509 Fungal Infections After Blast and Thermal Injury

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S91-S91
Author(s):  
Kaitlin A Pruskowski ◽  
Julie A Rizzo ◽  
Leopoldo C Cancio
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Early Recognition ◽  
Critical Factor ◽  
Retrospective Chart Review ◽  
Blast Injury ◽  
Wound Infections ◽  
Level Of Invasion

Abstract Introduction Invasive fungal wound infections have been reported after combat-related blast injury sustained in recent conflicts. Systemic antifungal agents are commonly used as an adjunct to urgent surgical debridement. There is currently controversy in defining the depth of fungal invasion, which is the most critical factor that determines the treatment strategy. The objective of this study was to describe fungal infections in blast injury patients admitted to our burn center. Methods This was a retrospective chart review. Subjects who were admitted between January 2004 and February 2019, received a systemic antifungal agent, and experienced a blast injury were included. Culture and histopathology results were recorded. Results Eighty one patients were included. Seventy five subjects (92.6%) were active-duty service members at the time of injury and 79 (97.5%) subjects were male. On average, subjects were 27.4±7.8 years old with a burn size of 51.4±25.3% TBSA. Twenty seven subjects (33.3%) died during their hospital stay. The 75 subjects had 157 cultures positive for fungi, including 130 tissue cultures. The most common genera isolated was Aspergillus (n=148), Candida (n=106), Fusarium (n=16), and Mucor (n=12). Fifty seven percent of subjects who grew Mucor died, as compared to 52% who grew Aspergillus, 50% who grew Fusarium, and 32.3% who grew Candida. For histopathology, 33 subjects (40.7%) had results with fungus in non-viable tissue, 27 subjects (25.9%) had results with fungus in viable tissue, and 14 (17.3%) had results with angioinvasion. Subjects who had fungus in viable tissue had the highest mortality rate (71.4%), followed by angioinvasion (64.3%), and fungus in non-viable tissue (33.3%). The 75 subjects received 121 courses of systemic antifungals. The average duration of therapy was 12.3±13.6 days. The most common antifungals ordered were voriconazole (n=58), fluconazole (n=53), and liposomal amphotericin B (n=42). Conclusions Invasive fungal infection after blast injury had a high mortality rate. Early recognition and management of fungal infections is paramount to patient survival. A consensus is needed on how to best define the depth and level of invasion of fungal wound infections, and to determine the optimal treatment duration of systemic antifungal agents for these patients. Applicability of Research to Practice Invasive fungal wound infections carry a high mortality rate. A consensus is needed on the optimal systemic therapy.

508 Fungal Infections in Burn Patients from 2014–2019: A 5-year Retrospective Review

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S90-S91
Author(s):  
Kaitlin A Pruskowski ◽  
Julie A Rizzo ◽  
Leopoldo C Cancio
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Bacterial Infections ◽  
Burn Injury ◽  
Fungal Infections ◽  
Early Recognition ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Average Hospital ◽  
Time From Injury

Abstract Introduction Topical and systemic antibiotic agents used to treat burn wounds allow for fungal growth. Fungal infections often occur later in the hospital course and carry a higher mortality rate than bacterial infections in critically ill burn patients. The primary objective of this study was to describe the incidence and characteristics of fungal infections in our burn center. Methods This was a retrospective chart review. Subjects who were admitted between January 2014 and February 2019 after sustaining a burn injury and received a systemic antifungal agent were included. All cultures and histopathology results that were positive for fungus were recorded. Results Ninety one subjects were included in this analysis. The average age was 42.3±16.9 years and 74 (81.3%) subjects were male. Seventy four (81.3%) subjects were admitted after flame burn. The average burn size was 40.1±24.2% TBSA. The average hospital length of stay was 57.2±44.8 days. Thirty eight (41.7%) subjects died during their hospital stay. The 91 subjects had 220 cultures positive for fungi: 29 blood cultures, 19 BAL cultures, 23 sputum cultures, 118 tissue cultures, and 31 urine cultures. The most common fungal genera isolated were: Candida (n=146), Aspergillus (n=55), and Fusarium (n=44). Twenty six (28.6%) subjects had histopathology results that showed fungus in non-viable tissue, with an average time from injury to fungus of 20.4±11.8 days. Twenty six (28.6%) subjects had histopathology results that showed fungus in viable tissue, with an average time from injury to fungus of 22.7±16.7 days. Of note, these were not the group that had fungus in non-viable tissue. Twelve (13.2%) subjects had angioinvasion, with an average time to angioinvasion of 26.6±22 days. The 91 subjects received 133 courses of antifungals. The average course of antifungal therapy was 7.8±8.9 days. The most common antifungals used were: micafungin (n=54), fluconazole (n=53), and liposomal amphotericin B (n=44). Conclusions Patients who were started on a systemic antifungal had a high mortality rate. Common fungi isolated included Candida and Aspergillus, which is consistent with previous literature. Further research is needed on the early recognition, accurate diagnosis, and timely management of fungal infections in this patient population. Applicability of Research to Practice Fungal infections after burn injury carry a high mortality rate. Early recognition and timely management of these infections is paramount.

scholarly journals An Uncommon Feature of Chronic Granulomatous Disease in a Neonate

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Razieh Afrough ◽  
Sayyed Shahabeddin Mohseni ◽  
Setareh Sagheb
Keyword(s):  
Mortality Rate ◽  
Chronic Granulomatous Disease ◽  
High Mortality ◽  
Neonatal Period ◽  
Fungal Infections ◽  
Granuloma Formation ◽  
Granulomatous Disease ◽  
Life Threatening

Chronic Granulomatous Disease (CGD) represents recurrent life-threatening bacterial and fungal infections and granuloma formation with a high mortality rate. CGD’s sign and symptoms usually appear in infancy and children before the age of five; therefore, its presentation in neonatal period with some uncommon features may be easily overlooked. Here we describe a case of CGD in a 24-day-old boy, presenting with a diffuse purulent vesiculopustular rash and multiple osteomyelitis.

Infectious Cavernous Sinus Thrombosis Presenting as Temporal Arteritis—A Case Report

2020 ◽  
pp. 194187442095784
Author(s):  
Rizwan Sabir ◽  
McNeill Kirkpatrick ◽  
Jonathan Watts ◽  
Jindong Xu
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Mortality Rate ◽  
Cavernous Sinus ◽  
High Mortality ◽  
Temporal Arteritis ◽  
Early Recognition ◽  
Sinus Thrombosis ◽  
Cavernous Sinus Thrombosis ◽  
Delayed Recognition

Cavernous sinus thrombosis (CST) is rare and can present with various nonspecific symptoms. The high mortality rate of this disease is largely due to delayed recognition and treatment. We report a case who presented with unrelenting headache and was diagnosed with temporal arteritis (TA) but did not respond to steroids. Imaging helped make the CST diagnosis and the patient responded well to treatment. This case reiterates the importance of early recognition and treatment of CST, and reminds physicians to include CST as an essential differential diagnosis of TA.

scholarly journals Characteristics of Invasive Fungal Infections among HIV Individuals from an Indigenous Origin in Mexico

2018 ◽  
Vol 4 (3) ◽  
pp. 109
Author(s):  
Mercedes Aranda-Audelo ◽  
Norma Rivera-Martínez ◽  
Dora Corzo-León
Keyword(s):  
Acute Kidney Injury ◽  
T Cells ◽  
Retrospective Study ◽  
Mortality Rate ◽  
High Mortality ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Invasive Fungal Infections ◽  
Atypical Pneumonia ◽  
Hiv Aids

In individuals with HIV/AIDS, 47% of the deaths are attributed to invasive fungal infections (IFIs), despite antiretroviral (ARV) therapy. This is a retrospective study carried out in the Hospital Regional de Alta Especialidad Oaxaca (HRAEO), southwest Mexico, where IFIs that occurred during 2016–2017 are described. A total of 55 individuals were included. Histoplasmosis (36%) and possible-IFIs in neutropenic fever (20%) were the most frequent cases, followed by cryptococcosis (14%). The HIV/AIDS subpopulation corresponded with 26 cases (47%), all from an indigenous origin. The incidence of IFIs among them was 24% (95% CI = 15–33%). The CD4+ T cells median was 35 cells/mL (IQR 12–58). Four cases (15%) of unmasking IRIS were identified, three of histoplasmosis and one coccidioidomycosis. Co-infections were found in 52% (12/23), and tuberculosis in 50% (6/12) was the most frequent. The mortality rate was 48%. The general characteristics of the HIV individuals who died were atypical pneumonia (70% vs. 9%, p = 0.01), acute kidney injury, (70% vs. 9%, p = 0.008) and ICU stay (80% vs. 9%, p = 0.002). In conclusion, IFIs are diagnosed in one out of four individuals with HIV/AIDS along with other complicated infectious conditions, leading to major complications and a high mortality rate.

scholarly journals 366. Characteristics and Outcomes of COVID-19 Patients with Fungal Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S253-S253
Author(s):  
Erica Herc ◽  
Nicholas F Yared ◽  
Adam Kudirka ◽  
Geehan Suleyman
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Fungal Infections ◽  
Average Length ◽  
Demographic Data ◽  
Descriptive Analysis ◽  
Retrospective Chart Review ◽  
Central Line ◽  
Source Control

Abstract Background There is concern that patients with coronavirus disease 2019 (COVID-19) are at risk of developing secondary bacterial and fungal infections; however, data on the clinical characteristics and outcomes of COVID-19 patients with fungal infections are limited. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with fungal infections. Methods This was a retrospective chart review of 51 patients with fungal infections at an 877-bed teaching hospital in Detroit, Michigan from March through May 2020. Demographic data, comorbidities, complications, treatment, and outcomes, including relapse, readmission and mortality were collected. We performed a descriptive analysis. Results A total of 51 patients with fungal infections were included, in which 31 (60.8%) had confirmed or suspected COVID-19 infection. Of the COVID-19 patients, the average age was 66 years and the majority (54.9%) were female. The average length of stay (LOS) was 29.3 days. Aspergillus sp. (2 A. fumigatus, 1 A. niger) were isolated in 3 (10%) patients while 23 (74.2%) had candidemia diagnosed via blood culture or T2Candida® Panel. One had a positive serum galactomannan. The average time from admission to diagnosis was 13 days. Significant comorbidities included hypertension (74%), diabetes (51.6%), coronary artery disease (25.8%), congestive heart failure (32.2%), chronic kidney disease (22.6%), and malignancy (16.1%). Most patients received steroids (83.9%) and broad-spectrum antibiotics (80.6%), had a central line (80.6%), and required intensive care unit management (90%). Only 71% were treated with antifungals. One patient with candidemia relapsed due to poor source control; two were readmitted within 30 days. In-hospital mortality rate was 51.6% among COVID-19 patients. Conclusion COVID-19 patients with fungal infections had multiple comorbidities, prolonged hospitalization and predisposing risk factors for fungal infections with a high in-hospital mortality rate. Prevention of fungal infections in COVID-19 patients is paramount. Disclosures All Authors: No reported disclosures

scholarly journals Fournier’s gangrene. A clinical review

2016 ◽  
Vol 88 (3) ◽  
pp. 157 ◽  
Author(s):  
Ariana Singh ◽  
Kamran Ahmed ◽  
Abdullatif Aydin ◽  
Muhammad Shamim Khan ◽  
Prokar Dasgupta
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Early Recognition ◽  
Care Pathway ◽  
Disease Process ◽  
Fournier’S Gangrene ◽  
Prognostic Indicators ◽  
Fournier's Gangrene ◽  
Randomized Controlled Studies ◽  
Clinical Awareness

Introduction and Hypothesis: Fournier’s gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier’s gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier’s gangrene, in particular the various prognostic indicators and management strategies. Methods: A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Results: Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier’s gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents their routine use in the management of Fournier’s gangrene. The absence of a specific care pathway may hinder efficient management of Fournier’s gangrene, thus based on current guidelines a management pathway is suggested.

Myocarditis in drug rash with eosinophilia and systemic symptoms

2014 ◽  
Vol 25 (6) ◽  
pp. 1210-1213 ◽  
Author(s):  
Cynthia H. Ho ◽  
Merujan Y. Uzunyan
Keyword(s):  
Mortality Rate ◽  
Hypersensitivity Reaction ◽  
Natriuretic Peptide ◽  
High Mortality ◽  
Early Recognition ◽  
Drug Hypersensitivity ◽  
Drug Hypersensitivity Reaction ◽  
Drug Rash ◽  
Systemic Symptoms

AbstractDrug rash with eosinophilia and systemic symptoms is a drug hypersensitivity reaction. Hepatitis and nephritis are the most common visceral manifestations. Myocarditis is important to recognise, given the high mortality rate. We describe a child with drug rash with eosinophilia and systemic symptoms and discuss the role of N-terminal pro-hormone of basic natriuretic peptide in early recognition of associated myocarditis.

scholarly journals Sepsis: implication for nursing

2016 ◽  
Vol 10 (4) ◽  
pp. 360
Author(s):  
Fabio Bertoncini ◽  
Dino Stefano Di Massimo ◽  
Claudia Gatta
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Health Problem ◽  
Early Recognition ◽  
Pathological State ◽  
Nursing Role ◽  
Infection Management ◽  
Clinical Nurses ◽  
Reduction Of Mortality ◽  
Pass Through

Sepsis is a serious health problem that is off worldwide interest; it is associated with a high mortality rate despite continuing improvements in infection management and the awareness of population is still poor despite its importance. Direct interventions to achieve the goal of clinician, like reduction of mortality, pass through the resuscitation and antibiotics but their effectiveness depends on the early recognition of symptoms and therefore the septic state. The nursing role is crucial both for the early recognition of the disease state, as well as to treat the patient with professionalism and promptness and to provide appropriate assistance to the kind of complexity that creates this pathological state: to achieve these aims, recommendations and bundles were developed to guide clinical nurses in septic patients’ care.

Emamectin benzoate is a safe and effective anthelmintic against coelomic nematode Philometra rubra in striped bass Morone saxatilis

2020 ◽  
Vol 142 ◽  
pp. 47-53
Author(s):  
K Béland ◽  
G Séguin ◽  
S Lair
Keyword(s):  
Mortality Rate ◽  
Striped Bass ◽  
High Mortality ◽  
Morone Saxatilis ◽  
Treatment Results ◽  
Emamectin Benzoate ◽  
Once Daily ◽  
Fish Hatchery ◽  
Parasitic Burden

An unusually high mortality rate due to verminous (Philometra rubra) coelomitis was documented in wild-hatched striped bass Morone saxatilis raised in a fish hatchery as part of a stock restoration program. To decrease the parasitic burden and therefore potentially minimize mortality, the effectiveness of 2 different anthelmintics was evaluated. Two trials were conducted on wild-collected fingerlings naturally infected by P. rubra. In 2006, 144 yearling fish were randomly assigned to 4 experimental groups: (1) levamisole (Levasol®) at 2 mg l-1 via immersion for 8 h once weekly for 3 wk; (2) levamisole at a dose of 2.5 mg kg-1 biomass via feed once daily for 7 d; (3) emamectin benzoate (Slice®) at a dose of 0.05 mg kg-1 biomass via feed once daily for 7 d; and (4) control. Emamectin successfully eliminated live nematodes in 84.9% of the fish, whereas the administration of levamisole, either via immersion or feed, was not successful in significantly reducing the number of live P. rubra. In 2007, the administration of the same dosage of emamectin to approximately 1000 naturally infected yearling striped bass was associated with a 100% mortality rate of P. rubra in the 30 fish randomly examined 5 wk after the beginning of the treatment. Results of these trials indicate that, at the dosage used, the administration of emamectin at the end of the summer is safe for striped bass yearlings and considerably reduces the prevalence and intensity of the infection by this parasite.

Inovasi Teknologi Pembuatan Pakan Udang dengan Penambahan Tepung Kopasanda (Chromolaena odorata L.) di Desa Tamangapa Kecamatan Ma’rang Kab. Pangkep

2019 ◽  
Vol 3 (2) ◽  
pp. 140
Author(s):  
Harlina Harlina ◽  
Hadijah Hadijah ◽  
Kamaruddin Kamaruddin ◽  
Ernaningsih Ernaningsih
Keyword(s):  
Mortality Rate ◽  
Community Service ◽  
High Mortality ◽  
Raw Materials ◽  
Development Program ◽  
Chromolaena Odorata ◽  
Farmed Fish ◽  
Counseling Training ◽  
Shrimp Feed ◽  
Simple Technology

Tamangapa village, Ma’rang district is part of the community development program conducted by Universitas Muslim Indonesia in Pangkajene Kepulauan regency. The local shrimp farmers of Tamangapa village have been facing major issue due to expensive artificial feed and high mortality rate. In order to solve the needs of feed and high mortality rate for farmed fish or shrimp, the source of the natural ingredients using kopasanda leaves Chromolaena odorata L is required. The use of a natural ingredient is also used to prevent the vibriosis using simple technology such as the utilization of local raw materials which is affordable and locally available. The present community service aimed to provide the proper knowledge and skills to members of the fish/shrimp farmer’s group through counseling, training and mentoring. This community service program encouraged the local farmers to be able to utilize the local raw materials as a source of shrimp feed, use the feed pellet machine, and packaging leading to independent feed production. The participatory training method, lectures, forum group discussions, and practices of making shrimp feed and packaging were applied. The Implementation of the Community Partnership Program of Shrimp and Fish Cultivation Groups is independently able to produce organic fish or shrimp feed for farmer’s group leading to higher productivity of aquaculture.

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