Nocardia spp.: A Rare Cause of Pneumonia Globally

2020 ◽  
Vol 41 (04) ◽  
pp. 538-554
Author(s):  
Joseph P. Lynch ◽  
Gail Reid ◽  
Nina M. Clark
Keyword(s):  
Susceptibility Testing ◽  
Organ Transplant ◽  
Clinical Manifestations ◽  
Community Acquired Pneumonia ◽  
Solid Organ ◽  
In Vitro Susceptibility ◽  
Timely Initiation ◽  
Life Threatening ◽  
Initiation Of Therapy

AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

scholarly journals Invasive infections with Purpureocillium lilacinum: clinical characteristics and outcome of 101 cases from FungiScope® and the literature

2021 ◽  
Author(s):  
Rosanne Sprute ◽  
Jon Salmanton-García ◽  
Ertan Sal ◽  
Xhorxha Malaj ◽  
Zdeněk Ráčil ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Organ Transplant ◽  
Solid Organ ◽  
Intrinsic Resistance ◽  
Breakthrough Infection ◽  
Purpureocillium Lilacinum ◽  
Invasive Infections ◽  
Oncological Diseases ◽  
Overall Mortality

Abstract Objectives To provide a basis for clinical management decisions in Purpureocillium lilacinum infection. Methods Unpublished cases of invasive P. lilacinum infection from the FungiScope® registry and all cases reported in the literature were analysed. Results We identified 101 cases with invasive P. lilacinum infection. Main predisposing factors were haematological and oncological diseases in 31 cases (30.7%), steroid treatment in 27 cases (26.7%), solid organ transplant in 26 cases (25.7%), and diabetes mellitus in 19 cases (18.8%). The most prevalent infection sites were skin (n = 37/101, 36.6%) and lungs (n = 26/101, 25.7%). Dissemination occurred in 22 cases (21.8%). Pain and fever were the most frequent symptoms (n = 40/101, 39.6% and n = 34/101, 33.7%, respectively). Diagnosis was established by culture in 98 cases (97.0%). P. lilacinum caused breakthrough infection in 10 patients (9.9%). Clinical isolates were frequently resistant to amphotericin B, whereas posaconazole and voriconazole showed good in vitro activity. Susceptibility to echinocandins varied considerably. Systemic antifungal treatment was administered in 90 patients (89.1%). Frequently employed antifungals were voriconazole in 51 (56.7%) and itraconazole in 26 patients (28.9%). Amphotericin B treatment was significantly associated with high mortality rates (n = 13/33, 39.4%, P = <0.001). Overall mortality was 21.8% (n = 22/101) and death was attributed to P. lilacinum infection in 45.5% (n = 10/22). Conclusions P. lilacinum mainly presents as soft-tissue, pulmonary or disseminated infection in immunocompromised patients. Owing to intrinsic resistance, accurate species identification and susceptibility testing are vital. Outcome is better in patients treated with triazoles compared with amphotericin B formulations.

Assessment of Laboratory Performance With Streptococcus pneumoniae Antimicrobial Susceptibility Testing in the United States

1999 ◽  
Vol 123 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Gary V. Doern ◽  
Angela B. Brueggemann ◽  
Michael A. Pfaller ◽  
Ronald N. Jones
Keyword(s):  
United States ◽  
Streptococcus Pneumoniae ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
The United States ◽  
National Committee ◽  
In Vitro Susceptibility ◽  
Susceptibility Tests

Abstract Objective.—To assess the performance of clinical microbiology laboratories in the United States when conducting in vitro susceptibility tests with Streptococcus pneumoniae. Methods.—The results of a nationwide College of American Pathologists Proficiency Survey test sample, in which susceptibility testing of an isolate of S pneumoniae was performed, were assessed with respect to precision and accuracy. Results.—Wide variability was noted among participating laboratories with both minimum inhibitory concentration procedures and disk diffusion susceptibility tests when both methods were applied to S pneumoniae. Despite this high degree of variation, categorical interpretive errors were uncommon. Numerous laboratories reported results for antimicrobial agents that are not recommended by the National Committee for Clinical Laboratory Standards for tests with S pneumoniae. Conclusions.—Current susceptibility testing practices with S pneumoniae in the United States indicate limited precision and a tendency for laboratories to test and report results obtained with antimicrobial agents of questionable therapeutic value against this organism. Continued efforts to standardize susceptibility testing of S pneumoniae in the United States are warranted. In addition, modifications of existing interpretive criteria may be necessary.

Vaginitis Due To Pichia fermentans in a Patient Affected by Endometrial Cancer: A Novel Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Zarifeh Adampour ◽  
Malihe Hasanzadeh ◽  
Hossein Zarrinfar ◽  
Maryam Nakhaei ◽  
Monika Novak Babič
Keyword(s):  
Endometrial Cancer ◽  
Susceptibility Testing ◽  
Antifungal Susceptibility ◽  
Female Genital Tract ◽  
Antifungal Susceptibility Testing ◽  
Vein Thrombosis ◽  
Microbial Infections ◽  
Life Threatening ◽  
In Vitro Antifungal Susceptibility

Introduction: Endometrial cancer is one of the most common malignancies of the female genital tract, which can be serious or life-threatening. Microbial infections can be one of the underlying causes of this type of cancer. Case Presentation: The present study describes the isolation of Pichia fermentans (Candida firmentaria var. firmentaria) from the vaginal secretions of a 61-year-old woman affected by endometrial cancer. She reported abdominal pain and vaginal discharge for 3 months, and had a history of diabetes, hypertension, Deep Vein Thrombosis (DVT), and Acute Myeloid Leukemia (AML). The isolated yeast was identified based on nuclear ribosomal internal transcribed spacer (ITS1-ITS2 rDNA) sequence analysis. The in vitro antifungal susceptibility testing showed a higher effect for ketoconazole against P. fermentans than fluconazole, itraconazole and voriconazole. Conclusion: Correct differentiation between P. fermentans and other yeast should be considered. The in vitro antifungal susceptibility testing is recommended for rare yeast, and will help the physicians in providing the best treatment.

scholarly journals Atypical clinical and laboratory features of fish-tank granuloma: A case report

2018 ◽  
Vol 6 ◽  
pp. 2050313X1880407 ◽  
Author(s):  
Michael Sander ◽  
Judith L Isaac-Renton ◽  
Megan A Sander
Keyword(s):  
Case Report ◽  
Susceptibility Testing ◽  
Mycobacterium Marinum ◽  
In Vitro Susceptibility ◽  
Laboratory Features ◽  
In Vitro Susceptibility Testing ◽  
Fish Tank ◽  
Fish Tank Granuloma

We report a case of cutaneous Mycobacterium marinum infection with the unusual reported features of pruritus and paresthesia. In addition, we report a lack of in-vivo response to antibiotics based on in-vitro susceptibility testing.

scholarly journals 2562. Re-Appraisal of Aminoglycoside (AG) Susceptibility Testing Breakpoints Based on the Application of Pharmacokinetics–Pharmacodynamics (PK-PD) and Contemporary Microbiology Surveillance Data

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S71-S71 ◽  
Author(s):  
Sujata M Bhavnani ◽  
Nikolas J Onufrak ◽  
Jeffrey P Hammel ◽  
David R Andes ◽  
John S Bradley ◽  
...  
Keyword(s):  
Susceptibility Testing ◽  
Surveillance Data ◽  
Simulated Patients ◽  
High Dose ◽  
Target Attainment ◽  
In Vitro Susceptibility ◽  
Population Pk ◽  
Dosing Regimens

Abstract Background Resistance to AGs and numerous other classes continues to emerge. To ensure that susceptibility is accurately characterized and that clinicians have reliable data to select effective agents, appropriate in vitro susceptibility testing interpretive criteria (susceptible breakpoints [BKPTs]) are crucial to ensure optimal patient care. Recently, USCAST, the USA voice to EUCAST/EMA, evaluated the BKPTs for the 3 most commonly used AGs, gentamicin, tobramycin, and amikacin [Bhavnani et al., IDWeek 2016; P-1977]. As a result of consultation from interested parties, which included evaluating AG dosing regimens provided in the US-FDA product package inserts and simulated patients with varying creatinine clearance, these BKPTS were reassessed. Methods Data sources considered included longitudinal US reference MIC distributions using in vitro surveillance data collected over 18 years, QC performance (MIC, disk diffusion), population pharmacokinetics (PK), and in vivo PK-PD models. Using population PK models, PK-PD targets for efficacy and Monte Carlo simulation, percent probabilities of PK-PD target attainment by MIC after administration of traditional and extended interval AG dosing regimens were evaluated among simulated patients. Epidemiological cut-off and PK-PD BKPTs were considered when recommending BKPTs for AG–pathogen pairs. Results An example of PK-PD target attainment analysis output is provided in Figure 1 and a subset of recommended AG BKPTs for 3 pathogens is shown in Table 1. Updated USCAST BKPTs, which were based on the application of population PK and PK-PD models, simulation techniques, and contemporary MIC distribution statistics, are generally lower than those of EUCAST/EMA, USA-FDA, and CLSI. Adequate PK-PD target attainment was not achieved for some AG-pathogen pairs, even when high-dose AG dosing regimens and PK-PD targets for stasis were evaluated (e.g., gentamicin vs. P. aeruginosa; amikacin vs. S. aureus). Conclusion These revised AG BKPT recommendations, which will be made freely available to EUCAST, USA-FDA, and CLSI, will be finalized after considering comments from additional interested stakeholders. This process will be followed in an effort to bring harmonization to global BKPTs for AGs. Disclosures All authors: No reported disclosures.

scholarly journals Hepatitis E Virus Immunopathogenesis

Pathogens ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1180
Author(s):  
Kush Kumar Yadav ◽  
Scott P. Kenney
Keyword(s):  
Hepatitis E Virus ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Oral Route ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
In Vivo Models ◽  
Transplant Patients

Hepatitis E virus is an important emerging pathogen producing a lethal impact on the pregnant population and immunocompromised patients. Starting in 1983, it has been described as the cause for acute hepatitis transmitted via the fecal–oral route. However, zoonotic and blood transfusion transmission of HEV have been reported in the past few decades, leading to the detailed research of HEV pathogenesis. The reason behind HEV being highly virulent to the pregnant population particularly during the third trimester, leading to maternal and fetal death, remains unknown. Various host factors (immunological, nutritional, hormonal) and viral factors have been studied to define the key determinants assisting HEV to be virulent in pregnant and immunocompromised patients. Similarly, chronic hepatitis is seen particularly in solid organ transplant patients, resulting in fatal conditions. This review describes recent advances in the immunopathophysiology of HEV infections in general, pregnant, and immunocompromised populations, and further elucidates the in vitro and in vivo models utilized to understand HEV pathogenesis.

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