scholarly journals 935. A Hospital Cluster of the Emerging Drug-resistant Yeast Saprochaete clavata

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S560-S560
Author(s):  
Xin Hui S Chan ◽  
Cristina Cubillo-Garcia ◽  
Shanom Ali ◽  
Rebecca Gorton ◽  
Johanna Rhodes ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Delayed Diagnosis ◽  
Drug Resistant ◽  
Antifungal Stewardship ◽  
Ascomycetous Yeast ◽  
Invasive Infections ◽  
Clear Point ◽  
Immunosuppressed Patients ◽  
Refractory Malignancy ◽  
Guided Therapy

Abstract Background Saprochaete clavata, an ascomycetous yeast intrinsically resistant to echinocandins, is a rare yet emerging pathogen associated with invasive infections in immunosuppressed patients, particularly those with haematological malignancies. It is commonly misidentified as the closely-related S. capitata. Outbreaks have been associated with a high mortality rate of >50%, due in part to delayed diagnosis and resistance to commonly-used antifungals. Environmental source identification is challenging, although dishwashers and milk flasks have been implicated in previous hospital clusters. Methods We describe a cluster of five haematology-oncology patients with disseminated S. clavata infections between April 2020 and April 2021 following current or recent admissions to the same ward. Results All had prolonged (median=24 days, range=9-210) and profound immunosuppression from chemotherapy and/or stem cell transplantation for acute myeloid leukaemia (n=3) or lymphoma (n=2) at the time of culture positivity. Four were severely neutropaenic (median=0.08/mm3, range=0.01-0.26). Median patient age was 62 years (range=58-73). S. clavata was isolated from blood (n=3), urine (n=2), and liver tissue (n=1) samples. Whole genome sequencing of these isolates was performed to confirm the presence of an outbreak. All patients received empirical treatment with intravenous caspofungin before culture-guided therapy with intravenous liposomal amphotericin B +/- oral flucytosine. Two of the five patients died although both had advanced refractory malignancy. Detailed environmental sampling of fridges/freezers, drains, and vents in patient rooms and clean areas for handling or storage of food and medication failed to identify a clear point source despite isolation of multiple environmental organisms. No further cases have emerged after intensification of the cleaning regimen in these areas. Conclusion Our experience highlights the emerging threat of drug-resistant yeasts particularly in the immunocompromised. Management of such outbreaks requires a multidisciplinary approach incorporating antifungal stewardship, infection control, and environmental microbiology, alongside close clinical liaison between haemato-oncologists and infection specialists. Disclosures All Authors: No reported disclosures

scholarly journals Cancer immunotherapy in special challenging populations: recommendations of the Advisory Committee of Spanish Melanoma Group (GEM)

2021 ◽  
Vol 9 (3) ◽  
pp. e001664
Author(s):  
Maria Gonzalez-Cao ◽  
Teresa Puertolas ◽  
Mar Riveiro ◽  
Eva Muñoz-Couselo ◽  
Carolina Ortiz ◽  
...  
Keyword(s):  
Cancer Immunotherapy ◽  
Multidisciplinary Approach ◽  
Checkpoint Inhibitors ◽  
Solid Organ Transplantation ◽  
Latent Tuberculosis ◽  
Solid Organ ◽  
Chronic Infections ◽  
Immunosuppressed Patients ◽  
History Of ◽  
Evidence Based Guidelines

Cancer immunotherapy based on the use of antibodies targeting the so-called checkpoint inhibitors, such as programmed cell death-1 receptor, its ligand, or CTLA-4, has shown durable clinical benefit and survival improvement in melanoma and other tumors. However, there are some special situations that could be a challenge for clinical management. Persons with chronic infections, such as HIV-1 or viral hepatitis, latent tuberculosis, or a history of solid organ transplantation, could be candidates for cancer immunotherapy, but their management requires a multidisciplinary approach. The Spanish Melanoma Group (GEM) panel in collaboration with experts in virology and immunology from different centers in Spain reviewed the literature and developed evidence-based guidelines for cancer immunotherapy management in patients with chronic infections and immunosuppression. These are the first clinical guidelines for cancer immunotherapy treatment in special challenging populations. Cancer immunotherapy in chronically infected or immunosuppressed patients is feasible but needs a multidisciplinary approach in order to decrease the risk of complications related to the coexistent comorbidities.

scholarly journals Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 877
Author(s):  
Amir Arastehfar ◽  
Toni Gabaldón ◽  
Rocio Garcia-Rubio ◽  
Jeffrey D. Jenks ◽  
Martin Hoenigl ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Antifungal Drugs ◽  
Great Promise ◽  
Therapeutic Drug ◽  
Agricultural Crop ◽  
Drug Resistant ◽  
Drug Pressure ◽  
Related Factors ◽  
Antifungal Stewardship

The high clinical mortality and economic burden posed by invasive fungal infections (IFIs), along with significant agricultural crop loss caused by various fungal species, has resulted in the widespread use of antifungal agents. Selective drug pressure, fungal attributes, and host- and drug-related factors have counteracted the efficacy of the limited systemic antifungal drugs and changed the epidemiological landscape of IFIs. Species belonging to Candida, Aspergillus, Cryptococcus, and Pneumocystis are among the fungal pathogens showing notable rates of antifungal resistance. Drug-resistant fungi from the environment are increasingly identified in clinical settings. Furthermore, we have a limited understanding of drug class-specific resistance mechanisms in emerging Candida species. The establishment of antifungal stewardship programs in both clinical and agricultural fields and the inclusion of species identification, antifungal susceptibility testing, and therapeutic drug monitoring practices in the clinic can minimize the emergence of drug-resistant fungi. New antifungal drugs featuring promising therapeutic profiles have great promise to treat drug-resistant fungi in the clinical setting. Mitigating antifungal tolerance, a prelude to the emergence of resistance, also requires the development of effective and fungal-specific adjuvants to be used in combination with systemic antifungals.

scholarly journals The Current State of Antifungal Stewardship in Immunocompromised Populations

2021 ◽  
Vol 7 (5) ◽  
pp. 352
Author(s):  
William Alegria ◽  
Payal K. Patel
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Costs ◽  
Adverse Drug Events ◽  
Immunocompromised Patient ◽  
Antibiotic Use ◽  
Drug Resistant ◽  
Antifungal Stewardship ◽  
Current State ◽  
Complex Population ◽  
Antifungal Use

Inappropriate antifungal use is prevalent and can lead to drug-resistant fungi, expose patients to adverse drug events, and increase healthcare costs. While antimicrobial stewardship programs have traditionally focused on antibiotic use, the need for targeted antifungal stewardship (AFS) intervention has garnered interest in recent years. Despite this, data on AFS in immunocompromised patient populations is limited. This paper will review the current state of AFS in this complex population and explore opportunities for multidisciplinary collaboration.

scholarly journals Anticapsular and Antifungal Activity of α-Cyperone

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 51
Author(s):  
Connor Horn ◽  
Govindsamy Vediyappan
Keyword(s):  
Antifungal Activity ◽  
Fungal Pathogens ◽  
Fungal Infections ◽  
Antifungal Drugs ◽  
Cyperus Rotundus ◽  
Drug Resistant ◽  
Fungal Virulence ◽  
Medical Needs ◽  
Number Of Patients ◽  
Immunosuppressed Patients

Fungal infections affect 300 million people and cause 1.5 million deaths globally per year. With the number of immunosuppressed patients increasing steadily, there is an increasing number of patients infected with opportunistic fungal infections such as infections caused by the species of Candida and Cryptococcus. In fact, the drug-resistant Can. krusei and the emerging pan-antifungal resistant Can. auris pose a serious threat to human health as the existing limited antifungals are futile. To further complicate therapy, fungi produce capsules and spores that are resistant to most antifungal drugs/host defenses. Novel antifungal drugs are urgently needed to fill unmet medical needs. From screening a collection of medicinal plant sources for antifungal activity, we have identified an active fraction from the rhizome of Cyperus rotundus, the nut grass plant. The fraction contained α-Cyperone, an essential oil that showed fungicidal activity against different species of Candida. Interestingly, the minimal inhibitory concentration of α-Cyperone was reduced 8-fold when combined with a clinical antifungal drug, fluconazole, indicating its antifungal synergistic potential and could be useful for combination therapy. Furthermore, α-Cyperone affected the synthesis of the capsule in Cryp. neoformans, a causative agent of fungal meningitis in humans. Further work on mechanistic understanding of α-Cyperone against fungal virulence could help develop a novel antifungal agent for drug-resistant fungal pathogens.

Exuberant manifestation of neurofibromatosis type 1 affecting 3 generations: delayed diagnosis and the importance of the multidisciplinary approach

2019 ◽  
Vol 128 (3) ◽  
pp. e108-e112
Author(s):  
Elen de Souza Tolentino ◽  
Gustavo Nascimento de Souza Pinto ◽  
Larissa Maciel ◽  
Cleverson Teixeira Soares ◽  
Vanessa Soares Lara ◽  
...  
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Multidisciplinary Approach ◽  
Delayed Diagnosis ◽  
Neurofibromatosis Type

scholarly journals Dyke-Davidoff-Masson Syndrome: A Delayed Diagnosis of an Acquired Variant

2018 ◽  
Vol 2 (2) ◽  
pp. e000121
Author(s):  
T Seetam Kumar ◽  
Abhijit Vipul ◽  
Rohtas Yadav
Keyword(s):  
Mental Retardation ◽  
Early Diagnosis ◽  
Female Patient ◽  
Clinical Presentation ◽  
Delayed Diagnosis ◽  
Intractable Epilepsy ◽  
Drug Resistant ◽  
Cerebral Hemiatrophy ◽  
Frontal Sinuses

Dyk-Davidof-Masson Syndrome (DDMS) is an important cause of intractable and drug-resistant seizures. It has varied clinical presentation and history with distinct neuroimaging features. Here, we describe a female patient presented with recurrent intractable convulsion, mental retardation, hemiparesis, and characteristic neuroimaging features of cerebral hemiatrophy, calvarial thickening, and ipsilateral hyperpneumatization of the frontal sinuses which is suggestive of DDMS. Early institution of neuroimaging in patients with intractable epilepsy will make early diagnosis and better outcome.

scholarly journals HELLP syndrome: An experience of treating with plasma exchange

2013 ◽  
Vol 1 (2) ◽  
pp. 102-103
Author(s):  
Shahzadi Sayeeda Tun Nessa ◽  
Mohammd Mufizul Islam Polash ◽  
Md Motiul Islam ◽  
Ahmad Mursel Anam ◽  
Muhammad Mahbubul Rahman Bhuiyan
Keyword(s):  
Hellp Syndrome ◽  
Multidisciplinary Approach ◽  
Delayed Diagnosis ◽  
Severe Preeclampsia ◽  
Coagulation System ◽  
Hepatic Inflammation ◽  
Placental Development ◽  
Low Platelet Count ◽  
Independent Entity ◽  
And Function

In the spectrum of patient with severe pre-eclampsia, there is a potentially lethal complication called HELLP syndrome( haemolysis, elevated liver enzyme and low platelet count).1 The pathogenesis of HELLP syndrome is unclear. If it is a form of severe preeclampsia, it likely originates from aberrant placental development and function. As an independent entity, it has been attributed to abnormal placentation, similar to preeclampsia, but with greater hepatic inflammation and greater activation of the coagulation system than in preeclampsia.2,3,4 HELLP develops in approximately 0.5 to 0.9 percent of all pregnancies and in 10 to 20 percent of women with severe preeclampsia/eclampsia.5 Maternal mortality rate in HELLP syndrome is variable(1-23%) due to severity of disease, delayed diagnosis and presence of multi-organ involvement.6,7 So the recognition of HELLP syndrome and an aggressive multidisciplinary approach are required for the improvement of meternofoetal prognosis. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17204 Bangladesh Crit Care J September 2013; 1 (2): 102-103

scholarly journals Dual Ureaplasma parvum arthritis: a case report of U. parvum septic arthritis following contralateral reactive arthritis in an immunosuppressed patient

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lea Lemoine ◽  
Cecile Le Brun ◽  
Francois Maillot ◽  
Camille Thorey ◽  
Annaelle Boucaud ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Reactive Arthritis ◽  
Immunocompromised Patient ◽  
Immunosuppressed Patient ◽  
Sample Treatment ◽  
Case Presentation ◽  
Ureaplasma Parvum ◽  
High Prevalence ◽  
Invasive Infections ◽  
Immunosuppressed Patients

Abstract Background Ureaplasma parvum is usually part of the normal genital flora. Rarely can it cause invasive infections such as genitourinary infections, septic arthritis, or meningitis. Case presentation Here we present the first description of chronic ureterocystitis in a 56-year-old immunocompromised patient, complicated first by reactive arthritis and secondarily by contralateral septic arthritis due to U. parvum infection. U. parvum was detected in synovial fluid and in a urine sample. Treatment consisted of double-J stenting and targeted antibiotic therapy. Evolution showed resolution of urinary symptoms and clinical improvement of arthritis despite functional sequelae. Conclusions Given the high prevalence of U. parvum colonisation, this diagnosis should remain a diagnosis of exclusion. However, because of the difficulty in detecting this microorganism, it should be considered in unexplained subacute urethritis or arthritis, including reactive arthritis, especially in immunosuppressed patients. Real-time PCR positivity in the absence of a differential diagnosis should not be overlooked.

scholarly journals Langerhan’s cell Histiocytosis of Sphenoid Sinus causing Vision Loss: A Case Report

2019 ◽  
Vol 57 (218) ◽  
Author(s):  
Suresh Mani ◽  
Regi Thomas ◽  
John Mathew ◽  
Rajiv Michael
Keyword(s):  
Sphenoid Sinus ◽  
Multidisciplinary Approach ◽  
Vision Loss ◽  
Clinical Presentation ◽  
Delayed Diagnosis ◽  
Rare Entity ◽  
Management Options ◽  
Pertinent Literature ◽  
Radiological Features ◽  
Variable Clinical Presentation

Langerhan's cell histiocytosis is an uncontrolled proliferation of dendritic cells. The involvement of skull base is rare. Variable clinical presentation and multi organ involvement often warrant a multidisciplinary approach for a successful diagnosis. We are reporting a case of 16-year-old male with sphenoid sinus Langerhan’s cell histiocytosis which presented as a sudden and painless loss of vision. It is a rare entity in the diagnosis of blindness. Delayed diagnosis and treatment can result in serious complications. The radiological features and management options are discussed with a review of the pertinent literature.  

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