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Wang H, Yu D, Chen X, Zhou Y, Qian X, Liu D, Wang L, Tang Y, Wang M. Performance of rapid on-site evaluation of touch imprints of bronchoscopic biopsies or lung tissue biopsies for the diagnosis of invasive pulmonary filamentous fungi infections in non-neutropenic patients. J Clin Microbiol 2024; 62:e0047924. [PMID: 38856218 PMCID: PMC11250116 DOI: 10.1128/jcm.00479-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
The diagnosis of invasive pulmonary fungal disease depends on histopathology and mycological culture; there are few studies on touch imprints of bronchoscopic biopsies or lung tissue biopsies for the diagnosis of pulmonary filamentous fungi infections. The purpose of the present study was to explore the detection accuracy of rapid on-site evaluation of touch imprints of bronchoscopic biopsies or lung tissue biopsies for the filamentous fungi, and it aims to provide a basis for initiating antifungal therapy before obtaining microbiological evidence. We retrospectively analyzed the diagnosis and treatment of 44 non-neutropenic patients with invasive pulmonary filamentous fungi confirmed by glactomannan assay, histopathology, and culture from February 2017 to December 2023. The diagnostic positive rate and sensitivity of rapid on-site evaluation for these filamentous fungi identification, including diagnostic turnaround time, were calculated. Compared with the final diagnosis, the sensitivity of rapid on-site evaluation was 81.8%, and the sensitivity of histopathology, culture of bronchoalveolar lavage fluid, and glactomannan assay of bronchoalveolar lavage fluid was 86.4%, 52.3%, and 68.2%, respectively. The average turnaround time of detecting filamentous fungi by rapid on-site evaluation was 0.17 ± 0.03 hours, which was significantly faster than histopathology, glactomannan assay, and mycological culture. A total of 29 (76.3%) patients received earlier antifungal therapy based on ROSE diagnosis and demonstrated clinical improvement. Rapid on-site evaluation showed good sensitivity and accuracy that can be comparable to histopathology in identification of pulmonary filamentous fungi. Importantly, it contributed to the triage of biopsies for further microbial culture or molecular detection based on the preliminary diagnosis, and the decision on early antifungal therapy before microbiological evidence is available.
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Affiliation(s)
- Hansheng Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Dan Yu
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xiao Chen
- Department of Laboratory, Shiyan Maternal and Child Health Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yanhui Zhou
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Xin Qian
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Lei Wang
- Department of Laboratory, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yijun Tang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Meifang Wang
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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Awad MT, Niwinski RM, Beran A, Tidwell C, Soubani AO. Tocilizumab and Corticosteroids Increase Risk of COVID-19-Associated Pulmonary Aspergillosis Development Among Critically Ill Patients. Am J Ther 2023; 30:e268-e274. [PMID: 37278708 DOI: 10.1097/mjt.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mohammed T Awad
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI
| | | | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN
| | - Chad Tidwell
- Internal Medicine Department, Wayne State University School of Medicine, Detroit, MI
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI
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3
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Mereuta VD, Sava A, Stan CI, Eva L, Dumitrescu GF, Dobrin N, Tudorache C, Chiriac A, Strambu IR, Chiran DA, Dumitrescu AM. Cervico-Dorsal Intramedullary Spinal Cord Abscess with Aspergillus fumigates following Pulmonary Infection in an Immunocompetent Patient. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040806. [PMID: 37109764 PMCID: PMC10143747 DOI: 10.3390/medicina59040806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
Invasive forms of aspergillosis of the nervous system are relatively rare and are usually diagnosed in immunocompromised patients. We present the case of a young female patient, treated in the last two months with corticosteroids and antifungal drug for pulmonary aspergillosis, who developed progressive paraparesis. An intramedullary abscess at the C7-D1 level was identified and the lesion was treated with a combination of surgery and antifungal therapy. Histopathologic findings of surgical specimens showed myelomalacia with Aspergillus hyphae and a peripheral rim of neutrophils. We consider that the use of multiple drugs and corticosteroids for our patient's initial community pneumonia could be the factor that transformed her into a mildly immunocompromised individual and permitted the Aspergillus spp. to disseminate through the blood and into the spinal cord. Moreover, we highlight the fact that more attention should be paid to living and working conditions of the patients, as a simple colonization of the lung with Aspergillus spp. could develop, in a short time, into an invasive disease with a high risk of mortality.
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Affiliation(s)
- Vasile Deniss Mereuta
- Department of Oral and Maxillofacial Surgery, St. Spiridon" Emergency Clinical County Hospital, 700111 Iași, Romania
| | - Anca Sava
- Department of Morpho-Functional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Pathology, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, 700309 Iași, Romania
| | - Cristinel Ionel Stan
- Department of Morpho-Functional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Lucian Eva
- 2nd Neurosurgical Clinic, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, 700309 Iași, Romania
| | | | - Nicolaie Dobrin
- 2nd Neurosurgical Clinic, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, 700309 Iași, Romania
| | - Cornelia Tudorache
- Department of Radiology, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, 700309 Iași, Romania
| | - Alexandru Chiriac
- 2nd Neurosurgical Clinic, "Prof. Dr. N. Oblu" Emergency Clinical Hospital, 700309 Iași, Romania
| | - Irina Ruxandra Strambu
- "Marius Nasta" Institute of Pneumology, 050159 Bucharest, Romania
- Department of Pneumology, "Carol Davila", University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Dragos Andrei Chiran
- Department of Morpho-Functional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ana Maria Dumitrescu
- Department of Morpho-Functional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
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Sato N, Yokoi H, Ichioka M, Ishii A, Matsubara T, Yanagita M. Invasive aspergillosis in the patient with focal segmental glomerulosclerosis initiating hemodialysis: a case report and mini-review. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Invasive aspergillosis (IA) is a severe form of fungal infection caused by the genus Aspergillus in immunocompromised hosts and has a high mortality rate. End-stage kidney disease (ESKD) is one of the risk factors for developing fungal infection; however, the detailed clinical and treatment course of ESKD patients with IA has been scarcely reported, especially for the patient initiating hemodialysis (HD). Here, we experienced a patient under immunosuppressive therapy for focal segmental glomerulosclerosis (FSGS) who suffered from IA involving lung and brain and resulted in initiating HD.
Case presentation
A 66-year-old male patient with a history of suspected non-tuberculosis mycobacterial lung disease was initially admitted to the hospital with minimal change disease and subsequently diagnosed as FSGS with worsening urinary protein levels. The combined treatment including immunosuppressive treatments of cyclosporin and glucocorticoids and low-density lipoprotein apheresis was initiated, and then, he experienced the symptoms of dry cough, somnolence, and disorientation, which were subsequently diagnosed as IA involving lung and brain. The patient required renal replacement therapy, and maintenance HD was continued. Despite the intensive treatment with multiple antifungals of liposomal amphotericin B, voriconazole, micafungin, and amphotericin B, the pneumonia of the patient did not improve, and he subsequently passed away.
Conclusions
We report the case of the IA under immunosuppressive treatment, who was subsequently initiated maintenance HD. The detailed clinical course of medications used to treat the patient is presented with the literature review of IA in ESKD and HD patients and those with past acid-fast bacterial infections. The careful determination of the intensity of immunosuppression and monitoring of the patient’s symptoms and early definitive diagnosis is crucial in treating IA in immunocompromised hosts with ESKD or in HD under immunosuppressive treatment, as the mortality for these patients is suspected to be high despite the intensive treatment.
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Mizushima R, Haruhara K, Fukasawa N, Satake M, Fukui A, Koike K, Tsuboi N, Takahashi H, Yokoo T. Two entities in pulmonary nodules of a diabetic patient receiving corticosteroid therapy for bullous pemphigoid: an autopsy case report. BMC Infect Dis 2022; 22:597. [PMID: 35799119 PMCID: PMC9264713 DOI: 10.1186/s12879-022-07566-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Invasive pulmonary aspergillosis (IPA) is a serious complication occurring in immunocompromised patients, who often show multiple nodular lesions with or without cavitation. Due to high mortality and poor prognosis, the earlier detection and initiation of treatment are needed, while the definitive diagnosis is often difficult to make in clinical settings. Septic pulmonary embolism (SPE) is a complication that occurs in patients with bloodstream infections (e.g., infectious endocarditis). Patients with SPE also present with multiple nodules, nodules with or without cavitation, which are quite similar to the findings of IPA. We herein report an autopsy case that showed multiple nodules due to IPA and infectious endocarditis-related SPE. Case A 69-year-old man receiving maintenance hemodialysis due to diabetic nephropathy was admitted with worsening skin rash due to bullous pemphigoid and toxic epidermal necrolysis. He was treated with intravenous methylprednisolone followed by an increased dose of oral prednisolone. On the 6th week of admission, he was diagnosed with infectious endocarditis after the isolation of Corynebacterium in blood samples, with a nodule lesion with cavitation in the right lung. Intravenous vancomycin was initiated. After antibacterial treatment, the nodules in the right lung gradually diminished, whereas a nodule with cavitation in the left lung emerged. The nodule in the left lung showed rapid growth along with elevation of serum β-d-glucan and galactomannan antigen. Despite starting treatment with antifungal agents, he died from respiratory failure. An autopsy revealed Groccott staining-positive aspergillus in the left lung, but not in the right lung. We found fibrosis with mitral valve vegetation, indicating a recovery from infectious endocarditis. Conclusion Although similar features of nodules with cavitation on CT imaging were shared with SPE and IPA, this case demonstrated that these heterogeneous diseases can occur within the lungs and the distinctly different transitions of CT imaging are helpful for suspecting the presence of multiple pathogeneses.
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Affiliation(s)
- Reimi Mizushima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kotaro Haruhara
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Nei Fukasawa
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mari Satake
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Clinical and Epidemiological Profile of Patients with Invasive Aspergillosis from a Fourth Level Hospital in Bogota, Colombia: A Retrospective Study. J Fungi (Basel) 2021; 7:jof7121092. [PMID: 34947074 PMCID: PMC8707106 DOI: 10.3390/jof7121092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
Invasive aspergillosis (IA) is a severe mycosis caused by Aspergillus species. The infection mainly affects immunocompromised patients with a significant clinical burden. This study aimed to determine the clinical and epidemiological characteristics of patients diagnosed with IA in a fourth level hospital in Colombia, as these data are scarce in the country. A retrospective, observational study, from a single center was conducted with 34 male and 32 female patients, between 1 month- and 90-year-old, diagnosed with proven (18.2%), probable (74.2%) and possible (7.6%) IA, during a 21-year period. The most frequent underlying conditions for IA were chemotherapy (39.4%) and corticosteroid use (34.8%). The lung was the most common affected organ (92.4%). Computed tomography (CT) imaging findings were mainly nodules (57.6%) and consolidation (31.8%). A low positive correlation was found between serum galactomannan and hospitalization length. Aspergillus fumigatus prevailed (73.3%) in sputum and bronchoalveolar lavage cultures. Most patients were hospitalized in general wards (63.6%) and treated with voriconazole (80.3%). Mortality rate was 15.2%. Common risk factors for IA were identified in the Colombian cohort, including medications and underlying diseases. However, their frequency differs from other countries, reinforcing the idea that local surveillance is essential and at-risk patients should be carefully monitored.
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Johnson AK, Ghazarian Z, Cendrowski KD, Persichino JG. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep 2021; 32:64-67. [PMID: 33842203 PMCID: PMC8025540 DOI: 10.1016/j.mmcr.2021.03.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 12/21/2022] Open
Abstract
Invasive pulmonary mucormycosis and aspergillosis are rare, life-threatening fungal infections. Most documented cases have been reported in patients with diabetes mellitus, neutropenia, or treatment with corticosteroids. Both infections have been recognized as secondary complications of COVID-19, especially among critically ill patients. We report the first case of combined probable pulmonary aspergillosis and possible mucormycosis in a male with COVID-19 in the ICU.
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Affiliation(s)
- Andre K Johnson
- Riverside Community Hospital, Division of Infectious Diseases, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
| | - Zeron Ghazarian
- Riverside Community Hospital, Division of Pulmonary and Critical Care, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
| | - Kristina D Cendrowski
- Riverside Community Hospital, Department of Pathology, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
| | - Jon G Persichino
- Riverside Community Hospital, Division of Infectious Diseases, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
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Dotis J, Kondou A, Koukloumperi E, Karava V, Papadopoulou A, Gkogka C, Printza N. Aspergillus peritonitis in peritoneal dialysis patients: A systematic review. J Mycol Med 2020; 30:101037. [PMID: 32893119 DOI: 10.1016/j.mycmed.2020.101037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/24/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Fungal peritonitis in patients undergoing peritoneal dialysis (PD) is very difficult to treat and is associated with significant morbidity and mortality. Among fungal pathogens, Aspergillus peritonitis presents a higher mortality rate when compared to Candida peritonitis and its identification as well as appropriate treatment remains a challenge for the physicians. We critical reviewed all published cases in literature of Aspergillus peritonitis in PD patients. The results showed that a total of 55 cases (51% males) of Aspergillus peritonitis in PD patients were reported from 1968 to 2019. Mean patient age was 49.54±19.63years and mean PD duration prior to fungal infection was 33.31±32.45months. Aspergillus fumigatus was isolated in 17/55 patients, Aspergillus niger in 15, Aspergillus terreus in 9, unidentified Aspergillus spp. in 6, Aspergillus flavus in 4, whereas sporadic cases of other Aspergillus spp. were reported. As far as predisposing factors are concerned, 75% of patients suffered from prior bacterial peritonitis receiving antimicrobial therapy. Initial antifungal treatment was intravenous and/or intraperitoneal administration of amphotericin B formulations monotherapy in 47.2% of patients or in combination with fluconazole in 13.2%, or with itraconazole in 13.2%, or with caspofungin in 3.8%, or with ketoconazole or with 5-FC in 1.9%, each. Peritoneal catheter removal was performed in 85.5% of cases. Mortality rate was 38.2%, while 81.8% of the survived patients switched to hemodialysis. Conclusively, Aspergillus peritonitis diagnosis can be difficult, due to unspecific symptoms. Early treatment with appropriate antifungal agents can be determinant for patient prognosis. Despite appropriate treatment, reported mortality remains high.
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Affiliation(s)
- J Dotis
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
| | - A Kondou
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - E Koukloumperi
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - V Karava
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - A Papadopoulou
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - C Gkogka
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - N Printza
- First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Persichino JG, Can AD, Van TT, Matthews MN, Filler SG. Invasive pulmonary mucormycosis and aspergillosis in a patient with decompensated hepatic cirrhosis. Med Mycol Case Rep 2018; 21:12-15. [PMID: 29560305 PMCID: PMC5857481 DOI: 10.1016/j.mmcr.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/09/2018] [Accepted: 03/01/2018] [Indexed: 12/15/2022] Open
Abstract
Invasive pulmonary mucormycosis and aspergillosis are rare, life-threatening fungal infections. Most documented cases have been reported in non-cirrhotic patients with diabetes mellitus, neutropenia, or treatment with corticosteroids. The prevalence of each infection is low among patients with hepatic cirrhosis. We report the first likely case of combined invasive pulmonary mucormycosis and aspergillosis in a male with decompensated hepatic cirrhosis. This report also highlights the first non-diabetic case of invasive pulmonary mucormycosis with decompensated hepatic cirrhosis.
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Affiliation(s)
- Jon G. Persichino
- Harbor-UCLA Medical Center, Division of Infectious Diseases, 1000 West Carson Street, Torrance, CA 90509, USA
- Corresponding author.
| | - Argun D. Can
- Harbor-UCLA Medical Center, Division of Respiratory & Critical Care Physiology & Medicine, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Tam T. Van
- Harbor-UCLA Medical Center, Department of Pathology, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Michele N. Matthews
- Harbor-UCLA Medical Center, Department of Pathology, 1000 West Carson Street, Torrance, CA 90509, USA
| | - Scott G. Filler
- Harbor-UCLA Medical Center, Division of Infectious Diseases, 1000 West Carson Street, Torrance, CA 90509, USA
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Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol 2018; 17:362-372. [PMID: 29477506 DOI: 10.1016/s1474-4422(18)30030-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 12/16/2022]
Abstract
Fungal infections of the CNS are challenging to treat and their optimal management requires knowledge of their epidemiology, host characteristics, diagnostic criteria, and therapeutic options. Aspergillus and Cryptococcus species predominate among fungal infections of the CNS. Most of these fungi are ubiquitous, but some have restricted geographical distribution. Fungal infections of the CNS usually originate from primary sites outside the CNS (eg, fungal pneumonia) or occur after inoculation (eg, invasive procedures). Most patients with these infections have immunodeficiencies, but immunocompetent individuals can also be infected through heavy exposure. The infecting fungi can be grouped into moulds, yeasts, and dimorphic fungi. Substantial progress has been made with new diagnostic approaches and the introduction of novel antifungal drugs, but fungal infections of the CNS are frequently lethal because of diagnostic delays, impaired drug penetration, resistance to antifungal treatments, and inadequate restoration of immune function. To improve outcomes, future research should advance diagnostic methods (eg, molecular detection and fungus identification), develop antifungal compounds with enhanced CNS-directed efficacy, and further investigate crucial host defence mechanisms.
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Affiliation(s)
- Stefan Schwartz
- Medical Department, Division of Haematology, Oncology and Tumour Immunology, Charité, Berlin, Germany.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Harrison
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Markus Ruhnke
- Department of Haematology and Oncology, Paracelsus-Hospital, Osnabrück, Germany
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