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Accetta J, Powell E, Boh E, Bull L, Kadi A, Luk A. Isavuconazonium for the treatment of Purpureocillium lilacinum infection in a patient with pyoderma gangrenosum. Med Mycol Case Rep 2020; 29:18-21. [PMID: 32547913 PMCID: PMC7286926 DOI: 10.1016/j.mmcr.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022] Open
Abstract
Purpureocillium lilacinum is a rare but emerging pathogen in immunocompromised patients that primarily infects the skin and subcutaneous tissue. We present a novel case of Purpureocillium lilacinum infection in a patient with pyoderma gangrenosum who was successfully treated with isavuconazonium, followed by a literature review of 13 total cases of infection with Purpureocillium lilacinum gathered from a review of the PubMed database. Previous reports have utilized voriconazole, an antifungal with significant toxic side effects. Our case highlights the importance of culture and biopsy in patients with pyoderma gangrenosum who are unresponsive to standard treatment irrespective of pathergy risk.
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Affiliation(s)
- Julia Accetta
- Tulane University, Department of Medicine, 1415 Tulane Avenue, 70112, New Orleans, United States
- Corresponding author.
| | - Emily Powell
- Tulane University, Department of Dermatology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Erin Boh
- Tulane University, Department of Dermatology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Lisa Bull
- Tulane University, Department of Pathology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Abida Kadi
- Tulane University, Department of Pathology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Alfred Luk
- Tulane University, Department of Medicine, 1415 Tulane Avenue, 70112, New Orleans, United States
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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]
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Abstract
Mold infections carry a substantial clinical and economic burden in solid organ transplant (SOT) recipients with a high overall mortality of near 30%. The most important pathogens include Aspergillus, the Zygomycetes, Fusarium, Scedosporium/Pseudallescheria, and the dematiaceous (dark) molds. Risk factors for the infections vary by transplant type but include degree of immune suppression and loss of skin or mucosal integrity. Correct diagnosis usually requires histopathology and/or culture. Management often requires a multidisciplinary team approach with combined antifungal and surgical therapies. This article reviews the epidemiology, risk factors, microbiology, diagnostic, and treatment approach to mold infections in SOT recipients.
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van der Merwe A, Graewe F, Zühlke A, Barsdorf NW, Zarrabi AD, Viljoen JT, Ackermann H, Spies PV, Opondo D, Al-Qaoud T, Bezuidenhout K, Nel JD, Bailey B, Moosa MR. Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up. Lancet 2017; 390:1038-1047. [PMID: 28823494 DOI: 10.1016/s0140-6736(17)31807-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Ritual circumcision complicated by gangrene is a leading cause of penile loss in young men in South Africa. This deeply rooted cultural tradition is unlikely to be abolished. Conventional reconstructive techniques using free vascularised tissue flaps with penile implants are undesirable in this often socioeconomically challenged group because donor site morbidity can hinder manual labour and vigorous sexual activity might lead to penile implant extrusion. The psychosociological effects of penile loss in a young man are devastating and replacing it with the same organ is likely to produce the maximum benefit. METHODS We first performed a cadaver-to-cadaver penile transplantation as preparation. After approval from the Human Research Ethics Committee was obtained, we recruited potential recipients. We screened the potential participants for both physical and psychological characteristics, including penile stump length, and emotional suitability for the procedure. A suitable donor became available and the penis was harvested. We surgically prepared the penile stump of the recipient and attached the penile graft. Immunosuppression treatment with antithymyocyte globulin, methylprednisolone, tacrolimus, mycophenolate mofetil, and prednisone were commenced. Tadalafil at 5 mg once per day was commenced after 1 week as penile rehabilitation and was continued for 3 months. We collected on quality-of-life scores (Short Form 36 version 2 [SF-36v2] questionnaires) before surgery and during follow-up and measured erectile function (International Index for Erectile Function [IIEF] score) and urine flow rates at 24 months post transplant. FINDINGS The warm ischaemia time for the graft after removal was 4 min and the cold ischaemia time was 16 h. The surgery lasted 9 h. An arterial thrombus required urgent revision 8 h after the operation. On post operative day 6, an infected haematoma and an area of proximal skin necrosis were surgically treated. The recipient was discharged after 1 month and first reported satisfactory sexual intercourse 1 week later (despite advice to the contrary). The recipient reported regular sexual intercourse from 3 months after the operation. An episode of acute kidney injury at 7 months was reversed by reducing the tacrolimus dose to 14 mg twice per day. At 8 months after surgery, the patient had a skin infection with phaeohyphomycosis due to Alternaria alternata, which we treated with topical antifungal medication. Quality-of-life scores improved substantially after the operation (SF-36v2 mental health scores improved from 25 preoperatively, to 57 at 6 months and 46 at 24 months post transplant; physical health scores improved from 37 at baseline to 60 at 6 months and 59 at 24 months post-transplant). At 24 months, measured maximum urine flow rate (16·3 mL/s from a volume voided of 109 mL) and IIEF score (overall satisfaction score of 8 from a maximum of 10) were normal, showing normal voiding and erectile function, respectively. INTERPRETATION Penile transplantation restored normal physiological functions in this transplant recipient without major complications in the first 24 months. FUNDING Department of Health, Western Cape Government.
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Affiliation(s)
- André van der Merwe
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
| | - Frank Graewe
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alexander Zühlke
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Nicola W Barsdorf
- Health Research Ethics, Division of Research Development and Support, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Amir D Zarrabi
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Jeremy T Viljoen
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hilgard Ackermann
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Pieter V Spies
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Dedan Opondo
- Division of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Talal Al-Qaoud
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin, Milwaukee, WI, USA
| | - Karla Bezuidenhout
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Johan D Nel
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Bertha Bailey
- Renal Unit, Tygerberg Academic Hospital, Cape Town, South Africa
| | - M Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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Paecilomyces variotii Fungemia in a Patient with Lymphoma Needing Liver Transplant. Mycopathologia 2017; 182:761-765. [DOI: 10.1007/s11046-017-0131-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
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Echenique IA, Angarone MP, Gordon RA, Rich J, Anderson AS, McGee EC, Abicht TO, Kang J, Stosor V. Invasive fungal infection after heart transplantation: A 7-year, single-center experience. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 07/19/2016] [Accepted: 09/12/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Ignacio A. Echenique
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Michael P. Angarone
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Robert A. Gordon
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Jonathan Rich
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Allen S. Anderson
- Division of Cardiology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Edwin C. McGee
- Division of Cardiac Surgery; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Travis O. Abicht
- Division of Cardiac Surgery; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Joseph Kang
- Division of Biostatistics; Department of Preventative Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Valentina Stosor
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Organ Transplantation; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
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Bajwa R, Wojciechowski AL, Hsiao CB. Cutaneous alternariosis in a renal transplant patient successfully treated with posaconazole: Case report and literature review. Med Mycol Case Rep 2017; 15:16-20. [PMID: 28180057 PMCID: PMC5279863 DOI: 10.1016/j.mmcr.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 11/20/2022] Open
Abstract
Cutaneous alternariosis is an uncommon fungal infection that most commonly presents in organ transplant patients on immunosuppressive therapy. There are no clinical trials or guidelines to guide treatment of this condition, however itraconazole is the most commonly used antifungal in published cases. Here we report on a case of cutaneous alternariosis in a renal transplant recipient treated with a newer antifungal, posaconazole. A review of published reports of cutaneous alternariosis since 2008 is also discussed.
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Affiliation(s)
- Rajinder Bajwa
- Niagara Falls Memorial Medical Center, 621 10th Street, Niagara Falls, NY 14302, USA
| | - Amy L. Wojciechowski
- Niagara Falls Memorial Medical Center, 621 10th Street, Niagara Falls, NY 14302, USA
- D’Youville College School of Pharmacy, 320 Porter Avenue, Buffalo, NY 14201, USA
- Corresponding author at: Niagara Falls Memorial Medical Center, 621 10th Street, Niagara Falls, NY 14302, USA.
| | - Chiu-Bin Hsiao
- Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA
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Angeletti S, Ceccarelli G, Vita S, Dicuonzo G, Lopalco M, Dedej E, Blasi A, Antonelli F, Conti A, De Cesaris M, Farchi F, Lo Presti A, Ciccozzi M. Unusual microorganisms and antimicrobial resistances in a group of Syrian migrants: Sentinel surveillance data from an asylum seekers centre in Italy. Travel Med Infect Dis 2016; 14:115-22. [PMID: 26987764 DOI: 10.1016/j.tmaid.2016.03.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/18/2016] [Accepted: 03/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Three years of civil war in Syria have caused death and increase of communicable diseases. The suffering population has been forced to migrate creating a fertile condition for epidemic spread of infection within the refugee camps. METHODS Forty-eight Syrian migrants, upon their arrival in Italy, were accommodated at the asylum seekers centre of Castelnuovo di Porto. They received a physical examination and were subjected to microbiological surveillance by blood, rectal, pharyngeal and nasal swabs collection and delivering to the Clinical Pathology and Microbiology Laboratory of the University Campus Bio-Medico of Rome. RESULTS All refugees resulted negative for HBV, HCV and HIV infections. In swabs a large number of unusual gram-negative bacteria species were isolated, such as Pseudomonas putida, Pseudomonas monteilii, Pseudomonas fulva, Pseudomonas moselii, Aeromonas veronii, Aeromonas caviae, Aeromonas hydrophila, Acinteobacter guilloviae, Acinteobacter lowffii; Acinetobacter johnsonii; Acinteobacter tjernbergae; Pantoea agglomerans; Pantoea calida. Among isolates, strains resistant to carbapenems, ESBL producers and methicillin resistant were found. CONCLUSIONS The microbiological surveillance performed represents a useful action to understand refugees health status and to trace unusual microorganisms movement even carriers of antimicrobial resistance during migrants traveling.
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Affiliation(s)
- Silvia Angeletti
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases. University of Rome, "Sapienza," Policlinico Umberto I", Rome, Italy; Migrant Health Research Organisation (Mi-HeRO) - Centro di Ricerca sulla Salute delle Popolazioni Mobili e Globale, Italy
| | - Serena Vita
- Department of Public Health and Infectious Diseases. University of Rome, "Sapienza," Policlinico Umberto I", Rome, Italy; Migrant Health Research Organisation (Mi-HeRO) - Centro di Ricerca sulla Salute delle Popolazioni Mobili e Globale, Italy
| | - Giordano Dicuonzo
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Maurizio Lopalco
- Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - Etleva Dedej
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Aletheia Blasi
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Francesca Antonelli
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Alessia Conti
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Marina De Cesaris
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy
| | - Francesca Farchi
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy
| | - Alessandra Lo Presti
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy
| | - Massimo Ciccozzi
- Clinical Pathology and Microbiology Laboratory, University Hospital Campus Bio-Medico of Rome, Italy; Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy.
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Brás S, Sabino R, Laureano A, Simões H, Fernandes C, Marques-Pinto G, Cardoso J, Veríssimo C. Cutaneous infection by different Alternaria species in a liver transplant recipient. Med Mycol Case Rep 2015; 8:1-4. [PMID: 25750855 PMCID: PMC4348454 DOI: 10.1016/j.mmcr.2015.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 12/02/2022] Open
Abstract
Fungal invasive infections are rare in general population but are an emergent cause of infection in the immunocompromized population, especially in the solid organ transplant recipients. Herein the authors report a clinical case of a liver transplanted patient suffering a cutaneous co-existent infection with A. alternata as well as A. infectoria. To our knowledge this is the first case of cutaneous concomitant infection due to those two species reported not only in Portugal but also worldwide. The patient was treated with surgical excision of the lesions and oral itraconazol without relapse.
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Affiliation(s)
- Susana Brás
- Departement of Dermatology and Venereology, Curry Cabral Hospital - Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Raquel Sabino
- Laboratório Nacional de Referência de Infecções Parasitárias e Fúngicas, Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - André Laureano
- Departement of Dermatology and Venereology, Curry Cabral Hospital - Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Helena Simões
- Laboratório Nacional de Referência de Infecções Parasitárias e Fúngicas, Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Cândida Fernandes
- Departement of Dermatology and Venereology, Curry Cabral Hospital - Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Gabriela Marques-Pinto
- Departement of Dermatology and Venereology, Curry Cabral Hospital - Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Jorge Cardoso
- Departement of Dermatology and Venereology, Curry Cabral Hospital - Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Cristina Veríssimo
- Laboratório Nacional de Referência de Infecções Parasitárias e Fúngicas, Departamento de Doenças Infecciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
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Scientific Opinion on the maintenance of the list of QPS biological agents intentionally added to food and feed (2013 update). EFSA J 2013. [DOI: 10.2903/j.efsa.2013.3449] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Abstract
The most important emerging and rare fungal pathogens in solid organ transplant recipients are the Zygomycetes, Scedosporium, Fusarium, and the dark molds. Factors affecting the emergence of these fungi include the combination of intensive immunosuppressive regimens with increasingly widespread use of long-term azole antifungal therapy; employment of aggressive diagnostic approaches (eg, sampling of bronchoalveolar lavage fluid); and changes in patients' interactions with the environment. This article reviews the epidemiology, microbiology, and clinical impact of emerging fungal infections in solid organ transplant recipients, and provides up-to-date recommendations on their treatment.
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Affiliation(s)
- Shmuel Shoham
- Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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