Fungal Infection in Lung Transplantation

AbstractInvasive fungal infections threaten lung transplant outcomes with high associated morbidity and mortality. Pharmacologic prophylaxis may be key to prevent posttransplant invasive fungal infections, but cost, adverse effects, and absorption issues are barriers to effective prophylaxis. Trends in fungal infection diagnostic strategies utilize molecular diagnostic methodologies to complement traditional histopathology and culture techniques. While lung transplant recipients are susceptible to a variety of fungal pathogens, Candida spp. and Aspergillus spp. infections remain the most common. With emerging resistant organisms and multiple novel antifungal agents in the research pipeline, it is likely that treatment strategies will continue to evolve.

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Identification and in Vitro Susceptibility Pattern of Fungal Pathogens in Immunocompromised Patients with invasive Fungal Infections

10.51429/ejmm30317 ◽

2021 ◽

Vol 30 (3) ◽

pp. 127-134

Author(s):

Shaimaa A.S. Selem ◽

Neveen A. Hassan ◽

Mohamed Z. Abd El-Rahman ◽

Doaa M. Abd El-Kareem

Keyword(s):

Intensive Care ◽

Fungal Infection ◽

Fungal Pathogens ◽

Fungal Infections ◽

Antifungal Susceptibility ◽

Invasive Fungal Infections ◽

Immunocompromised Patients ◽

University Hospitals ◽

Vitek 2

Background: In intensive care units, invasive fungal infections have become more common, particularly among immunocompromised patients. Early identification and starting the treatment of those patients with antifungal therapy is critical for preventing unnecessary use of toxic antifungal agents. Objective: The aim of this research is to determine which common fungi cause invasive fungal infection in immunocompromised patients, as well as their antifungal susceptibility patterns in vitro, in Assiut University Hospitals. Methodology: This was a hospital based descriptive study conducted on 120 patients with clinical suspicion of having fungal infections admitted at different Intensive Care Units (ICUs) at Assiut University Hospitals. Direct microscopic examination and inoculation on Sabouraud Dextrose Agar (SDA) were performed on the collected specimens. Isolated yeasts were classified using phenotypic methods such as chromogenic media (Brilliance Candida agar), germ tube examination, and the Vitek 2 system for certain isolates, while the identification of mould isolates was primarily based on macroscopic and microscopic characteristics. Moulds were tested in vitro for antifungal susceptibility using the disc diffusion, and yeast were tested using Vitek 2 device cards. Results: In this study, 100 out of 120 (83.3%) of the samples were positive for fungal infection. Candida and Aspergillus species were the most commonly isolated fungal pathogens. The isolates had the highest sensitivity to Amphotericin B (95 %), followed by Micafungin (94 %) in an in vitro sensitivity survey. Conclusion: Invasive fungal infections are a leading cause of morbidity and mortality in immunocompromised patients, with Candida albicans being the most frequently isolated yeast from various clinical specimens; however, the rise in resistance, especially to azoles, is a major concern.

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Opportunistic Fungal Infection

Chest Imaging ◽

10.1093/med/9780199858064.003.0037 ◽

2019 ◽

pp. 209-213

Author(s):

Sonia L. Betancourt

Keyword(s):

Fungal Infection ◽

Opportunistic Infection ◽

Fungal Pathogens ◽

Fungal Infections ◽

Hematologic Malignancy ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Candida Spp ◽

Common Opportunistic Infection ◽

Cryptococcus Spp

Opportunistic fungal infections are caused by fungi that are nonpathogenic in the immunocompetent host, many of which are part of the normal upper respiratory tract flora. These organisms may cause pulmonary infection in immunocompromised hosts. Immunocompromised patients and patients with febrile neutropenia with opportunistic fungal infections may have normal chest radiographs. Thus, chest CT should be performed for further evaluation. Imaging abnormalities in this patient population should raise suspicion for opportunistic infection. Neutropenia is the single most important risk factor for Aspergillosis. Aspergillus is the most common opportunistic infection in patients with hematologic malignancy and bone marrow transplantation. Aspergillus spp., Candida spp., and Cryptococcus spp. are the most common fungal infections in patients with solid organ transplantation. Pneumocystis jirovecii is the most common fungal infection in patients AIDS with CD4 count s<200 cells/mm3. Cryptococcal pneumonia is also common in this population. There has been a recent increase in uncommon fungal pathogens causing invasive pulmonary disease.

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Treatment of fungal disease in the setting of neutropenia

Hematology ◽

10.1182/asheducation-2013.1.423 ◽

2013 ◽

Vol 2013 (1) ◽

pp. 423-427 ◽

Cited By ~ 33

Author(s):

Thomas J. Walsh ◽

Maria N. Gamaletsou

Keyword(s):

Fungal Pathogens ◽

Fungal Infections ◽

Empirical Therapy ◽

Invasive Fungal Infections ◽

Attributable Mortality ◽

Preemptive Therapy ◽

Emerging Pathogens ◽

Fusarium Spp ◽

Candida Spp ◽

Neutropenic Patients

Abstract Invasive fungal infections are important causes of morbidity and attributable mortality in neutropenic patients with hematological malignancies, myelodysplasia, and aplastic anemia. Successful risk-based strategies can be implemented for prophylaxis, empirical therapy, and preemptive therapy for the prevention and early treatment of invasive fungal infections in neutropenic hosts. The use of echinocandins for invasive candidiasis and voriconazole for invasive aspergillosis has significantly improved outcome. Recent studies demonstrate, however, that resistant fungal pathogens may emerge during the course of these antifungal interventions. Although triazole-resistant Candida spp. have been well described as causes of breakthrough candidemia, other organisms now pose a similar threat. Such organisms include echinocandin-resistant Candida glabrata and Candida parapsilosis species complex. The Mucorales, Fusarium spp., and Scedosporium spp. may emerge in the setting of voriconazole prophylaxis. The challenges of these emerging pathogens underscore the need for the development of new antifungal agents and strategies.

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Prevention, Diagnosis, and Treatment of Invasive Fungal Infections in Patients with Cancer and Neutropenia

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2004.0036 ◽

2004 ◽

Vol 2 (5) ◽

pp. 455-469 ◽

Cited By ~ 4

Author(s):

Thomas A. Cumbo ◽

Brahm H. Segal

Keyword(s):

Fungal Infection ◽

Fungal Pathogens ◽

Fungal Infections ◽

Invasive Fungal Infections ◽

Detection Methods ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Effective Prevention ◽

Nccn Guidelines ◽

Patients With Cancer

Invasive fungal infections are a major cause of morbidity and mortality in patients with prolonged neutropenia and in allogeneic hematopoietic stem cell transplant recipients. The degree and duration of neutropenia influence the risk of opportunistic fungal infections. Because Candida and Aspergillus species are the major causes of invasive fungal infections in neutropenic patients, the fungal section of the NCCN guidelines focus on these two pathogens. Effective prevention and therapy of invasive fungal pathogens is a priority in highly immunocompromised patients with cancer. Three strategies in preventing and treating patients at high risk for fungal infection will be considered: (1) prophylaxis; (2) empirical therapy; and (3) treatment for probable or proven fungal infection. In addition to more effective antifungal agents, growing interest has been noted in novel non-culture detection methods to facilitate early diagnosis of invasive fungal infections.

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The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea

Journal of Fungi ◽

10.3390/jof7080639 ◽

2021 ◽

Vol 7 (8) ◽

pp. 639

Author(s):

Yae-Jee Baek ◽

Yun-Suk Cho ◽

Moo-Hyun Kim ◽

Jong-Hoon Hyun ◽

Yu-Jin Sohn ◽

...

Keyword(s):

Cohort Study ◽

South Korea ◽

Fungal Infection ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Lung Transplant ◽

Fungal Infections ◽

Transplant Recipients ◽

Tertiary Center ◽

Lung Transplant Recipients

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of Candida spp. was approximately three times higher than that of Aspergillus spp. In the setting of itraconazole administration for 6 months post-LTx, C. glabrata accounted for 36.5% of all Candida-positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non-Aspergillus molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx.

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Post-Translational Modifications Drive Success and Failure of Fungal–Host Interactions

Journal of Fungi ◽

10.3390/jof7020124 ◽

2021 ◽

Vol 7 (2) ◽

pp. 124

Author(s):

Charmaine Retanal ◽

Brianna Ball ◽

Jennifer Geddes-McAlister

Keyword(s):

Fungal Pathogens ◽

Fungal Infections ◽

Treatment Options ◽

Global Scale ◽

Host Cells ◽

Candida Spp ◽

Post Translational Modifications ◽

Fungal Host ◽

Resistant Species

Post-translational modifications (PTMs) change the structure and function of proteins and regulate a diverse array of biological processes. Fungal pathogens rely on PTMs to modulate protein production and activity during infection, manipulate the host response, and ultimately, promote fungal survival. Given the high mortality rates of fungal infections on a global scale, along with the emergence of antifungal-resistant species, identifying new treatment options is critical. In this review, we focus on the role of PTMs (e.g., phosphorylation, acetylation, ubiquitination, glycosylation, and methylation) among the highly prevalent and medically relevant fungal pathogens, Candida spp., Aspergillus spp., and Cryptococcus spp. We explore the role of PTMs in fungal stress response and host adaptation, the use of PTMs to manipulate host cells and the immune system upon fungal invasion, and the importance of PTMs in conferring antifungal resistance. We also provide a critical view on the current knowledgebase, pose questions key to our understanding of the intricate roles of PTMs within fungal pathogens, and provide research opportunities to uncover new therapeutic strategies.

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Incidence of Invasive Fungal Infections Among Lung Transplant Recipients: A Multicenter Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv133.920 ◽

2015 ◽

Vol 2 (suppl_1) ◽

Author(s):

Rajal K. Mody ◽

Angela Cleveland ◽

Robin Avery ◽

Mindy Schuster ◽

Fernanda Silveira ◽

...

Keyword(s):

Multicenter Study ◽

Lung Transplant ◽

Fungal Infections ◽

Invasive Fungal Infections ◽

Transplant Recipients ◽

Lung Transplant Recipients

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Autopsy dissection techniques and investigations in deaths due to COVID-19 triggered fungal infections - A diagnostic review

Indian Journal of Forensic and Community Medicine ◽

10.18231/j.ijfcm.2021.043 ◽

2021 ◽

Vol 8 (4) ◽

pp. 207-213

Author(s):

Himanshi Narang ◽

Amit Patil

Keyword(s):

Fungal Infection ◽

Paranasal Sinuses ◽

Fungal Infections ◽

Invasive Disease ◽

Invasive Fungal Infections ◽

Correct Interpretation ◽

Research Papers ◽

Dissection Techniques ◽

Second Wave

The COVID-19 pandemic, which originated from Wuhan, China, has rapidly spread worldwide, including India. As India grappled with the second wave, COVID-triggered fungal infection has suddenly risen tremendously, raising a sense of panic in the country. The fungal infection in COVID-19 includes Mucormycosis and Aspergillosis, as common fungal infections primarily affecting rhino-orbital structures. Many research papers have published postmortem findings in autopsies conducted on COVID-19 decedents, thereby helping to understand this contagious disease's pathogenesis. But, with the arrival of COVID-triggered fungal infection, which is a crucial invasive disease responsible for fatality, very few research papers have commented on the postmortem findings of invasive fungal infections affecting the rhino-orbital and craniocerebral structures in COVID-19 deaths. Therefore, the role of invasive fungal infection due to COVID-19 illness must be established in the causation of deaths in COVID-19 patients. This review research deals with autopsy dissection techniques and possible postmortem findings of invasive fungal infections involving the nasal and paranasal sinuses and orbital structures in COVID-19 deaths. The findings of fungal infection affecting nasal and paranasal systems may not differ in live patients and in a deceased; however, it is essential that correct interpretation of the postmortem findings aided by pre-or post-autopsy investigations is necessary to establish the role of covid triggered fungal infection in such deaths.

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Fungal Infection in Cystic Fibrosis

Current Respiratory Medicine Reviews ◽

10.2174/1573398x17666210520175847 ◽

2021 ◽

Vol 17 (2) ◽

pp. 118-124

Author(s):

Amirmehdi Sarvestani ◽

Mohammad Almasian ◽

Amirhossein Nafari

Keyword(s):

Cystic Fibrosis ◽

Fungal Infection ◽

Fungal Pathogens ◽

Respiratory Infections ◽

Fungal Infections ◽

Genetic Disorder ◽

Medical Science ◽

Resistant Species ◽

Online Databases ◽

New Treatments

Background: The prevalence of fungal infections has been increasing in recent years. Cystic fibrosis (CF) is a genetic disorder that affects organs such as the intestines, liver, pancreas, and especially the lungs. Introduction: Fungal pathogens are becoming a challenge in CF. Advanced medical science is associated with longer life expectancy in some patient groups. Method: A review was conducted on studies found on online databases, including Google Scholar, PubMed, and Scopus. Internet-based searches were performed on these databases for cystic fibrosis, respiratory infections, and fungal infection profiling to identify all relevant studies published between 2010 and 2020. Result: Fungal pathogens most frequently isolated from the respiratory tract include the Aspergillus genus, the Candida genus, Scedosporium apiospermum, and the Rasamsonia genus. In cystic fibrosis, these organisms usually colonize the respiratory and intestinal tracts and cause hypersensitivity responses and invasive diseases. Conclusion: Fungus-patient interactions are complicated and depend on various factors. Moreover, the emergence of drug-resistant species is a serious health issue, and the development of new treatments is crucial.

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The importance of rapid diagnosis for multidrug-resistant Candida: an interview with Maurizio Sanguinetti

Future Microbiology ◽

10.2217/fmb-2019-0198 ◽

2019 ◽

Vol 14 (12) ◽

pp. 1011-1012

Author(s):

Maurizio Sanguinetti

Keyword(s):

Infectious Diseases ◽

Fungal Pathogens ◽

Fungal Infections ◽

Resistance Mechanisms ◽

Rapid Diagnosis ◽

Antifungal Drugs ◽

Full Professor ◽

Research Activity ◽

Diagnostic Strategies ◽

Personalized Care

In this exclusive interview, Maurizio Sanguinetti discusses current issues with Candida fungal infection diagnoses, in light of its rising resistance to antifungal drugs. This interview was conducted by Ellen Colvin, Editor of Future Microbiology. Maurizio Sanguinetti, MD, is full Professor of Microbiology at the Università Cattolica del Sacro Cuore of Rome, Italy, and Director of the Institute of Microbiology and Chief of the Department of Laboratory Sciences and Infectious Diseases Sciences at the Fondazione Policlinico Agostino Gemelli IRCCS of Rome, Italy. For several years, the research activity of Maurizio Sanguinetti has mainly focused on the development of molecular methods for the rapid diagnosis of bacterial, mycobacterial and fungal infections; the elucidation of virulence and antimicrobial resistance mechanisms in clinically relevant bacterial and fungal pathogens; the characterization of the human microbiota in relationship to infectious and noninfectious diseases and implementation of new diagnostic strategies for the personalized care of patients with infectious diseases.

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