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Lamoth F, Prakash K, Beigelman-Aubry C, Baddley JW. Lung and sinus fungal infection imaging in immunocompromised patients. Clin Microbiol Infect 2024; 30:296-305. [PMID: 37604274 DOI: 10.1016/j.cmi.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Imaging is a key diagnostic modality for suspected invasive pulmonary or sinus fungal disease and may help to direct testing and treatment. Fungal diagnostic guidelines have been developed and emphasize the role of imaging in this setting. We review and summarize evidence regarding imaging for fungal pulmonary and sinus disease (in particular invasive aspergillosis, mucormycosis and pneumocystosis) in immunocompromised patients. OBJECTIVES We reviewed data on imaging modalities and findings used for diagnosis of invasive fungal pulmonary and sinus disease. SOURCES References for this review were identified by searches of PubMed, Google Scholar, Embase and Web of Science through 1 April 1 2023. CONTENT Computed tomography imaging is the method of choice for the evaluation of suspected lung or sinus fungal disease. Although no computed tomography radiologic pattern is pathognomonic of pulmonary invasive fungal disease (IFD) the halo sign firstly suggests an angio-invasive pulmonary aspergillosis while the Reversed Halo Sign is more suggestive of pulmonary mucormycosis in an appropriate clinical setting. The air crescent sign is uncommon, occurring in the later stages of invasive aspergillosis in neutropenic patients. In contrast, new cavitary lesions should suggest IFD in moderately immunocompromised patients. Regarding sinus site, bony erosion, peri-antral fat or septal ulceration are reasonably predictive of IFD. IMPLICATIONS Imaging assessment of the lung and sinuses is an important component of the diagnostic work-up and management of IFD in immunocompromised patients. However, radiological features signs have sensitivity and specificity that often vary according to underlying disease states. Periodic review of imaging studies and diagnostic guidelines characterizing imaging findings may help clinicians to consider fungal infections in clinical care thereby leading to an earlier confirmation and treatment of IFD.
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Affiliation(s)
- Frederic Lamoth
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratory Medicine and Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katya Prakash
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Catherine Beigelman-Aubry
- Radiodiagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John W Baddley
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
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Robin C, Cordonnier C, Tridello G, Knelange N, Xhaard A, Chantepie S, Tanguy-Schmidt A, Schouten HC, Yeshurun M, Rocha V, Srour M, Kröger N, Ledoux MP, Dalgaard J, Thiebaut A, Giardino S, Calore E, Zuckerman T, Groll AH, Raida L, Avcin S, Vicent MG, Kaare A, Drozd-Sokolowska J, Turlure P, Bretagne S, Mikulska M, Camara RDL, Cesaro S, Styczynski J. Pneumocystis Pneumonia After Allogeneic Hematopoietic Cell Transplantation: A Case-Control Study on Epidemiology and Risk Factors on Behalf of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:235.e1-235.e10. [PMID: 38007092 DOI: 10.1016/j.jtct.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
Pneumocystis pneumonia (PCP) is a life-threatening complication after allogeneic hematopoietic cell transplantation (allo-HCT). However, allo-HCT procedures have evolved toward older patients, unrelated donors, and reduced-intensity conditioning, possibly modifying the risks. Polymerase chain reaction (PCR), widely used nowadays, is more sensitive than microscopy diagnostic methods. This study aimed to assess the factors associated with PCP in allo-HCT recipients within 2 years of HCT and managed according to current procedures. This multicenter, nested case-control study included PCP cases diagnosed by PCR, cytology, or immunofluorescence on bronchoalveolar lavage fluid between 2016 and 2018. Two controls per case were selected from the ProMISe registry and matched for the center, transplant date, and underlying disease. Fifty-two cases and 104 controls were included among the 5452 patients who underwent allo-HCT in the participating centers. PCP occurred at a median of 11.5 months after transplantation. The mortality rate was 24% on day 30 after the PCP diagnosis and 37% on day 90. The clinical presentation and mortality rates of the 24 patients diagnosed using only PCR were not different from those diagnosed with microscopy methods. Our study demonstrates a substantial incidence of, and mortality from, PCP, after allogeneic HCT despite well-established prophylactic approaches. In our experience, PCP nowadays occurs later after transplant than previously reported, justifying the prolongation of prophylaxis after six months in many cases. Allo-HCT recipients diagnosed with PCR as the only PCP marker should benefit from specific treatment as for other patients.
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Affiliation(s)
- Christine Robin
- Department of Haematology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France.
| | - Catherine Cordonnier
- Department of Haematology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
| | - Gloria Tridello
- Department of Mother and Child, Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Alienor Xhaard
- Haematology Transplant Unit, APHP, Saint-Louis Hospital, Paris, France
| | - Sylvain Chantepie
- Basse-Normandie Haematology Institute, Caen University Hospital, Caen, France
| | - Aline Tanguy-Schmidt
- Blood Diseases Department, France Federation University Hospital "Grand Ouest against Leukemia", Angers France; CRCI2NA, Angers, France
| | | | - Moshe Yeshurun
- Institute of Hematology, Rabin Medical Center, Petach Tikva, Israel
| | - Vanderson Rocha
- Hematology Bone Marrow Transplant Unit, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Micha Srour
- Department of Haematology, Lille University Hospital, Lille, France
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Marie-Pierre Ledoux
- Department of Haematology, Cancer Institute of Strasburg, Strasbourg, France
| | - Jakob Dalgaard
- Department of Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Thiebaut
- Department of Haematology, Grenoble Alpes University Hospital, Grenoble, France
| | - Stefano Giardino
- Haematopoietic Stem Cell Transplantation Unit IRCCS Istituto Giannina Gaslini, Pediatric Haematology and Oncology, Genova, Italy
| | - Elisabetta Calore
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Tsila Zuckerman
- Department of Haematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Pediatric Haematology/Oncology, University Children's Hospital, Infectious Disease Research Program, Munster, Germany
| | - Ludek Raida
- Department of Haemato-Oncology, Olomouc University Hospital, Olomouc, Czech Republic
| | | | | | - Ain Kaare
- Clinic of Haematology and Oncology, Tartu University Hospital, Tartu, Estonia
| | - Joanna Drozd-Sokolowska
- Department of Haematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Pascal Turlure
- Department of Haematology, Limoges University Hospital, Limoges, France
| | | | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL), Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rafael de la Camara
- Department of Haematology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Simone Cesaro
- Department of Mother and Child, Pediatric Haematology Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Jan Styczynski
- Pediatric Haematology and Oncology, University Hospital, Collegium Medicum UMK, Bydgoszcz, Poland
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Price JS, Fallon M, Posso R, Backx M, White PL. An Evaluation of the OLM PneumID Real-Time Polymerase Chain Reaction to Aid in the Diagnosis of Pneumocystis Pneumonia. J Fungi (Basel) 2023; 9:1106. [PMID: 37998911 PMCID: PMC10672265 DOI: 10.3390/jof9111106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The use of the PCR to aid in the diagnosis of Pneumocystis pneumonia (PcP) has demonstrated excellent clinical performance, as evidenced through various systematic reviews and meta-analyses, yet there are concerns over the interpretation of positive results due to the potential presence of Pneumocystis colonization of the airways. While this can be overcome by applying designated positivity thresholds to PCR testing, the shear number of assays described limits the development of a universal threshold. Commercial assays provide the opportunity to overcome this problem, provided satisfactory performance is determined through large-scale, multi-centre evaluations. METHODS Retrospective case/control and consecutive cohort performance evaluations of the OLM PneumID real-time PCR assay were performed on DNA eluates from a range of samples sent from patients where "in-house" PCR had been performed as part of routine diagnostic testing. The clinical performance of the PneumID assay was determined before including it in a diagnostic algorithm to provide the probability of PcP (dependent on diagnostic evidence). RESULTS After being used to test 317 patients (32 with PcP), the overall performance of the PneumID assay was found to be excellent (Sensitivity/Specificity: 96.9%/95.1%). False positivity could be removed by applying a threshold specific to sample type (<33.1 cycles for BAL fluid; <37.0 cycles for throat swabs), whereas considering any positive respiratory samples as significant generated 100% sensitivity, making absolute negativity sufficient to exclude PcP. Incorporating the PneumID assay into diagnostic algorithms alongside (1-3)-β-D-Glucan testing provided high probabilities of PcP (up to 85.2%) when both were positive and very low probabilities (<1%) when both were negative. CONCLUSIONS The OLM PneumID qPCR provides a commercial option for the accurate diagnosis of PcP, generating excellent sensitivity and specificity, particularly when testing respiratory specimens. The combination of PcP PCR with serum (1-3)-β-D-Glucan provides excellent clinical utility for diagnosing PcP.
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Affiliation(s)
| | | | | | | | - P. Lewis White
- Public Health Wales Mycology Reference Laboratory, PHW Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK; (J.S.P.); (M.F.); (R.P.); (M.B.)
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4
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Varas Vicente P, Parra Fariñas R, Alonso-Sardón M, Benéitez Andrés E, Rodriguez Alonso B, Romero-Alegría Á, Almeida H, Muro A, Pardo-Lledias J, Belhassen-García M. Impact of pneumocystosis on the Spanish health care system, 1997-2020: Profile of HIV and non-HIV immunocompromised patients. J Infect Public Health 2023; 16:831-840. [PMID: 37030036 DOI: 10.1016/j.jiph.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Pneumocystis jirovecii is an opportunistic fungus recognized for causing P. jirovecii pneumonia. The global prevalence is thought to be higher than 400,000 annual cases, although detailed information about epidemiological patterns is scarce. METHODOLOGY A retrospective longitudinal descriptive study was performed among patients with diagnosis of pneumocystosis according to Classification of Diseases 9th edition, Clinical Modification (code 136.3 for the cases from 1997 to 2015; and 10th edition code B59.0 for cases from 2016 to 2020 in Spanish public hospitals from 1 January 1997-31 December 2020. RESULTS A total of 25289 cases were diagnosed. The period incidence rate was 2.36 (95 % CI, 2.33-2.39) cases per 100,000 person-years. Infection was more frequent among men (72.2 %) than among women (27.8 %). Comorbidity was the main characteristic of this cohort. Up to 72.3 % of pneumocystis-infected patients (18293) had HIV coinfection. During the study period, there was a progressive decrease in the number of HIV coinfected cases as the group of patients without HIV infection increased, with the largest group in 2017. The lethality rate in the cohort was 16.7 %. The global cost was €229,234,805 and the average ( ± SD) cost per patient was €9065 ( ± 9315). CONCLUSIONS The epidemiology of pneumocystosis in Spain has changed in the last two decades. We noted in our study the possibility of a reemergence among non-HIV immunocompromised patients as patients with hematological and nonhematological neoplasia and other risk groups. The lethality of pneumocystosis continues to be high, and the underlying diseases are the main variable associated with lethality.
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Affiliation(s)
| | - Raúl Parra Fariñas
- Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Universidad de Cantabria, Spain
| | - Montserrat Alonso-Sardón
- Área de Medicina Preventiva, Epidemiología y Salud Pública, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain
| | | | | | - Ángela Romero-Alegría
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Salamanca, Spain
| | - Hugo Almeida
- Servicio de Medicina Interna, CAUSA, IBSAL, CIETUS, Salamanca, Spain
| | - Antonio Muro
- Infectious and Tropical Diseases Group (e-INTRO), IBSAL-CIETUS, Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Javier Pardo-Lledias
- Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Universidad de Cantabria, IDIVAL (Instituto de Investigación Valdecilla), Santander, Spain
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain.
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5
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Mouren D, Goyard C, Catherinot E, Givel C, Chabrol A, Tcherakian C, Longchampt E, Vargaftig J, Farfour E, Legal A, Couderc LJ, Salvator H. COVID-19 and Pneumocystis jirovecii pneumonia: Back to the basics. Respir Med Res 2021; 79:100814. [PMID: 33610911 PMCID: PMC7863763 DOI: 10.1016/j.resmer.2021.100814] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 01/15/2023]
MESH Headings
- Aged
- COVID-19/complications
- COVID-19/diagnosis
- COVID-19/diagnostic imaging
- COVID-19 Nucleic Acid Testing
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Pneumocystis carinii
- Pneumonia, Pneumocystis/complications
- Pneumonia, Pneumocystis/diagnostic imaging
- Pneumonia, Pneumocystis/prevention & control
- Radiography, Thoracic
- Tomography, X-Ray Computed
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Affiliation(s)
- D Mouren
- Hôpital Foch, service de pneumologie, Suresnes, France; Hôpital Bichat, service de pneumologie B et transplantation pulmonaire, Paris, France.
| | - C Goyard
- Hôpital Foch, service de pneumologie, Suresnes, France
| | - E Catherinot
- Hôpital Foch, service de pneumologie, Suresnes, France
| | - C Givel
- Hôpital Foch, service de pneumologie, Suresnes, France; Faculté des sciences de la vie Simone-Veil, université Paris-Saclay, Kremlin-Bicêtre, France
| | - A Chabrol
- Hôpital Foch, service de pneumologie, Suresnes, France
| | - C Tcherakian
- Hôpital Foch, service de pneumologie, Suresnes, France
| | - E Longchampt
- Hôpital Foch, service d'anatomie pathologique, Suresnes, France
| | - J Vargaftig
- Hôpital René-Huguenin, département d'hématologie clinique, Saint-Cloud, France
| | - E Farfour
- Hôpital Foch, service de microbiologie, Suresnes, France
| | - A Legal
- Hôpital Foch, service de pneumologie, Suresnes, France
| | - L-J Couderc
- Hôpital Foch, service de pneumologie, Suresnes, France; Faculté des sciences de la vie Simone-Veil, université Paris-Saclay, Kremlin-Bicêtre, France; UPRES EA 220, université Paris-Saclay, Kremlin-Bicêtre, France
| | - H Salvator
- Hôpital Foch, service de pneumologie, Suresnes, France; UPRES EA 220, université Paris-Saclay, Kremlin-Bicêtre, France
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Cristante J, Lepelley M, Mallaret M, Carreau A, Chabre O. Pneumocystis pneumonia can complicate medical treatment of hypercortisolism even in outpatients with Cushing's disease. Ann Endocrinol (Paris) 2020; 81:551-560. [PMID: 33278378 DOI: 10.1016/j.ando.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022]
Abstract
Several cases of Pneumocystosis pneumonia (PCP) have been reported in patients with hypercortisolism, mainly in patients with severe ectopic ACTH syndrome (EAS). We report 2 cases of PCP that did not develop until after starting treatment with metyrapone, one of which occurred in an outpatient with Cushing's disease (CD) without pulmonary symptoms before medical treatment for CD. Patient 1 presented as an outpatient with CD and severe hypercortisolism but nonetheless in good general condition. Treatment with metyrapone was started before pituitary surgery. Patient 2 had EAS due to prostate cancer. Respiratory failure in the two patients occurred 4 days and 30 days, respectively, after the start of metyrapone treatment. In both cases, chest CT showed bilateral interstitial infiltrates, and Pneumocystis jirovecii was found on bronchoalveolar lavage (BAL). A literature review was performed to identify risk factors for PCP in patients with CD: we identified 20 other cases of PCP in patients treated for hypercortisolism, including 16 patients with EAS. Ninety percent of patients had free urinary cortisol greater than 6 times the upper limit of normal (ULN). In conclusion, onset of PCP after initiation of anticortisolic therapy is not limited to patients with EAS, and may occur in CD patients with elevated cortisol levels, even if the patient remains in good general condition and has no pulmonary symptoms before treatment. In such patients, routine prophylactic treatment with trimethoprim/sulfamethoxazole (TMP/SMX) should be considered.
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Affiliation(s)
- Justine Cristante
- Endocrinology Unit, University Hospital Centre Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
| | - Marion Lepelley
- Pharmacovigilance Unit, University Hospital Centre Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
| | - Michel Mallaret
- Pharmacovigilance Unit, University Hospital Centre Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
| | - Agnès Carreau
- Endocrinology Unit, Annecy Genevois Hospital Centre, 1, avenue de l'Hôpital, Epagny Metz-Tessy, BP 90074, 74374 Pringy Cedex, France.
| | - Olivier Chabre
- Endocrinology Unit, University Hospital Centre Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
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Seiller H, Schmutz JL, Poreaux C, Bursztejn AC. [Fatal interstitial lung disease and pneumocystis during dermatomyositis associated with anti-MDA5 antibodies]. Ann Dermatol Venereol 2020; 147:862-867. [PMID: 33131899 DOI: 10.1016/j.annder.2020.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/24/2020] [Accepted: 08/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dermatomyositis (DM) in an auto-immune inflammatory myopathy with skin lesions, and, occasionally, organ involvement. Herein, we report a case of DM during anti-MDA5 antibody therapy associated with interstitial lung disease (ILD) and pneumocystosis. PATIENTS AND METHODS A 64-year-old woman was hospitalized for impairment of her general health and skin lesions. Dermatological examination revealed classic signs of DM associated with hyperkeratotic papules on the palm creases. This led us to suspect DM with anti-MDA5 antibodies, which was subsequently confirmed by immunologic tests. We also noted dysphonia, exertional dyspnea and proximal muscles weakness. Despite early corticosteroid therapy, combined later with azathioprine, the patient's dyspnoea worsened; one month later, sudden pulmonary decompensation resulted in her admission to intensive care. A chest scan showed evidence of ILD and infectious signs, and the bronchoalveolar lavage was positive for Pneumocystisjiroveci. Despite treatment of this opportunist infection with cotrimoxazole and intensified immunosuppression, the patient died in intensive care. DISCUSSION Anti-MDA5 antibodies are associated with a specific clinical phenotype and a high degree of risk that should alert the dermatologist to the high likelihood of ILD having a poor prognosis. Associated clinical signs are erythematous, hyperkeratotic or ulcerated papules on the palm creases, as well as fingertip or periungual ulcerations or digital necrosis. This situation is associated with a high risk of pneumocystosis. However, no recommendations concerning prophylaxis are currently available.
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Affiliation(s)
- H Seiller
- Département de dermato-allergologie, CHRU de Nancy, 6, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - J-L Schmutz
- Département de dermato-allergologie, CHRU de Nancy, 6, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - C Poreaux
- Département de dermato-allergologie, CHRU de Nancy, 6, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France
| | - A-C Bursztejn
- Département de dermato-allergologie, CHRU de Nancy, 6, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France.
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Pemán J, Ruiz-Gaitán A, García-Vidal C, Salavert M, Ramírez P, Puchades F, García-Hita M, Alastruey-Izquierdo A, Quindós G. Fungal co-infection in COVID-19 patients: Should we be concerned? Rev Iberoam Micol 2020; 37:41-46. [PMID: 33041191 PMCID: PMC7489924 DOI: 10.1016/j.riam.2020.07.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy.
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Affiliation(s)
- Javier Pemán
- Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | | | | | - Miguel Salavert
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Unidad de Enfermedades Infecciosas, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Paula Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Francesc Puchades
- Servicio de Medicina Interna, Consorci Hospital General Universitari, Valencia, Spain
| | - Marta García-Hita
- Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Alastruey-Izquierdo
- Laboratorio de Referencia e Investigación en Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Guillermo Quindós
- Departamento de Inmunología, Microbiología y Parasitología, Facultad de medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Spain
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9
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Szvalb AD, Malek AE, Jiang Y, Bhatti MM, Wurster S, Kontoyiannis DP. Serum (1,3)-Beta-d-Glucan has suboptimal performance for the diagnosis of Pneumocystis jirovecii pneumonia in cancer patients and correlates poorly with respiratory burden as measured by quantitative PCR. J Infect 2020; 81:443-451. [PMID: 32650108 DOI: 10.1016/j.jinf.2020.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Non-HIV immunocompromised patients with Pneumocystis jirovecii pneumonia (PCP) have lower fungal load than those with AIDS, potentially affecting the accuracy of diagnostic biomarkers. Therefore, we investigated the performance of serum (1,3)-Beta-d-Glucan (BDG) in conjunction with quantitative Pneumocystis jirovecii PCR (qPCR) in non-HIV cancer patients. METHODS We reviewed records of non-HIV cancer patients and classified them as definite, probable, or possible PCP cases, according to clinicoradiological features, microscopy findings, and qPCR results in bronchoscopy specimens. We evaluated the diagnostic performance of serum BDG and its correlation with qPCR results. RESULTS We identified 101 PCP patients (73 definite/probable, 28 possible) and 74 controls. Correlation of BDG and qPCR was low among all 101 qPCR-positive patients (Spearman's = 0.38) and in definite/probable PCP cases (Spearman's = 0.18). Considering all qPCR-positive patients, BDG showed consistently low sensitivity at different cutoffs. Among definite/probable cases, the diagnostic accuracy of BDG remained poor, yet slightly improved with high qPCR thresholds (AUC = 0.86 at ≥2000 DNA copies/mL). BDG had a low PPV but excellent NPV across different qPCR and BDG cutoffs. CONCLUSIONS BDG and qPCR levels correlate poorly in non-HIV cancer patients with PCP. BDG diagnostic performance is suboptimal but a negative test may be useful to rule out PCP in this population.
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Affiliation(s)
- Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Alexandre E Malek
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Micah M Bhatti
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Tomás AL, Cardoso F, de Sousa B, Matos O. Detection of anti-Pneumocystis jirovecii antibodies in human serum using a recombinant synthetic multi-epitope kexin-based antigen. Eur J Clin Microbiol Infect Dis 2020; 39:2205-9. [PMID: 32557324 DOI: 10.1007/s10096-020-03936-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
Abstract
Interest in the detection of specific anti-Pneumocystis jirovecii antibodies has emerged as less-invasive alternative diagnostic approaches. Here is presented the performance of an ELISA based on a recombinant synthetic multi-epitope kexin 1 (Kex1) antigen of P. jirovecii, previously developed. Results showed that IgM anti-Kex1 levels were found significantly increased in patients with Pneumocystis pneumonia (PcP) compared with non-PcP cases (p < 0.001), allowing a diagnostic performance of PcP with a 70.8% sensitivity and a 75.0% specificity. These results suggest that this Kex1-based ELISA is a promising tool toward the serodiagnosis of PcP when the standard methods are difficult to perform.
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Guillaume Z, Medioni J, Lillo-Lelouet A, Marret G, Oudard S, Simonaggio A. Severe Cellular Immunodeficiency Triggered by the CDK4/6 Inhibitor Palbociclib. Clin Breast Cancer 2020; 20:e192-e195. [PMID: 32088132 PMCID: PMC7102668 DOI: 10.1016/j.clbc.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/17/2019] [Accepted: 01/21/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Zoé Guillaume
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - Jacques Medioni
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France; University Paris Descartes Paris 5, Sorbonne Paris Cite, Paris, France
| | - Agnes Lillo-Lelouet
- Pharmacovigilance Department, Hôpital Européen Georges Pompidou, Paris, France
| | - Grégoire Marret
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France; University Paris Descartes Paris 5, Sorbonne Paris Cite, Paris, France
| | - Stéphane Oudard
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France; University Paris Descartes Paris 5, Sorbonne Paris Cite, Paris, France
| | - Audrey Simonaggio
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France; University Paris Descartes Paris 5, Sorbonne Paris Cite, Paris, France.
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Carreto-Binaghi LE, Morales-Villarreal FR, García-de la Torre G, Vite-Garín T, Ramirez JA, Aliouat EM, Martínez-Orozco JA, Taylor ML. Histoplasma capsulatum and Pneumocystis jirovecii coinfection in hospitalized HIV and non-HIV patients from a tertiary care hospital in Mexico. Int J Infect Dis 2019; 86:65-72. [PMID: 31207386 DOI: 10.1016/j.ijid.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Histoplasma capsulatum and Pneumocystis jirovecii are respiratory fungal pathogens that principally cause pulmonary disease. Coinfection with both pathogens is scarcely reported. This study detected this coinfection using specific molecular methods for each fungus in the bronchoalveolar lavage (BAL) of patients from a tertiary care hospital. MATERIALS AND METHODS BAL samples from 289 hospitalized patients were screened by PCR with specific markers for H. capsulatum (Hcp100) and P. jirovecii (mtLSUrRNA and mtSSUrRNA). The presence of these pathogens was confirmed by the generated sequences for each marker. The clinical and laboratory data for the patients were analyzed using statistical software. RESULTS The PCR findings separated three groups of patients, where the first was represented by 60 (20.8%) histoplasmosis patients, the second by 45 (15.6%) patients with pneumocystosis, and the last group by 12 (4.2%) patients with coinfection. High similarity among the generated sequences of each species was demonstrated by BLASTn and neighbor-joining algorithms. The estimated prevalence of H. capsulatum and P. jirovecii coinfection was higher in HIV patients.
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Affiliation(s)
- Laura E Carreto-Binaghi
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico; Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas" (INER), CDMX, 14080, Mexico.
| | | | | | - Tania Vite-Garín
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
| | - Jose-Antonio Ramirez
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
| | - El-Moukhtar Aliouat
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Centre d'Infection et d'Immunité de Lille, Lille, France.
| | | | - Maria-Lucia Taylor
- Laboratorio de Inmunología de Hongos, Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, 04510, Mexico.
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Rego de Figueiredo I, Vieira Alves R, Drummond Borges D, Torres M, Lourenço F, Antunes AM, Gruner H, Panarra A. Pneumocystosis pneumonia: A comparison study between HIV and non-HIV immunocompromised patients. Pulmonology 2019; 25:271-274. [PMID: 31076291 DOI: 10.1016/j.pulmoe.2019.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022] Open
Abstract
Pneumocystis pneumonia (PCP) is caused by the fungus Pneumocystis jirovecii, and its incidence has been on the rise in immunosuppressed patients without HIV. We performed a cross sectional study in patients with PCP and assessed demographic, clinical presentation and outcome measures such as mechanical ventilation and mortality differences between HIV and non-HIV patients. The two groups were statistically significantly different, with the HIV group being younger (45.5 years vs 55.9 years, p-value 0.001) and mostly composed of male patients (69% vs 31%, p-value <0.001). Also, the HIV patients had higher percentage of respiratory complaints (90% vs 68%, p-value 0.02) and lactate dehydrogenase elevation (73% vs 40%, p-value 0.001). In contrast, non-HIV patients had worse outcomes with higher incidence of invasive mechanical ventilation (23% vs 46%, p-value 0.005) and in-hospital mortality (13% vs 37%, p-value 0.002). These results reflect the literature and should raise awareness to a potentially fatal medical situation of increasing incidence.
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Affiliation(s)
- I Rego de Figueiredo
- Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal.
| | - R Vieira Alves
- Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal
| | - D Drummond Borges
- Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal
| | - M Torres
- Serviço de Doenças Infecciosas, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal
| | - F Lourenço
- Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal
| | - A M Antunes
- Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal
| | - H Gruner
- Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal
| | - A Panarra
- Serviço de Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisboa, Portugal
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Costedoat-Chalumeau N, Groh M, Piette JC, Launay O. [How to minimize the risk of infection in systemic lupus erythematosus?]. Rev Med Interne 2018; 40:347-350. [PMID: 29937299 DOI: 10.1016/j.revmed.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- N Costedoat-Chalumeau
- Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'Île-de-France, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Université Paris Descartes-Sorbonne Paris Cité, 75013 Paris, France; Inserm U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), 75006 Paris, France.
| | - M Groh
- Service de médecine interne, hôpital Foch, 92150 Suresnes, France
| | - J-C Piette
- Département de médecine interne et d'immunologie clinique, hôpital Pitié-Salpêtrière, affilié au Centre de référence maladies auto-immunes et systémiques rares de l'Île-de-France, AP-HP, 75013 Paris, France; Université Paris Descartes-Sorbonne Paris Cité, 75013 Paris, France
| | - O Launay
- Université Paris Descartes-Sorbonne Paris Cité, hôpital Cochin, AP-HP, 75014 Paris, France; Inserm, CIC 1417, F-CRIN I-REIVAC, 75014 Paris, France
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Kehrmann J, Veckollari B, Schmidt D, Schildgen O, Schildgen V, Wagner N, Zeschnigk M, Klein-Hitpass L, Witzke O, Buer J, Steinmann J. The lung microbiome in patients with pneumocystosis. BMC Pulm Med 2017; 17:170. [PMID: 29202739 PMCID: PMC5715545 DOI: 10.1186/s12890-017-0512-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022] Open
Abstract
Backround Pneumocystis jirovecii pneumonia (PCP) is an opportunistic fungal infection that is associated with a high morbidity and mortality in immunocompromised individuals. In this study, we analysed the microbiome of the lower respiratory tract from critically ill intensive care unit patients with and without pneumocystosis. Methods Broncho-alveolar fluids from 65 intubated and mechanically ventilated intensive care unit patients (34 PCP+ and 31 PCP- patients) were collected. Sequence analysis of bacterial 16S rRNA gene V3/V4 regions was performed to study the composition of the respiratory microbiome using the Illumina MiSeq platform. Results Differences in the microbial composition detected between PCP+ and PCP- patients were not statistically significant on class, order, family and genus level. In addition, alpha and beta diversity metrics did not reveal significant differences between PCP+ and PCP- patients. The composition of the lung microbiota was highly variable between PCP+ patients and comparable in its variety with the microbiota composition of the heterogeneous collective of PCP- patients. Conclusions The lower respiratory tract microbiome in patients with pneumocystosis does not appear to be determined by a specific microbial composition or to be dominated by a single bacterial species. Electronic supplementary material The online version of this article (10.1186/s12890-017-0512-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Kehrmann
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - B Veckollari
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - D Schmidt
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - O Schildgen
- Institute of Pathology, Kliniken der Stadt Köln gGmbH, Hospital of the University of Witten/Herdecke, Cologne, Germany
| | - V Schildgen
- Institute of Pathology, Kliniken der Stadt Köln gGmbH, Hospital of the University of Witten/Herdecke, Cologne, Germany
| | - N Wagner
- Institute of Human Genetics, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - M Zeschnigk
- Institute of Human Genetics, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - L Klein-Hitpass
- Biochip Laboratory, Institute for Cell Biology-Tumor Research, University of Duisburg-Essen, Essen, Germany
| | - O Witzke
- Department of Infectious Diseases, University of Duisburg-Essen, Essen, Germany
| | - J Buer
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - J Steinmann
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany. .,Present Address: Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Germany.
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Passos AIM, Dertkigil RP, Ramos MDC, Busso-Lopes AF, Tararan C, Ribeiro EO, Schreiber AZ, Trabasso P, Resende MR, Moretti ML. Serum markers as an aid in the diagnosis of pulmonary fungal infections in AIDS patients. Braz J Infect Dis 2017; 21:606-612. [PMID: 28759746 PMCID: PMC9425482 DOI: 10.1016/j.bjid.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction The etiology of pulmonary infections in HIV patients is determined by several variables including geographic region and availability of antiretroviral therapy. Materials and methods A cross-sectional prospective study was conducted from 2012 to 2016 to evaluate the occurrence of pulmonary fungal infection in HIV-patients hospitalized due to pulmonary infections. Patients’ serums were tested for (1–3)-β-D-Glugan, galactomannan, and lactate dehydrogenase. The association among the variables was analyzed by univariate and multivariate regression analysis. Results 60 patients were included in the study. The patients were classified in three groups: Pneumocystis jirovecii pneumonia (19 patients), community-acquired pneumonia (18 patients), and other infections (23 patients). The overall mortality was 13.3%. The time since diagnosis of HIV infection was shorter in the pneumocystosis group (4.94 years; p = 0.001) than for the other two groups of patients. The multivariate analysis showed that higher (1-3)-β-D-Glucan level (mean: 241 pg/mL) and lactate dehydrogenase (mean: 762 U/L) were associated with the diagnosis of pneumocystosis. Pneumocystosis was the aids-defining illness in 11 out of 16 newly diagnosed HIV-infected patients. Conclusion In the era of antiretroviral therapy, PJP was still the most prevalent pulmonary infection and (1-3)-β-D-Glucan and lactate dehydrogenase may be suitable markers to help diagnosing pneumocystosis in our HIV population.
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Affiliation(s)
- Ana Isabela Morsch Passos
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil
| | - Rachel Polo Dertkigil
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas, SP, Brazil
| | - Marcelo de Carvalho Ramos
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil
| | | | - Cibele Tararan
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil
| | - Erivan Olinda Ribeiro
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil
| | - Angélica Zaninelli Schreiber
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Patologia Clínica, Campinas, SP, Brazil
| | - Plinio Trabasso
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil
| | - Mariangela Ribeiro Resende
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil
| | - Maria Luiza Moretti
- Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Interna, Campinas, SP, Brazil.
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Gangneux JP, Bougnoux ME, Hennequin C, Godet C, Chandenier J, Denning DW, Dupont B. An estimation of burden of serious fungal infections in France. J Mycol Med 2016; 26:385-390. [PMID: 27887809 DOI: 10.1016/j.mycmed.2016.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE OF THE STUDY An estimation of burden of serious fungal diseases in France is essential data to inform public health priorities on the importance of resources and research needed on these infections. In France, precise data are available for invasive fungal diseases but estimates for several other diseases such as chronic and immunoallergic diseases are by contrast less known. MATERIALS AND METHODS A systematic literature search was conducted using the Web of Science Platform. Published epidemiology papers reporting fungal infection rates from France were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence, depending on the condition. RESULTS The model predicts high prevalences of severe asthma with fungal sensitization episodes (189 cases/100,000 adults per year), of allergic bronchopulmonary aspergillosis (145/100,000) and of chronic pulmonary aspergillosis (5.24/100,000). Besides, estimated incidence for invasive aspergillosis is 1.8/100,000 annually based on classical high risk factors. Estimates for invasive mucormycosis, pneumocystosis and cryptococcosis are 0.12/100,000, 1/100,000 and 0.2/100,000, respectively. Regarding invasive candidiasis, more than 10,000 cases per year are estimated, and a much higher number of recurrent vaginal candidiasis is probable but must be confirmed. Finally, this survey was an opportunity to report a first picture of the frequency of tinea capitis in France. CONCLUSION Using local and literature data of the incidence or prevalence of fungal infections, approximately 1,000,000 (1.47%) people in France are estimated to suffer from serious fungal infections each year.
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Affiliation(s)
- J-P Gangneux
- Centre hospitalier universitaire de Rennes, laboratoire de parasitologie-mycologie, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 09, France.
| | - M-E Bougnoux
- Centre hospitalier universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, laboratoire de parasitologie-mycologie, 149, rue de Sèvres, 75015 Paris, France
| | - C Hennequin
- Centre hospitalier universitaire Saint-Antoine, Assistance publique-Hôpitaux de Paris, laboratoire de parasitologie-mycologie, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - C Godet
- Centre hospitalier universitaire de Poitiers, service de médecine interne, maladies infectieuses et tropicales, 2, rue de la Milétrie, 86021 Poitiers, France
| | - J Chandenier
- Centre hospitalier universitaire de Tours, laboratoire de parasitologie-mycologie, 2, boulevard Tonnellé, 37000 Tours, France
| | - D W Denning
- The University of Manchester and National Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK
| | - B Dupont
- Centre hospitalier universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, laboratoire de parasitologie-mycologie, 149, rue de Sèvres, 75015 Paris, France
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El Fane M, Sodqi M, Oulad Lahsen A, Chakib A, Marih L, Marhoum El Filali K. [ Pneumocystosis during HIV infection]. Rev Pneumol Clin 2016; 72:248-254. [PMID: 27349824 DOI: 10.1016/j.pneumo.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 06/06/2023]
Abstract
Pneumocystosis is an opportunistic disease caused by invasion of unicellular fungus Pneumocystic jirovecii which is responsible for febrile pneumonia among patients with cellular immunodeficiency especially those HIV infected. Despite the decreasing of its incidence due to the introduction of antiretroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients, Pneumocystis pneumonia remains the first AIDS-defining event and a leading cause of mortality among HIV-infected patients. The usual radiological presentation is that of diffuse interstitial pneumonia. The diagnosis is confirmed by the detection of trophozoides and/or cysts P. jirovecii in bronchoalveolar lavage (BAL) samples using several staining techniques. The use of polymerase chain reaction in the BAL samples in conjunction with standard immunofluorescent or colorimetric tests have allowed for more has allowed for more rapid and accurate diagnosis. The standard regimen of treatment is the association of trimethoprim-sulfamethoxazole which has been utilized as an effective treatment with a favourable recovery. Early HIV diagnosis and antiretroviral therapy should reduce the incidence of this dreaded disease.
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Affiliation(s)
- M El Fane
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc.
| | - M Sodqi
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
| | - A Oulad Lahsen
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
| | - A Chakib
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
| | - L Marih
- Service des maladies infectieuses, CHU Ibn-Rochd, Casablanca, Maroc
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Bienvenu AL, Traore K, Plekhanova I, Bouchrik M, Bossard C, Picot S. Pneumocystis pneumonia suspected cases in 604 non-HIV and HIV patients. Int J Infect Dis 2016; 46:11-7. [PMID: 27021532 DOI: 10.1016/j.ijid.2016.03.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumocystis pneumonia (PCP) is one of the most devastating fungal diseases in patients with impaired immunity. Effective antiviral therapies have reduced the burden of PCP among AIDS patients, but an increase in the prevalence of this disease among persons receiving immunosuppressive therapies has been reported. METHODS We retrospectively reviewed HIV and non-HIV PCP patients diagnosed in our department during a nine year period. Data were collected from the local database completed during the diagnosis procedure. For each patient, demographic, clinical, radiological, biological and therapeutic data were analyzed. RESULTS A total of 21,274 bronchoalveolar samples were received from patients suspected of pneumocystosis during the study period, leading to a discharge diagnosis of PCP for 604 patients (143 HIV-positive and 461 HIV-negative). The ratio of non-HIV versus HIV patients presenting PCP increased from 1.7 to 5.6 during the study period. The mortality rate at day 14 was 16%, occurring mostly in non-HIV patients (20.6% compared to 1.4%, P<0.0001), while non-HIV patients were less symptomatic at diagnosis than AIDS patients. CONCLUSIONS This study presents one of the higher number of HIV and non-HIV patients presenting with PCP in a single center. Pneumocystosis is now a crucial health challenge for patients receiving immunosuppressive therapy, with a high mortality rate. This study highlights the need for international guidelines for prophylaxis of PCP in non-HIV patients.
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Affiliation(s)
- Anne-Lise Bienvenu
- Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Karim Traore
- Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Irina Plekhanova
- Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Mourad Bouchrik
- Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France
| | - Cécile Bossard
- Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Picot
- Institut de Parasitologie et Mycologie Médicale, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, Institut de Chimie et Biochimie Moléculaire et Supramoléculaire, UMR-5246 CNRS-INSA-CPE, Malaria Research Unit, Lyon, France.
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Almeida-Silva F, Damasceno LS, Serna MJ, Valero C, Quintella LP, Almeida-Paes R, Muniz Mde M, Zancope-Oliveira RM. Multiple opportunistic fungal infections in an individual with severe HIV disease: A case report. Rev Iberoam Micol 2016; 33:118-21. [PMID: 26896884 DOI: 10.1016/j.riam.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/09/2015] [Accepted: 09/07/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fungal infections have been commonly diagnosed in individuals with advanced HIV disease. Cryptococcosis, pneumocystosis, and histoplasmosis are the most frequent systemic mycoses in people suffering from HIV/AIDS. CASE REPORT We report a case of multiple fungal infections in an advanced AIDS-patient. A 33-year-old HIV-positive man from Brazil was hospitalized due to diarrhea, dyspnea, emaciation, hypoxemia, extensive oral thrush, and a CD4+ T lymphocyte count of 20cells/mm(3). Honeycombed-structures consistent with Pneumocystis jirovecii were observed by direct immunofluorescence in induced sputum. Cryptococcus neoformans was recovered from respiratory secretion and cerebrospinal fluid cultures. Histopathology of the bone marrow also revealed the presence of Histoplasma capsulatum. Molecular assays were performed in a sputum sample. Nested-PCR confirmed the presence of P. jirovecii and H. capsulatum; qPCR multiplex was positive for C. neoformans and H. capsulatum. With the treatment of antifungal drugs the patient progressed satisfactorily. CONCLUSIONS The diagnosis of several systemic mycoses demonstrates the vulnerability of advanced AIDS-patients. Thus, the detection of AIDS cases in the early stages of infection is necessary for a prompt and adequate introduction of HAART therapy, and the use of prophylaxis to control opportunistic infections.
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Khalife S, Chabé M, Gantois N, Audebert C, Pottier M, Hlais S, Pinçon C, Chassat T, Pierrot C, Khalife J, Aliouat-Denis CM, Aliouat EM. Relationship Between Pneumocystis carinii Burden and the Degree of Host Immunosuppression in an Airborne Transmission Experimental Model. J Eukaryot Microbiol 2015; 63:309-17. [PMID: 26509699 DOI: 10.1111/jeu.12280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/18/2015] [Accepted: 10/21/2015] [Indexed: 12/13/2022]
Abstract
To quantitatively assess the risk of contamination by Pneumocystis depending on the degree of immunosuppression (ID) of the exposed rat hosts, we developed an animal model, where rats went through different doses of dexamethasone. Then, natural and aerial transmission of Pneumocystis carinii occurred during cohousing of the rats undergoing gradual ID levels (receivers) with nude rats developing pneumocystosis (seeders). Following contact between receiver and seeder rats, the P. carinii burden of receiver rats was determined by toluidine blue ortho staining and by qPCR targeting the dhfr monocopy gene of this fungus. In this rat model, the level of circulating CD4(+) and CD8(+) T lymphocytes remained significantly stable and different for each dose of dexamethasone tested, thus reaching the goal of a new stable and gradual ID rat model. In addition, an inverse relationship between the P. carinii burden and the level of circulating CD4(+) or CD8(+) T lymphocytes was evidenced. This rat model may be used to study other opportunistic pathogens or even co-infections in a context of gradual ID.
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Affiliation(s)
- Sara Khalife
- Biology and Diversity of Emerging Eukaryotic Pathogens (BDPEE), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France.,Health and Environment Microbiology Laboratory, AZM Center for Research in Biotechnology and its Application, Doctoral School of Sciences and Technology, Lebanese University, Tripoli, Lebanon
| | - Magali Chabé
- Biology and Diversity of Emerging Eukaryotic Pathogens (BDPEE), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France.,Department of Parasitology, Faculty of Pharmacy of Lille, Univ. Lille, F-59000, Lille, France
| | - Nausicaa Gantois
- Biology and Diversity of Emerging Eukaryotic Pathogens (BDPEE), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France
| | | | - Muriel Pottier
- Biology and Diversity of Emerging Eukaryotic Pathogens (BDPEE), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France.,Department of Parasitology, Faculty of Pharmacy of Lille, Univ. Lille, F-59000, Lille, France
| | - Sani Hlais
- Health and Environment Microbiology Laboratory, AZM Center for Research in Biotechnology and its Application, Doctoral School of Sciences and Technology, Lebanese University, Tripoli, Lebanon
| | - Claire Pinçon
- EA2694, Department of Biostatistics, Faculty of Pharmacy of Lille, Univ. Lille, F-59000, Lille, France
| | - Thierry Chassat
- Animal Unit, Pasteur Institute of Lille, F-59000, Lille, France
| | - Christine Pierrot
- Molecular Signaling and the Control of Parasite Growth and Differentiation, Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France
| | - Jamal Khalife
- Molecular Signaling and the Control of Parasite Growth and Differentiation, Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France
| | - Cécile-Marie Aliouat-Denis
- Biology and Diversity of Emerging Eukaryotic Pathogens (BDPEE), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France.,Department of Parasitology, Faculty of Pharmacy of Lille, Univ. Lille, F-59000, Lille, France
| | - El Moukhtar Aliouat
- Biology and Diversity of Emerging Eukaryotic Pathogens (BDPEE), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France.,Department of Parasitology, Faculty of Pharmacy of Lille, Univ. Lille, F-59000, Lille, France.,Molecular Signaling and the Control of Parasite Growth and Differentiation, Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France
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Abstract
In HIV-negative adults, Pneumocystis jirovecii pneumonia can be observed when immunodeficiency is present, especially in case of drug-induced immune suppression (steroids, chemotherapy, transplantation). Clinical, radiological, and biological presentations are different in HIV-positive and HIV-negative individuals with different immunodeficiency profiles. In HIV-negative patients, dyspnea occurs more quickly (median duration of 5 days to get a diagnosis), diagnosis is more difficult because of less Pneumocystis in bronchoalveolar lavage, and mortality is higher than in HIV-positive individuals. Lung CT-scan typically shows diffuse ground glass opacities, but peri-bronchovascular condensations or ground glass opacities clearly limited by interlobular septa can also be observed. Lymphopenia is common but CD4+ T-cells count is rarely performed. HIV-negative patients with Pneumocystis pneumonia are co-infected with bacteria, viruses or fungi in about 30% cases. Bronchoalveolar lavage is often more neutrophilic than in HIV-positive individuals. PCR and β-D-glucan have good sensitivity but poor specificity to diagnose Pneumocystis pneumonia. Trimethoprim-sulfamethoxazole remains the first choice of treatment. Duration is 14 days in HIV-negative patients whereas it is typically of 21 days in HIV-positive individuals. Adjunctive corticosteroids are of beneficial effect in HIV-positive adult patients with substantial hypoxaemia but are not recommended in HIV-negative patients, as they could be deleterious in some individuals.
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Affiliation(s)
- M Rouyer
- Assistance publique-Hôpitaux de Paris, 75000 Paris, France
| | - A Stoclin
- Gustave-Roussy - Cancer Campus, 94805 Villejuif cedex, France
| | - F-X Blanc
- Institut du thorax, hôpital G.-et-R.-Laënnec, CHU de Nantes, 44000 Nantes, France.
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Gugnani HC, Denning DW. Burden of serious fungal infections in the Dominican Republic. J Infect Public Health 2016; 9:7-12. [PMID: 26027476 DOI: 10.1016/j.jiph.2015.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/21/2015] [Accepted: 04/03/2015] [Indexed: 12/17/2022] Open
Abstract
The Dominican Republic (DR) is the second largest Caribbean nation and, with Haiti, the DR accounts for nearly three-quarters of the cases of human immunodeficiency virus (HIV) infection in the Caribbean region and the highest rates of TB in the Americas. The present study estimated the burden of serious fungal infections and some other mycoses in the DR. The data were extracted from the World Health Organization Stop Tuberculosis (WHO STOP TB) program, the Joint United Nations Program on HIV/AIDS (UNAIDS), and searches for relevant literature via MEDLINE, PubMed, MedFacts, and so on. The chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and severe asthma with fungal sensitization (SAFS) rates were derived from the asthma and TB rates. When no data regarding mycoses were available, we used specific populations at risk and the frequencies of fungal infection in each of these populations to estimate the national prevalence. Among its population of 10,090,000, we estimated that 221,027 (2.2%) have a serious fungal infection, including 158,134 women with recurrent vulvovaginal candidiasis. We estimated high numbers of 25,150 for ABPA and 34,000 for severe asthma fungal sensitization (SAFS) (250 and 529/100,000, respectively). CPA was common, with an estimated 2122 cases, of which 707 followed pulmonary TB. The annual prevalence of CPA was estimated to be 1374 cases. Four cases of histoplasmosis and several cases of chromoblastomycosis have also been reported. Pityriasis versicolor and tinea capitis are frequent in children, and 11% have kerion. Local epidemiological investigations are urgently required to validate or modify these estimates of serious fungal infections in the DR.
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