1
|
Mirchevska G, Cekovska Z, Kaftandzieva A, Zafirovik Z, Trajkovska-Dokic E. Evaluation of (1,3)--d-glucan assay in diagnosis of invasive fungal infections with Aspergillus. Arch Public Health 2022. [DOI: 10.3889/aph.2022.6045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Invasive fungal infections caused by Aspergillus are a significant problem in immunocompromised and critically ill patients and associated with increased morbidity and mortality. Early diagnosis of invasive aspergillosis is still a big clinical and diagnostic challenge. Conventional methods are not sensitive enough, and therefore, there is a need for rapid, more sensitive methods for early diagnosis of invasive fungal infections with Aspergillus. The aim of this study was to evaluate the diagnostic performance, sensitivity and specificity of serological panfungal (1,3)-b-D-glucan marker compared to conventional method for diagnosis of invasive fungal infections with Aspergillus. Material and methods: Specimens of 125 patients divided into 4 groups (group I - immune deficiency, group II - prolonged ICU stay, group III - chronic aspergillosis, group IV - cystic fibrosis), classified according to clinical diagnosis and EORTC/MSG criteria, were analyzed at the Institute of Microbiology and Parasitology, with conventional and serological methods, during a period of two years. Results: A total of 71 isolates of Aspergillus were confirmed in this study. Four isolates were recovered from bloodculture of patients with primary immune deficiency. With BAL culture, Aspergillus was detected in the group of chronic aspergillosis (63.33%), followed by the groups of cystic fibrosis (56.67%), primary immune deficiency (51.43%), and the group with prolonged ICU stay (43.33%). Sensitivity and specificity of BAL culture were: 64.29% and 100%, 59.09% and 100%, 54.55% and 12.5%, 100% and 54.17%, in I, II, III and IV group, respectively. In 79.1% (53/67) from positive BAL cultures in all groups, A. fumigatus was confirmed, of which, 32.1% (17/53) in group III, followed by group I – 26.42% (14/53) and group IV – 26.42% (14/53), and 15.1% (8/53) in group II. Other species confirmed in BAL were A. flavus 16.42% (11/67) and A.terreus 4.48% (3/67). Sensitivity and specificity of the serological panfungal (1,3)-b-D-glucan (BDG) marker were: 64.71% and 85.71%, 50% and 87.5%, 36.36% and 50%, in groups I, II and III, respectively. No positive findings of the panfungal (1,3)-b-D-glucan (BDG) marker were found in the group with cystic fibrosis. Conclusion: The results obtained in this study have demonstrated that a positive (1,3)-b-D-glucan assay highlights the value of this test as a diagnostic adjunct in the serodiagnosis of invasive fungal infections with Aspergillus, and along with the results from conventional mycological investigation, helped in reaching a timely antifungal treatment with a favorable clinical outcome.
Collapse
|
2
|
Jeragh A, Ahmad S, Khan Z, Tarazi RY, Ajmi S, Joseph L, Varghese S, Vayalil S. Subcutaneous phaeohyphomycosis caused by Amesia atrobrunnea in Kuwait. J Mycol Med 2018; 29:193-197. [PMID: 30446389 DOI: 10.1016/j.mycmed.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 09/10/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
The recently described genus Amesia encompasses four species but only Amesia atrobrunnea (=Chaetomium atrobrunneum) is known to be pathogenic to humans. Here, we describe a case of subcutaneous phaeohyphomycosis in Kuwait in an apparently immunocompetent patient diagnosed by direct microscopy of the infected tissue and culture. The identity of A. atrobrunnea was established by typical morphological characteristics and by sequencing of internally transcribed spacer (ITS) region and D1/D2 domains of rDNA. To the best of our knowledge, this is the first report documenting etiologic role of this species in causing a locally invasive subcutaneous infection.
Collapse
Affiliation(s)
- A Jeragh
- Departments of Microbiology, Al Adan Hospital, Kuwait
| | - S Ahmad
- Department of Microbiology, Kuwait
| | - Z Khan
- Department of Microbiology, Kuwait; Mycology Reference Laboratory, Faculty of Medicine, Kuwait University, Kuwait.
| | - R Y Tarazi
- Cardiac surgery, Al Adan Hospital, Kuwait
| | - S Ajmi
- Departments of Microbiology, Al Adan Hospital, Kuwait
| | - L Joseph
- Department of Microbiology, Kuwait
| | | | - S Vayalil
- Mycology Reference Laboratory, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
3
|
Ahmad S, Al-Shaikh AA, Khan Z. Development of a novel inhalational model of invasive pulmonary aspergillosis in rats and comparative evaluation of three biomarkers for its diagnosis. PLoS One 2014; 9:e100524. [PMID: 24955575 PMCID: PMC4067343 DOI: 10.1371/journal.pone.0100524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/28/2014] [Indexed: 11/19/2022] Open
Abstract
Aspergillus fumigatus, a thermotolerant fungus, is the main causative agent of invasive pulmonary aspergillosis (IPA) in immunocompromised patients that is associated with high mortality rates. Early diagnosis of IPA is crucial for mortality reduction and improved prognosis. An experimental inhalational model of IPA was developed in rats and the efficacy of three biomarkers, namely β-D-glucan (BDG), a panfungal marker, galactomannan (GM), a genus-specific marker, and A. fumigatus DNA, a species-specific marker was evaluated in serum and bronchoalveolar lavage (BAL) specimens at different time points postinfection for early diagnosis of IPA. BDG and GM were detected by using commercial Fungitell and Platelia Aspergillus EIA kits, respectively. A. fumigatus DNA was detected by developing a sensitive, single-step PCR assay. IPA was successfully developed in immunosuppressed rats and all animals until 5 days post-infection were positive for A. fumigatus by culture and KOH-calcofluor microscopy also showed A. fumigatus in 19 of 24 (79%) lung tissue samples. Fourteen of 30 (47%) and 27 of 30 (90%) serum and BAL specimens, respectively, were positive for all three biomarkers with 100% specificity (none of sera or BAL specimens of 12 control rats was positive for biomarkers). Our data show that BAL is a superior specimen than serum and combined detection of BDG, GM and A. fumigatus DNA provide a sensitive diagnosis of IPA in an experimental animal model. Moreover, combined detection of GM and DNA in BAL and detection of either GM or DNA in serum was also positive in 27 of 30 (90%) animals. For economic reasons and considering that the positive predictive value of BDG is low, the detection of GM and/or DNA in serum and BAL samples has the potential to serve as an integral component of the diagnostic-driven strategy in high-risk patients suspected for IPA.
Collapse
Affiliation(s)
- Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ali A. Al-Shaikh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- * E-mail:
| |
Collapse
|
4
|
Litvintseva AP, Lindsley MD, Gade L, Smith R, Chiller T, Lyons JL, Thakur KT, Zhang SX, Grgurich DE, Kerkering TM, Brandt ME, Park BJ. Utility of (1-3)-β-D-glucan testing for diagnostics and monitoring response to treatment during the multistate outbreak of fungal meningitis and other infections. Clin Infect Dis 2013; 58:622-30. [PMID: 24336827 DOI: 10.1093/cid/cit808] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The 2012 outbreak of fungal meningitis associated with contaminated methylprednisolone produced by a compounding pharmacy has resulted in >750 infections. An important question facing patients and clinicians is the duration of antifungal therapy. We evaluated (1-3)-β-d-glucan (BDG) as a marker for monitoring response to treatment. METHODS We determined sensitivity and specificity of BDG testing using the Fungitell assay, by testing 41 cerebrospinal fluid (CSF) specimens from confirmed cases of fungal meningitis and 66 negative control CSF specimens. We also assessed whether BDG levels correlate with clinical status by using incident samples from 108 case patients with meningitis and 20 patients with serially collected CSF. RESULTS A cutoff value of 138 pg/mL provided 100% sensitivity and 98% specificity for diagnosis of fungal meningitis in this outbreak. Patients with serially collected CSF were divided into 2 groups: those in whom BDG levels declined with treatment and those in whom BDG remained elevated. Whereas most patients with a decline in CSF BDG had clinical improvement, all 3 patients with continually elevated BDG had poor clinical outcomes (stroke, meningitis relapse, or development of new disease). CONCLUSIONS Our data suggest that measuring BDG in CSF is a highly sensitive test for diagnosis of fungal meningitis in this outbreak. Analysis of BDG levels in serially collected CSF demonstrated that BDG may correlate with clinical response. Routine measurement of BDG in CSF may provide useful adjunctive data for the clinical management of patients with outbreak-associated meningitis.
Collapse
Affiliation(s)
- Anastasia P Litvintseva
- Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Al-Wathiqi F, Ahmad S, Khan Z. Molecular identification and antifungal susceptibility profile of Aspergillus flavus isolates recovered from clinical specimens in Kuwait. BMC Infect Dis 2013; 13:126. [PMID: 23496810 PMCID: PMC3599693 DOI: 10.1186/1471-2334-13-126] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/26/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Within the genus Aspergillus, A. flavus is the second most important species of clinical significance. It is predominantly associated with infections involving sinuses, eye and skin, mostly in geographic regions with hot and arid climate, including the Middle East. Recent reports on emergence of resistance to triazoles among Aspergillus spp. is a cause of concern for treatment of patients with invasive aspergillosis. In this study we present data on genetic characterization and antifungal susceptibility profile of clinical and environmental isolates of A. flavus. METHODS Ninety-nine Aspergillus section Flavi isolates, originating from clinical (n=92) and environmental (n=7) sources, initially identified by morphological characteristics, were analyzed by partial sequencing of β-tubulin and calmodulin gene fragments and their susceptibilities to six antifungal agents was determined by Etest on RPMI1640 and Muller-Hinton agar media. Etest minimum inhibitory concentrations (MICs) of amphotericin B and voriconazole were also compared with zone of inhibition diameters obtained by disc diffusion test on RPMI agar medium. RESULTS The identity of all clinical and environmental isolates was confirmed as A. flavus species by combined analysis of β-tubulin and calmodulin genes. The mean MIC90 (μg/ml) values on RPMI medium for amphotericin B, voriconazole, posaconazole, anidulafungin, micafungin and caspofungin were 3, 0.25, 0.25, 0.002, 0.002 and 0.032, respectively. No environmental isolate exhibited MIC value of >2 μg/ml for amphotericin B. For clinical isolates, the zone of inhibition diameters for amphotericin B and voriconazole ranged from 7-16 mm and 24-34 mm, respectively. Linear regression analysis between Etest MIC values and disk diffusion diameters revealed a significant inverse correlation with amphotericin B (p <0.001) and voriconazole (p<0.003). CONCLUSIONS The β-tubulin and calmodulin gene sequences confirmed that all 92 clinical isolates identified phenotypically belonged to A. flavus taxon, thus suggesting that the other species within Aspergillus section Flavi are of little clinical significance. Triazoles and echinocandins showed very good in vitro activity against the A. flavus, however, 10% clinical isolates showed MICs of >2 μg/ml for amphotericin B.
Collapse
Affiliation(s)
- Faten Al-Wathiqi
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, 13110, Safat, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, 13110, Safat, Kuwait
| | - Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, 13110, Safat, Kuwait
| |
Collapse
|
6
|
Detection of (1, 3)-β-D-glucan in bronchoalveolar lavage and serum samples collected from immunocompromised hosts. Mycopathologia 2012; 175:33-41. [PMID: 22945270 DOI: 10.1007/s11046-012-9579-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 08/23/2012] [Indexed: 01/26/2023]
Abstract
The incidence of invasive fungal infections (IFI) has increased in recent years, especially among immunocompromised hosts (ICH). In 2003, the Fungitell(®) assay received FDA clearance for the presumptive diagnosis of IFI using serum and detects (1-3)-β-D-glucan, which is a major cell wall component of certain fungi (e.g., Candida, Aspergillus, and Pneumocystis). The goal of the current study was to assess the performance of the assay on bronchoalveolar lavage (BAL) fluid and serum to identify IFI in ICH. Patients were classified as having proven, probable, possible, or no IFI according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) guidelines. Among 109 patients for whom the results of Fungitell were compared to the EORTC/MSG criteria, Fungitell showed a low positive predictive value for the identification of IFI from both BAL (20.0%) and serum (26.7%). However, the negative predictive value of Fungitell was significantly higher for both sample types (BAL, 83.0%; serum, 84.8%). Interestingly, the results of Fungitell were positive in BAL and serum in 7/8 (87.5%) patients diagnosed with Pneumocystis pneumonia (PcP) by real-time, non-nested PCR. These data indicate that the Fungitell assay has a low positive predictive value for the diagnosis of IFI in ICH, regardless of the specimen type that is tested. However, testing of serum samples by Fungitell may permit a rapid and noninvasive initial screening approach in patients with presumed PcP.
Collapse
|
7
|
Purpureocillium lilacinum as a cause of cavitary pulmonary disease: a new clinical presentation and observations on atypical morphologic characteristics of the isolate. J Clin Microbiol 2012; 50:1800-4. [PMID: 22322350 DOI: 10.1128/jcm.00150-12] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The first case of cavitary pulmonary disease caused by Purpureocillium lilacinum is described. The isolate showed atypical microscopic characteristics similar to Acremonium and Fusarium spp., which necessitated molecular identification by sequencing of multiple conserved loci. The patient responded to voriconazole, reinforcing its therapeutic efficacy for P. lilacinum infections.
Collapse
|
8
|
Abstract
Invasive fungal infections (IFIs) are associated with high morbidity and mortality in immunocompromised patients. Although Aspergillus spp. remain an important cause of IFI, other moulds such as Fusarium spp., dematiaceous fungi and Mucorales have become increasingly prevalent among this patient population. Diagnosis and treatment of invasive mould infections remain a challenge. Because of the poor prognosis associated with IFIs, understanding the activity, efficacy and limitations of the available drugs is critical to select the appropriate antifungal agent on an individualised basis.
Collapse
Affiliation(s)
- Marisa H Miceli
- Department of Internal Medicine, Oakwood Hospital and Medical Center, Dearborn, MI, USA
| | | |
Collapse
|
9
|
Khan Z, Ahmad S, Kapila K, Ramaswamy NV, Alath P, Joseph L, Chandy R. Pyrenochaeta romeroi: a causative agent of phaeohyphomycotic cyst. J Med Microbiol 2011; 60:842-846. [DOI: 10.1099/jmm.0.029520-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Kusum Kapila
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait
| | | | - Preetha Alath
- Department of Cytology, Kuwait Cancer Control Center, Kuwait
| | - Leena Joseph
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Rachel Chandy
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
10
|
Abstract
A case of Acremonium kiliense peritonitis is described. Diagnosis was established by repeated isolation of the fungus from peritoneal dialysate and by its identification on the basis of morphological characteristics and sequencing of internal transcribed spacer (ITS) regions of ribosomal DNA (rDNA). This report and available literature suggest that A. kiliense may have a greater clinical significance than hitherto recognized.
Collapse
|
11
|
Chowdhary A, Randhawa HS, Singh V, Khan ZU, Ahmad S, Kathuria S, Roy P, Khanna G, Chandra J. Bipolaris hawaiiensis as etiologic agent of allergic bronchopulmonary mycosis: first case in a paediatric patient. Med Mycol 2011; 49:760-5. [PMID: 21395476 DOI: 10.3109/13693786.2011.566895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Allergic bronchopulmonary mycosis (ABPM) is a worldwide hypersensitivity lung disease of multiple etiologies with Aspergillus fumigatus as the most common etiologic agent. We report the first instance of Bipolaris hawaiiensis causing ABPM in a paediatric patient. A six-year-old girl presented in June 2009 with productive cough, exertional dyspnoea, occasional wheezing, restricted air entry in left infra-scapular and infra-axillary areas, 7% eosinophils (absolute count 540/mm(3)) and total IgE 1051.3 IU/m in the sera. Bronchoscopy revealed narrowing of left main bronchus and mucoid impaction of the left lower lobe segmental bronchi. Cytological examination of BAL revealed few eosinophils, Charcot-Leyden crystals and mucus embedded hyphae. Examination of KOH wet mounts of repeated sputum and BAL specimens revealed septate, brownish hyphae and culture of the specimens resulted in the isolation of multiple colonies of a fungus later identified as B. hawaiiensis based on phenotypic characters and sequencing of internal transcribed spacer and D1/D2 regions of rDNA. In addition, (1-3)-β-D-glucan was demonstrated in serum (316 pg/ml) by Fungitell kit, supportive of fungal infection/colonization. Histopathologic studies of a bronchial biopsy revealed necrotic debris, macrophage aggregates, lymphocytes, polymorphs and PAS positive hypae. The patient was administered oral itraconazole for 12 weeks, intravenous liposomal amphotericin B for one month, weekly bronchoscopic suctioning and voriconazole instillation, resulting in reduced mucopurulent secretions and considerable clinical improvement. A serum sample collected on 5 November demonstrated precipitins against antigens of the B. hawaiiensis isolate. In March 2010, intradermal skin testing revealed a strong, type I hypersensitivity (induration diam-12 mm) against B. hawaiiensis. The patient relapsed with wheezing and difficulty in respiration in April 2010. Considering the positive type I cutaneous hypersensitivity, the aforementioned laboratory and clinical observations, the patient was finally diagnosed as having ABPM and was successfully treated with oral prednisone. A high index of clinical suspicion with requisite investigations is crucial for early diagnosis and appropriate therapy of ABPM in order to prevent the late sequelae of irreversible broncho-pulmonary damage.
Collapse
Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Mokaddas E, Burhamah MHA, Ahmad S, Khan ZU. Invasive pulmonary aspergillosis due to Aspergillus terreus: value of DNA, galactomannan and (1→3)-β-d-glucan detection in serum samples as an adjunct to diagnosis. J Med Microbiol 2010; 59:1519-1523. [DOI: 10.1099/jmm.0.023630-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A case of invasive pulmonary aspergillosis caused by Aspergillus terreus is described. The diagnosis was based on demonstration of branched septate hyphae in a sputum specimen and isolation of the fungus in culture. The diagnosis was further supported by detection of A. terreus-specific DNA, galactomannan (GM) and (1→3)-β-d-glucan (BDG) in consecutive serum specimens. The patient was treated for about 10 weeks with voriconazole. The decreasing levels of GM and BDG in serum samples were accompanied by symptomatic and radiological improvement. The report highlights the value of surrogate markers in the diagnosis and for monitoring the course of invasive aspergillosis during therapy.
Collapse
Affiliation(s)
- E. Mokaddas
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | | | - S. Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Z. U. Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| |
Collapse
|
14
|
Chowdhary A, Randhawa HS, Khan ZU, Ahmad S, Khanna G, Gupta R, Chakravarti A, Roy P. Rhinoentomophthoromycosis due to Conidiobolus coronatus. A case report and an overview of the disease in India. Med Mycol 2010; 48:870-9. [PMID: 20482451 DOI: 10.3109/13693786.2010.486010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rhinoentomophthoromycosis due to Conidiobolus coronatus is a rare, chronic, granulomatous disease, occurring mainly in tropical Africa, South and Central America and south-east Asia, including India. We report a case of rhinoentomophthoromycosis in a 30-year-old male farmer, a resident of Gorakhpur city in Uttar Pradesh, which was diagnosed by histopathology and isolation C. coronatus in culture. The patient presented with a swollen nose with obstruction that had progressed slowly over one year. His nasal swelling was bilateral, diffuse, mildly tender, erythematous, non-pitting, with mucosal crusting and hypertrophy of inferior turbinates but no regional lympha-denopathy. A contrast-enhanced computed tomography (CECT) scan revealed bilateral pan-sinusitis with nasoethmoid polyposis. Culture of tissue from the nasal biopsy on Sabouraud glucose agar yielded multiple colonies of a mold with satellite smaller colonies at periphery. The isolate demonstrated the macroscopic and microscopic morphologic characteristics of C. coronatus. Its identity was further confirmed by direct DNA sequencing of internal transcribed spacer (ITS) and D1/D2 regions of rDNA. Haemotoxylin and eosin stained tissue sections of the skin biopsy revealed irregular epidermal acanthosis, marked inflammatory and granulomatous reaction with sparse, non-septate hyphae. The patient was treated successfully with a combination therapy of oral saturated potassium iodide solution, itraconazole, and intravenous infusion of amphotericin B. An overview of rhinoentomophthoromycosis cases reported to-date in India is presented.
Collapse
Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | | | | | | | | | | | | |
Collapse
|
15
|
The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clin Microbiol Rev 2010; 23:235-51. [PMID: 20065332 DOI: 10.1128/cmr.00043-09] [Citation(s) in RCA: 254] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Sepsis, a leading cause of morbidity and mortality throughout the world, is a clinical syndrome with signs and symptoms relating to an infectious event and the consequent important inflammatory response. From a clinical point of view, sepsis is a continuous process ranging from systemic inflammatory response syndrome (SIRS) to multiple-organ-dysfunction syndrome (MODS). Blood cultures are the current "gold standard" for diagnosis, and they are based on the detection of viable microorganisms present in blood. However, on some occasions, blood cultures have intrinsic limitations in terms of sensitivity and rapidity, and it is not expected that these drawbacks will be overcome by significant improvements in the near future. For these principal reasons, other approaches are therefore needed in association with blood culture to improve the overall diagnostic yield for septic patients. These considerations have represented the rationale for the development of highly sensitive and fast laboratory methods. This review addresses non-culture-based techniques for the diagnosis of sepsis, including molecular and other non-culture-based methods. In particular, the potential clinical role for the sensitive and rapid detection of bacterial and fungal DNA in the development of new diagnostic algorithms is discussed.
Collapse
|
16
|
Ahmad S, Khan ZU, Theyyathel AM. Development of a nested PCR assay for the detection of Fusarium solani DNA and its evaluation in the diagnosis of invasive fusariosis using an experimental mouse model. Mycoses 2010; 53:40-7. [DOI: 10.1111/j.1439-0507.2008.01657.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Arendrup MC, Fisher BT, Zaoutis TE. Invasive fungal infections in the paediatric and neonatal population: diagnostics and management issues. Clin Microbiol Infect 2009; 15:613-24. [PMID: 19673972 DOI: 10.1111/j.1469-0691.2009.02909.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Invasive fungal infections in children appear to have increased over the past few decades. Especially neonates and children with primary and secondary immunodeficiencies are at risk. Candida and Aspergillus spp. are the most commonly isolated organisms. In addition, Malassezia may cause systemic infections in newborns and zygomycosis is important because of its rising incidence and high case fatality rate. Timely diagnosis and initiation of appropriate antifungal therapy is imperative for improving outcomes. However, traditional techniques are time-consuming and representative sample material, using invasive procedures, may be difficult to obtain in the paediatric setting. This review provides an overview of the advances in detection and rapid species identification, with a focus on issues relevant in these settings. Subsequently, the current antifungal treatment options for neonates and children are discussed in light of the antifungal spectrum of the available agents and the specific pharmacokinetic properties in different age groups. Although a multitude of newer antifungal compounds have become available within the last decade, further studies are necessary to clearly establish the role for each of these agents among neonates and children.
Collapse
Affiliation(s)
- M C Arendrup
- Unit of Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
| | | | | |
Collapse
|
18
|
Value of Candida serum markers in patients with invasive candidiasis after myeloablative chemotherapy. Diagn Microbiol Infect Dis 2009; 64:408-15. [DOI: 10.1016/j.diagmicrobio.2009.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/11/2009] [Accepted: 04/18/2009] [Indexed: 11/22/2022]
|
19
|
Khan Z, Ahmad S, Joseph L, Chandy R. Cutaneous phaeohyphomycosis due to Neoscytalidium dimidiatum : First case report from Kuwait. J Mycol Med 2009. [DOI: 10.1016/j.mycmed.2009.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Abstract
PURPOSE OF REVIEW Invasive aspergillosis is a common cause of morbidity and mortality in hematopoietic stem cells transplant recipients. Owing to its intrinsic high mortality rate, early diagnosis and treatment are critical. This review will therefore address the most important recent advances in diagnosing, preventing and treating invasive aspergillosis in hematopoietic stem cells transplant. RECENT FINDINGS The present review will focus on therapeutic and prophylactic aspects, with particular regard to clinical use of drugs other than voriconazole (which has a well known and consolidated role for first-line therapy), combination therapy and prophylactic regimens, particularly with posaconazole. This review will also briefly deal with the clinical role of diagnostic tests such as the detection of galactomannan in body fluids other than blood, beta-D-glucan in serum and fungal DNA by PCR in body fluids. SUMMARY Galactomannan antigen detection is a rather reliable diagnostic test for invasive aspergillosis, particularly when a lower threshold of sensitivity is used. PCR is still to be validated. Liposomal amphotericin B at 3 mg/kg per day showed a similar efficacy in invasive aspergillosis as reported for voriconazole. Therapeutic drug monitoring of Aspergillus-active azoles should be implemented whenever possible in order to maximize the antifungal effect and minimize toxicity. Posaconazole showed to be active in prophylaxis, though its effectiveness in the global patient population is still controversial.
Collapse
|
21
|
Application of Galactomannan Analysis and Protein Electrophoresis in the Diagnosis of Aspergillosis in Avian Species. J Zoo Wildl Med 2009; 40:64-70. [DOI: 10.1638/2007-0138.1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
22
|
Mucor circinelloides as a cause of invasive maxillofacial zygomycosis: an emerging dimorphic pathogen with reduced susceptibility to posaconazole. J Clin Microbiol 2009; 47:1244-8. [PMID: 19171681 DOI: 10.1128/jcm.02030-08] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A case of maxillofacial zygomycosis caused by Mucor circinelloides, identified by phenotypic and molecular methods and treated successfully with liposomal amphotericin B (AmBisome) and surgical debridement, is described. The isolate was resistant to posaconazole. This report underscores the importance of prior susceptibility testing of zygomycetes to guide therapy with the most effective antifungal agent for an improved prognosis.
Collapse
|