Practical Approach to the Pathologic Diagnosis of Mixed Filamentous Fungal Infections in Burn Wounds: A Case Series

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S133-S133
Author(s):  
A D Pyden ◽  
I Solomon ◽  
A Laga Canales
Keyword(s):  
Opportunistic Infections ◽  
Fungal Infections ◽  
Case Series ◽  
Fungal Species ◽  
Molecular Testing ◽  
Burn Wounds ◽  
Tissue Sections ◽  
True Infection ◽  
Extensive Burn

Abstract Introduction/Objective Opportunistic infections by fungi are a major source of morbidity and mortality in patients suffering from extensive burn wounds. Here we review a series of cases of infections by multiple fungi in burn wounds as diagnosed by histopathology and outline the key features for the pathologist to include in the report. Methods/Case Report Biopsies from patients with more than one fungal species identified in the laboratory in a concurrent culture or by PCR were included in this study. Three cases are presented with multiple fungi identified. Each case had yeast and at least one different hyaline mold species present on pathology; two cases additionally had mucormycetes present, with angioinvasion in one case. All organisms requiried microbiologic cultures and variably required molecular testing for full identification. Results (if a Case Study enter NA) N/A Conclusion Pathologists should be aware of the possibility of infection by multiple fungal species in burn wounds. Fungal morphology in tissue sections should allow for detection and distinction of mucormyctes and other hyaline molds. Histopathologic correlation with culture and/or PCR results is essential to distinguish potential contaminants from true infection.

scholarly journals Impact of antifungal resistance in Australia

2007 ◽  
Vol 28 (4) ◽  
pp. 174 ◽  
Author(s):  
David Ellis ◽  
Tania Sorrell ◽  
Sharon Chen
Keyword(s):  
Antifungal Activity ◽  
Selection Pressure ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Fungal Species ◽  
Antifungal Drugs ◽  
Drug Resistant ◽  
Populations At Risk ◽  
Complete Resistance ◽  
Major Increase

The last two to three decades have seen a major increase in invasive fungal infections (IFIs), a small, but increasing proportion of which are caused by pathogens with partial or complete resistance to antifungal drugs. The increase in IFIs has largely been associated with the increase in immunocompromised and critically ill patients. Opportunistic infections with relatively drug-resistant environmental fungi account for much of the resistance. In addition, amongst the only fungal species to colonise humans, Candida, two species that are resistant (C. krusei) or relatively resistant (C. glabrata) to fluconazole have emerged. In part this is explained by the selection pressure exerted by widespread use of fluconazole. Together with the introduction of new antifungal drugs with selective and/or variable antifungal activity, these changes have stimulated interest in understanding mechanisms and origins of resistance, the identification of resistance in the laboratory and its relationship to clinical outcomes, and in surveillance of clinical isolates and populations at risk of IFIs.

scholarly journals Severe polymicrobial and fungal periprosthetic osteomyelitis persisting after hip disarticulations treated with caspofungin in risk patients: a case series

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Andreas Enz ◽  
Silke Müller ◽  
Wolfram Mittelmeier ◽  
Annett Klinder
Keyword(s):  
Patient Outcome ◽  
Surgical Intervention ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Case Series ◽  
Recurrent Infection ◽  
Femoral Length ◽  
Younger Age ◽  
Risk Patients ◽  
Life Threatening

Abstract Background Periprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome. Cases All the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control. Conclusion The polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.

scholarly journals Risk of Infectious Complications in Patients with Chronic Lymphocytic Leukemia in the Era of BCR Inhibitors: A Retrospective Single Institution Experience

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5552-5552 ◽  
Author(s):  
Francesco Autore ◽  
Idanna Innocenti ◽  
Francesca Morelli ◽  
Federica Sora ◽  
Andrea Corbingi ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Case Series ◽  
Antifungal Prophylaxis ◽  
Antifungal Drugs ◽  
Lymphocytic Leukemia ◽  
Upper Respiratory Tract ◽  
Duration Of Treatment ◽  
Upper Respiratory

Abstract Introduction. The development of novel therapeutic agents in the treatment of lymphoid malignancies seemed to decrease the rate of complications, including infections, in spite of standard immuno-chemotherapy regimens. Patients receiving Ibrutinib experienced serious infections and other recent studies found that these patients are at risk for serious or opportunistic infections. Aim. The aim of our study was to evaluate incidence and type of infections in CLL patients treated with BCR inhibitors: Ibrutinib and Idelalisib plus Rituximab. Results. Our retrospective study included 46 CLL patients treated at our Institution since 2015: 37 patients were treated with Ibrutinib and 9 patients were treated with Idelalisib plus Rituximab. The median number of prior treatment regimens was 2 (range 0-5); only 1 patient started Ibrutinib as first-line therapy because of TP53 mutation. We recorded 32 episodes of infections, of which 23 occurred in 11 patients (out of 37, 30%) treated with Ibrutinib and 9 episodes in 5 patients (out of 9, 55%) treated with Idelalisib plus Rituximab. Daily Ibrutinib dose was 420 mg, Idelalisib was used at the dose of 150 mg twice a day. The median duration of treatment was 12 and 13 months in Ibrutinib and Idelalisib, respectively. We confirmed the higher prevalence of infections occurred during the first year of Ibrutinib treatment (84% in Varughese et al vs. 83% in our case series) and we found a high prevalence (78%) of infective episodes with Idelalisib plus Rituximab. The rate of infections was 0.6 episodes/patient for Ibrutinib and 1.0 episodes/patient for Idelalisib; each patient with infection showed a median of 2.1 and 1.8 episodes for Ibrutinib and Idelalisib, respectively. In the group of Ibrutinib the most common infections involved the upper respiratory tract (14 events, 61%), followed by urinary tract (6 events, 26%); in the Idelalisib group we found 6 infections (66%) of upper respiratory tract. Differences were found also in the pathogens implicated in the infections (Table I). All the infections, except one bacterial sepsis, were grade I or II; the patients were treated with antibacterial, antiviral or antifungal drugs in 56% of the cases. Only 3 patients treated with Ibrutinib required hospitalization and antibacterial or antifungal treatment as inpatients but no deaths were registered. In 30% of the Ibrutinib cases and in 53% of the Idelalisib cases the treatment was temporarily stopped. None of the patients received antifungal prophylaxis and nobody had invasive fungal infections. All patients received prophylaxis for Pneumocystis jirovecii and flu shot but no antiviral prophylaxis. Moreover, we detected 10 blood viral (EBV, CMV, HBV, BK) reactivations, without active disease, of which 60% with Idelalisib and 40% with Ibrutinib. Discussion. In conclusion when we treat as second or following line CLL patients with Ibrutinib we should take in account that about 30% of patients will develop one or more episodes of infective complications; in more than 60% the type of infection is bacterial. When we use Idelalisib plus Rituximab the rate of infections will be higher, around 55%, only 1/3 will be bacterial, but viral complications will be common. Disclosures Pagano: Gilead: Speakers Bureau; Merck: Speakers Bureau; Pfizer: Speakers Bureau; Basilea: Speakers Bureau; Janssen: Speakers Bureau.

scholarly journals Itchy Capillary Malformations: Unusual Appearance of Meyerson Phenomenon, a Case Series

2021 ◽  
Vol 13 (1) ◽  
pp. 131-134
Author(s):  
Manuel Sanchez-Diaz ◽  
Trinidad Montero-Vilchez ◽  
Luis Salvador-Rodriguez ◽  
Alejandro Molina-Leyva ◽  
Salvador Arias-Santiago ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Case Series ◽  
Diagnostic Errors ◽  
Rare Condition ◽  
Skin Lesions ◽  
Vascular Anomalies ◽  
Pediatric Dermatology ◽  
Melanocytic Lesions ◽  
Unusual Appearance

Meyerson phenomenon, also known as “halo-eczema,” has been widely described over melanocytic and non-melanocytic lesions. However, its appearance over vascular anomalies is rarely observed and could lead to diagnostic errors. A case study of five patients aged between four months and two years is reported. These patients developed unique erythematous and pruritic scaly patches, being diagnosed and treated as fungal infections. Due to the lack of response to the treatment, they were referred to the pediatric dermatology practice, where the diagnosis of Meyerson phenomenon over capillary malformations was made. Topical treatment with corticosteroids led to improvement in all cases. Although Meyerson phenomenon developing over vascular anomalies is a rare condition, it is important for pediatricians and dermatologists to assess it as a part of the differential diagnosis when treating a patient with skin lesions. Recognizing this phenomenon will prevent diagnostic and therapeutic errors.

scholarly journals Intracranial Mass Lesion Due to Fungal Infection: A Case Series and Review of Literature

2020 ◽  
Vol 6 (3) ◽  
pp. 143-150
Author(s):  
Ashok Gandhi ◽  
◽  
Surendra Jain ◽  
Sapna Gandhi ◽  
Keshav Mishra ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Fungal Infections ◽  
Correct Diagnosis ◽  
Case Series ◽  
Mass Effect ◽  
Fungal Species ◽  
Neurological Deficits ◽  
Reliable Technique ◽  
The Central Nervous System ◽  
Cranial Fossa

Background: Fungal infections of the central nervous system (CNS) usually present as subacute meningitis or intracranial space-occupying lesion with mass effect on surrounding structures and consequent focal neurological deficits. Intracranial fungal granulomas are often misdiagnosed clinically and radiologically as neoplastic lesions. Biopsy of the lesion is the only reliable technique to establish the correct diagnosis as well as to detect the causative fungal species. Voriconazole is a broad-spectrum triazole antifungal agent. It can be given orally and intravenously and has lesser adverse effects. Methods and Materials: In this article, we report a series of 6 cases of biopsy-proven fungal granuloma with varied clinical and radiological presentations who were given treatment with voriconazole for 6 months and demonstrated favorable response. Results: Out of 6 patients (4 males and 2 females), 1 was immunocompromised (DM with uncontrolled hyperglycemia). Headache was the most commonly observed symptom. Paranasal sinus and anterior cranial fossa were the most commonly affected site. Four patients received voriconazole therapy for 12 months and 1 received the same for 6 months before showing clinical resolution of disease. There was 1 death in the study group from non-related medical complications. Conclusion: Our series focuses on the correct diagnosis of fungal granuloma which can be achieved by biopsy and clinical evidence of the efficacy of voriconazole against intracranial fungal granuloma.

Synthesis and Biological Activity of 3-(substitutedphenyl)-6-(4-methoxyphenyl)-7H-[1,2,4]triazolo[3,4-b][1,3,4]thiadiazine: Part II

2020 ◽  
Vol 18 ◽  
Author(s):  
Niranjan Kaushik ◽  
Nitin Kumar ◽  
Anoop Kumar ◽  
Vikas Sharma
Keyword(s):  
Antifungal Activity ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Mass Spectral Data ◽  
Triazole Derivatives ◽  
Mass Spectral ◽  
Fungal Strains ◽  
Antifungal Properties ◽  
Antifungal Potential ◽  
Spectral Data Analysis

Background: Fungal infections are opportunistic infections that become a serious problem to human health. Objective: Considering the antifungal potential of triazole nucleus, the study was carried out with the objective to synthesize some novel triazole derivatives with antifungal potential. Method: 1,2,4-triazole derivatives were synthesized via a two step reaction (reported earlier). The first step involves reaction of substituted benzoic acid with thiocarbohydrazide to form 4-amino-3-(substituted phenyl)-5-mercapto-1, 2, 4-triazole derivatives (1a-1k) while in second step, synthesized compounds (1a-1k) were then subsequently treated with substituted acetophenone to yield substituted (4-methoxyphenyl-7H-[1, 2, 4] triazolo [3, 4-b][1,3,4] thiadiazine derivatives (2a-2k). All synthesized compounds were characterized by IR, 1H NMR, and Mass spectral data analysis and were screened for their antifungal properties against different fungal strains i.e. Candida tropicalis (ATCC-13803, ATCC-20913), Candida albicans (ATCC-60193), Candida inconspicua (ATCC-16783) and Candida glabrata (ATCC-90030, ATCC-2001). Results: Compound 2d displayed better percentage inhibition (26.29%, 24.81%) than fluconazole (24.44%, 22.96%) against ATCC-16783, ATCC-2001 fungal strains respectively at 100µg/ml. Compound 2f also displayed better percentage inhibition (28.51%) against ATCC-90030 as compared to fluconazone (27.4%) at 200 µg/ml. Similarly, compounds 2e and 2j also exhibited better antifungal properties than fluconazole at 200µg/ml. Compound 2e was found most potent against ATCC13803 (30.37%) and ATCC-90030 (30.37%) fungal strains as compared to fluconazole (28.14%, 27.4%) at 200 µg/ml respectively whereas compound 2j exhibited better antifungal activity (28.51%) against ATCC-60193 than fluconazole (27.7%) at 200 µg/ml. Conclusion: The results were in accordance with our assertions for triazole derivatives, as all compounds displayed moderate to good antifungal activity.

scholarly journals The Role of Fungi in the Cocoa Production Chain and the Challenge of Climate Change

2021 ◽  
Vol 7 (3) ◽  
pp. 202
Author(s):  
Johannes Delgado-Ospina ◽  
Junior Bernardo Molina-Hernández ◽  
Clemencia Chaves-López ◽  
Gianfranco Romanazzi ◽  
Antonello Paparella
Keyword(s):  
Climate Change ◽  
Fungal Infections ◽  
Close Association ◽  
Pathogenic Fungi ◽  
Fungal Species ◽  
Mitigation Strategies ◽  
Plant Diseases ◽  
Production Chain ◽  
Cocoa Production

Background: The role of fungi in cocoa crops is mainly associated with plant diseases and contamination of harvest with unwanted metabolites such as mycotoxins that can reach the final consumer. However, in recent years there has been interest in discovering other existing interactions in the environment that may be beneficial, such as antagonism, commensalism, and the production of specific enzymes, among others. Scope and approach: This review summarizes the different fungi species involved in cocoa production and the cocoa supply chain. In particular, it examines the presence of fungal species during cultivation, harvest, fermentation, drying, and storage, emphasizing the factors that possibly influence their prevalence in the different stages of production and the health risks associated with the production of mycotoxins in the light of recent literature. Key findings and conclusion: Fungi associated with the cocoa production chain have many different roles. They have evolved in a varied range of ecosystems in close association with plants and various habitats, affecting nearly all the cocoa chain steps. Reports of the isolation of 60 genera of fungi were found, of which only 19 were involved in several stages. Although endophytic fungi can help control some diseases caused by pathogenic fungi, climate change, with increased rain and temperatures, together with intensified exchanges, can favour most of these fungal infections, and the presence of highly aggressive new fungal genotypes increasing the concern of mycotoxin production. For this reason, mitigation strategies need to be determined to prevent the spread of disease-causing fungi and preserve beneficial ones.

scholarly journals The influence of intraspecific sequence variation during DNA metabarcoding: A case study of eleven fungal species

2021 ◽  
Author(s):  
Eva Lena F. Estensmo ◽  
Sundy Maurice ◽  
Luis Morgado ◽  
Pedro M. Martin‐Sanchez ◽  
Inger Skrede ◽  
...  
Keyword(s):  
Sequence Variation ◽  
Fungal Species ◽  
Dna Metabarcoding

scholarly journals Risk of infection associated with targeted therapies for solid organ and hematological malignancies

2021 ◽  
Vol 8 ◽  
pp. 204993612198954
Author(s):  
Isabel Ruiz-Camps ◽  
Juan Aguilar-Company
Keyword(s):  
Hematological Malignancies ◽  
Opportunistic Infections ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Checkpoint Inhibitors ◽  
Janus Kinase ◽  
Prolonged Treatment ◽  
Solid Organ ◽  
Risk Of Infection ◽  
Increased Risk

Higher risks of infection are associated with some targeted drugs used to treat solid organ and hematological malignancies, and an individual patient’s risk of infection is strongly influenced by underlying diseases and concomitant or prior treatments. This review focuses on risk levels and specific suggestions for management, analyzing groups of agents associated with a significant effect on the risk of infection. Due to limited clinical experience and ongoing advances in these therapies, recommendations may be revised in the near future. Bruton tyrosine kinase (BTK) inhibitors are associated with a higher rate of infections, including invasive fungal infection, especially in the first months of treatment and in patients with advanced, pretreated disease. Phosphatidylinositol 3-kinase (PI3K) inhibitors are associated with an increased risk of Pneumocystis pneumonia and cytomegalovirus (CMV) reactivation. Venetoclax is associated with cytopenias, respiratory infections, and fever and neutropenia. Janus kinase (JAK) inhibitors may predispose patients to opportunistic and fungal infections; need for prophylaxis should be assessed on an individual basis. Mammalian target of rapamycin (mTOR) inhibitors have been linked to a higher risk of general and opportunistic infections. Breakpoint cluster region-Abelson (BCR-ABL) inhibitors are associated with neutropenia, especially over the first months of treatment. Anti-CD20 agents may cause defects in the adaptative immune response, hypogammaglobulinemia, neutropenia, and hepatitis B reactivation. Alemtuzumab is associated with profound and long-lasting immunosuppression; screening is recommended for latent infections and prevention strategies against CMV, herpesvirus, and Pneumocystis infections. Checkpoint inhibitors (CIs) may cause immune-related adverse events for which prolonged treatment with corticosteroids is needed: prophylaxis against Pneumocystis is recommended.

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