scholarly journals Characterization and outcome of invasive infections due to Paecilomyces variotii: analysis of patients from the FungiScope® registry and literature reports

2020 ◽  
Author(s):  
Rosanne Sprute ◽  
Jon Salmanton-García ◽  
Ertan Sal ◽  
Xhorxha Malaj ◽  
Iker Falces-Romero ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Heart Valves ◽  
Favourable Outcome ◽  
Molecular Techniques ◽  
Major Surgery ◽  
Prosthetic Heart Valves ◽  
Paecilomyces Variotii ◽  
Invasive Infections ◽  
Oncological Diseases

Abstract Objectives To provide a basis for clinical management decisions in Paecilomyces variotii infection. Methods Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed. Results We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases. Conclusions P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome.

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.

The Effect of Dipyridamole and RA 233 on Human Platelet Function in Vitro

1973 ◽  
Vol 29 (03) ◽  
pp. 694-700 ◽  
Author(s):  
Paul L. Rifkin ◽  
Marjorie B. Zucker
Keyword(s):  
Mechanism Of Action ◽  
Human Blood ◽  
Glass Bead ◽  
Heart Valves ◽  
Human Platelet ◽  
Drug Effects ◽  
Simple Relation ◽  
Prosthetic Heart Valves ◽  
Induced Aggregation

SummaryDipyridamole (Persantin) is reported to prolong platelet survival and inhibit embolism in patients with prosthetic heart valves, but its mechanism of action is unknown. Fifty jxM dipyridamole failed to reduce the high percentage of platelets retained when heparinized human blood was passed through a glass bead column, but prolonged the inhibition of retention caused by disturbing blood in vitro. Possibly the prostheses act like disturbance. Although RA 233 was as effective as dipyridamole in inhibiting the return of retention, it was less effective in preventing the uptake of adenosine into erythrocytes, and more active in inhibiting ADP-induced aggregation and release. Thus there is no simple relation between these drug effects.

Noninvasive Electromagnetic Evaluation of Bjo¨rk-Shiley Heart Valves: Lifetime Prediction

2008 ◽  
Author(s):  
Raimond Grimberg ◽  
Adriana Savin ◽  
Shiu C. Chan ◽  
Rozina Steigmann ◽  
Lalita Udpa ◽  
...  
Keyword(s):  
Eddy Current ◽  
Heart Valves ◽  
Probability Of Detection ◽  
New Method ◽  
Lifetime Prediction ◽  
Prosthetic Heart Valves ◽  
In Vitro Experiments ◽  
Current Transducer ◽  
Eddy Current Transducer

Prosthetic heart valves of the Bjork-Shiley Convexo-Concave (BSCC) type have long been used extensively in implants; however, there have been reports of cases where one component of the valves failed, leading to the demise of the patient. This paper presents a new method for noninvasive electromagnetic evaluation for this type of valve, using an eddy current transducer with orthogonal coils. In vitro experiments have shown that discontinuities of outlet strut with depths equal or larger than 0.4mm can be detected with a probability of detection (POD) of 86.4%, and in the case of discontinuities with depth equal or larger than 0.6mm with POD of 97%.

Can the Hemodynamics of Prosthetic Heart Valves be Evaluated Sufficiently by In Vitro Tests?

1986 ◽  
pp. 47-54
Author(s):  
Martin Gottwik ◽  
S. Hartung ◽  
O. Epe ◽  
S. Langsdorf ◽  
J. Thormann ◽  
...  
Keyword(s):  
Heart Valves ◽  
In Vitro Tests ◽  
Prosthetic Heart Valves

scholarly journals In Vitro Activity of Chlorhexidine Compared with Seven Antifungal Agents against 98 Fusarium Isolates Recovered from Fungal Keratitis Patients

2019 ◽  
Vol 63 (8) ◽  
Author(s):  
Claudy Oliveira dos Santos ◽  
Eva Kolwijck ◽  
Henrich A. van der Lee ◽  
Marlou C. Tehupeiory-Kooreman ◽  
Abdullah M. S. Al-Hatmi ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Antifungal Agents ◽  
Culture Collection ◽  
Fungal Keratitis ◽  
Molecular Techniques ◽  
Temperate Climate ◽  
Eye Drops ◽  
Fungal Culture ◽  
Content Type

ABSTRACT Fungal keratitis is a common but severe eye infection in tropical and subtropical areas of the world. In regions with a temperate climate, the frequency of infection is rising in patients with contact lenses and following trauma. Early and adequate therapy is important to prevent disease progression and loss of vision. The management of Fusarium keratitis is complex, and the optimal treatment is not well defined. We investigated the in vitro activity of chlorhexidine and seven antifungal agents against a well-characterized collection of Fusarium isolates recovered from patients with Fusarium keratitis. The fungus culture collection of the Center of Expertise in Mycology Radboudumc/CWZ was searched for Fusarium isolates that were cultured from cornea scrapings, ocular biopsy specimens, eye swabs, and contact lens fluid containers from patients with suspected keratitis. The Fusarium isolates that were cultured from patients with confirmed keratitis were all identified using conventional and molecular techniques. Antifungal susceptibility testing was performed according to the EUCAST broth microdilution reference method. The antifungal agents tested included amphotericin B, voriconazole, posaconazole, miconazole, natamycin, 5-fluorocytosine, and caspofungin. In addition, the activity of chlorhexidine was determined. The fungal culture collection contained 98 Fusarium isolates of confirmed fungal keratitis cases from 83 Dutch patients and 15 Tanzanian patients. The isolates were collected between 2007 and 2017. Fusarium oxysporum (n = 24, 24.5%) was the most frequently isolated species followed by Fusarium solani sensu stricto (n = 18, 18.4%) and Fusarium petroliphilum (n = 11, 11.2%). Amphotericin B showed the most favorable in vitro inhibition of Fusarium species followed by natamycin, voriconazole, and chlorhexidine, while 5-fluorocytosine, posaconazole, miconazole, and caspofungin showed no relevant inhibiting effect. However, chlorhexidine showed fungicidal activity against 90% of F. oxysporum strains and 100% of the F. solani strains. Our study supports the clinical efficacy of chlorhexidine and therefore warrants its further clinical evaluation for primary therapy of fungal keratitis, particularly in low and middle income countries where fungal keratitis is much more frequent and, currently, antifungal eye drops are often unavailable.

Modeling Technique of Prosthetic Heart Valves

1984 ◽  
Vol 106 (1) ◽  
pp. 83-88 ◽  
Author(s):  
T. Kitamura ◽  
T. Kijima ◽  
H. Akashi
Keyword(s):  
Real Time ◽  
Heart Valves ◽  
Time Estimation ◽  
Modeling Technique ◽  
Computational Time ◽  
Prosthetic Heart Valves ◽  
The Real ◽  
Hemodynamic State ◽  
Real Time Estimation

This paper demonstrates a modeling technique of prosthetic heart valves. In the modeling, a pumping cycle is divided into four phases, in which the state of the valve and flow is different. The pressure-flow relation across the valve is formulated separately in each phase. This technique is developed to build a mathematical model used in the real time estimation of the hemodynamic state under artificial heart pumping. The model built by this technique is simple enough for saving the computational time in the real time estimation. The model is described by the first-order ordinary differential equation with 12 parameters. These parameters can be uniquely determined beforehand from in-vitro experimental data. It is shown that the model can adapt, with sufficient accuracy, to a change in the practical pumping condition and the viscosity of the fluid in their practical range, and is also demonstrated that the estimated backflow volume by model agrees closely with the actual one.

scholarly journals SIBS triblock copolymers in cardiac surgery: in vitro and in vivo studies in comparison with ePTFE

2020 ◽  
Vol 21 (4) ◽  
pp. 67-80
Author(s):  
M. A. Rezvova ◽  
E. A. Ovcharenko ◽  
P. A. Nikishev ◽  
S. V. Kostyuk ◽  
L. V. Antonova ◽  
...  
Keyword(s):  
Cell Adhesion ◽  
Heart Valves ◽  
Ex Vivo ◽  
Calcium Content ◽  
Positive Control ◽  
Prosthetic Heart Valves ◽  
Solution Casting Method ◽  
Cell Adhesion And Proliferation

Implantation of polymeric heart valves can solve the problems of existing valve substitutes – mechanical and biological. Objective: to comprehensively assess the hemocompatibility of styrene-isobutylene-styrene (SIBS) triblock copolymer, synthesized by controlled cationic polymerization in comparison with expanded polytetrafluoroethylene (ePTFE) used in clinical practice. Materials and methods. SIBS-based films were made by polymer solution casting method; in vitro biocompatibility assessment was performed using cell cultures, determining cell viability, cell adhesion and proliferation; tendency of materials to calcify was determined through in vitro accelerated calcification; in vivo biocompatibility assessment was performed by subcutaneous implantation of rat samples; hemocompatibility was determined ex vivo by assessing the degree of hemolysis, aggregation, and platelet adhesion. Results. The molecular weight of synthesized polymer was 33,000 g/mol with a polydispersity index of 1.3. When studying cell adhesion, no significant differences (p = 0.20) between the properties of the SIBS polymer (588 cells/mm2) and the properties of culture plastics (732 cells/mm2) were discovered. Cell adhesion for the ePTFE material was 212 cells/mm2. Percentage of dead cells on SIBS and ePTFE samples was 4.40 and 4.72% (p = 0.93), respectively, for culture plastic – 1.16% (p < 0.05). Cell proliferation on the ePTFE surface (0.10%) was significantly lower (p < 0.05) than for the same parameters for SIBS and culture plastic (62.04 and 44.00%). Implantation results (60 days) showed the formation of fibrous capsules with average thicknesses of 42 μm (ePTFE) and 58 μm (SIBS). Calcium content in the explanted samples was 0.39 mg/g (SIBS), 1.25 mg/g (ePTFE) and 93.79 mg/g (GA-xenopericardium) (p < 0.05). Hemolysis level of red blood cells after contact with SIBS was 0.35%, ePTFE – 0.40%, which is below positive control (p < 0.05). Maximum platelet aggregation of intact platelet-rich blood plasma was 8.60%, in contact with SIBS polymer – 18.11%, with ePTFE – 22.74%. Conclusion. In terms of hemocompatibility properties, the investigated SIBS polymer is not inferior to ePTFE and can be used as a basis for development of polymeric prosthetic heart valves.

Sign in / Sign up

Export Citation Format

Share Document