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Bassetti M, Giacobbe DR, Agvald-Ohman C, Akova M, Alastruey-Izquierdo A, Arikan-Akdagli S, Azoulay E, Blot S, Cornely OA, Cuenca-Estrella M, de Lange DW, De Rosa FG, De Waele JJ, Dimopoulos G, Garnacho-Montero J, Hoenigl M, Kanj SS, Koehler P, Kullberg BJ, Lamoth F, Lass-Flörl C, Maertens J, Martin-Loeches I, Muñoz P, Poulakou G, Rello J, Sanguinetti M, Taccone FS, Timsit JF, Torres A, Vazquez JA, Wauters J, Asperges E, Cortegiani A, Grecchi C, Karaiskos I, Le Bihan C, Mercier T, Mortensen KL, Peghin M, Rebuffi C, Tejada S, Vena A, Zuccaro V, Scudeller L, Calandra T. Invasive Fungal Diseases in Adult Patients in Intensive Care Unit (FUNDICU): 2024 consensus definitions from ESGCIP, EFISG, ESICM, ECMM, MSGERC, ISAC, and ISHAM. Intensive Care Med 2024; 50:502-515. [PMID: 38512399 PMCID: PMC11018656 DOI: 10.1007/s00134-024-07341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/31/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The aim of this document was to develop standardized research definitions of invasive fungal diseases (IFD) in non-neutropenic, adult patients without classical host factors for IFD, admitted to intensive care units (ICUs). METHODS After a systematic assessment of the diagnostic performance for IFD in the target population of already existing definitions and laboratory tests, consensus definitions were developed by a panel of experts using the RAND/UCLA appropriateness method. RESULTS Standardized research definitions were developed for proven invasive candidiasis, probable deep-seated candidiasis, proven invasive aspergillosis, probable invasive pulmonary aspergillosis, and probable tracheobronchial aspergillosis. The limited evidence on the performance of existing definitions and laboratory tests for the diagnosis of IFD other than candidiasis and aspergillosis precluded the development of dedicated definitions, at least pending further data. The standardized definitions provided in the present document are aimed to speed-up the design, and increase the feasibility, of future comparative research studies.
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Affiliation(s)
- Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi 10, 16132, Genoa, Italy.
| | - Daniele R Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi 10, 16132, Genoa, Italy
| | - Christina Agvald-Ohman
- Anaesthesiology and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas-CIBERINFEC, Madrid, Spain
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elie Azoulay
- Université de Paris, Paris, France
- Service de Médecine Intensive Et Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Oliver A Cornely
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Manuel Cuenca-Estrella
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - George Dimopoulos
- Department of Critical Care, University Hospital Attikon, Attikon Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed, Graz, Austria
- Translational Mycology Working Group, ECMM Excellence Center for Clinical Mycology, Medical University of Graz, Graz, Austria
| | - Souha S Kanj
- Division of Infectious Diseases, and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Philipp Koehler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Medical Faculty and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Bart J Kullberg
- Department of Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frédéric Lamoth
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Immunology and Allergy and Center of Human Immunology Lausanne, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Garyphallia Poulakou
- Third Department of Internal Medicine, School of Medicine, Sotiria General Hospital, National and Kapodistrian University, Athens, Greece
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
- Clinical Research in the ICU, CHU Nimes, Universite de Nimes-Montpellier, Nimes, France
- Medicine Department, Universitat Internacional de Catalunya (UIC), Sant Cugat, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio E Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-François Timsit
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Claude Bernard University Hospital, Paris, France
- IAME UMR 1137, Université Paris-Cité, Paris, France
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centres in Respiratory Diseases (CIBERES), Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Jose A Vazquez
- Department of Medicine/Division of Infectious Disease, Medical College of Georgia/Augusta University, Augusta, GA, USA
| | - Joost Wauters
- Medical Intensive Care Unit, University Hospitals Leuven, Louvain, Belgium
| | - Erika Asperges
- Infectious Diseases Unit, IRCCS San Matteo, Pavia, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy
| | - Cecilia Grecchi
- Malattie Infettive, Azienda Socio Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy
| | - Ilias Karaiskos
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - Clément Le Bihan
- Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University Health Care Center, Montpellier, France
| | - Toine Mercier
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium
- Department of Hematology, University Hospitals Leuven, Louvain, Belgium
| | - Klaus L Mortensen
- Department of Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, Varese, Italy
| | - Chiara Rebuffi
- Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sofia Tejada
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi 10, 16132, Genoa, Italy
| | | | - Luigia Scudeller
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Thierry Calandra
- Service of Immunology and Allergy and Center of Human Immunology Lausanne, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Gunst JD, Staerke NB, Pahus MH, Kristensen LH, Bodilsen J, Lohse N, Dalgaard LS, Brønnum D, Fröbert O, Hønge B, Johansen IS, Monrad I, Erikstrup C, Rosendal R, Vilstrup E, Mariager T, Bove DG, Offersen R, Shakar S, Cajander S, Jørgensen NP, Sritharan SS, Breining P, Jespersen S, Mortensen KL, Jensen ML, Kolte L, Frattari GS, Larsen CS, Storgaard M, Nielsen LP, Tolstrup M, Sædder EA, Østergaard LJ, Ngo HT, Jensen MH, Højen JF, Kjolby M, Søgaard OS. Efficacy of the TMPRSS2 inhibitor camostat mesilate in patients hospitalized with Covid-19-a double-blind randomized controlled trial. EClinicalMedicine 2021; 35:100849. [PMID: 33903855 PMCID: PMC8060682 DOI: 10.1016/j.eclinm.2021.100849] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The trans-membrane protease serine 2 (TMPRSS2) is essential for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cell entry and infection. Efficacy and safety of TMPRSS2 inhibitors in patients with coronavirus disease 2019 (Covid-19) have not been evaluated in randomized trials. METHODS We conducted an investigator-initiated, double-blind, randomized, placebo-controlled multicenter trial in patients hospitalized with confirmed SARS-CoV-2 infection from April 4, to December 31, 2020. Within 48 h of admission, participants were randomly assigned in a 2:1 ratio to receive the TMPRSS2 inhibitor camostat mesilate 200 mg three times daily for 5 days or placebo. The primary outcome was time to discharge or clinical improvement measured as ≥2 points improvement on a 7-point ordinal scale. Other outcomes included 30-day mortality, safety and change in oropharyngeal viral load. FINDINGS 137 patients were assigned to receive camostat mesilate and 68 to placebo. Median time to clinical improvement was 5 days (interquartile range [IQR], 3 to 7) in the camostat group and 5 days (IQR, 2 to 10) in the placebo group (P = 0·31). The hazard ratio for 30-day mortality in the camostat compared with the placebo group was 0·82 (95% confidence interval [CI], 0·24 to 2·79; P = 0·75). The frequency of adverse events was similar in the two groups. Median change in viral load from baseline to day 5 in the camostat group was -0·22 log10 copies/mL (p <0·05) and -0·82 log10 in the placebo group (P <0·05). INTERPRETATION Under this protocol, camostat mesilate treatment was not associated with increased adverse events during hospitalization for Covid-19 and did not affect time to clinical improvement, progression to ICU admission or mortality. ClinicalTrials.gov Identifier: NCT04321096. EudraCT Number: 2020-001200-42.
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Affiliation(s)
- Jesper D. Gunst
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Nina B. Staerke
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Marie H. Pahus
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Nicolai Lohse
- Department of Emergency Medicine, Copenhagen University Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Lars S. Dalgaard
- Department of Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Ole Fröbert
- Faculty of Health, Dept. of Cardiology, Örebro University, Sweden
| | - Bo Hønge
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Isik S. Johansen
- Research Unit for Infectious Diseases, Odense University Hospital, University of Southern Denmark, Denmark
| | - Ida Monrad
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Regitze Rosendal
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Emil Vilstrup
- Department of Medicine, Viborg Regional Hospital, Denmark
| | - Theis Mariager
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Dorthe G. Bove
- Department of Emergency Medicine, Copenhagen University Hospital, Hillerød, Denmark
| | - Rasmus Offersen
- Department of Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - Shakil Shakar
- Department of Internal Medicine, North Denmark Regional Hospital, Denmark
- Department of Emergency Medicine, North Denmark Regional Hospital, Denmark
| | - Sara Cajander
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Nis P. Jørgensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | | | - Peter Breining
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Jespersen
- Department of Emergency Medicine, Copenhagen University Hospital, Hillerød, Denmark
| | - Klaus L. Mortensen
- Department of Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - Mads L. Jensen
- Department of Medicine, Viborg Regional Hospital, Denmark
| | - Lilian Kolte
- Department of Lung and Infectious Diseases, Copenhagen University Hospital, Hillerød, Denmark
| | - Giacomo S. Frattari
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten S. Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P. Nielsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Martin Tolstrup
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva A. Sædder
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Lars J. Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hien T.T. Ngo
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Morten H. Jensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper F. Højen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Kjolby
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
- DANDRITE, Deptarment of Biomedicine, Aarhus University, Aarhus Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
- University of Dundee, Scotland, United Kingdom
| | - Ole S. Søgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lausch KR, Søgaard M, Rosenvinge FS, Johansen HK, Boysen T, Røder B, Mortensen KL, Nielsen L, Lemming L, Olesen B, Leitz C, Kristensen L, Dzajic E, Østergaard L, Schønheyder HC, Arendrup MC. High incidence of candidaemia in a nationwide cohort: Underlying diseases, risk factors and mortality. Int J Infect Dis 2018; 76:58-63. [PMID: 30176293 DOI: 10.1016/j.ijid.2018.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Denmark has a high incidence rate of candidaemia. A Nordic study suggested a higher Danish prevalence of haematological malignancies as an underlying reason. This nationwide study ascertained clinical characteristics of Danish candidaemia patients and investigated potential factors contributing to the high incidence and mortality. METHODS Microbiological and clinical data for candidaemia patients in 2010-2011 were retrieved. 30-day mortality was estimated by hazard ratios (HR) with 95% confidence intervals (CI, Cox regression). RESULTS Data were available for 912/973 candidaemia episodes (93.7%). Intensive care unit (ICU) held the largest share of patients (43.2%). Prevalent host factors were multi-morbidity (≥2 underlying diseases, 74.2%) and gastrointestinal disease (52.5%). Haematological disease was infrequent (7.8%). Risk factors included antibiotic exposure (90.5%), CVC (71.9%) and Candida colonisation (66.7%). 30-day mortality was 43.4%, and 53.6% in ICU. Mortality was lower for patients with recent abdominal surgery (HR 0.70, 95% CI: 0.54-0.92). CONCLUSION A substantial prevalence of multi-morbidity and a high 30-day mortality was found. We hypothesise, that an increasing population of severely ill patients with prolonged supportive treatment and microbiological testing may in part explain the high candidaemia incidence in Denmark. Nationwide studies are warranted to clarify this issue.
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Affiliation(s)
- K R Lausch
- Dpt. of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark.
| | - M Søgaard
- Dpt. of Cardiology, Aalborg University Hospital, Denmark; Aalborg Thrombosis Research Unit, Dpt. of Clinical Medicine, Faculty of Health, Aalborg, Denmark
| | - F S Rosenvinge
- Dpt. of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Dpt. of Clinical Microbiology, Lillebaelt Hospital, Denmark
| | - H K Johansen
- Dpt. of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - T Boysen
- Dpt. of Clinical Microbiology, Hvidovre Hospital, Hvidovre, Denmark
| | - B Røder
- Dpt. of Clinical Microbiology, Slagelse Sygehus, Slagelse, Denmark
| | - K L Mortensen
- Dpt. of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark; Dpt. of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Nielsen
- Dpt. of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - L Lemming
- Dpt. of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - B Olesen
- Dpt. of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - C Leitz
- Dpt. of Clinical Microbiology, Viborg Regionshospital, Viborg, Denmark
| | - L Kristensen
- Dpt. of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark; Dpt. of Clinical Microbiology, Herning Regionshospital, Denmark
| | - E Dzajic
- Dpt. of Clinical Microbiology, Sydvestjysk Sygehus, Denmark
| | - L Østergaard
- Dpt. of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark
| | - H C Schønheyder
- Dpt. of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Dpt. of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - M C Arendrup
- Dpt. of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Unit of Mycology, Statens Serum Institute, Copenhagen, Denmark; Dpt. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mortensen KL, Krogh TP, Jensen-Fangel S, Hauge EM. Severe acute pancytopaenia in a patient with rheumatoid arthritis complicated by fatal invasive pulmonary aspergillosis. Scand J Rheumatol 2016; 46:249-250. [PMID: 27575284 DOI: 10.1080/03009742.2016.1209553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- K L Mortensen
- a Department of Infectious Diseases , Aarhus University Hospital Skejby , Aarhus , Denmark.,b Department of Medicine , Randers Regional Hospital , Randers , Denmark
| | - T P Krogh
- c Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| | - S Jensen-Fangel
- a Department of Infectious Diseases , Aarhus University Hospital Skejby , Aarhus , Denmark
| | - E M Hauge
- c Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark.,d Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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Mortensen KL, Denning DW, Arendrup MC. The burden of fungal disease in Denmark. Mycoses 2016; 58 Suppl 5:15-21. [PMID: 26449502 DOI: 10.1111/myc.12383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 12/17/2022]
Abstract
The aim of this study is to calculate the burden of fungal disease in Denmark. We identified all published epidemiology papers reporting fungal infection rates in Denmark. Where no data existed, we used numbers of specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence. Approximately, one in six Danes will suffer from a fungal infection each year, most of which are skin or mucosal diseases causing disability but no deaths. Good data exist on candidaemia where a national voluntary reporting system is in place and have shown a high rate (9.6 per 100,000 inhabitants) compared other European countries. We present estimates of invasive aspergillosis and chronic pulmonary aspergillosis with rates of 4.4 per 100,000 and 3.1 per 100,000 inhabitants, respectively. Further studies are needed in order to better ascertain high-burden fungal infections such as recurrent vulvovaginal candidiasis (~1350 cases in 100,000 women) as well as allergic bronchopulmonary aspergillosis (~131 cases in 100,000 inhabitants) and severe asthma with fungal sensitisation (cases in 100,000 inhabitants). In conclusion, more than 93,000 Danes or about 2% of Denmark's population will have a non-trivial fungal infection during 1 year, which underscores the magnitude of the fungal burden.
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Affiliation(s)
- Klaus L Mortensen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - David W Denning
- The University of Manchester, Manchester Academic Health Science Centre and National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
| | - Maiken C Arendrup
- Unit of Mycology, Department Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark
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Storm L, Lausch KR, Arendrup MC, Mortensen KL, Petersen E. Vertebral infection with Candida albicans failing caspofungin and fluconazole combination therapy but successfully treated with high dose liposomal amphotericin B and flucytosine. Med Mycol Case Rep 2014; 6:6-9. [PMID: 25379389 PMCID: PMC4216330 DOI: 10.1016/j.mmcr.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 06/16/2014] [Accepted: 07/01/2014] [Indexed: 11/01/2022] Open
Abstract
A patient with Candida spondylitis failed two weeks of fluconazole combined with caspofungin, and the infection relapsed despite six weeks of liposomal amphotericin B followed by two months of fluconazole. Six months therapy with high dose liposomal amphotericin B combined with flucytosine effectively cured the patient.
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Affiliation(s)
- Line Storm
- Department of Infectious Diseases, Aarhus University Hospital Skejby, 100 Brendstrupgaardsvej, 8200 Aarhus N, Denmark
| | - Karen R Lausch
- Department of Infectious Diseases, Aarhus University Hospital Skejby, 100 Brendstrupgaardsvej, 8200 Aarhus N, Denmark
| | - Maiken C Arendrup
- Unit of Mycology, Department of Microbiology and Infection Control, Statens Serum Institut, 5 Artillerivej, 2300 Copenhagen S, Denmark
| | - Klaus L Mortensen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, 100 Brendstrupgaardsvej, 8200 Aarhus N, Denmark
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, 100 Brendstrupgaardsvej, 8200 Aarhus N, Denmark
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Abstract
PURPOSE Introducing a simple image grading system to support the interpretation of in vivo confocal microscopy (IVCM) images in filamentous fungal keratitis. SETTING Clinical and confocal studies took place at the Department of Ophthalmology, Aarhus University Hospital, Denmark. Histopathological analysis was performed at the Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark. METHODS A recent series of consecutive patients with filamentous fungal keratitis is presented to demonstrate the results from in-house IVCM. Based upon our experience with IVCM and previously published images, we composed a grading system for interpreting IVCM images of filamentous fungal keratitis. RESULTS A recent case series of filamentous fungal keratitis from 2011 to 2012 was examined. There were 3 male and 3 female patients. Mean age was 44.5 years (range 12-69), 6 out of 17 (35%) cultures were positive and a total of 6/7 (86%) IVCM scans were positive. Three different categories of IVCM results for the grading of diagnostic certainty were formed. CONCLUSION IVCM is a valuable tool for diagnosing filamentous fungal keratitis. In order to improve the reliability of IVCM, we suggest implementing a simple and clinically applicable grading system for aiding the interpretation of IVCM images of filamentous fungal keratitis.
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Affiliation(s)
- E Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark
| | - S Heegaard
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Skejby, Denmark ; Department of Ophthalmology, Glostrup Hospital, Glostrup, Aarhus University Hospital, Skejby, Denmark
| | - J U Prause
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Skejby, Denmark
| | - A Ivarsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark
| | - K L Mortensen
- Department of Clinical Microbiology and Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - J Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark
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Mortensen KL, Johansen HK, Fuursted K, Knudsen JD, Gahrn-Hansen B, Jensen RH, Howard SJ, Arendrup MC. A prospective survey of Aspergillus spp. in respiratory tract samples: prevalence, clinical impact and antifungal susceptibility. Eur J Clin Microbiol Infect Dis 2011; 30:1355-63. [PMID: 21541671 DOI: 10.1007/s10096-011-1229-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
Abstract
A three-month laboratory-based prospective survey was conducted at four major university hospitals covering one-third of the Danish population in order to determine the prevalence, significance, and susceptibility pattern of aspergilli in airway samples. Samples received in January-March 2007 for routine microbiologic investigation were examined for Aspergillus following routine procedures and with extended incubation (5 days). Identification was done by morphologic criteria and susceptibility testing using EUCAST method for azoles and amphotericin B E-test. Invasive aspergillosis (IA) was evaluated using modified EORTC/MSG criteria. A total of 11,368 airway samples were received. Growth of Aspergillus spp. was found in 129 and 151 patients using routine and extended incubation, respectively. Three patients had proven IA (2%), 11 probable (7%), four had allergic bronchopulmonary aspergillosis (ABPA) (3%), but the majority was colonised (88%). Underlying conditions were cystic fibrosis in 82 patients (55%), chronic obstructive pulmonary disease in 19 (13%) and haematological disorder in 11 (7%). Twenty-six patients (18%) were at intensive care unit and 69 (47%) received steroid treatment. Azole MICs were elevated for five isolates as follows (itraconazole, posaconazole, voriconazole MICs [mg/L]): two A. fumigatus isolates (>4; >4; 2 and >4; 0.125; 1), one A. lentulus isolate (2; 2; 0.5) and two A. terreus isolates (2; 2; 2 and 2; 0.125; 1). For four isolates the amphotericin B MIC was >1 μg/ml (3/112 A. fumigatus, 1/2 A. terreus). In conclusion, Aspergillus appears to be an important pathogen in Denmark. Elevated itraconazole MICs were detected in 4% of the isolates including a multi-azole resistant isolate.
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Affiliation(s)
- K L Mortensen
- Mycology Unit, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.
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Mortensen KL, Knudsen JB, Jensen-Fangel S, Stausbøl-Grøn B, Arendrup MC, Petersen E. Successful management of invasive aspergillosis presenting as pericarditis in an adult patient with chronic granulomatous disease. Mycoses 2009; 54:e233-6. [DOI: 10.1111/j.1439-0507.2009.01835.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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