Oral Yeast Colonization and Fungal Infections in Peritoneal Dialysis Patients: A Pilot Study

Peritonitis and exit-site infections are important complications in peritoneal dialysis (PD) patients that are occasionally caused by opportunistic fungi inhabiting distant body sites. In this study, the oral yeast colonization of PD patients and the antifungal susceptibility profile of the isolated yeasts were accessed and correlated with fungal infection episodes in the following 4 years. Saliva yeast colonization was accessed in 21 PD patients and 27 healthy controls by growth in CHROMagar-Candida® and 18S rRNA/ITS sequencing. PD patients presented a lower oral yeast prevalence when compared to controls, namely,Candida albicans. Other species were also isolated,Candida glabrataandCandida carpophila. The antifungal susceptibility profiles of these isolates revealed resistance to itraconazole, variable susceptibility to caspofungin, and higher MIC values of posaconazole compared to previous reports. The 4-year longitudinal evaluation of these patients revealedCandida parapsilosisandCandida zeylanoidesas PD-related exit-site infectious agents, but no correlation was found with oral yeast colonization. This pilot study suggests that oral yeast colonization may represent a limited risk for fungal infection development in PD patients. Oral yeast isolates presented a variable antifungal susceptibility profile, which may suggest resistance to some second-line drugs, highlighting the importance of antifungal susceptibility assessment in the clinical practice.

Download Full-text

CAPD Catheter Exit-Site and Tunnel Infection with Fungal Etiology—Treatment and Catheter Reinsertion for an Extremely Rare Complication

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00031 ◽

2017 ◽

Vol 37 (2) ◽

pp. 237-239

Author(s):

Manmeet Singh Jhawar ◽

Jasmin Das ◽

Pratish George ◽

Anil Luther

Keyword(s):

Candida Albicans ◽

Peritoneal Dialysis ◽

Case Report ◽

Fungal Infection ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Rare Complication ◽

Exit Site ◽

Duration Of Therapy ◽

Tunnel Infection ◽

Few Data

Fungal infection is an extremely rare etiology of exit-site and tunnel infection in patients on continuous ambulatory peritoneal dialysis (CAPD). There are few data available regarding its management—especially choice of antifungals, duration of therapy, and removal of catheter. There are no guidelines pertaining to reinsertion of the CAPD catheter following fungal exit-site and tunnel infection. This case report highlights Candida albicans as a rare cause of exit-site and tunnel infection of the CAPD catheter. The catheter was removed and the patient received appropriate antifungal therapy followed by reinsertion of the CAPD catheter and re-initiation on CAPD.

Download Full-text

Identification and in Vitro Susceptibility Pattern of Fungal Pathogens in Immunocompromised Patients with invasive Fungal Infections

10.51429/ejmm30317 ◽

2021 ◽

Vol 30 (3) ◽

pp. 127-134

Author(s):

Shaimaa A.S. Selem ◽

Neveen A. Hassan ◽

Mohamed Z. Abd El-Rahman ◽

Doaa M. Abd El-Kareem

Keyword(s):

Intensive Care ◽

Fungal Infection ◽

Fungal Pathogens ◽

Fungal Infections ◽

Antifungal Susceptibility ◽

Invasive Fungal Infections ◽

Immunocompromised Patients ◽

University Hospitals ◽

Vitek 2

Background: In intensive care units, invasive fungal infections have become more common, particularly among immunocompromised patients. Early identification and starting the treatment of those patients with antifungal therapy is critical for preventing unnecessary use of toxic antifungal agents. Objective: The aim of this research is to determine which common fungi cause invasive fungal infection in immunocompromised patients, as well as their antifungal susceptibility patterns in vitro, in Assiut University Hospitals. Methodology: This was a hospital based descriptive study conducted on 120 patients with clinical suspicion of having fungal infections admitted at different Intensive Care Units (ICUs) at Assiut University Hospitals. Direct microscopic examination and inoculation on Sabouraud Dextrose Agar (SDA) were performed on the collected specimens. Isolated yeasts were classified using phenotypic methods such as chromogenic media (Brilliance Candida agar), germ tube examination, and the Vitek 2 system for certain isolates, while the identification of mould isolates was primarily based on macroscopic and microscopic characteristics. Moulds were tested in vitro for antifungal susceptibility using the disc diffusion, and yeast were tested using Vitek 2 device cards. Results: In this study, 100 out of 120 (83.3%) of the samples were positive for fungal infection. Candida and Aspergillus species were the most commonly isolated fungal pathogens. The isolates had the highest sensitivity to Amphotericin B (95 %), followed by Micafungin (94 %) in an in vitro sensitivity survey. Conclusion: Invasive fungal infections are a leading cause of morbidity and mortality in immunocompromised patients, with Candida albicans being the most frequently isolated yeast from various clinical specimens; however, the rise in resistance, especially to azoles, is a major concern.

Download Full-text

Bacterial and fungal infections in patients on peritoneal dialysis

10.1093/med/9780199592548.003.0270 ◽

2015 ◽

Author(s):

Eric Goffin ◽

Laura Labriola ◽

Michel Jadoul

Keyword(s):

Peritoneal Dialysis ◽

Fungal Infections ◽

Generation Cephalosporin ◽

Favorable Effect ◽

Purulent Discharge ◽

Diabetic Patients ◽

Antibiotic Administration ◽

Polymorphonuclear Cells ◽

Exit Site ◽

Mortality And Morbidity

Infections specifically related to peritoneal dialysis include peritonitis on the one hand, and exit-site and tunnel infections on the other hand.The diagnosis of peritonitis rests on the classical triad of cloudy dialysate, abdominal pain, and presence of < 100 white-cells (including < 50 % polymorphonuclear cells) within the dialysate effluent. Because peritonitis is associated with high mortality and morbidity rates, empiric antibiotics should be initiated without delay, covering both Gram-positive and Gram-negative organisms. Most regimens include vancomycin or a first-generation cephalosporin for the former, and a third-generation cephalosporin or an aminoglycoside for the latter. Antibiotics are usually administered via the intraperitoneal route. Prophylaxis with an anti-fungal agent has to be considered in diabetic patients and in those who just received prolonged antibiotic administration. Cure is obtained in up to 80 % of the cases ; treatment failure however may occur with refractory or relapsing peritonitis episodes. This is especially common in fungal or fecal associated peritonitis, and will require catheter withdrawal. The incidence of peritonitis has dramatically decreased in recent years with the advent of new connectology systems, and both adequate preventive measures and improved patients’ education. Still it is not clearly documented that new biocompatible dialysate fluids have a favorable effect on peritonitis incidence.Exit-site and tunnel infections are defined by the presence of a purulent discharge around the catheter and by erythema, oedema and tenderness of the subcutaneous pathway of the catheter, respectively. Antibiotics are recommended in case of documented infection. Cuff shaving may sometimes be required, as well as catheter removal in case of unfavourable evolution.

Download Full-text

Subcutaneous gentamicin injection around the cuff in treatment of resistant exit site infection in peritoneal dialysis patients: a pilot study

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s140894 ◽

2017 ◽

Vol Volume 13 ◽

pp. 909-914 ◽

Cited By ~ 1

Author(s):

Oguzhan Dizdar ◽

Ozerhan Ozer ◽

Selahattin Erdem ◽

Ali Ihsan Gunal

Keyword(s):

Peritoneal Dialysis ◽

Pilot Study ◽

Site Infection ◽

Dialysis Patients ◽

Exit Site ◽

Exit Site Infection

Download Full-text

Determinants of Catheter Loss following Continuous Ambulatory Peritoneal Dialysis Peritonitis

Peritoneal Dialysis International ◽

10.1177/089686080802800410 ◽

2008 ◽

Vol 28 (4) ◽

pp. 361-370 ◽

Cited By ~ 24

Author(s):

Chih-Yu Yang ◽

Tzen-Wen Chen ◽

Yao-Ping Lin ◽

Chih-Ching Lin ◽

Yee-Yung Ng ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Leukocyte Count ◽

Fungal Infections ◽

Tertiary Care ◽

Albumin Level ◽

Catheter Removal ◽

Exit Site ◽

Exit Site Infection ◽

Reactive Protein ◽

Single Organism

Background Few patients are able to resume peritoneal dialysis (PD) therapy after an episode of peritonitis that requires catheter removal. PD catheter loss is therefore regarded as an important index of patient morbidity. The aim of the present study was to evaluate factors influencing catheter loss in patients suffering from continuous ambulatory PD (CAPD) peritonitis. Patients and Methods We retrospectively reviewed 579 episodes of CAPD peritonitis from 1999 to 2006 in a tertiary-care referral hospital. Demographic, biochemical, and microbiological characteristics were recorded. Episodes resulting in PD catheter removal ( n = 68; 12%) were compared by both univariate and multivariate analyses with those in which PD catheters were preserved. Results The incidence of PD catheter loss increased as the number of organisms cultured increased ( p = 0.001). Also, PD catheter removal was more likely to occur after peritonitis episodes with low serum albumin level ( p = 0.004), those with long duration of PD effluent leukocyte count remaining above 100/μL ( p < 0.001), those with concomitant tunnel infection ( p < 0.001), those with concomitant exit-site infection ( p = 0.005), and those with presence of catastrophic intra-abdominal visceral events ( p < 0.001). Duration on PD preceding the peritonitis episode was of borderline significance ( p = 0.080). On the contrary, initial PD effluent leukocyte count and serum level of C-reactive protein were not predictive of PD catheter loss. Micro-organisms of the Enterobacteriaceae family were the major pathogens responsible for PD catheter loss following polymicrobial peritonitis. Furthermore, we found that there was no association between polymicrobial peritonitis and the catastrophic intra-abdominal visceral event, although both resulted in a greater incidence of PD catheter loss. Among the single-organism group in our population, the microbiological determinants of PD catheter loss included fungi ( p < 0.001), anaerobes ( p = 0.018), and Pseudomonas sp (borderline significance: p = 0.095). Conclusion PD catheter loss as a consequence of peritonitis is related primarily to hypoalbuminemia, longer duration of PD effluent leukocyte count remaining above 100/μL, the etiologic source of the infection, and the organism causing the infection. Peritonitis associated with concomitant tunnel or exit-site infections and abdominal catastrophes were more likely to proceed to PD catheter loss. The microbiological determinants of PD catheter loss in the present study included polymicrobial infections caused by Enterobacteriaceae as well as monomicrobial pseudomonal, anaerobic, and fungal infections.

Download Full-text

Fungal infections in burns: Diagnosis and management

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699460 ◽

2010 ◽

Vol 43 (S 01) ◽

pp. S37-S42 ◽

Cited By ~ 1

Author(s):

Malini R. Capoor ◽

Sujata Sarabahi ◽

Vinay Kumar Tiwari ◽

Ravi Prakash Narayanan

Keyword(s):

Fungal Infection ◽

Wound Infection ◽

Antifungal Therapy ◽

Fungal Infections ◽

Antifungal Susceptibility ◽

Public Health Problem ◽

Antifungal Drugs ◽

Surgical Debridement ◽

Major Public Health Problem ◽

Clinical Awareness

ABSTRACTBurn wound infection (BWI) is a major public health problem and the most devastating form of trauma worldwide. Fungi cause BWI as part of monomicrobial or polymicrobial infection, fungaemia, rare aggressive soft tissue infection and as opportunistic infections. The risk factors for acquiring fungal infection in burns include age of burns, total burn size, body surface area (BSA) (30–60%), full thickness burns, inhalational injury, prolonged hospital stay, late surgical excision, open dressing, artificial dermis, central venous catheters, antibiotics, steroid treatment, long-term artificial ventilation, fungal wound colonisation (FWC), hyperglycaemic episodes and other immunosuppressive disorders. Most of the fungal infections are missed owing to lack of clinical awareness and similar presentation as bacterial infection coupled with paucity of mycology laboratories. Expedient diagnosis and treatment of these mycoses can be life-saving as the mortality is otherwise very high. Emergence of resistance in non-albicans Candida spp., unusual yeasts and moulds in fungal BWI, leaves very few fungi susceptible to antifungal drugs, leaving many patients susceptible. There is a need to speciate fungi as far as the topical and systemic antifungal is concerned. Deep tissue biopsy and other relevant samples are processed by standard mycological procedures using direct microscopy, culture and histopathological examination. Patients with FWC should be treated by aggressive surgical debridement and, in the case of fungal wound infection (FWI), in addition to surgical debridement, an intravenous antifungal drug, most commonly amphotericin B or caspofungin, is prescribed followed by de-escalating with voriconazole or itraconazole, or fluconazole depending upon the species or antifungal susceptibility, if available. The propensity for fungal infection increases, the longer the wound is present. Therefore, the development of products to close the wound more rapidly, improvement in topical antifungal therapy with mould activity and implementation of appropriate systemic antifungal therapy guided by antifungal susceptibility may improve the outcome for severely injured burn victims.

Download Full-text

Invasive Candida Infections in Pediatric Patients Treated on the Pilot Study of Decitabine and Vorinostat with Chemotherapy for Relapsed ALL: A Report from the Therapeutic Advances in Childhood Leukemia & Lymphoma (TACL) Consortium

Blood ◽

10.1182/blood.v124.21.3650.3650 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3650-3650 ◽

Cited By ~ 3

Author(s):

Michael J. Burke ◽

Patrick Brown ◽

Lia Gore ◽

Richard Sposto ◽

Deepa Bhojwani ◽

...

Keyword(s):

Young Adults ◽

Pilot Study ◽

Fungal Infection ◽

Fungal Infections ◽

Cell Transplant ◽

Infection Prophylaxis ◽

Children And Young Adults ◽

Candida Infections ◽

Grade 3 ◽

Anti Fungal

Abstract Introduction Children and young adults with relapsed acute lymphoblastic leukemia (ALL) are at high risk for infectious complications, particularly invasive fungal infections, during their intensive re-induction therapy. We report results of a Pilot study investigating decitabine and vorinostat in combination with intensive re-induction chemotherapy for children and young adults with relapsed or refractory ALL. This study is currently open through the TACL Consortium [NCT01483690] and all patients and/or their parents or guardians signed informed consent to participate in this institutional review board approved therapeutic trial in accordance to the Declaration of Helsinki. Methods Patients 1-25 years of age with 2nd or greater relapse or refractory ALL are eligible. Seventeen patients have enrolled with a median age of 12 years (range, 19 months - 21 years). Patients received one course of therapy which included decitabine (15mg/m2 days 1-7; 15-21), vorinostat (180mg/m2 days 3-10; 17-24), vincristine (1.5mg/m2 days 10, 17, 24, 31), dexamethasone (10mg/m2/dose BID days 8-12; 22-26), mitoxantrone (10mg/m2 days 8, 9), PEG-asparaginase (2500 IU/m2 days 10, 24) and intrathecal methotrexate (dosed according to age and CNS status). Nine patients (53%) relapsed after a prior allogeneic hematopoietic cell transplant and 5 patients had refractory disease (29%) prior to enrolling on this study. Initial infection prophylaxis guidelines did not require anti-bacterial or anti-fungal therapy. Results The study was suspended after 5 patients enrolled due to 2 patients reporting a DLT [Grade 3 cholestasis/steatosis, Grade 4 bilirubin (n=1); Grade 3 delirium, Grade 4 seizure, Grade 4 somnolence (n=1)] and 4 of the 5 patients (80%) reporting non-albicans Candidemia [C. kruseii (n=2), C. lusitaniae (n=1), C. guillermondii (n=1)]. Based on this significant rate of fungal infection, despite all patients receiving prophylactic anti-fungal therapy (micafungin n=2, fluconazole n=1, amphotericin n=1), the study was amended to decrease the decitabine dose (15mg/m2 to 10mg/m2) and duration of decitabine (days 1-7; 15-21 to 1-5; 15-19) as well as require treatment dose non-azole class anti-fungal therapy (echinocandin or amphotericin) to be given to all patients on study. Twelve patients enrolled post-amendment; only 1 of 12 (8.3%) experienced a fungal infection (C. guillermondii). Of note, this infection occurred in a patient using fluconazole for prophylaxis in place of a protocol-specified agent. There have been no fungal infections reported to date for the 11 patients on study who have received echinocandin or amphotericin therapy at treatment doses. Treatment responses include 9 patients achieving a complete remission (CR) (53%), 5 with stable disease (29%), two treatment related deaths and 1 patient removed from protocol therapy on day 6 based on the physician’s decision. The median minimal residual disease (MRD) response in patients who achieved a CR and submitted bone marrow samples for end of therapy testing (n=5) was 0.056% (range, 0.00%-5%). Conclusions We report a substantial initial incidence of invasive Candida infections in patients treated with decitabine and vorinostat in combination with intensive chemotherapy despite anti-fungal prophylaxis which appears to be abrogated once the fungal prophylaxis was required at treatment doses using either an echinocandin or amphotericin class agent. As well, the lower dose and duration of decitabine may have contributed to this improvement, resulting in potentially shorter periods of neutropenia which may contribute to the risk of fungal disease. The mechanism for the unique propensity for non-albicans Candida infections in this study remains unclear. The initial response to this regimen incorporating epigenetic therapy is promising with correlative biology studies investigating methylation, acetylation and gene expression changes pending study completion. The study continues to accrue at a dose expansion cohort. Disclosures Off Label Use: Decitabine in relapse ALL Vorinostat in relapse ALL.

Download Full-text

Correlation of diabetes with mycotic infections: a pilot study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20211214 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1671

Author(s):

Manish Munjal ◽

Naveen Mittal ◽

Ekta Bansal ◽

Shubham Munjal ◽

Devambika Mehta ◽

...

Keyword(s):

Pilot Study ◽

Prospective Study ◽

Fungal Infection ◽

Paranasal Sinuses ◽

Fungal Infections ◽

Fungal Species ◽

Age Group ◽

Medical College ◽

High Incidence ◽

Mycotic Infections

Background: The immuno-compromised individuals have a high Incidence of fungal infections of the nose and the paranasal sinuses. There is a variation in the fungal species that manifest in different subset of individuals. The species and the susceptible individuals were studied in the Punjab population, to suggest measures to attain a better outcome.Methods: 50 subjects treated for paranasal fungal infection by rhinology division of the oto-rhino-laryngology services, Dayanand Medical College and hospital, Ludhiana, were analysed. The prospective study was carried out in a period of one and a half year (June 2009 to December 2010).Results: Mycotic infections was predominantly noted in the age group 51-60 years i.e. in 14 patients (28%) followed by 41-50 years, 13 cases (26%). There were 29 (58%) of males and 21 (42%) females with a male:female ratio of 1.4:1. Amongst 50 patients with mycotic infection, 19 (38%) were diabetic. All 15 (100%) patients with zygomycosis had underlying diabetes while only 4 (21%) with aspergillosis were diabetic.Conclusions: Zygomycosis occurs usually in diabetics, while in aspergillosis the underlying morbidity may or may not be diabetes. Timely medical treatment is essential to check diabetes and species identification to select the appropriate antifungal medication.

Download Full-text