Fungal Infections in Major Burns - 2 Years Overview

Infections are the most severe and the most frequent complication in major burns requiring adequate diagnosis and treatment. Extensive burned areas, impaired immune system and antibiotic therapy contribute to the development of opportunistic fungal infections. An important aspect is the increased level of antimicrobial resistance in our country. We present a two years study on the burn patients hospitalized in our institution. A total of 355 burned patients were hospitalized during this period, 210 (59%) of them being addmited in Critical Care Burn Unit. We noted the main infectious complications and established a dinamic microbian mapping during patient hospitalization. Fungal infections were noted. We performed microbiological screening: testing at admission and once a week or in case of clinical signs from all potential sites. For the clinical therapy of mycoses, it is mandatory to know whether a fungal colonization or a fungal infection is involved. Unfortunately, often in severe burned patients, clinical presentation is unspecifi c and sensitivity of diagnostic results may be unreliable. Invasive fungal infections due to Candida species and Aspergillus species are important emerging causes of morbidity and mortality. The systemic use of antifungal agents is conducted depending on the general condition of the burn patient, the fungal species involved and the confi rmation of fungemia. In conclusion, specifi c treatment of infectious complications has to be conducted according to the characteristics of the patients in order to reduce morbidity and mortality and avoid the development of antimicrobial resistance.

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Antifungal agents

10.1093/med/9780198755388.003.0046 ◽

2017 ◽

Author(s):

Donna M. MacCallum

Keyword(s):

Antifungal Agent ◽

Antifungal Agents ◽

Drug Class ◽

Fungal Infections ◽

Fungal Species ◽

Invasive Fungal Infections ◽

Antifungal Drugs ◽

Morbidity And Mortality ◽

Significant Morbidity ◽

Drug Formulations

Although invasive fungal infections lead to significant morbidity and mortality, there remain limited numbers of antifungal drugs available to treat these infections. This chapter describes and discusses the therapeutic antifungal agent classes currently available clinically to treat invasive fungal infections. These include the polyenes, azoles, echinocandins, and flucytosine (5-fluorocytosine). For each drug class, those currently used clinically are listed and their modes of action described. The effectiveness of drugs against different fungal species is explored and any drawbacks to the use of each drug are discussed. Drug formulations and indications for the use of each antifungal agent are also detailed.

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Antifúngicos poliénicos. Mecanismo de acción y aplicaciones

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.2.02 ◽

2020 ◽

Vol 63 (2) ◽

pp. 7-17

Author(s):

Evelyn Rivera-Toledo ◽

Alan Uriel Jiménez-Delgadillo ◽

Patricia Manzano-Gayosso

Keyword(s):

Antifungal Activity ◽

Key Words ◽

Secondary Metabolism ◽

Amphotericin B ◽

Antifungal Agents ◽

Fungal Infections ◽

Variable Number ◽

Therapeutic Failure ◽

Morbidity And Mortality ◽

Clinical Use

The first compounds with specific antifungal activity were identified in the middle of the last century as a product of the secondary metabolism of bacteria of the order Actinomycetales, and their clinical use significantly diminished the morbidity and mortality associated with severe fungal infections. Many of such biosynthetic compounds are characterized by a chemical polygenic structure, with a variable number of carbon-carbon double bonds. Currently, besides polygenic antimycotics, there are other antifungal agents, such as the azole compounds, that have less toxicity in patients; however, cases of therapeutic failure with such compounds have been documented, therefore, the use of polygenics is still the best alternative in such cases. This review presents data about the properties and applications of antifungal-polygenic compounds using amphotericin B as a model. Key words: Amphotericin B; antifungal polyenes; ergosterol

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Systemic Antifungal Agents

10.2310/anes.2365 ◽

2018 ◽

Author(s):

Brett A Melnikoff ◽

René P Myers

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Antifungal Agents ◽

Fungal Infections ◽

Antifungal Prophylaxis ◽

Morbidity And Mortality ◽

Transplant Recipients ◽

Therapeutic Approaches ◽

Timely Fashion ◽

Antifungal Chemotherapy

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Despite the development of a number of new and useful antifungal agents in the past decade and the noteworthy improvements in therapeutic approaches to fungal infections, physicians’ ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. In patient populations estimated to be at high risk for acquiring a fungal infection, antifungal prophylaxis has reduced infection rates by about 50%; however, it has not been shown to significantly improve mortality. This review discusses both established and newly approved systemic antifungal agents. Tables list characteristics of currently available antifungals and antifungal chemotherapy. This review contains 2 tables and 32 references Key words: antifungal chemotherapy, antifungal prophylaxis, antifungals, Candida prophylaxis, systemic antifungal medications

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Epidemiology of fungal infections and risk factors in newborn patients

Reviews in Health Care ◽

10.7175/rhc.v4i1s.856 ◽

2013 ◽

Vol 4 (1S) ◽

pp. 5-17

Author(s):

Paolo Manzoni

Keyword(s):

Laboratory Tests ◽

Fungal Infections ◽

Clinical Signs ◽

Venous Catheter ◽

Extremely Low Birth Weight ◽

Diagnostic Process ◽

Fungal Colonization ◽

Specific Risk ◽

Rule Out ◽

Made In

The incidence of fungal infections among newborn babies is increasing, owing mainly to the increased ability to care and make survive immature infants at higher specific risk for fungal infections. The risk is higher in infants with very low and extremely low birth weight, in babies receiving total parenteral nutrition, in neonates with limited barrier effect in the gut, or with central venous catheter or other devices where fungal biofilms can originate. Also neonates receiving broad spectrum antibiotics, born through caesarian section or non-breastfed can feature an increased, specific risk. Most fungal infections in neonatology occur in premature children, are of nosocomial origin, and are due to Candida species. Colonization is a preliminary step, and some factors must be considered for the diagnosis and grading process: the isolation site, the number of colonized sites, the intensity of colonization, and the Candida subspecies. The most complicated patients are at greater risk of fungal infections, and prophylaxis or pre-emptive therapy should often be considered. A consistent decisional tree in neonatology is yet to be defined, but some efforts have been made in order to identify characteristics that should guide the prophylaxis or treatment choices. A negative blood culture and the absence of symptoms aren’t enough to rule out the diagnosis of fungal infections in newborn babies. Similarly, laboratory tests have been validated only for adults. The clinical judgement is of utmost importance in the diagnostic process, and should take into account the presence of clinical signs of infection, of a severe clinical deterioration, as well as changes in some laboratory tests, and also the presence and characteristics of a pre-existing fungal colonization.

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Systemic Antifungal Agents

DeckerMed Surgery ◽

10.2310/surg.2365 ◽

2018 ◽

Author(s):

Brett A Melnikoff ◽

René P Myers

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Antifungal Agents ◽

Fungal Infections ◽

Antifungal Prophylaxis ◽

Morbidity And Mortality ◽

Transplant Recipients ◽

Therapeutic Approaches ◽

Timely Fashion ◽

Antifungal Chemotherapy

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The Spectrum of Fungal Colonization and Their Attributable Effects on Cystic Fibrosis Patients with Rare CFTR Genetic Mutations

Microbiology Research ◽

10.3390/microbiolres12030042 ◽

2021 ◽

Vol 12 (3) ◽

pp. 591-605

Author(s):

Merlin Thomas ◽

Soha Aboukhalaf ◽

Toqa Darwish ◽

Menatalla Ali ◽

Omar Elsaied ◽

...

Keyword(s):

Lung Function ◽

Fungal Infections ◽

Medical Condition ◽

Pancreatic Insufficiency ◽

Fungal Species ◽

Lung Damage ◽

Fungal Colonization ◽

Heterozygous Mutation ◽

Homozygous Mutation ◽

Pulmonary Exacerbations

Chronic airway colonization by bacteria and fungi is very common in CF patients, causing irreversible lung damage. It is known that rates of fungal infections are much lower than those of bacterial infections, however they can worsen the medical condition of CF patients. In this study, we identify the most common fungal species isolated from 31 adult CF patients in Qatar and analyze their correlation with lung function, pulmonary exacerbations, bronchial asthma, and pancreatic insufficiency. Mycological evaluation, as well as medical records, were reviewed for the patients regularly under the adult CF service at Hamad General Hospital in the period between 2017–2019. All CF patients included in this study carry rare CFTR mutations. The majority of those patients (n = 25) carried the c.3700A>G; I1234V mutation, whereas three patients carried the heterozygous mutation (c.1657C>T and c.1115A>T) and the remaining three carried the homozygous mutation (c.920G>A). Twenty-two of the adult CF participants (70.9%) were colonized with fungal species regardless of the type of the CFTR mutation. Candida and Aspergillus species were the most common, colonizing 81% and 45% of the patients, respectively. For Candida colonized patients, Candida dubliniensis was the most frequently reported species (55.6%), whereas Aspergillus fumigatus colonization was the most common (50.0%) among Aspergillus colonized patients. These identified fungal pathogens were associated with poor lung function, pancreatic insufficiency, and asthma in this cohort. Such colonization could possibly aggravate the most known CF complications, notably pulmonary exacerbations, asthma, and pancreatic insufficiency.

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Novel Antifungal Agents and Their Activity against Aspergillus Species

Journal of Fungi ◽

10.3390/jof6040213 ◽

2020 ◽

Vol 6 (4) ◽

pp. 213

Author(s):

Roya Vahedi-Shahandashti ◽

Cornelia Lass-Flörl

Keyword(s):

Drug Interactions ◽

High Frequency ◽

Antifungal Agents ◽

Fungal Infections ◽

Resistance Mechanisms ◽

Invasive Fungal Infections ◽

Morbidity And Mortality ◽

Aspergillus Species ◽

Multiple Resistance ◽

Chemical Structures

There is a need for new antifungal agents, mainly due to increased incidence of invasive fungal infections (IFI), high frequency of associated morbidity and mortality and limitations of the current antifungal agents (e.g., toxicity, drug–drug interactions, and resistance). The clinically available antifungals for IFI are restricted to four main classes: polyenes, flucytosine, triazoles, and echinocandins. Several antifungals are hampered by multiple resistance mechanisms being present in fungi. Consequently, novel antifungal agents with new targets and modified chemical structures are required to combat fungal infections. This review will describe novel antifungals, with a focus on the Aspergillus species.

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UNRAVELING (COVID) MUCOR MYCOSIS, DENTISTS AT THE DEEP END - A MINI REVIEW

International Journal of Advanced Research ◽

10.21474/ijar01/13506 ◽

2021 ◽

Vol 9 (09) ◽

pp. 940-947

Author(s):

Nirmala Chandrasekaran ◽

◽

Anil Kumar Ramachandran ◽

G. Padmanabha Kumar ◽

Siddharth Dhanraj ◽

...

Keyword(s):

Fungal Infections ◽

Delayed Diagnosis ◽

Clinical Signs ◽

Signs And Symptoms ◽

Morbidity And Mortality ◽

Uncontrolled Diabetes ◽

Wide Range ◽

Oral And Maxillofacial Region ◽

Clinical Signs And Symptoms

COVID-19 otherwise called as SARS-Cov-2 caused by severe acute respiratory syndrome declared as pandemic by WHO, resulted in increased mortality globally. Post covid recovered patients developed a wide range of opportunistic bacterial and fungal infections including mucormycosis. Even though mucormycosis is known as a life-threatening disease in immunocompromised patients and patients with uncontrolled diabetes with high rates of morbidity and mortality, application of a proper protocol and adhering to the standard guidelines in the management from initial stage to advanced complex stage can reduce the morbidity and mortality. Since the early clinical signs and symptoms arise in the oral and maxillofacial region, the role of general dentist in early detection of the clinical signs and symptoms and in particular the early surgical intervention by the Oral & Maxillofacial surgeons can definitely reduce the morbidity and mortality caused by mucormycosis. Poor prognosis and increased morbidity are often related to delayed diagnosis and delayed management without proper guidelines. This article aims to describe in brief mucormycosis with the current update and the role of an endodontist in diagnosis and management of this fungal infection.

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Identification of Fungi in Burn Wounds Using Conventional and Vitek System in Duhok City, Iraq

Science Journal of University of Zakho ◽

10.25271/sjuoz.2020.8.2.701 ◽

2020 ◽

Vol 8 (2) ◽

pp. 62-65

Author(s):

Najim A. Yassin ◽

Noor M. Qadri Oumeri

Keyword(s):

Middle Ages ◽

Fungal Pathogens ◽

Late Onset ◽

Fungal Infections ◽

Fungal Growth ◽

Fungal Species ◽

Growth Patterns ◽

Morbidity And Mortality ◽

Cryptococcus Laurentii ◽

Fungal Isolation

Background: Fungal burns and wounds infections are frequent but underestimated causing invasive infections with late-onset morbidity and mortality in patients suffering severe perturbed immune systems. Objectives: This study aimed to investigate fungal infections in clinical specimens by using conventional and Vitek system. Methods: A total of 123 swabs were obtained from wound and burns patients with different age, gender, burn degrees and nationality that admitted burns and emergency hospital in Duhok city, Iraq, from October 2019 till January 2020. All swabs screened by direct examination, fungal isolation then subjecting the purified colonies to Vitak system 2 to confirm the identification of fungal species. Results: Out of 123, 55.5% and 44.5% revealed fungal growth in wound and burn swab, respectively with more mono-fungal growth patterns. Male, middle ages group, Iraqi nationality and second-degree burn were more affected. Cryptococcus laurentii was the predominant (40%) followed by Stephanoascus ciferri (23%), Aspergillus nigar (11%) and Candida albicans was very low rate (1.1%), while other fungal specie’s were recorded in fewer rates. The present study demonstrated that the wound and burn fungal infection cases are relatively high in above mentioned hospitals with a variety of fungal pathogens. Unexpectedly, the Cryptococcus laurentii and Stephanoascus ciferri were highly predominant. Conclusions: The study concluded the necessity of using Vitak system for full identification and emphasize on the cleaning of surroundings of patients in the burn and wound units care, reduction of humidity, regular employment of topical and systemic antifungal agents that reduce morbidity and mortality in burn unit in this setting.

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The Importance of Fluconazole in Treatment of Endogenous Endophtalmitis in Patients Prior Treated Using Negative Pressure Therapy for Wound Closure Contaminated with Meticillin-resistant Staphylococcus aureus

Revista de Chimie ◽

10.37358/rc.17.7.5725 ◽

2017 ◽

Vol 68 (7) ◽

pp. 1598-1601 ◽

Cited By ~ 1

Author(s):

Anisia Iuliana Alexa ◽

Roxana Ciuntu ◽

Alina Cantemir ◽

Nicoleta Anton ◽

Ciprian Danielescu ◽

...

Keyword(s):

Antifungal Agents ◽

Fungal Infections ◽

Prolonged Treatment ◽

Endogenous Endophthalmitis ◽

Pressure Therapy ◽

First Case ◽

Severe Infections ◽

Pars Plana ◽

Delay In Treatment ◽

Vitreous Biopsy

Severe infections with C. albicans should be treated promptly with antifungal agents, any delay in treatment increases the risk of endophthalmitis. The systemic Amphotericin B therapy is the gold standard in the treatment of endophthalmitis, but in the case of fungal infections it has not yet been determined. Numerous studies have shown that the use of Fluconazole is effective in the treatment of fungal endophthalmitis. In this paper, we report two cases (3 eyes) that have been presented for the same accusations of significant decrease of AV (visual acuity), ocular pain and blepharospasm suddenly installed, both of which required urgent antibiotic and intravenous antifungal treatment. Both are diagnosed with endogenous endophthalmitis and vitreous biopsy + VPP (pars plana vitrectomy) are performed, with a negative result of the vitreous culture. In both situations the treatment was with antibiotic and systemic antifungals. Postoperatively, evolution was favorable in the first case and less favorable in the second one. The prognosis depends on the virulence of the microorganisms and the time elapsed until initiation of the treatment. Also, the presence of risk factors such as diabetes, sepsis, recent abdominal surgery (C. Albicans is part of the comesary flora of the digestive tract) have influenced the prognosis decisively. Severe infections with C. albicans should be promptly treated with antifungal agents, any delay in treatment increases the risk of endophthalmitis. Even when prolonged treatment of candidemia is instituted, 3% of patients can develop endogenous endophthalmitis, so ocular evaluation is particularly important for patients immobilized in anesthesia and intensive care units.

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