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Ocansey B, Erskine I, Okine L, Potakey D, Pappoe-Ashong P, Sraku I, Quayson S, Opintan J, Kosmidis C, Denning D. A diverse spectrum of mycoses histologically diagnosed in Ghana: Insights from a 10-year retrospective study. Med Mycol 2024; 62:myae015. [PMID: 38383897 PMCID: PMC10919345 DOI: 10.1093/mmy/myae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
In Ghana, most laboratory diagnoses of severe mycoses are based on histopathology findings due to inadequate availability of serology, culture, and molecular tests. The aim of this study was to evaluate the spectrum of mycoses diagnosed in Ghana. We retrospectively reviewed reports from 2012 to 2021 from three major pathology laboratories in Ghana to identify reports indicating the presence of fungal elements and diagnosis of a mycosis, then extracted demographic, clinical history, site of infection, stain(s), used and diagnosed mycosis details. Over the 10-year period, 107 cases were found. No apparent increasing and decreasing trend in the number of cases per year or in a period was observed. The age range of affected patients was from 4 to 86 years. Special stains for fungi were only used in 22 of 107 (20.6%) of cases. The most frequently affected site was the sino-nasal area (34%). Mycosis type was determined for 58 (54.2%) cases, comprising aspergillosis (21), candidiasis (14), dermatophytosis (6), mucormycosis (3), two cases each of chromoblastomycosis, histoplasmosis, eumycetoma, entomophthoromycosis, sporotrichosis, and Malassezia infection and a single case each of cryptococcosis and deep onychomycosis. Of the 53 (49.5%) cases with presumptive diagnosis data, only seven (13.2%) had a pre-biopsy suspicion of mycosis. There is a wide spectrum of mycoses in Ghana, including endemic mycoses not previously reported. Improving the use of special fungal stains could increase yield and mycoses identification. Laboratory diagnostic capacity needs enhancement to complement histopathology investigations with serology, culture, and molecular methods.
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Affiliation(s)
- Bright Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, UK
| | - Isaac Erskine
- Department of Pathology, Korle-Bu Teaching Hospital and University of Ghana Medical School, Korle-Bu, GA-221-1570, Ghana
| | - Leonard Okine
- Cellular Pathology Division, Ghana Standard Authority, Accra, GA-288-5605, Ghana
| | - Daniel Potakey
- Department of Pathology, Korle-Bu Teaching Hospital and University of Ghana Medical School, Korle-Bu, GA-221-1570, Ghana
| | - Prince Pappoe-Ashong
- Department of Medical Microbiology, University of Ghana Medical School, Korle-Bu, GA-270-4330, Ghana
| | - Isaac Sraku
- Department of Medical Microbiology, University of Ghana Medical School, Korle-Bu, GA-270-4330, Ghana
| | - Solomon Quayson
- Department of Pathology, Korle-Bu Teaching Hospital and University of Ghana Medical School, Korle-Bu, GA-221-1570, Ghana
| | - Japheth Opintan
- Department of Medical Microbiology, University of Ghana Medical School, Korle-Bu, GA-270-4330, Ghana
| | - Chris Kosmidis
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, UK
- National Aspergillosis Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - David Denning
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, UK
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Bongomin F, Kwizera R, Namusobya M, van Rhijn N, Andia-Biraro I, Kirenga BJ, Meya DB, Denning DW. Re-estimation of the burden of serious fungal diseases in Uganda. Ther Adv Infect Dis 2024; 11:20499361241228345. [PMID: 38328511 PMCID: PMC10848809 DOI: 10.1177/20499361241228345] [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: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
Background It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. Objective We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Methods Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. Results With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Conclusion Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Kwizera
- Infectious Diseases Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Namusobya
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Norman van Rhijn
- Manchester Fungal Infection Group, Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Bruce J. Kirenga
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David W. Denning
- Manchester Fungal Infection Group, CTF Building, The University of Manchester, Grafton Street, Manchester M13 9NT, UK
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3
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Mazur L, Tian Z, Shedlock K, Zurca AD, Zhou S, Thomas NJ, Krawiec C. A Multicenter Retrospective Database Evaluation of Pediatric Patients Diagnosed With Tinea Capitis. Perm J 2023; 27:82-89. [PMID: 37771272 PMCID: PMC10723100 DOI: 10.7812/tpp/23.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE Tinea capitis is a common pediatric superficial dermatophyte infection associated with lower socioeconomic status, overcrowded environments, and poor hygiene internationally. Nevertheless, to the authors' knowledge, no studies in the United States have reported an association between tinea capitis diagnoses and diagnostic codes for social determinants of health (SDOH). The objectives of the present study were to analyze the diagnostic and treatment approach and frequency of SDOH diagnostic codes in order to assess the presence of racial disparities in the treatment of pediatric patients aged 0 to 18 years diagnosed with tinea capitis. METHODS This study comprised a retrospective analysis using the TriNetX electronic health record database of de-identified pediatric tinea capitis data in ambulatory and emergency settings. The data evaluated demographics, SDOH diagnostic codes, medication codes, and procedure codes. RESULTS Analysis of 19,677 patients (17,471 [88.8%] ambulatory and 2206 [11.2%] emergency encounters) demonstrated that a low frequency of patients had a confirmatory test for tinea capitis (ie, potassium hydroxide prep or fungal culture; 5.5%), prescription for dual therapy (25.2%), or SDOH diagnostic codes (5.5%). Patients with races classified as Black (odds ratio = 0.48, 95% confidence interval = 0.41-0.57, p < 0.001) and "other" (odds ratio = 0.52, 95% confidence interval = 0.33-0.81, p = 0.004) had a lower likelihood of having an ambulatory encounter, but a higher likelihood of receiving dual therapy. CONCLUSIONS This study found that diagnostic testing, dual therapy, and SDOH diagnostic codes were underutilized for pediatric patients diagnosed with tinea capitis. In addition, patients of races classified as Black and "other" were more likely to be diagnosed in emergency encounters, but had a higher likelihood of receiving dual therapy regardless of encounter type. Further research is needed to determine how to improve the management of tinea capitis and better understand its relationship with SDOH.
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Affiliation(s)
- Lauren Mazur
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Zizhong Tian
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Katherine Shedlock
- Academic Pediatrics, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Adrian D Zurca
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
| | - Shouhao Zhou
- Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Neal J Thomas
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Conrad Krawiec
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA, USA
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Baker J, Denning DW. The SSS revolution in fungal diagnostics: speed, simplicity and sensitivity. Br Med Bull 2023; 147:62-78. [PMID: 37328942 PMCID: PMC10502448 DOI: 10.1093/bmb/ldad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/24/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Fungal disease has historically presented a diagnostic challenge due to its often non-specific clinical presentations, relative infrequency and reliance on insensitive and time-intensive fungal culture. SOURCES OF DATA We present the recent developments in fungal diagnostics in the fields of serological and molecular diagnosis for the most clinically relevant pathogens; developments that have the potential to revolutionize fungal diagnosis through improvements in speed, simplicity and sensitivity. We have drawn on a body of evidence including recent studies and reviews demonstrating the effectiveness of antigen and antibody detection and polymerase chain reaction (PCR) in patients with and without concurrent human immunodeficiency virus infection. AREAS OF AGREEMENT This includes recently developed fungal lateral flow assays, which have a low cost and operator skill requirement that give them great applicability to low-resource settings. Antigen detection for Cryptococcus, Histoplasma and Aspergillus spp. are much more sensitive than culture. PCR for Candida spp., Aspergillus spp., Mucorales and Pneumocystis jirovecii is more sensitive than culture and usually faster. AREAS OF CONTROVERSY Effort must be made to utilize recent developments in fungal diagnostics in clinical settings outside of specialist centres and integrate their use into standard medical practice. Given the clinical similarities of the conditions and frequent co-infection, further study is required into the use of serological and molecular fungal tests, particularly in patients being treated for tuberculosis. GROWING POINTS Further study is needed to clarify the utility of these tests in low-resource settings confounded by a high prevalence of tuberculosis. AREAS TIMELY FOR DEVELOPING RESEARCH The diagnostic utility of these tests may require revision of laboratory work flows, care pathways and clinical and lab coordination, especially for any facility caring for the immunosuppressed, critically ill or those with chronic chest conditions, in whom fungal disease is common and underappreciated.
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Affiliation(s)
- Jacob Baker
- Department of Medicine, Shrewsbury and Telford Hospitals Trust, Mytton Oak Rd, Shrewsbury SY3 8XQ, UK
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Global Action For Fungal Infections (GAFFI), Rue Le Corbusier 1208 Geneva, Switzerland
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Smith DJ, Gold JAW, Benedict K, Wu K, Lyman M, Jordan A, Medina N, Lockhart SR, Sexton DJ, Chow NA, Jackson BR, Litvintseva AP, Toda M, Chiller T. Public Health Research Priorities for Fungal Diseases: A Multidisciplinary Approach to Save Lives. J Fungi (Basel) 2023; 9:820. [PMID: 37623591 PMCID: PMC10455901 DOI: 10.3390/jof9080820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Fungal infections can cause severe disease and death and impose a substantial economic burden on healthcare systems. Public health research requires a multidisciplinary approach and is essential to help save lives and prevent disability from fungal diseases. In this manuscript, we outline the main public health research priorities for fungal diseases, including the measurement of the fungal disease burden and distribution and the need for improved diagnostics, therapeutics, and vaccines. Characterizing the public health, economic, health system, and individual burden caused by fungal diseases can provide critical insights to promote better prevention and treatment. The development and validation of fungal diagnostic tests that are rapid, accurate, and cost-effective can improve testing practices. Understanding best practices for antifungal prophylaxis can optimize prevention in at-risk populations, while research on antifungal resistance can improve patient outcomes. Investment in vaccines may eliminate certain fungal diseases or lower incidence and mortality. Public health research priorities and approaches may vary by fungal pathogen.
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Affiliation(s)
- Dallas J. Smith
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
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Milani B, Dagne DA, Choi HL, Schito M, Stone HA. Diagnostic capacities and treatment practices on implantation mycoses: Results from the 2022 WHO global online survey. PLoS Negl Trop Dis 2023; 17:e0011443. [PMID: 37379338 PMCID: PMC10335693 DOI: 10.1371/journal.pntd.0011443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
Between January and March 2022, WHO conducted a global online survey to collect data on diagnostic capacities and treatment practices in different settings for four implantation mycoses: eumycetoma, actinomycetoma, cutaneous sporotrichosis and chromoblastomycosis. The survey investigated the type of diagnostic methods available in countries at various health system levels (tertiary, secondary, primary level) and the medicines used to treat implantation mycoses, with a view to understanding the level of drug repurposing for treatment of these diseases. 142 respondents from 47 countries, including all continents, contributed data: 60% were from middle-income countries, with 59% working at the tertiary level of the health system and 30% at the secondary level. The results presented in this article provide information on the current diagnostic capacity and treatment trends for both pharmacological and non-pharmacological interventions. In addition, the survey provides insight on refractory case rates, as well as other challenges, such as availability and affordability of medicines, especially in middle-income countries. Although the study has limitations, the survey-collected data confirms that drug repurposing is occurring for all four surveyed implantation mycoses. The implementation of an openly accessible global and/or a national treatment registry for implantation mycoses could contribute to address the gaps in epidemiological information and collect valuable observational data to inform treatment guidelines and clinical research.
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Affiliation(s)
- Barbara Milani
- WHO consultant, World Health Organization, Geneva, Switzeland
| | - Daniel Argaw Dagne
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
| | - Hye Lynn Choi
- Department of Control of Neglected Tropical Diseases [WHO/NTD], World Health Organization, Geneva, Switzeland
- Department of Regulation and Prequalification [WHO/RPQ], World Health Organization, Geneva, Switzeland
| | - Marco Schito
- CURE Drug Repurposing Collaboratory, Critical Path Institute, Tucson, Arizona, United States of America
| | - Heather Anne Stone
- Office of Medical Policy, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, United States of America
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The origin of human pathogenicity and biological interactions in Chaetothyriales. FUNGAL DIVERS 2023. [DOI: 10.1007/s13225-023-00518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
AbstractFungi in the order Chaetothyriales are renowned for their ability to cause human infections. Nevertheless, they are not regarded as primary pathogens, but rather as opportunists with a natural habitat in the environment. Extremotolerance is a major trend in the order, but quite different from black yeasts in Capnodiales which focus on endurance, an important additional parameter is advancing toxin management. In the ancestral ecology of rock colonization, the association with metabolite-producing lichens is significant. Ant-association, dealing with pheromones and repellents, is another mainstay in the order. The phylogenetically derived family, Herpotrichiellaceae, shows dual ecology in monoaromatic hydrocarbon assimilation and the ability to cause disease in humans and cold-blooded vertebrates. In this study, data on ecology, phylogeny, and genomics were collected and analyzed in order to support this hypothesis on the evolutionary route of the species of Chaetothyriales. Comparing the ribosomal tree with that of enzymes involved in toluene degradation, a significant expansion of cytochromes is observed and the toluene catabolism is found to be complete in some of the Herpotrichiellaceae. This might enhance human systemic infection. However, since most species have to be traumatically inoculated in order to cause disease, their invasive potential is categorized as opportunism. Only in chromoblastomycosis, true pathogenicity might be surmised. The criterion would be the possible escape of agents of vertebrate disease from the host, enabling dispersal of adapted genotypes to subsequent generations.
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Husain U, Verma P, Suvirya S, Priyadarshi K, Gupta P. An overview of mycetoma and its diagnostic dilemma: Time to move on to advanced techniques. Indian J Dermatol Venereol Leprol 2023; 89:12-17. [PMID: 36331840 DOI: 10.25259/ijdvl_615_2021] [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: 06/01/2021] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
The neglected tropical disease mycetoma can become extremely devastating, and can be caused both by fungi and bacteria; these are popularly known as eumycetoma and actinomycetoma respectively. The classical triad of the disease is subcutaneous swelling, multiple discharging sinuses and the presence of macroscopic granules. The present study aims to highlight the existing diagnostic modalities and the need to incorporate newer and more advanced laboratory techniques like pan fungal/pan bacterial 16S rRNA gene polymerase chain reaction (PCR) and sequencing, Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), rolling circle amplification (RCA), loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA). It is important for the medical team to be aware of the various diagnostic options (both existing and future), so that diagnosis of such a debilitating disease is never missed, both by clinicians and microbiologists/pathologists. The newer diagnostic methods discussed in this article will help in rapid, accurate diagnosis thus facilitating early treatment initiation, and decreasing the overall morbidity of the disease. In the Indian context, newer technologies need to be made available more widely. Making clinicians aware and promoting research and development in mycetoma diagnostics is the need of the hour.
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Affiliation(s)
- Uneza Husain
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Verma
- Department of Dermatology, Venereology, and Leprosy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Swastika Suvirya
- Department of Dermatology, Venereology, and Leprosy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ketan Priyadarshi
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Prashant Gupta
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Siddig EE, Nyuykonge B, Mhmoud NA, Abdallah OB, Bahar MEN, Ahmed ES, Nyaoke B, Zijlstra EE, Verbon A, Bakhiet SM, Fahal AH, van de Sande WWJ. Comparing the performance of the common used eumycetoma diagnostic tests. Mycoses 2022; 66:420-429. [PMID: 36583225 DOI: 10.1111/myc.13561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Mycetoma is a neglected tropical implantation disease caused by 70 different infectious agents. Identifying the causative organism to the species level is essential for appropriate patient management. Ultrasound, histopathology, culture and two species-specific PCRs are most the commonly used methods for species identification in endemic regions. The aim of this study was to compare the diagnostic performance of these commonly used assays using sequencing of barcoding genes as the gold standard. METHODS This descriptive cross-sectional study was conducted at the Mycetoma Research Centre, University of Khartoum, Sudan. It included 222 patients suspected of fungal mycetoma caused by Madurella mycetomatis. RESULTS 154 (69.3%) were correctly identified by ultrasound, histology, culture and both species-specific PCRs. In 60 patients, at least one of the diagnostic tests failed to identify M. mycetomatis. Five patients had no evidence of eumycetoma, and for three, only the ultrasound was indicative of mycetoma. The two species-specific PCRs were the most sensitive and specific methods, followed by culture and histology. Ultrasound was the least specific as it only allowed differentiation between actinomycetoma and eumycetoma. The time to result was 9.38 minutes for ultrasound, 3.76 hours for PCR, 8.5 days for histopathology and 21 days for grain culturing. CONCLUSION Currently, PCR directly on DNA isolated from grains is the most rapid and reliable diagnostic tool to identify M. mycetomatis eumycetoma.
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Affiliation(s)
- Emmanuel Edwar Siddig
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.,Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Bertrand Nyuykonge
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Najwa Adam Mhmoud
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan.,Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | | | | | | | - Borna Nyaoke
- Drugs for Neglected Diseases initiative, DNDi, Nairobi, Kenya
| | | | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | | | | | - Wendy W J van de Sande
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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10
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Lin P, Zhang J, Xie G, Li J, Guo C, Lin H, Zhang Y. Innate Immune Responses to Sporothrix schenckii: Recognition and Elimination. Mycopathologia 2022; 188:71-86. [PMID: 36329281 DOI: 10.1007/s11046-022-00683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
Sporothrix schenckii (S. schenckii), a ubiquitous thermally dimorphic fungus, is the etiological agent of sporotrichosis, affecting immunocompromised and immunocompetent individuals. Despite current antifungal regimens, sporotrichosis results in prolonged treatment and significant mortality rates in the immunosuppressed population. The innate immune system forms the host's first and primary line of defense against S. schenckii, which has a bi-layered cell wall structure. Many components act as pathogen-associated molecular patterns (PAMPs) in pathogen-host interactions. PAMPs are recognized by pattern recognition receptors (PRRs) such as toll-like receptors, C-type lectin receptors, and complement receptors, triggering innate immune cells such as neutrophils, macrophages, and dendritic cells to phagocytize or produce mediators, contributing to S. schenckii elimination. The ultrastructure of S. schenckii and pathogen-host interactions, including PRRs and innate immune cells, are summarized in this review, promoting a better understanding of the innate immune response to S. schenckii and aiding in the development of protective and therapeutic strategies to combat sporotrichosis.
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Affiliation(s)
- Peng Lin
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jianfeng Zhang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guinan Xie
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Junchen Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chenqi Guo
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haiyue Lin
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yu Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.
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11
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Cognialli R, Bloss K, Weiss I, Caceres DH, Davis R, Queiroz-Telles F. A Lateral Flow Assay for the Immunodiagnosis of Human Cat-Transmitted Sporotrichosis. Mycoses 2022; 65:926-934. [PMID: 35943444 PMCID: PMC9546384 DOI: 10.1111/myc.13516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/29/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cat-transmitted sporotrichosis (CTS) caused by Sporothrix brasiliensis has emerged as an important zoonosis in Brazil and neighboring countries. OBJECTIVES Evaluate the performance of a lateral flow assay (LFA) for the detection of anti-Sporothrix antibodies in human sera. METHODS A LFA for the detection of anti-Sporothrix antibodies (Anti-Sporo LFA) in human sera, developed by IMMY, was evaluated using 300 human sera collected prospectively at the Hospital de Clínicas, Federal University of Paraná (HC-UFPR), in Curitiba, Brazil. These specimens included 100 sera from patients with CTS. CTS cases were classified as: 59 lymphocutaneous, 27 fixed cutaneous,13 ocular, and one mixed form. One-hundred specimens from patients with other mycoses, including cryptococcosis (n=32), candidemia (n=27), paracoccidioidomycosis (n=14), aspergillosis (n=10), histoplasmosis (n=9), fusariosis (n=4), lobomycosis (n=1), chromoblastomycosis (n=1), mucormycosis (n=1), and trichosporonosis (n=1). And 100 specimens from apparently healthy volunteers (AHV). RESULTS The Anti-Sporo LFA showed a global sensitivity of 83% (95% confidence interval [CI] = 74%-90%), a global specificity of 82% (95% CI = 76%-87%), and accuracy of 82% (95% CI = 77%-86%). By clinical form sensitivity was as follows: Mixed form 100%, ocular 92%, lymphocutaneous 83%, and fixed cutaneous 78%. False-positive results were observed in 11 specimens from people with other mycoses and 26 specimens from AHV. CONCLUSION-DISCUSSION This study presents the results of the evaluation of the first lateral flow assay for the detection of anti-Sporothrix antibodies in human sera. The findings here show evidence that IMMY´s Anti-Sporo LFA is a promising tool for the rapid diagnosis of CTS.
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Affiliation(s)
- Regielly Cognialli
- Mycology Unit, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.,Postgraduate Program in Internal Medicine and Health Science, Federal University of Paraná, Curitiba, Brazil
| | - Konner Bloss
- Immuno-Mycologics (IMMY), Norman, Oklahoma, United States of America
| | - Izabella Weiss
- Department of Clinical Analysis, Federal University of Paraná, Curitiba, Brazil
| | - Diego H Caceres
- Immuno-Mycologics (IMMY), Norman, Oklahoma, United States of America.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Rachelle Davis
- Immuno-Mycologics (IMMY), Norman, Oklahoma, United States of America
| | - Flavio Queiroz-Telles
- Department of Clinical Analysis, Federal University of Paraná, Curitiba, Brazil.,Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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12
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Lim W, Verbon A, van de Sande W. Identifying novel drugs with new modes of action for neglected tropical fungal skin diseases (fungal skinNTDs) using an Open Source Drug discovery approach. Expert Opin Drug Discov 2022; 17:641-659. [PMID: 35612364 DOI: 10.1080/17460441.2022.2080195] [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: 01/19/2023]
Abstract
INTRODUCTION The three fungal skin neglected tropical diseases (NTD) mycetoma, chromoblastomycosis and sporotrichosis currently lack prioritization and support to establish drug discovery programs in search for novel treatment options. This has made the efforts to identify novel drugs for these skinNTDs fragmented. AREAS COVERED To help escalate the discovery of novel drugs to treat these fungal skinNTDs, the authors have prepared an overview of the compounds with activity against fungal skinNTDs by analyzing data from individual drug discovery studies including those performed on the Medicines for Malaria Venture (MMV) open access boxes. EXPERT OPINION The authors were unable to identify studies in which causative agents of all three skinNTDs were included, indicating that an integrated approach is currently lacking. From the currently available data, the azoles and iodoquinol were the only compounds with activity against causative agents from the three different fungal skinNTDs. Fungal melanin inhibition enhanced the activity of antifungal agents. For mycetoma, the fenarimols, aminothiazoles and benzimidazole carbamates are currently being investigated in the MycetOS initiative. To come to a more integrated approach to identify drugs active against all three fungal skinNTDs, compounds made in the MycetOS initiative could also be explored for chromoblastomycosis and sporotrichosis.
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Affiliation(s)
- Wilson Lim
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annelies Verbon
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wendy van de Sande
- Department of Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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13
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Pulmonary and Extrapulmonary Manifestations of Fungal Infections Misdiagnosed as Tuberculosis: The Need for Prompt Diagnosis and Management. J Fungi (Basel) 2022; 8:jof8050460. [PMID: 35628715 PMCID: PMC9143176 DOI: 10.3390/jof8050460] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 01/15/2023] Open
Abstract
Fungal infections commonly present with myriad symptoms that mimic other clinical entities, notable amongst which is tuberculosis. Besides histoplasmosis and chronic pulmonary aspergillosis, which can mimic TB, this review has identified several other fungal infections which also do. A total of 80 individual cases misdiagnosed as TB are highlighted: aspergillosis (n = 18, 22.5%), histoplasmosis (n = 16, 20%), blastomycosis (n = 14, 17.5%), cryptococcosis (n = 11, 13.8%), talaromycosis (n = 7, 8.8%), coccidioidomycosis (n = 5, 6.3%), mucormycosis (n = 4, 5%), sporotrichosis (n = 3, 3.8%), phaeohyphomycosis (n = 1, 1.3%) and chromoblastomycosis (n = 1, 1.3%). Case series from India and Pakistan reported over 100 cases of chronic and allergic bronchopulmonary aspergillosis had received anti-TB therapy before the correct diagnosis was made. Forty-five cases (56.3%) had favorable outcomes, and 25 (33.8%) died, outcome was unclear in the remainder. Seventeen (21.3%) cases were infected with human immunodeficiency virus (HIV). Diagnostic modalities were histopathology (n = 46, 57.5%), culture (n = 42, 52.5%), serology (n = 18, 22.5%), cytology (n = 2, 2.5%), gene sequencing (n = 5, 6.3%) and microscopy (n = 10, 12.5%) including Gram stain, India ink preparation, bone marrow smear and KOH mount. We conclude that the above fungal infections should always be considered or ruled out whenever a patient presents with symptoms suggestive of tuberculosis which is unconfirmed thereby reducing prolonged hospital stay and mortalities associated with a delayed or incorrect diagnosis of fungal infections.
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14
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Maubon D, Garnaud C, Ramarozatovo LS, Fahafahantsoa RR, Cornet M, Rasamoelina T. Molecular Diagnosis of Two Major Implantation Mycoses: Chromoblastomycosis and Sporotrichosis. J Fungi (Basel) 2022; 8:jof8040382. [PMID: 35448613 PMCID: PMC9027143 DOI: 10.3390/jof8040382] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Chromoblastomycosis and sporotrichosis are the two main implantation mycoses that are now recognized as fungal neglected tropical diseases (NTDs). Their laboratory diagnosis mainly relies on direct microscopy, histopathology, and identification of the fungus by culture. However, to be appropriately used, these techniques require mycological expertise that is not widely available and may be absent in peripheral health care facilities in endemic areas. In addition, they lack sensitivity and specificity, and the culture for isolation and identification can have a long time-to-results period. Molecular methods, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), have been developed in well-equipped reference laboratories. They greatly improve the rapidity and accuracy of diagnosis; in particular, for species identification. Recently, PCR and sequencing have paved the way for more user-friendly point-of-care tests, such as those based on LAMP or RCA technologies, which can be used in basic healthcare settings and even in field consultations.
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Affiliation(s)
- Danièle Maubon
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | - Cécile Garnaud
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
| | | | | | - Muriel Cornet
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique, Université Grenoble Alpes, Domaine de la Merci, Centre Hospitalier Universitaire Grenoble Alpes, Service de Parasitologie-Mycologie, Bd de la Chantourne, CEDEX, 38706 La Tronche, France; (D.M.); (C.G.)
- Correspondence:
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Abstract
As the at-risk population expands and new antifungal resistance patterns develop, it is critical to understand and recognize cutaneous manifestations of old and emerging fungal diseases. PURPOSE OF REVIEW The aim of this review is to provide an overview of the most frequent and emerging deep cutaneous fungal infections following either primary inoculation or secondary spread after haematogenous seeding in disseminated infections in different geographical areas. RECENT FINDINGS Fungal skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions based on the site of the infection, route of acquisition of the pathogen, epidemiological setting and the virulence of the fungus in relation to the host. The approach to a patient suspected of having a fungal SSTI is complex and usually poses a major diagnostic challenge. The treatment approach should include attempts at immune reconstitution, targeted antifungal therapy and/or aggressive surgical debridement. SUMMARY Fungal SSTIs can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and are being reported with increasing frequency worldwide.
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16
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Ocansey BK, Kosmidis C, Agyei M, Dorkenoo AM, Ayanlowo OO, Oladele RO, Darre T, Denning DW. Histoplasmosis in Africa: Current perspectives, knowledge gaps, and research priorities. PLoS Negl Trop Dis 2022; 16:e0010111. [PMID: 35202403 PMCID: PMC8870498 DOI: 10.1371/journal.pntd.0010111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Histoplasmosis is a chronic granulomatous disease caused by the thermally dimorphic fungus Histoplasma capsulatum. The 2 variants Histoplasma capsulatum var. capsulatum (Hcc) and Histoplasma capsulatum var. duboisii (Hcd) causes infection in humans and commonly termed classical or American histoplasmosis and African histoplasmosis, respectively. Histoplasma capsulatum var. farciminosum (Hcf) affects equines. In recent times, there have been heightened sensitization on fungal infections such as histoplasmosis in Africa, aimed at improving awareness among relevant stakeholders, particularly healthcare workers. This effort is expected to be paralleled with increased detection of both classical and African histoplasmosis, which has remained underdiagnosed over the years. In this narrative review, we describe the current perspectives of histoplasmosis in Africa, identify knowledge gaps, and suggest research priorities. Methods A PubMed, Google Scholar, and Africa Journal Online (AJOL) literature search was conducted for studies on histoplasmosis in Africa between 2000 and 2020. Histoplasmosis essays in medical mycology textbooks were also consulted. This narrative review was prepared from the data gathered. Findings In the past 2 decades, histoplasmosis in general has seen a relative increase in case detection in some Africa countries, probably attributable to the gradually increasing medical mycology advocacy efforts in Africa. Histoplasmosis cases are dominated by African histoplasmosis mostly in Western and Central Africa, while classical histoplasmosis is more common in Southern and Northern Africa. Although both classical and African histoplasmosis are common in Africa, the latter is more restricted to Africa, and cases outside the continent usually have a travel history to the continent. Despite the clinical and laboratory difference between African histoplasmosis and classical histoplasmosis, it is not straightforward to distinguish them. The typical manifestation of African histoplasmosis is the appearance of lesions affecting the skin, bones, and lymph nodes and unusually linked to human immunodeficiency virus (HIV)/AIDS. By contrast, classical histoplasmosis mostly affects the lungs and is often associated with immunosuppression, mainly HIV/AIDS. The present perspectives of histoplasmosis in Africa highlight unclear details on the true burden, strain diversity, infection route and genetic basis of African histoplasmosis, availability of specie-specific diagnostic tools, and compliance with recommended antifungal therapy. These knowledge gaps represent research questions that require scientific exploration. Conclusions Despite a subtle increase in identifying histoplasmosis cases in Africa, it remains underdiagnosed and neglected in some parts of the continent. Increasing awareness and training among healthcare workers, bridging diagnostic and therapeutic gaps, and encouraging more research in Africa are crucial to improve the current perspectives of histoplasmosis in Africa.
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Affiliation(s)
- Bright K. Ocansey
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- * E-mail: ,
| | - Chris Kosmidis
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Martin Agyei
- Department of Internal Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Améyo M. Dorkenoo
- Department of Biology and Basic Sciences, Faculty of Health Sciences, University of Lomé, Lomé, Togo
- Division of Laboratories, Ministry of Health and Public Hygiene, Lomé, Togo
| | - Olusola O. Ayanlowo
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rita O. Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tchin Darre
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - David W. Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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17
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Human sporotrichosis: recommendations from the Brazilian Society of Dermatology for the clinical, diagnostic and therapeutic management. An Bras Dermatol 2022; 97:757-777. [PMID: 36155712 PMCID: PMC9582924 DOI: 10.1016/j.abd.2022.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The increase in the zoonotic epidemic of sporotrichosis caused by Sporothrix brasiliensis, which started in the late 1990s in Rio de Janeiro and is now found in almost all Brazilian states, has been equally advancing in neighboring countries of Brazil. Changes in the clinical-epidemiological profile, advances in the laboratory diagnosis of the disease, and therapeutic difficulties have been observed throughout these almost 25 years of the epidemic, although there is no national consensus. The last international guideline dates from 2007. OBJECTIVES Update the clinical classification, diagnostic methods and recommendations on the therapeutic management of patients with sporotrichosis. METHODS Twelve experts in human sporotrichosis were selected from different Brazilian regions, and divided into three work groups: clinical, diagnosis and treatment. The bibliographic research was carried out on the EBSCOHost platform. Meetings took place via electronic mail and remote/face-to-face and hybrid settings, resulting in a questionnaire which pointed out 13 divergences, resolved based on the opinion of the majority of the participants. RESULTS The clinical classification and laboratory diagnosis were updated. Therapeutic recommendations were made for the different clinical forms. CONCLUSION Publication of the first national recommendation, carried out by the Brazilian Society of Dermatology, aimed at the Brazilian scientific community, especially dermatologists, infectologists, pediatricians, family medicine personnel, and laboratory professionals who work in the management of human sporotrichosis.
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18
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Hernández-Hernández F, Méndez-Tovar LJ. Eumycetoma and Global Warming. Fungal Biol 2022. [DOI: 10.1007/978-3-030-89664-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Bongomin F, Adetona Fayemiwo S. Epidemiology of fungal diseases in Africa: A review of diagnostic drivers. Curr Med Mycol 2021; 7:63-70. [PMID: 34553101 PMCID: PMC8443876 DOI: 10.18502/cmm.7.1.6246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/22/2020] [Accepted: 01/18/2021] [Indexed: 01/03/2023] Open
Abstract
Background and Purpose: There has been a significant increase in the burden of fungal diseases in the last few decades which has imposed a global threat to the health of humans, animals, and plants.
Epidemiology of fungal diseases is not completely understood in Africa. Most of these diseases are under-reported or not reported at all mainly due to the challenges related
to the availability of and access to fungal diagnostics and the lack of human resources in clinical and diagnostic mycology across the continent.
Therefore, it is imperative to highlight the epidemiology of the endemic and epidemic of emerging and re-emerging fungal diseases as well as their diagnostic challenges
in Africa based on the available data. Moreover, it is important to underline the existing gaps in this regard as well. Materials and Methods: For the purposes of the study, Medline and Google Scholar were searched to retrieve articles on these prominent fungal diseases, as well as their etiologies and available diagnostics. Results: It was found that histoplasmosis and other AIDS-associated mycoses have been reported in Africa, including blastomycosis, coccidioidomycosis,
and paracocci-dioidomycosis. Other reported infections were fungal neglected tropical diseases, especially sporotrichosis, dermatophytosis, mycetoma,
and chromoblastomycosis as well as emerging fungal diseases, such as Emergomyces africanus, Candida auris, and Blastomyces emzantsi. In Africa, the major drivers
of fungal diseases include human immunodeficiency infection, tuberculosis, and poverty. Conclusion: Serious fungal diseases are common in Africa; however, the true burden remains unknown.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Samuel Adetona Fayemiwo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, University Hospital Ibadan, Ibadan, Nigeria.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biological Sciences, University of Manchester, Manchester, UK
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20
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Olum R, Osaigbovo II, Baluku JB, Stemler J, Kwizera R, Bongomin F. Mapping of Chronic Pulmonary Aspergillosis in Africa. J Fungi (Basel) 2021; 7:jof7100790. [PMID: 34682212 PMCID: PMC8541146 DOI: 10.3390/jof7100790] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023] Open
Abstract
Africa has a high burden of tuberculosis, which is the most important risk factor for chronic pulmonary aspergillosis (CPA). Our goal was to systematically evaluate the burden of CPA in Africa and map it by country. We conducted an extensive literature search for publications on CPA in Africa using the online databases. We reviewed a total of 41 studies published between 1976 and 2021, including a total of 1247 CPA cases from 14 African countries. Most of the cases came from Morocco (n = 764, 62.3%), followed by South Africa (n = 122, 9.9%) and Senegal (n = 99, 8.1%). Seventeen (41.5%) studies were retrospective, 12 (29.3%) were case reports, 5 case series (12.2%), 5 prospective cohorts, and 2 cross-sectional studies. The majority of the cases (67.1%, n = 645) were diagnosed in men, with a median age of 41 years (interquartile range: 36–45). Active/previously treated pulmonary tuberculosis (n = 764, 61.3%), human immunodeficiency virus infection (n = 29, 2.3%), diabetes mellitus (n = 19, 1.5%), and chronic obstructive pulmonary disease (n = 10, 0.8%) were the common co-morbidities. Haemoptysis was the most frequent presenting symptom, reported in up to 717 (57%) cases. Smoking (n = 69, 5.5%), recurrent lung infections (n = 41, 3%) and bronchorrhea (n = 33, 3%) were noted. This study confirms that CPA is common in Africa, with pulmonary tuberculosis being the most important risk factor.
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Affiliation(s)
- Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Iriagbonse Iyabo Osaigbovo
- Department of Medical Microbiology, School of Medicine, College of Medical Sciences, University of Benin, Benin City PMB 1154, Nigeria;
| | - Joseph Baruch Baluku
- Division of Pulmonology, Mulago National Referral Hospital, Kampala P.O Box 7272, Uganda;
- Makerere University Lung Institute, Kampala P.O. Box 7749, Uganda
| | - Jannik Stemler
- Excellence Center for Medical Mycology (ECMM), Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50973 Cologne, Germany;
- Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstr. 52, 50931 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Herderstr. 52, 50931 Cologne, Germany
| | - Richard Kwizera
- Translational Research Laboratory, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda;
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Correspondence:
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León-Lara X, Atoche C, Arenas R, Martínez-Hernández F, Martínez-Chavarría LC, Xicohtencatl-Cortes J, Vázquez-Aceituno VA, Hernández-Castro R. Cyphellophora laciniata: A new etiological agent of chromoblastomycosis. J Mycol Med 2021; 32:101204. [PMID: 34598111 DOI: 10.1016/j.mycmed.2021.101204] [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: 05/26/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
Chromoblastomycosis is a chronic subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi especially in tropical and subtropical areas. Cyphellophora genus include melanized fungi reported as etiological agents of skin and nail infections. We report a 60-year-old male from the south of Mexico with a 40-year history of chromoblastomycosis caused by Cyphellophora laciniata. The isolated fungus was identified by sequencing of the internal transcribed spacer region of rDNA. The patient was treated with itraconazole and cryosurgery with unsatisfactory results.
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Affiliation(s)
- Ximena León-Lara
- Sección de Micología, Hospital General "Dr. Manuel Gea González", Tlalpan 14080, Ciudad de México, México
| | - Carlos Atoche
- Laboratorio de Micología, Centro Dermatológico "Dr. Fernando Latapi", Yucatán 97000, México
| | - Roberto Arenas
- Sección de Micología, Hospital General "Dr. Manuel Gea González", Tlalpan 14080, Ciudad de México, México
| | - Fernando Martínez-Hernández
- Departamento de Ecología de Agentes Patógenos. Hospital General "Dr. Manuel Gea González", Tlalpan 14080. Ciudad de México, México
| | - Luary C Martínez-Chavarría
- Departamento de Patología, Facultad de Medicina Veterinaria y Zootecnia. Universidad Nacional Autónoma de México, 04510 Coyoacán, Ciudad de México, México
| | - Juan Xicohtencatl-Cortes
- Laboratorio de Bacteriología Intestinal, Hospital Infantil de México "Dr. Federico Gómez", Cuauhtémoc 06720, Ciudad de México, México
| | - Víctor A Vázquez-Aceituno
- Departamento de Ecología de Agentes Patógenos. Hospital General "Dr. Manuel Gea González", Tlalpan 14080. Ciudad de México, México
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos. Hospital General "Dr. Manuel Gea González", Tlalpan 14080. Ciudad de México, México.
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22
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Santos DWCL, de Azevedo CDMPES, Vicente VA, Queiroz-Telles F, Rodrigues AM, de Hoog GS, Denning DW, Colombo AL. The global burden of chromoblastomycosis. PLoS Negl Trop Dis 2021; 15:e0009611. [PMID: 34383752 PMCID: PMC8360387 DOI: 10.1371/journal.pntd.0009611] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chromoblastomycosis (CBM), represents one of the primary implantation mycoses caused by melanized fungi widely found in nature. It is characterized as a Neglected Tropical Disease (NTD) and mainly affects populations living in poverty with significant morbidity, including stigma and discrimination. METHODS AND FINDINGS In order to estimate the global burden of CBM, we retrospectively reviewed the published literature from 1914 to 2020. Over the 106-year period, a total of 7,740 patients with CBM were identified on all continents except Antarctica. Most of the cases were reported from South America (2,619 cases), followed by Africa (1,875 cases), Central America and Mexico (1,628 cases), Asia (1,390 cases), Oceania (168 cases), Europe (35 cases), and USA and Canada (25 cases). We described 4,022 (81.7%) male and 896 (18.3%) female patients, with the median age of 52.5 years. The average time between the onset of the first lesion and CBM diagnosis was 9.2 years (range between 1 month to 50 years). The main sites involved were the lower limbs (56.7%), followed by the upper limbs (19.9%), head and neck (2.9%), and trunk (2.4%). Itching and pain were reported by 21.5% and 11%, respectively. Malignant transformation was described in 22 cases. A total of 3,817 fungal isolates were cultured, being 3,089 (80.9%) Fonsecaea spp., 552 (14.5%) Cladophialophora spp., and 56 Phialophora spp. (1.5%). CONCLUSIONS AND SIGNIFICANCE This review represents our current knowledge on the burden of CBM world-wide. The global incidence remains unclear and local epidemiological studies are required to improve these data, especially in Africa, Asia, and Latin America. The recognition of CBM as NTD emphasizes the need for public health efforts to promote support for all local governments interested in developing specific policies and actions for preventing, diagnosing and assisting patients.
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Affiliation(s)
- Daniel Wagner C. L. Santos
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Vania Aparecida Vicente
- Microbiology, Parasitology, and Pathology Post Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Flávio Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Anderson Messias Rodrigues
- Laboratory of Emerging Fungal Pathogens, Department of Microbiology, Immunology, and Parasitology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - G. Sybren de Hoog
- Microbiology, Parasitology, and Pathology Post Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Brazil
- Center of Expertise in Mycology, Radboud University Medical Center/CWZ, Nijmegen, The Netherlands
| | - David W. Denning
- Global Action Fund for Fungal Infections, Geneva, Switzerland
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester, United Kingdom
| | - Arnaldo Lopes Colombo
- Special Mycology Laboratory—LEMI, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
- Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil
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Abate DA, Ayele MH, Mohammed AB. Subcutaneous mycoses in Ethiopia: a retrospective study in a single dermatology center. Trans R Soc Trop Med Hyg 2021; 115:1468-1470. [PMID: 34101808 DOI: 10.1093/trstmh/trab080] [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: 01/05/2021] [Revised: 03/01/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The magnitude of various types of subcutaneous mycoses in Ethiopia is unknown. METHODS We performed a 5-y retrospective review of confirmed cases at ALERT hospital dermatology clinics. RESULT Confirmed cases of subcutaneous mycoses included chromoblastomycosis (n=12) and mycetoma (n=8). The patients originated from four regions: Oromia (n=10), Amhara (n=6), Addis Ababa (n=3) and South (n=1). Males were affected in 75% of cases (15/20). Ages ranged from 19 to 66 y with a median age of 44 y. Duration of disease ranged from 1 to 25 y. Extremities were affected in all cases, with lower limb involvement in 85% (17/20). CONCLUSION Chromoblastomycosis was the most frequent subcutaneous mycosis followed by mycetoma.
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Affiliation(s)
- Dagim A Abate
- Department of Dermatovenereology, School of Medicine, College of Health Sciences, Addis Ababa University, Zambia st, Addis Ababa, Ethiopia 2380
| | - Mesfin H Ayele
- Department of Dermatovenereology, School of Medicine, College of Health Sciences, Addis Ababa University, Zambia st, Addis Ababa, Ethiopia 2380
| | - Amel B Mohammed
- Department of Dermatovenereology, School of Medicine, College of Health Sciences, Addis Ababa University, Zambia st, Addis Ababa, Ethiopia 2380
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Kwizera R, Bongomin F, Lukande R. Deep fungal infections diagnosed by histology in Uganda: a 70-year retrospective study. Med Mycol 2021; 58:1044-1052. [PMID: 32242631 DOI: 10.1093/mmy/myaa018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/31/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
Fungal infections cause substantial morbidity and mortality. However, the burden of deep fungal infections is not well described in Uganda. We aimed to estimate the burden and etiology of histologically diagnosed deep fungal infections in Uganda. We retrospectively reviewed histology reports at the Pathology Reference Laboratory, Department of Pathology, Makerere University, Kampala, Uganda from January 1950 to September 2019 to identify any reports that had a fungal infection as the diagnosis. Over the study period, 697 cases of deep fungal infections were identified with an average incidence of 0.73/100,000 persons per decade. There was a general decline in the number of cases detected. Median age of the cases was 28 years (IQR: 11-40) and majority (59%) were male. The age group of 0-10 years were the most affected. The foot was the most affected part of the body (26%). Deep mycoses identified include eumycetoma (32%), subcutaneous phycomycosis (26%), histoplasmosis (9.2%), chromoblastomycosis (4.6%), aspergillosis (3.3%), cryptococcosis (3.3%), blastomycosis (1.6%), subcutaneous mycosis (1.4%), dermatomycosis (1.3%), coccidioidomycosis (0.6%), mucormycosis (0.6%), and sporotrichosis (0.1%). Histoplasma was the commonest causative agent (9.2%) followed by Aspergillus (3.4%) and Cryptococcus (3.3%), while 81% of the fungal pathogens were not identified to genus/species level. Only 31% of the cases were diagnosed clinically as deep fungal infections. There is a substantial burden of deep fungal infections caused by multiple fungal pathogens in Uganda. There is need to build local capacity for mycology so as to improve on the index of clinical suspicion and diagnostic capabilities.
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Affiliation(s)
- Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Robert Lukande
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Amona FM, Denning DW, Moukassa D, Develoux M, Hennequin C. Histoplasmosis in the Republic of Congo dominated by African histoplasmosis, Histoplasma capsulatum var. duboisii. PLoS Negl Trop Dis 2021; 15:e0009318. [PMID: 33956817 PMCID: PMC8101734 DOI: 10.1371/journal.pntd.0009318] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The Republic of Congo (RoC) is one of the African countries with the most histoplasmosis cases reported. This review summarizes the current status regarding epidemiology, diagnostic tools, and treatment of histoplasmosis in the RoC. A computerized search was performed from online databases Medline, PubMed, HINARI, and Google Scholar to collect literature on histoplasmosis in the RoC. We found 57 cases of histoplasmosis diagnosed between 1954 and 2019, corresponding to an incidence rate of 1-3 cases each year without significant impact of the AIDS epidemic in the country. Of the 57 cases, 54 (94.7%) were cases of Histoplasma capsulatum var. duboisii (Hcd) infection, African histoplasmosis. Three cases (5.3%) of Histoplasma capsulatum var. capsulatum infection were recorded, but all were acquired outside in the RoC. The patients' ages ranged between 13 months to 60 years. An equal number of cases were observed in adults in the third or fourth decades (n = 14; 24.6%) and in children aged ≤15 years. Skin lesions (46.3%), lymph nodes (37%), and bone lesions (26%) were the most frequent clinical presentations. Most diagnoses were based on histopathology and distinctive large yeast forms seen in tissue. Amphotericin B (AmB) was first line therapy in 65% of the cases and itraconazole (25%) for maintenance therapy. The occurrence of African histoplasmosis in apparently normal children raises the possibility that African histoplasmosis is linked to environmental fungal exposure.
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Affiliation(s)
- Fructueux Modeste Amona
- Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Republic of Congo
- Research Center and Study of Infectious and Tropical Pathologies, Oyo, Republic of Congo
- * E-mail:
| | - David W. Denning
- The University of Manchester and Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Donatien Moukassa
- Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Republic of Congo
- Research Center and Study of Infectious and Tropical Pathologies, Oyo, Republic of Congo
| | - Michel Develoux
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Christophe Hennequin
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
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Das L, Dahiya D, Gupta K, Prakash M, Malhotra B, Rastogi A, Choudhary H, Rudramurthy SM, Dutta P. Eumycetoma of the Foot due to Fusarium solani in a Person with Diabetes Mellitus: Report of a Case and Review of Literature. Mycopathologia 2021; 186:277-288. [PMID: 33687638 DOI: 10.1007/s11046-020-00524-y] [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: 10/10/2020] [Accepted: 12/21/2020] [Indexed: 10/20/2022]
Abstract
Eumycetomas are chronic suppurative granulomas caused by fungi characterised by invasive tumefactive lesions, sinuses and discharging grains. Herein, we describe a case of pedal eumycetoma due to Fusarium solani sensu stricto in a person with diabetes mellitus. A 45-year-old gentleman presented with an insidious onset swelling over his right foot with nodules and discharging grains. He had received itraconazole and anti-tuberculous therapy elsewhere, without response. Re-evaluation included a biopsy which confirmed eumycetoma and newly diagnosed diabetes. Surgical excision followed by histopathological, microbiological and multigene sequencing analyses [translation elongation factor, calmodulin and internal transcribed spacer region of rDNA] of the mould on culture were performed. Histopathology revealed septate fungal hyphae amidst a dense inflammatory infiltrate (Splendore-Hoeppli) reaction. Oral voriconazole was started and good glycemic control attained. Tissue growth sequences showed > 99% similarity with Fusarium solani sensu stricto. Antifungal susceptibility testing showed lowest MIC to voriconazole (0.5 mg/L). The patient showed excellent response to combined therapeutic modality with a near-complete resolution in size of lesion and obliteration of sinuses following 4 months of therapy and is planned for prolonged voriconazole therapy till complete radiological resolution. Diabetes predisposes to fungal infections of foot but eumycetomas are uncommon. Combined surgery and antifungals can improve morbidity and avoid amputations.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, PGIMER, 1012, Nehru Hospital Extension Block, Chandigarh, 160012, India
| | - Divya Dahiya
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | - Bhanu Malhotra
- Department of Endocrinology, PGIMER, 1012, Nehru Hospital Extension Block, Chandigarh, 160012, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, 1012, Nehru Hospital Extension Block, Chandigarh, 160012, India
| | - Hansraj Choudhary
- Department of Medical Microbiology, PGIMER, Nehru Hospital, Research Block A, Chandigarh, India
| | | | - Pinaki Dutta
- Department of Endocrinology, PGIMER, 1012, Nehru Hospital Extension Block, Chandigarh, 160012, India.
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Bonifaz A, Tirado-Sánchez A, Araiza J, Treviño-Rangel R, González GM. Deep mycoses and pseudomycoses of the foot: a single-center retrospective study of 160 cases, in a tertiary-care center in Mexico. Foot (Edinb) 2021; 46:101770. [PMID: 33453613 DOI: 10.1016/j.foot.2020.101770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Deep mycoses and pseudomycoses (DMP) may cause significant disability and even death; however, the reports regarding these diseases, mainly affecting the foot, are scarce. OBJECTIVE To describe the epidemiological, clinical, and diagnostic characteristics of DMP of the foot in 160 patients. METHODS A retrospective and observational study of DMP affecting the foot was carried out in a tertiary-care center in Mexico for 20 years (from January 2000 to December 2019). Cases with confirmatory microbiological studies were included; the identification of the isolated fungi was based on the forms of reproduction. For actinomycetes, morphological analysis in an automated system ATB Vitek® 1574 (Biomèrieux) was used. The fungi were identified by PCR, using several primers from the ITS regions and for actinomycetes in the 16S rRNA region. Data from histopathological studies were also collected. RESULTS One hundred and sixty proven cases of DMP of the foot were included. The cases were categorized into nine types of infections including mycetoma (actinomycetoma and eumycetoma) in 102 cases (63.7%); sporotrichosis in 21 cases (13.1%); chromoblastomycosis, 18 cases (11.2%); phaeohyphomycosis, 3 cases (1.8%); histoplasmosis, 12 cases (7.5%); coccidioidomycosis 2 cases (1.2%) and botryomycosis and nocardiosis with one case respectively (0.6%). Most cases developed after traumatic implantation (147 cases, 91.8%). One hundred fifteen cases (71.8%) were men. The evolution was chronic in 125 cases (78.2%); bone involvement was observed in 64 cases (40%). Parasitic forms were observed In 139 cases (86.8%). The isolation and identification of the etiological agents were confirmed in all cases. CONCLUSION The main DMP affecting the foot were infections due to traumatic implantation; most were endemic mycoses. The clinical characteristics and the evolution of the diseases are easily misdiagnosed, and thus, diagnostic tests are usually required.
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Affiliation(s)
- Alexandro Bonifaz
- Dermatology Service, & Mycology Department, Hospital General De México, "Dr. Eduardo Liceaga", Mexico.
| | - Andrés Tirado-Sánchez
- Dermatology Service, & Mycology Department, Hospital General De México, "Dr. Eduardo Liceaga", Mexico
| | - Javier Araiza
- Dermatology Service, & Mycology Department, Hospital General De México, "Dr. Eduardo Liceaga", Mexico
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Nargesi S, Bongomin F, Hedayati MT. The impact of COVID-19 pandemic on AIDS-related mycoses and fungal neglected tropical diseases: Why should we worry? PLoS Negl Trop Dis 2021; 15:e0009092. [PMID: 33561159 PMCID: PMC7872288 DOI: 10.1371/journal.pntd.0009092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The World Health Organization (WHO) considers mycetoma, chromoblastomycosis, and paracoccidioidomycosis to be fungal neglected tropical diseases (FNTDs). Depending on climatic, cultural, and economic contexts, these diseases have a similar geographical distribution as many other diseases, particularly tuberculosis (TB) and malaria, but are often less targeted by the national and many international healthcare systems. Another subgroup of fungal infections, such as candidiasis, cryptococcosis, pneumocystosis, histoplasmosis, and to a lesser extent, aspergillosis, are known as AIDS-related mycoses. Although antiretroviral therapy (ART) has been able to decrease the mortality rate of these diseases, particularly cryptococcosis, the disproportionately low distribution of funds to their diagnosis and treatment remains an obstacle in saving and improving the lives of patients affected. A new wave of viral diseases dubbed the Coronavirus Disease 2019 (COVID-19) hit the world at the end of 2019. Due to progressive symptoms and high mortality rates of COVID-19 compared to fungal infections, particularly the FNTDs, funding is currently allocated predominantly for diagnostic and therapeutic research on COVID-19. As a result, advances in FNTDs and AIDS-related mycosis care are considerably reduced. This paper explores the association between COVID-19, FNTDs, and AIDS-related mycoses with a predictive perspective.
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Affiliation(s)
- Sanaz Nargesi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
- * E-mail: (FB); (MTH)
| | - Mohammad T. Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
- * E-mail: (FB); (MTH)
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Mutalik VS, Bissonnette C, Kalmar JR, McNamara KK. Unique Oral Presentations of Deep Fungal Infections: A Report of Four Cases. Head Neck Pathol 2020; 15:682-690. [PMID: 32889592 PMCID: PMC8134600 DOI: 10.1007/s12105-020-01217-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/23/2020] [Indexed: 02/08/2023]
Abstract
Deep fungal infections rarely involve the oral cavity and most commonly affect immunocompromised patients. Oral deep fungal infections typically manifest as chronic mucosal ulcerations or granular soft tissue overgrowths. Since these lesions are non-specific and can mimic malignancy, it is crucial to obtain a thorough clinical history and an adequate biopsy to render the appropriate diagnosis. We report four new cases of deep fungal infections, diagnosed as histoplasmosis, blastomycosis and chromoblastomycosis, exhibiting unique oral and perioral presentations. Awareness of these unusual entities can help dental and medical practitioners expedite proper multidisciplinary care and minimize morbidity and mortality.
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Affiliation(s)
- Vimi S. Mutalik
- grid.21613.370000 0004 1936 9609Department of Dental Diagnostics and Surgical Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Caroline Bissonnette
- grid.261331.40000 0001 2285 7943Division of Oral and Maxillofacial Pathology and Radiology, The Ohio State University College of Dentistry, 305 West 12th Avenue, Columbus, OH 43210 USA
| | - John R. Kalmar
- grid.261331.40000 0001 2285 7943Division of Oral and Maxillofacial Pathology and Radiology, The Ohio State University College of Dentistry, 305 West 12th Avenue, Columbus, OH 43210 USA
| | - Kristin K. McNamara
- grid.261331.40000 0001 2285 7943Division of Oral and Maxillofacial Pathology and Radiology, The Ohio State University College of Dentistry, 305 West 12th Avenue, Columbus, OH 43210 USA
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Rudramurthy SM, Shankarnarayan SA, Hemashetter BM, Verma S, Chauhan S, Nath R, Savio J, Capoor M, Kaur H, Ghosh AK, Chakrabarti A. Phenotypic and molecular characterisation of Sporothrix globosa of diverse origin from India. Braz J Microbiol 2020; 52:91-100. [PMID: 32734470 DOI: 10.1007/s42770-020-00346-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/21/2020] [Indexed: 01/19/2023] Open
Abstract
Sporotrichosis is one of the neglected tropical diseases causing subcutaneous chronic granulomatous lesion by thermally dimorphic fungi belonging to Sporothrix species. Sporothrix brasiliensis, Sporothrix mexicana and Sporothrix globosa are the common pathogenic species. In Asian countries, S. globosa constitutes nearly 99.3% of all Sporothrix species. We studied 63 cases of sporotrichosis of geographically diverse origin from India and Sporothrix isolates were characterised for its growth in different media, temperatures, ability to assimilate sugars and antifungal susceptibility profile. Molecular characterization was performed by sequencing of the calmodulin (CAL), beta tubulin (BT) and translational elongation factor 1-alpha (TEF-1α) and typing by fluorescent amplified fragment length polymorphism (FAFLP). In patients who presented with fixed (49.2%), lymphocutaneous lesions (23.8%), in 26.9% the details were not known, none had systemic dissemination. All the isolates tested were Sporothrix globosa and that could grow up to 35 °C and unable to grow at and beyond 37 °C. The assimilation of sucrose, ribitol and raffinose helps in identifying S. globosa. Sequences of CAL or BT or TEF-1α can differentiate S. globosa from other species in the complex. FAFLP results exhibited low genetic diversity. No correlation was noted between genotypes and clinical presentation, or geographic distribution. Itraconazole, terbinafine and posaconazole showed good in vitro antifungal activity against S. globosa whereas fluconazole and micafungin had no activity. S. globosa of Indian origin is relatively less pathogenic than other pathogenic Sporothrix species as it does not cause systemic dissemination and in the diagnostic laboratory, incubation of the cultures below 37 °C is essential for effective isolation.
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Affiliation(s)
- Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Shamanth A Shankarnarayan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | | | - Santwana Verma
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Smriti Chauhan
- Department of Microbiology, Dr Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India
| | - Reema Nath
- Department of Microbiology, Assam Medical College, Dibrugarh, Assam, India
| | - Jayanthi Savio
- Department of Microbiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Malini Capoor
- Department of Medical Microbiology, Vardhman Mahavir Medical College, New Delhi, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Anup K Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
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31
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Bonifaz A, Tirado-Sánchez A, Vázquez-González D, Fierro-Arias L, Araiza J, González GM. Actinomycetoma by Actinomadura madurae. Clinical and therapeutic characteristics of 18 cases with two treatment modalities. J DERMATOL TREAT 2020; 33:954-958. [PMID: 32643472 DOI: 10.1080/09546634.2020.1793887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Actinomycetoma due to Actinomadura madurae is susceptible to numerous chemotherapeutic agents, however, the response to those treatments is variable and closely related to several factors. OBJECTIVE We aimed to evaluate the clinical-therapeutic characteristics of patients with actinomycetoma due to Actinomadura madurae with two treatment modalities. METHODS This was a retrospective study of eighteen patients with a diagnosis of actinomycetoma. The most widely used therapeutic scheme was streptomycin 1 g every third day plus TMP/SMX 800 mg/160 mg/12h, followed by TMP/SMX with DDS 100 mg/day. In six patients (33%), ciprofloxacin 500 mg every 12 h was used instead of DDS. RESULTS Conventional scheme achieved clinical and mycological cure in 58% of the cases, improvement in 16%, and 25% of the patients failed to treatment; in the cases treated with ciprofloxacin, clinical and microbiological cure was achieved in 83% of patients and clinical improvement in 16%. The treatment time to achieve clinical and mycological did not have a statistically significant difference (median 10 ± 1.38 vs. 12 ± 4.6). CONCLUSION Treatment based on streptomycin + TMP/SMX with ciprofloxacin was found to be effective in treating patients with actinomycetoma, and comparable to the conventional treatment with DDS in actinomycetoma due to A. madurae with minimal bone involvement.
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Affiliation(s)
- Alexandro Bonifaz
- Mycology Department, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Andrés Tirado-Sánchez
- Dermatology Service, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | - Leonel Fierro-Arias
- Mycology Department, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Javier Araiza
- Mycology Department, Hospital General de México. Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Gloria M González
- Microbiology Department, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Cox V, Fuller LC, Engelman D, Steer A, Hay RJ. Estimating the global burden of scabies: what else do we need? Br J Dermatol 2020; 184:237-242. [PMID: 32358799 DOI: 10.1111/bjd.19170] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 02/06/2023]
Abstract
Scabies is one of the most common disorders identified in any estimate of global skin disease prevalence. Furthermore, quantifying its impact on individuals and societies has been problematic. There has been a lack of clear case definitions and laboratory tests. There have been few epidemiological studies, particularly those focusing on low-income countries, variation in prevalence within high-income countries, or estimates of the effect of scabies on health beyond the skin, such as renal disease or mental wellbeing. Economic studies are also lacking. However, the new strategy of integrating surveillance for skin Neglected Tropical Diseases may well produce advancements on these issues, in addition to providing an overarching structure for health improvement and disease control.
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Affiliation(s)
- V Cox
- Royal Darwin Hospital, Darwin, Australia
| | - L C Fuller
- International Foundation for Dermatology, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - D Engelman
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - A Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - R J Hay
- International Foundation for Dermatology, London, UK.,St John's Institute of Dermatology, King's College London, London, UK
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Bienvenu AL, Picot S. Mycetoma and Chromoblastomycosis: Perspective for Diagnosis Improvement Using Biomarkers. Molecules 2020; 25:molecules25112594. [PMID: 32498471 PMCID: PMC7321093 DOI: 10.3390/molecules25112594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Mycetoma and chromoblastomycosis are both chronic subcutaneous infectious diseases that pose an obstacle to socioeconomic development. Besides the therapeutic issue, the diagnosis of most neglected tropical diseases (NTD) is challenging. Confirmation using direct microscopy and culture, recognized as WHO essential diagnostic tests, are limited to specialized facilities. In this context, there is a need for simple user-friendly diagnostic tests to be used in endemic villages. Methods: This review discuss the available biomarkers that could help to improve the diagnostic capacity for mycetoma and chromoblastomycosis in a theoretical and practical perspective. Results: A lack of research in this area has to be deplored, mainly for mycetoma. Biomarkers based on the immune response (pattern of leucocytes, antibody detection), the dermal involvement (extracellular matrix monitoring, protein expression), and the presence of the infectious agent (protein detection) are potential candidates for the detection or follow-up of infection. Conclusion: Confirmatory diagnosis based on specific diagnostic biomarkers will be the basis for the optimal treatment of mycetoma and chromoblastomycosis. It will be part of the global management of NTDs under the umbrella of stewardship activities.
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Affiliation(s)
- Anne-Lise Bienvenu
- Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, 69004 Lyon, France
- Service d’Hématologie, Groupement Hospitalier Nord, Hospices Civils de Lyon, 69004 Lyon, France
- Malaria Research Unit, University Lyon, ICBMS, UMR 5246 CNRS INSA CPE, Campus Lyon-Tech La Doua, F-69100 Lyon, France;
- Correspondence:
| | - Stephane Picot
- Malaria Research Unit, University Lyon, ICBMS, UMR 5246 CNRS INSA CPE, Campus Lyon-Tech La Doua, F-69100 Lyon, France;
- Groupement Hospitalier Nord, Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, 69004 Lyon, France
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Ali GA, Goravey W, Taj-Aldeen SJ, Petkar M, Al-Bozom I, Hadi HA. A case of mycetoma-like chromoblastomycosis in Qatar. IDCases 2020; 21:e00853. [PMID: 32528848 PMCID: PMC7283144 DOI: 10.1016/j.idcr.2020.e00853] [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: 05/24/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/03/2022] Open
Abstract
Chromoblastomycosis is one of the neglected tropical mycoses associated with chronic infection of the skin and subcutaneous tissues. We report a case of 49-year-old patient originally from India presented with a mycetoma-like lesion in his right foot which was slowly progressing over three-year period. The diagnosis of chromoblastomycosis was confirmed following surgical excision and identification of the unique histological pathology of muriform bodies. The patient was subsequently treated with a prolonged course of oral itraconazole with a favorable outcome. The clinical presentations, assessment and management of the disease are outlined.
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Affiliation(s)
| | | | - Saad J Taj-Aldeen
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
| | - Issam Al-Bozom
- Department of Laboratory Medicine and Pathology Hamad Medical Corporation, Doha, Qatar
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Zhang H, Zhu A. Emerging Invasive Fungal Infections: Clinical Features and Controversies in Diagnosis and Treatment Processes. Infect Drug Resist 2020; 13:607-615. [PMID: 32110071 PMCID: PMC7039084 DOI: 10.2147/idr.s237815] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background The diagnosis and treatment of invasive fungal infection (IFI) are still challenging due to its complexity and non-specificity. This study was aimed to investigate the clinical features, diagnosis process, and outcomes of patients with emerging IFIs. Methods A retrospective review of emerging IFIs in adult patients at a university hospital in China was conducted; diagnoses were based on the criteria of EORTC/MSG 2008. Results 145 IFI patients (pulmonary, intestinal and urinary) were enrolled in this study, including 80 proven (55.2%), 59 probable (40.7%), or 6 possible IFIs (4.1%). Among the 126 pulmonary IFIs, the positivity rate for sputum microscopy, sputum culture, and 1.3-ß-D-glucan (BG) test was 54.0%, 44.4%, and 37.3%, respectively. Among the 19 intestinal and urinary IFIs, routine examination of stool or urine and their culture were the main methods of detection. Positive results of 75 detected fungal strains from the samples showed that 30 cases were complicated with one or more bacterial infections. The average length of hospital stay of IFI patients was 14.0 (10.0, 20.0) days. The time from admission to antifungal therapy initiation (P<0.001), liver cirrhosis (P<0.001), hematological tumor (P<0.001), coinfection (P=0.019) and immune diseases (P=0.025) were independent predictors of prolonged hospitalization. Conclusion Delayed time was the primary predictor of prolonged hospitalization. This prediction is suggested to improve IFI diagnostic and therapeutic process of IFI to promote prognosis.
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Affiliation(s)
- Hongliang Zhang
- Emergency Department, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, People's Republic of China
| | - Aiqun Zhu
- Emergency Department, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, People's Republic of China.,Department of Nursing, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, People's Republic of China
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