non-Aspergillus Mould Infections Research Articles

Investigations of an increased incidence of non-Aspergillus invasive mould infections in an onco-haematology unit.

Invasive mould infections are life-threatening complications in patients with haematologic cancer and chemotherapy-induced neutropenia. While invasive aspergillosis represents the main cause of invasive mould infections, non-Aspergillusmould infections, such as mucormycosis, are increasingly reported. Consequently, their local epidemiology should be closely monitored. The aim of this study was to investigate the causes of an increased incidence of non-Aspergillusmould infections in the onco-haematology unit of a Swiss tertiary care hospital. All cases of proven and probable invasive mould infections were retrospectively identified via a local registry for the period 2007-2021 and their incidence was calculated per 10,000 patient-days per year. The relative proportion of invasive aspergillosis and non-Aspergillusmould infections was assessed. Factors that may affect invasive mould infections' incidence, such as antifungal drug consumption, environmental contamination and changes in diagnostic approaches, were investigated. A significant increase of the incidence of non-Aspergillusmould infections (mainly mucormycosis) was observed from 2017 onwards (Mann and Kendall test p = 0.0053), peaking in 2020 (8.62 episodes per 10,000 patient-days). The incidence of invasive aspergillosis remained stable across the period of observation. The proportion of non-Aspergillusmould infections increased significantly from 2017 (33% vs 16.8% for the periods 2017-2021 and 2007-2016, respectively, p = 0.02). Building projects on the hospital site were identified as possible contributors of this increase in non-Aspergillusmould infections. However, novel diagnostic procedures may have improved their detection. We report a significant increase in non-Aspergillusmould infections, and mainly in mucormycosis infections, since 2017. There seems to be a multifactorial origin to this increase. Epidemiological trends of invasive mould infections should be carefully monitored in onco-haematology units in order to implement potential corrective measures.

Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study.

Clinical signs and symptoms related to invasive fungal disease are nonspecific and need to be followed up by appropriate diagnostic procedures. The goal of this study was to analyze CT imaging patterns in invasive fungal infections and their correlation with the immune status and clinical outcome. We performed a retrospective multicenter study including 85 consecutive patients with invasive pulmonary fungal infection (2011-2014). Lung patterns on computed tomography (CT) scans were classified according to the Fleischner Society glossary. The patients were grouped according to immune status (neutropenia, steroid therapy, organ transplant recipient, and other cause) and outcome (positive outcome, progressive disease, and death). The Chi square test or Fisher exact test was used. Bonferroni correction was applied. The total number of patients with invasive Aspergillus and non-Aspergillus infection (IANA), Pneumocystis jirovecii pneumonia (PCP), and Cryptococcus (CRY) was 60, 22, and 3, respectively. Patients with IANA demonstrated significantly more nodules (93 % vs. 59 %, p = 0.001), significantly fewer ground glass opacities (58 % vs. 96 %, p = 0.005), and significantly fewer positive lymph nodes (5 % vs. 41 %, p < 0.001) than patients with PCP. All patients with PCP and CRY had a favorable outcome. Patients with IANA and an adverse outcome demonstrated significantly more nodules with halo sign than patients with IANA and a favorable outcome (42.5 % vs. 15.9 %, p < 0.0001). Interestingly, patients with IANA and a favorable outcome had a higher prevalence of pulmonary infarction than patients with an adverse outcome (8 % vs. 1 %, p = 0.047). Patients with neutropenia showed significantly more consolidations (66 %) than organ transplant recipients (27 %, p = 0.045). Patients with IANA showed a higher prevalence of nodules and a lower prevalence of ground glass opacities than patients with PCP. In patients with IANA, nodules with halo sign were associated with an adverse outcome. Patients with neutropenia showed generally more consolidations, but the consolidations were not associated with an adverse outcome. · Nodules, ground glass opacities, and consolidations are common CT findings in all invasive pulmonary fungal infections.. · There is no pattern that is unique for one specific pathogen, although nodules are more predominant in IANA and Cryptococcus, and ground glass opacities are more predominant in PCP patients.. · Immune status had an impact on CT findings in fungal pneumonia with less consolidation in patients after organ transplantation compared to patients with neutropenia.. · Nodules with a halo sign are associated with a worse outcome.. · Obmann VC, Bickel F, Hosek N et al. Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study. Fortschr Röntgenstr 2021; 193: 1304 - 1314.

Invasive Scedosporium and Lomentosora infections in the era of antifungal prophylaxis: A 20-year experience from a single centre in Spain.

Non-Aspergillus mould infections such as those caused by Scedosporium apiospermum or Lomentospora prolificans are an emerging threat. Few studies have monitored their long-term incidence. To analyse the epidemiology, risk factors, clinical features and incidence of patients with proven and probable infections. Patients admitted to Gregorio Marañón Hospital between 1998 and 2017 and from whom Scedosporium/Lomentospora was isolated were studied. Subjects were classified as having a probable/proven invasive fungal infection or colonization. Molecular identification and antifungal susceptibility testing of isolates causing infection were performed, as well as a description of the patients and incidence of infection. One or more Scedosporium/Lomentospora isolates were identified in 67 patients. Sixteen (23.9%) patients had developed infection: 11 scedosporiosis and 5 lomentosporiosis. Stable incidence was observed throughout the study period. Most patients were immunosuppressed and the most common underlying diseases were haematologic malignancy (25%), solid organ transplantation (25%) and chronic corticoid therapy (25%). Breakthrough infection occurred in four patients, 2/11 (18.2%) cases of scedosporiosis and 2/5 (40%) of lomentosporiosis. Overall mortality was 54.5% (6/11) and 80% (4/5) in subjects with scedosporiosis and lomentosporiosis, respectively. High MICs of amphotericin B and remarkable inter-species susceptibility variability to triazoles was observed for most isolates. In contrast to previous studies, the incidence of scedosporiosis and lomentosporiosis has not increased at our hospital over the years. The tendency to cause disseminated infection and a reduced susceptibility to most antifungal agents leads to high mortality.

Treatment of Non-Aspergillus Mold Infections: a Focus on Mucormycosis and Fusariosis

Mucormycosis and fusariosis are associated with severe morbidity and high fatality rate. This review will discuss the challenges associated with the treatment of mucormycosis and fusariosis with a focus on recent data on antifungal susceptibility, novel therapeutic modalities, and combination therapy. Overall, the review aims to provide guidance to optimize management of these difficult-to-treat infections. Isavuconazole has comparable efficacy with liposomal amphotericin B for the treatment of mucormycosis. Treatment of fusariosis remains challenging, but voriconazole has been associated with improved outcome. Posaconazole has successfully been used as salvage therapy for both infections. Combination therapy is increasingly used although robust data supporting its efficacy is limited. The first-line therapy for mucormycosis remains liposomal amphotericin B with posaconazole and isavuconazole being acceptable alternatives. Fusariosis should be treated with either voriconazole or liposomal amphotericin B. Combination therapy may have a role although its clinical benefit remains uncertain.

Therapeutic Challenges of Non-Aspergillus Invasive Mold Infections in Immunosuppressed Patients.

While Aspergillus spp. remain the major cause of invasive mold infections in hematologic cancer patients and transplant recipients, other opportunistic molds, such as Mucorales, Fusarium, and Scedosporium spp. are increasingly encountered in an expanding population of patients with severe and prolonged immunosuppression. High potential for tissue invasion and dissemination, resistance to multiple antifungals and high mortality rates are hallmarks of these non-Aspergillus invasive mold infections (NAIMIs). Assessment of drug efficacy is particularly difficult in the complex treatment scenarios of NAIMIs. Specifically, correlation between in vitro susceptibility and in vivo responses to antifungals is hard to assess, in view of the multiple, frequently interrelated factors influencing outcomes, such as pharmacokinetic/pharmacodynamic parameters determining drug availability at the site of infection, the net state of immune suppression, delay in diagnosis, or surgical debulking of infectious foci. Our current therapeutic approach of NAIMIs should evolve toward a better integration of the dynamic interactions between the pathogen, the drug and the host. Innovative concepts of experimental research may consist in manipulating the host immune system to induce a specific antifungal response or targeted drug delivery. In this review, we discuss the challenges in the management of NAIMIs and provide an update about the latest advances in diagnostic and therapeutic approaches.

Epidemiology and clinical outcomes of invasive mould infections in Indian intensive care units (FISF study)

Background and aimDue to limited data on invasive mould infections (IMIs) in the intensive care units (ICUs) of developing countries, we ascertain epidemiology and management of IMIs at 11 ICUs across India. MethodsConsecutive patients with proven or probable/putative IMIs were enrolled during the study period. Subjects were categorized into classical (neutropenia, malignancy, transplant recipients on immunosuppression) and non-classical (chronic obstructive pulmonary disease, diabetes, liver disease and glucocorticoids) risk groups. We analyzed the demographic, laboratory variables and outcomes of these patients. Results398 patients with IMIs (96 proven, 302 probable) were identified, amounting to a prevalence of 9.5 cases/1000 ICU admissions. The mean ± SD age of the participants was 45.6 ± 21.9 years. The mean ± SD APACHE II score was 14.3 ± 11.4. The IMIs were diagnosed at a median of 4 days after ICU admission. There were 145 and 253 subjects with classical and non-classical risk groups, respectively. Although Aspergillus spp. were the commonest (82.1%) isolates, Mucorales were detected in 14.4% subjects. A high APACHE II score and IMI due to mucormycosis were significant predictors of mortality. ConclusionsThe study highlights the distinct epidemiology of IMIs in India ICUs with high burden, new susceptible patient groups and considerable number of non-Aspergillus mould infections. [clinicaltrials.gov: NCT02683642].

1131. Characteristics and Risk Factors for Mortality in Hematologic Patients with Invasive Non-Aspergillus Mold Infections: A Single-Center 7-Year Cohort Study

BackgroundSince anti-mold active azole prophylaxis has become a standard approach for patients with high-risk hematologic diseases, the epidemiology of invasive fungal infections (IFIs) has shifted toward non-Aspergillus molds in recent years. The aim of this study was to identify the epidemiology and characteristics of non-Aspergillus invasive mold infections (NAIMIs) in the real-world.MethodsProven/probable NAIMIs developed in patients with hematologic diseases were reviewed from January 2011 to January 2018 at the Catholic Blood and Marrow Transplantation Center.ResultsThere were 662 patients with proven/probable IMIs, of which 40 patients (41 isolates) were diagnosed with NAIMIs. The incidence of NAIMIs showed an increasing trend since 2013 when posaconazole prophylaxis was approved in Korea [correlation coefficient (r) = 0.735, P = 0.265]. Mucormycosis (n = 24, 58.5%) was the most common, followed by Fusarium (n = 7, 17.1%), Alternaria (n = 2), Scopulariopsis (n = 2), Scedosporium (n = 2), Paecilomyces (n = 1), Coprinus (n = 1), Chaetomium (n = 1), and Schizophyllum (n = 1). Twenty-eight patients were under neutropenia upon diagnosis of NAIMI and 35.0% were allogeneic stem cell transplantation recipients. The most common sites of NAIMI were the lungs (60.0%), followed by the paranasal sinus (17.5%) and disseminated infections (12.5%). There were 35.5% breakthrough IMI cases. In addition, there were 42.5% mixed or concurrent IFIs and 77.5% had coexisting bacterial or viral infections. The overall mortality at 6 and 12 weeks was 32.5% and 42.5%, respectively. The mortality rates for mucormycosis and nonmucormycosis at 6 weeks were 21.7% and 47.1%, respectively. Breakthrough IFIs [adjusted hazards ratio (HR) = 4.83, P = 0.018] and surgical treatment [HR = 0.09, P = 0.003] were independently associated with 6-week mortality.ConclusionNAIMIs showed an increasing trend, mixed/concurrent IFIs were substantial, and coexisting bacterial or viral infections were found in more than two-thirds of patients. Breakthrough IFIs and surgical treatment have significant impact on mortality. More meticulous approaches to diagnosis and treatment strategies of NAIMIs are needed.Disclosures All authors: No reported disclosures.

Pulmonary Mucormycosis Treated Successfully With Isavuconazonium and Surgical Therapy

SESSION TITLE: Fungal Infections 2 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Pulmonary mucormycosis is a rare but devastating fungal infection typically affecting immunocompromised hosts. Although mucorales can affect any organ, the lungs are the predominant site of infection in solid organ transplant patients.1 They pose a diagnostic and therapeutic challenge; therefore a high index of suspicion is required for early diagnosis and treatment. We report a case of pulmonary mucormycosis presenting as a cavitary lung lesion in a post renal transplant patient. CASE PRESENTATION: A 41 year old African American male with type I diabetes mellitus presented with fever, chills, night sweats, 20 lb weight loss, and dysphagia of one month duration. He had received a cadaveric right renal transplant four months earlier for end stage renal disease secondary to diabetic nephropathy and has been on immunosuppressive therapy. Laboratory tests were negative for Aspergillus Ab, Histoplasma Ab, HIV 1/2 Ab, Quantiferon gold, acid-fast bacilli (AFB) and urine legionella antigen. Glycohemoglobin 9.3%. A CT scan of the chest revealed a 4.8 cm X 4.2 cm dense, thick walled right lower lobe (RLL) cavitary lesion (Fig.1). Fiberoptic bronchoscopy revealed diffuse white plaques in the RLL. Bronchoalveolar lavage (BAL) cultures were negative for Pneumocystis jiroveci, AFB and malignant cells. EGD revealed extensive candida esophagitis. The patient was started on fluconazole for candida esophagitis and presumed candida cavitary pneumonia. Although the dysphagia improved, the shortness of breath worsened requiring readmission to the hospital two weeks later. The patient had a CT-guided fine needle biopsy of the cavitary lesion and histopathology revealed nonseptate hyphae. Cultures confirmed Mucor species. The patient underwent a right lower lobectomy and was placed on isavuconazonium therapy. DISCUSSION: In solid organ transplant recipients, immunosuppressive therapy is a major predisposing factor for mucormycosis. It can present as a focal consolidation, pleural effusion or cavitary lesion. Although BAL and sputum culture can aid diagnosis, definitive diagnosis requires histopathology. Fine needle aspiration cytology (FNAC) is an easy and reliable way of obtaining a diagnostic specimen. The cornerstone of treatment is amphotericin, however isavuconazonium has less nephrotoxicity and is better tolerated.2 CONCLUSIONS: In the diagnosis and management of mucormycosis in immunocompromised hosts, it is important to have a high index of suspicion, obtain a histopathologic specimen and be aware of newer treatment options with safer side effect profiles. Early diagnosis and combined medical and surgical management can be curative. Reference #1: Park BJ, Pappas PG, Wannemuehler KA, et al. Invasive non-Aspergillus mold infections in transplant recipients, United States, 2001-2006. Emerging Infectious Diseases. 2011;17(10):1855-1864. Reference #2: Graves B, Morrissey CO, Wei A, et al. Isavuconazole as salvage therapy for mucormycosis. Medical Mycology Case Reprots. 2016;11:36-39. DISCLOSURE: The following authors have nothing to disclose: Tanveer Hassam No Product/Research Disclosure Information

Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: a CIBMTR infection and immune reconstitution analysis

Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: a CIBMTR infection and immune reconstitution analysis

Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality

The epidemiology of invasive fungal disease (IFD) due to filamentous fungi other than Aspergillus may be changing. We analysed clinical, microbiological and outcome data in Australian patients to determine the predisposing factors and identify determinants of mortality. Proven and probable non-Aspergillus mould infections (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) from 2004 to 2012 were evaluated in a multicentre study. Variables associated with infection and mortality were determined. Of 162 episodes of non-Aspergillus IFD, 145 (89.5%) were proven infections and 17 (10.5%) were probable infections. The pathogens included 29 fungal species/species complexes; mucormycetes (45.7%) and Scedosporium species (33.3%) were most common. The commonest comorbidities were haematological malignancies (HMs) (46.3%) diabetes mellitus (23.5%), and chronic pulmonary disease (16%); antecedent trauma was present in 21% of cases. Twenty-five (15.4%) patients had no immunocompromised status or comorbidity, and were more likely to have acquired infection following major trauma (p <0.01); 61 (37.7%) of cases affected patients without HMs or transplantation. Antifungal therapy was administered to 93.2% of patients (median 68 days, interquartile range 19–275), and adjunctive surgery was performed in 58.6%. The all-cause 90-day mortality was 44.4%; HMs and intensive-care admission were the strongest predictors of death (both p <0.001). Survival varied by fungal group, with the risk of death being significantly lower in patients with dematiaceous mould infections than in patients with other non-Aspergillus mould infections. Non-Aspergillus IFD affected diverse patient groups, including non-immunocompromised hosts and those outside traditional risk groups; therefore, definitions of IFD in these patients are required. Given the high mortality, increased recognition of infections and accurate identification of the causative agent are required.

Disseminated Cunninghamella bertholletiae Infection During Induction Chemotherapy in a Girl with High-Risk Acute Lymphoblastic Leukemia

Invasive fungal infections in children with acute lymphoblastic leukemia have been a major cause of mortality. Recent reports have described increasing incidence of invasive non-Aspergillus mold infections in patients with hematological malignancies. It is always challenging to treat invasive fungal infection and underlying hematological malignancies successfully. Here we report a girl with high-risk acute lymphoblastic leukemia who developed disseminated Cunninghamella bertholletiae infection during induction chemotherapy. This case illustrates the difficulties of diagnosis and treatment of invasive C. bertholletiae infection. It also highlights the necessity for physicians to keep high suspicion and awareness for this infrequent fungal infection.

Invasive Non-AspergillusMold Infections in Transplant Recipients, United States, 2001–2006

Recent reports describe increasing incidence of non-Aspergillus mold infections in hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. To investigate the epidemiology of infections with Mucorales, Fusarium spp., and Scedosporium spp. molds, we analyzed data from the Transplant-Associated Infection Surveillance Network, 23 transplant centers that conducted prospective surveillance for invasive fungal infections during 2001–2006. We identified 169 infections (105 Mucorales, 37 Fusarium spp., and 27 Scedosporium spp.) in 169 patients; 124 (73.4%) were in HCT recipients, and 45 (26.6%) were in SOT recipients. The crude 90-day mortality rate was 56.6%. The 12-month mucormycosis cumulative incidence was 0.29% for HCT and 0.07% for SOT. Mucormycosis incidence among HCT recipients varied widely, from 0.08% to 0.69%, with higher incidence in cohorts receiving transplants during 2003 and 2004. Non-Aspergillus mold infections continue to be associated with high mortality rates. The incidence of mucormycosis in HCT recipients increased substantially during the surveillance period.

Mucormycosis, Pseudallescheriasis, and Other Uncommon Mold Infections

Serious infections due to non-Aspergillus molds are being encountered with increasing frequency. Factors likely responsible for the rise of these infections include aging populations in countries with advanced medical technologies, the resultant increase in incidence of many cancers, increasingly intensive myeloablative therapies for these cancers, increasingly intensive care for critically ill patients, and increases in the frequency of solid organ and hematopoietic stem cell transplantation. Although diagnostic and therapeutic modalities have improved, mortality rates for invasive mold infections remain high. In this review, we summarize current knowledge about non-Aspergillus mold infections of the chest, with a focus on risk factors, clinical features, diagnosis, and treatment.

Disseminated Scopulariopsis brevicaulis infection in an allogeneic stem cell recipient: case report and review of the literature

AbstractA fatal case of disseminated Scopulariopsis brevicaulis infection in an allogeneic stem cell transplant recipient is described. The patient was initially thought to have pulmonary aspergillosis, on the basis of clinical signs and antigenaemia, but Aspergillus was not isolated by culture. Scopulariopsis brevicaulis was subsequently isolated from skin and then from sputum and stool. Further investigation revealed that the infection had spread from a primary pulmonary site to the skin. A review of the literature underscores the difficulty of diagnosing infections caused by such emerging fungal pathogens and the poor outcome of immunocompromised patients with non-Aspergillus mould infections.

Invasive mould infections in the setting of hematopoietic cell transplantation: current trends and new challenges

Invasive mould infections remain major causes of infection-related mortality following hematopoietic stem cell transplantation (HSCT). In this review, we summarize the recent advances in the diagnosis, prevention, and management of invasive mould infections in HSCT recipients. The evolving epidemiologic characteristics of post-HSCT invasive mould infections, specifically the rising incidence of Aspergillus and non-Aspergillus mould infections in the postengraftment period, necessitate the development of preventive strategies. The efficacy of prophylactic broad-spectrum triazoles against invasive mould infections in HSCT recipients has now been demonstrated in two large prospective studies. However, concerns over drug absorption, interactions, and costs may shift attention from universal prophylaxis to risk stratification and preemptive strategies. In this regard, recent studies have highlighted the potential of genetic polymorphism analysis to identify HSCT recipients at risk for invasive aspergillosis, and efforts are underway to improve the predictive values of antigen and nucleic acid detection assays. Emerging data on risk factors for invasive aspergillosis relapse after HSCT, antifungal drug monitoring, and the use of galactomannan testing to monitor treatment response may help inform therapeutic decisions for HSCT recipients. Evidence-driven management of invasive mould infections in HSCT recipients is becoming increasingly individualized, integrating host factors and pharmacologic and epidemiologic considerations. However, the optimal approach to invasive mould infection prevention in HSCT recipients remains to be resolved by prospective clinical studies.

DisseminatedScopulariopsis brevicaulisinfection in an allogeneic stem cell recipient: case report and review of the literature

A fatal case of disseminated Scopulariopsis brevicaulis infection in an allogeneic stem cell transplant recipient is described. The patient was initially thought to have pulmonary aspergillosis, on the basis of clinical signs and antigenaemia, but Aspergillus was not isolated by culture. Scopulariopsis brevicaulis was subsequently isolated from skin and then from sputum and stool. Further investigation revealed that the infection had spread from a primary pulmonary site to the skin. A review of the literature underscores the difficulty of diagnosing infections caused by such emerging fungal pathogens and the poor outcome of immunocompromised patients with non-Aspergillus mould infections.

Successful therapy with ABLC, surgery and posaconazole for Rhizopus microsporus var. rhizopodiformis liver eumycetoma in a child with acute leukaemia

Invasive fungal infection negatively influences the morbidity and mortality in heavily immuno-incompetent patients. Diagnosis of non-Aspergillus mould infections remains challenging despite application of a wide spectrum of non-culture-based microbiological techniques. Invasive diagnostic procedures are often essential. In this article, we present the case of a 15-month-old boy diagnosed with Rhizopus microsporus var. rhizopodiformis liver mycetoma during induction chemotherapy for acute promyelocytic leukaemia. Following surgery, he was effectively treated with a combination of ABLC and posaconazole during ongoing intensive chemotherapy. Posaconazole was also used as long-term secondary prophylaxis.

Galactomannan and advances in fungal diagnostics

Purpose of review Invasive fungal infections remain a predominant cause of morbidity and mortality in the immunocompromised population. Fungal diagnostics, namely the Platelia Aspergillus enzyme immunoassay (Bio-Rad, Redmond, WA) and the Fungitell 1→3-β-D-glucan assay (Associates of Cape Cod, East Falmouth, MA), are now commercially available to assist clinicians in the early diagnosis of fungal infections. This review highlights the performance characteristics of these tests and introduces the reader to other advances in fungal diagnostics. Recent findings Early diagnosis of invasive aspergillosis in patients with leukemia and hematopoietic stem cell transplants is facilitated by the use of the Platelia Aspergillus enzyme immunoassay. This test may also be useful for monitoring the course of invasive aspergillosis. The Fungitell1→3-β-D-glucan assay can be used for early diagnosis of fungal infections due to multiple different organisms, including certain non-Aspergillus mould infections and invasive candidiasis. Physicians utilizing these fungal diagnostic tests should be aware of important issues regarding test performance. Summary Advances in fungal diagnostics are an important addition to the diagnosis and management of invasive fungal infections. Additional tests such as fungal polymerase chain reaction are on the horizon and are expected to be helpful adjuncts to the diagnosis and management of invasive fungal infections.

Treatment of Non-Aspergillus Moulds in Immunocompromised Patients, with Amphotericin B Lipid Complex

An assessment was made of the efficacy and renal safety of amphotericin B lipid complex (ABLC) in the treatment of patients with invasive fungal infections caused by moulds other than Aspergillus species, on the basis of a retrospective analysis of data from the Collaborative Exchange of Antifungal Research (CLEAR) database. Data from CLEAR for 64 patients with zygomycosis were published previously. The database was further queried and yielded results for 28 patients with fusariosis and 84 patients infected with other non-Aspergillus moulds. Of 26 patients with fusariosis whose results could be evaluated, 46% (n = 12) were cured or improved, and an additional 12% (n = 3) were stable. Of 79 patients infected with other non-Aspergillus moulds whose results could be evaluated, 61% (n = 48) were cured or improved, and an additional 15% (n = 12) were stable. In an area with little guidance for therapy, the CLEAR data indicate that ABLC can be an effective broad-spectrum treatment choice for several invasive and refractory non-Aspergillus mould infections.

Prophylactic strategies before solid-organ transplantation.

Prophylactic measures prior to organ transplantation are evolving based on recent reports of emerging infectious diseases, as well as an expanded understanding of the epidemiology of familiar infections. This review will highlight developments with potential impact on donor and recipient screening and pretransplant management. Key findings regarding bacterial infections include the lack of utility of mupirocin intranasal decolonization for prevention of Staphylococcus aureus infections after liver transplantation, and the description of transmission of Pseudomonas infection to multiple recipients via an innominate artery graft. The implications of donor bacterial colonization in lung transplantation are further explored. The emergence of non-Candida albicans yeast and non-Aspergillus mold infections may lead to changes in prophylactic strategies. The majority of cystic fibrosis patients have had Aspergillus colonization at some time before transplant; one-quarter of these develop tracheobronchial aspergillosis and anastomotic complications. There are several key developments regarding viral infections. Donor-derived human herpesvirus-8-infected neoplastic cells have been identified in recipients with Kaposi sarcoma. The transmission of human T-cell lymphotropic virus -1 (HTLV-1) to multiple recipients who developed myelopathy underscores the continuing need for donor screening. The striking event of West Nile virus transmission to multiple recipients from a single donor also has raised questions regarding donor screening for this virus. New information on the use of hepatitis B core antibody-positive donor livers, as well as the emergence of hepatitis B virus escape mutants, is discussed. Finally, information on successful retransplantation after BK polyomavirus (BKV) allograft nephropathy is beginning to appear. The pretransplant phase continues to be an important time period for screening and intervention in order to reduce the risk of posttransplant infections. Recent findings add to our current understanding of epidemiology and risk stratification; however, more randomized trials are needed.