Frequency Of Fungal Infections Research Articles

Grzybice zatok przynosowych leczone metodą endoskopową w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Białymstoku

Over the last years we have observed a high frequency of fungal infections of the paranasal sinuses. Fungal infections can be grouped into invasive and non-invasive forms. Surgical removal of the sinus fungal masses to ensure drainage and aeration is performed using the endoscopic sinus surgery. General or local antifungal drugs are not indicated in the cases of non-invasive forms. For the treatment of invasive fungal sinusitis aggressive antifungal therapy and surgical treatment are the mainstays of management. The treatment results of 18 patients suffering from fungal infections of the paranasal sinuses operated endoscopically during 4 years period (2006-2009) in Otolaryngology Department of Medical University in Białystok were presented.

Infections after the use of alemtuzumab in solid organ transplant recipients: a comparative study

We undertook a retrospective cohort study comparing infection in solid organ transplant recipients receiving alemtuzumab ( n = 726) versus basiliximab ( n = 215) or antithymocyte globulin (ATG) ( n = 85). Eighty-one percent of patients had kidney transplants. Overall, 33% of patients in the alemtuzumab group (240/724) developed infection compared with 40% (87/215) in the basiliximab group (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.53–0.99; P = .04). The frequency of infection was similar in the alemtuzumab and ATG groups (33% versus 36%, respectively, P = .53). The frequency of fungal infections, most caused by Candida spp., was similar in the alemtuzumab and basiliximab groups (10% versus 9%); disseminated fungal infection occurred in 68% of the patients with fungal infection receiving alemtuzumab and in 30% of the patients with fungal infection receiving basiliximab (OR, 4.76; 95% CI, 1.58–14.28; P = .003). Basiliximab posed a higher risk than alemtuzumab for infection. Disseminated candidal infections were more common in patients receiving alemtuzumab.

Microbial profile and drug resistance ofCandidastrains isolated from the blood of children: an 11‐year study

The latest observations indicate a continuous increase in the frequency of fungal infections, particularly in hospital patients, accompanied by changes in both the profile of the isolated strains and their drug susceptibility. The objective of this study was to evaluate the trend in the incidence of candidaemia and susceptibility of antifungal drugs in the Polish Mother's Memorial Hospital over an 11-year period. Blood samples taken from the hospitalised children were sent to the Department of Clinical Microbiology for diagnostic purposes. A total of 195 Candida strains were isolated: 47.7%Candida albicans and 52.3% non-albicans. Candida parapsilosis was isolated in 65.7% of non-albicans strains. The prevalence of Candida spp. decreased from 16.9-20.5% in the years 1996-1997 to 3.1-2.1% in the years 2005-2006. In the years 2000-2005, non-albicans strains were more prevalent. All C. albicans strains were susceptible to amphotericin B, 2.94% of non-C. albicans strains were semisusceptible to amphotericin B, 98.92% of C. albicans and 85.29% of non-albicans strains were susceptible to 5-fluorocytosine. Candida spp. strains are predominant pathogens in fungaemia in children in our hospital. Over the last few years,C. albicans have been replaced by non-albicans strains (predominantly C. parapsilosis), which exhibit a higher level of drug resistance. The number of Candida spp. isolated from blood decreased during the 11-year study.

Long-time storage effect on the seed health of spring barley grains

Long-time storage effect on the seed health of spring barley grains Seeds of 5 cultivars of spring barley, originated from field experiments conducted in 2000 at Radzików, were tested immediately after harvest and after three, four and five years of storage in uncontrolled conditions, for incidence of seed-borne fungi with special regard to "field fungi" (Bipolaris sorokiniana and Fusarium spp.) and "storage fungi" (species of Penicillium and Aspergillus). The studies showed that barley seeds were infected before storage by numerous fungi as well as the saprophytes: Alternaria alternata, Acremonium spp,Acremoniella atra and the pathogens: Bipolaris sorokiniana and ten Fusarium species. The analysis after storage showed that the frequency of fungal infection had changed. The occurrence of some fungi was significantly affected by the period of storage. An increase of infection by species of Penicillium and Aspergillus known as "storage fungi" was detected on seeds after storage, especially after four years. At the same time, isolation of species of Fusarium and Bipolaris sorokiniana from these seeds decreased. Differences in number of ‘field’ and ‘storage’ fungi were found in dependence on period of storage, also. The smallest infection by Bipolaris sorokiniana and Fusarium was observed on seed after five years of storage.

Trend Reversal in the Frequency of Mycoses in Hematological Neoplasias

Fungal infections of internal organs are a major complication for patients with hematological neoplasias. For more than 20 years, the frequency of such mycoses has been increasing with the aggressiveness of tumor treatment. Autopsy findings over a 30-year period (1976 to 2005) from a single institution (Institute of Pathology, University of Essen) were retrospectively classified according to basic disease, frequency of mycoses, kind of mycoses, organs involved, hematopoietic transplantation, and cause of death. 340 of 1591 autopsied patients with hematological neoplasias (21.4%) revealed an invasive mycosis. The proportion increased from about 10% before 1980 to some 30% in the 1990s but fell to 21% by 2005. The frequency of mycoses decreased significantly both for transplanted patients (from 47.5% to 30.3%) and for non-transplanted patients (from 29.8% to 16.4%). The rate of deaths due to mycosis also decreased. The relative frequency of candidal mycoses went down, while aspergilloses predominated. The organ most frequently involved was the lung. The autopsy results signal a trend reversal in the leading complication of the treatment of hematological neoplasias and lend support to the assumption that antimycotic strategies are having a positive effect.

Nail changes due to docetaxel—a neglected side effect and nuisance for the patient

The objective of this study is to estimate the frequency and severity of nail changes due to treatment with the cytotoxic drug docetaxel and, secondly, to estimate how the nail changes effects the patients cosmetically and functionally in their daily activities. Finally, we want to clarify whether fungal infection could contribute in causing the nail changes. Fifty-five patients with metastatic breast cancer in treatment with the cytotoxic drug docetaxel participated in the study. They filled out two questionnaires about their experience with possible nail changes. The frequency of fungal infection was examined. At each of the two visits, information about the number of treatment cycles, dose of docetaxel the patient received, frequency of lymph oedema, previous treatment with chemotherapy and the reason of discontinuance of treatment, if relevant, were registered. Finally, photos were taken to document the nail changes in hands and feet. Fifty-eight percent had some degree of nail changes and an increase to 88.5% was seen after three additional cycles. A large proportion of the patients experienced the nail changes as a cosmetic nuisance, and more than 32% had functional problems. Nail changes occur more frequently than previous studies have shown. Furthermore, our study indicates that the nail changes are affecting a large proportion of the patients, both cosmetically and functionally, which may lead to a decrease in their quality of life. No significant association was found according to the possible relation between nail changes and fungal infection.

Pathobiology of fungal infections of the central nervous system with special reference to the Indian scenario

Ubiquitously present fungi in the environment find a nidus in the human body and adopt its metabolic machinery to be in symbiosis or become pathogenic. Immunocompromised states like human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS), systemic neoplasia and organ transplantation have enhanced the frequency of fungal infections. High-risk behavior, IV drug abuse and air travel have led to the emergence of new fungal infections hitherto geographically localized. The pathology in the central nervous system (CNS) is dictated largely by the size of the fungus - the yeast forms, by virtue of their small size enter the microcirculation to cause meningitis and microabscesses, while hyphal forms invade the vasculature to manifest as large pale or hemorrhagic infarcts. The growth kinetics of fungi, the antigenic character of the capsule. the proteases secreted by the mycelial forms and the biochemical milieu in the host also determine clinical manifestations. A hospital-based analysis of the available information from India suggests that in the non-HIV patient population, hyphal forms like Aspergillosis and Zygomycosis are the most common pathogens, while yeast forms like Cryptococcus and Candida are the prime pathogens in cases of HIV/AIDS, the altered macrophage function acting in synergy with suppressed cell-mediated immunity. In Northeastern states, systemic infection by Penicillium marneffei is reported in association with HIV though CNS involvement is not recorded. Although fungal infections of the CNS are reported from various hospitals in India, studies are limited by non-availability of relevant microbiological studies and the reported prevalence data is biased by the surgical practices, availability of postmortem and microbiology and laboratory support. Detailed clinical and mycological investigations related to the interaction between the fungus and host environment is a fertile area of research to understand the basic pathogenetic mechanisms.

Interactions médicamenteuses des antifongiques systémiques

The increasing frequency of fungal infections in the human body, notably with emerging agents, has been a serious concern for those studying the evolution of pathological infections over the past two decades. Serious fatality rates and the morbid nature of these fungal infections are their primary characteristics. AS a result of this situation, new effective drugs and even a new class of fungicides have recently been added to the arsenal of antifungal treatments. These antifungal agents vary in their pharmacokinetic characteristics, their spectrum and their interactions with other medications. This is especially important as patients receiving these medications are at risk because they often receive a combination of therapies. The treating clinician must decide which combination of drugs is most suitable for his patient's clinical situation by taking into account all possible interactions of these medications. The authors consequently envisage a summary of drug interactions between the most commonly used antifungal medications, with an emphasis on newly available drugs.

Efficacy of Fluconazole Prophylaxis for Autologous Peripheral Blood Stem Cell Transplantation: Results of a Prospective, Randomized, Controlled, Multicenter, Open Label Study.

Infection is the leading cause of morbidity and mortality among hematopoietic stem cell transplant (HSCT) recipients. Fungal infection is particularly a threat because of difficulty in both diagnosis and treatment. The frequency of fungal infection is largely dependent on the mode of transplantation and duration of neutropenia. While fluconazole prophylaxis in allogeneic and autologous BMT is well studied, a trial in autologous PBSCT is lacking.Methods: The Texas Stem Cell Transplant Consortium initiated a phase III randomized study to evaluate the efficacy of fluconazole for prophylaxis of invasive fungal infections (IFI) following autologous PBSCT with an initial planned enrollment of 150 patients. Patients were randomized to receive either no prophylaxis or fluconazole 400mg/day (or 12mg/kg if <18 years of age) beginning on the day of stem cell re-infusion. The prophylaxis phase continued until the post-nadir absolute neutrophil count (ANC) reached 1000/μL or until the patient developed an IFI according to criteria developed by the IFI Cooperative Group of the EORTC. Primary endpoints measured included the comparative incidence of proven, probable or possible IFI through engraftment and through day 100 post-transplantation and IFI-related mortality through day 100. Overall survival and the comparative incidence of superficial fungal infection were also analyzed.Results: Thirty patients have been enrolled to date (16 fluconazole, 14 without prophylaxis). The median stem cell dose received was 3.5 million CD34+ cells/kg for patients randomized to fluconazole versus 6.2 million CD34+ cells/kg for those that did not receive antifungal prophylaxis. The median duration of neutropenia, defined as an ANC <1000/μL, was 7.5 days versus 7 days with a median duration of fever ≥100.5°F of 2 days and 2.5 days respectively. Superficial fungal infection developed in none of the patients that received fluconazole versus 31.3% of patients that did not receive antifungal prophylaxis. Additionally, the incidence of proven IFI was 0% in the fluconazole group versus 18.8% in those that did not receive prophylaxis and mortality due to proven IFI was 0% and 16.7% respectively. Although the small numbers do not allow for statistical comparison, the study was terminated early as a result of the high incidence of IFI and IFI-related mortality in the patients randomized to receive no anti-fungal prophylaxis.Conclusion: Results of this study suggest that fluconazole prophylaxis should be provided as standard of care in patients following autologous PBSCT.

Frequency of mycoses in autopsy material

Pituicytoma is a rare low-grade tumor (WHO Grade I) of pituicytes involving the sellar–suprasellar region, and originating from the specialized glial cells of the neurohypophysis. Clinically and radiologically, they closely mimic pituitary adenoma or meningioma. Diagnosis requires histopathological examination of the resected tissue. This uncommon glial neoplasm is a rarity, with only 57 cases reported in the literature so far. We report three cases of pituicytoma (aged between 7 and 24 years) presenting with reduced vision, headache and features of hypercortisolism in one case. Radiologically, these lesions mimicked meningioma, hypothalamic chiasmatic glioma and pituitary microadenoma, respectively. The second case is a 7-year-old girl, the youngest case on record. Since this tumor is uncommon, it is frequently misdiagnosed. Awareness of this entity is essential for planning management and treatment. We present a brief review of all cases reported in the medical literature, and describe the clinical symptomatology, associated endocrinological abnormalities, imaging characteristics, behavior and outcome.

In Vitro Antifungal Susceptibility Testing

With the rising frequency of fungal infections, as well as increasing reports of resistance to antifungal agents, it is imperative that clinically applicable antifungal susceptibility testing be available. In 1997 the National Committee for Clinical Laboratory Standards published standard guidelines for antifungal susceptibility testing of Candida sp and Cryptococcus neoformans with amphotericin B, flucytosine, fluconazole, itraconazole, and ketoconazole. Although the methods are standard, they are time consuming, can be difficult to interpret, and are approved only for testing limited organisms and drugs. Modifications to the methods and alternative approaches have been proposed to make these tests more convenient and efficient, applicable to a greater number of species, and appropriate for performing in the clinical laboratory.

Fungal pneumonia

Concomitant with advances in medicine, involving the development and use of antibiotics, immunosuppressive drugs, organ/stem cell transplantation and pre-existing illnesses such as AIDS, the frequency of fungal infection has increased dramatically. These factors determine the susceptibility of the lung for an acute or chronic course of disease. Early detection, characterisation and follow-up of the pulmonary infiltrates is the major task of the radiologist. The correct timing to perform an investigation and adequate technique are an additional essential factor in this setting. Furthermore, radiological procedures support the clinicians in identifying the underlying micro-organism. The radiologist can suggest which micro-organism might cause the infiltrate. Certain findings and patterns can point to a specific causative agent, but experience, local epidemiology and clinical information are necessary for the differential diagnosis of infiltrates in long-term immunocompromised hosts. In addition, radiological techniques are useful in guiding interventions for identification of the underlying micro-organism or for therapeutical procedures. This review summarises useful radiological information of appearance and complications of fungal pneumonia.

TRUE MYCOTIC ARTERITIS BY CANDIDA ALBICANS IN 2 KIDNEY TRANSPLANT RECIPIENTS FROM THE SAME DONOR

Although the frequency of fungal infections in kidney transplant recipients has decreased in the last 2 decades, candidal infection is still a major nonimmunological cause of graft rejection and transplant nephrectomy. We report on 2 patients with candidal arteritis, which evolved into a “true” mycotic aneurysm in one and an external iliac artery rupture in the other. Both patients received a kidney from the same donor. To our knowledge we report the first cases of candidal arteritis in 2 kidney transplant recipients.

Changes in pathological findings at autopsy in AIDS cases for the last 15 years

To analyze changes in frequency of systemic AIDS pathology over time and its relationship to central nervous system pathology. A total of 390 AIDS autopsy cases obtained at University of California at San Diego Medical Center from 1982 to 1998 were reviewed retrospectively and linear regression analysis was used to evaluate significance of changes over time. Overall, the frequency of cytomegalovirus, Pneumocystis carinii pneumonia and Mycobacterium avium complex decreased, whereas bacterial infections increased and the frequency of fungal infection remained unchanged over time. The frequency of non-Hodgkin's lymphoma showed an upward trend over time, while the frequency of Kaposi's sarcoma remained unchanged. Following involvement of the lung (84%), the brain continued to be the second most frequently affected organ (63%). Whereas alterations of the brain by opportunistic infections or non-Hodgkin's lymphoma showed a downward trend, HIV encephalitis continued to be detected in at least 25% of the cases. Cases with advanced HIV-related neuropathology and cases with no HIV involvement of the brain showed significant systemic pathology with opportunistic infections and neoplasms. In contrast, cases with early brain pathology (e.g., lymphocytic meningitis) showed minimal systemic pathology. Overall these trends remained unchanged throughout the total period covered by this study. This study suggests that despite the beneficial effects of antiretroviral and anti-opportunistic infection therapy, involvement of the brain by HIV continues to be a frequent autopsy finding.

Sequencing, disruption, and characterization of the Candida albicans sterol methyltransferase (ERG6) gene: drug susceptibility studies in erg6 mutants.

The rise in the frequency of fungal infections and the increased resistance noted to the widely employed azole antifungals make the development of new antifungals imperative for human health. The sterol biosynthetic pathway has been exploited for the development of several antifungal agents (allylamines, morpholines, azoles), but additional potential sites for antifungal agent development are yet to be fully investigated. The sterol methyltransferase gene (ERG6) catalyzes a biosynthetic step not found in humans and has been shown to result in several compromised phenotypes, most notably markedly increased permeability, when disrupted in Saccharomyces cerevisiae. The Candida albicans ERG6 gene was isolated by complementation of a S. cerevisiae erg6 mutant by using a C. albicans genomic library. Sequencing of the Candida ERG6 gene revealed high homology with the Saccharomyces version of ERG6. The first copy of the Candida ERG6 gene was disrupted by transforming with the URA3 blaster system, and the second copy was disrupted by both URA3 blaster transformation and mitotic recombination. The resulting erg6 strains were shown to be hypersusceptible to a number of sterol synthesis and metabolic inhibitors, including terbinafine, tridemorph, fenpropiomorph, fluphenazine, cycloheximide, cerulenin, and brefeldin A. No increase in susceptibility to azoles was noted. Inhibitors of the ERG6 gene product would make the cell increasingly susceptible to antifungal agents as well as to new agents which normally would be excluded and would allow for clinical treatment at lower dosages. In addition, the availability of ERG6 would allow for its use as a screen for new antifungals targeted specifically to the sterol methyltransferase.

Dysregulation of the polymorphonuclear leukocyte--Candida spp. interaction in HIV-positive patients.

In HIV-infected patients there is an increased frequency of fungal infections. Dysregulation of the response of phagocytic cells to fungal pathogens may be involved. Phagocytosis of Candida spp., consecutive intracellular production of reactive oxygen species, and candicidal activity were analysed in polymorphonuclear leukocytes (PML) from HIV-1-infected patients, who were at stage C3 of the 1993 revised Centers for Disease Control and Prevention classification system, by means of flow cytometry. Phagocytic ability was assessed by measuring uptake of fluorescein isothiocyanate-labelled Candida albicans, C. krusei and C. glabrata. Reactive oxygen intermediate production was estimated by the quantity of dihydrorhodamine-123 converted to rhodamine-123 intracellularly. The candicidal effect was assessed by the propidium iodide uptake of killed yeast cells. As compared to PML of healthy, HIV-negative controls, PML of AIDS patients exhibited an increased phagocytic activity and a similar ability to generate reactive oxygen products. In contrast, PML of AIDS patients displayed a decreased candicidal activity (P < 0.05 compared to controls). These results suggest that in patients with advanced HIV-1 infection the impairment of non-oxidative killing mechanisms of phagocytic cells may contribute to the high incidence of fungal infections.

Effect of Prophylactic Fluconazole on the Frequency of Fungal Infections, Amphotericin B Use, and Health Care Costs in Patients Undergoing Intensive Chemotherapy for Hematologic Neoplasias

Fungal infections are a major problem in patients with hematologic malignancy. Attempts to reduce their frequency with antifungal agents have not been successful. A double-blind, controlled, single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy. Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions. End points were amphotericin B use, fungal infection, stable neutrophil count > 0.5 x 10(9)/L, toxicity precluding further fluconazole use, and death. By Kaplan-Meier estimation, the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole (P = .003). Also, fluconazole reduced the number of febrile days by 20% (P = .002) and prevented oropharyngeal candidiasis (1/75 vs. 9/76, P = .018). The frequency of deep mycoses (8/76 vs. 8/75) and outcome were unaffected. Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia (P = .01).

Epidemiology and Control of Fungal Infections

The increase in the frequency of fungal infections over the past decade is significant. This increase has particularly occurred among patients in hospitals, where the rate of candidal bloodstream infection has increased by as much as 487% throughout the decade of the 1980s. This increased frequency of infection has been accompanied by significant excess mortality. The documentation of nosocomial transmission of fungal pathogens and the recognition of resistance to antifungal agents pose a significant problem. The fact that the lack of hand washing by patient care providers in intensive care units has been linked to hand carriage of strains of Candida that were isolated from the bloodstream of patients in intensive care units suggests that cross-infection is an important and preventable feature of candidal bloodstream infection. New and more-effective strategies must be developed for prophylaxis of endogenous infections and prevention of transmission within the hospital setting.

High mortality in systemic fungal infections following renal transplantation in third-world countries

Amongst 310 recipients of live related renal transplants, systemic fungal infections were observed in 19 patients (6.1%). These included cryptococcosis in eight (42%), candidiasis in seven (37%), mucormycosis in two (11%), aspergillosis in one (5.5%), and a mixed cryptococcal and Aspergillus infection in one patient (5.5%). Infections occurred within 12 months of transplantation in seven patients and after 13-37 months in the remaining patients. Prolonged fever not responding to antibiotics was the most common presentation. Central nervous system was involved in all patients with cryptococcosis, while Candida infection primarily involved the urinary tract. Both patients with mucormycosis exhibited signs and symptoms of florid rhinocerebral disease and a rapid downhill course. Pulmonary manifestations were the most prominent features of patients with aspergillosis. Parenteral amphotericin B with or without 5-fluorocytosine was started in all, but three patients could receive the therapy only for 1-3 weeks. Three patients with cryptococcosis developed amphotericin-related complications and were changed to oral fluconazole. Seven patients recovered and 12 (63%) died. None of the patients had cytomegalovirus infection preceding the onset of fungal disease. The high frequency of fungal infections amongst our allograft recipients could not be ascribed to over immunosuppression, since 16 patients (84%) were only on maintenance doses of immunosuppressive drugs and in 13 (68.4%) graft function was normal at the time of diagnosis. The high frequency of fungal infections in our patients was most probably related to the poor hygienic and sanitary conditions which continue to be prevalent in the tropical environment of third-world countries. Delays in the diagnosis and late institution of therapy result in a high mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Fungal infections in cancer patients: an international autopsy survey.

In an attempt to estimate the frequency of fungal infections among cancer patients, a survey of autopsy examinations was conducted in multiple institutions in Europe, Japan and Canada. Fungal infections were identified most often in leukemic patients and transplant recipients (25% each). Fifty-eight percent of fungal infections were caused by Candida spp. and 30% by Aspergillus spp. There was considerable variability in the frequency of fungal infections in different countries. Nevertheless, this study clearly demonstrates that fungal infections represent a common complication in cancer patients, especially in patients with leukemia.