scholarly journals COVID-19-associated Invasive Fungal Infection

2021 ◽  
Author(s):  
John W Baddley ◽  
George R Thompson ◽  
Sharon C-A Chen ◽  
P Lewis White ◽  
Melissa D Johnson ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Fungal Infections ◽  
Lung Damage ◽  
Fungal Colonization ◽  
Recent Emergence ◽  
Viral Illness ◽  
Poor Outcomes ◽  
Endemic Mycoses

Abstract COVID-19 can become complicated by secondary invasive fungal infections (IFI), stemming primarily from severe lung damage and immunologic deficits associated with the virus or immunomodulatory therapy. Other risk factors include poorly controlled diabetes, structural lung disease and/or other comorbidities, and fungal colonization. Opportunistic invasive fungal infection following severe respiratory viral illness has been increasingly recognized, most notably with severe influenza. There have been many reports of fungal infections associated with COVID-19, initially predominated by pulmonary aspergillosis, but with recent emergence of mucormycosis, candidiasis and endemic mycoses. These infections can be challenging to diagnose and are associated with poor outcomes. The reported incidence of IFI has varied, often related to heterogeneity in patient populations, surveillance protocols and definitions used for classification of fungal infections. Herein, we review IFI complicating COVID-19 and address knowledge gaps related to epidemiology, diagnosis and management of COVID-19-associated fungal infections.

scholarly journals Epidemiology and Clinical Features of Invasive Fungal Infection in a US Health Care Network

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Brandon J Webb ◽  
Jeffrey P Ferraro ◽  
Susan Rea ◽  
Stephanie Kaufusi ◽  
Bruce E Goodman ◽  
...  
Keyword(s):  
Health Care ◽  
Fungal Infection ◽  
Clinical Features ◽  
Invasive Fungal Infection ◽  
Fungal Infections ◽  
Dimorphic Fungi ◽  
European Organization ◽  
Care Network ◽  
Health Care Network ◽  
Intermountain Healthcare

Abstract Background A better understanding of the epidemiology and clinical features of invasive fungal infection (IFI) is integral to improving outcomes. We describe a novel case-finding methodology, reporting incidence, clinical features, and outcomes of IFI in a large US health care network. Methods All available records in the Intermountain Healthcare Enterprise Data Warehouse from 2006 to 2015 were queried for clinical data associated with IFI. The resulting data were overlaid in 124 different combinations to identify high-probability IFI cases. The cohort was manually reviewed, and exclusions were applied. European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group definitions were adapted to categorize IFI in a broad patient population. Linear regression was used to model variation in incidence over time. Results A total of 3374 IFI episodes occurred in 3154 patients. The mean incidence was 27.2 cases/100 000 patients per year, and there was a mean annual increase of 0.24 cases/100 000 patients (P = .21). Candidiasis was the most common (55%). Dimorphic fungi, primarily Coccidioides spp., comprised 25.1% of cases, followed by Aspergillus spp. (8.9%). The median age was 55 years, and pediatric cases accounted for 13%; 26.1% of patients were on immunosuppression, 14.9% had autoimmunity or immunodeficiency, 13.3% had active malignancy, and 5.9% were transplant recipients. Lymphopenia preceded IFI in 22.1% of patients. Hospital admission occurred in 76.2%. The median length of stay was 16 days. All-cause mortality was 17.0% at 42 days and 28.8% at 1 year. Forty-two-day mortality was highest in Aspergillus spp. (27.5%), 20.5% for Candida, and lowest for dimorphic fungi (7.5%). Conclusions In this population, IFI was not uncommon, affected a broad spectrum of patients, and was associated with high crude mortality.

scholarly journals 78. Non-Invasive Prediction of Invasive Fungal Infection by Plasma-Based Microbial Cell-Free DNA Next-Generation Sequencing (mcfDNA NGS) in Pediatric Patients with Relapsed or Refractory Leukemia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
Joshua Wolf ◽  
Joshua Wolf ◽  
Gabriela Maron ◽  
Kathryn Goggin ◽  
Kim J Allison ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Fungal Pathogen ◽  
Pediatric Patients ◽  
Hematopoietic Cell Transplantation ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Non Invasive ◽  
Clinical Onset ◽  
Fungal Dna

Abstract Background Diagnosis of invasive fungal infections (IFIs), a life-threatening complication of cancer therapy or hematopoietic cell transplantation (HCT) can be challenging, and IFI has poor outcomes. Prediction or early non-invasive diagnosis of IFI in high-risk hosts before onset of symptoms could reduce morbidity and mortality. Because non-invasive plasma mcfDNA NGS can detect invasive fungal infections, and may predict bloodstream infections in immunocompromised patients, we hypothesized that mcfDNA NGS might also predict invasive fungal infection before clinical presentation. Methods In a prospective study, serial remnant plasma samples were collected from pediatric patients undergoing treatment for relapsed or refractory leukemia. IFI events were classified according to EORTC criteria by 2 independent experts, and episodes empirically treated for suspected IFI, but not meeting ‘possible’ criteria were classified as ‘suspected’. All samples collected within 30 days before clinical diagnosis of non-fungemic IFI were tested for fungal DNA by mcfDNA NGS using a research-use only assay by Karius, Inc. optimized for fungi; because of overlapping clinical syndromes, non-fungal DNA was not considered in this study. Results There were 15 episodes of suspected IFI in 14 participants with ≥1 sample available from either diagnostic (within 1 day of diagnosis) or predictive (2 to 30 days prior to diagnosis) periods (5 “suspected”, and 4 probable and 6 proven by EORTC definitions). Of 10 probable or proven IFIs, 6 (60%) had a relevant fungal pathogen identified mcfDNA NGS at diagnosis. In each of these cases the fungal DNA was also detectable prior to clinical onset of IFI (Range 2 to 41 days; Figure 1). In an additional case, manual review of sequence data identified the fungal DNA at diagnosis and during the prior month. Of 5 “suspected” IFI episodes, all were determined by expert review as not representing fungal infection; fungal DNA was identified by mcfDNA NGS in 2/54 (3.7%) of samples from these episodes. Table 1. Characteristics of Invasive Fungal Infections Conclusion mcfDNA NGS can identify fungal pathogen DNA before clinical onset of IFI, so might predict IFI in immunocompromised hosts, and may help differentiate fungal infection from other etiologies of lung nodules or infiltrates. Disclosures Joshua Wolf, MBBS, PhD, FRACP, Karius Inc. (Research Grant or Support) Joshua Wolf, MBBS, PhD, FRACP, Nothing to disclose Radha Duttagupta, PhD, Karius inc (Employee) Lily Blair, PhD, Karius Inc. (Employee) Asim A. Ahmed, MD, Karius, Inc. (Employee)

scholarly journals Risk Factors of Invasive Fungal Infection in Recipients After Liver Transplantation: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Min Liu ◽  
Zhijun Zhu ◽  
Liying Sun
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Fungal Colonization ◽  
Newcastle Ottawa Scale ◽  
The Cochrane Library

Objectives: Invasive fungal infection (IFI) remains an important cause of mortality in liver transplantation (LT). The objective of this meta-analysis was to identify the risk factors for IFI after LT.Methods: We searched for relevant studies published up to June 2020 from PubMed, Web of Science, Embase, and the Cochrane Library. Odds ratios (ORs) and their corresponding 95% CIs were used to identify significant differences in the risk factors. Heterogeneity between studies was evaluated by the I2 test, and potential publication bias was assessed with Egger's test. The quality of included studies was evaluated with the Newcastle-Ottawa Scale (NOS).Results: A total of 14 studies enrolling 4,284 recipients were included in the meta-analysis. Reoperation (OR = 2.18, 95% CI: 1.61–2.94), posttransplantation dialysis (OR = 2.03, 95% CI: 1.52–2.72), bacterial infection (OR = 1.81, 95% CI: 1.33–2.46), live donor (OR = 1.78, 95% CI: 1.20–2.63), retransplantation (OR = 2.45, 95% CI: 1.54–3.89), and fungal colonization (OR = 2.60, 95% CI: 1.99–3.42) were associated with the risk factors of IFI after LT.Conclusions: Despite some risk factors that have been identified as significant factors for IFI post-LT, which may inform prevention recommendations, rigorous and well-designed studies with adequate sample sizes should be conducted to solve the limitations of this study.

scholarly journals Dosing of Antimycotic Treatment in Sepsis–Induced Liver Dysfunction by Functional Liver Testing with LiMAx®

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Carmen Kirchner ◽  
Jasmin Sibai ◽  
Elke Schwier ◽  
Dietrich Henzler ◽  
Claas Eickmeyer ◽  
...  
Keyword(s):  
Liver Function ◽  
Fungal Infection ◽  
Medical History ◽  
Invasive Fungal Infection ◽  
Fungal Infections ◽  
Multiorgan Failure ◽  
Clinical Status ◽  
Good Condition ◽  
Added Value ◽  
Renal Infarction

Background. Sepsis-treatment is one of the major challenges in our time. Especially fungal infections play an important role in patient’s morbidity and mortality. In patients with septic shock, liver function is often significantly impaired and therefore also hepatic drug metabolism is altered. Case Presentation. We report about a 56-year-old man suffering from invasive fungal infection with multiorgan failure, after complicated medical history due to symptomatic infrarenal aortic aneurysm. On the first postoperative day, a CT scan was undertaken due to massive back pain showing renal infarction on both sides. As qualitative and quantitative renal function was impaired, hemodialysis was started immediately. Subsequently, the patient developed a compartment syndrome of the left leg and underwent fasciotomy. On admission day 7, the patient presented with hematochezia leading to colonoscopy. During this procedure, an ischemic colitis was observed. As conservative treatment failed, the patient underwent Hartmann’s procedure due to progredient ischemia followed by a worsening of the clinical status due to sepsis. The patient suffered from an invasive fungal infection with Candida spp. and Aspergillus spp. Systemic antifungal treatment was initiated. Although azoles are considered first-line treatment in these cases we chose the echinocandin caspofungin for its presumed lower impact on liver function compared to azoles like voriconazole or Amphothericin B. However, caspofungin is also metabolised in the liver and can cause hepatotoxic effects. Therefore we measured metabolic liver function capacity using LiMAx®and adapted the patient’s dose of caspofungin to the evaluated liver function capacity to achieve an effective and liver-protective level of the active drug. After complicated medical history with 15 weeks of hospital stay, the patient was discharged in general good condition. Conclusions. To our knowledge, this is the first report that relates antimycotic drug dosing to a functional liver test. We provide a new approach for sepsis treatment considering liver function capacity to optimize dosage of hepatically metabolised drugs with potential hepatotoxic effects.

Fungal Infections

2013 ◽  
Author(s):  
Sara Buckman ◽  
Luis A. Fernandez
Keyword(s):  
Fungal Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Diagnostic Methods ◽  
Fungal Colonization ◽  
Surgical Patient ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant patients, and sick neonates all being especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients, developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients, organ transplantation has evolved dramatically, and the use of invasive therapies has increased markedly. With these changes has come an increase in the incidence of serious Candida infections, as well as an increase in the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. This review covers fungal colonization versus infection, types of fungal infection, epidemiology and risk factors, clinical evaluation, investigative studies, management of acute candidemia and acute disseminated candidiasis, management of nonhematogenous candidiasis, peritonitis and intra-abdominal abscess, management of other fungal infections (Aspergillus, Cryptococcus, Mucor, Rhizopusi), systemic antifungal agents, and the pathogenesis of Candida infection. Tables describe the clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candida infections, antifungal chemotherapy, and characteristics of currently available antifungals. Figures show Candida endophthalmitis; superficial candidiasis; biopsy samples of chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis; and the various forms of Candida. Algorithms demonstrate the approach to the surgical patient at risk for candidiasis, aspergillosis, and other types of fungal infection. This review contains 5 figures, 4 tables, and 189 references.

Evidence-based assessment of primary antifungal prophylaxis in patients with hematologic malignancies

Blood ◽  
2003 ◽  
Vol 101 (9) ◽  
pp. 3365-3372 ◽  
Author(s):  
Oliver A. Cornely ◽  
Andrew J. Ullmann ◽  
Meinolf Karthaus
Keyword(s):  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Fungal Infections ◽  
High Risk Patient ◽  
Risk Groups ◽  
Hematologic Malignancies ◽  
Antifungal Prophylaxis ◽  
Severe Neutropenia ◽  
Evidence Based ◽  
Cell Transplants

Invasive fungal infection is an increasing source of morbidity and mortality in patients with hematologic malignancies, particularly those with prolonged and severe neutropenia (absolute white blood cell count < 100/μL). Early diagnosis of invasive fungal infection is difficult, suggesting that antifungal prophylaxis could be the best approach for neutropenic patients undergoing intensive myelosuppressive chemotherapy. Consequently, antifungal prophylaxis has been extensively studied for more than 20 years. Nonabsorbable polyenes reduce superficial mycoses but are not effective in preventing or treating invasive fungal infections. Intravenous amphotericin B and the newer azoles were used in numerous clinical trials, but the value of antifungal prophylaxis in defined risk groups with cancer is still open to discussion. Recipients of allogeneic stem cell transplants and patients with a relapsed leukemia are high-risk patient populations. In addition, certain risk factors are well defined, for example, neutropenia more than 10 days, corticosteroid therapy, sustained immunosuppression, and graft-versus-host disease. In contrast to study efforts, evidence-based recommendations on the clinical use of antifungal prophylaxis according to risk groups are rare. The objective of this review of 50 studies accumulating more than 9000 patients is to assess evidence-based criteria with regard to the efficacy of antifungal prophylaxis in neutropenic cancer patients.

Risk Factors for Progression to Invasive Fungal Infection in Preterm Neonates With Fungal Colonization

PEDIATRICS ◽  
2006 ◽  
Vol 118 (6) ◽  
pp. 2359-2364 ◽  
Author(s):  
P. Manzoni ◽  
D. Farina ◽  
M. Leonessa ◽  
E. A. d'Oulx ◽  
P. Galletto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Preterm Neonates ◽  
Fungal Colonization

Invasive fungal infections are associated with severe depletion of circulating RANTES

2005 ◽  
Vol 54 (11) ◽  
pp. 1017-1022 ◽  
Author(s):  
Michael Ellis ◽  
Basel al-Ramadi ◽  
Ulla Hedström ◽  
Hussain Alizadeh ◽  
Victor Shammas ◽  
...  
Keyword(s):  
T Cell ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Host Response ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Time Of Death ◽  
Haematological Malignancies ◽  
Platelet Counts ◽  
The Mean

Serum RANTES (regulated on activation, normal T-cell expressed and secreted) concentrations were measured in 14 patients who had haematological malignancies and developed invasive fungal infections (three of them definite, eight probable and three possible). RANTES levels fell substantially from pre-chemotherapy values at the start of and throughout the fungal infection, and recovered in patients who survived the fungal infection. However, in patients who died from the invasive fungal infection, RANTES levels did not recover. For survivors the mean ± sd levels for RANTES were 7656 ± 877 pg ml−1 on the day prior to chemotherapy, 3723 ± 2443 pg ml−1 on the first day of fungal infection diagnosis (significantly different from baseline; P = 0.001) and 9078 ± 2256 pg ml−1 at recovery from the fungal infection (significantly different from lowest value; P < 0.0001). Platelet counts were closely correlated with the RANTES levels (r = 0.63, P < 0.001). The RANTES concentrations for the three patients who died were similar to those who survived at all equivalent timepoints, but were significantly lower at the time of death (792 ± 877) compared to the values at recovery for survivors (P = 0.005). The finding that patients who died from an invasive fungal infection had very low platelet counts and RANTES concentrations suggests that these could play a role in host response to such infections.

scholarly journals Fungal Infections in Liver Transplant Recipients

2021 ◽  
Vol 7 (7) ◽  
pp. 524
Author(s):  
Michael Scolarici ◽  
Margaret Jorgenson ◽  
Christopher Saddler ◽  
Jeannina Smith
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Morbidity And Mortality ◽  
Transplant Recipients ◽  
Liver Transplant Recipients

Invasive fungal infections (IFIs) are one of the most feared complications associated with liver transplantation, with high rates of morbidity and mortality. We discuss the most common invasive fungal infections in the setting of liver transplant, including Candida, Aspergillus, and Cryptococcal infections, and some less frequent but devastating mold infections. Further, we evaluate the use of prophylaxis to prevent invasive fungal infection in this population as a promising mechanism to reduce risks to patients after liver transplant.

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