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Schwartz IS, Link KE, Daneshjou R, Cortés-Penfield N. Black Box Warning: Large Language Models and the Future of Infectious Diseases Consultation. Clin Infect Dis 2024; 78:860-866. [PMID: 37971399 PMCID: PMC11006107 DOI: 10.1093/cid/ciad633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/27/2023] [Indexed: 11/19/2023] Open
Abstract
Large language models (LLMs) are artificial intelligence systems trained by deep learning algorithms to process natural language and generate text responses to user prompts. Some approach physician performance on a range of medical challenges, leading some proponents to advocate for their potential use in clinical consultation and prompting some consternation about the future of cognitive specialties. However, LLMs currently have limitations that preclude safe clinical deployment in performing specialist consultations, including frequent confabulations, lack of contextual awareness crucial for nuanced diagnostic and treatment plans, inscrutable and unexplainable training data and methods, and propensity to recapitulate biases. Nonetheless, considering the rapid improvement in this technology, growing calls for clinical integration, and healthcare systems that chronically undervalue cognitive specialties, it is critical that infectious diseases clinicians engage with LLMs to enable informed advocacy for how they should-and shouldn't-be used to augment specialist care.
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine E Link
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, NewYork, New York, USA
- Healthcare & Life Sciences Division, Hugging Face, Brooklyn, NewYork, USA
| | - Roxana Daneshjou
- Department of Dermatology, Stanford School of Medicine, Stanford, California, USA
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, California, USA
| | - Nicolás Cortés-Penfield
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Höft MA, Duvenage L, Salie S, Keeton R, Botha A, Schwartz IS, Govender NP, Brown GD, Hoving JC. The pathogenesis of experimental Emergomycosis in mice. PLoS Negl Trop Dis 2024; 18:e0011850. [PMID: 38198478 PMCID: PMC10805315 DOI: 10.1371/journal.pntd.0011850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/23/2024] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
Emergomyces africanus is a recently identified thermally-dimorphic fungal pathogen that causes disseminated infection in people living with advanced HIV disease. Known as emergomycosis, this disseminated disease is associated with very high case fatality rates. Over the last decade, improved diagnostics and fungal identification in South Africa resulted in a dramatic increase in the number of reported cases. Although the true burden of disease is still unknown, emergomycosis is among the most frequently diagnosed dimorphic fungal infections in Southern Africa; and additional species in the genus have been identified on four continents. Little is known about the pathogenesis and the host's immune response to this emerging pathogen. Therefore, we established a murine model of pulmonary infection using a clinical isolate, E. africanus (CBS 136260). Both conidia and yeast forms caused pulmonary and disseminated infection in mice with organisms isolated in culture from lung, spleen, liver, and kidney. Wild-type C57BL/6 mice demonstrated a drop in body weight at two weeks post-infection, corresponding to a peak in fungal burden in the lung, spleen, liver, and kidney. An increase in pro-inflammatory cytokine production was detected in homogenized lung supernatants including IFN-γ, IL-1β, IL-6, IL12-p40 and IL-17 at three- and four-weeks post-infection. No significant differences in TNF, IL-12p70 and IL-10 were observed in wild-type mice between one and four-weeks post-infection. Rag-1-deficient mice, lacking mature T-and B-cells, had an increased fungal burden associated with reduced IFN-γ production. Together our data support a protective T-helper type-1 immune response to E. africanus infection. This may provide a possible explanation for the susceptibility of only a subset of people living with advanced HIV disease despite hypothesized widespread environmental exposure. In summary, we have established a novel murine model of E. africanus disease providing critical insights into the host immune components required for eliminating the infection.
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Affiliation(s)
- Maxine A. Höft
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucian Duvenage
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sumayah Salie
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roanne Keeton
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Stellenbosch, South Africa
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Nelesh P. Govender
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
| | - Gordon D. Brown
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
| | - Jennifer Claire Hoving
- CMM AFRICA Medical Mycology Research Unit, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Medical Research Council Centre for Medical Mycology at the University of Exeter, Geoffrey Pope Building Stocker Road, Exeter, United Kingdom
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Thu NTM, Borda H, Vitsupakorn S, Reddy KS, Kasmani N, Barwatt J, Schwartz IS, Giamberardino C, Perfect JR, Hoa NT, Le T. Development and validation of a colorimetric antifungal susceptibility testing method for the dimorphic fungus Talaromyces marneffei. Med Mycol 2023; 61:myad111. [PMID: 37994652 PMCID: PMC10681740 DOI: 10.1093/mmy/myad111] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023] Open
Abstract
Antifungal drug resistance is an emerging cause of treatment failure in invasive fungal infections, and antifungal susceptibility testing (AFST) may inform treatment decisions. Currently, there are no established AFST guidelines for Talaromyces marneffei (Tm) or other dimorphic fungi. We developed a colorimetric AFST method using a fluorescent redox indicator alamarBlue, which changes from blue to pink in proportion to cellular metabolic activity. We determined the optimal time for alamarBlue addition to be 24 h post-inoculation and for MIC reading to be 72 h post-inoculation. Our method allows three ways to determine minimum inhibitory concentration (MIC): visual inspection of color change, optical density, and fluorescence intensity. We validated the assay by determining the MICs for seven antifungals against 32 Tm clinical isolates and assessed the essential agreement (EA) and inter-rater reliability between our alamarBlue and the Clinical Laboratory Standard Institute (CLSI) broth microdilution methods. The MIC ranges (from low to high) were: 0.008-0.025 μg/ml for itraconazole, 0.004-0.13 μg/ml for voriconazole, 0.03-0.13 μg/ml for posaconazole, 0.06-0.5 µg/ml for flucytosine, 0.5-1 µg/ml for amphotericin B, 0.5-4 µg/ml for caspofungin, and 0.5-16 µg/ml for fluconazole. The EAs were 100% between all three MIC readouts of the alamarBlue method, and 94%-100% between the alamarBlue and CLSI methods. Our alamarBlue method had substantially higher inter-rater agreement and offers a more reliable method that can be standardized across laboratories in both high- and low-resource settings compared to the established CLSI methodology.
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Affiliation(s)
- Nguyen Thi Mai Thu
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Hannah Borda
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Shawin Vitsupakorn
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Kaushik Sreerama Reddy
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Navsin Kasmani
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Joseph Barwatt
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Charles Giamberardino
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - John R Perfect
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
| | - Ngo Thi Hoa
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Tropical Medicine Research Center for Talaromycosis, Biomedical Research Centre, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA
- Tropical Medicine Research Center for Talaromycosis, Biomedical Research Centre, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Thompson GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, Boyer J, Patterson TF, Chen SCA, Pappas PG, Hoenigl M. Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2023; 36:e0001923. [PMID: 37439685 PMCID: PMC10512793 DOI: 10.1128/cmr.00019-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
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Affiliation(s)
- George R. Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Medical Center, Sacramento, California, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, California, USA
| | - Jeffrey D. Jenks
- Durham County Department of Public Health, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W. Baddley
- Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S. Lewis
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthias Egger
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Johannes Boyer
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas F. Patterson
- Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter G. Pappas
- Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Hoenigl
- Division of Infectious Diseases, ECMM Excellence Center for Medical Mycology, Department of Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Friedman DZP, Schwartz IS. Emerging Diagnostics and Therapeutics for Invasive Fungal Infections. Infect Dis Clin North Am 2023; 37:593-616. [PMID: 37532392 DOI: 10.1016/j.idc.2023.05.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Recently, there have been significant advances in the diagnosis and management of invasive fungal infections. Compared with traditional fungal diagnostics, molecular assays promise improved sensitivity and specificity, the ability to test a range of samples (including noninvasive samples, ie, blood), the detection of genetic mutations associated with antifungal resistance, and the potential for a faster turnaround time. Antifungals in late-stage clinical development include agents with novel mechanisms of action (olorofim and fosmanogepix) and new members of existing classes with distinct advantages over existing antifungals in toxicity, drug-drug interactions, and dosing convenience (oteseconazole, opelconazole, rezafungin, ibrexafungerp, encochleated amphotericin B).
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Affiliation(s)
- Daniel Z P Friedman
- Section of Infectious Diseases and Global Health, The University of Chicago, 5841 South Maryland Avenue, MC5065, Chicago, IL 60637, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, 315 Trent Drive, Durham, NC 27705, USA.
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Ganesh A, Rosentreter RE, Chen Y, Mehta R, McLeod GA, Wan MW, Krett JD, Mahjoub Y, Lee AS, Schwartz IS, Richer LP, Metz LM, Smith EE, Hill MD. Patient-reported outcomes of neurologic and neuropsychiatric symptoms in mild COVID-19: a prospective cohort study. CMAJ Open 2023; 11:E696-E705. [PMID: 37553227 PMCID: PMC10414975 DOI: 10.9778/cmajo.20220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Various neurologic manifestations have been reported in patients with COVID-19, mostly in retrospective studies of patients admitted to hospital, but there are few data on patients with mild COVID-19. We examined the frequency and persistence of neurologic/neuropsychiatric symptoms in patients with mild COVID-19 in a 1-year prospective cohort study, as well as assessment of use of health care services and patient-reported outcomes. METHODS Participants in the Alberta HOPE COVID-19 trial (hydroxychloroquine v. placebo for 5 d), managed as outpatients, were prospectively assessed 3 months and 1 year after their positive test result. They completed detailed neurologic/neuropsychiatric symptom questionnaires, the telephone version of the Montreal Cognitive Assessment (T-MoCA), the Kessler Psychological Distress Scale (K10) and the EuroQol EQ-5D-3L (measure of quality of life). Close informants completed the Mild Behavioural Impairment Checklist (MBI-C) and the Informant Questionnaire on Cognitive Decline in the Elderly. We also tracked use of health care services and neurologic investigations. RESULTS The cohort consisted of 198 participants (87 female [43.9%] median age 45 yr, interquartile range 37-54 yr). Of the 179 participants with symptom assessments, 139 (77.6%) reported at least 1 neurologic symptom, the most common being anosmia/dysgeusia (99 [55.3%]), myalgia (76 [42.5%]) and headache (75 [41.9%]). Forty patients (22.3%) reported persistent symptoms at 1 year, including confusion (20 [50.0%]), headache (21 [52.5%]), insomnia (16 [40.0%]) and depression (14 [35.0%]); 27/179 (15.1%) reported no improvement. Body mass index (BMI), a history of asthma and lack of full-time employment were associated with the presence and persistence of neurologic/neuropsychiatric symptoms; female sex was independently associated with both (presence: odds ratio [OR] adjusted for age, race, BMI, history of asthma and neuropsychiatric history 5.04, 95% confidence interval [CI] 1.58 to 16.10). Compared to participants without persistent symptoms, those with persistent symptoms had more hospital admissions and family physician visits, and worse MBI-C scores and less frequent independence for instrumental activities at 1 year (83.8% v. 97.8%, p = 0.005). Patients with any or persistent neurologic symptoms had worse psychologic distress (K10 score ≥ 20: adjusted OR 12.1, 95% CI 1.4 to 97.2) and quality of life (median EQ-5D-3L visual analogue scale rating 75 v. 90, p < 0.001); 42/84 (50.0%) had a T-MoCA score less than 18 at 3 months, as did 36 (42.9%) at 1 year. Participants who reported memory loss were more likely than those who did not report such symptoms to have informant-reported cognitive-behavioural decline (1-yr MBI-C score ≥ 6.5: adjusted OR 15.0, 95% CI 2.42 to 92.60). INTERPRETATION Neurologic/neuropsychiatric symptoms were commonly reported in survivors of mild COVID-19, and they persisted in 1 in 5 patients 1 year later. Symptoms were associated with worse participant- and informant-reported outcomes. Trial registration: ClinicalTrials.gov, no. NCT04329611.
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Affiliation(s)
- Aravind Ganesh
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta.
| | - Ryan E Rosentreter
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Yushi Chen
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Rahul Mehta
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Graham A McLeod
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Miranda W Wan
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Jonathan D Krett
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Yasamin Mahjoub
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Angela S Lee
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Ilan S Schwartz
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Lawrence P Richer
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Luanne M Metz
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Eric E Smith
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Michael D Hill
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
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Schwartz IS, Marek C, Sandhu H, Abdelmonem A, Petersen G, Dishner E, Heidari A, Thompson GR. Multicentric Case Series and Literature Review of Coccidioidal Otomastoiditis. Emerg Infect Dis 2023; 29:1297-1301. [PMID: 37347877 PMCID: PMC10310367 DOI: 10.3201/eid2907.230129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Coccidioidomycosis involving the ear, mastoid bone, or both is uncommon. We describe 5 new cases from the United States and review 4 cases reported in the literature of otomycosis and mastoiditis caused by Coccidioides. Of the 9 cases, 8 were linked to residence in or travel to California. Two patients had poorly controlled diabetes mellitus, 7 had otomastoiditis, 1 had otitis externa without mastoid involvement, and 1 had mastoiditis without otic involvement. Four patients had concurrent or prior pulmonary coccidioidomycosis. Ipsilateral facial nerve palsies developed in 2 patients. All patients received antifungal treatment for varying durations, and 8 of the 9 patients underwent surgical debridement. Clinicians should consider coccidioidomycosis as a differential diagnosis for otomastoiditis in patients with geographic risks.
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8
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Schwartz IS, Bahr NC. Out of bounds: a critical appraisal of the changing geography of the endemic mycoses. Clin Infect Dis 2022; 76:1302-1303. [PMID: 36546694 DOI: 10.1093/cid/ciac963] [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] [Received: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine , Durham, NC
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas , Kansas City, KS
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9
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Caceres DH, Echeverri Tirado LC, Bonifaz A, Adenis A, Gomez BL, Flores CLB, Canteros CE, Santos DW, Arathoon E, Soto ER, Queiroz‐Telles F, Schwartz IS, Zurita J, Damasceno LS, Garcia N, Fernandez NB, Chincha O, Araujo P, Rabagliati R, Chiller T, Giusiano G. Current situation of endemic mycosis in the Americas and the Caribbean: Proceedings of the first international meeting on endemic mycoses of the Americas (IMEMA). Mycoses 2022; 65:1179-1187. [PMID: 35971917 PMCID: PMC9804294 DOI: 10.1111/myc.13510] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Americas are home to biologically and clinically diverse endemic fungi, including Blastomyces, Coccidioides, Emergomyces, Histoplasma, Paracoccidioides and Sporothrix. In endemic areas with high risk of infection, these fungal pathogens represent an important public health problem. OBJECTIVES This report aims to summarise the main findings of the regional analysis carried out on the status of the endemic mycoses of the Americas, done at the first International Meeting on Endemic Mycoses of the Americas (IMEMA). METHODS A regional analysis for the Americas was done, the 27 territories were grouped into nine regions. A SWOT analysis was done. RESULTS All territories reported availability of microscopy. Seventy percent of territories reported antibody testing, 67% of territories reported availability of Histoplasma antigen testing. None of the territories reported the use of (1-3)-β-d-glucan. Fifty two percent of territories reported the availability of PCR testing in reference centres (mostly for histoplasmosis). Most of the territories reported access to medications such as trimethoprim-sulfamethoxazole, itraconazole, voriconazole and amphotericin B (AMB) deoxycholate. Many countries had limited access to liposomal formulation of AMB and newer azoles, such as posaconazole and isavuconazole. Surveillance of these fungal diseases was minimal. CONCLUSIONS A consensus emerged among meeting participants, this group concluded that endemic mycoses are neglected diseases, and due to their severity and lack of resources, the improvement of diagnosis, treatment and surveillance is needed.
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Affiliation(s)
- Diego H. Caceres
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA,Center of Expertise in Mycology Radboudumc/CWZNijmegenThe Netherlands,Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health SciencesUniversidad del RosarioBogotaColombia
| | - Laura C. Echeverri Tirado
- Medical Mycology Group, School of Medicine, Microbiology and Parasitology DepartmentUniversidad de AntioquiaMedellínAntioquiaColombia
| | | | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane Inserm 1424CayenneFrance,Centre Hospitalier de CayenneCayenneFrance
| | - Beatriz L. Gomez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health SciencesUniversidad del RosarioBogotaColombia
| | | | - Cristina E. Canteros
- Departamento de Micología, Instituto Nacional de Enfermedades Infecciosas (INEI)Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. Carlos G. Malbrán"Buenos AiresArgentina
| | - Daniel Wagner Santos
- Department of Infectious Diseases and Infection ControlUniversidade Federal do Maranhão, UFMASão LuísMaranhãoBrazil,Instituto D'Or de Pesquisa e Ensino, IDOR, Hospital UDISão LuisMaranhãoBrazil
| | | | - Elia Ramirez Soto
- Centro Nacional de Enfermedades Tropicales (CENETROP)Santa CruzBolivia
| | | | - Ilan S. Schwartz
- Department of Medicine, Division of Infectious DiseasesUniversity of AlbertaEdmontonAlbertaCanada
| | - Jeannete Zurita
- Facultad de MedicinaPontificia Universidad Católica del EcuadorQuitoEcuador,Unidad de Investigaciones en Biomedicina, Zurita & Zurita LaboratoriosQuitoEcuador
| | - Lisandra Serra Damasceno
- Faculdade de MedicinaUniversidade Federal do CearáFortalezaCEBrazil,Hospital São José de Doenças Infecciosas, Secretaria de SaúdeCearáBrazil
| | - Nataly Garcia
- Sociedad Venezolana de MicrobiologíaCaracasVenezuela
| | - Norma B. Fernandez
- Sección Micologia, Division InfectologíaHospital de Clinicas “José de San Martín” Universidad de Buenos AiresBuenos AiresArgentina
| | - Omayra Chincha
- Universidad Peruana Cayetano Heredia (UPCH), Hospital Cayetano HerediaLimaPeru
| | - Patricia Araujo
- Departamento de Bacteriología y MicologíaLaboratorio Central de Salud Pública, Ministerio de Salud Pública y Bienestar SocialAsunciónParaguay
| | - Ricardo Rabagliati
- Departamento de Enfermedades Infecciosas del Adulto, Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Tom Chiller
- Centers for Disease Control and Prevention (CDC)AtlantaGeorgiaUSA
| | - Gustavo Giusiano
- Instituto de Medicina RegionalUniversidad Nacional del Nordeste, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET)ResistenciaChacoArgentina
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10
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Vohra-Miller S, Schwartz IS. NVX-CoV2373, un vaccin à sous-unités protéiques contre l’infection au SRAS-CoV-2. CMAJ 2022; 194:E1554-E1555. [DOI: 10.1503/cmaj.220688-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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11
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Vohra-Miller S, Schwartz IS. NVX-CoV2373, a protein-based vaccine against SARS-CoV-2 infection. CMAJ 2022; 194:E1214. [PMID: 36096501 PMCID: PMC9477250 DOI: 10.1503/cmaj.220688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sabina Vohra-Miller
- Division of Clinical Public Health (Vohra-Miller), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Schwartz), Department of Medicine, Duke University, Durham, NC
| | - Ilan S Schwartz
- Division of Clinical Public Health (Vohra-Miller), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Division of Infectious Diseases (Schwartz), Department of Medicine, Duke University, Durham, NC.
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12
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Laupland KB, Townsend SC, Schwartz IS. The rose-coloured glasses are cracked. J Assoc Med Microbiol Infect Dis Can 2022; 7:159-162. [PMID: 36337602 PMCID: PMC9629727 DOI: 10.3138/jammi-2022-03-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Kevin B Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, British Columbia, Canada
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shane C Townsend
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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13
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Affiliation(s)
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
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14
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Lam PW, Schwartz IS, Medford RJ. Use of virtual care by infectious disease specialists in Canada: A national survey. Antimicrob Steward Healthc Epidemiol 2022; 2:e106. [PMID: 36483399 PMCID: PMC9726522 DOI: 10.1017/ash.2022.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the type and extent of virtual care use among infectious disease specialists in Canada, with a focus on the clinical factors that influence the decision to provide virtual versus in-person care. METHODS Infectious disease physicians practicing in Canada were invited to complete a survey regarding their experiences with virtual care. The survey included 14 vignettes depicting new outpatient and post-hospital-discharge referrals. Participants were asked to select which (if any) virtual care modalities they would feel comfortable using and to specify a reason if they did not feel comfortable providing care virtually. Machine learning and natural language processing techniques were used to identify themes. RESULTS In total, 57 infectious disease physicians completed the survey. Respondents reported devoting 36.5% (SD, 18.4%) of their infectious disease practice to outpatient care, with 44.2% (SD, 23.2%) of it being delivered virtually. Respondents were more comfortable providing virtual care to post-hospital-discharge referrals who had been seen by an infectious disease physician compared to new outpatient referrals. When respondents were not comfortable with using any virtual care modality, the following common themes emerged: the need for physical examination, the importance of establishing a therapeutic relationship, the need for additional in-person tests or diagnostics, and patient counselling. CONCLUSION This study provides a glimpse into the current state of virtual care use in Canada and some of the major themes that affect decision making for virtual versus in-person care.
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Affiliation(s)
- Philip W. Lam
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, TorontoOntario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard J. Medford
- Division of Infectious Diseases & Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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15
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Hoenigl M, Sprute R, Arastehfar A, Perfect JR, Lass-Flörl C, Bellmann R, Prattes J, Thompson GR, Wiederhold NP, Al Obaidi MM, Willinger B, Arendrup MC, Koehler P, Oliverio M, Egger M, Schwartz IS, Cornely OA, Pappas PG, Krause R. Invasive candidiasis: Investigational drugs in the clinical development pipeline and mechanisms of action. Expert Opin Investig Drugs 2022; 31:795-812. [PMID: 35657026 PMCID: PMC9339492 DOI: 10.1080/13543784.2022.2086120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The epidemiology of invasive Candida infections is evolving. Infections caused by non-albicans Candida spp. are increasing; however, the antifungal pipeline is more promising than ever and is enriched with repurposed drugs and agents that have new mechanisms of action. Despite progress, unmet needs in the treatment of invasive candidiasis remain and there are still too few antifungals that can be administered orally or that have CNS penetration. AREAS COVERED The authors shed light on those antifungal agents active against Candida that are in late-stage clinical development. Mechanisms of action and key pharmacokinetic and pharmacodynamic properties are discussed. Insights are offered on the potential future roles of the investigational agents MAT-2203, oteseconazole, ATI-2307, VL-2397, NP-339, and the repurposed drug miltefosine. EXPERT OPINION Ibrexafungerp and fosmanogepix have novel mechanisms of action and will provide effective options for the treatment of Candida infections (including those caused by multiresistant Candida spp). Rezafungin, an echinocandin with an extended half-life allowing for once weekly administration, will be particularly valuable for outpatient treatment and prophylaxis. Despite this, there is an urgent need to garner clinical data on investigational drugs, especially in the current rise of azole-resistant and multi-drug resistant Candida spp.
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Affiliation(s)
- Martin Hoenigl
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA.,Clinical and Translational Fungal - Working Group, University of California San Diego, La Jolla, CA
| | - Rosanne Sprute
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, 07110, USA
| | - John R Perfect
- Division of Infectious Diseases and Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Excellence Center for Medical Mycology (ECMM), Medical University of Innsbruck, Innsbruck, Austria
| | - Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Juergen Prattes
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, University of California Davis Medical Center
| | - Nathan P Wiederhold
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Mohanad M Al Obaidi
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Maiken C Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Matteo Oliverio
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Matthias Egger
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany
| | - Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Krause
- Division of Infectious Diseases, Excellence Center for Medical Mycology (ECMM), Medical University of Graz, Graz, Austria
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16
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Cawcutt KA, Marcelin JR, Cortés-Penfield N, Cutrell JB, Dong SW, Mahoney MV, McCarty TP, Mediwala Hornback K, Titanji BK, Woc-Colburn LE, Schwartz IS. #SoMe the Money! Value, Strategy, and Implementation of Social Media Engagement for Infectious Diseases Trainees, Clinicians, and Divisions. Clin Infect Dis 2022; 74:S229-S236. [PMID: 35568477 DOI: 10.1093/cid/ciac063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/09/2021] [Indexed: 12/22/2022] Open
Abstract
Social media platforms have revolutionized how we consume information, along with how to effectively present communication, education, and advocacy efforts. There is profound value in leveraging social media within these aspects for the field of infectious diseases, for divisions and individual clinicians. Herein, we provide the rationale to incorporate social media as a key competency for infectious diseases training and specific guidance on aspects of education and strategic development of new accounts critical for success.
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Affiliation(s)
- Kelly A Cawcutt
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jasmine R Marcelin
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Nicolás Cortés-Penfield
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - James B Cutrell
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sara W Dong
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Todd P McCarty
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Krutika Mediwala Hornback
- Department of Pharmacy Practice, Medical University of South Carolina (MUSC) Health, Charleston, South Carolina, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USAand
| | - Laila E Woc-Colburn
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USAand
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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17
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Schwartz IS, McCarty T, Woc-Colburn LE, Titanji BK, Cutrell JB, Cortes-Penfield NW. Educational Impact of #IDJClub, a Twitter-Based Infectious Diseases Journal Club. Clin Infect Dis 2022; 74:S244-S250. [PMID: 35568479 PMCID: PMC9383960 DOI: 10.1093/cid/ciac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Journal clubs have been an enduring mainstay of medical education, and hosting these on social media platforms can expand accessibility and engagement. We describe the creation and impact of #IDJClub, an infectious diseases (ID) Twitter journal club. METHODS We launched #IDJClub in October 2019. Using the account @IDJClub, an ID physician leads a 1-hour open-access Twitter discussion of a recent publication. All participants use the hashtag #IDJClub. Sessions started monthly, but increased due to demand during the coronavirus disease 2019 (COVID-19) pandemic. We used Symplur 's Healthcare Hashtag project to track engagement of #IDJClub per 60-minute discussion plus the following 30 minutes to capture ongoing conversations. We also conducted an online anonymous survey using Likert scales and open-ended questions to assess educational impact. RESULTS In its first 20 months, 31 journal clubs were held, with medians of 42 (interquartile range [IQR], 28.5-60) participants and 312 (IQR, 205-427.5) tweets per session. 134 participants completed the survey, of whom 39% were ID physicians, 19% pharmacists, 13% ID fellows, and 10% medical residents. Most agreed or strongly agreed that #IDJClub provided clinically useful knowledge (95%), increased personal confidence in independent literature appraisal (72%), and was more educational than traditional journal clubs (72%). The format addressed several barriers to traditional journal club participation such as lack of access, subject experts, and time. CONCLUSIONS #IDJClub is an effective virtual journal club, providing an engaging, open-access tool for critical literature appraisal that overcomes several barriers to traditional journal club participations while fostering connectedness within the global ID community.
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Todd McCarty
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laila E Woc-Colburn
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James B Cutrell
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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18
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Lee TC, Morris AM, Schwartz IS, McDonald EG. Allocated but not treated: the silent 16. Lancet 2022; 399:1775. [PMID: 35526549 PMCID: PMC9071205 DOI: 10.1016/s0140-6736(22)00377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Todd C Lee
- Division of Infectious Diseases, McGill University, Montreal, QC H4A 3S1, Canada; Clinical Practice Assessment Unit, McGill University, Montreal, QC H4A 3S1, Canada; Department of Medicine and Royal Victoria Hospital, McGill University, Montreal, QC H4A 3S1, Canada.
| | - Andrew M Morris
- Division of Infectious Diseases, Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, McGill University, Montreal, QC H4A 3S1, Canada; Division of General Internal Medicine, McGill University, Montreal, QC H4A 3S1, Canada; Department of Medicine and Royal Victoria Hospital, McGill University, Montreal, QC H4A 3S1, Canada
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19
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Spellberg B, Aggrey G, Brennan MB, Footer B, Forrest G, Hamilton F, Minejima E, Moore J, Ahn J, Angarone M, Centor RM, Cherabuddi K, Curran J, Davar K, Davis J, Dong MQ, Ghanem B, Hutcheon D, Jent P, Kang M, Lee R, McDonald EG, Morris AM, Reece R, Schwartz IS, So M, Tong S, Tucker C, Wald-Dickler N, Weinstein EJ, Williams R, Yen C, Zhou S, Lee TC. Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2022; 5:e2211321. [PMID: 35536578 PMCID: PMC9092201 DOI: 10.1001/jamanetworkopen.2022.11321] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. OBJECTIVE To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools. EVIDENCE REVIEW This consensus statement and systematic review study used a novel approach from the WikiGuidelines Group, an open access collaborative research project, to construct clinical guidelines for pyogenic osteomyelitis. In June 2021 and February 2022, authors recruited via social media conducted multiple PubMed literature searches, including all years and languages, regarding osteomyelitis management; criteria for article quality and inclusion were specified in the group's charter. The GRADE system for evaluating evidence was not used based on previously published concerns regarding the potential dissociation between strength of recommendation and quality of evidence. Instead, the charter required that clear recommendations be made only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were drafted to discuss pros and cons of care choices. Both clear recommendations and clinical reviews were planned with the intention to be regularly updated as new data become available. FINDINGS Sixty-three participants with diverse expertise from 8 countries developed the group's charter and its first guideline on pyogenic osteomyelitis. These participants included both nonacademic and academic physicians and pharmacists specializing in general internal medicine or hospital medicine, infectious diseases, orthopedic surgery, pharmacology, and medical microbiology. Of the 7 questions addressed in the guideline, 2 clear recommendations were offered for the use of oral antibiotic therapy and the duration of therapy. In addition, 5 clinical reviews were authored addressing diagnosis, approaches to osteomyelitis underlying a pressure ulcer, timing for the administration of empirical therapy, specific antimicrobial options (including empirical regimens, use of antimicrobials targeting resistant pathogens, the role of bone penetration, and the use of rifampin as adjunctive therapy), and the role of biomarkers and imaging to assess responses to therapy. CONCLUSIONS AND RELEVANCE The WikiGuidelines approach offers a novel methodology for clinical guideline development that precludes recommendations based on low-quality data or opinion. The primary limitation is the need for more rigorous clinical investigations, enabling additional clear recommendations for clinical questions currently unresolved by high-quality data.
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Affiliation(s)
- Brad Spellberg
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Gloria Aggrey
- Montgomery Medical Associates PC, Rockville, Maryland
| | - Meghan B. Brennan
- University of Wisconsin Hospital and Clinics, William S. Middleton Memorial Veterans Hospital, Madison
| | - Brent Footer
- Providence Portland Medical Center, Portland, Oregon
| | | | | | - Emi Minejima
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
- Department of Clinical Pharmacy, University of Southern California School of Pharmacy, Los Angeles
| | - Jessica Moore
- Providence Little Company of Mary Medical Center, San Pedro, California
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor
| | | | - Robert M. Centor
- Department of Medicine, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Alabama
| | | | - Jennifer Curran
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Kusha Davar
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Joshua Davis
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Mei Qin Dong
- New York Health and Hospitals Bellevue Hospital, New York, New York
| | | | - Doug Hutcheon
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital Bern University Hospital, Bern, Switzerland
| | - Minji Kang
- University of Texas Southwestern, Dallas
| | - Rachael Lee
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham
| | - Emily G. McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Canada
| | - Andrew M. Morris
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, Canada
| | - Rebecca Reece
- Section of Infectious Diseases, Department of Medicine, West Virginia University School of Medicine, Morgantown
| | - Ilan S. Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Miranda So
- Sinai Health System-University Health Network Antimicrobial Stewardship Program, UHN and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Steven Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital and University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Christopher Tucker
- Hospital Medicine, Magnolia Regional Health Center, Corinth, Mississippi
| | - Noah Wald-Dickler
- Los Angeles County+University of Southern California (USC) Medical Center, Los Angeles
| | - Erica J. Weinstein
- Division of Infectious Diseases, Department of Medicine and Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Riley Williams
- Pharmacy Service, Oklahoma City VA Health Care System, Oklahoma City, Oklahoma
| | | | - Shiwei Zhou
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Todd C. Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Canada
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20
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De Luca DG, Alexander DC, Dingle TC, Dufresne PJ, Hoang LM, Kus JV, Schwartz IS, Mulvey MR, Bharat A. Four genomic clades of Candida auris identified in Canada, 2012-2019. Med Mycol 2021; 60:6462910. [PMID: 34910140 DOI: 10.1093/mmy/myab079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/18/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
Candida auris is an emerging yeast that is associated with antifungal resistance and healthcare-associated outbreaks. From 2012-2019, there were 24 known cases of C. auris colonization or infection in Canada. Isolates were from axilla/groin (n = 6), ear (n = 5), blood (n = 4), toe (n = 2), and a variety of other sites (n = 7). Canadian isolates belonged to the four main genomic clades: Clade I (formerly called South Asian clade, n = 12), Clade II (East Asian, n = 3), Clade III (African, n = 4), and Clade IV (South American, n = 5). Isolates within each clade were clonal, however, whole genome sequencing may be helpful in identifying clusters within healthcare facilities.
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Affiliation(s)
- Domenica G De Luca
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg MB, Canada.,University of Manitoba, Winnipeg, MB, Canada
| | | | - Tanis C Dingle
- Alberta Precision Laboratories, Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Philippe J Dufresne
- Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada
| | - Linda M Hoang
- BC Centre for Disease Control, Vancouver, BC, Canada
| | | | | | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg MB, Canada.,University of Manitoba, Winnipeg, MB, Canada
| | - Amrita Bharat
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg MB, Canada.,University of Manitoba, Winnipeg, MB, Canada
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21
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Schwartz IS, Lee TC, McDonald EG, Laupland KB. What went wrong: A reckoning of Canada's contributions to evidence-based medicine through clinical trials during the COVID-19 pandemic. J Assoc Med Microbiol Infect Dis Can 2021; 6:241-244. [PMID: 36338462 PMCID: PMC9629253 DOI: 10.3138/jammi-2021-0922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 06/16/2023]
Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kevin B Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, British Columbia, Canada
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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22
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Baddley JW, Thompson GR, Chen SCA, White PL, Johnson MD, Nguyen MH, Schwartz IS, Spec A, Ostrosky-Zeichner L, Jackson BR, Patterson TF, Pappas PG. Coronavirus Disease 2019-Associated Invasive Fungal Infection. Open Forum Infect Dis 2021; 8:ofab510. [PMID: 34877364 PMCID: PMC8643686 DOI: 10.1093/ofid/ofab510] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) can become complicated by secondary invasive fungal infections (IFIs), stemming primarily from severe lung damage and immunologic deficits associated with the virus or immunomodulatory therapy. Other risk factors include poorly controlled diabetes, structural lung disease and/or other comorbidities, and fungal colonization. Opportunistic IFI following severe respiratory viral illness has been increasingly recognized, most notably with severe influenza. There have been many reports of fungal infections associated with COVID-19, initially predominated by pulmonary aspergillosis, but with recent emergence of mucormycosis, candidiasis, and endemic mycoses. These infections can be challenging to diagnose and are associated with poor outcomes. The reported incidence of IFI has varied, often related to heterogeneity in patient populations, surveillance protocols, and definitions used for classification of fungal infections. Herein, we review IFI complicating COVID-19 and address knowledge gaps related to epidemiology, diagnosis, and management of COVID-19-associated fungal infections.
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Affiliation(s)
- John W Baddley
- Department of Medicine, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, University of California, Davis Medical Center, Sacramento, California, USA
| | - Sharon C -A Chen
- Centre for Infectious Diseases and Microbiology, Westmead Hospital and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, United Kingdom
| | - Melissa D Johnson
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | | | | | - Thomas F Patterson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Peter G Pappas
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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23
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Thompson GR, Le T, Chindamporn A, Kauffman CA, Alastruey-Izquierdo A, Ampel NM, Andes DR, Armstrong-James D, Ayanlowo O, Baddley JW, Barker BM, Lopes Bezerra L, Buitrago MJ, Chamani-Tabriz L, Chan JFW, Chayakulkeeree M, Cornely OA, Cunwei C, Gangneux JP, Govender NP, Hagen F, Hedayati MT, Hohl TM, Jouvion G, Kenyon C, Kibbler CC, Klimko N, Kong DCM, Krause R, Lee Lee L, Meintjes G, Miceli MH, Rath PM, Spec A, Queiroz-Telles F, Variava E, Verweij PE, Schwartz IS, Pasqualotto AC. Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology. Lancet Infect Dis 2021; 21:e364-e374. [PMID: 34364529 PMCID: PMC9450022 DOI: 10.1016/s1473-3099(21)00191-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022]
Abstract
The global burden of the endemic mycoses (blastomycosis, coccidioidomycosis, emergomycosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and talaromycosis) continues to rise yearly and these infectious diseases remain a leading cause of patient morbidity and mortality worldwide. Management of the associated pathogens requires a thorough understanding of the epidemiology, risk factors, diagnostic methods and performance characteristics in different patient populations, and treatment options unique to each infection. Guidance on the management of these infections has the potential to improve prognosis. The recommendations outlined in this Review are part of the "One World, One Guideline" initiative of the European Confederation of Medical Mycology. Experts from 23 countries contributed to the development of these guidelines. The aim of this Review is to provide an up-to-date consensus and practical guidance in clinical decision making, by engaging physicians and scientists involved in various aspects of clinical management.
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Affiliation(s)
- George R Thompson
- Department of Internal Medicine, Division of Infectious Disease, UC Davis Medical Center, Sacramento, CA, USA; Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA.
| | - Thuy Le
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ariya Chindamporn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Carol A Kauffman
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Neil M Ampel
- Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ, USA
| | - David R Andes
- Department of Internal Medicine, Division of Infectious Diseases, and Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, WI, USA
| | | | - Olusola Ayanlowo
- Department of Medicine, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria
| | - John W Baddley
- Department of Internal Medicine, Division of Infectious Disease, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bridget M Barker
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Leila Lopes Bezerra
- Cellular Mycology and Proteomics Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria J Buitrago
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Leili Chamani-Tabriz
- Infectious Diseases Unit, Department of Internal Medicine, Saudi German Hospital Dubai, Dubai, UAE
| | - Jasper F W Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Methee Chayakulkeeree
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Oliver A Cornely
- Department of Internal Medicine, Excellence Center for Medical Mycology, University Hospital of Cologne, Cologne, Germany; Department of Internal Medicine, Division of Infectious Diseases, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - Cao Cunwei
- Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jean-Pierre Gangneux
- Department of Internal Medicine, Division of Infectious Diseases, Rennes University, CHU Rennes, Inserm, IRSET-UMR_S 1085, Rennes, France
| | - Nelesh P Govender
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; Department of Internal Medicine, Division of Infectious Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands; Laboratory of Medical Mycology, Jining No 1 People's Hospital, Jining, China
| | - Mohammad T Hedayati
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tobias M Hohl
- Infectious Disease Service, Department of Medicine; Memorial Sloan Kettering Cancer Center, New York, NY, USA; Immunology Program, Sloan Kettering Institute, New York, NY, USA
| | - Grégory Jouvion
- Sorbonne Université, INSERM, Pathophysiology of Pediatric Genetic Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Armand-Trousseau, UF Génétique Moléculaire, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - Chris Kenyon
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Nikolai Klimko
- Department of Clinical Mycology, Allergy, and Immunology, I Mechnikov North-Western State Medical University, St Petersburg, Russia
| | - David C M Kong
- Pharmacy Department, Ballarat Health Services, Ballarat, VIC, Australia; National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Low Lee Lee
- Department of Internal Medicine, Hospital Sultanah Bayiyah, Alor Setar, Kedah, Malaysia
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marisa H Miceli
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Andrej Spec
- Division of Infectious Disease, Washington University School of Medicine, St Louis, MO, USA
| | - Flavio Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ebrahim Variava
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul E Verweij
- Department of Medical Microbiology, Excellence Center for Medical Mycology, Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Alessandro C Pasqualotto
- Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre Porto Alegre, Brazil; Molecular Biology Laboratory, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
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24
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Stone NRH, Schwartz IS. Identifying the Patients Most Likely to Die from Cryptococcal Meningitis: Time to Move from Recognition to Intervention. Clin Infect Dis 2021; 73:e3083-e3084. [PMID: 33206149 DOI: 10.1093/cid/ciaa1756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Neil R H Stone
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta Edmonton, Alberta, Canada
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25
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Schwartz IS, Muñoz JF, Kenyon CR, Govender NP, McTaggart L, Maphanga TG, Richardson S, Becker P, Cuomo CA, McEwen JG, Sigler L. Blastomycosis in Africa and the Middle East: A Comprehensive Review of Reported Cases and Reanalysis of Historical Isolates Based on Molecular Data. Clin Infect Dis 2021; 73:e1560-e1569. [PMID: 32766820 PMCID: PMC8492124 DOI: 10.1093/cid/ciaa1100] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Blastomycosis has been reported from countries in Africa and the Middle East, but a decades-long debate has persisted regarding whether this is the same disease known in North America and caused by Blastomyces dermatitidis and Blastomyces gilchristii. METHODS We reviewed published cases of human and veterinary blastomycosis from Africa and the Middle East. We abstracted epidemiological and clinical features of cases, including sites of disease, diagnosis, management, outcomes, and, where available, genetic and antigenic typing of case isolates. In addition, we sequenced nucleic acids from 9 clinical isolates from Africa deposited in global collections as B. dermatitidis; for 5, we sequenced the internal transcribed spacer regions, and for the other 4 we sequenced the whole genomes. RESULTS We identified 172 unique human patients with blastomycosis, including 159 patients from 25 African countries and 12 patients from 5 Middle Eastern countries, and also identified 7 reports of veterinary blastomycosis. In humans, cutaneous disease predominated (n = 100/137, 73%), followed by pulmonary (n = 73/129, 57%) and osteoarticular involvement (n = 61/128, 48%). Unusual direct microscopy/histopathological presentations included short hyphal fragments in tissues (n = 23/129, 18%). There were 34 genotyped case isolates that comprised 4 species: Blastomyces percursus (n = 22, 65%), from 8 countries throughout all regions; Blastomyces emzantsi (n = 9, 26%), from South Africa; B. dermatitidis (n = 1, 3%), from the Democratic Republic of Congo; and B. gilchristii (n = 2, 6%), from South Africa and Zimbabwe. CONCLUSIONS Blastomycosis occurs throughout Africa and the Middle East and is caused predominantly by B. percursus and, at least in South Africa, B. emzantsi, resulting in distinct clinical and pathological patterns of disease.
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jose F Muñoz
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Chris R Kenyon
- Clinical Sciences Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nelesh P Govender
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Tsidiso G Maphanga
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Susan Richardson
- Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pierre Becker
- Belgian Coordinated Collections of Microorganisms (BCCM/IHEM) Fungal Collection, Mycology and Aerobiology, Sciensano, Brussels, Belgium
| | | | - Juan G McEwen
- School of Medicine, Universidad de Antioquia, Medellín, Colombia
- Cellular and Molecular Biology Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia
| | - Lynne Sigler
- Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
- UAMH Centre for Global Microfungal Diversity, University of Toronto, Ontario, Canada
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26
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Laupland KB, Collignon PJ, Schwartz IS. Sleeping with the enemy: Will the COVID-19 pandemic turn the tide of antimicrobial-resistant infections? J Assoc Med Microbiol Infect Dis Can 2021; 6:177-180. [PMID: 36337755 PMCID: PMC9615466 DOI: 10.3138/jammi-2021-05-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 05/28/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Kevin B Laupland
- Department of Medicine, Royal Inland Hospital, Kamloops, British Columbia, Canada
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter J Collignon
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Garran, Australian Capital Territory, Australia
- Department of Infectious Disease, Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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27
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Toplis B, Bosch C, Schwartz IS, Kenyon C, Boekhout T, Perfect JR, Botha A. The virulence factor urease and its unexplored role in the metabolism of Cryptococcus neoformans. FEMS Yeast Res 2021; 20:5850754. [PMID: 32490521 DOI: 10.1093/femsyr/foaa031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/24/2020] [Accepted: 06/01/2020] [Indexed: 12/25/2022] Open
Abstract
Cryptococcal urease is believed to be important for the degradation of exogenous urea that the yeast encounters both in its natural environment and within the human host. Endogenous urea produced by the yeast's own metabolic reactions, however, may also serve as a substrate for the urease enzyme. Using wild-type, urease-deletion mutant and urease-reconstituted strains of Cryptococcus neoformans H99, we studied reactions located up- and downstream from endogenous urea. We demonstrated that urease is important for cryptococcal growth and that, compared to nutrient-rich conditions at 26°C, urease activity is higher under nutrient-limited conditions at 37°C. Compared to cells with a functional urease enzyme, urease-deficient cells had significantly higher intracellular urea levels and also showed more arginase activity, which may act as a potential source of endogenous urea. Metabolic reactions linked to arginase were also affected, since urease-positive and urease-negative cells differed with respect to agmatinase activity, polyamine synthesis, and intracellular levels of proline and reactive oxygen species. Lastly, urease-deficient cells showed higher melanin levels at 26°C than wild-type cells, while the inverse was observed at 37°C. These results suggest that cryptococcal urease is associated with the functioning of key metabolic pathways within the yeast cell.
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Affiliation(s)
- Barbra Toplis
- Department of Microbiology, Stellenbosch University, Matieland 7602, Stellenbosch, South Africa
| | - Caylin Bosch
- Department of Microbiology, Stellenbosch University, Matieland 7602, Stellenbosch, South Africa
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada, T6G 2G3
| | - Chris Kenyon
- Sexually Transmitted Infection Unit, Institute of Tropical Medicine, 2000 Antwerp, Belgium.,Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, 3584CT Utrecht, The Netherlands.,Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, 1090 GE Amsterdam, The Netherlands
| | - John R Perfect
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710-1000, North Carolina, USA
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Matieland 7602, Stellenbosch, South Africa
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28
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Abstract
Invasive mould disease (IMD) might affect up to a third of critically ill patients with COVID-19. COVID-19-associated pulmonary aspergillosis (CAPA) is typically diagnosed on the basis of a combination of non-specific clinical, radiographical, and mycological findings, but whether most cases represent invasive disease is unresolved. We systematically reviewed autopsy series of three or more decedents with COVID-19 for evidence of IMD. We searched PubMed, Web of Science, OVID (Embase), and medRxiv for studies in English or French published from Jan 1, 2019, to Sept 26, 2020. We identified 1070 references, of which 50 studies met the criteria. These studies described autopsies from 677 decedents, with individual-level data for 443 decedents. The median age was 70·0 years (IQR 57·0–79·0). Of decedents with individual-level data, 133 (30%) had diabetes, 97 (22%) had pre-existing lung disease, and 27 (6%) had immunocompromising conditions. Of 548 decedents with such data, 320 (58%) received invasive mechanical ventilation; among 140 decedents for whom this was known, ventilation was for a median of 9·0 days (IQR 5·0–20·0). Treatment included immunomodulation in 60 decedents and antifungals in 50 decedents. Autopsy-proven IMD occurred in 11 (2%) of 677 decedents, including eight CAPA, two unspecified IMD, and one disseminated mucormycosis. Among 320 decedents who received mechanical ventilation, six (2%) had IMD. We conclude that IMD, including CAPA, is an uncommon autopsy finding in COVID-19.
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Affiliation(s)
- Brittany E Kula
- Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Cornelius J Clancy
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Hong Nguyen
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ilan S Schwartz
- Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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29
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Dingle TC, Croxen MA, Fathima S, Shokoples S, Sonpar A, Saxinger L, Schwartz IS. Histoplasmosis acquired in Alberta, Canada: an epidemiological and genomic study. The Lancet Microbe 2021; 2:e191-e197. [DOI: 10.1016/s2666-5247(20)30229-9] [Citation(s) in RCA: 3] [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] [Received: 06/16/2020] [Revised: 09/29/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022] Open
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30
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Daniel Z P Friedman
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Tanis C Dingle
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Alberta Public Laboratories, Alberta Health Services, Edmonton, Canada
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Archuleta S, Gharamti AA, Sillau S, Castellanos P, Chadalawada S, Mundo W, Bandali M, Oñate J, Martínez E, Chastain DB, DeSanto K, Shapiro L, Schwartz IS, Franco-Paredes C, Henao-Martínez AF. Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study. Ther Adv Infect Dis 2021; 8:20499361211004367. [PMID: 33815790 PMCID: PMC7992770 DOI: 10.1177/20499361211004367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/15/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Diabetes mellitus is an established risk factor for bacterial infections, but its role in cryptococcosis is unclear. The study aimed to determine whether uncontrolled diabetes (HbA1c >7%) was an independent risk factor for mortality in cryptococcosis. Methods: A retrospective case–control study partially matched by age and gender was performed in patients tested for Cryptococcus infection at the University of Colorado Hospital from 2000 to 2019. A multivariable logistic regression model was used to identify mortality predictors. Cox proportional hazard model was used for survival analysis. Results: We identified 96 cases of cryptococcosis and 125 controls. Among cases, cryptococcal meningitis (49.0%) and pneumonia (36.5%) constituted most infections. Cases with pulmonary cryptococcosis with uncontrolled diabetes had a higher mortality at 10 weeks (50% versus 7%, p = 0.006) and 1 year (66.7% versus 13.8%, p = 0.005) compared to pulmonary cases with controlled or no diabetes. Unadjusted Cox proportional hazard model found an increased rate of death for uncontrolled diabetes at 10 weeks [hazard ratio 8.4, confidence interval (CI): 1.4–50.8, p = 0.02] and 1 year (hazard ratio 7.0, CI: 1.7–28.4, p = 0.007) among pulmonary cryptococcosis cases. Multivariable analysis showed a significantly increased odds of 10 weeks [odds ratio (OR) = 4.3, CI: 1.1–16.5, p = 0.035] and 1 year (OR = 5.0, CI: 1.4–18.3, p = 0.014) mortality for uncontrolled diabetes among pulmonary cryptococcosis cases. After adjustment for gender, age, and case/control, for every 1% increase in HbA1c levels, the odds of pulmonary cryptococcosis mortality at 1 year increased by 11% (OR = 1.6, CI 95%: 1.1–2.3, p = 0.006). Conclusion: Uncontrolled diabetes is associated with worse outcomes in pulmonary cryptococcosis, including a 4-fold and 6-fold increased odds of death at 10 weeks and 1 year, respectively. Glucose control interventions should be explored to improve clinical outcomes in patients with pulmonary cryptococcosis.
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Affiliation(s)
- Solana Archuleta
- School of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Amal A Gharamti
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Stefan Sillau
- Department of Neurology, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | | | | | - William Mundo
- School of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Mehdi Bandali
- School of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | | | | | - Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Kristen DeSanto
- Health Sciences Library, University of Colorado Denver, Aurora, Colorado, USA
| | - Leland Shapiro
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Andrés F Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA
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Clancy CJ, Schwartz IS, Kula B, Nguyen MH. Bacterial Superinfections Among Persons With Coronavirus Disease 2019: A Comprehensive Review of Data From Postmortem Studies. Open Forum Infect Dis 2021; 8:ofab065. [PMID: 33732753 PMCID: PMC7928570 DOI: 10.1093/ofid/ofab065] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Limited clinical data suggest a ~16% prevalence of bacterial superinfections among critically ill patients with coronavirus disease 2019 (COVID-19). METHODS We reviewed postmortem studies of patients with COVID-19 published in English through September 26, 2020, for histopathologic findings consistent with bacterial lung infections. RESULTS Worldwide, 621 patients from 75 studies were included. The quality of data was uneven, likely because identifying superinfections was not a major objective in 96% (72/75) of studies. Histopathology consistent with a potential lung superinfection was reported in 32% (200/621) of patients (22-96 years old; 66% men). Types of infections were pneumonia (95%), abscesses or empyema (3.5%), and septic emboli (1.5%). Seventy-three percent of pneumonias were focal rather than diffuse. The predominant histopathologic findings were intra-alveolar neutrophilic infiltrations that were distinct from those typical of COVID-19-associated diffuse alveolar damage. In studies with available data, 79% of patients received antimicrobial treatment; the most common agents were beta-lactam/beta-lactamase inhibitors (48%), macrolides (16%), cephalosoprins (12%), and carbapenems (6%). Superinfections were proven by direct visualization or recovery of bacteria in 25.5% (51/200) of potential cases and 8% of all patients in postmortem studies. In rank order, pathogens included Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Lung superinfections were the cause of death in 16% of potential cases and 3% of all patients with COVID-19. CONCLUSIONS Potential bacterial lung superinfections were evident at postmortem examination in 32% of persons who died with COVID-19 (proven, 8%; possible, 24%), but they were uncommonly the cause of death.
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Affiliation(s)
- Cornelius J Clancy
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Kula
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Hong Nguyen
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Schwartz IS, Woc-Colburn L, McCarty TP, Cutrell JB, Cortes-Penfield NW. 135. Impact of #idjclub, a Synchronous Twitter Journal Club, as a Novel Infectious Disease Education Platform. Open Forum Infect Dis 2020. [PMCID: PMC7777623 DOI: 10.1093/ofid/ofaa439.445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Journal clubs have been a mainstay of medical education since the days of Osler. Social media platforms allow virtual journal clubs to connect global participants. We describe the creation and impact of #IDJClub, an Infectious Diseases (ID) Twitter journal club. Methods We launched #IDJClub in October 2019. The format presents a recent ID publication for a 1-hour synchronous Twitter chat led by an ID physician from @IDJClub. Sessions started monthly, but increased in frequency due to interest during the COVID-19 pandemic. Pre-scripted tweets guide participants through the article description and analysis. We used Symplur’s Healthcare Hashtag project to track the number of impressions, tweets, participants, and the engagement rate (average tweets/participant) of #IDJClub per 60 minute discussion plus the following 30 minutes to capture ongoing conversations. We also conducted an online anonymous survey using Likert scales and open-ended questions to assess educational impact. Results As of June 11 2020, @IDJClub garnered 5,338 followers from around the world (Figure 1). In its first 9 months, 12 virtual journal clubs were conducted with a mean of 791,624 impressions, 328 tweets, and 48 participants per session, which steadily increased over time (Figure 2). A total of 134 participants completed the survey, of whom 40% were ID physicians, 19% pharmacists, 13% ID fellows, and 10% medical residents. Most respondents followed 1–2 (38%) or 3–4 (38%) of the discussions, with variable levels of active participation. Majorities agreed that #IDJClub provided clinically useful knowledge, increased personal confidence in review of literature, and compared favorably with in-person journal clubs (Figure 3). The format addressed several barriers such as lack of access to in-person journal clubs or subject experts at one’s own institution and lack of time to read new research or attend traditional journal clubs (Figure 4). ![]()
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Conclusion #IDJClub is an effective platform for virtual journal club, providing an engaging, open-access tool for critical appraisal of ID literature. This innovation in medical education overcomes several barriers to traditional journal clubs while fostering professional relationships within the global ID community. ![]()
Disclosures Todd P. McCarty, MD, Amplyx (Scientific Research Study Investigator)Cidara (Scientific Research Study Investigator)
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Affiliation(s)
| | - Laila Woc-Colburn
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, Houston, Texas
| | - Todd P McCarty
- University of Alabama at Birmingham; Birmingham VA Medical Center, Birmingham, Alabama
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Maphanga TG, Naicker SD, Gómez BL, Mhlanga M, Mpembe RS, Schwartz IS, Bamford C, Nel J, Govender NP. Cross-reactivity of a Histoplasma capsulatum antigen enzyme immunoassay in urine specimens from persons with emergomycosis in South Africa. Med Mycol 2020; 59:672-682. [PMID: 33330930 DOI: 10.1093/mmy/myaa100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/28/2020] [Revised: 10/26/2020] [Indexed: 01/20/2023] Open
Abstract
Histoplasma antigen detection in urine is a rapid diagnostic method for disseminated histoplasmosis, although cross-reactivity has been reported in specimens from patients with other thermally dimorphic fungal infections. We tested urine specimens, from persons with suspected invasive fungal infections, using a commercial monoclonal antibody Histoplasma enzyme immunoassay (EIA) at a South African national mycology reference laboratory from August 2014 through December 2018. Corresponding fungal culture and histopathology results were obtained from an electronic laboratory information system. In some cases, cultured fungal isolates were sent with the urine specimen for species-level identification by phenotypic and molecular methods. Cross-reactivity was confirmed using culture filtrates of several fungal pathogens. Of 212 referred cases, 41 (19%) were excluded since they had no recorded clinical history (n = 1), alternative diagnoses were confirmed (n = 2), or no fungal culture or histopathology results (n = 38). Eighty-seven of 212 (41%) had laboratory evidence of an invasive fungal disease, while 84 (40%) did not. Of the 87 cases, 37 (43%) were culture-confirmed mycoses: emergomycosis (n = 18), histoplasmosis (n = 8), sporotrichosis (n = 6), cryptococcosis (n = 2), talaromycosis (n = 1), and other fungi isolated (n = 2). The sensitivity and specificity of the EIA were calculated for two groups: culture-confirmed (n = 37) and histology-confirmed invasive fungal disease (n = 50). The sensitivity and specificity of the EIA for diagnosis of histoplasmosis compared to culture were 88% (7/8, 95%CI 47-100%) and 72% (21/29, 95%CI 53-87%), respectively, and for diagnosis of emergomycosis/histoplasmosis compared to histology was 83% (29/35, 95%CI 66-93%) and 93% (14/15, 95%CI 68-100%), respectively. Cross-reactions occurred in urine specimens of patients with Emergomyces africanus infection and in culture filtrates of E. africanus, T. marneffei and Blastomyces species. A commercial Histoplasma EIA had satisfactory accuracy for diagnosis of culture-confirmed histoplasmosis, but cross-reacted in urine specimens from patients with invasive disease caused by the closely-related pathogen, E. africanus and in culture filtrates of E. africanus and other related fungi. LAY SUMMARY Emergomyces africanus and Histoplasma capsulatum are fungi that cause a multi-system disease among HIV-seropositive persons with a low CD4 cell count. Handling live cultures of these fungi to confirm a diagnosis requires specialized laboratory equipment and infrastructure which is infrequently accessible in low-resource settings. The features of the two diseases (i.e., disseminated histoplasmosis and emergomycosis) may be indistinguishable when infected tissue is prepared, stained, and examined under a microscope. Enzyme immunoassays (EIA) have been developed as rapid diagnostic tools for the detection of a cell wall component of H. capsulatum in urine specimens, although cross-reactions have been reported in specimens from patients with other fungal infections. We evaluated the accuracy of a commercial Histoplasma EIA to diagnose histoplasmosis and to assess cross-reactions in urine specimens from persons with emergomycosis and in cultures of E. africanus and related fungi. We report a sensitivity and specificity of 88% (95%CI 47-100%) and 72% (95%CI 53-87%) for diagnosis of histoplasmosis compared to culture and 83% (95%CI 66-93%) and 93% (95%CI 68-100%) for diagnosis of either histoplasmosis/emergomycosis compared to a diagnosis made by microscopic examination of infected tissue. The assay cross-reacted in urine specimens from patients with emergomycosis and in culture filtrates of related fungi. Although the EIA cross-reacted with other related fungi, this test can decrease the time to diagnosis and facilitate early treatment of emergomycosis and histoplasmosis in South Africa.
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Affiliation(s)
- Tsidiso G Maphanga
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa
| | - Serisha D Naicker
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Beatriz L Gómez
- School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Mabatho Mhlanga
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ruth S Mpembe
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ilan S Schwartz
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Colleen Bamford
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Jeremy Nel
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nelesh P Govender
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.,Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
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Grant JM, Schwartz IS, Laupland KB. Stockholm Syndrome: How to come to peace with our captor. J Assoc Med Microbiol Infect Dis Can 2020; 5:209-213. [PMID: 36340055 PMCID: PMC9602877 DOI: 10.3138/jammi-2020-10-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer M Grant
- Divisions of Medical Microbiology and Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin B Laupland
- Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Emily L Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Erin K McCreary
- Department of Medicine, Division of Infectious Diseases, UPMC Health System and the University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Skipper CP, Pastick KA, Engen NW, Bangdiwala AS, Abassi M, Lofgren SM, Williams DA, Okafor EC, Pullen MF, Nicol MR, Nascene AA, Hullsiek KH, Cheng MP, Luke D, Lother SA, MacKenzie LJ, Drobot G, Kelly LE, Schwartz IS, Zarychanski R, McDonald EG, Lee TC, Rajasingham R, Boulware DR. Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 : A Randomized Trial. Ann Intern Med 2020; 173:623-631. [PMID: 32673060 PMCID: PMC7384270 DOI: 10.7326/m20-4207] [Citation(s) in RCA: 354] [Impact Index Per Article: 88.5] [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] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND No effective oral therapy exists for early coronavirus disease 2019 (COVID-19). OBJECTIVE To investigate whether hydroxychloroquine could reduce COVID-19 severity in adult outpatients. DESIGN Randomized, double-blind, placebo-controlled trial conducted from 22 March through 20 May 2020. (ClinicalTrials.gov: NCT04308668). SETTING Internet-based trial across the United States and Canada (40 states and 3 provinces). PARTICIPANTS Symptomatic, nonhospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 and high-risk exposure within 4 days of symptom onset. INTERVENTION Oral hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 more days) or masked placebo. MEASUREMENTS Symptoms and severity at baseline and then at days 3, 5, 10, and 14 using a 10-point visual analogue scale. The primary end point was change in overall symptom severity over 14 days. RESULTS Of 491 patients randomly assigned to a group, 423 contributed primary end point data. Of these, 341 (81%) had laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or epidemiologically linked exposure to a person with laboratory-confirmed infection; 56% (236 of 423) were enrolled within 1 day of symptoms starting. Change in symptom severity over 14 days did not differ between the hydroxychloroquine and placebo groups (difference in symptom severity: relative, 12%; absolute, -0.27 point [95% CI, -0.61 to 0.07 point]; P = 0.117). At 14 days, 24% (49 of 201) of participants receiving hydroxychloroquine had ongoing symptoms compared with 30% (59 of 194) receiving placebo (P = 0.21). Medication adverse effects occurred in 43% (92 of 212) of participants receiving hydroxychloroquine versus 22% (46 of 211) receiving placebo (P < 0.001). With placebo, 10 hospitalizations occurred (2 non-COVID-19-related), including 1 hospitalized death. With hydroxychloroquine, 4 hospitalizations occurred plus 1 nonhospitalized death (P = 0.29). LIMITATION Only 58% of participants received SARS-CoV-2 testing because of severe U.S. testing shortages. CONCLUSION Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19. PRIMARY FUNDING SOURCE Private donors.
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Affiliation(s)
- Caleb P Skipper
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Katelyn A Pastick
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Nicole W Engen
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Ananta S Bangdiwala
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Mahsa Abassi
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Sarah M Lofgren
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Darlisha A Williams
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Elizabeth C Okafor
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Matthew F Pullen
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Melanie R Nicol
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Alanna A Nascene
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Kathy H Hullsiek
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - Matthew P Cheng
- Research Institute of the McGill University Health Centre and McGill University, Montréal, Quebec, Canada (M.P.C., E.G.M., T.C.L.)
| | - Darlette Luke
- M Health Fairview Investigational Drug Service Pharmacy, Minneapolis, Minnesota (D.L.)
| | - Sylvain A Lother
- University of Manitoba, Winnipeg, Manitoba, Canada (S.A.L., L.J.M., G.D., R.Z.)
| | - Lauren J MacKenzie
- University of Manitoba, Winnipeg, Manitoba, Canada (S.A.L., L.J.M., G.D., R.Z.)
| | - Glen Drobot
- University of Manitoba, Winnipeg, Manitoba, Canada (S.A.L., L.J.M., G.D., R.Z.)
| | - Lauren E Kelly
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada (L.E.K.)
| | | | - Ryan Zarychanski
- University of Manitoba, Winnipeg, Manitoba, Canada (S.A.L., L.J.M., G.D., R.Z.)
| | - Emily G McDonald
- Research Institute of the McGill University Health Centre and McGill University, Montréal, Quebec, Canada (M.P.C., E.G.M., T.C.L.)
| | - Todd C Lee
- Research Institute of the McGill University Health Centre and McGill University, Montréal, Quebec, Canada (M.P.C., E.G.M., T.C.L.)
| | - Radha Rajasingham
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
| | - David R Boulware
- University of Minnesota, Minneapolis, Minnesota (C.P.S., K.A.P., N.W.E., A.S.B., M.A., S.M.L., D.A.W., E.C.O., M.F.P., M.R.N., A.A.N., K.H.H., R.R., D.R.B.)
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Lofgren SM, Nicol MR, Bangdiwala AS, Pastick KA, Okafor EC, Skipper CP, Pullen MF, Engen NW, Abassi M, Williams DA, Nascene AA, Axelrod ML, Lother SA, MacKenzie LJ, Drobot G, Marten N, Cheng MP, Zarychanski R, Schwartz IS, Silverman M, Chagla Z, Kelly LE, McDonald EG, Lee TC, Hullsiek KH, Boulware DR, Rajasingham R. Safety of Hydroxychloroquine Among Outpatient Clinical Trial Participants for COVID-19. Open Forum Infect Dis 2020; 7:ofaa500. [PMID: 33204764 PMCID: PMC7654376 DOI: 10.1093/ofid/ofaa500] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background Use of hydroxychloroquine in hospitalized patients with coronavirus disease 2019 (COVID-19), especially in combination with azithromycin, has raised safety concerns. Here, we report safety data from 3 outpatient randomized clinical trials. Methods We conducted 3 randomized, double-blind, placebo-controlled trials investigating hydroxychloroquine as pre-exposure prophylaxis, postexposure prophylaxis, and early treatment for COVID-19 using an internet-based design. We excluded individuals with contraindications to hydroxychloroquine. We collected side effects and serious adverse events. We report descriptive analyses of our findings. Results We enrolled 2795 participants. The median age of research participants (interquartile range) was 40 (34–49) years, and 59% (1633/2767) reported no chronic medical conditions. Overall 2544 (91%) participants reported side effect data, and 748 (29%) reported at least 1 medication side effect. Side effects were reported in 40% with once-daily, 36% with twice-weekly, 31% with once-weekly hydroxychloroquine, compared with 19% with placebo. The most common side effects were upset stomach or nausea (25% with once-daily, 19% with twice-weekly, and 18% with once-weekly hydroxychloroquine, vs 11% for placebo), followed by diarrhea, vomiting, or abdominal pain (23% for once-daily, 17% twice-weekly, and 13% once-weekly hydroxychloroquine, vs 7% for placebo). Two individuals were hospitalized for atrial arrhythmias, 1 on placebo and 1 on twice-weekly hydroxychloroquine. No sudden deaths occurred. Conclusions Data from 3 outpatient COVID-19 trials demonstrated that gastrointestinal side effects were common but mild with the use of hydroxychloroquine, while serious side effects were rare. No deaths occurred related to hydroxychloroquine. Randomized clinical trials, in cohorts of healthy outpatients, can safely investigate whether hydroxychloroquine is efficacious for COVID-19. ClinicalTrials.gov Identifier NCT04308668 for postexposure prophylaxis and early treatment trials; NCT04328467 for pre-exposure prophylaxis trial.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mahsa Abassi
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | - Sylvain A Lother
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lauren J MacKenzie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Glen Drobot
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Marten
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Matthew P Cheng
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Silverman
- Lawson Research Institute, St. Joseph's Healthcare Center, London, Ontario
| | - Zain Chagla
- McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Kelly
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Emily G McDonald
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Todd C Lee
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Chagla Z, Laupland KB, Schwartz IS. Desperate times call for evidence-based measures: Prioritizing science during the COVID-19 pandemic. J Assoc Med Microbiol Infect Dis Can 2020; 5:127-129. [PMID: 36341318 PMCID: PMC9608727 DOI: 10.3138/jammi-2020-06-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Zain Chagla
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia, and Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Ilan S Schwartz
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Lofgren SM, Nicol MR, Bangdiwala AS, Pastick KA, Okafor EC, Skipper CP, Pullen MF, Engen NW, Abassi M, Williams DA, Nascene AA, Axelrod ML, Lother SA, MacKenzie LJ, Drobot G, Marten N, Cheng MP, Zarychanshi R, Schwartz IS, Silverman M, Chagla Z, Kelly LE, McDonald EG, Lee TC, Hullsiek KH, Boulware DR, Rajasingham R. Safety of Hydroxychloroquine among Outpatient Clinical Trial Participants for COVID-19. medRxiv 2020. [PMID: 32743591 DOI: 10.1101/2020.07.16.20155531] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Use of hydroxychloroquine in hospitalized patients with COVID-19, especially in combination with azithromycin, has raised safety concerns. Here, we report safety data from three outpatient randomized clinical trials. METHODS We conducted three randomized, double-blind, placebo-controlled trials investigating hydroxychloroquine as pre-exposure prophylaxis, post-exposure prophylaxis and early treatment for COVID-19. We excluded individuals with contraindications to hydroxychloroquine. We collected side effects and serious adverse events. We report descriptive analyses of our findings. RESULTS We enrolled 2,795 participants. The median age of research participants was 40 (IQR 34-49) years, and 59% (1633/2767) reported no chronic medical conditions. Overall 2,324 (84%) participants reported side effect data, and 638 (27%) reported at least one medication side effect. Side effects were reported in 29% with daily, 36% with twice weekly, 31% with once weekly hydroxychloroquine compared to 19% with placebo. The most common side effects were upset stomach or nausea (25% with daily, 18% with twice weekly, 16% with weekly, vs. 10% for placebo), followed by diarrhea, vomiting, or abdominal pain (23% for daily, 16% twice weekly, 12% weekly, vs. 6% for placebo). Two individuals were hospitalized for atrial arrhythmias, one on placebo and one on twice weekly hydroxychloroquine. No sudden deaths occurred. CONCLUSION Data from three outpatient COVID-19 trials demonstrated that gastrointestinal side effects were common but mild with the use of hydroxychloroquine, while serious side effects were rare. No deaths occurred related to hydroxychloroquine. Randomized clinical trials can safely investigate whether hydroxychloroquine is efficacious for COVID-19.
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Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, Skipper CP, Nascene AA, Nicol MR, Abassi M, Engen NW, Cheng MP, LaBar D, Lother SA, MacKenzie LJ, Drobot G, Marten N, Zarychanski R, Kelly LE, Schwartz IS, McDonald EG, Rajasingham R, Lee TC, Hullsiek KH. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med 2020; 383:517-525. [PMID: 32492293 PMCID: PMC7289276 DOI: 10.1056/nejmoa2016638] [Citation(s) in RCA: 890] [Impact Index Per Article: 222.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown. METHODS We conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days. RESULTS We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was -2.4 percentage points (95% confidence interval, -7.0 to 2.2; P = 0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported. CONCLUSIONS After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure. (Funded by David Baszucki and Jan Ellison Baszucki and others; ClinicalTrials.gov number, NCT04308668.).
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Affiliation(s)
- David R Boulware
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Matthew F Pullen
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Ananta S Bangdiwala
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Katelyn A Pastick
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Sarah M Lofgren
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Elizabeth C Okafor
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Caleb P Skipper
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Alanna A Nascene
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Melanie R Nicol
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Mahsa Abassi
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Nicole W Engen
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Matthew P Cheng
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Derek LaBar
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Sylvain A Lother
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Lauren J MacKenzie
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Glen Drobot
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Nicole Marten
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Ryan Zarychanski
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Lauren E Kelly
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Ilan S Schwartz
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Emily G McDonald
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Radha Rajasingham
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Todd C Lee
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
| | - Kathy H Hullsiek
- From the University of Minnesota (D.R.B., M.F.P., A.S.B., K.A.P., S.M.L., E.C.O., C.P.S., A.A.N., M.R.N., M.A., N.W.E., R.R., K.H.H.) and M Health Fairview Investigational Drug Service Pharmacy (D.L.), Minneapolis; and the Research Institute of the McGill University Health Centre and the Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal (M.P.C., E.G.M., T.C.L.), the Department of Internal Medicine, University of Manitoba (S.A.L., L.J.M., G.D., N.M., R.Z.), the Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba (R.Z.), and the George and Fay Yee Centre for Healthcare Innovation (L.E.K.), Winnipeg, and the University of Alberta, Edmonton (I.S.S.) - all in Canada
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Spec A, Schwartz IS. Balancing Scientific Rigor With Urgency in the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2020; 7:ofaa304. [PMID: 32855988 PMCID: PMC7443100 DOI: 10.1093/ofid/ofaa304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Knowledge dissemination during COVID19 has been notable for the rise of pre-prints and publication by press release, favoring speed over accuracy. We stress the importance of journals in this landscape and highlight the value of editorial judgment and peer review.
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Affiliation(s)
- Andrej Spec
- Division of Infectious Disease, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Horianopoulos LC, Gluck-Thaler E, Benoit Gelber I, Cowen LE, Geddes-McAlister J, Landry CR, Schwartz IS, Scott JA, Sellam A, Sheppard DC, Spribille T, Subramaniam R, Walker AK, Harris SD, Shapiro RS, Gerstein AC. The Canadian Fungal Research Network: current challenges and future opportunities. Can J Microbiol 2020; 67:13-22. [PMID: 32717148 DOI: 10.1139/cjm-2020-0263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fungi critically impact the health and function of global ecosystems and economies. In Canada, fungal researchers often work within silos defined by subdiscipline and institutional type, complicating the collaborations necessary to understand the impacts fungi have on the environment, economy, and plant and animal health. Here, we announce the establishment of the Canadian Fungal Research Network (CanFunNet, https://fungalresearch.ca), whose mission is to strengthen and promote fungal research in Canada by facilitating dialogue among scientists. We summarize the challenges and opportunities for Canadian fungal research that were discussed at CanFunNet's inaugural meeting in 2019, and identify 4 priorities for our community: (i) increasing collaboration among scientists, (ii) studying diversity in the context of ecological disturbance, (iii) preserving culture collections in the absence of sustained funding, and (iv) leveraging diverse expertise to attract trainees. We have gathered additional information to support our recommendations, including a survey identifying underrepresentation of fungal-related courses at Canadian universities, a list of Canadian fungaria and culture collections, and a case study of a human fungal pathogen outbreak. We anticipate that these discussions will help prioritize fungal research in Canada, and we welcome all researchers to join this nationwide effort to enhance knowledge dissemination and funding advocacy.
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Affiliation(s)
- Linda C Horianopoulos
- Department of Microbiology and Immunology, University of British Columbia, 2185 East Mall, Vancouver, BC V6T 1Z4, Canada
| | - Emile Gluck-Thaler
- Department of Biological Sciences, University of Pittsburgh, 4249 Fifth Avenue, Pittsburgh, PA 15260, USA
| | - Isabelle Benoit Gelber
- Centre for Structural and Functional Genomics, Department of Biology, Concordia University, 7141 Sherbrooke Street West, Montréal, QC H4B 1R6, Canada
| | - Leah E Cowen
- Department of Molecular Genetics, University of Toronto, 661 University Avenue, Toronto, ON M5G 1M1, Canada
| | - Jennifer Geddes-McAlister
- Department of Molecular and Cellular Biology, University of Guelph, 474-570 Gordon Street, Guelph, ON N1G 1Y2, Canada
| | - Christian R Landry
- Département de biologie and Département de biochimie, microbiologie et bio-informatique, Université Laval, 1030, avenue de la Médecine, Québec, QC G1V 0A6, Canada
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 8440 112 Street NW, Edmonton, AB T6G 2R7, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, 223 College Street, Toronto, ON, M5T 1R4, Canada
| | - Adnane Sellam
- Department of Microbiology, Infectious Disease and Immunology, Montreal Heart Institute, Université de Montréal, 5000, rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Donald C Sheppard
- Department of Microbiology and Immunology, McGill University, 3775, rue University, Room 511, Montréal, QC H3A 2B4.,McGill Interdisciplinary Initiative in Infection and Immunity, 3666 McTavish Street, 2nd Floor, Montréal, QC H3Y 1Y2, Canada
| | - Toby Spribille
- Department of Biological Sciences, University of Alberta, 11335 Saskatchewan Drive NW, Edmonton, AB T6G 2H5, Canada
| | - Rajagopal Subramaniam
- Agriculture and Agri-Food Canada, Ottawa Research and Development Centre, 960 Carling Avenue, Ottawa, ON K1A 0C6, Canada
| | - Allison K Walker
- Department of Biology, Acadia University, 33 Westwood Avenue, Room 302, Wolfville, NS B4P 2R6, Canada
| | - Steven D Harris
- Department of Biological Sciences, University of Manitoba, Biological Sciences Building, Winnipeg, MB R3T 2N2, Canada
| | - Rebecca S Shapiro
- Department of Molecular and Cellular Biology, University of Guelph, 474-570 Gordon Street, Guelph, ON N1G 1Y2, Canada
| | - Aleeza C Gerstein
- Department of Microbiology, University of Manitoba, 213 Buller Building, Winnipeg, MB R3T 2N2, Canada.,Department of Statistics, University of Manitoba, 318 Machray Hall, Winnipeg, MB R3T 2N2, Canada
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C Parfitt E, Schwartz IS, Laupland KB. Putting the cart before the horse: Development of a de novo clinical infectious diseases service. J Assoc Med Microbiol Infect Dis Can 2020; 5:53-56. [PMID: 36338180 PMCID: PMC9602885 DOI: 10.3138/jammi-2019-02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Elizabeth C Parfitt
- Department of Medicine, Royal Inland Hospital, Kamloops, British Columbia, Canada
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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45
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine (Schwartz); Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology (Dingle), Faculty of Medicine and Dentistry, University of Alberta; Provincial Laboratory for Public Health (Dingle), Alberta Public Laboratories, Edmonton, Alta.
| | - Tanis C Dingle
- Division of Infectious Diseases, Department of Medicine (Schwartz); Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology (Dingle), Faculty of Medicine and Dentistry, University of Alberta; Provincial Laboratory for Public Health (Dingle), Alberta Public Laboratories, Edmonton, Alta
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Pastick KA, Okafor EC, Wang F, Lofgren SM, Skipper CP, Nicol MR, Pullen MF, Rajasingham R, McDonald EG, Lee TC, Schwartz IS, Kelly LE, Lother SA, Mitjà O, Letang E, Abassi M, Boulware DR. Review: Hydroxychloroquine and Chloroquine for Treatment of SARS-CoV-2 (COVID-19). Open Forum Infect Dis 2020; 7:ofaa130. [PMID: 32363212 PMCID: PMC7184359 DOI: 10.1093/ofid/ofaa130] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly emerging viral infection causing coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine have garnered unprecedented attention as potential therapeutic agents against COVID-19 following several small clinical trials, uncontrolled case series, and public figure endorsements. While there is a growing body of scientific data, there is also concern for harm, particularly QTc prolongation and cardiac arrhythmias. Here, we perform a rapid narrative review and discuss the strengths and limitations of existing in vitro and clinical studies. We call for additional randomized controlled trial evidence prior to the widespread incorporation of hydroxychloroquine and chloroquine into national and international treatment guidelines.
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Affiliation(s)
- Katelyn A Pastick
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | | | - Fan Wang
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota
| | - Sarah M Lofgren
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Caleb P Skipper
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Melanie R Nicol
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew F Pullen
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Radha Rajasingham
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Todd C Lee
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, Department of Pharmacology, University of Manitoba, Winnipeg, Canada
| | - Sylvain A Lother
- Department of Medicine, Sections of Critical Care and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Oriol Mitjà
- Fight AIDS and Inf Dis Foundation, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Emili Letang
- Department of Infectious Diseases, Hospital del Mar/Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- ISGlobal, Barcelona Institute for Global Health, Universitat de Barcelona, Barcelona, Spain
| | - Mahsa Abassi
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David R Boulware
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Ashraf N, Kubat RC, Poplin V, Adenis AA, Denning DW, Wright L, McCotter O, Schwartz IS, Jackson BR, Chiller T, Bahr NC. Re-drawing the Maps for Endemic Mycoses. Mycopathologia 2020; 185:843-865. [PMID: 32040709 PMCID: PMC7416457 DOI: 10.1007/s11046-020-00431-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/24/2020] [Indexed: 01/19/2023]
Abstract
Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.
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Affiliation(s)
- Nida Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Ryan C Kubat
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Victoria Poplin
- Department of Internal Medicine, University of Kansas, Kansas City, KS, USA
| | - Antoine A Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - David W Denning
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Wright
- Geographic Research Analysis and Services Program, Division of Toxicology and Human Health Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Orion McCotter
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brendan R Jackson
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tom Chiller
- Mycotic Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Internal Medicine, University of Kansas, Kansas City, KS, USA.
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48
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Schwartz IS, Wiederhold NP, Hanson KE, Patterson TF, Sigler L. Blastomyces helicus, a New Dimorphic Fungus Causing Fatal Pulmonary and Systemic Disease in Humans and Animals in Western Canada and the United States. Clin Infect Dis 2020; 68:188-195. [PMID: 29878145 PMCID: PMC6321858 DOI: 10.1093/cid/ciy483] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background Blastomyces helicus (formerly Emmonsia helica) is a dimorphic fungus first isolated from a man with fungal encephalitis in Alberta, Canada. The geographic range, epidemiology, and clinical features of disease are unknown. Methods We reviewed human and veterinary isolates of B. helicus identified among Blastomyces and Emmonsia isolates at the University of Alberta Microfungus Collection and Herbarium, University of Texas Health San Antonio’s Fungus Testing Laboratory, and Associated Regional and University Pathologists Laboratories. Isolates were selected based on low Blastomyces dermatitidis DNA probe values and/or atypical morphology. Species identification was confirmed for most isolates by DNA sequence analysis of the internal transcribed spacer with or without D1/D2 ribosomal RNA regions. Epidemiological and clinical data were analyzed. Results We identified isolates from 10 human and 5 veterinary cases of B. helicus infection; all were referred from western regions of Canada and the United States. Isolates remained sterile in culture, producing neither conidia nor sexual spores in the mycelial phase, but often producing coiled hyphae. Isolates were most frequently cultured from blood and bronchoalveolar lavage in humans and lungs in animals. Most infected persons were immunocompromised. Histopathological findings included pleomorphic, small or variably sized yeast-like cells, with single or multiple budding, sometimes proliferating to form short, branching, hyphal-like elements. Disease carried a high case-fatality rate. Conclusions Blastomyces helicus causes fatal pulmonary and systemic disease in humans and companion animals. It differs from B. dermatitidis in morphological presentation in culture and in histopathology, by primarily affecting immunocompromised persons, and in a geographic range that includes western regions of North America.
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.,San Antonio Center for Medical Mycology
| | - Nathan P Wiederhold
- San Antonio Center for Medical Mycology.,Fungus Testing Laboratory, University of Texas Health San Antonio
| | - Kimberly E Hanson
- Division of Infectious Diseases, Department of Medicine.,Clinical Microbiology Division, Department of Pathology, University of Utah, Salt Lake City
| | - Thomas F Patterson
- San Antonio Center for Medical Mycology.,South Texas Veterans Health Care System, San Antonio
| | - Lynne Sigler
- Department of Biological Sciences, University of Alberta, Edmonton, Canada
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Abstract
Blastomycosis is a serious fungal disease of humans and other mammals caused by environmentally acquired infection with geographically restricted, thermally dimorphic fungi belonging to the genus Blastomyces. The genetic and geographic diversity of these pathogens is greater than previously appreciated. In addition to Blastomyces dermatitidis and the cryptic species Blastomyces gilchristii, which cause blastomycosis in mid-western and various eastern areas of North America, atypical blastomycosis is occasionally caused by Blastomyces helicus in western parts of North America and Blastomyces percursus in Africa. Blastomycosis is acquired by inhalation of the conidia that are produced in the mold phase; in the lungs, temperature-dependent transformation occurs to the yeast phase. In this form, the organism is phagocytized by macrophages and can spread hematogenously to various organs causing disseminated infection. Pulmonary disease is most common and varies from mild, self-limited infection to severe, potentially fatal adult respiratory distress syndrome. Disseminated infection is manifested primarily by skin lesions, but many other organs can be involved. Diagnosis is established by growth of the organism in culture; however, a tentative diagnosis can be made quickly by histopathological identification of the classic yeast form in tissues or by finding Blastomyces antigen in urine or serum. Blastomycosis is treated initially with amphotericin B when the disease is severe, involves the central nervous system, or the host is immunosuppressed. Itraconazole is recommended for primary therapy in mild-to-moderate infection and for step-down therapy after initial amphotericin B treatment. Voriconazole and posaconazole can be used for patients in whom itraconazole is not tolerated.
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carol A Kauffman
- Infectious Diseases Division, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, Michigan
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50
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Dingle TC, Schwartz IS. The authors respond to " Candida auris can be identified accurately". CMAJ 2020; 192:E45. [PMID: 31932343 PMCID: PMC6957318 DOI: 10.1503/cmaj.74194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Tanis C Dingle
- Assistant professor, Division of Diagnostic and Applied Microbiology, Department of Medicine, University of Alberta, Edmonton, Alta
| | - Ilan S Schwartz
- Assistant professor, Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alta
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