1
|
Shah K, Deshpande M, Shah P. Healthcare-associated fungal infections and emerging pathogens during the COVID-19 pandemic. FRONTIERS IN FUNGAL BIOLOGY 2024; 5:1339911. [PMID: 38465254 PMCID: PMC10920311 DOI: 10.3389/ffunb.2024.1339911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Historically, fungi were mainly identified as plant and insect pathogens since they grow at 28°C. At the same time, bacteria are known to be the most common human pathogens as they are compatible with the host body temperature of 37°C. Because of immunocompromised hosts, cancer therapy, and malnutrition, fungi are rapidly gaining attention as human pathogens. Over 150 million people have severe fungal infections, which lead to approximately more than one million deaths per year. Moreover, diseases like cancer involving long-term therapy and prophylactic use of antifungal drugs in high-risk patients have increased the emergence of drug-resistant fungi, including highly virulent strains such as Candida auris. This clinical spectrum of fungal diseases ranges from superficial mucocutaneous lesions to more severe and life-threatening infections. This review article summarizes the effect of hospital environments, especially during the COVID-19 pandemic, on fungal infections and emerging pathogens. The review also provides insights into the various antifungal drugs and their existing challenges, thereby driving the need to search for novel antifungal agents.
Collapse
Affiliation(s)
- Krish Shah
- Biological Sciences Bellarmine College Preparatory, San Jose, CA, United States
| | | | - P. Shah
- Science Ambassador/Bio-Rad Laboratories, Hercules, CA, United States
| |
Collapse
|
2
|
Successful treatment of hepatic and mesh Aspergillosis in a neonate with giant omphalocele. J Mycol Med 2022; 32:101245. [DOI: 10.1016/j.mycmed.2022.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/23/2022]
|
3
|
Merad Y, Derrar H, Belmokhtar Z, Belkacemi M. Aspergillus Genus and Its Various Human Superficial and Cutaneous Features. Pathogens 2021; 10:643. [PMID: 34071092 PMCID: PMC8224566 DOI: 10.3390/pathogens10060643] [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: 02/02/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Superficial and cutaneous aspergillosis is a rare fungal disease that is restricted to the outer layers of the skin, nails, and the outer auditory canal, infrequently invading the deeper tissue and viscera, particularly in immunocompromised patients. These mycoses are acquired through two main routes: direct traumatic inoculation or inhalation of airborne fungal spores into paranasal sinuses and lungs. Lesions are classified into three categories: otomycosis, onychomycosis, and cutaneous aspergillosis. Superficial and cutaneous aspergillosis occurs less frequently and therefore remains poorly characterized; it usually involves sites of superficial trauma-namely, at or near intravenous entry catheter site, at the point of traumatic inoculation (orthopaedic inoculation, ear-self-cleaning, schizophrenic ear self-injuries), at surgery incision, and at the site of contact with occlusive dressings, especially in burn patients. Onychomycosis and otomycosis are more seen in immunocompetent patients, while cutaneous aspergillosis is widely described among the immunocompromised individuals. This paper is a review of related literature.
Collapse
Affiliation(s)
- Yassine Merad
- Department Parasitology-Mycology, ‘Hassani Abdelkader’ Hospital, UDL Faculty of Medicine, Laboratoire de Synthèse de L’information Environementale, UDL, Sidi-Bel-Abbes 22000, Algeria
| | - Hichem Derrar
- Department of Pulmonary Diseases, ‘Hassani Abdelkader’ Hospital, UDL Faculty of Medicine, Sidi-Bel-Abbes 22000, Algeria;
| | - Zoubir Belmokhtar
- Department of Environmental Sciences, Faculty of Natural Science and Life, University Djilali Liabes, Sidi-Bel-Abbes 22000, Algeria;
| | - Malika Belkacemi
- Department of Hemobiology and Blood Transfusion, ‘Hassani Abdelkader’ Hospital, UDL Faculty of Medecine, Sidi-Bel-Abbes 22000, Algeria;
| |
Collapse
|
4
|
Aljariri AA, Shaikh A, Nashwan AJ, Petkar MA, Ganesan S. Nasal-alar invasive cutaneous aspergillosis in a patient with anaplastic astrocytoma: A case report. Clin Case Rep 2021; 9:2295-2299. [PMID: 33936682 PMCID: PMC8077370 DOI: 10.1002/ccr3.4018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/17/2021] [Accepted: 02/18/2021] [Indexed: 11/08/2022] Open
Abstract
Invasive aspergillosis is commonly encountered in immunosuppressed patients either primarily through direct inoculation or secondary from blood dissemination. This report describes a case of 53 years old immunocompromised female patient who was diagnosed with frontotemporal anaplastic astrocytoma and developed nasal skin lesion turned to be invasive cutaneous aspergillosis.
Collapse
Affiliation(s)
- Adham A. Aljariri
- Otolaryngology DepartmentAmbulatory Care Center (ACC)Hamad Medical Corporation (HMC)DohaQatar
| | - Ahmed Shaikh
- Otolaryngology DepartmentAmbulatory Care Center (ACC)Hamad Medical Corporation (HMC)DohaQatar
| | - Abdulqadir J. Nashwan
- Hazm Mebaireek General Hospital (HMGH)Hamad Medical Corporation (HMC)DohaQatar
- University of Calgary in Qatar (UCQ)DohaQatar
| | - Mahir A. Petkar
- Pathology DepartmentHamad General Hospital (HGH)Hamad Medical Corporation (HMC)DohaQatar
| | - Shanmugam Ganesan
- Otolaryngology DepartmentAmbulatory Care Center (ACC)Hamad Medical Corporation (HMC)DohaQatar
| |
Collapse
|
5
|
Olivero RM, Caulfield AJ, Fulton BK. An Extremely Premature Newborn with Cutaneous Lesions. Neoreviews 2019; 20:e757-e760. [PMID: 31792164 DOI: 10.1542/neo.20-12-e757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Rosemary M Olivero
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital of Spectrum Health and Michigan State College of Human Medicine, Grand Rapids, MI
| | | | - Barbara K Fulton
- Michigan Pathology Specialists PC, Spectrum Health System, Grand Rapids, MI
| |
Collapse
|
6
|
Maddy AJ, Sanchez N, Shukla BS, Maderal AD. Dermatological manifestations of fungal infection in patients with febrile neutropaenia: A review of the literature. Mycoses 2019; 62:826-834. [DOI: 10.1111/myc.12928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Austin J. Maddy
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida
| | - Nelson Sanchez
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida
| | - Bhavarth S. Shukla
- Department of Internal Medicine University of Miami Miller School of Medicine Miami Florida
| | - Andrea D. Maderal
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida
| |
Collapse
|
7
|
Shields BE, Rosenbach M, Brown-Joel Z, Berger AP, Ford BA, Wanat KA. Angioinvasive fungal infections impacting the skin. J Am Acad Dermatol 2019; 80:869-880.e5. [DOI: 10.1016/j.jaad.2018.04.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 01/19/2023]
|
8
|
Dermatologic Conditions of the Early Post-Transplant Period in Hematopoietic Stem Cell Transplant Recipients. Am J Clin Dermatol 2019; 20:55-73. [PMID: 30298481 DOI: 10.1007/s40257-018-0391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hematopoietic stem cell transplants (HSCTs) are used to treat a variety of conditions, including hematologic malignancies, bone marrow failure syndromes, and immunodeficiencies. Over 60,000 HSCTs are performed annually worldwide, and the numbers continue to increase. Indeed, as new conditioning regimens develop, more and more individuals, including those of older age, will be eligible for transplants. Nevertheless, although HSCTs are clearly a life-saving and necessary treatment for thousands of patients per year, there is still substantial morbidity and mortality associated with the procedure. Of note, skin eruptions in the post-HSCT period are frequent and often significantly reduce quality of life in recipients. Moreover, these cutaneous findings sometimes herald an underlying systemic condition, presenting possible opportunities for timelier intervention. Dermatologists therefore play a vital role in distinguishing life-threatening conditions from benign issues and prompting recognition of critical complications earlier in their course. This article aims to review the major dermatologic conditions occurring in the early post-HSCT period.
Collapse
|
9
|
Pastrone L, Corsetti MT, Depaoli L, Sampò S, Colonna M, Rocchetti A. An atypical occurrence of Aspergillosis in leukemic patient: Brief description of a clinical case. J Mycol Med 2018; 28:655-658. [DOI: 10.1016/j.mycmed.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/13/2018] [Accepted: 10/05/2018] [Indexed: 11/27/2022]
|
10
|
Invasive Aspergillosis in Children: Update on Current Guidelines. Mediterr J Hematol Infect Dis 2018; 10:e2018048. [PMID: 30210741 PMCID: PMC6131109 DOI: 10.4084/mjhid.2018.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023] Open
Abstract
Invasive aspergillosis (IA) is an important cause of infectious morbidity and mortality in immunocompromised paediatric patients. Despite improvements in diagnosis, prevention, and treatment, IA is still associated with high mortality rates. To address this issue, several international societies and organisations have proposed guidelines for the management of IA in the paediatric population. In this article, we review current recommendations of the Infectious Diseases Society of America, the European Conference on Infection in Leukaemia and the European Society of Clinical Microbiology and Infectious Diseases for the management and prevention of IA in children.
Collapse
|
11
|
Woods GL, Davis JC, Vaughan WP. Failure of the Sterile Air-Flow Component of a Protected Environment Detected by Demonstration of Chaetomium Species Colonization of Four Consecutive Immunosuppressed Occupants. Infect Control Hosp Epidemiol 2016. [DOI: 10.2307/30145161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractFour bone marrow transplant recipients consecutively occupying the same room on our Oncology-Hematology Special Care Unit (OHSCU) became colonized with Chaetomium species between January and April, 1987. These patients, aged 27 to 43 years, were immunocompromised as a result of intensive chemotherapy, and were consequently at increased risk for development of invasive fungal infection. At the time of Chaetomium colonization, all patients were febrile, two had transient new infiltrates on chest x-ray, and three were receiving amphotericin B therapy. Subsequent environmental cultures revealed Chaetomium contamination of the OHSCU air-handling system, including the HEPA (high-efficiency particulate air) filters in seven of the nine rooms comprising the unit. Because fungal colonization of HEPA filters used to create a “protective environment” for immunocompromised patients can occur and can serve as a source for patient infections, guidelines concerning proper surveillance of these HEPA filters should be established. We suggest that before a new patient enters a “protected” room, the clean side of the HEPA filter should be cultured. If fungi are recovered from that culture, we would recommend changing the filter.
Collapse
|
12
|
Abstract
Primary cutaneous aspergillosis (PCA) is an uncommon infection of the skin. There is a paucity of organized literature regarding this entity in regard to patient characteristics, associated Aspergillus species, and treatment modalities on outcome (disease recurrence, disease dissemination, and mortality).We reviewed all published reports of PCA from 1967 to 2015. Cases were deemed eligible if they included the following: patient baseline characteristics (age, sex, underlying condition), evidence of proven or probable PCA, primary treatment strategy, and outcome.We identified 130 eligible cases reported from 1967 to 2015. The patients were predominantly male (63.8%) with a mean age of 30.4 ± 22.1 years. Rates of PCA recurrence, dissemination, and mortality were 10.8%, 18.5%, and 31.5%, respectively. In half of the cases, there was an association with a foreign body. Seven different Aspergillus species were reported to cause PCA. Systemic antifungal therapy without surgery was the most common form of therapy (60% of cases). Disease dissemination was more common in patients with underlying systemic conditions and occurred on average 41.4 days after PCA diagnosis (range of 3-120 days). In a multivariate linear regression model of mortality including only patients with immunosuppressive conditions, dissemination and human immunodeficiency virus/acquired immune deficiency syndrome were statistically significantly associated with increased mortality.Nearly one-third of patients with PCA die with the disease. Dissemination and host status are critical in patient outcome.
Collapse
Affiliation(s)
- Alexander M. Tatara
- Department of Bioengineering, Rice University
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX
- Correspondence: Dimitrios P. Kontoyiannis, Department of Infectious Diseases, Infection Control and Employee Health, Unit 1416, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 (e-mail: )
| |
Collapse
|
13
|
Reischies F, Hoenigl M. The role of surgical debridement in different clinical manifestations of invasive aspergillosis. Mycoses 2014; 57 Suppl 2:1-14. [PMID: 25186615 DOI: 10.1111/myc.12224] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
Invasive aspergillosis (IA) has a wide spectrum of clinical presentations and is associated with high mortality rates. Early initiation of systemic antimould therapy remains the most important measure to reduce mortality. Surgical debridement is an important additional therapeutic option mainly in cases of extrapulmonary IA. The main intention for surgical intervention in IA is to obtain material for diagnosis and antifungal susceptibility testing. There are, however, also therapeutic implications for surgical interventions in rare manifestation of IA such as endocarditis or mycotic aneurysm. Here, we will review the role of surgical interventions in the treatment of different clinical manifestations of IA.
Collapse
Affiliation(s)
- Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | | |
Collapse
|
14
|
Eldridge ML, Chambers CJ, Sharon VR, Thompson GR. Fungal infections of the skin and nail: new treatment options. Expert Rev Anti Infect Ther 2014; 12:1389-405. [DOI: 10.1586/14787210.2014.960849] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue
Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147-59. [DOI: 10.1093/cid/ciu296] [Citation(s) in RCA: 1187] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
Collapse
Affiliation(s)
- Dennis L. Stevens
- Division of Infectious Diseases, Department of Veterans Affairs, Boise, Idaho
| | - Alan L. Bisno
- Medical Service, Miami Veterans Affairs Health Care System, Florida
| | | | | | - Ellie J. C. Goldstein
- University of California, Los Angeles, School of Medicine, and R. M. Alden Research Laboratory, Santa Monica, California
| | | | - Jan V. Hirschmann
- Medical Service, Puget Sound Veterans Affairs Medical Center, Seattle, Washington
| | - Sheldon L. Kaplan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - James C. Wade
- Geisinger Health System, Geisinger Cancer Institute, Danville, Pennsylvania
| |
Collapse
|
16
|
Chung EH, Lee SY. A Case of Primary Cutaneous Scar Infection Caused by Aspergillus niger. Ann Dermatol 2014; 26:659-60. [PMID: 25324671 PMCID: PMC4198606 DOI: 10.5021/ad.2014.26.5.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 09/09/2013] [Accepted: 10/13/2013] [Indexed: 12/02/2022] Open
Affiliation(s)
- Euy-Hyun Chung
- Department of Dermatology, Soon Chun Hyang University College of Medicine, Cheonan, Korea
| | - Sung-Yul Lee
- Department of Dermatology, Soon Chun Hyang University College of Medicine, Cheonan, Korea
| |
Collapse
|
17
|
Venugopal TV, Venugopal PV. Primary cutaneous aspergillosis from Tamilnadu diagnosed by fine needle aspiration cytology. Med Mycol Case Rep 2012; 1:103-6. [PMID: 24371752 DOI: 10.1016/j.mmcr.2012.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 09/20/2012] [Accepted: 09/21/2012] [Indexed: 11/26/2022] Open
Abstract
Aspergillus are ubiquitous and more than 30 species have been reported to be involved in human infection. Most of the cases occur in immunocompromised patients and are disseminated in the blood. Primary cutaneous aspergillosis in immunocompetent hosts is rare. We report a unique case of primary cutaneous aspergillosis in an immunocompetent patient diagnosed by fine needle aspiration cytology. The characteristic ascocarp and ascospores of Aspergillus species were found in the aspirate and Aspergillus glaucus was isolated in pure culture. The case is presented to increase the awareness of the usefulness of fine needle aspiration cytology for diagnosing fungal infections.
Collapse
Affiliation(s)
- Taralakshmi V Venugopal
- Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Tiruporur, Kanchipuram 603 110, India
| | | |
Collapse
|
18
|
Saghrouni F, Gheith S, Yaacoub A, Ammous O, Ben Abdeljelil J, Fathallah A, Mokni M, Ben Saïd M. Primary cutaneous aspergillosis due to Aspergillus flavus in a neutropenic patient. J Mycol Med 2011. [DOI: 10.1016/j.mycmed.2011.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
19
|
Tragiannidis A, Roilides E, Walsh TJ, Groll AH. Invasive Aspergillosis in Children With Acquired Immunodeficiencies. Clin Infect Dis 2011; 54:258-67. [DOI: 10.1093/cid/cir786] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
20
|
|
21
|
Kerl K, Koch B, Fegeler W, Rossig C, Ehlert K, Groll A. Catheter-associated aspergillosis of the chest wall following allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2010; 13:182-5. [DOI: 10.1111/j.1399-3062.2010.00559.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Kindo AJ, Rana NS, Rekha A, Kalyani J. Fungal infections in the soft tissue: A study from a tertiary care center. Indian J Med Microbiol 2010; 28:164-6. [DOI: 10.4103/0255-0857.62498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
23
|
Olorunnipa O, Zhang AY, Curtin CM. Invasive Aspergillosis of the Hand Caused by Aspergillus ustus: a Case Report. Hand (N Y) 2010; 5:102-5. [PMID: 19568818 PMCID: PMC2820612 DOI: 10.1007/s11552-009-9211-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
This is a case report of a 61-year-old cardiac transplant patient who developed a disseminated infection involving the upper extremity with a rare fungus known as Aspergillus ustus. The patient was successfully treated with aggressive serial debridements, antifungal medications, and reduction of immunosuppression. With these interventions, the patient avoided amputation despite the aggressive nature of this infection.
Collapse
Affiliation(s)
- Olushola Olorunnipa
- Division of Plastic Surgery, School of Medicine, Stanford University, Suite 400, 770 Welch Rd., Palo Alto, CA 94304 USA
| | - Andrew Y. Zhang
- Division of Plastic Surgery, School of Medicine, Stanford University, Suite 400, 770 Welch Rd., Palo Alto, CA 94304 USA
| | - Catherine M. Curtin
- Division of Plastic Surgery, School of Medicine, Stanford University, Suite 400, 770 Welch Rd., Palo Alto, CA 94304 USA ,Department of Surgery, Palo Alto VA, 3801 Miranda Ave., Palo Alto, CA 94304 USA
| |
Collapse
|
24
|
Abstract
Aspergillosis is an uncommon perinatal infection diagnosed with increasing frequency in recent years. We report a premature infant who required both nutrition and ventilation artificially assisted and developed a disseminated invasive nosocomial infection from Aspergillus flavus. Autopsy revealed marked hypotrophy of the thymus and multisystem invasive aspergillosis chiefly involving the vascular and alimentary systems and also the respiratory tract, the central nervous system, and the skin. From what we know, this is the first case of the literature with a misleading initial clinical presentation involving the alimentary tract (hepatomegaly, ingravescent cholestatic icterus) and evolving in intestinal occlusion.
Collapse
Affiliation(s)
- Luca Roncati
- Department of Diagnostic Services, Pathology and Forensic Medicine, Section of Pathology, University of Modena and Reggio Emilia, via del Pozzo n.71, Modena, Italy
| | | | | | | |
Collapse
|
25
|
Deep cutaneous fungal infections in immunocompromised children. J Am Acad Dermatol 2009; 61:857-64. [DOI: 10.1016/j.jaad.2009.02.052] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 11/15/2022]
|
26
|
Palmero ML, Pope E, Brophy J. Sporotrichoid aspergillosis in an immunocompromised child: a case report and review of the literature. Pediatr Dermatol 2009; 26:592-6. [PMID: 19840318 DOI: 10.1111/j.1525-1470.2009.00991.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary cutaneous aspergillosis is an uncommon, opportunistic infection. Atypical presentations have recently emerged with the expanding range of primary and acquired diseases that cause immunosuppression. Primary cutaneous aspergillosis may invade the deep lymphatic structures and present in a sporotrichoid pattern. In pediatric patients with an otherwise normal previous medical history, primary cutaneous aspergillosis should raise the suspicion of an immunodeficiency and prompt referral to immunology and infectious disease specialists should be made. Early diagnosis and management of primary cutaneous aspergillosis prevents invasive aspergillosis, minimizing morbidity and mortality in the immunocompromised patients.
Collapse
Affiliation(s)
- Maria Lourdes Palmero
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | |
Collapse
|
27
|
Krishnan S, Manavathu EK, Chandrasekar PH. Aspergillus flavus: an emerging non-fumigatus Aspergillus species of significance. Mycoses 2009; 52:206-22. [PMID: 19207851 DOI: 10.1111/j.1439-0507.2008.01642.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Invasive aspergillosis is rare in immunocompetent people but contributes to significant morbidity and mortality in immunosuppressed patients. The majority (approximately 80%) of invasive Aspergillus infections is caused by Aspergillus fumigatus. The second most frequent (approximately 15-20%) pathogenic species is Aspergillus flavus and to a lesser extent, Aspergillus niger and Aspergillus terreus. Aspergillus flavus has emerged as a predominant pathogen in patients with fungal sinusitis and fungal keratitis in several institutions worldwide. To date, there has not been any publication exclusively reviewing the topic of A. flavus in the literature. This article reviews the microbiology, toxigenicity and epidemiology of A. flavus as well as describes the clinical characteristics, diagnosis and management of infections caused by this organism.
Collapse
Affiliation(s)
- Suganthini Krishnan
- Division of Infectious Diseases, Wayne State University, John D. Dingell VA Medical Center, Detroit, MI 48201, USA.
| | | | | |
Collapse
|
28
|
Quatresooz P, Piérard-Franchimont C, Arrese JE, Piérard GE. Clinicopathologic presentations of dermatomycoses in cancer patients. J Eur Acad Dermatol Venereol 2008; 22:907-17. [PMID: 18503529 DOI: 10.1111/j.1468-3083.2008.02774.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many of the skin fungal infections in cancer patients may look similar to those infections in non-cancer patients. However, in some cases, they become more extensive and even life threatening. Prolonged and severe neutropenia is the main risk factor for the dramatic issue of fungal infections. The dermatomycoses in cancer patients can be classified in four broad groups: primary superficial dermatophytoses, primary superficial yeast infections, opportunistic mold infections with distinct potential for dissemination and secondary cutaneous manifestations of fungaemia. Occasionally, more than one fungus are found inside a given skin lesion. A special condition is represented by the mycotic colonization of mucosal squamous cell carcinomas. Angio-invasion by fungi accounts for the frequency of disseminated infections prevailing in immunocompromised cancer patients. In case of skin involvement, the dermatologist may assist by recognizing subtle semiological signs and performing biopsies for swift histological examination, molecular biology and/or culture.
Collapse
Affiliation(s)
- P Quatresooz
- Department of Dermatopathology, University Hospital Sart Tilman, Liège, Belgium.
| | | | | | | |
Collapse
|
29
|
Burgos A, Zaoutis TE, Dvorak CC, Hoffman JA, Knapp KM, Nania JJ, Prasad P, Steinbach WJ. Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics 2008; 121:e1286-94. [PMID: 18450871 DOI: 10.1542/peds.2007-2117] [Citation(s) in RCA: 220] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised children. Invasive aspergillosis has been well characterized in adults; however, the incidence and analysis of risk factors, diagnostic tools, treatments, and outcomes have not been well described for a large cohort of pediatric patients. METHODS We conducted the largest retrospective review of contemporary cases of proven and probable pediatric invasive aspergillosis diagnosed at 6 major medical centers (January 1, 2000, to July 1, 2005). RESULTS Aspergillus fumigatus was the species most frequently recovered (52.8%) for the 139 patients analyzed. The majority of the children had a malignancy with or without hematopoietic stem cell transplant. Significant risk factors that impacted survival were immunosuppressive therapies and allogeneic stem cell transplant. The most common clinical site of invasive aspergillosis was the lungs (59%), and the most frequent diagnostic radiologic finding was nodules (34.6%). Only 2.2% of children showed the air crescent sign, 11% demonstrated the halo sign, and cavitation was seen in 24.5% of patients. Before the diagnosis of invasive aspergillosis, 43.1% of patients received fluconazole, and 39.2% received liposomal amphotericin B. After the diagnosis of invasive aspergillosis, 57% were treated with a lipid formulation of amphotericin B; however, 45.8% received > or = 3 concomitant antifungal agents. Analysis did not show superiority of any 1 antifungal related to overall mortality. A total of 52.5% (73 of 139) died during treatment for invasive aspergillosis. Of all the interventions implemented, surgery was the only independent predictor of survival. CONCLUSIONS Our analyses revealed common findings between adult and pediatric invasive aspergillosis. However, one key difference is diagnostic radiologic findings. Unlike adults, children frequently do not manifest cavitation or the air crescent or halo signs, and this can significantly impact diagnosis. Immune reconstitution, rather than specific antifungal therapy, was found to be the best predictor of survival.
Collapse
Affiliation(s)
- Ana Burgos
- Division of Pediatric Hematology/Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
The spectrum of skin diseases that occurs in the oncology patient differs somewhat from that seen in other immunosuppressed populations. We review the cutaneous manifestations of invasive mold infections in the leukemia/lymphoma population. Aspergillus mold infections are now the leading infectious cause of death in this population. We also review the pustular eruption caused by a new class of chemotherapy for solid malignancies. An update on cutaneous graft-versus-host disease appears elsewhere in this journal. Cutaneous squamous cell carcinomas and basal cell carcinomas occur more frequently in the chronic lymphocytic leukemia and non-Hodgkin's lymphoma population; this is discussed, as is the more aggressive clinical course of these tumors.
Collapse
Affiliation(s)
- Steven R Mays
- Department of Dermatology, MD Anderson Cancer Center, Houston, TX 77030, USA.
| | | |
Collapse
|
31
|
|
32
|
Klein KC, Blackwood RA. Topical voriconazole solution for cutaneous aspergillosis in a pediatric patient after bone marrow transplant. Pediatrics 2006; 118:e506-8. [PMID: 16816005 DOI: 10.1542/peds.2005-2213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Invasive aspergillosis seems to be on the rise, especially in immunocompromised children. Historically, only systemic amphotericin B has been effective against Aspergillus. Development of newer antifungal agents, such as voriconazole and caspofungin, has improved the treatment options available for aspergillosis, although no definitive management strategy has been established. Here we describe the use of topical voriconazole combined with systemic antifungal agents for cutaneous aspergillosis in a pediatric patient after bone marrow transplant.
Collapse
Affiliation(s)
- Kristin C Klein
- Clinical Sciences Division, University of Michigan College of Pharmacy and Health System, Ann Arbor, Michigan, USA.
| | | |
Collapse
|
33
|
Mays SR, Bogle MA, Bodey GP. Cutaneous fungal infections in the oncology patient: recognition and management. Am J Clin Dermatol 2006; 7:31-43. [PMID: 16489841 DOI: 10.2165/00128071-200607010-00004] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
There are two main types of fungal infections in the oncology patient: primary cutaneous fungal infections and cutaneous manifestations of fungemia. The main risk factor for all types of fungal infections in the oncology patient is prolonged and severe neutropenia; this is especially true for disseminated fungal infections. Severe neutropenia occurs most often in leukemia and lymphoma patients exposed to high-dose chemotherapy. Fungal infections in cancer patients can be further divided into five groups: (i) superficial dermatophyte infections with little potential for dissemination; (ii) superficial candidiasis; (iii) opportunistic fungal skin infections with distinct potential for dissemination; (iv) fungal sinusitis with cutaneous extension; and (v) cutaneous manifestations of disseminated fungal infections. In the oncology population, dermatophyte infections (i) and superficial candidiasis (ii) have similar presentations to those seen in the immunocompetent host. Primary cutaneous mold infections (iii) are especially caused by Aspergillus, Fusarium, Mucor, and Rhizopus spp. These infections may invade deeper tissues and cause disseminated fungal infections in the neutropenic host. Primary cutaneous mold infections are treated with systemic antifungal therapy and sometimes with debridement. The role of debridement in the severely neutropenic patient is unclear. In some patients with an invasive fungal sinusitis (iv) there may be direct extension to the overlying skin, causing a fungal cellulitis of the face. Aspergillus, Rhizopus, and Mucor spp. are the most common causes. We also describe the cutaneous manifestations of disseminated fungal infections (v). These infections usually occur in the setting of prolonged neutropenia. The most common causes are Candida, Aspergillus, and Fusarium spp. Therapy is with systemic antifungal therapy. The relative efficacies of amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin are discussed. Recovery from disseminated fungal infections is unlikely, however, unless the patient's neutropenia resolves.
Collapse
Affiliation(s)
- Steven R Mays
- Department of Dermatology, University of Texas Medical School, Houston, Texas 77030, USA.
| | | | | |
Collapse
|
34
|
Vonberg RP, Gastmeier P. Nosocomial aspergillosis in outbreak settings. J Hosp Infect 2006; 63:246-54. [PMID: 16713019 DOI: 10.1016/j.jhin.2006.02.014] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 02/08/2006] [Indexed: 12/22/2022]
Abstract
Nosocomial aspergillosis represents a serious threat for severely immunocompromised patients and numerous outbreaks of invasive aspergillosis have been described. This systematic review summarizes characteristics and mortality rates of infected patients, distribution of Aspergillus spp. in clinical specimens, concentrations of aspergillus spores in volumetric air samples, and outbreak sources. A web-based register of nosocomial epidemics (outbreak database), PubMed and reference lists of relevant articles were searched systematically for descriptions of aspergillus outbreaks in hospital settings. Fifty-three studies with a total of 458 patients were included. In 356 patients, the lower respiratory tract was the primary site of aspergillus infection. Species identified most often were Aspergillus fumigatus (154 patients) and Aspergillus flavus (101 patients). Haematological malignancies were the predominant underlying diseases (299 individuals). The overall fatality rate in these 299 patients (57.6%) was significantly greater than that in patients without severe immunodeficiency (39.4% of 38 individuals). Construction or demolition work was often (49.1%) considered to be the probable or possible source of the outbreak. Even concentrations of Aspergillus spp. below 1 colony-forming unit/m(3) were sufficient to cause infection in high-risk patients. Virtually all outbreaks of nosocomial aspergillosis are attributed to airborne sources, usually construction. Even small concentrations of spores have been associated with outbreaks, mainly due to A. fumigatus or A. flavus. Patients at risk should not be exposed to aspergilli.
Collapse
Affiliation(s)
- R-P Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Germany.
| | | |
Collapse
|
35
|
Piérard GE, Arrese JE, Quatresooz P. Comparative Clinicopathological Manifestations of Human Aspergillosis. ACTA ACUST UNITED AC 2006. [DOI: 10.1159/000089608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
36
|
Infectious Complications of Cancer Therapy. Oncology 2006. [PMCID: PMC7121206 DOI: 10.1007/0-387-31056-8_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Advances in the management of cancer, particularly the development of new chemotherapeutic agents, have greatly improved the survival and outcome of patients with hematologic malignancies and solid tumors; overall 5-year survival rates in cancer patients have improved from 39% in the 1960s to 60% in the 1990s.1 However, infection, caused by both the underlying malignancy and cancer chemotherapy, particularly myelosuppressive chemotherapy, remains a persistent challenge.
Collapse
|
37
|
Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005; 41:1373-406. [PMID: 16231249 DOI: 10.1086/497143] [Citation(s) in RCA: 926] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 07/14/2005] [Indexed: 01/11/2023] Open
Affiliation(s)
- Dennis L Stevens
- Infectious Diseases Section, Veterans Affairs Medical Center, Boise, Idaho 83702, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hope WW, Walsh TJ, Denning DW. The invasive and saprophytic syndromes due to Aspergillus spp. Med Mycol 2005; 43 Suppl 1:S207-38. [PMID: 16110814 DOI: 10.1080/13693780400025179] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Aspergillus spp. produce a wide range of invasive and sapropytic syndromes which may involve any tissue. Within a given tissue or organ the pathology and pathogenesis varies enormously, ranging from angioinvasive disease to noninvasive saprophytic disease. The individual invasive and saprophytic syndromes in which a causative role can be attributed to Aspergillus spp. are detailed specifically with reference to the underlying pathology and pathogenesis, the clinical setting and features, and the manner in which a diagnosis can be established.
Collapse
Affiliation(s)
- W W Hope
- University of Manchester and Wythenshawe Hospital, Manchester UK
| | | | | |
Collapse
|
39
|
Katta R, Bogle MA, Levy ML. Primary cutaneous opportunistic mold infections in a pediatric population. J Am Acad Dermatol 2005; 53:213-9. [PMID: 16021112 DOI: 10.1016/j.jaad.2005.03.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to describe the features of cutaneous opportunistic mold infections in a general pediatric population. METHODS Computerized pathology records from Texas Children's Hospital in Houston during the years 1991 to 2000 were used to identify any biopsy specimens of skin diagnosed as having fungus or mold. The corresponding medical records were reviewed to identify cases of cutaneous opportunistic mold infections. Cases were limited to those with histologic confirmation of hyphae within the dermis or extending to the dermis. RESULTS A total of 11 cases in neonates and 22 cases in children and adolescents were identified. Prematurity and low birth weight were the major risk factors in the neonatal population. The nonneonatal cases mainly occurred in those with malignancies or undergoing transplantation. Mortality in neonates was 64%, but decreased to 18% in the nonneonatal population. CONCLUSION Our overview of cutaneous infection by opportunistic molds in a pediatric population highlights the risk factors, causative organisms, and outcome of this group of infections. Even in the presence of severe compromise of the immune system, children with primary cutaneous mold infections had a favorable outcome with appropriate diagnosis and therapy.
Collapse
Affiliation(s)
- Rajani Katta
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | |
Collapse
|
40
|
Abstract
Aspergillus infections are occurring with an increasing frequency in transplant recipients. Notable changes in the epidemiologic characteristics of this infection have occurred; these include a change in risk factors and later onset of infection. Management of invasive aspergillosis continues to be challenging, and the mortality rate, despite the use of newer antifungal agents, remains unacceptably high. Performing molecular studies to discern new targets for antifungal activity, identifying signaling pathways that may be amenable to immunologic interventions, assessing combination regimens of antifungal agents or combining antifungal agents with modulation of the host defense mechanisms, and devising diagnostic assays that can rapidly and reliably diagnose infections represent areas for future investigations that may lead to further improvement in outcomes.
Collapse
Affiliation(s)
- Nina Singh
- University of Pittsburgh Medical Center, VA Medical Center, Infectious Disease Section, University Dr. C, Pittsburgh, PA 15240, USA. nis5+@pitt.edu
| | | |
Collapse
|
41
|
Park SB, Kang MJ, Whang EA, Han SY, Kim HC, Park KK. A case of primary cutaneous aspergillosis in a renal transplant recipient. Transplant Proc 2004; 36:2156-7. [PMID: 15518783 DOI: 10.1016/j.transproceed.2004.08.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Opportunistic fungal infections are life-threatening complications which are a major cause of morbidity and mortality in immunocompromized hosts such as those who have undergone organ transplantation. Aspergillosis comprises a spectrum of disease caused by a ubiquitous saprophytic mold. Invasive aspergillus is a serious life-threatening complication in immunocompromised hosts. Primary cutaneous aspergillosis occurs relatively less frequently and is poorly characterized. We report a case of cutaneous aspergillosis in a 51-year-old renal transplant recipient, which was successfully treated with local excision and concomitant antifungal therapy. CASE A 51-year-old male renal transplant recipient presented with cutaneous nodules on the dorsum of the right hand. He underwent renal transplantation for end-stage renal disease due to adult dominant polycystic kidney disease (ADPKD) 3 years prior. Initially he suffered an acute rejection episode that was treated with steroid pulse and OKT3 therapy. Eventually he was stabilized on a combination of tacrolimus, prednisone, and mycophenolate mofetil. Three years after transplantation, he developed painless multiple (largest one 5 x 3 cm sized) nodules on the dorsum of his right hand. He was afebrile with no systemic symptoms. A skin biopsy showed a dense solid infiltration of giant cells, histiocytes, and lymphoplasma cells admixed with intra- and extracellular fungal hyphae and spores. The hyphae were septate and acute angle branching, which was consistent with aspergillosis. Oral itraconazole 200 mg/d for 5 weeks was ineffective. Treatment with liposomal amphotericin B for 4 weeks was initiated and MMF was discontinued. The medication was well tolerated with no hepatotoxic effects. Although new lesions did not appear, existing ones did not significantly improve after 4 weeks of treatment. Therefore, most lesions were excised surgically and liposomal amphotericin B continued for 2 weeks followed by treatment with oral fluconazole for 2 months. Ten moths later there was no evidence of recurrence.
Collapse
Affiliation(s)
- S B Park
- Department of Internal medicine, Keimyung University School of Medicine, Daegu, Korea.
| | | | | | | | | | | |
Collapse
|
42
|
Radhakrishnan R, Donato ML, Prieto VG, Mays SR, Raad II, Kuerer HM. Invasive cutaneous fungal infections requiring radical resection in cancer patients undergoing chemotherapy. J Surg Oncol 2004; 88:21-26. [PMID: 15384060 DOI: 10.1002/jso.20115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Invasive fungal infections have emerged as a significant problem in patients with cancer with the development of better systemic therapies for malignancy and more effective antibacterial agents. The currently available world published medical literature was reviewed on invasive fungal infections in cancer patients with specific attention devoted to the multidisciplinary role of surgery in refractory cutaneous cases. Infections can develop on the forearm where peripheral intravenous catheters had been inserted in cancer patients undergoing cytotoxic chemotherapy. Curative intent begins with systemic contemporary anti-fungal therapy. Following resolution of neutropenia, patients may require radical surgical debridement with negative margins of resection for complete eradication of the fungal infection. Although invasive fungal infections refractory to antifungal systemic therapy in immunocompromised patients undergoing chemotherapy are a rare event, it is critical for surgeons and other multidisciplinary clinicians to recognize these potentially life-threatening infections that may necessitate radical surgical resection for cure.
Collapse
Affiliation(s)
- Ravi Radhakrishnan
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
Aspergillosis is an uncommon neonatal infection, diagnosed with an increasing frequency over the last two decades. We report a premature neonate who developed aspergillosis while receiving amphotericin B and fluconazole for candidiasis. Despite early recognition and diagnosis, the infant died. We review the clinical appearance of Aspergillus species, the distinctions between primary cutaneous aspergillosis and invasive aspergillosis, and advances in diagnosis and treatment.
Collapse
Affiliation(s)
- Mark D Herron
- Department of Dermatology, University of Utah School of Medicine, UT 84132, USA
| | | | | | | |
Collapse
|
44
|
Abstract
Several aspects of emerging pediatric cutaneous infections are of importance to the clinician. New manifestations of parvovirus infection should be recognized promptly, especially because transmission to susceptible populations might lead to serious complications. In the immunocompromised pediatric population, the outcome of cutaneous mold infections can be improved with prompt recognition and initiation of treatment. The incidence of community-acquired MRSA infections in pediatrics is becoming more than a regional concern, and this coincides with the issue of limited antibiotic susceptibility for MRSA as well as other infections. New antibiotics such as linezolid are emerging as potential treatments for drug-resistant pathogens. An older group of antibiotics, the fluoroquinolones, appear to be well tolerated in children and should not be withheld from this population when the benefits of treatment out-weigh the risks.
Collapse
Affiliation(s)
- Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, CC 620.16 6560, Houston, TX 77030-2399, USA.
| | | |
Collapse
|
45
|
Abstract
A case of primary cutaneous aspergillosis in a 39-year-old woman with apparently normal immune status is reported. The woman had an occasionally suppurating nodular lesion which developed in the site of a trauma on the back of the right wrist. Diagnosis was based on histological and mycological examination. Systemic involvement was not found. Surgical excision led to clinical and mycological recovery, confirmed at follow-up 18 months later.
Collapse
Affiliation(s)
- Clara Romano
- Institute of Dermatological Sciences, University of Siena, Siena, Italy.
| | | |
Collapse
|
46
|
|
47
|
Miele PS, Levy CS, Smith MA, Dugan EM, Cooke RH, Light JA, Lucey DR. Primary cutaneous fungal infections in solid organ transplantation: a case series. Am J Transplant 2002; 2:678-83. [PMID: 12201372 DOI: 10.1034/j.1600-6143.2002.20716.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cutaneous fungal infections in solid-organ transplant patients present in a variety of nonspecific ways, requiring a high index of suspicion to diagnose correctly. In the present series of four transplant recipients, subsequent primary cutaneous fungal infections presented as papules, plaques, ulcers and subcutaneous nodules. Transplantations included one cardiac, two renal and one renal-pancreatic transplant. Fungal infections were limited to the skin; there was no evidence of disseminated disease in any case. The pathogens isolated were Scedosporium apiospermum (Pseudallescheria boydii), Alternaria species, Aspergillus fumigatus, and a coelomycete in the Coniothyrium-Microsphaeropsis complex of dark molds. Individuals were successfully treated with surgical debridement, antifungal agents, and reduction of immunosuppressive therapy. All patients and allografts survived. Accurate diagnosis, aggressive surgery and appropriate antifungal therapy, combined with close outpatient follow-up, optimize the likelihood of a cure in a transplant population.
Collapse
|
48
|
Abstract
Aspergillus is a ubiquitous fungus that causes a variety of clinical syndromes in the lung, ranging from aspergilloma in patients with lung cavities, to chronic necrotizing aspergillosis in those who are mildly immunocompromised or have chronic lung disease. Invasive pulmonary aspergillosis (IPA) is a severe and commonly fatal disease that is seen in immunocompromised patients, while allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to Aspergillus antigens that mainly affects patients with asthma. In light of the increasing risk factors leading to IPA, such as organ transplantation and immunosuppressive therapy, and recent advances in the diagnosis and treatment of Aspergillus-related lung diseases, it is essential for clinicians to be familiar with the clinical presentation, diagnostic methods, and approach to management of the spectrum of pulmonary aspergillosis.
Collapse
Affiliation(s)
- Ayman O Soubani
- Division of Pulmonary, Critical Care, and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
| | | |
Collapse
|
49
|
Sierra Pacho M, Giménez Cortés ME, Blanco Barrios S, Morán Estefanía M, Martín Pascual A. Aspergilosis cutánea secundaria en paciente inmunodeprimido. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
50
|
Warnock DW, Hajjeh RA, Lasker BA. Epidemiology and Prevention of Invasive Aspergillosis. Curr Infect Dis Rep 2001; 3:507-516. [PMID: 11722807 DOI: 10.1007/s11908-001-0087-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aspergillus species are the most common causes of invasive mold infections in immunocompromised persons. This review examines the available information regarding the rising incidence of invasive aspergillosis in different high-risk groups, including persons with acute leukemia, hematopoietic stem cell transplant recipients, and liver and lung transplant recipients. The risk factors for infection in these groups are discussed. Because Aspergillus species are widespread in the environment, it is difficult to link specific sources and exposures to the development of human infections. However, molecular strain typing and other studies indicate that a significant number of Aspergillus infections are now being acquired outside the health care setting, either before patients are admitted to hospital, or after they have been discharged. The role of environmental control measures and antifungal drug prophylaxis in the prevention of hospital- and community-acquired aspergillosis is discussed.
Collapse
Affiliation(s)
- David W. Warnock
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-11, Atlanta, GA 30333, USA.
| | | | | |
Collapse
|