1
|
Ren L, Liu Z, Wang J, Su Y. Mixed fungal infection of Actinomucor elegans and Aspergillus fumigatus in a person with severe fever with thrombocytopenia syndrome. Diagn Microbiol Infect Dis 2025; 112:116750. [PMID: 39986132 DOI: 10.1016/j.diagmicrobio.2025.116750] [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: 01/08/2025] [Revised: 02/10/2025] [Accepted: 02/14/2025] [Indexed: 02/24/2025]
Abstract
In this report, a 69-year-old man with fever, thrombocytopenia, and hepatic and renal dysfunction presented to our hospital. His disease progression was rapid, and he became unconscious. The patient was diagnosed with severe fever with thrombocytopenia syndrome (SFTS). However, his inflammation markers continued to rise until a mixed fungal infection was detected. Metagenomic next-generation sequencing of blood detected elevated sequence numbers for Actinomucor elegans and Aspergillus fumigatus. The culture of the bronchoalveolar lavage fluid were positive for Aspergillus fumigatus and Escherichia coli. Infection was controlled after adjusting the antifungal regimens against Actinomucor elegans. The patient's condition gradually improved. This patient was diagnosed with possible mucormycosis. Reports of Mucorales infection associated with SFTS are rare. We hope that this case report will draw the attention of physicians in the area where SFTS occurs to figure out if patients with SFTS are susceptible to mucormycosis.
Collapse
Affiliation(s)
- Lu Ren
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhen Liu
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Wang
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yuan Su
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| |
Collapse
|
2
|
Henry B, Lefevre Utile A, Jaureguiberry S, Angoulvant A. Gastrointestinal and Intra-Abdominal Mucormycosis in Non-Haematological Patients-A Comprehensive Review. J Fungi (Basel) 2025; 11:298. [PMID: 40278118 PMCID: PMC12028458 DOI: 10.3390/jof11040298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 03/30/2025] [Accepted: 04/04/2025] [Indexed: 04/26/2025] Open
Abstract
Intra-abdominal and gastrointestinal mucormycosis are less frequent than rhino-orbito-cerebral and pulmonary mucormycosis, but highly lethal. Their diagnosis remains challenging due to the non-specific clinical presentation. We collected English-language cases of intra-abdominal and gastrointestinal mucormycosis in non-haematological and non-neonatal patients published up to October 2024. This review analysed the epidemiological, clinical, and therapeutic charts of 290 cases. A proportion of 53.4% were reported from India and the USA. The main predisposing conditions were diabetes, solid organ transplant, ICU, and corticosteroid treatment. The most common site was the stomach (53.8%). Gastrointestinal perforation, skin breakdown, and abdominal wall infection were sources of intra-abdominal localisation. The most common symptoms were abdominal pain, vomiting, and gastrointestinal bleeding. The diagnosis relied on histology (93.8%), mycology with microscopy and culture (38.8%), and molecular methods (9.9%). Mortality (52.9%) was lower when treatment was intravenous amphotericin B, combined or not with surgery. Prompt treatment, essential for a favourable outcome, relies on early suspicion and diagnosis. Gastrointestinal and intra-abdominal mucormycosis should also be suspected in patients admitted in ICU with ventilation/nasogastric tube and corticosteroids and those with abdominal trauma or surgery, presenting abdominal distension, pain, and GI bleeding. Mycological diagnosis including direct examination, culture and Mucorales qPCR on tissue should assist with rapid diagnosis and thus treatment.
Collapse
Affiliation(s)
- Benoît Henry
- Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Universitaire de Bicêtre, 94275 Le Kremlin-Bicêtre, France
| | - Alain Lefevre Utile
- Service of Paediatrics, Department Women-Mother-Child, Lausanne University Hospital, 1005 Lausanne, Switzerland
| | - Stephane Jaureguiberry
- Service des Maladies Infectieuses et Tropicales, APHP, Hôpital Universitaire de Bicêtre, 94275 Le Kremlin-Bicêtre, France
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), U1018, INSERM, 94807 Villejuif, France
| | - Adela Angoulvant
- Faculty of Medicine, University of Paris Saclay, AP-HP, 94275 Le Kremlin-Bicêtre, France
| |
Collapse
|
3
|
Valdez-Martinez A, Santoyo-Alejandre MI, Arenas R, Fuentes-Venado CE, Ramírez-Lozada T, Bastida-González F, Calzada-Mendoza CC, Martínez-Herrera E, Pinto-Almazán R. Neonatal Mucormycosis: A Rare but Highly Lethal Fungal Infection in Term and Preterm Newborns-A 20-Year Systematic Review. Trop Med Infect Dis 2025; 10:86. [PMID: 40278759 PMCID: PMC12030780 DOI: 10.3390/tropicalmed10040086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Revised: 03/08/2025] [Accepted: 03/13/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND/OBJECTIVES Mucormycosis is a rare but life-threatening fungal infection, particularly in neonates, due to their undeveloped immune system. This systematic review aims to analyze the risk factors, clinical presentations, treatments, and outcomes of neonatal mucormycosis reported between 2004 and 2024. METHODS A systematic literature search was conducted in PubMed, Scopus, and Web of Science following PRISMA guidelines. Only studies reporting cases of mucormycosis in neonates (≤28 days old) were included. Data on risk factors, clinical features, diagnostic methods, antifungal therapies, surgical interventions, and outcomes were extracted and analyzed. RESULTS A total of 44 studies met the inclusion criteria, comprising 61 neonatal cases. The most common clinical presentations were gastrointestinal (n = 39), cutaneous (n = 19), rhino-orbito-cerebral (n = 2), and disseminated mucormycosis (n = 1). Diagnosis was primarily based on histopathology (93.4%) and fungal culture (26.2%). The main antifungal treatment was liposomal amphotericin B (63.9%), often combined with surgical debridement (60.6%). Mortality rates remained high (47.5%), particularly in cases of prematurely extreme neonates with angioinvasive disease or delayed diagnosis. CONCLUSIONS Neonatal mucormycosis remains a severe condition with high morbidity and mortality. Early diagnosis through a combination of clinical suspicion and laboratory confirmation, along with prompt antifungal therapy and surgical management, apparently is crucial for improving outcomes. Further studies are needed to optimize treatment strategies and improve neonatal survival.
Collapse
Affiliation(s)
- Alfredo Valdez-Martinez
- Sección de Micología, Hospital General “Dr. Manuel Gea González”, Tlalpan, Mexico City 14080, Mexico; (A.V.-M.); (R.A.)
- Hospital General del Zona 33, Instituto Mexicano del Seguro Social, Nayarit 63735, Mexico;
| | | | - Roberto Arenas
- Sección de Micología, Hospital General “Dr. Manuel Gea González”, Tlalpan, Mexico City 14080, Mexico; (A.V.-M.); (R.A.)
| | - Claudia Erika Fuentes-Venado
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Mexico City 11340, Mexico; (C.E.F.-V.); (C.C.C.-M.)
- Servicio de Medicina Física y Rehabilitación, Hospital General de Zona No 197, Texcoco 56160, Mexico
| | - Tito Ramírez-Lozada
- Servicio de Ginecología y Obstetricia, Hospital Regional de Alta Especialidad de Ixtapaluca, Instituto Mexicano de Seguro Social para el Bienestar (IMSS-BIENESTAR), Carretera Federal México-Puebla Km 34.5, Ixtapaluca 56530, Mexico;
| | - Fernando Bastida-González
- Laboratorio de Biología Molecular, Laboratorio Estatal de Salud Pública del Estado de México, Toluca de Lerdo 50130, Mexico;
| | - Claudia Camelia Calzada-Mendoza
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Mexico City 11340, Mexico; (C.E.F.-V.); (C.C.C.-M.)
| | - Erick Martínez-Herrera
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Mexico City 11340, Mexico; (C.E.F.-V.); (C.C.C.-M.)
- Fundación Vithas, Grupo Hospitalario Vithas, 28043 Madrid, Spain
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IISGS), Servizo Galego de Saúde-Universidade de Vigo (UVIGO), 36213 Vigo, Spain
| | - Rodolfo Pinto-Almazán
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Mexico City 11340, Mexico; (C.E.F.-V.); (C.C.C.-M.)
- Fundación Vithas, Grupo Hospitalario Vithas, 28043 Madrid, Spain
| |
Collapse
|
4
|
Gu Y, Singh S, Alqarihi A, Alkhazraji S, Gebremariam T, Youssef EG, Liu H, Fan X, Jiang WR, Andes D, Cochrane TR, Schwartz JA, Filler SG, Uppuluri P, Ibrahim AS. A humanized antibody against mucormycosis targets angioinvasion and augments the host immune response. Sci Transl Med 2025; 17:eads7369. [PMID: 40073153 PMCID: PMC12020122 DOI: 10.1126/scitranslmed.ads7369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 12/23/2024] [Accepted: 02/07/2025] [Indexed: 03/14/2025]
Abstract
Mucormycosis is a fungal infection caused by Mucorales fungi that cause severe disease and fatality, especially in immunocompromised individuals. Although vaccines and immunotherapeutics have been successful in combating viral and bacterial infections, approved antifungal immunotherapies are yet to be realized. To address this gap, monoclonal antibodies targeting invasive fungal infections have emerged as a promising approach, particularly for immunocompromised patients who are unlikely to maximally benefit from vaccines. The Mucorales spore coat (CotH) proteins have been identified as crucial fungal invasins that bind to glucose-regulated protein 78 (GRP78) and integrins of host barrier cells. Previously, we described a murine monoclonal antibody, anti-CotH C2, which protected diabetic ketoacidosis (DKA) and neutropenic mice from mucormycosis. Here, we advanced the development of the C2 immunoglobulin G1 (IgG1) by humanizing it, establishing a stable Chinese hamster ovary cell line producing the antibody at commercial yields, and carried out optimization of the upstream and downstream manufacturing processes. The resultant humanized IgG1 (VX-01) exhibited a 10-fold increase in binding affinity to CotH proteins and conferred comparable in vitro and in vivo efficacy when compared to C2 antibody. The mechanism of protection was reliant on prevention of angioinvasion and enhancing opsonophagocytic killing. VX-01 demonstrated acceptable safety profiles with no detectable damage to host cells in vitro and weak or moderate binding to only cytoplasmic proteins in ex vivo good laboratory practice-human tissue cross-reactivity studies. Our studies warrant continued development of VX-01 as a promising adjunctive immunotherapy.
Collapse
Affiliation(s)
- Yiyou Gu
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
| | - Shakti Singh
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
- Department of Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA 90095, United States of America
| | - Abdullah Alqarihi
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
| | - Sondus Alkhazraji
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
| | - Teclegiorgis Gebremariam
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
| | - Eman G. Youssef
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
| | - Hong Liu
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
| | - Xiaomin Fan
- AvantGen, Inc., San Diego, CA 92121, United States of America
| | - Wen-Rong Jiang
- JOINN Biologics, Richmond, CA 94806, United States of America
| | - David Andes
- Department of Medicine at the University of Wisconsin; Madison, WI 53705, United States of America
| | | | - Julie A. Schwartz
- Charles River Laboratories, Reno, NV 89511, United States of America
| | - Scott G. Filler
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
- Department of Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA 90095, United States of America
| | - Priya Uppuluri
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
- Department of Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA 90095, United States of America
| | - Ashraf S. Ibrahim
- The Lundquist Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center; Torrance, CA 90502, United States of America
- Department of Medicine, David Geffen School of Medicine at UCLA; Los Angeles, CA 90095, United States of America
- Vitalex Biosciences LLC, Trabuco Canyon, CA 92679, United States of America
| |
Collapse
|
5
|
Zhang Q, Choi K, Wang X, Xi L, Lu S. The Contribution of Human Antimicrobial Peptides to Fungi. Int J Mol Sci 2025; 26:2494. [PMID: 40141139 PMCID: PMC11941821 DOI: 10.3390/ijms26062494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/07/2025] [Accepted: 03/08/2025] [Indexed: 03/28/2025] Open
Abstract
Various species of fungi can be detected in the environment and within the human body, many of which may become pathogenic under specific conditions, leading to various forms of fungal infections. Antimicrobial peptides (AMPs) are evolutionarily ancient components of the immune response that are quickly induced in response to infections with many pathogens in almost all tissues. There is a wide range of AMP classes in humans, many of which exhibit broad-spectrum antimicrobial function. This review provides a comprehensive overview of the mechanisms of action of AMPs, their distribution in the human body, and their antifungal activity against a range of both common and rare clinical fungal pathogens. It also discusses the current research status of promising novel antifungal strategies, highlighting the challenges that must be overcome in the development of these therapies. The hope is that antimicrobial peptides, as a class of antimicrobial agents, will soon progress through large-scale clinical trials and be implemented in clinical practice, offering new treatment options for patients suffering from infections.
Collapse
Affiliation(s)
| | | | | | | | - Sha Lu
- Department of Dermatology and Venereology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, #107 Yanjiang West Rd., Guangzhou 510120, China; (Q.Z.); (K.C.); (X.W.); (L.X.)
| |
Collapse
|
6
|
Czech MM, Cuellar-Rodriguez J. Mucormycosis. Infect Dis Clin North Am 2025; 39:121-144. [PMID: 39638718 PMCID: PMC11786989 DOI: 10.1016/j.idc.2024.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
Mucormycosis is an aggressive and frequently lethal disease. Most patients with mucormycosis have poorly controlled diabetes mellitus and rhino-orbito-cerebral disease. Patients with hematologic malignancy and transplant recipients mostly present with rhino-orbito-cerebral or pulmonary disease. Prompt recognition of clinical symptoms and radiographic features of mucormycosis is required to establish timely diagnosis and initiate targeted therapy. Diagnosis is, historically, made by direct microscopy, culture, and pathology of biopsy tissue, but molecular methods are increasingly playing a role in establishing an earlier diagnosis. Treatment is multidisciplinary, involving early surgical intervention, antifungal therapy, and correction of underlying immune compromising risk factors when possible.
Collapse
Affiliation(s)
- Mary M Czech
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Building 10 2C146B, Bethesda, MD 20892, USA
| | - Jennifer Cuellar-Rodriguez
- Transplant Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
7
|
Corey Z, Luu LA, Newman S, Raghavan SS. Violaceous Nodules on the Left Forearm of an Immunosuppressed Patient Following Heart Transplantation for Cardiac Amyloidosis. Dermatopathology (Basel) 2025; 12:2. [PMID: 40145526 PMCID: PMC11755463 DOI: 10.3390/dermatopathology12010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Revised: 01/12/2025] [Accepted: 01/13/2025] [Indexed: 03/28/2025] Open
Abstract
We present the case of a 60-year-old immunocompromised man who presented with two pruritic pink-red indurated nodules with overlying scale and focal areas of ulceration on his left dorsal and left medial forearm, which evolved over a 2-month period. The pathology showed numerous fungal hyphae present that were pauci-septate with various branched angles and variable hyphal thickness. Fungal cultures grew Rhizopus species and a universal fungal PCR detected the Rhizopus oryzae complex. Based on the clinicopathologic correlation, the diagnosis of cutaneous mucormycosis was made. Cutaneous mucormycosis is an aggressive fungal infection of the Mucorales family occurring after the inoculation of fungal spores in disrupted skin. It usually presents as a necrotic eschar but can also present as cellulitis that evolves into a necrotic ulcer. A prompt diagnosis is critical for the effective management of cutaneous mucormycosis. The treatment includes an immediate systemic treatment with amphotericin B and a surgical debridement of the necrotic regions. Given the wide range of presenting symptoms, clinical suspicion for this emergent condition must remain high in immunocompromised and diabetic patients.
Collapse
Affiliation(s)
- Zachary Corey
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Lydia A. Luu
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (L.A.L.); (S.N.)
| | - Sabrina Newman
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (L.A.L.); (S.N.)
| | - Shyam S. Raghavan
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| |
Collapse
|
8
|
Qin J, Bi H, Tang G, Liu X, Qu J, Lv X, Liu Y. Real-World Effectiveness and Safety of Isavuconazole Versus Amphotericin B for Patients with Invasive Mucormycosis. Microorganisms 2025; 13:55. [PMID: 39858823 PMCID: PMC11767576 DOI: 10.3390/microorganisms13010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Revised: 12/26/2024] [Accepted: 12/30/2024] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Invasive mucormycosis (IM) poses a substantial morbidity and mortality burden among immunocompromised patients. OBJECTIVES We aim to compare the real-world effectiveness and safety of isavuconazole with those of amphotericin B in patients with IM. PATIENTS AND METHODS In this observational cohort study, we enrolled patients who were diagnosed with IM and treated with either isavuconazole or amphotericin B. RESULTS A total of 106 patients met the study criteria. Of these, 47 received isavuconazole, and 59 received amphotericin B as the primary treatment. The two cohorts had similar baseline characteristics, including a history of malignancy, use of immunosuppressants, infection sites, and pathogens. The amphotericin B group demonstrated a significantly greater incidence of renal disorders (p < 0.001) and hypokalemia (p < 0.001) than the isavuconazole group. The proportion of patients who received salvage therapy was greater in the amphotericin B group than in the isavuconazole group (42% vs. 6%, p < 0.001). Eighteen patients in the amphotericin B group discontinued treatment because of adverse events, whereas no patients in the isavuconazole group discontinued treatment because of adverse events. A significant difference in the primary therapeutic response between the isavuconazole and amphotericin B groups was noted (p = 0.013), with a higher treatment failure rate in the amphotericin B group (68% vs. 36%, p = 0.001). However, there were no significant differences in all-cause mortality or mucormycosis-attributable mortality rates between the two groups. CONCLUSIONS Isavuconazole outperformed amphotericin B as a first-line treatment option for IM in terms of its clinical effectiveness and safety.
Collapse
Affiliation(s)
- Jiayuan Qin
- Center of Infectious Diseases, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu 610041, China; (J.Q.); (H.B.); (G.T.); (J.Q.); (X.L.)
- State Key Laboratory of Biotherapy, Division of Infectious Diseases, Chengdu 610041, China
| | - Hongxia Bi
- Center of Infectious Diseases, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu 610041, China; (J.Q.); (H.B.); (G.T.); (J.Q.); (X.L.)
- State Key Laboratory of Biotherapy, Division of Infectious Diseases, Chengdu 610041, China
| | - Guangmin Tang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu 610041, China; (J.Q.); (H.B.); (G.T.); (J.Q.); (X.L.)
- State Key Laboratory of Biotherapy, Division of Infectious Diseases, Chengdu 610041, China
| | - Xinyao Liu
- Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Junyan Qu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu 610041, China; (J.Q.); (H.B.); (G.T.); (J.Q.); (X.L.)
- State Key Laboratory of Biotherapy, Division of Infectious Diseases, Chengdu 610041, China
| | - Xiaoju Lv
- Center of Infectious Diseases, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu 610041, China; (J.Q.); (H.B.); (G.T.); (J.Q.); (X.L.)
- State Key Laboratory of Biotherapy, Division of Infectious Diseases, Chengdu 610041, China
| | - Yanbin Liu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu 610041, China; (J.Q.); (H.B.); (G.T.); (J.Q.); (X.L.)
- State Key Laboratory of Biotherapy, Division of Infectious Diseases, Chengdu 610041, China
| |
Collapse
|
9
|
Sakalihasan S, Lifrange F, Czajkowski M, Goncette V, Duysinx B, Lovinfosse P, Can D, Schils R, Hayette MP, De Voeght A. Severe dual fungal infection after bispecific antibody therapy: A case of invasive aspergillosis and mucormycosis in immunocompromised patient. IDCases 2024; 39:e02140. [PMID: 39810812 PMCID: PMC11732460 DOI: 10.1016/j.idcr.2024.e02140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 12/03/2024] [Accepted: 12/20/2024] [Indexed: 01/16/2025] Open
Abstract
Bispecific antibody is a new treatment for hematological disease, especially for lymphoma, myeloma and acute lymphoblastic leukemia. This class of treatment presents the same kind of side effect as CAR-T cell which are immune-mediated. Nevertheless, infectious complication remains a major concerns with related mortality. Fungal infection are rarely reported in clinical trial but remains a major concern. We report a case of a co-infection of Aspergillus and Mucorales in a patient with diffuse large B-cell lymphoma (DLBCL) following treatment with the bispecific antibody epcoritamab. The patient developed severe cytokine release syndrome (CRS) and subsequent fungal infections, which were challenging to diagnose and treat due to the complexities of managing immunocompromised patients and co-infection. Advanced diagnostics, including PET-CT, and a combination of antifungal therapies were crucial in achieving remission. The case underscores the need for early diagnosis, multidisciplinary management, and innovative treatment strategies in similar high-risk patients.
Collapse
Affiliation(s)
- Sarah Sakalihasan
- Department of Medicine, Division of Hematology, CHU of Liège, Liège 4000, Belgium
| | - Frédéric Lifrange
- Department of Pathology, University Hospital Center of Liege, Liege, Belgium
| | - Mathieu Czajkowski
- Service d′ORL, d′audiophonologie et de chir. cervico-faciale, University Hospital Center of Liege, Liege, Belgium
| | - Veronique Goncette
- Department of Hospital Pharmacy, University Hospital of Liège, Liège, Belgium
| | - Bernard Duysinx
- Division of Pulmonology, University Hospital of Liège, Liège, Belgium
| | - Pierre Lovinfosse
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, University of Liège (ULiège), Liège, Belgium
| | - Damla Can
- Division of Radiology, University Hospital of Liège, Liège, Belgium
| | - Raphael Schils
- Department of Medicine, Division of Internal Medicine and Infectious Diseases, University of Liege, Liege, Belgium
| | - Marie-Pierre Hayette
- Department of Clinical Microbiology, University Hospital of Liege, Liege 4000, Belgium
| | - Adrien De Voeght
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Laboratory of Hematology, University of Liège, Liège, Belgium
- Department of Medicine, Division of Hematology, CHU of Liège, Liège 4000, Belgium
| |
Collapse
|
10
|
Pikoulas A, Morianos I, Nidris VN, Hamdy R, López-López A, Moran-Garrido M, Muthu V, Halabalaki M, Papadovasilaki M, Irene K, Gu Y, Aerts R, Mercier T, Vanbiervliet Y, Cho SY, Spallone A, Samonakis D, Kastritis E, Drakos E, Tzardi M, Eliopoulos A, Georgila K, Carvalho A, Kurzai O, Rudramurthy S, Lanternier F, Petratos K, Maertens J, Bruno V, Kontoyiannis D, Barbas C, Soliman S, Ibrahim A, Chamilos G. Albumin orchestrates a natural host defense mechanism against mucormycosis. RESEARCH SQUARE 2024:rs.3.rs-5441197. [PMID: 39678331 PMCID: PMC11643317 DOI: 10.21203/rs.3.rs-5441197/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
Mucormycosis is an emerging, life-threatening human infection caused by fungi of the order Mucorales. Metabolic disorders uniquely predispose an ever-expanding group of patients to mucormycosis via poorly understood mechanisms. Therefore, it is highly likely that uncharacterized host metabolic effectors confer protective immunity against mucormycosis. Here, we uncover a master regulatory role of albumin in host defense against Mucorales through the modulation of the fungal pathogenicity program. Our initial studies identified severe hypoalbuminemia as a prominent metabolic abnormality and a biomarker of poor outcome in independent cohorts of mucormycosis patients. Strikingly, we found that purified albumin selectively inhibits Mucorales growth among a range of human pathogens, and albumin-deficient mice display susceptibility specifically to mucormycosis. The antifungal activity of albumin is mediated by the release of bound free fatty acids (FFAs). Importantly, albumin prevents FFA oxidation, which results in loss of their antifungal properties. A high degree of FFA oxidation is found in the sera of patients with mucormycosis. Physiologically, albumin-bound FFAs blocks the expression of the mycotoxin mucoricin and renders Mucorales avirulent in vivo. Overall, we discovered a novel host defense mechanism that directs the pathogen to suppress its growth and the expression of virulence factors in response to unfavorable metabolic cues regulated by albumin. These findings have major implications for the pathogenesis and management of mucormycosis.
Collapse
Affiliation(s)
| | - Ioannis Morianos
- IMBB, FORTH, Nikolaou Plastira 100 GR-70013, Heraklion, Crete GREECE
| | | | - Rania Hamdy
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Angeles López-López
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Ma
| | - Maria Moran-Garrido
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Boadilla del Monte, Ma
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Maria Halabalaki
- Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Yiyou Gu
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center
| | - Robina Aerts
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Toine Mercier
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Yuri Vanbiervliet
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Sung-Yeon Cho
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Efstathios Kastritis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Tzardi
- School of Medicine, University of Crete and University Hospital
| | - Aristides Eliopoulos
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Georgila
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, 97080, Würzburg, Germany
| | - Shivaprakash Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cite, France
| | | | - Johan Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Coral Barbas
- Centro de Metabolómica y Bioanálisis (CEMBIO), Universidad San Pablo-CEU
| | | | - Ashraf Ibrahim
- The Lundquist Institute at Harbor-University of California Los Angeles Medical Center
| | | |
Collapse
|
11
|
Mahapatra C, Jadhav S, Kumar P, Roy DN, Kumar A, Paul MK. Potential activity of nanomaterials to combat SARS-CoV-2 and mucormycosis coinfection. Expert Rev Anti Infect Ther 2024; 22:1143-1155. [PMID: 39466600 DOI: 10.1080/14787210.2024.2423359] [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: 05/25/2023] [Revised: 09/26/2024] [Accepted: 10/27/2024] [Indexed: 10/30/2024]
Abstract
INTRODUCTION Mucormycosis, popularly known as the black fungus, has become a worldwide concern in the continuing COVID-19 pandemic, causing increased morbidity and death in immunocompromised people. Due to multi-drug resistance and the limited number of antifungals, surgical interventions, including the excision of infected tissue, remain a standard treatment option. Surgical treatment usually results in the loss of organs or their function, long-term intensive care, and a significant risk of reinfection during the procedure. A comprehensive approach is needed to treat the disease, and nanomaterials can be a powerful alternative therapeutic approach. AREAS COVERED We searched PubMed, Scopus, and Google Scholar with the keywords 'emerging role of nanomaterials,' and 'combating COVID-19-related mucormycosis,' and reviewed the related research paper. Antifungal nanomaterials and their delivery can significantly impact the treatment of COVID-19-related fungal infections like mucormycosis. However, the therapeutic options for mucormycosis are limited and drug resistance is also reported. EXPERT OPINION The current review encompasses a detailed overview of the recent developments in antifungal/antiviral nanomaterials and the properties of these therapeutic nanomaterials that may contribute to formulating an efficient strategy against invasive mucormycosis. Further extensive research is needed to develop nano-based therapeutics for the management of mucormycosis-viral coinfection with a definitive end-point.
Collapse
Affiliation(s)
- Chinmaya Mahapatra
- Department of Biotechnology, National Institute of Technology (NIT), Raipur, India
| | - Sakshi Jadhav
- Department of Biotechnology and Medical Engineering, National Institute of Technology (NIT), Rourkela, India
| | - Prasoon Kumar
- Department of Biotechnology and Medical Engineering, National Institute of Technology (NIT), Rourkela, India
| | - Dijendra Nath Roy
- Department of Biotechnology, National Institute of Technology (NIT), Raipur, India
| | - Awanish Kumar
- Department of Biotechnology, National Institute of Technology (NIT), Raipur, India
| | - Manash K Paul
- Department of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| |
Collapse
|
12
|
Wurster S, Cho SY, Allos H, Franklin A, Axell-House DB, Jiang Y, Kontoyiannis DP. Concordance of Chest Radiography and Chest Computed Tomography Findings in Patients with Hematologic Malignancy and Invasive Mucormycosis: What Are the Prognostic Implications? J Fungi (Basel) 2024; 10:703. [PMID: 39452655 PMCID: PMC11508256 DOI: 10.3390/jof10100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/04/2024] [Accepted: 10/06/2024] [Indexed: 10/26/2024] Open
Abstract
Invasive pulmonary mucormycosis (IPM) is a deadly opportunistic mold infection in patients with hematological malignancies (HM). Radiologic imaging is essential for its timely diagnosis. Here, we compared IPM lesions visualized by chest computed tomography (CCT) and chest X-ray (CXR) and determined the prognostic significance of discordant imaging. Therefore, we reviewed 44 consecutive HM patients with probable/proven IPM at MD Anderson Cancer Center in 2000-2020 who had concurrent CCT and CXR studies performed. All 44 patients had abnormal CCTs and 39 (89%) had anormal CXR findings at IPM diagnosis. However, only 26 patients (59%) showed CCT-matching IPM-suspicious lesions on CXR. Acute Physiology and Chronic Health Evaluation II score > 18 at IPM diagnosis and breakthrough infection to Mucorales-active antifungals were the only independent risk factors for 42-day and/or 84-day mortality. Absence of neutropenia at IPM diagnosis, neutrophil recovery in neutropenic patients, and surgical revision of mucormycosis lesions were protective factors. Although not reaching significance on multivariable analysis, visualization of CCT-matching lesions on CXR was associated with significantly increased 84-day mortality (log-rank test, p = 0.033), possibly as a surrogate of extensive lesions and tissue necrosis. This observation supports the exploration of radiologic lesion kinetics as a prognostic staging tool in IPM patients.
Collapse
Affiliation(s)
- Sebastian Wurster
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
| | - Sung-Yeon Cho
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
- Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Catholic Hematology Hospital, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea
| | - Hazim Allos
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
| | - Alexander Franklin
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dierdre B. Axell-House
- Division of Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX 77030, USA;
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
| |
Collapse
|
13
|
Cheng Q, Dickwella Widanage MC, Yarava JR, Ankur A, Latgé JP, Wang P, Wang T. Molecular architecture of chitin and chitosan-dominated cell walls in zygomycetous fungal pathogens by solid-state NMR. Nat Commun 2024; 15:8295. [PMID: 39333566 PMCID: PMC11437000 DOI: 10.1038/s41467-024-52759-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 09/20/2024] [Indexed: 09/29/2024] Open
Abstract
Zygomycetous fungal infections pose an emerging medical threat among individuals with compromised immunity and metabolic abnormalities. Our pathophysiological understanding of these infections, particularly the role of fungal cell walls in growth and immune response, remains limited. Here we conducted multidimensional solid-state NMR analysis to examine cell walls in five Mucorales species, including key mucormycosis causative agents like Rhizopus and Mucor species. We show that the rigid core of the cell wall primarily comprises highly polymorphic chitin and chitosan, with minimal quantities of β-glucans linked to a specific chitin subtype. Chitosan emerges as a pivotal molecule preserving hydration and dynamics. Some proteins are entrapped within this semi-crystalline chitin/chitosan layer, stabilized by the sidechains of hydrophobic amino acid residues, and situated distantly from β-glucans. The mobile domain contains galactan- and mannan-based polysaccharides, along with polymeric α-fucoses. Treatment with the chitin synthase inhibitor nikkomycin removes the β-glucan-chitin/chitosan complex, leaving the other chitin and chitosan allomorphs untouched while simultaneously thickening and rigidifying the cell wall. These findings shed light on the organization of Mucorales cell walls and emphasize the necessity for a deeper understanding of the diverse families of chitin synthases and deacetylases as potential targets for novel antifungal therapies.
Collapse
Affiliation(s)
- Qinghui Cheng
- Department of Chemistry, Michigan State University, East Lansing, MI, USA
| | - Malitha C Dickwella Widanage
- Department of Chemistry, Michigan State University, East Lansing, MI, USA
- Renewable Resources and Enabling Sciences Center, National Renewable Energy Laboratory, Golden, CO, USA
| | | | - Ankur Ankur
- Department of Chemistry, Michigan State University, East Lansing, MI, USA
| | - Jean-Paul Latgé
- Institute of Molecular Biology and Biotechnology, University of Crete, Heraklion, Greece
| | - Ping Wang
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tuo Wang
- Department of Chemistry, Michigan State University, East Lansing, MI, USA.
| |
Collapse
|
14
|
Mittal S, Joshi MK, Jaiswal R, Parshad R. Pulmonary mucormycosis eroding the chest wall: challenges in the management. BMJ Case Rep 2024; 17:e259929. [PMID: 39122378 DOI: 10.1136/bcr-2024-259929] [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] [Indexed: 08/12/2024] Open
Abstract
Pulmonary mucormycosis is a rare, life-threatening fungal infection usually seen in immunocompromised patients. Mortality in such patients is high due to underlying immunosuppression and poor general condition of the patients. Invasion of the adjacent structures is known but, to the best of our knowledge, pulmonary mucormycosis presenting with a full thickness chest wall erosion has not been reported. We report such a case with chest wall destruction with superadded bacterial infection. The use of prosthetic materials for chest wall reconstruction was not possible due to the presence of infection. In addition, there were other intra-operative and post-operative challenges which we managed using a multidisciplinary approach. This report highlights the successful outcome of this complex situation using pre-operative optimisation, adequate surgical debridement and effective management of post-operative complications with patience and perseverance.
Collapse
Affiliation(s)
- Sonali Mittal
- Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mohit Kumar Joshi
- Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rahul Jaiswal
- Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rajinder Parshad
- Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| |
Collapse
|
15
|
Mills KAM, Aufiero MA, Hohl TM. Epithelial responses to fungal pathogens. Curr Opin Microbiol 2024; 80:102508. [PMID: 38986398 PMCID: PMC11331878 DOI: 10.1016/j.mib.2024.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024]
Abstract
Epithelial cells orchestrate immune responses against fungal pathogens. This review highlights advances in integrating epithelial cells in immune responses against inhaled molds and dimorphic fungi, and against Candida species that colonize mucosal surfaces. In the lung, epithelial cells respond to interleukin-1 (IL-1) and interferon signaling to regulate effector cell influx and fungal killing. In the alimentary and vulvovaginal tracts, epithelial cells modulate fungal commensalism, invasive growth, and local immune tone, in part by responding to damage caused by candidalysin, a C. albicans peptide toxin, and through IL-17-dependent release of antimicrobial peptides that contribute to Candida colonization resistance. Understanding fungal-epithelial interactions in mammalian models of disease is critical to predict vulnerabilities and to identify opportunities for immune-based strategies to treat fungal infections.
Collapse
Affiliation(s)
- Kathleen A M Mills
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Mariano A Aufiero
- Louis V. Gerstner Jr. Graduate School of Biomedical Sciences, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tobias M Hohl
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA; Louis V. Gerstner Jr. Graduate School of Biomedical Sciences, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
16
|
Martín-Cerezuela M, Maya Gallegos C, Marqués-Miñana MR, Broch Porcar MJ, Cruz-Sánchez A, Mateo-Pardo JC, Peris Ribera JE, Gimeno R, Castellanos-Ortega Á, Poveda Andrés JL, Ramírez Galleymore P. Isavuconazole Pharmacokinetics in Critically Ill Patients: Relationship with Clinical Effectiveness and Patient Safety. Antibiotics (Basel) 2024; 13:706. [PMID: 39200006 PMCID: PMC11350865 DOI: 10.3390/antibiotics13080706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
Isavuconazole is used to treat fungal infections. This study aims to describe isavuconazole pharmacokinetics in critically ill patients and evaluate their relationship with clinical efficacy and patient safety. We conducted a prospective, observational study in patients treated with intravenous isavuconazole. Samples were collected at predose (Cmin), 1 h (Cmax) and 12 h (C50) after the last dose. The plasma concentration was determined by high-performance liquid chromatography. The relationship between plasma concentration and clinical and microbiological outcomes and safety was evaluated. The influence of covariates (age, sex, weight, SAPS3, creatinine, liver enzymes and extracorporeal devices: continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO)) was analysed. Population pharmacokinetic modelling was performed using NONMEN®. A total of 71 isavuconazole samples from 24 patients were analysed. The mean Cmin was 1.76 (1.02) mg/L; 87.5% reached the optimal therapeutic target and 12.5% were below 1 mg/L. Population pharmacokinetics were best described by a one-compartment model with first-order elimination. No factor had a significant impact on the plasma concentration or pharmacokinetic parameters. Thus, isavuconazole could be safely used in a critically ill population, even in those treated with CRRT and ECMO, from a pharmacokinetic standpoint. Therefore, routine therapeutic drug monitoring may not be strictly necessary in daily clinical practice.
Collapse
Affiliation(s)
- María Martín-Cerezuela
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - Cristina Maya Gallegos
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - María Remedios Marqués-Miñana
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - María Jesús Broch Porcar
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - Andrés Cruz-Sánchez
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - Juan Carlos Mateo-Pardo
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | | | - Ricardo Gimeno
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - Álvaro Castellanos-Ortega
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| | - José Luis Poveda Andrés
- Pharmacy Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (M.M.-C.); (M.R.M.-M.); (A.C.-S.); (J.L.P.A.)
| | - Paula Ramírez Galleymore
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain; (C.M.G.); (M.J.B.P.); (J.C.M.-P.); (R.G.); (Á.C.-O.)
| |
Collapse
|
17
|
Lin L, Zhang H. Treatment of pediatric invasive mucor lung abscess using local fenestration and drainage surgery: A case report. Asian J Surg 2024; 47:2831-2832. [PMID: 38378415 DOI: 10.1016/j.asjsur.2024.02.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Liangkang Lin
- Department of Pediatrics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Haiyang Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
18
|
Chamilos G, Garre V. Editorial: Advancements in the understanding of Mucorales biology and the management of mucormycosis. Front Cell Infect Microbiol 2024; 14:1427252. [PMID: 38836052 PMCID: PMC11148426 DOI: 10.3389/fcimb.2024.1427252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Georgios Chamilos
- Laboratory of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, Crete, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology, Heraklion, Crete, Greece
| | - Victoriano Garre
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| |
Collapse
|
19
|
Tanwar M, Singh A, Singh TP, Sharma S, Sharma P. Comprehensive Review on the Virulence Factors and Therapeutic Strategies with the Aid of Artificial Intelligence against Mucormycosis. ACS Infect Dis 2024; 10:1431-1457. [PMID: 38682683 DOI: 10.1021/acsinfecdis.4c00082] [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] [Indexed: 05/01/2024]
Abstract
Mucormycosis, a rare but deadly fungal infection, was an epidemic during the COVID-19 pandemic. The rise in cases (COVID-19-associated mucormycosis, CAM) is attributed to excessive steroid and antibiotic use, poor hospital hygiene, and crowded settings. Major contributing factors include diabetes and weakened immune systems. The main manifesting forms of CAM─cutaneous, pulmonary, and the deadliest, rhinocerebral─and disseminated infections elevated mortality rates to 85%. Recent focus lies on small-molecule inhibitors due to their advantages over standard treatments like surgery and liposomal amphotericin B (which carry several long-term adverse effects), offering potential central nervous system penetration, diverse targets, and simpler dosing owing to their small size, rendering the ability to traverse the blood-brain barrier via passive diffusion facilitated by the phospholipid membrane. Adaptation and versatility in mucormycosis are facilitated by a multitude of virulence factors, enabling the pathogen to dynamically respond to various environmental stressors. A comprehensive understanding of these virulence mechanisms is imperative for devising effective therapeutic interventions against this highly opportunistic pathogen that thrives in immunocompromised individuals through its angio-invasive nature. Hence, this Review delineates the principal virulence factors of mucormycosis, the mechanisms it employs to persist in challenging host environments, and the current progress in developing small-molecule inhibitors against them.
Collapse
Affiliation(s)
- Mansi Tanwar
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Anamika Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Tej Pal Singh
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Sujata Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Pradeep Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi-110029, India
| |
Collapse
|
20
|
Fitero A, Negrut N, John HT, Ferician A, Marian P. Corona-Associated Mucormycosis: Case Series Reports and Review of the Literature. J Fungi (Basel) 2024; 10:305. [PMID: 38786660 PMCID: PMC11122562 DOI: 10.3390/jof10050305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
During the COVID-19 pandemic, a significant increase in cases of mucormycosis was observed in COVID-19 patients, especially in India, but not exclusively. The presented cases highlight the heterogeneous nature of mucormycosis, emphasizing the importance of recognizing predisposing factors, such as immunosuppression, due to comorbidities or medication. Diagnosing mucormycosis poses a challenge due to nonspecific clinical manifestations, requiring a multidisciplinary approach for accurate diagnosis. Treatment involves a multi-pronged approach centered around the early initiation of antifungal therapy alongside surgical intervention and the management of underlying conditions, with an emphasis on controlling immunosuppression. Understanding the relationship between COVID-19 and predisposing factors for mucormycosis is fundamental for developing prevention and treatment strategies.
Collapse
Affiliation(s)
- Andreea Fitero
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Nicoleta Negrut
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Harrie Toms John
- Department of Ear, Nose and Throat, University Hospitals of Northamptonshire, Cliftonville, Northampton NN1 5BD, UK;
| | - Anca Ferician
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.F.); (P.M.)
| | - Paula Marian
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.F.); (P.M.)
| |
Collapse
|
21
|
Muruganantham JK, Veerabathiran R. Genetic Basis for Mucormycosis Progression in COVID-19 Patients: From Susceptibility to Severity. INFECTIOUS DISEASES & IMMUNITY 2024. [DOI: 10.1097/id9.0000000000000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
Abstract
The dynamics of COVID-19 and mucormycosis reveal a complex interplay of genetic factors that influence the susceptibility, severity, and immune responses. COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), exhibits an increased incidence of mucormycosis, particularly in individuals with comorbidities or corticosteroid therapy. Mucormycosis is a fungal infection that affects the sinuses, orbits, and lungs and demands timely intervention with antifungal medications and surgery because of its life-threatening nature. Research on the genetic underpinnings of this intersection has unveiled key insights into the pathogenicity of Mucorales. Breakthroughs in genetic tools have exposed virulence factors, such as the CotH protein family and high-affinity iron-uptake mechanisms. Genetic susceptibility is a pivotal element in identifying individuals at risk of developing COVID-19, facilitating early detection, and allowing for personalized treatment strategies. DPP9, MIF, and TYK2 are among the genes implicated in COVID-19 severity, emphasizing the intricate relationship between genetic makeup and viral response. The genetic landscape extends to viral entry mechanisms, thereby affecting infection efficiency. Specific polymorphisms in genes such as IFNAR2, OAS3, and TYK2 are associated with COVID-19 severity, indicating shared genetic bases between severe and hospitalized cases. Mucormycosis is genetically predisposed, particularly in immunocompromised individuals. The challenge lies in understanding the genetic factors influencing susceptibility and offering insights into pathogenesis and potential therapeutic avenues. Organ transplantation adds another layer, increasing susceptibility to infections such as COVID-19 and mucormycosis. The impact of immunosuppression on COVID-19 severity remains elusive, necessitating ongoing research on the immunological mechanisms. Despite the challenges posed by emerging SARS-CoV-2 variants, the intricate connection between genetic factors and the interplay of COVID-19 and mucormycosis presents an opportunity for personalized treatment, targeted interventions, and refined public health strategies.
Collapse
|
22
|
Garcia-Bustos V, Acosta-Hernández B, Cabañero-Navalón MD, Ruiz-Gaitán AC, Pemán J, Rosario Medina I. Potential Fungal Zoonotic Pathogens in Cetaceans: An Emerging Concern. Microorganisms 2024; 12:554. [PMID: 38543604 PMCID: PMC10972490 DOI: 10.3390/microorganisms12030554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 11/12/2024] Open
Abstract
Over 60% of emerging infectious diseases in humans are zoonotic, often originating from wild animals. This long-standing ecological phenomenon has accelerated due to human-induced environmental changes. Recent data show a significant increase in fungal infections, with 6.5 million cases annually leading to 3.7 million deaths, indicating their growing impact on global health. Despite the vast diversity of fungal species, only a few are known to infect humans and marine mammals. Fungal zoonoses, especially those involving marine mammals like cetaceans, are of global public health concern. Increased human-cetacean interactions, in both professional and recreational settings, pose risks for zoonotic disease transmission. This review focuses on the epidemiology, clinical manifestations, and zoonotic potential of major fungal pathogens shared in humans and cetaceans, highlighting their interspecies transmission capability and the challenges posed by antifungal resistance and environmental changes. It underscores the need for enhanced awareness and preventative measures in high-risk settings to protect public health and marine ecosystems.
Collapse
Affiliation(s)
- Victor Garcia-Bustos
- University Institute of Animal Health and Food Security (ULPGC-IUSA), University of Las Palmas de Gran Canaria, 35416 Arucas, Spain;
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.D.C.-N.); (A.C.R.-G.); (J.P.)
| | - Begoña Acosta-Hernández
- University Institute of Animal Health and Food Security (ULPGC-IUSA), University of Las Palmas de Gran Canaria, 35416 Arucas, Spain;
| | - Marta Dafne Cabañero-Navalón
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.D.C.-N.); (A.C.R.-G.); (J.P.)
| | - Alba Cecilia Ruiz-Gaitán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.D.C.-N.); (A.C.R.-G.); (J.P.)
| | - Javier Pemán
- Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain; (M.D.C.-N.); (A.C.R.-G.); (J.P.)
| | - Inmaculada Rosario Medina
- University Institute of Animal Health and Food Security (ULPGC-IUSA), University of Las Palmas de Gran Canaria, 35416 Arucas, Spain;
| |
Collapse
|
23
|
Ben-Ami R. Experimental Models to Study the Pathogenesis and Treatment of Mucormycosis. J Fungi (Basel) 2024; 10:85. [PMID: 38276032 PMCID: PMC10820959 DOI: 10.3390/jof10010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 01/27/2024] Open
Abstract
Mucormycosis presents a formidable challenge to clinicians and researchers. Animal models are an essential part of the effort to decipher the pathogenesis of mucormycosis and to develop novel pharmacotherapeutics against it. Diverse model systems have been established, using a range of animal hosts, immune and metabolic perturbations, and infection routes. An understanding of the characteristics, strengths, and drawbacks of these models is needed to optimize their use for specific research aims.
Collapse
Affiliation(s)
- Ronen Ben-Ami
- Department of Infectious Diseases, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| |
Collapse
|
24
|
Egge SL, Wurster S, Cho SY, Jiang Y, Axell-House DB, Miller WR, Kontoyiannis DP. Co-Occurrence of Gram-Negative Rods in Patients with Hematologic Malignancy and Sinopulmonary Mucormycosis. J Fungi (Basel) 2024; 10:41. [PMID: 38248950 PMCID: PMC10820027 DOI: 10.3390/jof10010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Both Mucorales and Gram-negative rods (GNRs) commonly infect patients with hematological malignancies (HM); however, their co-occurrence is understudied. Therefore, we retrospectively reviewed the records of 63 patients with HM and proven or probable sinopulmonary mucormycosis at MD Anderson Cancer Center (Houston, Texas) from 2000-2020. Seventeen out of sixty-three reviewed patients (27.0%) had sinopulmonary co-occurrence of GNRs (most commonly Pseudomonas aeruginosa and Stenotrophomonas maltophilia) within 30 days of a positive Mucorales culture or histology demonstrating Mucorales species. Eight of seventeen co-isolations of Mucorales and GNRs were found in same-day samples. All 15 patients with GNR co-occurrence and reported antimicrobial data had received anti-Pseudomonal agents within 14 days prior to diagnosis of mucormycosis and 5/15 (33.3%) had received anti-Stenotrophomonal agents. Demographic and clinical characteristics of patients with and without GNR co-occurrence were comparable. Forty-two-day all-cause mortality was high (34.9%) and comparable in patients with (41.2%) and without (32.6%) GNR detection (p = 0.53). In summary, over a quarter of heavily immunosuppressed patients with sinopulmonary mucormycosis harbored GNRs in their respiratory tract. Although no impact on survival outcomes was seen in a background of high mortality in our relatively underpowered study, pathogenesis studies are needed to understand the mutualistic interplay of GNR and Mucorales and their influence on host responses.
Collapse
Affiliation(s)
- Stephanie L. Egge
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX 77030, USA
- Division of Infectious Diseases, Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Sung-Yeon Cho
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
- Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Catholic Hematology Hospital, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Dierdre B. Axell-House
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX 77030, USA
- Division of Infectious Diseases, Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - William R. Miller
- Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX 77030, USA
- Division of Infectious Diseases, Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
25
|
Deenadayalan N, Pandyan PDA, Satheesh C, Aparnaa M, Samyo GS. Unravelling the Complexity of Mucormycosis-A Rare Case Report. Ann Maxillofac Surg 2024; 14:96-98. [PMID: 39184405 PMCID: PMC11340844 DOI: 10.4103/ams.ams_204_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 08/27/2024] Open
Abstract
Rationale Mucormycosis is a rare, life-threatening, invasive fungal infection often referred to as black fungus. It has gained significant attention due to its increasing incidence during the coronavirus pandemic of 2019. Patient Concern An 8-month-old child, whose identity is being withheld, arrived at our clinic with her parents with the chief complaint of swelling in the upper lip and cheek. Diagnosis Various laboratory procedures, including blood cultures and imaging scans were performed to determine the presence of mucormycosis. Treatment Under general anaesthesia, decortication and resection was done surgically, followed by an intraoral elastomeric impression made over the resected region. Soft silicone splints as oral seals for the suckling reflex were made postoperatively within a week. Immediate post-operative therapeutic low-level laser therapy was done. Outcome Wound healing has been achieved. Take-away Lessons Multidisciplinary intervention provides the best outcomes for the successful treatment and rehabilitation of paediatric patients with mucormycosis of the facial region.
Collapse
Affiliation(s)
- N. Deenadayalan
- Department of Oral and Maxillofacial Surgery, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - P. Deepak Abraham Pandyan
- Department of Oral and Maxillofacial Surgery, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - C Satheesh
- Department of Oral and Maxillofacial Surgery, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - M. Aparnaa
- Department of Oral and Maxillofacial Surgery, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - George Stephenson Samyo
- Department of Oral and Maxillofacial Surgery, Madha Dental College and Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
26
|
Dailey Garnes NJM, Kontoyiannis DP. Mucormycosis: update on clinical presentation, diagnosis, and treatment. Curr Opin Infect Dis 2023; 36:427-435. [PMID: 37732771 DOI: 10.1097/qco.0000000000000976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Mucormycosis (MCR) is a common opportunistic mold infection, and Mucorales were recently designated by WHO as priority pathogens. The interest in this infection has risen significantly since the major outbreak of MCR in the context of the COVID-19 pandemic, particularly in India. Herein, we summarize recently (last 24 months) published information regarding clinical aspects of MCR. RECENT FINDINGS The disease remains protean in its clinical presentation, difficult to diagnose, and challenging to treat. In 2021, cases of COVID-19-associated mucormycosis (CAM) exploded in India during COVID-19 and manifested primarily as sino-orbital or sino-cerebral disease. Its classic risk factors included the triad of COVID-19, uncontrolled diabetes mellitus and use of corticosteroids. Despite difficulties in the timely diagnosis of MCR, significant progress has been made with the use of molecular techniques in blood to assist with earlier diagnosis, which can facilitate earlier appropriate therapy and improve outcomes. In addition, advances have been made in the use of imaging to stage the disease, determining what types of multimodal therapy are required depending on staging, and tissue-based identification of Mucorales. SUMMARY Although the outlook for MCR has improved, effective new antifungals, risk stratification, and the optimal multimodality approaches remain an unmet need.
Collapse
Affiliation(s)
- Natalie J M Dailey Garnes
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | |
Collapse
|