Fungal infection after keratoplasty and the role of antifungal supplementation to storage solution: a review

2019 ◽  
Vol 104 (8) ◽  
pp. 1036-1036 ◽  
Author(s):  
Tarika Thareja ◽  
Regis Kowalski ◽  
Roheena Kamyar ◽  
Deepinder Dhaliwal ◽  
Bennie H Jeng ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Fungal Infections ◽  
Corneal Transplantation ◽  
Eye Banking ◽  
Eye Banks ◽  
Corneal Toxicity ◽  
Randomised Control Trials ◽  
Corneal Storage ◽  
Storage Solution

Fungal infection after corneal transplantation is a rare, yet potentially devastating, postoperative complication and has become a growing concern for the transplant surgeon and eye banking community. The Eye Bank Association of America (EBAA) has reported an increasing trend in the rate of postkeratoplasty fungal infections and a reversal in the previously documented predominance of bacterial over fungal infections. Additionally, several studies have confirmed a high correlation between positive corneoscleral donor rim fungal cultures and postoperative infections. Optisol GS (Bausch & Lomb, Irvine, California, USA), the most extensively used corneal storage solution in US eye banks, does not currently contain any antifungal supplementation. Although large randomised control trials evaluating the efficacy and safety of routine antifungal supplementation to corneal storage solution are lacking, several investigative studies have assessed the role of antifungal agents in reducing fungal contamination of donor corneas without causing undue corneal toxicity. This review will present the current epidemiology of postkeratoplasty fungal infections and evidence for obtaining routine fungal rim cultures and antifungal supplementation of storage solution.

Fungal infection after endothelial keratoplasty: association with hypothermic corneal storage

2018 ◽  
Vol 103 (10) ◽  
pp. 1487-1490 ◽  
Author(s):  
Nicola Lau ◽  
Aida Hajjar Sesé ◽  
Victor A Augustin ◽  
Geert Kuit ◽  
Mark R Wilkins ◽  
...  
Keyword(s):  
Organ Culture ◽  
Fungal Infection ◽  
Fungal Infections ◽  
Case Definition ◽  
Endothelial Keratoplasty ◽  
Donor Tissue ◽  
Purpureocillium Lilacinum ◽  
Eye Banks ◽  
The Usa ◽  
Host Cornea

PurposeTo compare the incidence of fungal infection after endothelial keratoplasty (EK) when donor tissue had been stored in hypothermic medium or organ culture.MethodsWe describe the clinical features of 10 cases of fungal infection (keratitis or endophthalmitis) following EK identified at three European centres. Case definition was the culture of fungus or a positive PCR from the host cornea or anterior chamber after EK. A survey of the incidence of infection after EK was conducted by the European Eye Bank Association. The main outcome measure was the number of cases in which donor tissue had been stored in hypothermic medium compared with organ culture.ResultsThe 10 cases occurred between 2014 and 2017. All donor corneas had been stored in hypothermic medium sourced from three US eye banks. Three pairs of mate corneas caused infections in six recipients. Candida spp were identified from nine cases, with one isolate of Purpureocillium lilacinum. Data on 16 862 corneas supplied for EK were available from 16 European eye banks for the 5-year period from 2012. There were 17 reported cases of infection, of which 15 (88%) were fungal infections and 14 (82%) were Candida spp. Fungal infection was reported from 3 of 14 476 (0.02%) corneas supplied in organ culture compared with 12 of 2386 (0.50%) corneas supplied in hypothermic medium (p<0.0001). The incidence of infection after hypothermic storage was similar for material sourced from Europe (0.52%) or the USA (0.61%).ConclusionsInfection after EK is strongly associated with Candida spp. The possible explanations for the higher incidence of infection when tissue is stored in hypothermic medium are discussed.

scholarly journals Autopsy dissection techniques and investigations in deaths due to COVID-19 triggered fungal infections - A diagnostic review

2021 ◽  
Vol 8 (4) ◽  
pp. 207-213
Author(s):  
Himanshi Narang ◽  
Amit Patil
Keyword(s):  
Fungal Infection ◽  
Paranasal Sinuses ◽  
Fungal Infections ◽  
Invasive Disease ◽  
Invasive Fungal Infections ◽  
Correct Interpretation ◽  
Research Papers ◽  
Dissection Techniques ◽  
Second Wave

The COVID-19 pandemic, which originated from Wuhan, China, has rapidly spread worldwide, including India. As India grappled with the second wave, COVID-triggered fungal infection has suddenly risen tremendously, raising a sense of panic in the country. The fungal infection in COVID-19 includes Mucormycosis and Aspergillosis, as common fungal infections primarily affecting rhino-orbital structures. Many research papers have published postmortem findings in autopsies conducted on COVID-19 decedents, thereby helping to understand this contagious disease's pathogenesis. But, with the arrival of COVID-triggered fungal infection, which is a crucial invasive disease responsible for fatality, very few research papers have commented on the postmortem findings of invasive fungal infections affecting the rhino-orbital and craniocerebral structures in COVID-19 deaths. Therefore, the role of invasive fungal infection due to COVID-19 illness must be established in the causation of deaths in COVID-19 patients. This review research deals with autopsy dissection techniques and possible postmortem findings of invasive fungal infections involving the nasal and paranasal sinuses and orbital structures in COVID-19 deaths. The findings of fungal infection affecting nasal and paranasal systems may not differ in live patients and in a deceased; however, it is essential that correct interpretation of the postmortem findings aided by pre-or post-autopsy investigations is necessary to establish the role of covid triggered fungal infection in such deaths.

scholarly journals Prevalence and clinical profile of patients with chronic fungal maxillary sinusitis

2019 ◽  
Vol 5 (2) ◽  
pp. 280
Author(s):  
Vijay Gupta ◽  
Arindam Gupta
Keyword(s):  
Fungal Infection ◽  
Maxillary Sinus ◽  
Paranasal Sinus ◽  
Fungal Infections ◽  
Maxillary Sinusitis ◽  
Clinical Profile ◽  
Chronic Maxillary Sinusitis ◽  
High Index Of Suspicion ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Fungal paranasal sinus disease is considered to be rare but there has been a marked increase in the number and diversity of reported cases of fungal infections of maxillary sinus in recent years. Objectives were to study the incidence of fungal infection in case of chronic maxillary sinusitis, to identify specific type of fungus involved in maxillary sinus infection and to study clinical profile of the patients with fungal infections of maxillary sinus.</p><p class="abstract"><strong>Methods:</strong> A prospective study of was conducted involving the patients attending outpatient department of Otorhinolaryngology, who were clinically and radiologically proved cases of chronic maxillary sinusitis. Patients diagnosed with underlying paranasal sinus malignancies were excluded from the study. 70 patients of chronic maxillary sinusitis were included in the study. Isolates were identified based on colonial and microscopical morphology. Subcultures were done and slide cultures were prepared to identify the fungi.  </p><p class="abstract"><strong>Results:</strong> Fungus was cultured from 12.8% of patients suffering from chronic maxillary sinusitis. The most frequent victims of the disease were young persons in the second decade of life. All patients found positive for fungus had unilateral maxillary sinusitis. <em>Aspergillus niger, Aspergillus fumigatus, Candida albicans</em> and <em>Mucormycosis</em> were the various fungi isolated from cultures of antral washings.</p><p class="abstract"><strong>Conclusions:</strong> The results of the study emphasise the role of fungi as important pathogens of chronic maxillary sinusitis. There must be high index of suspicion of fungal infection when a young adult with a unilateral antral opacity on X-ray with frank pus in antral washings.</p><p> </p>

scholarly journals The Emerging Role of Mast Cells in Response to Fungal Infection

2021 ◽  
Vol 12 ◽  
Author(s):  
Miao Yu ◽  
Xiao-ting Song ◽  
Bo Liu ◽  
Ting-ting Luan ◽  
Shuang-lu Liao ◽  
...  
Keyword(s):  
Mast Cells ◽  
Fungal Infection ◽  
Signaling Pathways ◽  
Fungal Infections ◽  
Sporothrix Schenckii ◽  
Intestinal Barrier ◽  
Allergic Diseases ◽  
Extracellular Dna ◽  
Intestinal Barrier Function

Mast cells (MCs) have been considered as the core effector cells of allergic diseases. However, there are evidence suggesting that MCs are involved in the mechanisms of fungal infection. MCs are mostly located in the border between host and environment and thus may have easy contact with the external environmental pathogens. These cells express receptors which can recognize pathogen-associated molecular patterns such as Toll-like receptors (TLR2/4) and C-type Lectins receptors (Dectin-1/2). Currently, more and more data indicate that MCs can be interacted with some fungi (Candida albicans, Aspergillus fumigatus and Sporothrix schenckii). It is demonstrated that MCs can enhance immunity through triggered degranulation, secretion of cytokines and chemokines, neutrophil recruitment, or provision of extracellular DNA traps in response to the stimulation by fungi. In contrast, the involvement of MCs in some immune responses may lead to more severe symptoms, such as intestinal barrier function loss, development of allergic bronchial pulmonary aspergillosis and increased area of inflammatory in S. schenckii infection. This suggests that MCs and their relevant signaling pathways are potential treatment regimens to prevent the clinically unwanted consequences. However, it is not yet possible to make definitive statements about the role of MCs during fungal infection and/or pathomechanisms of fungal diseases. In our article, we aim to review the function of MCs in fungal infections from molecular mechanism to signaling pathways, and illustrate the role of MCs in some common host-fungi interactions.

scholarly journals Risky business: oropharyngeal bacteria linked to risk for invasive fungal infection

2021 ◽  
Author(s):  
Anna Dongari-Bagtzoglou
Keyword(s):  
Fungal Infection ◽  
Fungal Infections ◽  
Clinical Investigation ◽  
Invasive Infection ◽  
Site Specific ◽  
Specific Host ◽  
Bacterial Microbiota ◽  
A Site ◽  
Risky Business

This work combines a clinical investigation with a mouse model of fungal infection to study the role of bacterial microbiota in fungal invasion. The investigators identified a dysbiosis in the oropharyngeal mucosa that was associated with a high risk for invasive infection in hematologic oncology patients. This study builds on our current understanding that the pathogenesis of fungal infections has to be studied in the context of a specific host background and a site-specific bacterial microbiota.

scholarly journals One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

2020 ◽  
pp. bjophthalmol-2020-317938
Author(s):  
Gilles Thuret ◽  
Emilie Courrier ◽  
Sylvain Poinard ◽  
Philippe Gain ◽  
Marc Baud'Huin ◽  
...  
Keyword(s):  
Corneal Transplantation ◽  
Donor Selection ◽  
European Countries ◽  
Donor Pool ◽  
Eye Banking ◽  
Eye Banks ◽  
Selection Algorithms ◽  
Pandemic Severity ◽  
The Impact ◽  
The Relationship

ObjectivesTo assess to which extent the COVID-19 pandemic affected corneal transplantation by virtue of donor selection algorithms in different European countries.DesignSurvey.Setting110 eye banks in 26 European countries.Participants64 eye banks covering 95% of European corneal transplantation activity.InterventionsA questionnaire listing the number of corneas procured and distributed from February to May 2018–2020 was circulated to eye banks.Main outcome measuresThe primary outcome was the number of corneal procurements. Additional outcomes were national algorithms for donor selection, classified according to their stringency (donors with COVID-19 history, suspected for COVID-19, asymptomatic, PCR testing) and the pandemic severity in each country. We calculated Spearman’s correlation coefficient to determine, two by two, the relationship between the 3-month decline in eye banking activity (procurement), the stringency of donor selection algorithm and the grading of pandemic severity (cases and deaths). A partial correlation was run to determine the relationship between decline and stringency while controlling for pandemic severity.ResultsProcurements decreased by 38%, 68% and 41%, respectively, in March, April and May 2020 compared with the mean of the previous 2 years, while grafts decreased, respectively, by 28%, 68% and 56% corresponding to 3866 untreated patients in 3 months. Significant disparities between countries and the decrease in activity correlated with stringency in donor selection independent of pandemic severity.ConclusionsOur data demonstrate significant differences between countries regarding donor screening algorithms based on precautionary principles and, consequently, a decrease in the donor pool, already constrained by a long list of contraindications. Fundamental studies are needed to determine the risk of SARS-CoV-2 transmission by corneal transplantation and guide evidence-based recommendations for donor selection to justify their substantial medical and economic impact.

scholarly journals The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea

2021 ◽  
Vol 7 (8) ◽  
pp. 639
Author(s):  
Yae-Jee Baek ◽  
Yun-Suk Cho ◽  
Moo-Hyun Kim ◽  
Jong-Hoon Hyun ◽  
Yu-Jin Sohn ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Fungal Infection ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lung Transplant ◽  
Fungal Infections ◽  
Transplant Recipients ◽  
Tertiary Center ◽  
Lung Transplant Recipients

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of Candida spp. was approximately three times higher than that of Aspergillus spp. In the setting of itraconazole administration for 6 months post-LTx, C. glabrata accounted for 36.5% of all Candida-positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non-Aspergillus molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx.

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.

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