Frequency Of Fungal Infections Research Articles

Corticosteroids and invasive fungal infections in hospitalized COVID-19 patients – A single-center cross-sectional study

Background: During the coronavirus disease 2019 (COVID-19) epidemic, an increase in the incidence of fungal infections was observed. However, the real magnitude of these fungal infections and their risk factors among COVID-19 patients in the Indian population is unknown. Aim: To study the frequency, and spectrum of invasive fungal infections (IFI) among hospitalized COVID-19 patients, and the risk factors associated with invasive fungal infections. Methods: We performed a retrospective, cross-sectional study; including all adult patients, admitted to Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), a tertiary care hospital in Southern India between April 2020 and August 2021, with COVID-19. Based on clinical-radiological features, patients with fungal infections were grouped into three diagnostic categories. Demographics, clinical, and laboratory features of patients with fungal infections were analyzed to identify the risk factors. Results: About 10% (449 out of 4650) of the admitted patients with recent COVID-19, had some form of IFI. Among the patients with IFI, 80% (366 out of 449) were hospitalized for active COVID-19, whereas almost all the patients admitted with post-COVID complications had IFI. Of the 449 patients with IFI, 377 had mold infections and 88 had invasive candidiasis. Mucormycosis was the most common mold infection. Diabetes and diabetic ketoacidosis were strong independent predictors of IFI. We also found an association between end-stage renal disease, central venous catheterization, antibiotic usage, prior stroke, and corticosteroid therapy with IFI. Conclusions: The frequency of fungal infections among hospitalized COVID-19 patients was high. Special precautions in COVID-19 patients with diabetes mellitus, corticosteroid therapy, and prior antibiotic usage may help to reduce invasive fungal infections.

Treatment results of children with the diagnosis of acute myeloid leukemia. Is trisomy 21 an important cause of mortality?

Background: Acute myeloid leukemia (AML) is the second most common leukemia accounts for 20% of childhood leukemia. Intensive chemotherapy and hematopoietic stem cell transplantation (HSCT) improve outcomes. In this study, it was aimed to present the clinical features and treatment results of patients diagnosed with pediatric AML in the last three years. Methods: It is an observational clinical study, patients who received chemotherapy and HSCT with the diagnosis of AML between 2018 and 2020 were retrospectively evaluated. Age, gender, AML subtype, genetic characteristics, laboratory findings, treatment responses, febrile neutropenia and fungal infection frequencies of the patients were evaluated. HSCT indications, pre-transplant bone marrow aspiration results, transplant type, donor characteristics, and post-transplant complications of patients who underwent HSCT were recorded. Post-treatment status and treatment success rates of the patients were evaluated. Results: Of the 46 patients included in the study, 26 were female and 20 were male. The mean age was 8.2 ± 5.75 years. The most common subtypes were AML M4 and M5 with 9 patients. Total of 201 febrile neutropenia attacks were observed. Suspicious or definite proven Aspergillus infection was detected in 20 of the patients. HSCT was applied to 27 of the patients. Four patients were Down syndrome-myeloid leukemia (DS-ML) and FLT3-ITD mutation was detecetd in 5 patients. Conclusions: FLT3-ITD mutation, relapse disease, and pre-HSCT M2 bone marrow were found to be highly correlated with progressive disease and mortality. In addition, patients with Down syndrome had a high mortality due to additional comorbidity and drug adverse effects.

Distribution and antifungal resistance rate of yeast isolated from various samples

Objective: Yeast causes hospital-acquired infections at increasing rates, which can cause serious mortality, especially in patients with a suppressed immune system. This study aimed to determine the species distribution and antifungal resistance rates of yeast isolated in a hospital. Material and Methods: Isolated yeasts from clinical specimens of patients who received inpatient treatment in different clinics in our hospital between 1 December 2019 and 30 September 2020 were examined. In all of these isolates, species identification was made with an automated system in addition to classical methods. Additionally, the antifungal susceptibility of yeast against amphotericin B, flucytosine, Fluconazole, micafungin, caspofungin, and Voriconazole was investigated using an automated system. Results: In the study, yeasts isolated from 183 clinical samples, including 64 vagen, 62 blood, 28 urine, 12 wounds, eight tracheal aspirates, five peritoneal fluids, three catheters and one cerebrospinal fluid (CSF) samples were included. Of these isolates, 93 were Candida albicans (50,82%), 40 were Candida parapsilosis (21,86%), 17 were Candida tropicalis (9,29%), eight were Candida glabrata (4,37%), eight were Stephanoascus ciferrii (4,37%), five were Candida lusitaniae (2,19%), four were Candida famata (2,19%), four were Cryptococcus laurentii (2,19%) and four were Candida krusei ( 2,19%). Antifungal susceptibility testing was performed in 103 of the isolates. The highest resistance was found against Fluconazole, with 16.8%, and the lowest resistance was against flucytosine, with 2.2%. Antifungal resistance rates of Fluconazole, Voriconazole, amphotericin B, flucytosine, caspofungin and micafungin were found as 16.8%, 8.2%, 6.1%, 2.2%, 2.9% and 6.8% respectively. Conclusion: Due to the increasing frequency of fungal infections due to long-term hospitalization, it has been concluded that identifying the causative species and reporting the antifungal susceptibility status is important in monitoring the change in resistance rates and guiding the treatment.

Common Invasive Fungal Infection in Bangladesh and Available Management

Invasive fungal diseases are an important cause of mortality in immunocompromised patients and in patients with chronic illnesses. Multiple studies in Bangladesh have documented the frequency of fungal infections in our country and results varied. However, better understanding of the invasive fungal infection includes learning about the epidemiology, clinical features, and diagnostic method which is integral part of improving outcomes. In this review, we discuss the common invasive fungal infection that are prevalent in our country along with the clinical pictures, diagnosis, and treatment. It is hoped that this article will highlight the burden of fungal infections on public health and promote effective diagnosis and therapy. J Bangladesh Coll Phys Surg 2023; 41: 164-169

Antifungal Activity, Structural Stability, and Immunomodulatory Effects on Human Immune Cells of Defensin from the Lentil Lens culinaris.

An increase in the frequency of mycoses and spreading of multidrug-resistant fungal pathogens necessitates the search for new antifungal agents. Earlier, we isolated the novel defensin from lentil Lens culinaris seeds, designated as Lc-def, which inhibited the growth of phytopathogenic fungi. Here, we studied an antifungal activity of Lc-def against human pathogenic Candida species, structural stability of the defensin, and its immunomodulatory effects that may help to prevent fungal infection. We showed that Lc-def caused 50% growth inhibition of clinical isolates of Candida albicans, C. krusei, and C. glabrata at concentrations of 25–50 μM, but was not toxic to different human cells. The lentil defensin was resistant to proteolysis by C. albicans and was not cleaved during simulated gastroduodenal digestion. By using the multiplex xMAP assay, we showed for the first time for plant defensins that Lc-def increased the production of such essential for immunity to candidiasis pro-inflammatory cytokines as IL-12 and IL-17 at the concentration of 2 μM. Thus, we hypothesized that the lentil Lc-def and plant defensins in general may be effective in suppressing of mucocutaneous candidiasis due to their antifungal activity, high structural stability, and ability to activate a protective immune response.

β-Nitrostyrene derivatives as broad range potential antifungal agents targeting fungal cell wall

The prevalence of multidrug resistance has been increasingly witnessed during the past few decades. Resistance of human pathogenic fungi against the currently available antifungal agents has increased the frequency of fungal infections and associated mortality rates. The discovery of novel lead antifungal agents is important to challenge multidrug resistance. The present study examined the antifungal potential of chemically synthesized β-Nitrostyrene derivatives. Among the eight β-Nitrostyrene derivatives used in this study, SS45, SS46 and SS47 showed strong antifungal potential. The results show that β-Nitrostyrene derivatives inhibited the growth of different species of human pathogenic Candida, particularly the highly prevalent C. albicans, C. glabrata and the emerging pathogenic C. auris species. Moreover, β-Nitrostyrene derivatives also show strong antifungal activities against drug-resistant clinical isolates and drug transporter overexpressing fungal species. The drug susceptibility assays revealed that β-Nitrostyrene derivatives are fungicidal and show the synergy of action when combined with antifungal drugs caspofungin and fluconazole. The transcriptomic study performed on C. albicans in the presence of β-Nitrostyrene derivatives revealed the differential expression of genes related to cell wall metabolism. Mechanistically, β-Nitrostyrene derivatives impact cell wall morphology, enhance ROS generation and modulate drug efflux. Collectively this study reveals that β-Nitrostyrene derivatives have strong antifungal potential with a particular mode of activity similar to known cell wall perturbing antifungal agents and thus can be exploited as promising potential antifungal agents for further studies.

THE ROLE OF PROSTHODONTICS IN VARIOUS CLINICAL SCENARIOS OF MUCORMYCOSIS: A REVIEW ARTICLE

Coronavirus disease 2019 (COVID-19) is a new disease thing caused by a unique coronavirus (SARS-CoV-2) first documented in China in December 2019 and subsequently causing a worldwide pandemic. COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been sweeping across the globe. During the current pandemic of COVID-19, acountless of manifestations and complications have emerged and are being reported on. There is anincidence of patients with COVID-19 who are at increased risk of acute cardiac injury, arrhythmias, thromboembolic complications like pulmonary embolism and acute stroke), and secondary infection to name a few.The frequency of fungal infections is increasing due to immunodeficiency viruses and immunosuppressive drugs. Candidiasis is the most common fungal infection of the oral cavity.Mucormycosis is an invasive fungal infection, often acute and extremely severe, occurring in patients with an underlying condition. Mucormycosis isproduced by saprophytic fungi of the order Mucorales. The estimated prevalence of mucormycosis is about70 times greater in India than that in global data. Diabetes mellitus is the most common risk factor, followed by hematological malignancy and solid-organ transplant.

Differing rates of fungi in sinonasal cultures from pediatric sinusitis patients

ObjectivesPediatric chronic rhinosinusitis (PCRS) is a unique clinical entity and the underlying source of inflammation is unknown. Certain subgroups, such as children with nasal polyps and cystic fibrosis (CF) sinusitis are often recalcitrant to standard medical PCRS treatments that target bacterial inflammation. Fungal infection and allergy to fungal proteins drive inflammation in other airway diseases, resulting in chronic inflammation of both the upper and lower airways. However, there is limited understanding of the role of fungi in the pathophysiology of PCRS. The objective of this study is to define the frequency of fungal infection in pediatric CRS patients, hypothesizing that certain subgroups may have more frequent positive fungal sinus cultures than other subgroups of pediatric sinusitis. MethodsRetrospective study of patients undergoing sinus surgery at a tertiary care pediatric hospital to determine the period prevalence of positive fungal cultures in subgroups of patients. Results400 children from 2012 to 2019 were included. 265 patients had surgical culture results available. Of the 52 patients with CF 11 (21%) had positive fungal sinus cultures. Similarly, 28% of the 25 patients with non-CF nasal polyps had positive cultures. Only 8.2% of 110 CRS without polyps patients had positive cultures, significantly fewer than other subgroups (X2 (1, N = 240) = 17.22, p < 0.01). ConclusionChildren with CF and children with nasal polyps had more frequent positive fungal cultures than children without nasal polyps having sinus surgery. This confirms that pediatric CF and pediatric CRS with polyps represent unique populations to study the impact of fungal infection in CRS. Further research is required to determine if these fungi represent colonization or contribute to the inflammatory environment of the airways.

Antimycotic Drugs and their Mechanisms of Resistance to Candida Species

Fungal infections have shown an upsurge in recent decades, which is mainly because of the increasing number of immunocompromised patients and the occurrence of invasive candidiasis has been found to be 7-15 fold greater than that of invasive aspergillosis. The genus Candida comprises more than 150 distinct species, however, only a few of them are found to be pathogenic to humans. Mortality rates of Candida species are found to be around 45% and the reasons for this intensified mortality are inefficient diagnostic techniques and unfitting initial treatment strategies. There are only a few antifungal drug classes that are employed for the remedy of invasive fungal infections. which include azoles, polyenes, echinocandins, and pyrimidine analogs. During the last 2-3 decades, the usage of antifungal drugs has increased several folds due to which the reports of escalating antifungal drug resistance have also been recorded. The resistance is mostly to the triazole- based compounds. Due to the occurrence of antifungal drug resistance, the success rates of treatment have been reduced as well as major changes have been observed in the frequency of fungal infections. In this review, we have summarized the major molecular mechanisms for the development of antifungal drug resistance.

Fungal Urinary Tract Infection; A Study Conducted On Patients With Liver Cirrhosis

Objective: To determine frequency of fungal infection of urinary tract in patients with liver cirrhosis Design &amp; duration: This is a cross sectional study. This study was completed in duration of six months. Setting: Study was conducted in Margalla Hospital Gulshan Colony PMO, Taxila. Patients &amp; Methods: Patients admitted in study hospital with liver cirrhosis having child class A, B and C were evaluated for fungal urinary tract infection, belonging to any gender, having age above 40 years. All data was documented and analyzed using SPSS software version-20 and means, frequencies, standard deviation and p-value were calculated. Results presented in the form of tables and graphs. Results: Total 400 cases were evaluated for fungal urinary tract infection having liver cirrhosis admitted in study hospital in given duration of study. Fungal cause of UTI was found in 260 cases including 29.3% male and 70.7% female cases. While other causes were found in 140 cases. According to child classification out of 260 cases with fungal UTI, 11 cases were in class B and 249 cases were in class-C while no case belonged to class-A. Most of the cases (42%) with UTI were in age interval of 40-50 years. Duration of CLD was 2-4 years in most of the cases (30%). Conclusion: Fungal cause of urinary tract infection is very common among patients with liver cirrhosis and older age as these cases have week immunity Key words: Liver cirrhosis, chronic liver disease, urinary tract infection, fungal infection, immunocompromised

Inhibitory Property of Poly (AN-co-VP) Copolymer on Some Dermatophyte Fungi and Yeasts that Cause Fungal Infections

In recent years, the high frequency of fungal infections originating from Candida and dermatophyte strains has accelerated treatment attempts. Antimicrobial susceptibility test for poly (AN-co-VP) / copolymer, which we think could be an ideal drug in treatment interventions was evaluated with disk diffusion method and minimum inhibitor concentration. In the antimicrobial measurement data, it was determined that the poly (AN-co-VP) / coolymer dissolved in pure water is an significant inhibitory property against the growth of yeast (on Candida spp. with 11.33 ± 0.3 mm barrier area) and dermatophyte fungi (on Epidermophyton sp. and Trichophyton sp. with 12.33 ± 0.3 mm barrier area) (p

Dermatophyte infections in children compared to adults in Germany: a retrospective multicenter study in Germany.

Dermatophyte infections of the skin and nails are common worldwide and vary between geographical areas and over time. The aim of this study was to determine the epidemiological profile of dermatophytes in Germany with a focus on comparing children with adults. In this retrospective multicenter study, mycological dermatophyte culture results in the period 01/2014 to 12/2016 were analyzed according to identified pathogen, age and gender of patients, and type of disease. Of 1,136 infections (children: n=88, adults: n=1,048), 50.8% were clinically classified as onychomycosis, followed by tinea pedis (34.6%), tinea corporis (16.2%), tinea manus (16.2%), tinea capitis (2.5%), and tinea faciei (1.2%). The most frequent pathogen was Trichophyton (T.) rubrum (78.6%), followed by T.interdigitale (14.3%), T.benhamiae (3.2%), T.mentagrophytes (2.1%), and Microsporum canis (1.7%). The fungal spectrum differed particularly in tinea corporis and tinea capitis between children and adults with a more diverse pathogen spectrum in children. Trichophyton tonsurans was rarely identified as cause for tinea corporis (2.7%) or tinea capitis (3.3%). Differences in pathogens and frequency of fungal infections between age groups should be considered for optimal selection of the appropriate therapeutic regimen.

Fungal Infections of Oral Cavity: Diagnosis, Management, and Association with COVID-19.

The frequency of fungal infections is increasing due to immunodeficiency viruses and immunosuppressive drugs. The most common fungal infection of the oral cavity is candidiasis. The existence of Candida can be a part of normal commensal; hence, the isolation of Candida in the absence of clinical symptoms should exclude candidiasis. The pathogenicity of Candida is witnessed as opportunistic when immune status is compromised. Oral fungal infections are uncommon, but when identified, these infections are associated with greater discomfort and are sometimes destruction of tissues. Cytology and tissue biopsy are helpful in confirming the clinical diagnosis. The management of oral fungal infections must strategically focus on signs, symptoms, and culture reports. This article reviews information on diagnosis and therapeutic management of aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, mucormycosis, and geotrichosis.

Fungal infections of the feet in patients with erysipelas of the lower limb: is it a significant clinical problem?

Erysipelas is a bacterial infection of the superficial layers of the skin usually caused by Group A Streptococci, often seen in clinical practice. Fungal infections of the feet and elderly age are some of the most significant risk factors for the infection. The aim of the study was to evaluate the frequency of fungal infections from different regions of the feet in patients with erysipelas. 56 patients with clinically diagnosed erysipelas and 56 healthy individuals were clinically examined and tested for fungal infection in three locations: toenails, interdigital space, and soles. The collected samples were evaluated under a microscope and then mycological cultures on Sabouraud's medium were prepared. After 4weeks of incubation, the cultures were analysed with the identification of particular pathogens. 42.9% (24/56) of the patients with erysipelas had positive mycological cultures. Toenails and interdigital spaces (both 62.5%) were the most frequently affected areas, followed by soles (37.5%). The most common pathogen was T. rubrum (43.18%), followed by Candida spp. (27.27%), and T. mentagrophytes var.interdigitale (13.63%). Only 14.3% (8/56) of the samples taken from the control group were positive and T.rubrum was the only type of fungus cultured. Fungal infections of the feet are important risk factors for the first episode as well as recurrent erysipelas. Prevention and early treatment of fungal infections, especially in elderly people, can significantly reduce the incidence of erysipelas.

Increasing Susceptibility of Drug-Resistant Candida albicans to Fluconazole and Terbinafine by 2(5H)-Furanone Derivative.

The frequency of mycoses caused by drug-resistant fungal pathogen Candida albicans has increased drastically over the last two decades. The spread of drug-resistant strains, along with the limitations of currently available antifungals, complicates the management of fungal infections, thereby representing great challenges for clinical healthcare. Among various antimicrobial pharmacophores, 2(5H)-furanone derivatives have demonstrated antimicrobial, antifungal, and antibiofilm activities. In this study, we report the antifungal activity of the 2(5H)-furanone derivative F105, consisting of three pharmacophores, namely chlorinated 2(5H)-furanone, sulfonyl group, and l-menthol moiety. Although exhibiting moderate antifungal activity alone with the minimum inhibitory concentration (MIC) values of 32–256 μg/mL, F105 potentiates the activity of fluconazole and terbinafine with fractional inhibitory concentration index (FICI) values of 0.27–0.50. Thus, 16 μg/mL of F105 reduced the MICs of these antifungals against fluconazole-resistant C. albicans isolates four-fold, achieving similar values as for the intermediately susceptible phenotype. Confocal laser scanning microscopy revealed that the fluorescent 2(5H)-furanone derivative F145 was also able to penetrate through biofilms formed by C. albicans. Indeed, in the presence of F105, even sub-MIC concentrations of both fluconazole and terbinafine led to significant reduction of C. albicans CFUs in the mature biofilm. Thus, F105 appears to be a promising candidate for the development of novel antifungal agents as well as enhancers of current antifungal agents, particularly for the treatment of drug-resistant C. albicans infections.

Frequency of fungal infections in nasal polypi.

Objectives: Determine the frequency of fungal infections in nasal polypi. Study Design: Cross sectional study. Setting: Histopathology Department at Shaikh Zayed Hospital Lahore. Period: Six months from 12/2/2015 to 12/8/2015. Material &amp; Methods: Two hundred surgical resections/biopsies using 95% confidence level, with 7% margin of error were collected. Formalin fixed specimens of patients of both genders and 10- 60 years of age with nasal polyps received after surgical procedure in department of ENT. Grossing and processing was done. Hematoxyin &amp; Eosin stained sections were examined by two consultant Histopathologists independently. The presence of fungal hyphae was confirmed by PAS and Silver stains. The study was approved by College of Physicians &amp; Surgeons Pakistan. All the data was entered and analyzed by using SPSS version 20. Results: Out of 200 patients all the patients showed the prescence of inflammatory cells in polyps (100%) with predominantly eosinophils in their submucosa (82%). Fungus was present in 48 cases (24%) most of them were in the age group of 42-57 years (13%) and 31(15.5%) patients having BMI &lt;30 and 17(8.5%) having BMI &gt;30 were positive for fungus.30 cases were of Aspergillus (62.5%) and rest 8 were of Mucor (37.5%). The fungus positive cases were more in males (13.5%). 160 of the cases were of unilateral polyps (80%) and 40 were of bilateral polypi (20%). Only 8% of the patients having diabetes had fungal infection. Conclusion: Hence, the frequency of fungal infection in nasal polypi is low with Aspergillus being the commonest pathogen affecting males predominantly.

Survival Benefits from Antifungal Prophylaxis and a Dedicated Inpatient Malignant Hematology Service during Induction Chemotherapy for Acute Myeloid Leukemia

Introduction: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in patients undergoing induction chemotherapy for acute myeloid leukemia (AML). During induction chemotherapy for AML patients, antifungal prophylaxis (AP) has been associated with a decreased incidence of IFIs and increased survival. However, some centers do not use AP, as it is unclear whether it improves outcomes in settings where the incidence of IFIs is low (&amp;lt;8% of mold infections), as at our center. We retrospectively assessed the differences in clinical outcomes and resource utilization in patients undergoing induction chemotherapy for AML before and after implementation of an AP policy and a dedicated inpatient malignant hematology service at our institution. Methods: AML patients ≥18 years of age who underwent induction chemotherapy between 1/1/07 and 4/1/19 were identified by pharmacy records. Data was verified and extracted by two members of the research team. Primary endpoints were in-hospital mortality during induction chemotherapy and rates of fungal infections within 90-days after induction. Secondary endpoints were 30-day post induction and 90-day post-discharge survival, rates of proven/probable IFI by application of the Mycoses Study Group definitions, diagnostic resource utilization and tolerability. Categorical variables were compared with x2 or Fisher's exact tests and continuous variables with independent samples t-test or the non-parametric Mann-Whitney test as appropriate. Post-induction survival was also analyzed with Kaplan-Meier (KM) curves. Results: 108 adult AML patients were retrospectively reviewed. Fifty-six received AP during induction and 52 did not, without significant differences in demographic or leukemia-specific factors. AP was associated with numerically less fungal infections (9/56 (16%) vs. 14/52 (27%), P=0.169) and proven/probable IFIs (3/52 (6%) vs. 0/56, P=0.1). AP was also associated with lower in-hospital (11/52 (21%) vs. 4/56 (7%), P=0.035) mortality. Clinicians obtained more electrocardiograms (median 4 vs. 1.5, P&amp;lt;0.001) in the AP group; otherwise, there were no significant differences in the number of imaging studies, bronchoscopies, blood cultures, β-D-glucan and Aspergillus galactomannan tests, or adverse events, specifically clinically significant QT prolongation, nephrotoxicity or hepatotoxicity. Antifungals were more likely to be started in the non-prophylaxis group (36/52 (69%)) than changed in the prophylaxis group (23/56 (41%), P=0.003). Implementation of a dedicated inpatient malignant hematology service led to standardization of practices including AP (24/76 (32%) vs. 32/32 (100%), P&amp;lt;0.001) and was associated with significantly lower in-hospital (14/76 (18%) vs. 1/32 (3%), P=0.036) and 90-day post-discharge (16/71 (23%) vs. 1/29 (3%), P=0.021) mortality. Before implementation of this service, AP was associated with numerically lower in-hospital mortality during induction (3/24 (13%) vs. 11/52 (21%), P=0.366), and significantly improved 30-day post-induction survival (Fig. 1, log-rank P=0.042). Conclusions: In a setting where mold infections are rare, AP in patients undergoing induction chemotherapy for AML was associated with improved survival, empiric or targeted antifungal treatment, and a signal for decreased frequency of fungal infections, without substantial increases in utilization of diagnostic resources. This study is limited in its single-center retrospective study design, the overall small number of patients, and is confounded by simultaneous changes in practice, especially with the implementation of a dedicated malignant hematology service. Notably however there was improved 30-day mortality in patients on AP versus those not on AP prior to the implementation of the malignant hematology service. Our findings indicate that outcomes are optimized when adult patients with AML receive their care by a dedicated malignant hematology team, with implications for low-volume institutions and community practices, where AML inductions are not always performed under the care of malignant hematology specialists. Our results suggest that AP and admitting or transferring adult AML patients to a center with a dedicated malignant hematology service, when feasible, may lead to better outcomes. Figure 1 Disclosures Farmakiotis: Astellas: Research Funding; Viracor-Eurofins: Consultancy, Research Funding.

Estimated Burden of Fungal Infections in Namibia.

Namibia is a sub-Saharan country with one of the highest HIV infection rates in the world. Although care and support services are available that cater for opportunistic infections related to HIV, the main focus is narrow and predominantly aimed at tuberculosis. We aimed to estimate the burden of serious fungal infections in Namibia, currently unknown, based on the size of the population at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports. When no data existed, risk populations were used to estimate the frequencies of fungal infections, using the previously described methodology. The population of Namibia in 2011 was estimated at 2,459,000 and 37% were children. Among approximately 516,390 adult women, recurrent vulvovaginal candidiasis (≥4 episodes /year) is estimated to occur in 37,390 (3003/100,000 females). Using a low international average rate of 5/100,000, we estimated 125 cases of candidemia, and 19 patients with intra-abdominal candidiasis. Among survivors of pulmonary tuberculosis (TB) in Namibia 2017, 112 new cases of chronic pulmonary aspergillosis (CPA) are likely, a prevalence of 354 post-TB and a total prevalence estimate of 453 CPA patients in all. Asthma affects 11.2% of adults, 178,483 people, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) were estimated in approximately 179/100,000 and 237/100,000 people, respectively. Invasive aspergillosis (IA) is estimated to affect 15 patients following leukaemia therapy, and an estimated 0.13% patients admitted to hospital with chronic obstructive pulmonary disease (COPD) (259) and 4% of HIV-related deaths (108) — a total of 383 people. The total HIV-infected population is estimated at 200,000, with 32,371 not on antiretroviral therapy (ART). Among HIV-infected patients, 543 cases of cryptococcal meningitis and 836 cases of Pneumocystis pneumonia are estimated each year. Tinea capitis infections were estimated at 53,784 cases, and mucormycosis at five cases. Data were missing for fungal keratitis and skin neglected fungal tropical diseases such as mycetoma. The present study indicates that approximately 5% of the Namibian population is affected by fungal infections. This study is not an epidemiological study—it illustrates estimates based on assumptions derived from similar studies. The estimates are incomplete and need further epidemiological and diagnostic studies to corroborate, amend them, and improve the diagnosis and management of these diseases.

Infectious profile in children with ALL during chemotherapy: A report of study group for infections

IntroductionThe treatment-related mortality in currently published studies of acute lymphoblastic leukemia (ALL) in children is 2–4%, mainly due to infections. The aim of the study was to analyse the incidence, epidemiology, profile of infection and the death rate in children with ALL. Patients and methodsThe retrospective analysis included 1363 patients, aged 1–18 years, with newly diagnosed ALL, who were treated in 17 pediatric hematology centers between 2012 and 2017 in Poland. The patients received therapy according to the ALL IC-BFM 2002 and 2009 (International Berlin-Frankfurt-Munster Study Group) protocols. ResultsIn our study, 726 out of 1363 (53.2%) children were reported to have a microbiologically documented bacterial infection during chemotherapy. 1511 episodes of these infection were diagnosed. A total number of 251/1363 (18.4%) children experienced a viral infection. 304 episodes were documented by PCR test (polymerase chain reaction). A fungal infection was reported in 278 (20.4%) children, including 10.1% of probable, 6.0% of proven, 83% of possible diagnosis. A higher frequency of fungal infection was noted in the recent years. In our material, the rate of death was 2.4%, mainly due to fungal infection. ConclusionsOur results present the epidemiology of infectious disease in the Polish ALL patient population. The most frequent were bacterial infections, followed by fungal and viral ones. Similar to the previously published data, the mortality rate in our material was 2.4%.

Identification and in Vitro Susceptibility Pattern of Fungal Pathogens in Immunocomprimised Patients with Pulmonary Fungal Infections

AbstractBackground: The frequency of fungal infections of the lung has increased particularly in immunocompromised pa-tients. Early diagnosis and treatment is important to start antifungal therapy and to avoid unnecessary use of toxic antifungal agents. This study aimed to identify the common fungal species causing pulmonary infection in immunocom-promised patients and their in vitro antifungal sensitivity pattern in Assiut University Hospitals (AUH).Subjects and Methods: This was a hospital based descrip-tive study conducted on 135 patients admitted at different Intensive Care Units (ICUs) and Oncology Department at Assiut University Hospitals (AUH). Collected respiratory specimens were subjected to direct microscopic examination and inoculation on Sabouraud Dextrose Agar (SDA). Identi-fication of isolated yeasts was done using phenotypic methods including chromogenic media (Brilliance Candida agar and CHROMagar Candida differential media), germ tube test, cornmeal agar and API candida while mould isolates identifi-cation was mainly dependent on macroscopic and microscopic features. Some isolates had confirmed using rRNA gene sequencing. In vitro antifungal susceptibility testing was done using disc diffusion method.Results: In this study 80/135 (59.3%) of collected samples were positive for fungal infection. The most common fungal pathogens isolated were Candida and Aspergillus species. In vitro sensitivity test showed that the yeast isolates had the highest sensitivity to Nystatin (90.9%) followed by Ampho-tericin B (80.3%) while for mould isolates, the highest sensi-tivity was to Voriconazole (71.4%) followed by Amphotericin B (57.1%).Conclusion: Pulmonary fungal infection appears to be an important problem in immunocomprimised patients with Candida albicans was the most commonly isolated yeast from various clinical specimens; also the increase in the resistance especially to azoles is a major concern.