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Brown GD, Ballou ER, Bates S, Bignell EM, Borman AM, Brand AC, Brown AJP, Coelho C, Cook PC, Farrer RA, Govender NP, Gow NAR, Hope W, Hoving JC, Dangarembizi R, Harrison TS, Johnson EM, Mukaremera L, Ramsdale M, Thornton CR, Usher J, Warris A, Wilson D. The pathobiology of human fungal infections. Nat Rev Microbiol 2024:10.1038/s41579-024-01062-w. [PMID: 38918447 DOI: 10.1038/s41579-024-01062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/27/2024]
Abstract
Human fungal infections are a historically neglected area of disease research, yet they cause more than 1.5 million deaths every year. Our understanding of the pathophysiology of these infections has increased considerably over the past decade, through major insights into both the host and pathogen factors that contribute to the phenotype and severity of these diseases. Recent studies are revealing multiple mechanisms by which fungi modify and manipulate the host, escape immune surveillance and generate complex comorbidities. Although the emergence of fungal strains that are less susceptible to antifungal drugs or that rapidly evolve drug resistance is posing new threats, greater understanding of immune mechanisms and host susceptibility factors is beginning to offer novel immunotherapeutic options for the future. In this Review, we provide a broad and comprehensive overview of the pathobiology of human fungal infections, focusing specifically on pathogens that can cause invasive life-threatening infections, highlighting recent discoveries from the pathogen, host and clinical perspectives. We conclude by discussing key future challenges including antifungal drug resistance, the emergence of new pathogens and new developments in modern medicine that are promoting susceptibility to infection.
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Affiliation(s)
- Gordon D Brown
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK.
| | - Elizabeth R Ballou
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Steven Bates
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Elaine M Bignell
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Andrew M Borman
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Alexandra C Brand
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Alistair J P Brown
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Carolina Coelho
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Peter C Cook
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Rhys A Farrer
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Nelesh P Govender
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Neil A R Gow
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - William Hope
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - J Claire Hoving
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Rachael Dangarembizi
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Thomas S Harrison
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Elizabeth M Johnson
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Liliane Mukaremera
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Mark Ramsdale
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | | | - Jane Usher
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Duncan Wilson
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, UK
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2
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Sautour M, Guilloteau A, Valot S, Basmaciyan L, Bailly E, Sixt N, Tetu J, Lafon I, Caillot D, Dalle F. Risk of fungal exposure in the homes of patients with hematologic malignancies. J Mycol Med 2024; 34:101492. [PMID: 38865808 DOI: 10.1016/j.mycmed.2024.101492] [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: 09/04/2023] [Revised: 05/23/2024] [Accepted: 06/07/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Patients with hematological malignancies are at a high risk of developing invasive fungal infections (IFI) because they undergo several cycles of treatment leading to episodes of neutropenia. In addition, they alternate between hospital stays and periods spent at home. Thus, when an IFI is diagnosed during their hospital stays, it is highly challenging to identify the origin of the fungal contamination. The objective of this study was to analyze at home fungal exposure of 20 patients with leukemia by taking air and water samples in their living residence. METHODS Air was sampled in 3 rooms of each home with a portable air system impactor. Tap water was collected at 3 water distribution points of each home. For positive samples, fungi were identified by mass spectrometry or on the basis of their morphological features. RESULTS 85 % of homes revealed the presence in air of Aspergillus spp. and those belonging to the section Fumigati presented the highest concentrations and the greatest frequency of isolation. Concerning mucorales, Rhizopus spp. and Mucor spp. were isolated in air of 20 % and 5 % of dwellings, respectively. In 4 homes, more than 70 % of the fungal species identified in air were potential opportunists; these were mainly Aspergillus spp. with concentrations greater than 20 cfu/m3. The water samples revealed the presence of Fusarium in 3 dwellings, with concentrations up to 80 cfu/L. Finally, for one patient, fungal species isolated during a period of hospitalization were phenotypically similar to those isolated in samples taken at home. For a second patient, a PCR Mucorale was positive on a sample of bronchoalveolar fluid while air samples taken at his home also revealed also the presence of mucorales. CONCLUSION The presence of opportunistic fungal species in the air of all the explored homes suggests the need for strengthened preventive measures in the home of immunocompromised patients. It would be interesting to compare the fungi isolated (from patients and from their environment) by genotyping studies aimed at specifying the correspondence existing between fungal species present in the patients' homes and those responsible for IFI in the same patients.
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Affiliation(s)
- Marc Sautour
- Parasitology and Mycology Laboratory, University Hospital of Dijon, 21070 BP, Dijon 37013 CEDEX, France; UMR PAM A 02.102 Procédés Alimentaires et Microbiologiques, University Bourgogne Franche-Comté, AgroSup, Dijon, France.
| | - Adrien Guilloteau
- Hospital Hygiene and Epidemiology Unit, University Hospital of Dijon, BP, 21070, Dijon 37013 CEDEX, France
| | - Stéphane Valot
- Parasitology and Mycology Laboratory, University Hospital of Dijon, 21070 BP, Dijon 37013 CEDEX, France
| | - Louise Basmaciyan
- Parasitology and Mycology Laboratory, University Hospital of Dijon, 21070 BP, Dijon 37013 CEDEX, France; UMR PAM A 02.102 Procédés Alimentaires et Microbiologiques, University Bourgogne Franche-Comté, AgroSup, Dijon, France
| | - Eloise Bailly
- UMR PAM A 02.102 Procédés Alimentaires et Microbiologiques, University Bourgogne Franche-Comté, AgroSup, Dijon, France
| | - Nathalie Sixt
- Department of Bacteriology, University Hospital of Dijon, BP, 21070, Dijon 37013 CEDEX, France
| | - Jennifer Tetu
- Department of Bacteriology, University Hospital of Dijon, BP, 21070, Dijon 37013 CEDEX, France
| | - Ingrid Lafon
- Clinical Haematology unit, University Hospital of Dijon, BP, 21070, Dijon 37013 CEDEX, France
| | - Denis Caillot
- Clinical Haematology unit, University Hospital of Dijon, BP, 21070, Dijon 37013 CEDEX, France
| | - Frédéric Dalle
- Parasitology and Mycology Laboratory, University Hospital of Dijon, 21070 BP, Dijon 37013 CEDEX, France; UMR PAM A 02.102 Procédés Alimentaires et Microbiologiques, University Bourgogne Franche-Comté, AgroSup, Dijon, France
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3
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Carlesse F, Paixão de Sousa da Silva AM, Sztajnbok J, Litivinov N, Peron K, Otsuka M, Volpe Arnoni M, Schirmer M, de Oliveira Costa P, Munhoz Cavalcanti de Albuquerque AL, Morales H, Lopez-Medina E, A. Portilla C, Valenzuela R, Motta F, Motta FA, de Almeida Junior JN, Santolaya ME, Lopes Colombo A. Landscape of Invasive Fusariosis in Pediatric Cancer Patients: Results of a Multicenter Observational Study From Latin America. Open Forum Infect Dis 2024; 11:ofae285. [PMID: 38872851 PMCID: PMC11170500 DOI: 10.1093/ofid/ofae285] [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: 10/03/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
Invasive fusariosis (IF) is a life-threatening opportunistic infection that affects vulnerable hosts. We conducted a multicenter and multinational retrospective study to characterize the natural history and clinical management of IF in pediatric cancer patients. We selected patients <18 years old who were sequentially hospitalized in 10 Latin American medical centers with a diagnosis of IF between 2002 and 2021. Data were collected using an electronic case report form complemented by a dictionary of terms. We assessed mortality rates at 30, 60, and 90 days. We collected data from 60 episodes of IF (median age, 9.8 years) that were mostly documented in patients with hematologic cancer (70%). Other risk conditions found were lymphopenia (80%), neutropenia (76.7%), and corticosteroid exposure (63.3%). IF was disseminated in 55.6% of patients. Skin lesions was present in 58.3% of our patients, followed by pulmonary involvement in 55%, sinusitis in 21.7%, bone/joint involvement in 6.7% and 1 case each of endocarditis and brain abscess. Positive blood and skin biopsy cultures were detected in 60% and 48.3% of cases, respectively. Fusarium solani complex was the most commonly identified agent (66.6%). The majority of patients received monotherapy within the first 72 hours (71.6%), either with voriconazole or amphotericin B formulation. The mortality rates at 30, 60, and 90 days were 35%, 41.6%, and 45%, respectively. An important factor affecting mortality rates appears to be disseminated disease. The high percentage of patients with fungal involvement in multiple organs and systems highlights the need for extensive workup for additional sites of infection in severely immunocompromised children.
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Affiliation(s)
- Fabianne Carlesse
- Instituto de Oncologia Pediátrica—IOP-GRAACC-UNIFESP, Departamento de Pediatria, São Paulo, Brazil
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jaques Sztajnbok
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Instituto de Infectologia Emilio Ribas, Intensive Care Unit, Department of Emergency Medical Care, São Paulo, Brazil
| | - Nadia Litivinov
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Karina Peron
- Instituto de Tratamento do Cancer Infantil (ITACI), Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Marcelo Schirmer
- Instituto Nacional do Cancer—INCA, Department of Pediatrics, Rio de Janeiro, Brazil
| | | | | | - Hugo Morales
- Hospital Erasto Gaertner, Department of Pediatrics, Curitiba, Brazil
| | - Eduardo Lopez-Medina
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Carlos A. Portilla
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Romina Valenzuela
- Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Fabrizio Motta
- Santa Casa de Misericórdia de Porto Alegre, Department of Pediatrics, Porto Alegre, Brazil
| | | | - João Nobrega de Almeida Junior
- Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil
| | - Maria Elena Santolaya
- Faculty of Medicine, Hospital Dr Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Arnaldo Lopes Colombo
- Departamento de Medicina- Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Antimicrobial Resistance Institute of São Paulo (ARIES), Departamento de Medicina, UNIFESP, São Paulo, Brazil
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Machiavello Roman FJ, Pischel L, Azar MM. Lung infections due to emerging fungal pathogens. Curr Opin Pulm Med 2024; 30:258-265. [PMID: 38411158 DOI: 10.1097/mcp.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW This review highlights the epidemiology, pathogenesis and clinical management of pulmonary infections caused by emerging fungal organisms. RECENT FINDINGS Emerging fungal infections have arisen as a result of population and environmental changes. An enlarging pool of immunocompromised hosts on triazole antifungal prophylaxis has led to an increased incidence of non- Aspergillus molds, such as Fusarium , Scedosporium and Lomentospora spp. Advances in diagnostic capabilities led to the identification of the Emergomyces genus and non- dermatitidis Blastomyces species, which have a significant disease burden in Africa and the Middle East. Climate change has contributed to changing the distribution of previously confined endemic mycoses, like coccidioidomycosis and talaromycosis. These emerging organisms pose important diagnostic and therapeutic challenges. SUMMARY Newly recognized pathogenic fungi and established endemic mycoses with expanding geographic boundaries have become important agents of pulmonary disease. There is a dearth of clinical evidence on the appropriate management of these infections.
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Affiliation(s)
| | | | - Marwan M Azar
- Department of Medicine, Section of Infectious Diseases and Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Caliskan ZC, Karahan G, Koray N, Gokcinar Y, Gülmez D, Arikan-Akdagli S, Unal S, Uzun O. Invasive fungal rhinosinusitis by Fusarium proliferatum/annulatum in a patient with acute myeloid leukemia: A case report and review of the literature. J Mycol Med 2024; 34:101461. [PMID: 38310659 DOI: 10.1016/j.mycmed.2024.101461] [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: 01/10/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
Antifungal prophylaxis with a mold-effective agent has led to a substantial decrease in invasive infections caused by Aspergillus spp. in the management of patients with acute myeloid leukemia undergoing induction chemotherapy. However, difficult-to-treat infections caused by other molds, such as Fusarium, Lomentospora, and Scedosporium species may still complicate the neutropenic period. Here, we present a case of a 23-year-old woman with acute myeloid leukemia who developed a breakthrough invasive fungal rhinosinusitis caused by Fusarium proliferatum/annulatum on posaconazole prophylaxis. The infection was diagnosed using clinical, microbiological, and radiological criteria and the isolate was identified using Matrix Assisted Lazer Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) and sequencing. We searched Pubmed with "Fusarium proliferatum", "Fusarium annulatum", "immunosuppression AND fusariosis", "rhinosinusitis AND Fusarium proliferatum" and summarized the English literature for similar rhinosinusitis cases infected with the same pathogen.
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Affiliation(s)
- Zeynep Cansu Caliskan
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
| | - Gizem Karahan
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Neslihan Koray
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Yasin Gokcinar
- Hacettepe University Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Dolunay Gülmez
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Sevtap Arikan-Akdagli
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Serhat Unal
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Omrum Uzun
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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6
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Jimbo-Zapata A, Sevillano G, Rodríguez P, Ramírez-Iglesias JR, Navarro JC. First report of fatal fungemia due Fusarium oxysporum in a patient with COVID-19 in Ecuador. Med Mycol Case Rep 2024; 43:100622. [PMID: 38225951 PMCID: PMC10788292 DOI: 10.1016/j.mmcr.2023.100622] [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: 08/26/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024] Open
Abstract
Filamentous fungal infections are an important cause of systemic infections in immunocompromised patients. Fusarium genus members potentially cause disseminated infections, especially in patients with catheters, due to the ability to adhere to these devices. We describe a case of fatal fungemia due to Fusarium oxysporum in a patient with COVID-19 in Ecuador. The genus identification was carried out with conventional techniques and species identification by molecular and phylogenetic techniques through sequencing of the ITS region.
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Affiliation(s)
- Alexander Jimbo-Zapata
- Universidad Internacional SEK, Facultad de Ciencias de la Salud, Grupo de Investigación en Enfermedades Emergentes, Desatendidas, Ecoepidemiología y Biodiversidad, Quito, Ecuador
- Universidad Internacional SEK, Maestría en Biomedicina, Facultad de Ciencias de la Salud, Quito, Ecuador
- Área de Micología y Tuberculosis, Unidad Técnica de Patología Clínica, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador
| | - Gabriela Sevillano
- Universidad Internacional SEK, Facultad de Ciencias de la Salud, Grupo de Investigación en Enfermedades Emergentes, Desatendidas, Ecoepidemiología y Biodiversidad, Quito, Ecuador
- Universidad Internacional SEK, Maestría en Biomedicina, Facultad de Ciencias de la Salud, Quito, Ecuador
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Pilar Rodríguez
- Área de Micología y Tuberculosis, Unidad Técnica de Patología Clínica, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador
| | - José Rubén Ramírez-Iglesias
- Universidad Internacional SEK, Facultad de Ciencias de la Salud, Grupo de Investigación en Enfermedades Emergentes, Desatendidas, Ecoepidemiología y Biodiversidad, Quito, Ecuador
| | - Juan-Carlos Navarro
- Universidad Internacional SEK, Facultad de Ciencias de la Salud, Grupo de Investigación en Enfermedades Emergentes, Desatendidas, Ecoepidemiología y Biodiversidad, Quito, Ecuador
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7
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Demonchy J, Biard L, Clere-Jehl R, Wallet F, Mokart D, Moreau AS, Argaud L, Verlhac C, Pène F, Lautrette A, Bige N, de Jong A, Canet E, Quenot JP, Issa N, Zerbib Y, Bouard I, Picard M, Zafrani L. Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. Emerg Infect Dis 2024; 30. [PMID: 38270146 PMCID: PMC10826781 DOI: 10.3201/eid3002.231221] [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: 01/26/2024] Open
Abstract
Invasive fusariosis can be life-threatening, especially in immunocompromised patients who require intensive care unit (ICU) admission. We conducted a multicenter retrospective study to describe clinical and biologic characteristics, patient outcomes, and factors associated with death and response to antifungal therapy. We identified 55 patients with invasive fusariosis from 16 ICUs in France during 2002----2020. The mortality rate was high (56%). Fusariosis-related pneumonia occurred in 76% of patients, often leading to acute respiratory failure. Factors associated with death included elevated sequential organ failure assessment score at ICU admission or history of allogeneic hematopoietic stem cell transplantation or hematologic malignancies. Neither voriconazole treatment nor disseminated fusariosis were strongly associated with response to therapy. Invasive fusariosis can lead to multiorgan failure and is associated with high mortality rates in ICUs. Clinicians should closely monitor ICU patients with a history of hematologic malignancies or stem cell transplantation because of higher risk for death.
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8
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Sudhaharan S, Pamidimukkala U, Singh KN, Chavali P. Clinical spectrum of fusariosis from a tertiary care center in India- a retrospective study. IRANIAN JOURNAL OF MICROBIOLOGY 2024; 16:145-150. [PMID: 38682054 PMCID: PMC11055442 DOI: 10.18502/ijm.v16i1.14884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background and Objectives Fusarium spp. is an emerging pathogen that presents with varied clinical presentations but there are very few studies from India that elaborate on the spectrum of infection caused by the fungus. Hence, the present study was conducted in our institute to understand the clinical spectrum of fusariosis. Materials and Methods The present study was a retrospective study conducted at a tertiary care institute, in Hyderabad, Telangana, India for four years from January 2018 to December 2022. All the patients with clinically significant isolation of Fusarium spp. from various samples were included in the study. Results There were 25 cases of fusariosis diagnosed during the study period. Fusarium was isolated predominantly from debrided tissue following road traffic accidents in 12/25 (84%) of the cases, nails in 3/25 (12%) and superficial leg ulcer in 1/25 (4%) of the cases. Speciation was done for four patients. Three were Fusarium incarnatum and one was Fusarium solani. The patients were treated surgically and with/without antifungal therapy and were discharged in a stable condition. Conclusion Traumatic injuries were the major cause of infections in the present study. As Fusarium is a virulent and highly resistant pathogen, an early suspicion and an appropriate diagnosis would lead to a better outcome in these patients.
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Affiliation(s)
- Sukanya Sudhaharan
- Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Umabala Pamidimukkala
- Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kumari Neha Singh
- Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Padmasri Chavali
- Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
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9
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Raymakers JW, Castelijn DA, Rutten CE, Hodiamont CJ. Fusariosis in patients with hematological malignancies: Two case reports. Med Mycol Case Rep 2023; 42:100602. [PMID: 37767184 PMCID: PMC10520354 DOI: 10.1016/j.mmcr.2023.08.005] [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: 06/07/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Immunosuppressed patients with hematological malignancies are at risk for invasive fungal infections (IFI), including infections with Fusarium species (spp.), which are increasingly reported. Particularly at risk are patients with acute myeloid leukemia (AML) treated with high-dose cytarabine as remission-induction therapy. Whether cytarabine increases the risk of IFI in comparison to other chemotherapy remains not fully determined. Additionally, no clear correlation between the in vitro established minimal inhibitory concentrations (MICs) of antifungal agents and clinical outcome has been established for fusariosis. To increase awareness and knowledge of invasive fusariosis, we report two cases of Fusarium spp. infections in neutropenic patients following treatment with cytarabine for AML. Despite high MICs for azoles both patients were treated with an azole in combination with liposomal amphotericin B. The combination therapy was successful in one patient, however the other patient did not survive the disseminated Fusarium infection.
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Affiliation(s)
- Jord W. Raymakers
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Daan A.R. Castelijn
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Caroline E. Rutten
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Caspar J. Hodiamont
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Furaijat G, Bettac L, Kächele M, Grüner B, Skrabal C, Barth TFE, Parlak M, Hagemann JB, Peters L, Walther G, Kersten J. An unusual presentation of invasive Fusarium aortitis in a patient who is immunocompromised: A case report. Int J Infect Dis 2023; 134:102-105. [PMID: 37279826 DOI: 10.1016/j.ijid.2023.05.069] [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: 02/22/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
Fusarium (F.) species are ubiquitous filamentous fungi that may cause various opportunistic infections, especially in patients who are immunocompromised. A rare manifestation of disseminated fusariosis affects the aortic valve and results in invasive aortitis, which poses a significant challenge for clinicians in diagnosis and treatment. Here, we report a case of a patient, aged 54 years, who is immunocompromised, presenting initially with Fusarium keratitis and chorioretinitis in both eyes and a new endovascular aortic mass. Positron emission tomography/computed tomography was performed, suggesting aortitis. Transoesophageal echocardiography and electrocardiogram-guided computed tomography-angiography confirmed a large intraluminal mass in the ascending aorta. The aortic mass and a part of the ascending aorta were resected surgically, and a filamentous fungus with the microscopic features of the genus Fusarium was isolated and later identified molecularly as F. petroliphilum. The course of the treatment was complicated by perioperative cerebral embolization and mesenteric ischemia. These complications could be attributed to a preoperatively existing occlusion of the superior and inferior mesenteric artery and a subtotal stenosis of the celiac trunk. This case report describes a rare manifestation of disseminated fusariosis, frequently characterized by protracted clinical courses with poor prognosis. Fusariosis may manifest at different sites at different times or persist as a long-lasting disease with reactivation. This case highlights the importance of the interdisciplinary approach for effectively treating invasive mycoses.
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Affiliation(s)
- Ghefar Furaijat
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Lucas Bettac
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Martin Kächele
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Beate Grüner
- University of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Christian Skrabal
- University of Ulm, Department of Cardiac, Thoracic and Vascular Surgery, Ulm, Germany
| | | | - Melih Parlak
- University of Ulm, Department of Ophthalmology, Ulm, Germany
| | | | - Lynn Peters
- University of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Grit Walther
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research, and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Johannes Kersten
- University of Ulm, Division of Sports and Rehabilitation Medicine, Ulm, Germany.
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11
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Moreno-Sabater A, Sterlin D, Imamovic L, Bon F, Normand AC, Gonnin C, Gazzano M, Bensalah M, Dorgham K, Ben Salah E, Acherar A, Parizot C, Rigourd V, Begue H, Dalle F, Bachmeyer C, Hennequin C, Yssel H, Malphettes M, Fieschi C, Fadlallah J, Gorochov G. Intestinal Candida albicans overgrowth in IgA deficiency. J Allergy Clin Immunol 2023; 152:748-759.e3. [PMID: 37169153 DOI: 10.1016/j.jaci.2023.03.033] [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: 11/19/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Secretory IgA interacts with commensal bacteria, but its impact on human mycobiota ecology has not been widely explored. In particular, whether human IgA-deficiency is associated with gut fungal dysbiosis remains unknown. OBJECTIVES Our goal was to study the impact of IgA on gut mycobiota ecology. METHODS The Fungi-Flow method was used to characterize fecal, systemic, and maternal IgA, IgM, and IgG responses against 14 representative fungal strains (yeast/spores or hyphae forms) in healthy donors (HDs) (n = 34, 31, and 20, respectively) and to also compare gut mycobiota opsonization by secretory antibodies in HDs (n = 28) and patients with selective IgA deficiency (SIgAd) (n = 12). Stool mycobiota composition was determined by internal transcribed spacer gene sequencing in HDs (n = 23) and patients with SIgAd (n = 17). Circulating CD4+ T-cell cytokine secretion profiles were determined by intracellular staining. The impact of secretory IgA, purified from breast milk (n = 9), on Candidaalbicans growth and intestinal Caco-2 cell invasion was tested in vitro. RESULTS Homeostatic IgA binds commensal fungi with a body fluid-selective pattern of recognition. In patients with SIgAd, fungal gut ecology is preserved by compensatory IgM binding to commensal fungi. Gut Calbicans overgrowth nevertheless occurs in this condition but only in clinically symptomatic patients with decreased TH17/TH22 T-cell responses. Indeed, secretory IgA can reduce in vitro budding and invasion of intestinal cells by Calbicans and therefore exert control on this pathobiont. CONCLUSION IgA has a selective impact on Calbicans ecology to preserve fungal-host mutualism.
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Affiliation(s)
- Alicia Moreno-Sabater
- Sorbonne Université, Institut national de la santé et de la recherche médicale (INSERM), Centre d'Immunologie et des Maladies Infectieuses, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Antoine, Paris, France
| | - Delphine Sterlin
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lejla Imamovic
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Fabienne Bon
- UMR PAM Université de Bourgogne Franche-Comté (UBFC), AgroSup Dijon, Équipe Vin, Aliment, Microbiologie, Stress, Groupe Interactions Candida-muqueuses, Dijon, France
| | - Anne-Cecile Normand
- Service de Parasitologie-Mycologie, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Cecile Gonnin
- Département d'Immunologie, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marianne Gazzano
- Département d'Immunologie, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Merieme Bensalah
- Département d'Immunologie, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Karim Dorgham
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Elyes Ben Salah
- Département d'Immunologie, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Aniss Acherar
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Christophe Parizot
- Département d'Immunologie, AP-HP, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Virginie Rigourd
- Lactarium régional d'Ile de France. AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Hervé Begue
- UMR PAM Université de Bourgogne Franche-Comté (UBFC), AgroSup Dijon, Équipe Vin, Aliment, Microbiologie, Stress, Groupe Interactions Candida-muqueuses, Dijon, France
| | - Frederic Dalle
- UMR PAM Université de Bourgogne Franche-Comté (UBFC), AgroSup Dijon, Équipe Vin, Aliment, Microbiologie, Stress, Groupe Interactions Candida-muqueuses, Dijon, France; Department of Parasitology/Mycology, Dijon Bourgogne University Hospital, Dijon, France
| | - Claude Bachmeyer
- Service de Médecine Interne, AP-HP, Hôpital Tenon, Paris, France
| | - Christophe Hennequin
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Hans Yssel
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France
| | - Marion Malphettes
- Université Paris Cité, Department of Clinical Immunology, Hôpital Saint-Louis, Paris, AP-HP, France
| | - Claire Fieschi
- Université Paris Cité, Department of Clinical Immunology, Hôpital Saint-Louis, Paris, AP-HP, France
| | - Jehane Fadlallah
- Université Paris Cité, Department of Clinical Immunology, Hôpital Saint-Louis, Paris, AP-HP, France
| | - Guy Gorochov
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.
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12
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Lamoth F, Nucci M, Fernandez-Cruz A, Azoulay E, Lanternier F, Bremerich J, Einsele H, Johnson E, Lehrnbecher T, Mercier T, Porto L, Verweij PE, White L, Maertens J, Alanio A. Performance of the beta-glucan test for the diagnosis of invasive fusariosis and scedosporiosis: a meta-analysis. Med Mycol 2023; 61:myad061. [PMID: 37381179 PMCID: PMC10405209 DOI: 10.1093/mmy/myad061] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023] Open
Abstract
The (1→3)-β-D-glucan (BDG) is a component of the fungal cell wall that can be detected in serum and used as an adjunctive tool for the diagnosis of invasive mold infections (IMI) in patients with hematologic cancer or other immunosuppressive conditions. However, its use is limited by modest sensitivity/specificity, inability to differentiate between fungal pathogens, and lack of detection of mucormycosis. Data about BDG performance for other relevant IMI, such as invasive fusariosis (IF) and invasive scedosporiosis/lomentosporiosis (IS) are scarce. The objective of this study was to assess the sensitivity of BDG for the diagnosis of IF and IS through systematic literature review and meta-analysis. Immunosuppressed patients diagnosed with proven or probable IF and IS, with interpretable BDG data were eligible. A total of 73 IF and 27 IS cases were included. The sensitivity of BDG for IF and IS diagnosis was 76.7% and 81.5%, respectively. In comparison, the sensitivity of serum galactomannan for IF was 27%. Importantly, BDG positivity preceded the diagnosis by conventional methods (culture or histopathology) in 73% and 94% of IF and IS cases, respectively. Specificity was not assessed because of lacking data. In conclusion, BDG testing may be useful in patients with suspected IF or IS. Combining BDG and galactomannan testing may also help differentiating between the different types of IMI.
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Affiliation(s)
- Frederic Lamoth
- To whom correspondence should be addressed. Frederic Lamoth, Infectious Diseases Service and Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 48, 1011 Lausanne, Switzerland. Tel: +41 21 314 11 11; E-mail:
| | - Marcio Nucci
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Grupo Oncoclinicas, Brazil
| | - Ana Fernandez-Cruz
- Infectious Disease Unit, Internal Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Fundación de Investigación Puerta de Hierro-Segovia de Arana, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris Cité University, Paris, France
| | - Fanny Lanternier
- Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Groupe de recherche Mycologie Translationnelle, Département de Mycologie, Université Paris Cité, Paris, France
- Infectious Diseases Unit, Hopital Necker Enfants malades, APHP, Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Paris, France
| | - Jens Bremerich
- Cardiothoracic Imaging Section, Department of Radiology, Basel University Hospital, 4031 Basel, Switzerland
| | - Hermann Einsele
- University Hospital Würzburg, Internal Medicine II, Würzburg, Germany
| | - Elizabeth Johnson
- UK Health Security Agency (UKHSA) Mycology Reference Laboratory, Southmead Hospital, Bristol, UK and MRC Centre for Medical Mycology, Exeter University, Exeter, UK
| | - Thomas Lehrnbecher
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Toine Mercier
- Department of Oncology-Hematology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium and Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Luciana Porto
- Division of Neuroradiology, Pediatric Neuroradiology Department, University Hospital, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Center, Nijmegen, The Netherlands
| | - Lewis White
- Public Health Wales Mycology Reference Laboratory and Cardiff University Centre for Trials Research/Division of Infection and Immunity, UHW, Cardiff, UK
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium and Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Alexandre Alanio
- To whom correspondence should be addressed. Alexandre Alanio, Laboratoire de parasitologie mycologie, Hôpital Saint Louis, Université Paris Cité Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris France. Tel: +33142499501; E-mail:
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13
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Cighir A, Mare AD, Vultur F, Cighir T, Pop SD, Horvath K, Man A. Fusarium spp. in Human Disease: Exploring the Boundaries between Commensalism and Pathogenesis. Life (Basel) 2023; 13:1440. [PMID: 37511815 PMCID: PMC10381950 DOI: 10.3390/life13071440] [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: 06/12/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Fusarium is a large fungal genus that is widely distributed in the environment, mostly known for its plant pathogenicity. Rarely, it is involved in human pathology, where the type of infection caused is highly dependent upon the portal of entry and the immune status of the host. The study at hand aims to summarize routine methods used in diagnosing such infections as well as more advanced molecular diagnostic methods, techniques that can play a huge role in differentiating between colonization and infection when trying to decide the therapeutic outcome. Consequently, to further support our findings, two different strains (one isolated from corneal scrapings and one isolated from purulent discharge) were analyzed in a clinical context and thoroughly tested using classical and modern diagnostic methods: identification by macroscopical and microscopical examinations of the culture and mass spectrometry, completed by molecular methods such as PCR for trichothecene and ERIC-PCR for genetic fingerprinting. Isolation of a clinically relevant Fusarium spp. from a sample still remains a diagnostic challenge for both the clinician and the microbiologist, because differentiating between colonization and infection is very strenuous, but can make a difference in the treatment that is administered to the patient.
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Affiliation(s)
- Anca Cighir
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
- Department of Medical Laboratory, Mureș Clinical County Hospital, 1 Gheorghe Marinescu Street, 540103 Târgu Mures, Romania
| | - Anca Delia Mare
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
- Department of Medical Laboratory, Mureș Clinical County Hospital, 1 Gheorghe Marinescu Street, 540103 Târgu Mures, Romania
| | - Florina Vultur
- Department of Ophthalmology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
- Ophthalmology Clinic, Mureș Clinical County Hospital, 1 Gheorghe Marinescu Street, 540103 Târgu Mures, Romania
| | - Teodora Cighir
- Department of Medical Laboratory, Mureș Clinical County Hospital, 1 Gheorghe Marinescu Street, 540103 Târgu Mures, Romania
| | - Suzana Doina Pop
- Department of Ophthalmology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
- Ophthalmology Clinic, Mureș Clinical County Hospital, 1 Gheorghe Marinescu Street, 540103 Târgu Mures, Romania
| | - Karin Horvath
- Department of Ophthalmology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
- Ophthalmology Clinic, Mureș Clinical County Hospital, 1 Gheorghe Marinescu Street, 540103 Târgu Mures, Romania
| | - Adrian Man
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, 38 Gheorghe Marinescu Street, 540139 Târgu Mures, Romania
- Department of Medical Laboratory, Mureș Clinical County Hospital, 1 Gheorghe Marinescu Street, 540103 Târgu Mures, Romania
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14
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Mohorea-Neata AL, Ghita MC, Moroti R, Ghiaur A, Ionescu B, Tatic A, Stancioaica MC, Bardas A, Al-Hatmi A, Coriu D. Invasive fusariosis in acute leukaemia patients-An outbreak in the haematology ward. Mycoses 2023. [PMID: 37128958 DOI: 10.1111/myc.13596] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/09/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
Fusarium, a common fungus, emerges as a pathogen in severely immunocompromised patients. We present a series of patients who developed invasive fusariosis (IF) during admission to an acute leukaemia ward: an outbreak of 12 cases in June and July 2018, followed by four sporadic cases until 2021. No case was reported earlier. All patients were clustered in the same location with indoor air and water installations found to be contaminated with Fusarium spp. thus a nosocomial outbreak was assumed. Following the water installation replacement, the number of Fusarium cases dramatically dropped to one or two isolated instances per year in the same location. All 16 patients had acute leukaemia and developed IF during severe neutropenia following induction therapy. IF diagnosis was based on positive blood cultures (14 patients) and/or on tissue biopsies (3 patients). The median time from admission to the IF onset was 20 days, and from the first day of severe neutropenia (≤500/mm3) was 11.5 days. All patients were febrile, eight had moderate-to-severe myalgias, eight had respiratory involvements: lung lesions and/or sinusitis and seven had characteristic skin lesions. Follow-up: 12 out of 16 (75%) were alive on Day 90; nine out of 15 (60%) were alive on Month 6. All with intractable neutropenia died. In severely neutropenic febrile patients, the triad of respiratory involvement/skin lesions/severe myalgia may suggest Fusarium aetiology. The ability to recover from neutropenia is critical to surmount IF. The indoor environment in immunocompromised dedicated settings must be constantly controlled.
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Affiliation(s)
| | | | - Ruxandra Moroti
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- National Institute for Infectious Diseases 'Matei Bals', Bucharest, Romania
| | | | | | - Aurelia Tatic
- Fundeni Clinical Institute, Bucharest, Romania
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alexandru Bardas
- Fundeni Clinical Institute, Bucharest, Romania
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Abdullah Al-Hatmi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
- Centre of Expertise in Mycology Radboud University Medical Centre/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Daniel Coriu
- Fundeni Clinical Institute, Bucharest, Romania
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
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15
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Oliveira M, Oliveira D, Lisboa C, Boechat JL, Delgado L. Clinical Manifestations of Human Exposure to Fungi. J Fungi (Basel) 2023; 9:jof9030381. [PMID: 36983549 PMCID: PMC10052331 DOI: 10.3390/jof9030381] [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: 01/18/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Biological particles, along with inorganic gaseous and particulate pollutants, constitute an ever-present component of the atmosphere and surfaces. Among these particles are fungal species colonizing almost all ecosystems, including the human body. Although inoffensive to most people, fungi can be responsible for several health problems, such as allergic fungal diseases and fungal infections. Worldwide fungal disease incidence is increasing, with new emerging fungal diseases appearing yearly. Reasons for this increase are the expansion of life expectancy, the number of immunocompromised patients (immunosuppressive treatments for transplantation, autoimmune diseases, and immunodeficiency diseases), the number of uncontrolled underlying conditions (e.g., diabetes mellitus), and the misusage of medication (e.g., corticosteroids and broad-spectrum antibiotics). Managing fungal diseases is challenging; only four classes of antifungal drugs are available, resistance to these drugs is increasing, and no vaccines have been approved. The present work reviews the implications of fungal particles in human health from allergic diseases (i.e., allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization, thunderstorm asthma, allergic fungal rhinosinusitis, and occupational lung diseases) to infections (i.e., superficial, subcutaneous, and systemic infections). Topics such as the etiological agent, risk factors, clinical manifestations, diagnosis, and treatment will be revised to improve the knowledge of this growing health concern.
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Affiliation(s)
- Manuela Oliveira
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Ipatimup-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
| | - Diana Oliveira
- CRN-Unidade de Reabilitação AVC, Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Avenida dos Sanatórios 127, 4405-565 Vila Nova de Gaia, Portugal
| | - Carmen Lisboa
- Serviço de Microbiologia, Departamento de Patologia, Faculdade de Medicina do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Serviço de Dermatologia, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE-Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - José Laerte Boechat
- CINTESIS@RISE-Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Luís Delgado
- CINTESIS@RISE-Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Laboratório de Imunologia, Serviço de Patologia Clínica, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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16
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Nosratabadi M, Faeli L, Haghani I, Mohammadi R, Khodavaisy S, Kachuei R, Katiraee F, Aghili SR, Shokohi T, Hedayati MT, Nazeri M, Javan-Nikkhah M, Zarrinfar H, Javidnia J, Najafzadeh MJ, Salimi M, M S Al Hatmi A, Badali H, Abastabar M. In vitro antifungal susceptibility profile of Iranian Fusarium isolates: Emphasising on the potent inhibitory effect of efinaconazole compared to other drugs. Mycoses 2023; 66:258-275. [PMID: 36447396 DOI: 10.1111/myc.13550] [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: 08/27/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Fusarium species are opportunistic human pathogens that remarkably cause fungal infections ranging from superficial to fatal invasive disseminated infections. Fusarium species are notoriously resistant to the majority of antifungal agents. OBJECTIVES Therefore, detailed studies regarding in vitro susceptibility are required and may lead to a better prognosis of severe infections. METHODS We evaluated 25 antifungal drugs in vitro against 282 clinical and environmental Fusarium isolates. RESULTS Fusarium species demonstrated high MICs/MECs values to the most commonly used antifungal drugs in clinical practice. The geometric mean (GM) MICs for luliconazole (0.004 μg/ml) and lanoconazole (0.012 μg/ml) were the lowest, followed by efinaconazole (0.98 μg/ml) and amphotericin B (1.04 μg/ml). CONCLUSIONS Efinaconazole, a novel triazole, may be a promising candidate for the treatment of superficial Fusarium infections. Furthermore, the development of systemic formulations of these drugs as well as further in vitro and in vivo investigations could aid in the treatment of systemic fusariosis.
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Affiliation(s)
- Mohsen Nosratabadi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Faeli
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Haghani
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rasoul Mohammadi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Kachuei
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah, Tehran, Iran
| | - Farzad Katiraee
- Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tehran, Iran
| | - Seyed Reza Aghili
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Taghi Hedayati
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Nazeri
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Javan-Nikkhah
- Department of Plant Protection, College of Agriculture and Natural Resources, University of Tehran, Karaj, Iran
| | - Hossein Zarrinfar
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Javidnia
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad-Javad Najafzadeh
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Salimi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdullah M S Al Hatmi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa, Oman.,Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Hamid Badali
- Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, Texas, San Antonio, USA
| | - Mahdi Abastabar
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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17
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Mateu‐Arrom L, Rusiñol L, Puig L. Reddish and edematous nodules in an immunosuppressed patient. Int J Dermatol 2022. [DOI: 10.1111/ijd.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/19/2022] [Accepted: 11/05/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Laura Mateu‐Arrom
- Department of Dermatology Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
| | - Lluis Rusiñol
- Department of Dermatology Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
| | - Luís Puig
- Department of Dermatology Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
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Asiimwe DD, Ravi M, Isache C. Fusariosis: An Invasive Fungal Disease in a Neutropenic Patient With Acute Myeloid Leukemia. Cureus 2022; 14:e29303. [PMID: 36277532 PMCID: PMC9579060 DOI: 10.7759/cureus.29303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
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Dellière S, Guitard J, Sabou M, Angebault C, Moniot M, Cornu M, Hamane S, Bougnoux ME, Imbert S, Pasquier G, Botterel F, Garcia-Hermoso D, Alanio A. Detection of circulating DNA for the diagnosis of invasive fusariosis: retrospective analysis of 15 proven cases. Med Mycol 2022; 60:6679565. [PMID: 36044994 DOI: 10.1093/mmy/myac049] [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: 05/10/2022] [Revised: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Fusarium spp. are plant pathogens and opportunistic pathogens in severely immunocompromised (hematological malignancy, neutropenia, solid organ transplantation, …) and severely burned patients. Invasive fusariosis often disseminates and mortality remains high partly due to delayed diagnosis in the absence of a positive culture. The aim of our study is to design a qPCR assay and evaluate the detection of Fusarium spp. DNA for early diagnosis of invasive infection. A qPCR assay was designed and optimized to identify all Fusarium species complex and secondarily evaluated on patient samples. A total of 81 blood samples from 15 patients diagnosed with proven invasive fusariosis from 9 centers in France were retrospectively tested. Circulating DNA was detected in 14 patients out of 15 (sensitivity of 93% [IC95, 70.1-99.7]). Detection was possible up to 18 days (median 6 days) before the diagnosis was confirmed by positive blood culture or biopsy. By comparison serum galactomannan and ß-D-glucan were positive in 7.1 and 58.3% of patients respectively. qPCR was negative for all patients with other invasive fungal diseases (IFD) tested (n = 12) and IFD-free control patients (n = 40). No cross-reactions were detected using DNA extracted from 81 other opportunistic fungi. We developed and validated a pan-Fusarium qPCR assay in serum/plasma with high sensitivity, specificity and reproducibility that could facilitates early diagnosis and treatment monitoring of invasive fusariosis.
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Affiliation(s)
- Sarah Dellière
- Laboratoire de parasitologie-mycologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.,Institut Pasteur, Université de Paris Cité, CNRS, Unité de Mycologie Moléculaire, UMR2000, F-75015 Paris, France
| | - Juliette Guitard
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, F-75012 Paris, France
| | - Marcela Sabou
- Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des interactions hôte pathogène, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Cécile Angebault
- Laboratoire de parasitologie-mycologie, AP-HP, Hôpitaux Universitaires Henri Mondor, UR Dynamyc UPEC, EnVA, ANSES, F-94010 Créteil, France
| | - Maxime Moniot
- Service de parasitologie-mycologie, CHU Clermont-Ferrand, 3IHP, France
| | - Marjorie Cornu
- Inserm U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, F-59000, Lille, France ; CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France
| | - Samia Hamane
- Laboratoire de parasitologie-mycologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | | | - Sébastien Imbert
- Laboratoire de parasitologie-mycologie, Bordeaux University Hospital, F-33000 Bordeaux, France
| | - Grégoire Pasquier
- University of Montpellier, CNRS, IRD, Academic Hospital (CHU) of Montpellier, MiVEGEC, Montpellier, France
| | - Françoise Botterel
- Laboratoire de parasitologie-mycologie, AP-HP, Hôpitaux Universitaires Henri Mondor, UR Dynamyc UPEC, EnVA, ANSES, F-94010 Créteil, France
| | - Dea Garcia-Hermoso
- Institut Pasteur, Université de Paris Cité, CNRS, Unité de Mycologie Moléculaire, UMR2000, F-75015 Paris, France.,Institut Pasteur, Centre National de Référence Mycologie et Antifongiques, F-75015 Paris, France
| | - Alexandre Alanio
- Laboratoire de parasitologie-mycologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.,Institut Pasteur, Université de Paris Cité, CNRS, Unité de Mycologie Moléculaire, UMR2000, F-75015 Paris, France.,Institut Pasteur, Centre National de Référence Mycologie et Antifongiques, F-75015 Paris, France
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Disseminated fusariosis with cerebral involvement in a patient with acute myeloid leukemia: Successful outcome with intrathecal –and systemic antifungal treatment. J Infect Chemother 2022; 28:1324-1328. [DOI: 10.1016/j.jiac.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/30/2022] [Accepted: 04/14/2022] [Indexed: 12/31/2022]
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Invasive Fusariosis in Pediatric Hematology/Oncology and Stem Cell Transplant Patients: A Report from the Israeli Society of Pediatric Hematology-Oncology. J Fungi (Basel) 2022; 8:jof8040387. [PMID: 35448618 PMCID: PMC9030963 DOI: 10.3390/jof8040387] [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: 02/19/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Invasive Fusarium species infections in immunocompromised patients occur predominantly in those with hematological malignancies. Survival rates of 20−40% were reported in adults, but data in children are limited. Our retrospective, nationwide multicenter study of invasive fusariosis in pediatric hematology/oncology and stem cell transplant (SCT) patients identified twenty-two cases. Underlying conditions included hematological malignancies (n = 16; 73%), solid tumors (n = 2), and non-malignant hematological conditions (n = 4). Nineteen patients (86%) were neutropenic, nine (41%) were SCT recipients, and seven (32%) received corticosteroids. Sixteen patients (73%) had disseminated fusariosis, five had local infection, and one had isolated fungemia. Fifteen patients (68%) had skin involvement and eight (36%) had a bloodstream infection. Four patients (18%) presented with osteoarticular involvement and four with pulmonary involvement. Nineteen patients (86%) received combination antifungal therapy upfront and three (14%) received single-agent treatment. Ninety-day probability of survival was 77%: four of the five deaths were attributed to fusariosis, all in patients with relapsed/refractory acute leukemias. Ninety-day probability of survival for patients with relapsed/refractory underlying malignancy was 33% vs. 94% in others (p < 0.001). Survival rates in this largest pediatric population-based study were strikingly higher than those reported in adults, demonstrating that invasive fusariosis is a life-threatening but salvageable condition in immunosuppressed children.
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22
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Kaur H, Riedel DJ. Nosocomial disseminated fusariosis in a hematopoietic stem cell transplant recipient. Transpl Infect Dis 2022; 24:e13831. [PMID: 35338691 DOI: 10.1111/tid.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Harpreet Kaur
- University of Maryland Medical Center, Baltimore, MD, United States.,University of Maryland School of Medicine, Baltimore, MD, United States
| | - David J Riedel
- University of Maryland School of Medicine, Baltimore, MD, United States
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Sun PL, Hsu TH, Huang TE, Hung YT, Su YJ, Hung WK. Disseminated fusariosis with endophthalmitis in a patient with acute myeloid leukemia. DERMATOL SIN 2022. [DOI: 10.4103/1027-8117.359339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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