Nosocomial Fungal Infections Research Articles

Predictors and outcomes of patients with COVID-19 admitted to intensive care units in Pakistan and the development of nosocomial fungal infections: Findings and implications

ObjectivesPatients with COVID-19 admitted to intensive care units (ICUs) typically have many complications and co-morbidities, including secondary bacterial and fungal infections, which increase morbidity and mortality. The first step to address this is to measure the prevalence rates, predictors of fungal infections, and outcomes of patients with COVID-19 admitted to ICUs in Pakistan. MethodsRetrospective review of medical records of patients admitted with COVID-19 to the ICUs of six tertiary care hospitals in Pakistan between March 2020 and June 2023. ResultsA total of 636 patients were included; 68.9% were aged ≥50 years and 62.6% were male. Diabetes mellitus was the commonest co-morbidity (23.7%). A total of 67.8% of patients had severe COVID-19, with 23% critical cases. Antibiotics and antipyretics (all patients) were the most frequently prescribed medicines, along with corticosteroids (72.5%). A total of 63 nosocomial fungal infections developed in 53 patients, with mechanical ventilation and tracheal intubation being significant predictors of secondary fungal infections among patients with COVID-19. The mortality rate was 4.9%, with secondary fungal infections significantly associated with higher mortality. ConclusionsApproximately 8% of patients with COVID-19 admitted to the ICUs of tertiary developed secondary fungal infections associated with greater mortality. The key factors associated with secondary fungal infections need to be carefully monitored to reduce future mortality in these patients. We will continue to monitor the situation.

Fungal presence and health implications in hospital water systems

ABSTRACT Given the increasing occurrence of invasive fungal infections and the limited efficacy of modern antifungal medications, it is crucial to disseminate information regarding the potential sources of nosocomial mycoses through the One Health approach. This study investigated the presence and antifungal susceptibility of fungi in biofilm and water samples obtained from the drinking water distribution system (DWDS) of hospitals. The positivity rate for fungi in biofilm and water samples was 41% and 9%, respectively, with Aspergillus species, a significant causative agent of nosocomial mycoses, being the predominant fungi identified. Analysis of antifungal susceptibility test revelead a comparable resistance profile between some isolated species from the DWDS and those reported for certain clinical samples. While further research is required to determine the specific contribution of waterborne fungi to nosocomial fungal infections, our results emphasize the importance of controlling biofilm formation within DWDSs, particularly in high-risk hospital wards.

IAFPs-Mv-BiTCN: Predicting antifungal peptides using self-attention transformer embedding and transform evolutionary based multi-view features with bidirectional temporal convolutional networks

Globally, fungal infections have become a major health concern in humans. Fungal diseases generally occur due to the invading fungus appearing on a specific portion of the body and becoming hard for the human immune system to resist. The recent emergence of COVID-19 has intensely increased different nosocomial fungal infections. The existing wet-laboratory-based medications are expensive, time-consuming, and may have adverse side effects on normal cells. In the last decade, peptide therapeutics have gained significant attention due to their high specificity in targeting affected cells without affecting healthy cells. Motivated by the significance of peptide-based therapies, we developed a highly discriminative prediction scheme called iAFPs-Mv-BiTCN to predict antifungal peptides correctly. The training peptides are encoded using word embedding methods such as skip-gram and attention mechanism-based bidirectional encoder representation using transformer. Additionally, transform-based evolutionary features are generated using the Pseduo position-specific scoring matrix using discrete wavelet transform (PsePSSM-DWT). The fused vector of word embedding and evolutionary descriptors is formed to compensate for the limitations of single encoding methods. A Shapley Additive exPlanations (SHAP) based global interpolation approach is applied to reduce training costs by choosing the optimal feature set. The selected feature set is trained using a bi-directional temporal convolutional network (BiTCN). The proposed iAFPs-Mv-BiTCN model achieved a predictive accuracy of 98.15 % and an AUC of 0.99 using training samples. In the case of the independent samples, our model obtained an accuracy of 94.11 % and an AUC of 0.98. Our iAFPs-Mv-BiTCN model outperformed existing models with a ~4 % and ~5 % higher accuracy using training and independent samples, respectively. The reliability and efficacy of the proposed iAFPs-Mv-BiTCN model make it a valuable tool for scientists and may perform a beneficial role in pharmaceutical design and research academia.

Characterization of Nosocomial Fungal Infection among Hepatic ICU Patients in National Liver Institute

Characterization of Nosocomial Fungal Infection among Hepatic ICU Patients in National Liver Institute

The C. auris Epidemic: Understanding its Impact on ICU Patients

Candida species are the most common cause of nosocomial fungal infections and the fourth most common cause of hospital-acquired illnesses. Fungal infection has been known to cause severe complications and even death in immunocompromised patients. With the rise in antibiotic resistance and an increase in invasive medical procedures, ICU patients are becoming more vulnerable to this infection. In order to fight this epidemic, it is essential to comprehend the causes, signs, and available treatments for Candida species. Candida auris is an exceptionally rare type of fungus that first surfaced in 2009 and poses a threat to global health. C auris-associated invasive infections have a greater mortality rate than infections caused by other Candida species. C. auris possesses a tendency to develop antifungal medication resistance, which would make therapy more challenging. While the precise cause of C. auris illnesses is uncertain, it is believed that healthcare workers can contract the illness by touching infected objects or surfaces. Medical professionals, nurses, and various other staff members all contribute significantly to preventing the transmission of C. auris infestations. Utilizing hand hygiene techniques like thorough hand washing or hand sanitizers that contain alcohol can significantly reduce the spread of fungi. It is crucial to provide healthcare workers with ongoing instruction in infection control, the proper use of antifungal medications, and the early identification of C. auris infections.

1422. Surveillance for fungi in hospital environments housing high-risk hosts using culture and culture-independent methods

Abstract Background Nosocomial outbreaks of fungal infections are increasingly reported. There are scant data on fungal burdens in hospital environments. Standardized surveillance methods are lacking. Methods We developed culture and culture-independent (real-time PCR, reference to standard curve) methods for measuring airborne fungal burdens using SAS Super 100 and SASS 3100 Dry Air samplers. We performed serial surveillance in 7 units with high-risk, immunosuppressed patients in 2 hospitals and outside. Results Methods were optimized for multiple variables, including volume, duration, flow of air sampling; culturing techniques (direct impact plates, cultures at different stages of filter processing); filter DNA recovery (extraction protocols, stage of filter processing); PCR (targets, primers, PCR parameters). To date, we have surveyed each unit ≥4 times. Pathogenic moulds were cultured in >50% of outdoor and indoor air, including azole-resistant Aspergillus species [Figures 1A-B]. Fungal burdens were significantly greater outside than inside hospitals, by both positive culture % and DNA burden [Figure 2]. There was no correlation between outside and inside genome equivalents (GEs; R2< 0.06), nor were there significant differences in GEs within a given unit (nurses stations, patient rooms; all p >0.1). GEs were greater in culture-positive than culture-negative samples (Aspergillus, 2.4 vs. 1.5 log10; pan-fungal, 2.8 vs. 1.5 log10GE; p< 0.0001; best results with sonicated filters). Direct impact cultures were less sensitive than filter cultures. Conclusion We developed standardized methods for sampling airborne fungi in hospitals that yield reproducible results. Fungal burdens were significantly lower in hospitals than those immediately outside, but fungal DNA and viable Aspergillus and other moulds were commonly recovered from units housing high-risk patients. Outside fungal burdens could not be used to estimate relative burdens within hospitals. Direct impact cultures, commonly used in surveillance, lacked sensitivity for detecting viable fungi and did not correlate with DNA burdens. We are optimizing direct metagenomic sequencing from airborne samples. We will assess correlations between environmental surveillance data and nosocomial fungal infections. Disclosures Alexander Sundermann, DrPH, CIC, FAPIC, OpGen: Honoraria Graham M. Snyder, MD, SM, Infectious Diseases Connect: Advisor/Consultant

Impact of invasive fungal infections in men from a state in southern Brazil: A geospatial analysis.

To analyse the records of male hospitalisation for fungal infections, including their spatial distribution and the main invasive epidemiological and sociodemographic characteristics in the State of Paraná, Brazil. Spatial analysis based on data from male admission records for invasive fungal infections (IFIs) in the State of Paraná, from 2015 to 2019. Data were taken from the hospital records obtained in the Hospital Information System of the Unified Health System, being collected, georeferenced and analysed to infer the existence of autocorrelation with the hospitalisation rates in the state. From 2015 to 2019, there were 385 cases of IFIs in men, being more prevalent in white individuals aged 61-70 years. We observed that the metropolitan, southeast, central-eastern, north-central, northwestern and western regions formed high-high clusters, with regions with a high number of registered cases. In the regression, there was an association with socioeconomic and demographic factors that showed a correlation with the rates of hospitalisation for IFIs. The study draws attention to Paraná as an endemic region for paracoccidioidomycosis, in addition to presenting high rates of nosocomial fungal infections. We also emphasise the importance of compulsory notification in the state and in the country to gain greater control over the incidence and prevalence of cases and to incentivise the creation of public policies for the prevention of IFIs.

Pseudomonas aeruginosa increases the susceptibility of Candida albicans to amphotericin B in dual-species biofilms.

Biofilms are the leading cause of nosocomial infections and are hard to eradicate due to their inherent antimicrobial resistance. Candida albicans is the leading cause of nosocomial fungal infections and is frequently co-isolated with the bacterium Pseudomonas aeruginosa from biofilms in the cystic fibrosis lung and severe burn wounds. The presence of C. albicans in multispecies biofilms is associated with enhanced antibacterial resistance, which is largely mediated through fungal extracellular carbohydrates sequestering the antibiotics. However, significantly less is known regarding the impact of polymicrobial biofilms on antifungal resistance. Here we show that, in dual-species biofilms, P. aeruginosa enhances the susceptibility of C. albicans to amphotericin B, an effect that was biofilm specific. Transcriptional analysis combined with gene ontology enrichment analysis identified several C. albicans processes associated with oxidative stress to be differentially regulated in dual-species biofilms, suggesting that P. aeruginosa exerts oxidative stress on C. albicans, likely through the secretion of phenazines. However, the mitochondrial superoxide dismutase SOD2 was significantly down-regulated in the presence of P. aeruginosa. Monospecies biofilms of the sod2Δ mutant were more susceptible to amphotericin B, and the susceptibility of these biofilms was further enhanced by exogenous phenazines. We propose that in dual-species biofilms, P. aeruginosa simultaneously induces mitochondrial oxidative stress, while down-regulating key detoxification enzymes, which prevents C. albicans mounting an appropriate oxidative stress response to amphotericin B, leading to fungal cell death. This work highlights the importance of understanding the impact of polymicrobial interactions on antimicrobial susceptibility.

Establishment of a risk classifier to predict the in-hospital death risk of nosocomial fungal infections in cancer patients

BackgroundPatients with malignancy are at a higher risk of developing nosocomial infections. However, limited studies investigated the clinical features and prognostic factors of nosocomial infections due to fungi in cancer patients. Herein, this study aims to investigate the clinical characteristics of in-hospital fungal infections and develop a nomogram to predict the risk of in-hospital death during fungal infection of hospitalized cancer patients.MethodsThis retrospective observational study enrolled cancer patients who experienced in-hospital fungal infections between September 2013 and September 2021. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of in-hospital mortality. Variables demonstrating significant statistical differences in the multivariate analysis were utilized to construct a nomogram for personalized prediction of in-hospital death risk associated with nosocomial fungal infections. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.ResultsA total of 216 participants were included in the study, of which 57 experienced in-hospital death. C.albicans was identified as the most prevalent fungal species (68.0%). Respiratory infection accounted for the highest proportion of fungal infections (59.0%), followed by intra-abdominal infection (8.8%). The multivariate regression analysis revealed that Eastern Cooperative Oncology Group Performance Status (ECOG-PS) 3–4 (odds ratio [OR] = 6.08, 95% confidence interval [CI]: 2.04–18.12), pulmonary metastases (OR = 2.76, 95%CI: 1.11–6.85), thrombocytopenia (OR = 2.58, 95%CI: 1.21–5.47), hypoalbuminemia (OR = 2.44, 95%CI: 1.22–4.90), and mechanical ventilation (OR = 2.64, 95%CI: 1.03–6.73) were independent risk factors of in-hospital death. A nomogram based on the identified risk factors was developed to predict the individual probability of in-hospital mortality. The nomogram demonstrated satisfactory performance in terms of classification ability (area under the curve [AUC]: 0.759), calibration ability, and net clinical benefit.ConclusionsFungi-related nosocomial infections are prevalent among cancer patients and are associated with poor prognosis. The constructed nomogram provides an invaluable tool for oncologists, enabling them to make timely and informed clinical decisions that offer substantial net clinical benefit to patients.

C5a-licensed phagocytes drive sterilizing immunity during systemic fungal infection

Systemic candidiasis is a common, high-mortality, nosocomial fungal infection. Unexpectedly, it has emerged as a complication of anti-complement C5-targeted monoclonal antibody treatment, indicating a critical niche for C5 in antifungal immunity. We identified transcription of complement system genes as the top biological pathway induced in candidemic patients and as predictive of candidemia. Mechanistically, C5a-C5aR1 promoted fungal clearance and host survival in a mouse model of systemic candidiasis by stimulating phagocyte effector function and ERK- and AKT-dependent survival in infected tissues. C5ar1 ablation rewired macrophage metabolism downstream of mTOR, promoting their apoptosis and enhancing mortality through kidney injury. Besides hepatocyte-derived C5, local C5 produced intrinsically by phagocytes provided a key substrate for antifungal protection. Lower serum C5a concentrations or a C5 polymorphism that decreases leukocyte C5 expression correlated independently with poor patient outcomes. Thus, local, phagocyte-derived C5 production licenses phagocyte antimicrobial function and confers innate protection during systemic fungal infection.

Green Biofabrication of Silver Nanoparticles of Potential Synergistic Activity with Antibacterial and Antifungal Agents against Some Nosocomial Pathogens.

Nosocomial bacterial and fungal infections are one of the main causes of high morbidity and mortality worldwide, owing to the high prevalence of multidrug-resistant microbial strains. Hence, the study aims to synthesize, characterize, and investigate the antifungal and antibacterial activity of silver nanoparticles (AgNPs) fabricated using Camellia sinensis leaves against nosocomial pathogens. The biogenic AgNPs revealed a small particle diameter of 35.761 ± 3.18 nm based on transmission electron microscope (TEM) graphs and a negative surface charge of -14.1 mV, revealing the repulsive forces between nanoparticles, which in turn indicated their colloidal stability. The disk diffusion assay confirmed that Escherichia coli was the most susceptible bacterial strain to the biogenic AgNPs (200 g/disk), while the lowest sensitive strain was found to be the Acinetobacter baumannii strain with relative inhibition zones of 36.14 ± 0.67 and 21.04 ± 0.19 mm, respectively. On the other hand, the biogenic AgNPs (200 µg/disk) exposed antifungal efficacy against Candida albicans strain with a relative inhibition zone of 18.16 ± 0.14 mm in diameter. The biogenic AgNPs exposed synergistic activity with both tigecycline and clotrimazole against A. baumannii and C. albicans, respectively. In conclusion, the biogenic AgNPs demonstrated distinct physicochemical properties and potential synergistic bioactivity with tigecycline, linezolid, and clotrimazole against gram-negative, gram-positive, and fungal strains, respectively. This is paving the way for the development of effective antimicrobial combinations for the effective management of nosocomial pathogens in intensive care units (ICUs) and health care settings.

Antifungal Potential of Marine Organisms of the Yucatan Peninsula (Mexico) against Medically Important Candida spp.

Invasive fungal infections represent a global health threat. They are associated with high mortality and morbidity rates, partly due to the ineffectiveness of the available antifungal agents. The rampant increase in infections recalcitrant to the current antifungals has worsened this scenario and made the discovery of new and more effective antifungals a pressing health issue. In this study, 65 extracts from marine organisms of the Yucatan Peninsula, Mexico, were screened for antifungal activity against Candida albicans and Candida glabrata, two of the most prevalent fungal species that cause nosocomial invasive fungal infections worldwide. A total of 51 sponges, 13 ascidians and 1 gorgonian were collected from the coral reef and mangrove forest in the Yucatan Peninsula (Mexico) and extracted with organic solvents. Nine crude extracts showed potent antifungal activity, of which four extracts from the sponge species Aiolochroia crassa, Amphimedon compressa, Monanchora arbuscula and Agelas citrina had promising activity against Candida spp. Bioassay-guided fractionation of the M. arbuscula extract revealed the remarkable fungicidal activity of some fractions. Analysis of the chemical composition of one of the most active fractions by UHPLC-HRMS and NMR indicated the presence of mirabilin B and penaresidin B, and their contribution to the observed antifungal activity is discussed. Overall, this work highlights marine organisms of the Yucatan Peninsula as important reservoirs of natural products with promising fungicidal activity, which may greatly advance the treatment of invasive fungal infections, especially those afflicting immunosuppressed patients.

Fungicidal Effectiveness of Super-Oxidized Solution In Vitro: Potential Implications for Wound Care

Introduction. Drug-resistant fungal infections in chronic wounds represent a major clinical challenge to clinicians. Fungal infections delay wound healing by prolonging inflammation and encouraging biofilm formation, which protects microbes against host defenses and anti-infective medications. As such, interventions that prevent and control nosocomial fungal infections without interfering with the wound healing process are increasingly required. Although conventional antiseptics can effectively exert fungicidal effects, they also have adverse effects on human cells. SOS is a well-known bactericidal agent that enhances the wound healing process, especially for chronic wounds. However, few studies have evaluated the antimicrobial activity of SOS on fungi. Objective. The objective of this study was to evaluate whether SOS exerts fungicidal activities against common fungal species. Materials and Methods. The efficacy of SOS was tested against 6 fungal species (Candida albicans, Candida auris, Candida tropicalis, Candida parapsilosis, Sporothrix schenckii, Trichophyton mentagrophytes) using an in vitro time-kill assay. Results. SOS achieved 99.9999% reduction of all tested fungi within 1 minute of exposure. Conclusions. This study shows that SOS may be an effective tool for the prevention and control of fungal infections.

Effects of Medicinal Plants on Fungal Community Structure and Function in Hospital Grassplot Soil.

Hospital grassplot soil is an important repository of pathogenic fungi exposed to the hospital environment, and the diffusion of these fungi-containing soil particles in the air increases the risk of nosocomial fungal infections. In this study, from the perspective of soil microbes-plant holobiont, four medicinal plants Mirabilis jalapa, Artemisia argyi, Viola philippica, and Plantago depressa were used as materials, based on ITS high-throughput amplicon sequencing and simulated pot experiments to explore the effect of medicinal plants on the fungal community in hospital grassplot soil, in order to provide a new exploration for hospital grassplot soil remediation. The results showed that the fungal community ecological guilds in primary test soil was mainly pathogen, and the abundance of animal pathogen with potential threats to human reached 61.36%. After planting medicinal plants, the composition and function of soil fungal community changed significantly. Although this change varied with plant species and growth stages, all samples collected in the pot experiment showed that the pathogen abundance decreased and the saprotroph abundance increased. In addition, 45 of the 46 core fungal genera defined in all potted samples were present in primary test soil, and many of them were human potential pathogens. These findings imply that the idea of enhancing soil quality in hospital grassplot soil by planting specific plants is feasible. However, the initial fungal community of the hospital grassplot soil has a certain stability, and it is difficult to completely eliminate the threat of pathogenic fungi by planting medicinal plants.

P362 Seasonal trend of fungal flora in water of tertiary care hospital in North India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesThe study was conducted to assess the seasonal variation of fungal flora in hospital water of a tertiary care hospital in North India.MethodsA total of 200 water samples from the main reservoir, overhead and underground tanks, and taps of critical care units of the hospital were collected. The water samples were filtered by membrane filtration technique (0.22 micron) and cultured on dichloran rose-Bengal chloramphenicol agar with and without benomyl. The plates were incubated for upto 15 days and fungal colonies recovered were sub-cultured on Sabouraud Dextrose Agar and identified by phenotypic methods. Yeasts were identified by Matrix Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF-MS).ResultsMycelial fungi were isolated from 100% of the water samples which included Alternaria, Curvularia, Nigrospora, Penicillium, Aspergillus, Paecilomyces, Scytillidium, and Mycelia sterilia as depicted in Figure 1. Different fungi were prevailing in different water storage units like: Advance eye center— A. fumigatus, A. flavus, Fusarium solani, Alternaria spp. Rhizopus arrhizus, Ustilago spp., mycelia sterilia, Trichosporon spp.; Advance trauma Center—Cladophaialophora spp., Alternaria alternata, Penicillium, spp. A. flavus, A. nidulans, A. fumigatus, F. solani, Rhodotorula spp.: Bone marrow transplant unit— Alterneria alternata, A. niger, A. flavus, A. versicolor, Cladosporium spp., Fonsecaea pedrosoi, Fusarium spp., Nigrospora spherica, Penicillium spp., Rhodotorula spp., Trichosporon ashaii. The seasonal variation of fungal isolation is depicted in Figure 2. Isolation rate of Aspergillus species was 35% in winters, 31% in post-monsoon, 25% in summers. Isolation rate of Penicillium species was 19% in post-monsoon, 16% in winter and 15% in summers. Maximum number of dematiaceous fungi were isolated in summer season with isolation rate of 30% in summers as compared with 21.5% in post-monsoon and 19% in winters. Few yeasts isolated were Rhodotorula, Trichosporon, and Ustilago. Mucorales isolated rarely included Rhizopus, Absidia, Syncephalastrum, and Mucor species. Fungal colony forming units in the water samples ranged from 50 to 450 colony forming units/liter of water.ConclusionThe distribution of fungi in hospital water showed diversity and seasonal variability. Aspergillus species were isolated in maximum number in the winter season, Penicillium species in post-monsoon season and dematiaceous fungi in the winter season. Water as a source of fungal infection in critical care units, remains a relatively neglected area. Water supply could be a source of nosocomial fungal infections. Improving the quality of water by regular testing for fungal contamination and appropriate action to reduce its burden may reduce the hospital-acquired fungal infections.

S6.1d First case report of pediatric blood stream infection by Candida magnoliae in a known case of B cell ALL post -induction chemotherapy in Central India

S6.1 Antifungal Prophylaxis in Children with Cancer and HSCT, September 22, 2022, 4:45 PM - 6:15 PM ObjectivesDocumentation and dissemination of findings of a rare fungal isolate in an immunosuppressed child.MethodsA case study with rare fungal isolate in correlation to age, clinical condition, sample, and comorbidity was done. A 6-year-old male child was admitted for routine management of B cell acute lymphoid leukemia. The patient completed induction chemotherapy in July 2021. The patient was planned for consolidation in the last week of July and to rule out any infection blood and urine samples were sent. Paired blood samples were received in pediatric automated BacT/Alert blood culture bottles. After 8 days both the blood culture bottles flashed positive. On gram stain, budding yeast cells oval to globose were seen. No pseudohyphae were seen. Nigrosin staining result was negative. It was processed further on HiCrome™ agar showing cream-colored colonies at 370 C, cornmeal agar with 1% tween 80 for Dalmau technique showed only oval to globose yeast cells with blastoconidia, enlarged cells appearing as chlamydoconidia without pseudohyphae or true hyphae were seen. Glucose and sucrose were fermented and trehalose was weakly fermented. Urease was negative. Isolate was identified as Candida glabrata/Candida auris. Antifungal susceptibility showed elevated MIC for fluconazole but susceptible to amphotericin B, voriconazole, and caspofungin. As part of routine collaboration with reference center PGIMER, bloodstream Candida isolates were sent for confirmation, and quality control.ResultsThe isolate phenotypically suspected as C. glabrata causing fungemia was confirmed by the reference center as C. magnoliae. Currently, patient is on routine follow-up and doing well. On reviewing of available literature on C. magnoliae; bloodstream infections in two low birth weight neonates from Brazil, one immunocompetent child with tenosynovitis from the USA, and a terminal oncology patient from Italy were noted.In a Chinese study of 2007, phylogenetic analysis showed a close relationship of C. magnoliae to Candida krusei.ConclusionImmunosuppression with longstanding or repeated hospital admissions is a risk for nosocomial fungal infections, especially, bloodstream infections. Already confusing phenotypic identification among C. glabrata, C. auris, C. haemoulonii, and now the current isolate C. magnoliae further complicates and challenges diagnostic workflow impacting timely management of cases. Further studies and more documentation of such findings in literature are necessary for newer insights.

Impact of SARS-CoV-2 on lung cancer patient under immunotherapy

Abstract Patients with lung cancer have an increased vulnerability to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infection, and the association of the two diseases increases the severity of the infection. We present the case of a patient aged 72 years, a former 30 pack year (PA) smoker with 12 years withdrawal, and unvaccinated anti-SARS-CoV-2, with GOLD 2 COPD, hypertensive, recently diagnosed with left bronchopulmonary neoplasm and under immunotherapy. The patient had a fast-evolving SARS-COVID infection to a critical form, complicated with acute pulmonary embolism, nosocomial fungal infection, myelodysplastic syndrome, moderate multifactorial anaemic syndrome and heart disease. The unfavourable evolution of the patient’s condition led to the temporary suspension of oncological treatment throughout the critical period, but without the progression of neoplastic disease. Although bronchopulmonary neoplasm emphasises the severity of SARS-CoV-2 infection, it is not mandatory to develop a harmful oncologic outcome without proper treatment, especially immunotherapy.

Sequencing of ca-int-l gene of Candida Spp. In infected urinary tract among Iraqi women

The most common nosocomial fungal infection in hospitals is urinary tract candidiasis. Candida albicans is the most prevalent cause of nosocomial fungal urinary tract infections, however Candida species distribution is changing rapidly. At the same time, the rise in urinary tract candidiasis has resulted in the emergence of antifungal-resistant Candida species. This study aimed to diagnose Candida Spp. In women with UTI and reveal the nucleotides sequences of CA-INT-L Gene to look for mutation within the gene. This study included 100 women patients suffering from urinary tract infections and vaginal swabs samples from those individuals were taken to identify the presence of Candida. They were between the ages of 22 and 67. Candida identification has been accomplished using a variety of chemical and microscopically techniques. 100 samples have been clinically diagnosed with Candida Spp. But only 62 of the samples were positive by Vitik. This number has also reduced to only 25 after using the PCR. The sequence of the CA-INT-L showed different variations within the gene of the isolates.

Long-term antibiotic exposure promotes mortality after systemic fungal infection by driving lymphocyte dysfunction and systemic escape of commensal bacteria

Antibiotics are a modifiable iatrogenic risk factor for the most common human nosocomial fungal infection, invasive candidiasis, yet the underlying mechanisms remain elusive. We found that antibiotics enhanced the susceptibility to murine invasive candidiasis due to impaired lymphocyte-dependent IL-17A- and GM-CSF-mediated antifungal immunity within the gut. This led to non-inflammatory bacterial escape and systemic bacterial co-infection, which could be ameliorated by IL-17A or GM-CSF immunotherapy. Vancomycin alone similarly enhanced the susceptibility to invasive fungal infection and systemic bacterial co-infection. Mechanistically, vancomycin reduced the frequency of gut Th17 cells associated with impaired proliferation and RORγt expression. Vancomycin's effects on Th17 cells were indirect, manifesting only invivo in the presence of dysbiosis. In humans, antibiotics were associated with an increased risk of invasive candidiasis and death after invasive candidiasis. Our work highlights the importance of antibiotic stewardship in protecting vulnerable patients from life-threatening infections and provides mechanistic insights into a controllable iatrogenic risk factor for invasive candidiasis.

Immunosuppressed Patients with Clinically Diagnosed Invasive Fungal Infections: The Fungal Species Distribution, Antifungal Sensitivity and Associated Risk Factors in a Tertiary Hospital of Anhui Province.

ObjectiveSince the nosocomial fungal infections increasingly emerge, we extensively investigated the fungal species stratification and antifungal sensitivity profiles, clinical characteristics and associated risk factors of immunosuppressed patients with clinically diagnosed invasive fungal infections (IFIs) in a tertiary hospital of Anhui province.MethodsIn total, 112 subjects with immunosuppressive state were enrolled from a comprehensive tertiary hospital in Central China between July 2019 and December 2021. Eight-one fungal isolates were clinically recovered by fungus-culturing approaches. The identifications were conducted through a mass spectrometry detecting platform. The susceptibilities to antifungals were tested using the broth micro-dilution method, and the possible antifungal azole-resistance mechanism in specific Candida species was availably explored by sequencing. Patient medical profiles were accessed via the digitized retrieval system of hospital, from which clinical outcomes and multiple risk factors for immunosuppressed patients with clinically diagnosed IFIs were explicitly documented for evaluation.ResultsCandida species predominated in clinically diagnosed IFIs of immunosuppressed patients (accounting for 88.88%), followed by Trichosporon and Aspergillus species (6.17% and 4.94%, respectively). The source types of specimen were primarily comprised of urine (41.98%), respiratory samples (33.33%) and peripheral blood (9.88%). Frequently isolated Candida and Trichosporon species exhibited a high level of in vitro sensitivity for amphotericin B and 5-fluorocytosine, whereas a substantial portion of Candida species including C. glabrata, C. parapsilosis complex and C. tropicalis, and Trichosporon species showed lowered sensitivity patterns toward itraconazole, fluconazole and voriconazole at different levels. Specifically, gene mutations of ERG11 were identified in azole-resistant C. tropicalis. Distinct risk factors were analyzed to be highly associated with the clinically diagnosed IFI incidence, mainly including hospitalization duration, surgical procedures, immunosuppressive treatments, underlying diseases and other conditions.ConclusionCandida, Trichosporon and Aspergillus species were the top three pathogenic fungal agents causing clinically diagnosed IFIs in immunosuppressed patients. The attenuated sensitivity to azoles in Candida and Trichosporon species needs close surveillance, and ERG11 polymorphism might contribute to azole resistance in specific Candida species. Multiple featured risk factors for immunosuppressed patients developing clinically diagnosed IFIs require further consideration during clinical practice.