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Mohammad N, Huguenin A, Lefebvre A, Menvielle L, Toubas D, Ranque S, Villena I, Tannier X, Normand AC, Piarroux R. Nosocomial transmission of Aspergillus flavus in a neonatal intensive care unit: Long-term persistence in environment and interest of MALDI-ToF mass-spectrometry coupled with convolutional neural network for rapid clone recognition. Med Mycol 2024; 62:myad136. [PMID: 38142226 DOI: 10.1093/mmy/myad136] [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: 08/07/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 12/25/2023] Open
Abstract
Aspergillosis of the newborn remains a rare but severe disease. We report four cases of primary cutaneous Aspergillus flavus infections in premature newborns linked to incubators contamination by putative clonal strains. Our objective was to evaluate the ability of matrix-assisted laser desorption/ionisation time of flight (MALDI-TOF) coupled to convolutional neural network (CNN) for clone recognition in a context where only a very small number of strains are available for machine learning. Clinical and environmental A. flavus isolates (n = 64) were studied, 15 were epidemiologically related to the four cases. All strains were typed using microsatellite length polymorphism. We found a common genotype for 9/15 related strains. The isolates of this common genotype were selected to obtain a training dataset (6 clonal isolates/25 non-clonal) and a test dataset (3 clonal isolates/31 non-clonal), and spectra were analysed with a simple CNN model. On the test dataset using CNN model, all 31 non-clonal isolates were correctly classified, 2/3 clonal isolates were unambiguously correctly classified, whereas the third strain was undetermined (i.e., the CNN model was unable to discriminate between GT8 and non-GT8). Clonal strains of A. flavus have persisted in the neonatal intensive care unit for several years. Indeed, two strains of A. flavus isolated from incubators in September 2007 are identical to the strain responsible for the second case that occurred 3 years later. MALDI-TOF is a promising tool for detecting clonal isolates of A. flavus using CNN even with a limited training set for limited cost and handling time.
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Affiliation(s)
- Noshine Mohammad
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Paris, France
- Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, Paris, France
| | - Antoine Huguenin
- Laboratoire de Parasitologie-Mycologie, Pôle de Biologie et de Pathologie, CHU de Reims, Reims, France
- Université de Reims Champagne Ardenne, ESCAPE EA7510, Reims, France
| | | | - Laura Menvielle
- CHU de Reims, Hôpital Américain, Service de réanimation néonatale, 45 rue Cognaq Jay, Reims, France
| | - Dominique Toubas
- Laboratoire de Parasitologie-Mycologie, Pôle de Biologie et de Pathologie, CHU de Reims, Reims, France
- Université de Reims Champagne Ardenne, ESCAPE EA7510, Reims, France
- Equipe Opérationnelle d'Hygiène, CHU de Reims, France
- CHU de Reims, Hôpital Américain, Service de réanimation néonatale, 45 rue Cognaq Jay, Reims, France
- BioSpecT (Translational BioSpectroscopy) EA 7506, SFR Santé, Université de Reims Champagne-Ardenne, Reims, France
| | - Stéphane Ranque
- IHU-Méditerranée Infection, Marseille, France
- Aix-Marseille Université, AP-HM, IRD, SSA, VITROME, Marseille, France
| | - Isabelle Villena
- Laboratoire de Parasitologie-Mycologie, Pôle de Biologie et de Pathologie, CHU de Reims, Reims, France
- Université de Reims Champagne Ardenne, ESCAPE EA7510, Reims, France
| | - Xavier Tannier
- Sorbonne Université, INSERM, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des connaissances en e-Santé, LIMICS, Paris, France
| | - Anne-Cécile Normand
- Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, Paris, France
| | - Renaud Piarroux
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Paris, France
- Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, Paris, France
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Huang L, Huang X, Wang Z, Zhang Y. Stem Cell Treatment for Diabetic Foot Ulcers: A Meta-analysis of Randomized Clinical Trials. Adv Skin Wound Care 2023; 36:234-241. [PMID: 36924415 DOI: 10.1097/01.asw.0000923320.13406.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
GENERAL PURPOSE To provide information on the efficacy of stem cells in the treatment of diabetic foot ulcers. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will: 1. Explain outcomes from the use of stem cell treatment for diabetic foot ulcers. 2. Identify features in the methodology of randomized controlled trials examining the efficacy of stem cells in the treatment of diabetic foot ulcers.
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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.
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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;
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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
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Warris A, Lehrnbecher T, Roilides E, Castagnola E, Brüggemann RJM, Groll AH. ESCMID-ECMM guideline: diagnosis and management of invasive aspergillosis in neonates and children. Clin Microbiol Infect 2019; 25:1096-1113. [PMID: 31158517 DOI: 10.1016/j.cmi.2019.05.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
SCOPE Presenting symptoms, distributions and patterns of diseases and vulnerability to invasive aspergillosis (IA) are similar between children and adults. However, differences exist in the epidemiology and underlying conditions, the usefulness of newer diagnostic tools, the pharmacology of antifungal agents and in the evidence from interventional phase 3 clinical trials. Therefore, the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) have developed a paediatric-specific guideline for the diagnosis and management of IA in neonates and children. METHODS Review and discussion of the scientific literature and grading of the available quality of evidence was performed by the paediatric subgroup of the ESCMID-ECMM-European Respiratory Society (ERS) Aspergillus disease guideline working group, which was assigned the mandate for the development of neonatal- and paediatric-specific recommendations. QUESTIONS Questions addressed by the guideline included the epidemiology of IA in neonates and children; which paediatric patients may benefit from antifungal prophylaxis; how to diagnose IA in neonates and children; which antifungal agents are available for use in neonates and children; which antifungal agents are suitable for prophylaxis and treatment of IA in neonates and children; what is the role of therapeutic drug monitoring of azole antifungals; and which management strategies are suitable to be used in paediatric patients. This guideline provides recommendations for the diagnosis, prevention and treatment of IA in the paediatric population, including neonates. The aim of this guideline is to facilitate optimal management of neonates and children at risk for or diagnosed with IA.
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Affiliation(s)
- A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands.
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University 96 School of Health Sciences, Thessaloniki, Greece; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
| | - E Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG)
| | - R J M Brüggemann
- Radboud Center for Infectious Diseases, Radboud University Medical Centre, Center of Expertise in Mycology Radboudumc/CWZ, European Confederation of Medical Mycology (ECMM) Excellence Center of Medical Mycology, Nijmegen, the Netherlands; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG)
| | - A H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
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Gallais F, Denis J, Koobar O, Dillenseger L, Astruc D, Herbrecht R, Candolfi E, Letscher-Bru V, Sabou M. Simultaneous primary invasive cutaneous aspergillosis in two preterm twins: case report and review of the literature. BMC Infect Dis 2017; 17:535. [PMID: 28768499 PMCID: PMC5541690 DOI: 10.1186/s12879-017-2646-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/27/2017] [Indexed: 11/16/2022] Open
Abstract
Background Primary invasive cutaneous aspergillosis is a rare fungal infection that occurs mostly in immunocompromised patients. Newborns of very low birth weight present a high risk for this type of infection due to an immaturity of the cutaneous barrier and of the immune system. Case presentation We describe here a case of simultaneous invasive cutaneous aspergillosis in two preterm twins. Two male preterm bichorionic biamniotic twins (A & B) were born at a general hospital by spontaneous normal delivery at 24 weeks and 6 days of gestation. They were transferred to our hospital where they receive surfactant, antibiotics and hydrocortisone. Six days later, twin A showed greenish lesions in the umbilical region. The spectrum of antibiotic therapy was broadened and fluconazole was added. The umbilical catheters of the two twins were removed and replaced by epicutaneo-cava venous catheters and the cultures were positive for Aspergillus fumigatus. Fluconazole was replaced in both twins by liposomal amphotericin B and the incubators were changed. The serum galactomannan was also positive for both twins. At day 10, yellowish lesions appeared in the abdominal region in twin B. He died on day 18 following complications related to his prematurity. Concerning the twin A, serum galactomannan was negative on day 30; liposomal amphotericin B was stopped 1 week later, with a relay by econazole (cream). His condition improved and on day 66 he was transferred for follow-up at the general hospital where he was born. Conclusion The source of contamination by A. fumigatus was not identified, but other similar cases from the literature include construction work at or near the hospital, oximeter sensors, latex finger stalls, non-sterile gloves, humidifying chambers of incubators, bedding and adhesive tapes. The skin fragility of preterm newborns is an excellent potential entry point for environmental fungal infections. These cases highlight the importance of suspecting primary cutaneous aspergillosis in extremely low birth weight neonates with rapidly progressive necrotic lesions.
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Affiliation(s)
- Floriane Gallais
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie ; Hôpitaux Universitaires de Strasbourg. 1 Place de l'Hôpital, F-67000, Strasbourg, France.
| | - Julie Denis
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie ; Hôpitaux Universitaires de Strasbourg. 1 Place de l'Hôpital, F-67000, Strasbourg, France.,Université de Strasbourg, Institut de Parasitologie et de Pathologie Tropicale, DIHP EA 7292, Fédération de Médecine Translationnelle, 3 rue Koeberlé, F-67000, Strasbourg, France
| | - Olfa Koobar
- Service de Réanimation Néonatale, Hôpital de Hautepierre ; Hôpitaux Universitaires de Strasbourg, Avenue Molière, F-67200, Strasbourg, France
| | - Laurence Dillenseger
- Service de Réanimation Néonatale, Hôpital de Hautepierre ; Hôpitaux Universitaires de Strasbourg, Avenue Molière, F-67200, Strasbourg, France
| | - Dominique Astruc
- Service de Réanimation Néonatale, Hôpital de Hautepierre ; Hôpitaux Universitaires de Strasbourg, Avenue Molière, F-67200, Strasbourg, France
| | - Raoul Herbrecht
- Service d'Oncologie et d'Hématologie, Hôpital de Hautepierre ; Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France
| | - Ermanno Candolfi
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie ; Hôpitaux Universitaires de Strasbourg. 1 Place de l'Hôpital, F-67000, Strasbourg, France.,Université de Strasbourg, Institut de Parasitologie et de Pathologie Tropicale, DIHP EA 7292, Fédération de Médecine Translationnelle, 3 rue Koeberlé, F-67000, Strasbourg, France
| | - Valérie Letscher-Bru
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie ; Hôpitaux Universitaires de Strasbourg. 1 Place de l'Hôpital, F-67000, Strasbourg, France.,Université de Strasbourg, Institut de Parasitologie et de Pathologie Tropicale, DIHP EA 7292, Fédération de Médecine Translationnelle, 3 rue Koeberlé, F-67000, Strasbourg, France
| | - Marcela Sabou
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie ; Hôpitaux Universitaires de Strasbourg. 1 Place de l'Hôpital, F-67000, Strasbourg, France.,Université de Strasbourg, Institut de Parasitologie et de Pathologie Tropicale, DIHP EA 7292, Fédération de Médecine Translationnelle, 3 rue Koeberlé, F-67000, Strasbourg, France
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1574] [Impact Index Per Article: 196.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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Wattier RL, Ramirez-Avila L. Pediatric Invasive Aspergillosis. J Fungi (Basel) 2016; 2:jof2020019. [PMID: 29376936 PMCID: PMC5753081 DOI: 10.3390/jof2020019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 02/06/2023] Open
Abstract
Invasive aspergillosis (IA) is a disease of increasing importance in pediatrics due to growth of the immunocompromised populations at risk and improvements in long-term survival for many of these groups. While general principles of diagnosis and therapy apply similarly across the age spectrum, there are unique considerations for clinicians who care for children and adolescents with IA. This review will highlight important differences in the epidemiology, clinical manifestations, diagnosis, and therapy of pediatric IA.
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Affiliation(s)
- Rachel L Wattier
- Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California-San Francisco, 550 16th St, 4th Floor, Box 0434, San Francisco, CA 94143, USA.
| | - Lynn Ramirez-Avila
- Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California-San Francisco, 550 16th St, 4th Floor, Box 0434, San Francisco, CA 94143, USA.
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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.
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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: )
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Abstract
Primary cutaneous aspergillosis is rare in premature infants. It requires combined medical and surgical strategies. Liposomal amphotericin B is recommended as first-line therapy, but salvage regimens with others antifungal agents, such as voriconazole, have been reported. Voriconazole's pharmacodynamics is unknown in this population. We report a case of severe toxicity to voriconazole in a preterm patient with primary cutaneous aspergillosis.
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Bernardeschi C, Foulet F, Ingen-Housz-Oro S, Ortonne N, Sitbon K, Quereux G, Lortholary O, Chosidow O, Bretagne S. Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review. Medicine (Baltimore) 2015; 94:e1018. [PMID: 26131805 PMCID: PMC4504535 DOI: 10.1097/md.0000000000001018] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Invasive aspergillosis (IA) has poor prognosis in immunocompromised patients. Skin manifestations, when present, should contribute to an early diagnosis. The authors aimed to provide prevalence data and a clinical and histologic description of cutaneous manifestations of primary cutaneous IA (PCIA) and secondary CIA (SCIA) in a unique clinical series of IA and present the results of an exhaustive literature review of CIA. Cases of proven and probable IA with cutaneous manifestations were retrospectively extracted from those registered between 2005 and 2010 in a prospective multicenter aspergillosis database held by the National Reference Center for Invasive Mycoses and Antifungals, Pasteur Institute, France. Patients were classified as having PCIA (i.e., CIA without extracutaneous manifestations) or SCIA (i.e., disseminated IA). Among the 1,410 patients with proven or probable IA, 15 had CIA (1.06%), 5 PCIA, and 10 SCIA. Hematological malignancies were the main underlying condition (12/15). Patients with PCIA presented infiltrated and/or suppurative lesions of various localizations not related to a catheter site (4/5), whereas SCIA was mainly characterized by disseminated papules and nodules but sometimes isolated nodules or cellulitis. Histologic data were available for 11 patients, and for 9, similar for PCIA and SCIA, showed a dense dermal polymorphic inflammatory infiltrate, with the epidermis altered in PCIA only. Periodic acid Schiff and Gomori-Grocott methenamine silver nitrate staining for all but 2 biopsies revealed hyphae compatible with Aspergillus. Aspergillus flavus was isolated in all cases of PCIA, with Aspergillus fumigatus being the most frequent species (6/10) in SCIA. Two out 5 PCIA cases were treated surgically. The 3-month survival rate was 100% and 30% for PCIA and SCIA, respectively. Our study is the largest adult series of CIA and provides complete clinical and histologic data for the disease. Primary cutaneous IA should be recognized early, and cases of extensive necrosis should be treated surgically; its prognosis markedly differs from that for SCIA. Any suppurative, necrotic, papulonodular, or infiltrated skin lesion in an immunocompromised patient should lead to immediate biopsy for histologic analysis and mycological skin direct examination and culture.
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Affiliation(s)
- Céline Bernardeschi
- Dermatology Department, UPEC (CB, SI-H-O, OC); Mycology and Parasitology Department (FF); Pathology Department, AP-HP, Henri Mondor Hospital, Créteil (NO); Pasteur Institute, National Reference Center for Invasive Mycoses and Antifungals, Paris (KS, OL, SB); Skin Cancer Unit, Nantes University Hospital (GQ); Infectious Diseases and Tropical Medicine Department, AP-HP, Necker-Enfants malades Hospital, Necker-Pasteur Infectious Diseases Center, IHU Imagine, Paris (OL); Université Paris Descartes (NO, OL); Université Paris-Est-Créteil UPEC, Créteil (OC); Mycology and Parasitology Department, AP-HP, Saint Louis Hospital, Paris (SB); Université Paris Diderot (SB); INSERM Centre d'Investigation Clinique, Créteil, (OC); and EA EpidermE, UPEC, Créteil, France (SI-H-O, OC)
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Kanamori H, Rutala WA, Sickbert-Bennett EE, Weber DJ. Review of Fungal Outbreaks and Infection Prevention in Healthcare Settings During Construction and Renovation. Clin Infect Dis 2015; 61:433-44. [DOI: 10.1093/cid/civ297] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/04/2015] [Indexed: 01/08/2023] Open
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Tekin A, Dal T, Tekin R, Deveci Ö, Fırat U, Mete M, Dayan S. Soft Tissue Abscess Caused by Aspergillus Fumigatus in an Immunosuppressive Patient. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Severe cutaneous aspergillosis in a premature neonate linked to nonsterile disposable glove contamination? Am J Infect Control 2012; 40:465-7. [PMID: 21885159 DOI: 10.1016/j.ajic.2011.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/14/2011] [Accepted: 05/16/2011] [Indexed: 11/23/2022]
Abstract
After having eliminated a dysfunction of the hospital's ventilation system and any other possible environmental reservoir, the investigation of a fatal case of primary cutaneous aspergillosis in a neonate with extremely low birth weight led to the conclusion that nonsterile disposable gloves kept stored in their native packages were the likely source of contamination.
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Manzoni P, Rizzollo S, Monetti C, Carbonara C, Priolo C, Mastretta E, Barberis L, Galletto P, Cigna P, Leonessa ML, Sala U, Gomirato G, Mostert M, Stronati M, Ruffinazzi G, Tzialla C, Jacqz-Aigrain E, Kaguelidou F, Farina D. Neonatal cutaneous disseminated aspergillosis in a preterm extremely-low-birth-weight infant with favourable outcome at 3-year follow-up: a case report. Early Hum Dev 2012; 88 Suppl 2:S65-8. [PMID: 22633518 DOI: 10.1016/s0378-3782(12)70018-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Invasive disseminated neonatal aspergillosis is an uncommon disease, with only scattered reports in literature in the last few years. Here we report on a 25-week gestational age, 730 g at birth preterm female infant who developed on day-of-life 10 multiple cutaneous exhulcerative lesions in her right arm, trunk and abdomen. Early recognition and diagnosis of these lesions as a due to cutaneous initial symptom of cutaneous disseminated aspergillosis, as well as prompt treatment with Liposomal amphotericin B + Itraconazole, secured successful recovery from the systemic infection. Skin lesions healed without any surgical treatment. The infant was discharged in good health. Long-term follow-up at three years of age revealed normality of all neurodevelopmental and cognitive parameters. To our knowledge, this is one of the very few cases of survival, free from sequelae, for a preterm infant affected by neonatal cutaneous disseminated aspergillosis.
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Affiliation(s)
- P Manzoni
- Neonatology and NICU, AO Regina Margherita-S Anna S Anna Hospital, Torino, Italy.
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16
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Hospital-acquired phaeohyphomycosis due to Exserohilum rostratum in a child with leukemia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 18:200-2. [PMID: 18923719 DOI: 10.1155/2007/384743] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 11/17/2006] [Indexed: 11/17/2022]
Abstract
The present study describes a case of cutaneous phaeohyphomycosis caused by Exserohilum rostratum in a child undergoing treatment for leukemia. The infection was possibly due to contaminated intravenous dressings and was successfully treated with surgical excision combined with liposomal amphotericin B. Consequently, new infection control policies have been implemented at CHU Sainte-Justine (Montreal, Quebec).
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Stock C, Veyrier M, Magnin-Verschelde S, Duband S, Lavocat MP, Teyssier G, Berthelot P. [Primary cutaneous aspergillosis complicated with invasive aspergillosis in an extremely preterm infant: case report and literature review]. Arch Pediatr 2010; 17:1455-9. [PMID: 20488684 DOI: 10.1016/j.arcped.2010.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 07/22/2009] [Accepted: 04/08/2010] [Indexed: 11/30/2022]
Abstract
Aspergillus is a ubiquitous fungus that can cause primary cutaneous aspergillosis in extremely low-birth-weight (ELBW) neonates, then be invasive and lead to death. ELBW neonates are particularly at risk because of decreased qualitative immune defenses and defects in the skin barrier. Broad-spectrum antimicrobial therapy and corticosteroids, often used in these patients, contribute to increased risk. We present a fatal case of primary cutaneous aspergillosis complicated with invasive aspergillosis, confirmed by autopsy, in an ELBW infant. The source of contamination was probably non-sterile disposable latex gloves used for neonatal care. The early recognition of this source led to its eviction for other hospitalized ELBW infants and no outbreak was observed.
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Affiliation(s)
- C Stock
- Service de réanimation néonatale et pédiatrique, centre hospitalier universitaire de Saint-Étienne, hopital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
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18
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[Primary cutaneous aspergillosis in an immunocompetent farmworker]. Ann Dermatol Venereol 2010; 137:373-6. [PMID: 20470919 DOI: 10.1016/j.annder.2010.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 01/08/2010] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Aspergillosis is an uncommon fungal infection in which primary cutaneous sites are very rare. Most cases occur in immunodepressed patients and are disseminated in the blood. We report a case of primary cutaneous aspergillosis in a 37-year-old immunocompetent farmworker presenting as a kerion-like lesion. CASE REPORT A 37-year-old farmworker presented erythematous and nodular lesions of the face. These lesions were not associated with any general symptoms and failed to respond to antibiotic treatment. Histological examination of a skin biopsy sample showed a granulomatous reaction in the dermis associated with an extensive neutrophilic infiltrate. PAS staining revealed the presence of right-angled branched hyphae with conidia. Aspergillus fumigatus was isolated and identified in cultures. Clinical and biological examinations did not reveal any systemic localisation of aspergillosis, ruling out the hypothesis of blood dissemination. This primary cutaneous infection occurred in an immunocompetent patient, in whom laboratory tests ruled out any underlying immunosuppression. Systemic antifungal treatment with voriconazole led to complete resolution. DISCUSSION Reports in the literature of primary cutaneous aspergillosis in immunocompetent patients are extremely rare. Clinical lesions may comprise often painful weeping or necrotic macules or papules or subcutaneous nodules that can progress towards abscess or necrosis. The semiological similarity between these lesions and kerions can lead to misdiagnosed cases and delayed treatment.
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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.
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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
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21
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Muñoz P, Guinea J, Bouza E. Update on invasive aspergillosis: clinical and diagnostic aspects. Clin Microbiol Infect 2006. [DOI: 10.1111/j.1469-0691.2006.01603.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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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: 139] [Impact Index Per Article: 7.3] [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.
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Affiliation(s)
- W W Hope
- University of Manchester and Wythenshawe Hospital, Manchester UK
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23
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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.
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Affiliation(s)
- Rajani Katta
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
PURPOSE OF REVIEW Cutaneous fungal infections are not uncommon in newborns and are seen in premature or otherwise immunocompromised neonates as well as in healthy full-term neonates. Healthy newborns can develop clinical manifestations as a result of infection with Candida species or as a result of skin colonization with Malassezia species; cutaneous infection with other fungal pathogens is rare. Immunocompromised and premature neonates, however, are susceptible to infection with opportunistic pathogens and are also at higher risk for invasive infection with common pathogens such as Candida. This review discusses the fungal species associated with cutaneous fungal infection in neonates, emphasizes the relevant clinical features, and also reviews the use of newer antifungal agents, including lipid-associated amphotericin B, voriconazole, and caspofungin. RECENT FINDINGS Neonatal cutaneous infections with opportunistic fungal pathogens, including Aspergillus and the Zygomycetes, have been reported with increasing frequency as advances in neonatal care have improved the survival rate in very low birthweight neonates. Although these infections are frequently fatal, survival in some neonates has been reported with the use of aggressive surgical debridement and systemic antifungal therapy. Newer antifungal agents, including voriconazole and caspofungin, show promise in the treatment of potentially fatal fungal infections in neonates. SUMMARY Cutaneous fungal infections in neonates range from generally benign conditions such as congenital candidiasis and neonatal cephalic pustulosis to potentially fatal infections with opportunistic pathogens in very low birthweight or immunocompromised neonates. The prompt recognition and appropriate treatment of cutaneous fungal disease in neonates is critical to the prevention of adverse outcomes.
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Affiliation(s)
- Kara N Smolinski
- Division of Emergency Medicine, and Section of Pediatric Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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25
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Abstract
UNLABELLED Primary cutaneous aspergillosis is a rare diagnosis. Predisposing factors are immunodeficiency and macerated skin. The mortality of infections with Aspergillus species is high, especially in neonatal intensive care units (NICUs). We present a premature (24 wk of gestation) infant with primary cutaneous aspergillosis appearing on the sixth day of life. Predisposing factors in this patient were prematurity, extremely vulnerable skin, treatment with antibiotics and renovation in the radiology department nearby. The patient was treated with amphotericin B intravenously for a total of 40 d. He did not have, nor develop, disseminated aspergillosis, and suffered no side effects from the treatment. The only remaining trace of his infection was scarring in the affected area. CONCLUSION After having treated this patient successfully and having gone through the available literature, we conclude that treating primary cutaneous aspergillosis with intravenous amphotericin B prevents disseminated aspergillosis and is the treatment of choice.
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Abstract
A premature newborn infant born at 30 weeks gestation developed erythematous papular skin lesions that coalesced to form a necrotic plaque with black eschar. Skin histopathology and culture demonstrated infection with Aspergillus flavus. There was no evidence of Aspergillus flavus infection elsewhere.
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Affiliation(s)
- S Amuchou Singh
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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27
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Paterson DL. New clinical presentations of invasive aspergillosis in non-conventional hosts. Clin Microbiol Infect 2004; 10 Suppl 1:24-30. [PMID: 14748800 DOI: 10.1111/j.1470-9465.2004.00840.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infections by Aspergillus spp. are most typically associated with invasive pulmonary aspergillosis. However, an increasing number of reports deal with unusual manifestations of invasive aspergillosis. In the lung this may take the form of chronic invasive pulmonary aspergillosis, bronchocentric granulomatosis or tracehobronchitis. A number of extrapulmonary infections have been noted, sometimes in immunocompetent individuals. Examples include vertebral osteomyelitis, primary cutaneous aspergillosis (such as in premature neonates), prosthetic vascular graft infection and infective endocarditis. Early recognition of these entities, prompt initiation of new, highly active antifungal therapies and adjunctive surgical management may improve the prognosis of these conditions.
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Affiliation(s)
- D L Paterson
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Suite 3A, Falk Medical Building, Pittsburgh, PA 15213, USA.
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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.
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Affiliation(s)
- Mark D Herron
- Department of Dermatology, University of Utah School of Medicine, UT 84132, USA
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29
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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.
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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.
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30
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Abstract
Neonatal primary cutaneous aspergillosis usually presents as an erythematous plaque with pustules that evolve into an eschar. Immunocompromised patients and premature neonates are at risk of developing this disease. Early diagnosis and treatment are critical in preventing progression to a systemic illness. We report a preterm neonate with primary cutaneous aspergillosis and discuss the etiologies, presentations, and treatments for this illness.
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Affiliation(s)
- Christy A Woodruff
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA
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31
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Richardson V, Ortíz D, Newton OA, Nandí E. Disseminated and cutaneous aspergillosis in a premature infant: a fatal nosocomial infection. Pediatr Dermatol 2001; 18:366-7. [PMID: 11576421 DOI: 10.1046/j.1525-1470.2001.1946f.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
This article presents the various manifestations of cardiac infections found in the immunosuppressed host. Emphasis is placed on the correlation between specific impairments of host defenses and the occurrence of certain types of pathogens. The effect of immunosuppression on the clinical manifestations of these infections is discussed. Finally, appropriate diagnostic modalities are presented for the major types of infections.
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Affiliation(s)
- J L Brusch
- Department of Medicine, Infectious Disease Service, Cambridge Hospital, Massachusetts, USA
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James MJ, Lasker BA, McNeil MM, Shelton M, Warnock DW, Reiss E. Use of a repetitive DNA probe to type clinical and environmental isolates of Aspergillus flavus from a cluster of cutaneous infections in a neonatal intensive care unit. J Clin Microbiol 2000; 38:3612-8. [PMID: 11015372 PMCID: PMC87445 DOI: 10.1128/jcm.38.10.3612-3618.2000] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aspergillus flavus is second to A. fumigatus as a cause of invasive aspergillosis, but no standard method exists for molecular typing of strains from human sources. A repetitive DNA sequence cloned from A. flavus and subcloned into a pUC19 vector, pAF28, was used to type 18 isolates from diverse clinical, environmental, and geographic sources. The restriction fragment length polymorphisms generated with EcoRI- or PstI-digested genomic DNA and probed with digoxigenin-labeled pAF28 revealed complete concordance between patterns. Eighteen distinct fingerprints were observed. The probe was used to investigate two cases of cutaneous A. flavus infection in low-birth-weight infants in a neonatal intensive care unit (NICU). Both infants were transported by the same ambulance and crew to the NICU on the same day. A. flavus strains of the same genotype were isolated from both infants, from a roll of tape used to fasten their umbilical catheters, from a canvas bag used to store the tape in the ambulance, and from the tape tray in the ambulance isolette. These cases highlight the need to consider exposures in critically ill neonates that might occur during their transport to the NICU and for stringent infection control practices. The hybridization profiles of strains from a second cluster of invasive A. flavus infections in two pediatric hematology-oncology patients revealed a genotype common to strains from a definite case patient and a health care worker. A probable case patient was infected with a strain with a genotype different from that of the strain from the definite case patient but highly related to that of an environmental isolate. The high degree of discrimination and reproducibility obtained with the pAF28 probe underscores its utility for typing clinical and environmental isolates of A. flavus.
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Affiliation(s)
- M J James
- Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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35
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Mahieu LM, De Dooy JJ, Van Laer FA, Jansens H, Ieven MM. A prospective study on factors influencing aspergillus spore load in the air during renovation works in a neonatal intensive care unit. J Hosp Infect 2000; 45:191-7. [PMID: 10896797 DOI: 10.1053/jhin.2000.0773] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The relationship between air contamination (cfu/m(3)) with fungal spores, especially Aspergillus spp., in three renovation areas of a neonatal intensive care unit (NICU) and colonization and infection rates in a high care area (HC) equipped with high efficiency particulate air (HEPA) filtration and a high pressure system, was evaluated. Data on the type and site of renovation works, outdoor meteorological conditions, patient crowding and nasopharyngeal colonization rate were collected. Factors not associated with Aspergillus spp. concentration were outdoor temperature, air pressure, wind speed, humidity, rainfall, patient density in the NICU, renovation works in the administrative area and in the isolation rooms. Multivariate analysis revealed that renovation works and air concentration of Aspergillus spp. spores in the medium care area (MC) resulted in a significant increase of the concentration in the HC of the NICU. The use of a mobile HEPA air filtration system (MedicCleanAir(R)Forte, Willebroek, Belgium) caused a significant decrease in the Aspergillus spp. concentration. There was no relationship between Aspergillus spp. air concentration and nasopharyngeal colonization in the neonates. Invasive aspergillosis did not occur during the renovation. This study highlights the importance of optimal physical barriers and air filtration to decrease airborne fungal spores in high-risk units during renovation works. The value of patient surveillance and environmental air sampling is questionable since no relationship was found between air contamination and colonization in patients.
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Affiliation(s)
- L M Mahieu
- Departments of Paediatrics, Division of Neonatology, University Hospital of Antwerp, Edegem, Belgium.
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36
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Affiliation(s)
- F C Amod
- Department of Microbiology, University of Natal, Medical School, Congella, South Africa.
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37
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38
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Affiliation(s)
- J A van Burik
- Department of Medicine, Division of Allergy and Infectious Diseases, Seattle, Washington, USA.
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39
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Chakrabarti A, Gupta V, Biswas G, Kumar B, Sakhuja VK. Primary cutaneous aspergillosis: our experience in 10 years. J Infect 1998; 37:24-7. [PMID: 9733373 DOI: 10.1016/s0163-4453(98)90303-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We describe nine patients with primary cutaneous aspergillosis who were diagnosed during the 10-year period between 1987 and 1996. All except one were adults. Seven of those nine cases had an immunocompromised state. Among the immunocompromised patients, six had burn wounds and one was a renal transplant recipient. Aspergillus flavus was isolated from seven patients and A. fumigatus from one, and in one other case the species could not be determined. Three patients who had total burn surface area of more than 70% died. The other patients responded well to extensive surgical debridement with or without institution of oral itraconazole.
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Affiliation(s)
- A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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40
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Golden MC, Hahm SJ, Elessar RE, Saksonov S, Steinberg JJ. DNA damage by gliotoxin from Aspergillus fumigatus. An occupational and environmental propagule: adduct detection as measured by 32P DNA radiolabelling and two-dimensional thin-layer chromatography. Mycoses 1998; 41:97-104. [PMID: 9670759 DOI: 10.1111/j.1439-0507.1998.tb00308.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Gliotoxin is produced by the fungus Aspergillus fumigatus. Aspergillus is widespread in the environment and this ubiquitous nature results in disease and co-carcinogenesis to be distributed world-wide. Gliotoxin contains an epipolythiodioxopiperazine (ETP) ring that is believed to be involved in redox reactions. The reactive oxygen species produced interact with DNA to form hydroxylated and other altered DNA products. To measure DNA adduct formation, we used 32P radiolabelling and, after enzymatic DNA digestion, separated adducts in two dimensions using thin-layer chromatography (2D-TLC), with ultimate autoradiography and densitometry. HeLa DNA was incubated with 0.1 mmol l-1 and 0.3 mmol l-1 of gliotoxin (and necessary redox agents) for 1 and 20 h. We found an increase in 6-hydro-5,6-dihydroxythymidine (thymine glycol) monophosphate [d(TG)MP] from 0.0% to 30.4%, an increase in 8-hydroxy-2'-deoxyguanidine monophosphate [8(OH)dGMP] from 0.0% to 4.2%, an increase in deoxynucleotide diphosphate (dNDP) from zero adducts to six DNA adducts, as well as an increase of other as yet unidentified adducts. Also, time exposure may have a greater effect than concentration based on a 20-h incubation with 0.3 mmol l-1 gliotoxin that completely obliterates the pyrimidines deoxythymidine 3'-monophosphate (dTMP) and deoxycytidine 3'-monophosphate (dCMP).
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Affiliation(s)
- M C Golden
- Department of Pathology, Montefiore Medical Center, Bronx, New York 10467-2490, USA
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41
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42
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Bretagne S, Bart-Delabesse E, Wechsler J, Kuentz M, Dhédin N, Cordonnier C. Fatal primary cutaneous aspergillosis in a bone marrow transplant recipient: nosocomial acquisition in a laminar-air flow room. J Hosp Infect 1997; 36:235-9. [PMID: 9253705 DOI: 10.1016/s0195-6701(97)90199-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case of primary cutaneous aspergillosis occurring in an allogeneic bone marrow transplant recipient in a laminar airflow room is reported. The patient developed grade III graft-versus-host-disease and epidermolysis. Although the patient had remained in his laminar airflow room from the graft onward, he subsequently developed primary cutaneous aspergillosis. The aspergillosis became invasive and the patient died. The patient was probably contaminated by air containing conidia when he left the sterile room for endoscopy, and the fluidized bed used may have contributed to the local development of the disease. This nosocomial aspergillosis stresses the necessity of performing invasive procedures under laminar airflow protection to prevent Aspergillus contamination in immunocompromised hosts at risk for aspergillosis.
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Affiliation(s)
- S Bretagne
- Laboratoire de Parasitologie-Mycologie, Hôpital Henri Mondor, Créteil, France
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