: PMC8018825 DOI: 10.18502/cmm.6.3.4498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Herein, we describe a rare case of fatal cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent individual without any underlying risk factors. Case report A 55-year-old female presented with a short history of fever for 1 month, as well as headache, sudden onset of right-sided upper and lower limb weakness, and loss of speech for 10 days. Contrast-enhanced magnetic resonance imaging scan revealed large, peripherally enhancing, well-defined, cystic, space- occupying, axial lesion in the left parietal lobe with a mass effect. The patient was subjected to craniotomy, and the drained pus revealed pigmented septate hyphae in potassium hydroxide mount examination, which was identified as Cladophialophora bantiana. The patient was started on amphotericin B and voriconazole. However, she developed acute respiratory infection leading to multi-organ failure and death on day 27 post-operation. Conclusion In the absence of comparative trials owing to the rarity of the disease, the radical resection of lesion, drainage of pus, and prolonged targeted antifungal therapy with close postoperative radiological surveillance are the therapeutic measures of choice for patients with brain abscess caused by phaeoid fungi.
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Affiliation(s)
- Ranjana Rohilla
- Department of Microbiology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | | | - Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Neelam Kaistha
- Department of Microbiology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
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17
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G Rathod P, Mishra B, Thakur A, S Loomba P, Sharma A, Bajaj A, Das M, Bhasin A. Cerebral phaeohyphomycosis due to Cladophialophora bantiana in an immunocompetent individual: A case report and brief review of literature. Curr Med Mycol 2021; 6:52-57. [PMID: 33628983 PMCID: PMC7888520 DOI: 10.18502/cmm.6.2.2693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy. Case report We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient's outcome was good with surgical excision and voriconazole therapy. Conclusion Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.
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Affiliation(s)
- Prachala G Rathod
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Bibhabati Mishra
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Archana Thakur
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Poonam S Loomba
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Abha Sharma
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ashish Bajaj
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Madhusmita Das
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ashna Bhasin
- Department of Microbiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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18
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Petraitis V, Petraitiene R, Katragkou A, Maung BBW, Moradi PW, Sussman-Straus GE, Naing E, Kovanda LL, Finkelman MA, Walsh TJ. Antifungal efficacy of isavuconazole and liposomal amphotericin B in a rabbit model of Exserohilum rostratum meningoencephalitis: A preclinical paradigm for management of CNS phaeohyphomycosis. Med Mycol 2021; 59:189-196. [PMID: 33313821 PMCID: PMC7857906 DOI: 10.1093/mmy/myaa102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/22/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022] Open
Abstract
Treatment options for Exserohilum rostratum meningoencephalitis and other causes of phaeohyphomycosis of the central nervous system (CNS) are limited, while mortality and morbidity remain high. We therefore evaluated isavuconazole, a new antifungal triazole in comparison to liposomal amphotericin B (LAMB), in vitro and in the rabbit model of Exserohilum rostratum meningoencephalitis. We hypothesized that isavuconazole alone or in combination with LAMB or micafungin may be alternative options for treatment of CNS phaeohyphomycosis. We therefore investigated the in vitro antifungal activity of isavuconazole alone or in combination with amphotericin B deoxycholate (DAMB) or micafungin and efficacy of treatment with isavuconazole and LAMB in a rabbit model of experimental E. rostratum meningoencephalitis. Combination checkerboard plates were used to determine the minimum inhibitory concentrations, minimal lethal concentrations, fractional inhibitory concentration indices, and Bliss surface analysis of isavuconazole and amphotericin B deoxycholate (DAMB), either alone or in combination. As there were no in vitro synergistic or antagonistic interactions for either combination of antifungal agents against the E. rostratum isolates, in vivo studies were conducted with isavuconazole and LAMB as monotherapies. Rabbits were divided in following groups: treated with isavuconazole at 60 mg/kg/d (ISAV60), LAMB at 5.0 (LAMB5), 7.5 (LAMB7.5), and 10 mg/kg/d (LAMB10), and untreated controls (UC). In ISAV60-, LAMB5-, LAMB7.5-, and LAMB10-treated rabbits, significant reductions of fungal burden of E. rostratum in cerebral, cerebellar, and spinal cord tissues (P < 0.01) were demonstrated in comparison to those of UC. These antifungal effects correlated with significant reduction of CSF (1→3)-β-D-glucan levels vs UC (P < 0.05). These data establish new translational insights into treatment of CNS phaeohyphomycosis.
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Affiliation(s)
- Vidmantas Petraitis
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Ruta Petraitiene
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Aspasia Katragkou
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
| | - Bo Bo Win Maung
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Patriss W Moradi
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Gittel E Sussman-Straus
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Ethan Naing
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Laura L Kovanda
- Astellas Pharma Global Development, Inc., Northbrook, Illinois, USA
| | | | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, New York, USA
- Department of Microbiology & Immunology, Weill Cornell Medicine of Cornell University, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medicine of Cornell University, New York, New York, USA
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19
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Rai M, Ingle AP, Ingle P, Gupta I, Mobin M, Bonifaz A, Alves M. Recent advances on mycotic keratitis caused by dematiaceous hyphomycetes. J Appl Microbiol 2021; 131:1652-1667. [PMID: 33462841 DOI: 10.1111/jam.15008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Abstract
Dematiaceous hyphomycetes (DH) are darkly pigmented fungi ubiquitously found all over the world as plant pathogens and saprophytes, and many of the members of this group have emerged as opportunistic pathogens. These fungi are responsible for a wide variety of infections including mycotic keratitis, which is considered as one of the major causes of corneal blindness, particularly in tropical and subtropical countries with an annual global burden of about 1 000 000 patients. The infection is more common in workers working in an outdoor environment. Moreover, trauma is found to be the most important predisposing cause of mycotic keratitis. Considerable delay in diagnosis and scarcity of effective pharmacological drugs are the major factors responsible for increased morbidity and visual impairment. Considering the crucial role of DH in mycotic keratitis, in the present review, we have focused on major DH with special emphasis on their pathogenicity, diagnosis and treatment strategies.
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Affiliation(s)
- M Rai
- Department of Biotechnology, Sant Gadge Baba Amravati University, Amravati, Maharashtra, India
| | - A P Ingle
- Department of Biotechnology, Engineering School of Lorena, University of Sao Paulo, Lorena, SP, Brazil
| | - P Ingle
- Department of Biotechnology, Sant Gadge Baba Amravati University, Amravati, Maharashtra, India
| | - I Gupta
- Department of Biotechnology, Sant Gadge Baba Amravati University, Amravati, Maharashtra, India
| | - M Mobin
- Research Laboratory, University Center UNINOVAFAPI, Teresina, Brazil
| | - A Bonifaz
- Department of Mycology & Dermatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - M Alves
- Department of Ophthalmology, University of Campinas, Campinas, SP, Brazil
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20
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Challa S. Invasive Fungal Infections of the Central Nervous System in Immune-Competent Hosts. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00384-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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21
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Petraitiene R, Petraitis V, Maung BW, Naing E, Kavaliauskas P, Walsh TJ. Posaconazole Alone and in Combination with Caspofungin for Treatment of Experimental Exserohilum rostratum Meningoencephalitis: Developing New Strategies for Treatment of Phaeohyphomycosis of the Central Nervous System. J Fungi (Basel) 2020; 6:jof6010033. [PMID: 32150900 PMCID: PMC7151063 DOI: 10.3390/jof6010033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Phaeohyphomycosis of the central nervous system (CNS) is a life-threatening infection associated with severe morbidity. New approaches to treatment of CNS phaeohyphomycosis are critically needed. We therefore studied posaconazole with or without caspofungin for treatment of experimental CNS phaeohyphomycosis caused by Exserohilum rostratum. Each clinical isolate of E. rostratum isolate was inoculated intracisternally with 1.0 × 106 microconidia to fully anesthetized New Zealand White rabbits. Profound persistent neutropenia and immunosuppression were established and maintained using cytarabine and methylprednisolone, respectively. Study groups consisted of posaconazole suspension administered as oral formulation at 10 (PSC10) or 20 (PSC20) mg/kg, caspofungin (CFG) at 2 mg/kg intravenously (IV), combinations of PSC10+CFG or PSC20+CFG, and untreated controls (UC). Posaconazole produced a significant reduction of residual fungal burden of E. rostratum in cerebrum, cerebellum, spinal cord, and paravertebral muscle (p < 0.01), in comparison to UC. The combination of PSC10+CFG and PSC20+CFG achieved full clearance of residual fungal burden from cerebrum, while only PSC20+CFG treated rabbits demonstrated clearance from cerebellum, spinal cord, and paravertebral muscle (p < 0.01). These data correlated with the significant reduction of CSF (1→3)-β-d-glucan levels in rabbits treated with PSC20 and PSC20+CFG in comparison to those of UC (p < 0.05). Posaconazole alone or in combination with caspofungin demonstrated significant antifungal efficacy in the treatment of experimental E. rostratum meningoencephalitis and warrants further study for treatment of CNS phaeohyphomycosis.
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Affiliation(s)
- Ruta Petraitiene
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA; (V.P.); (B.W.M.); (E.N.); (P.K.); (T.J.W.)
- Correspondence: ; Tel.: +1-212-746-7806
| | - Vidmantas Petraitis
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA; (V.P.); (B.W.M.); (E.N.); (P.K.); (T.J.W.)
- Institute of Infectious Diseases and Pathogenic Microbiology, LT-59115 Prienai, Lithuania
| | - BoBo Win Maung
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA; (V.P.); (B.W.M.); (E.N.); (P.K.); (T.J.W.)
| | - Ethan Naing
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA; (V.P.); (B.W.M.); (E.N.); (P.K.); (T.J.W.)
| | - Povilas Kavaliauskas
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA; (V.P.); (B.W.M.); (E.N.); (P.K.); (T.J.W.)
- Institute of Infectious Diseases and Pathogenic Microbiology, LT-59115 Prienai, Lithuania
| | - Thomas J. Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA; (V.P.); (B.W.M.); (E.N.); (P.K.); (T.J.W.)
- Department of Pediatrics, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA
- Department of Microbiology & Immunology, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA
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22
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Hardman N, Young N, Hobson R, Sandoe J, Wellberry-Smith M, Thomson S, Barton R. Prolonged survival after disseminated Rhinocladiella infection treated with surgical excision and posaconazole. Transpl Infect Dis 2020; 22:e13264. [PMID: 32053285 DOI: 10.1111/tid.13264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/23/2019] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Abstract
Cerebral abscess due to pigmented molds is a rare but usually fatal infection occasionally seen in transplant recipients. A 67-year-old man of Iraqi origin underwent a deceased donation renal transplant for renal failure and 2 months later was diagnosed with an abscess in the left posterior frontal lobe of his brain. Subsequent biopsy proved this to be due to the mold Rhinocladiella mackenziei. Further interventions included two operations to aspirate the lesion, voriconazole, then liposomal amphotericin B, then a combination of posaconazole and flucytosine which he continued for over 4 years. He also suffered from right ankle pain and was diagnosed with septic arthritis; R mackenziei was isolated from pus aspirated from the ankle joint. He responded well to the treatment and has had little loss of function, and on CT, the cerebral lesion has stabilized. Beta-D-glucan, initially at very high levels proved useful to monitor response over the 5 years and the latest sample was negative (38 pg/mL). This case is notable for the first disseminated case of this infection, its favorable outcome on a novel antifungal combination and a new approach to monitoring the course of disease.
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Affiliation(s)
- Nicola Hardman
- Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Nicola Young
- Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Richard Hobson
- Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Jonathan Sandoe
- Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | - Simon Thomson
- Department of Neurosurgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Richard Barton
- Mycology Reference Centre, Leeds Teaching Hospitals Trust, Leeds, UK
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