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Moraitaki E, Kyriakidis I, Pelagiadis I, Katzilakis N, Stratigaki M, Chamilos G, Tragiannidis A, Stiakaki E. Epidemiology of Invasive Fungal Diseases: A 10-Year Experience in a Tertiary Pediatric Hematology-Oncology Department in Greece. J Fungi (Basel) 2024; 10:498. [PMID: 39057383 PMCID: PMC11278103 DOI: 10.3390/jof10070498] [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: 06/21/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Although advances in the management of pediatric neoplasms have profoundly improved infectious disease outcomes, invasive fungal diseases (IFDs) remain a major cause of morbidity and mortality in children and adolescents with high-risk hematological malignancies. A retrospective study was conducted in the Pediatric Hematology-Oncology Department of the University General Hospital of Heraklion for 2013-2022 to estimate the prevalence and describe the clinical and epidemiological characteristics of IFDs for pediatric and adolescent patients with neoplasia. Demographic, clinical, and laboratory parameters were analyzed to identify risk factors for the development of IFD. The overall prevalence of IFDs was estimated to be 7.8% (12/154 patients) throughout the study. The mean age at IFD diagnosis was 9.8 years (SD 6.4 years). The most common IFD was possible/probable invasive pulmonary aspergillosis (IPA; in ≈50%), followed by candidemia/invasive candidiasis (in 44%). Candida parapsilosis was the most prevalent Candida species (4/6 events). Of interest, the majority (75%) of IFDs were breakthrough infections. Patients with increased risk for IFDs were those who were colonized by fungi in sites other than the oral cavity, hospitalized in the intensive care unit for >7 days, received >7 different antimicrobials in the last 3 months, or had severe neutropenia for >44 days. Two children out of a total of 12 with IFD died due to refractory disease or relapse (16.7%). More detailed and prospective epidemiological studies on fungal infections in pediatric patients with hematological or solid neoplasms can contribute to the optimization of prevention and treatment.
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Affiliation(s)
- Eleni Moraitaki
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.M.); (I.K.); (I.P.); (N.K.); (M.S.)
- MSc Program “Hematology-Oncology of Childhood and Adolescence”, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Ioannis Kyriakidis
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.M.); (I.K.); (I.P.); (N.K.); (M.S.)
| | - Iordanis Pelagiadis
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.M.); (I.K.); (I.P.); (N.K.); (M.S.)
| | - Nikolaos Katzilakis
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.M.); (I.K.); (I.P.); (N.K.); (M.S.)
| | - Maria Stratigaki
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.M.); (I.K.); (I.P.); (N.K.); (M.S.)
| | - Georgios Chamilos
- Clinical Microbiology and Microbial Pathogenesis Department, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - Athanasios Tragiannidis
- Pediatric & Adolescent Hematology Oncology Unit, 2nd Pediatric Department, AHEPA Hospital, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 71003 Heraklion, Greece; (E.M.); (I.K.); (I.P.); (N.K.); (M.S.)
- MSc Program “Hematology-Oncology of Childhood and Adolescence”, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Salmanton-García J, Hoenigl M, Gangneux JP, Segal E, Alastruey-Izquierdo A, Arikan Akdagli S, Lagrou K, Özenci V, Vena A, Cornely OA. The current state of laboratory mycology and access to antifungal treatment in Europe: a European Confederation of Medical Mycology survey. THE LANCET. MICROBE 2023; 4:e47-e56. [PMID: 36463916 DOI: 10.1016/s2666-5247(22)00261-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022]
Abstract
Access to the appropriate tools is crucial for early diagnosis and clinical management of invasive fungal infections. This Review aims to describe the invasive fungal infection diagnostic capacity of Europe to better understand the status and the most pressing aspects that need improvement. To our knowledge, this is the first time that the mycological diagnostic capability and access to antifungal treatments of institutions has been evaluated at a pan-European level. Between Nov 1, 2021, and Jan 31, 2022, 388 institutions in Europe self-assessed their invasive fungal infection management capability. Of the 388 participating institutions from 45 countries, 383 (99%) had access to cultures, 375 (97%) to microscopy, 363 (94%) to antigen-detection assays, 329 (85%) to molecular tests (mostly PCR), and 324 (84%) to antibody tests for diagnosis and management. With the exception of microscopy, there were considerable differences in access to techniques among countries according to their gross domestic product. At least one triazole was available in 363 (94%) of the institutions, one echinocandin in 346 (89%), and liposomal amphotericin B in 301 (78%), with country gross domestic product-based differences. Differences were also observed in the access to therapeutic drug monitoring. Although Europe is well prepared to manage invasive fungal infections, some institutions do not have access to certain diagnostic tools and antifungal drugs, despite most being considered essential by WHO. These limitations need to be overcome to ensure that all patients receive the best diagnostic and therapeutic management.
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Affiliation(s)
- Jon Salmanton-García
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Center of Excellence for Medical Mycology, Medical University of Graz, Graz, Austria; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jean-Pierre Gangneux
- CHU de Rennes, INSERM, Institut de Recherche en Santé, Environnement et Travail, (UMR_S 1085), University of Rennes, Rennes, France
| | - Esther Segal
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Sevtap Arikan Akdagli
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Türkiye
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine, Center of Excellence for Medical Mycology, and National Reference Center for Mycosis, UZ Leuven, Leuven, Belgium
| | - Volkan Özenci
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Antonio Vena
- Department of Health Sciences, University of Genoa, Genoa, Italy; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne, University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; Centre for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany; Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Wang F, Ge D, Wang L, Li N, Chen H, Zhang Z, Zhu W, Wang S, Liang W. Rapid and sensitive recombinase polymerase amplification combined with lateral flow strips for detecting Candida albicans. Anal Biochem 2021; 633:114428. [PMID: 34678249 DOI: 10.1016/j.ab.2021.114428] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 12/30/2022]
Abstract
Owing to modern lifestyles and increasing amounts of medical intervention, clinical infections caused by conditionally pathogenic fungi are becoming increasingly serious. Among these, Candida albicans is the most common. Therefore, the rapid and accurate detection of this pathogenic fungus is important to guiding the selection of clinical therapeutic agents. Recombinase polymerase amplification (RPA) combined with lateral flow strips (LFS) is a promising molecular detection method with the advantages of rapidity, simplicity of operation and high sensitivity. However, this simplicity brings with it the inherent and non-negligible risk of false-positive signals from primer-dimers. In this study, primer-dependent artifacts were eliminated by using probes in the RPA reaction, introducing specific base substitutions to the primer and probe sequences and analyzing and screening the formation of primer-probe complexes. These measures were rigorously tested for efficacy, leading to the creation of an improved RPA-LFS system. The standardized method enabled the specific detection of C. albicans within 25 min at 37 °C without interference. The system had a detection limit of 1 CFU per reaction without DNA purification or 102 fg genomic DNA/50 μL. The detection sensitivity was not affected by the presence of other fungal DNA. The RPA-LFS method can therefore be used to detect clinical samples, and the results are accurate and consistent in comparison with those obtained using quantitative PCR. This study provides a paradigm for eliminating the risk of false-positive primer dimers in isothermal amplification assays and establishes a simple and easy method for the detection of C. albicans.
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Affiliation(s)
- Fang Wang
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China
| | - Duobao Ge
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China
| | - Lei Wang
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China; School of Biotechnology, Jiangsu University of Science and Technology, Zhenjiang, 212018, Jiangsu, China
| | - Na Li
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China
| | - Huimin Chen
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China
| | - Zhexiong Zhang
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China
| | - Wenjun Zhu
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China
| | - Siming Wang
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China.
| | - Wei Liang
- Department of Central Laboratory, the Second People's Hospital of Lianyungang City (Cancer Hospital of Lianyungang), Affiliated to Bengbu Medical College, Lianyungang, 222000, Jiangsu, China.
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Tragiannidis A, Kattamis A, Vyzantiadis TA. Invasive Fungal Infections in Children with Haematological Malignancies: Diagnostic and Therapeutic Challenges. J Fungi (Basel) 2021; 7:jof7070516. [PMID: 34203146 PMCID: PMC8305930 DOI: 10.3390/jof7070516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Athanasios Tragiannidis
- Children & Adolescent Haematology-Oncology Unit, Second Department of Paediatrics, Aristotle University of Thessaloniki, AHEPA Hospital, 53646 Thessaloniki, Greece;
| | - Antonios Kattamis
- Paediatric Haematology-Oncology Unit, First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece;
| | - Timoleon-Achilleas Vyzantiadis
- First Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2310-999027
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