Epidemiology Of Fungal Infections Research Articles

Epidemiology of fungal infection in COVID 19 in Spain during 2020 and 2021: a nationwide study

We realize a nationwide population-based retrospective study to analyze the characteristics and risk factors of fungal co-infections in COVID-19 hospitalized patients as well as describe their causative agents in the Spanish population in 2020 and 2021. Data were obtained from records in the Minimum Basic Data Set of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health, and annually published with two years lag. The assessment of the risk associated with the development of healthcare-associated fungal co-infections was assessed using an adjusted logistic regression model. The incidence of fungal co-infection in COVID-19 hospitalized patients was 1.41%. The main risk factors associated were surgery, sepsis, age, male gender, obesity, and COPD. Co-infection was associated with worse outcomes including higher in-hospital and in ICU mortality, and higher length of stay. Candida spp. and Aspergillus spp. were the microorganisms more frequent. This is the first study analyzing fungal coinfection at a national level in hospitalized patients with COVID-19 in Spanish population and one of the few studies available that demonstrate that surgery was an independent risk factor of Aspergillosis coinfection in COVID-19 patients.

Pathology and Epidemiology of Fungal Infections in Layer Chicken Flocks

Fungal infections have a key effect on the commercial poultry production and welfare. Infections caused by fungi and their food contaminants are zoonotic and influence food safety. Eggs and cooked meats remain major public health concerns. Therefore, this research is aimed at examining the pathology and understanding the epidemiology of fungal infection in layer chicken flocks. The study was carried out on twenty-layer flocks from Kafrelsheikh Governorate, Egypt, from January 2019 to December 2020. In total, 600 samples were collected from 100 healthy and diseased layer chickens from different organs (skin, liver, lung, kidney, spleen, and ovary). In this work, we present the clinical and pathological characteristics of some fungal pathogens (Aspergillus spp. and Fusarium spp.) in layer chicken flocks, as they are responsible for reducing the egg production. In total, 19 fungal strains were isolated from individual chickens, and these were analysed to determine the fungal species. The total proportion of fungal infections at the farm level was (3/20) 15%. The main clinical signs were emaciation and mortalities that reached 4.34 % ± 0.84 . We report the first isolation of Aspergillus piperis and Fusarium species from the ovary of poultry, which is the main reason for egg retention and multiple numerous nodules of occasional caseating centers in layer ovaries. The histopathological findings of Aspergillus infection are indicated by the presence of branched hyphae that tend to be numerous and progressive. Furthermore, we found spherules with multiple endospores of Fusarium spp. in the ovaries. Morphological and molecular identification and analysis were performed to confirm the etiological agents.

Liposomal amphotericin B-the future.

Advances in medicine have led to a growing number of people with compromised or suppressed immune systems who are susceptible to invasive fungal infections. In particular, severe fungal infections are becoming increasingly common in ICUs, affecting people within and outside of traditional risk groups alike. This is exemplified by the emergence of severe viral pneumonia as a significant risk factor for invasive pulmonary aspergillosis, and the recognition of influenza-associated pulmonary aspergillosis and, more recently, COVID-19-associated pulmonary aspergillosis. The treatment landscape for haematological malignancies has changed considerably in recent years, and some recently introduced targeted agents, such as ibrutinib, are increasing the risk of invasive fungal infections. Consideration must also be given to the risk of drug-drug interactions between mould-active azoles and small-molecule kinase inhibitors. At the same time, infections caused by rare moulds and yeasts are increasing, and diagnosis continues to be challenging. There is growing concern about azole resistance among both moulds and yeasts, mandating continuous surveillance and personalized treatment strategies. It is anticipated that the epidemiology of fungal infections will continue to change and that new populations will be at risk. Early diagnosis and appropriate treatment remain the most important predictors of survival, and broad-spectrum antifungal agents will become increasingly important. Liposomal amphotericin B will remain an essential therapeutic agent in the armamentarium needed to manage future challenges, given its broad antifungal spectrum, low level of acquired resistance and limited potential for drug-drug interactions.

Current situation of fungal diseases in Eritrea.

The epidemiology of fungal infections in Eritrea is unknown. Most cases are under‐reported due to a lack of diagnostics. This study estimates the burden of serious fungal infections and highlights treatment and diagnostic gaps in the country. All publications related to fungal infections were identified by searches using PubMed/Medline and Google Scholar. Where no data were available, data from neighbouring countries, then sub‐Saharan African countries, then other parts of the world were considered for deriving estimates. The Eritrea population was 3,546,427 in 2020. In 2020, HIV/AIDS patients numbered 1400 and TB incidence were 2875. The five‐year adult prevalence of asthma (2016–2020) was 41,390, and the total prevalence estimate of chronic obstructive pulmonary disease (COPD) was 308,328. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in AIDS patients was estimated at 96 and 205 cases. Oesophageal candidiasis incidence is 715 HIV‐infected patients. Chronic pulmonary aspergillosis prevalence, including post‐tuberculosis cases, was estimated at 1399 (39/100,000). Fungal asthma has a prevalence of 1035 and 1366 in adults. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 59,391 and 342,585, respectively. There are no data on candidaemia, but it is estimated at 5/100,000 (177 cases annually). Invasive aspergillosis in leukaemia, lung cancer, COPD and HIV is estimated at 540 cases and fungal keratitis in 514 cases annually. Serious fungal infections are prevalent in Eritrea with approximately 408,164 people (11.5%) affected annually. Studies on fungal diseases to improve diagnosis and treatment are required with the implementation of a national surveillance program.

Микологический айсберг: современные сдвиги в эпидемиологии микозов

Infectious diseases caused by fungi (mycoses) are one of the significant problems of modern medicine Worldwide, more than 300 million people suffer from severe and chronic mycoses, 25 million patients are at risk of disability or death. Due to changes in treatment strategies and the wider use of antifungal prevention in recent years, the epidemiology of fungal infections has changed and has become particularly relevant due to a significant increase in cases of invasive mycoses. Deep, visceral mycoses, sometimes associated with HIV infection, oncohematological pathology, organ transplantation, nursing of newborns, have become more frequent, while the role of fungi that were previously considered apatogenic increases. In the context of the COVID-19 pandemic, risk factors for these infections continue to increase, and therefore it is likely that the incidence of fungal infections, including those associated as nosocomial, will increase in the coming years. The increasing role of fungi in the etiology of hospital infections, the introduction into clinical practice of a significant number of new drugs was inevitably accompanied by the formation of resistance of fungi to antimycotics. According to literature data, the rate of emergence of pathogenic fungi resistant to a limited number of widely used antifungal agents is unprecedented. Thus, in modern conditions associated with the increase in resistance of pathogenic fungi, the key measures should be aimed at developing optimal strategies for containing resistance to antifungal drugs. Key words: mycoses, fungal infections, antimycotics, resistance, risk factors, pandemic, COVID-19

Global epidemiological burden of fungal infections in cirrhosis patients: A systematic review with meta-analysis.

Fungal infections (FIs) have serious implications, yet understated in cirrhosis. Therefore, we reviewed the epidemiology and trends of FIs among cirrhotics. Four electronic databases were searched for full-text articles describing prevalence of FIs in cirrhosis. Studies from post-transplant, malignancy and classical-immuno-deficiency patients were excluded. A random-effects meta-analysis was done to pool estimates of FIs (overall, and by type and infection-site), and their variation(I2 ) was explored on moderator-analysis and meta-regression. Risk of bias and asymmetry in estimates was assessed by a checklist and Egger's regression, respectively.(CRD42019142782). Thirty-four low-risk and four moderate-risk studies (31984 cirrhotics) were included. Pooled estimates of overall FIs (17 studies), invasive fungal infections (IFIs; 17 studies), invasive candidiasis (23 studies) and invasive aspergillosis (16 studies) in cirrhosis were 10.2%(6.0-16.9), 9.5%(5.4-16.2), 4.0%(2.0-8.0) and 2.8%(1.5-5.3), respectively (I2 >90%;each). Site of FIs in decreasing order of pooled prevalence was pulmonary, urinary tract, bloodstream, peritoneal, oesophageal and cerebral. Geographic differences in these estimates were remarkable, with highest burden of overall FIs from Belgium, the United States and India. Non-albicans-Candida and Aspergillus infections have increased over the last decade in cirrhosis. Intensive-care-unit (ICU)-admitted and acute-on-chronic liver failure (ACLF) patients had the highest prevalence of IFIs. MELD score(cases), bias score and sample size across studies were the predictors of variance in overall FI estimates.Diabetes, steroid and broad-spectrum antibiotic-exposure, and multiple organ failures were the common predispositions reported in patients with FIs. FIs impose a substantial burden in cirrhosis. ACLF and ICU admission should be considered as a host factor for defining IFIs. Epidemiology of FIs can guide interpretation of biomarkers and antifungal treatment in cirrhosis.

Epidemiology of fungal infection after hepatobiliary surgeries at National Liver Institute Hospital (Menoufia University)

Objectives To estimate the incidence rate of fungal infections after hepatobiliary surgery and identification of the risk factors. Background Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients, especially in the ICU, the incidence of invasive candidiasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Participants and methods A prospective cohort hospital-based study was carried out at the National Liver Institute, Menoufia University. The studied group was 210 patients, all of them were examined thoroughly, their data were registered and sampled two times, one at the day of admission to be sure that they are free of fungal infection and the second was after hepatobiliary surgery. A predesigned questionnaire was used, which includes data about personal history, medical history, and suggested risk factors for fungal infections. Results In the present study, the incidence rate of fungal infection among patients who had hepatobiliary surgeries in National Liver Institute was found (45.2%) and by logistic regression analysis of data indicated that the most relevant factors for fungal infection were age (P < 0.001), antibiotic use (P < 0.05), liver disease (P < 0.05), central venous catheter (P < 0.05), urinary catheter (P < 0.05), and ICU hospitalization more than 48 h (P < 0.001). Conclusion High incidence of fungal infection after hepatobiliary surgeries is considered a great health problem. The main risk factors of fungal infection are low immunity, chronic disease, diabetes, hepatitis B virus and/or hepatitis C virus infection, cancer, anemias, organ transplantation, blood transfusion, had central venous catheter, intravenous catheter, had abdominal drain, urinary catheter, parenteral nutrition, history of past operations, and hospitalized in the ICU more than 48 h.

Epidemiology of Mycotic Infections: Experience From A Tertiary Care Center Of Uttarakhand, India

Introduction: The overall changing epidemiology of fungal infections in the current scenario isbecause of an increase in immunocompromised population including cancer patients, Humanimmunodeficiency virus (HIV)-infected patients, transplant receipts, and prolonged hospitalizationwith overuse of antimicrobial agents. These infections are challenging to diagnose and subsequentlymanage as their clinical symptomatology often mimics other common diseases like tuberculosis.Rapid diagnosis is limited and culture is often delayed due to slow growth rates of the causativeagents. Objective: This is a retrospective study to know the spectrum and burden of mycoticinfections in a tertiary care hospital. Methods: All samples collected from clinically suspected casesof fungal infections were sent to the Microbiology department over one year. The common specimensreceived were respiratory samples, scrapings from cornea, skin, and nail. All samples were firstobserved under direct microscopy using Potassium hydroxide (KOH) examination for the presence offungal elements and Gram stain for yeasts. India Ink examination was performed for sterile fluids.Fungal culture was done on Sabouraud's dextrose agar. Result: A total of 900 samples from variousdepartments were included, KOH examination was positive for 380 samples (42%) and fungalgrowth was obtained in 144 samples (16%). Rare fungi like Trichosporon dohaense (blood culture),Cladophialophora bantiana (brain abscess), Scedosporium apiospermum and Candida auris (bloodculture) were also isolated. Conclusion: Similar studies are needed to estimate the actual burden ofthe fungal infections in tertiary care health facilities, to help decrease the morbidity and mortalityassociated with underdiagnosed mycotic infections.

Epidemiology of dermatophytoses in paediatric population in Southwestern Poland, 2011-2016.

IntroductionDermatophytoses are the most common superficial fungal infections in paediatric population. Its pathogen pattern has changed over years.AimTo analyse the spectrum of dermatophytoses in children living in Southwestern Poland, in the years 2011–2016.Material and methodsA total of 1705 patients were diagnosed with fungal skin infection in the Mycological Laboratory, Dermatology Department of the Wroclaw Medical University. Of them, 163 were under 18 years of age.ResultsIn 105 cases, dermatophytoses were detected. The collected specimens were examined using direct microscopy examination, staining, culture on specific media and PCR technique. The most common dermatophytes were Trichophyton rubrum and Trichophyton tonsurans (31.4% each), followed in the descending order by Trichophyton mentagrophytes (21.9%), Microsporum canis (13.3%) and Epidermophyton floccosum (1.9%). The most commonly affected body sites were glabrous skin of the trunk and extremities (41.7%), followed by face (22.2%), scalp (15.7%) and toe nails (14.8%).ConclusionsThis study revealed the most common types of dermatophytoses and their pathogens in children in Southwestern Poland. In comparison to earlier data obtained from this region, new epidemiological trends have been revealed. We observed the shift towards anthropophilic dermatophyte infections and an increasing number of onychomycosis in children. Because of climatic variations, migration, and changing lifestyle practices, further studies on dermatophytoses are necessary to improve our knowledge on the epidemiology of fungal infections.

Changing Trend of Superficial Mycoses with Increasing Nondermatophyte Mold Infection: A Clinicomycological Study at a Tertiary Referral Center in Assam.

Background:Superficial mycosis is the commonest infections affecting human globally. Though they do not cause mortality, their clinical significance lies in their morbidity, recurrence, and cosmetic disfigurement, thus creating a major public health problem. The infections are more prevalent in the tropical regions. The etiological agents are also seen to vary with time and geographical location.Aim:This study was carried out to find out the trend of superficial mycosis in Assam, along with a clinicomycological correlation.Materials and Methods:A total of 130 clinically diagnosed cases of superficial mycoses attending the outpatient department (OPD) of a tertiary hospital in Assam for a period of 1 year were taken up for the study. After taking the informed consent and a proper history, the clinical materials like skin scrapings, nail clippings, and infected hair were sent for mycological examination.Results:The infection was found to be more prevalent among males than females (M:F, 3:2) and among the farmers and laborers (24.61%). Tinea corporis was the commonest clinical type (21.5%). Among the fungal isolates, dermatophytes were the most frequent isolates (43.54%), out of which Trichophyton rubrum was commonest. nondermatophyte moulds like Fusarium, Aspergillus, Scopulariopsis, Trichosporon, and Penicillium spp. were isolated.Conclusion:The epidemiology of fungal infection and the causative fungi is seen to vary geographically and with time. This study reflects the changing trend of fungal infection in the north eastern region with a high rate of isolation of nondermatophyte moulds as the causative agent.

Molecular detection of fungi of public health importance in wild animals from Southern Brazil.

Some animals have an important relationship with fungal infections, and searching for pathogens in animal samples may be an opportunity for eco-epidemiological research. Since studies involving wildlife are generally restricted, using samples from road kills is an alternative. The aim of this study was to verify whether pathogenic fungi of public health importance occur in wildlife road kills from Santa Catarina State, Brazil. Organ samples (n=1063) from 297 animals were analysed according to Polymerase Chain Reaction (PCR) using universal primers to detect fungi in general and, subsequently, using primers specific to Paracoccidioides brasiliensis, Histoplasma capsulatum and Cryptococcus spp. There were 102 samples positive for fungal species. Eight samples were positive for P.brasiliensis, three samples were positive for Cryptococcus spp. and one sample had coinfection by these two fungi. No sample was positive for Histoplasma spp. according to the molecular detection. Genetic sequencing allowed the identification of Fungal sp. in 89 samples, Cryptococcus neoformans in two samples and Aspergillus penicillioides in three samples. This study shows the importance of wild animals in the epidemiology of fungal infections and assists in the mapping of pathogen occurrence in a region that was not previously evaluated.

The phyllosphere as a little-known reservoir of the Fusarium genus, a fungi of importance to medical mycology

The phyllosphere is an ecological niche that includes the area of the leaf blade, which is a living environment for microorganisms of various taxonomic and trophic groups, including saprotrophic and phytopathogenic fungi. This study analysed the degree of colonisation of the phyllosphere of rush plants of selected bathing lakes by fungi of the Fusarium genus that are of significance to the etiology and epidemiology of fungal infections, and to toxicology and allergology. The research materials was plants of the littoral zone of Lakes Skanda and Kortowskie, which were subjected to a standard phytopathological assessment. The fungi obtained in macrocultures were used to prepare microscopic specimens required for the identification of morphological characteristics of the asexual and sexual stages. A total of 560 fungal isolates were obtained from the phyllosphere of nine plant species, of which 40 (7.14%) were fungi of the Fusarium genus. Most isolates were noted on Phragmites australis. Both macro- and microconidia of Fusarium were observed on this plant, while only macroconidia were observed on other plants. The results confirmed that the phyllosphere was an important reservoir of fungi that are potentially pathogenic to humans.

Potentially pathogenic fungi of the Candida genus isolated from the Łyna River – a 20-year study

This paper concerns part of a monitoring study and contains the results of 20-year observations on the species diversity and dynamics of the count Candida genus fungi which inhabit surface waters. The research material consisted of water samples collected from the Łyna River, the main river of the Warmińsko-Mazurskie Voivodeship, within the administrative boundaries of the city of Olsztyn. The samples were subjected to routine diagnostic testing applied in hydromycological studies. The obtained fungi isolates were determined, documented photographically and deposited in a strain collection of the Department of Microbiology and Mycology at the University of Warmia and Mazury in Olsztyn. A total of 23s of the Candida genus were isolated, including six species in the teleomorphic stage. It was noted that over the past decade, the taxonomic diversity of the fungi had increased significantly (from 2 to 23 species). Potential anthropopathogens had also emerged. Over the twenty-year period of observations, the species that were always isolated were Candida albicans and C. guilliermondii, characterised by high pathogenicity and bioindicative properties, which are important in the epidemiology of fungal infections.

Epidemiology of fungal infections in China.

With the increasing number of immunocompromised hosts, the epidemiological characteristics of fungal infections have undergone enormous changes worldwide, including in China. In this paper, we reviewed the existing data on mycosis across China to summarize available epidemiological profiles. We found that the general incidence of superficial fungal infections in China has been stable, but the incidence of tinea capitis has decreased and the transmission route has changed. By contrast, the overall incidence of invasive fungal infections has continued to rise. The occurrence of candidemia caused by Candida species other than C. albicans and including some uncommon Candida species has increased recently in China. Infections caused by Aspergillus have also propagated in recent years, particularly with the emergence of azole-resistant Aspergillus fumigatus. An increasing trend of cryptococcosis has been noted in China, with Cryptococcus neoformans var. grubii ST 5 genotype isolates as the predominant pathogen. Retrospective studies have suggested that the epidemiological characteristics of Pneumocystis pneumonia in China may be similar to those in other developing countries. Endemic fungal infections, such as sporotrichosis in Northeastern China, must arouse research, diagnostic, and treatment vigilance. Currently, the epidemiological data on mycosis in China are variable and fragmentary. Thus, a nationwide epidemiological research on fungal infections in China is an important need for improving the country's health.

(47) - Epidemiology of Fungal Infections (FI) in Mechanical Circulatory Support Device (MCSD) Recipients: Analysis of IMACS Registry 2013-2015

(47) - Epidemiology of Fungal Infections (FI) in Mechanical Circulatory Support Device (MCSD) Recipients: Analysis of IMACS Registry 2013-2015

Serious fungal infections in Korea.

Information on the incidence and prevalence of fungal infections is of critical value in public health policy. However, nationwide epidemiological data on fungal infections are scarce, due to a lack of surveillance and funding. The objective of this study was to estimate the disease burden of fungal infections in the Republic of Korea. An actuarial approach using a deterministic model was used for the estimation. Data on the number of populations at risk and the frequencies of fungal infections in those populations were obtained from national statistics reports and epidemiology papers. Approximately 1 million people were estimated to be affected by fungal infections every year. The burdens of candidemia (4.12 per 100,000), cryptococcal meningitis (0.09 per 100,000), and Pneumocystis pneumonia (0.51 per 100,000) in South Korea were estimated to be comparable to those in other countries. The prevalence of chronic pulmonary aspergillosis (22.4 per 100,000) was markedly high, probably due to the high burden of tuberculosis in Korea. The low burdens of allergic bronchopulmonary aspergillosis (56.9 per 100,000) and severe asthma with fungal sensitization (75.1 per 100,000) warrant further study. Oral candidiasis (539 per 100,000) was estimated to affect a much larger population than noted in previous studies. Our work provides valuable insight on the epidemiology of fungal infections; however, additional studies are needed.

Epidemiology of Fungal Infections in Patients Admitted via Emergency Department in Korea (2011~2013)

Epidemiology of Fungal Infections in Patients Admitted via Emergency Department in Korea (2011~2013)

Infecções fúngicas nosocomiais correlacionadas a Candida spp.: incidência e distribuição de espécies na região metropolitana do Rio de Janeiro

Candida sp. is the most frequently isolated fungal agent and associated with high morbidity and mortality rates in hospitalized patients. Although well-established, the epidemiology of infections has shown wide variation in relation to the region and the period studied. The objective of this study was to evaluate the incidence and distribution of Candida species in four cities in the metropolitan region of Rio de Janeiro state in the period from 2013 to 2014. A total of one hundred strains were recovered from different health facilities of the investigated areas. For the identification of isolates, phenotypic tests (micromorphology on CHROMagar, germ tube and chlamydospore production) and mass spectrometry (MALDI-TOF/MS) were used. Of all the isolates, 68,0% belonged to the Candida non-albicans group and 32,0% belonged to the Candida albicans specie. Regarding clinical specimens, 44,0% of the studied strains were isolated from urine samples, followed by blood culture (13,0%). In this study, the hospital sector with the highest fungal recovery rate was the Intensive Care Unit, with 40% of the isolates. Among the four evaluated regions, the city of Niteroi was the one with the highest percentage of isolation (52,0%). The comparison between the four identification methods demonstrated the effectiveness and prevalence of MALDI-TOF/MS technique for the diagnosis of Candida clinical isolates. The correct identification of the etiologic agents has direct impact on the epidemiology of fungal infections and consequently, on the management, control and treatment of hospitalized patients.

Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: A prospective surveillance study

Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: A prospective surveillance study

Epidemiology of fungal infections and risk factors in newborn patients

The incidence of fungal infections among newborn babies is increasing, owing mainly to the in­creased ability to care and make survive immature infants at higher specific risk for fungal infections. The risk is higher in infants with very low and extremely low birth weight, in babies receiving total parenteral nutrition, in neonates with limited barrier effect in the gut, or with central venous catheter or other devices where fungal biofilms can originate. Also neonates receiving broad spectrum antibiotics, born through caesarian section or non-breastfed can feature an increased, specific risk. Most fungal infections in neonatology occur in premature children, are of nosocomial origin, and are due to Candida species. Colonization is a preliminary step, and some factors must be considered for the diagnosis and grading process: the iso­lation site, the number of colonized sites, the intensity of colonization, and the Candida subspecies. The most complicated patients are at greater risk of fungal infections, and prophylaxis or pre-emptive therapy should often be considered. A consistent decisional tree in neonatology is yet to be defined, but some efforts have been made in order to identify characteristics that should guide the prophylaxis or treatment choices. A negative blood culture and the absence of symptoms aren’t enough to rule out the diagnosis of fungal infections in newborn babies. Similarly, laboratory tests have been validated only for adults. The clinical judgement is of utmost importance in the diagnostic process, and should take into account the presence of clinical signs of infection, of a severe clinical deterioration, as well as changes in some laboratory tests, and also the presence and characteristics of a pre-existing fungal colonization.