Occurrence Of Fungal Infections Research Articles

Diversity in Fungal Infections in the Initial Waves of COVID-19: An Occurrence Based Systematic Review

Background: Fungal coinfections have been part of the complications in coronavirus disease (COVID-19) patients. While systematic reviews on individual fungus was available, comprehensive data on the occurrence of various fungal infections was limited. Methodology: A systematic search in the databases ‘PubMed’ and ‘Global Research Database on COVID-19 by the World Health Organization (WHO) was made using relevant search terms. Only fungal coinfections/superinfections in confirmed COVID-19 cases were considered. All observational studies, case series, and case reports in English were included. Overall, the occurrence of the fungal infections and the associated factors was noted. Chi-square and Fisher’s exact tests compared epidemiological factors between survived and dead. Results: Data from 126 eligible studies reporting 870 cases showed that mucormycosis was the most common infection (42.5%), followed by aspergillosis (32.41%) and candidiasis (22.87%). The majority of the infections were seen in severe COVID-19 (94.01%), in ICU (67.25%), and with mechanical ventilation (73.61%). Prior steroid therapy was seen in 81.3% in mucormycosis. In aspergillosis, mechanical ventilation, infection due to Aspergillus fumigatus and administration of steroids at more than the recommended dose were significantly associated with those who died (p<0.05). Conclusion: Mucormycosis, followed by invasive pulmonary aspergillosis and invasive candidiasis, has been the most common coinfections/superinfections in COVID-19 patients. Early diagnosis led to better survival in Covid associated mucormycosis (CAM); however, in COVID-19-associated pulmonary aspergillosis (CAPA), mechanical ventilation, larger doses of corticosteroids than recommended and infection with A. fumigatus were significant associations among those who succumbed to the condition.

In silico molecular modelling studies and antibiofilm efficacy of shikonin against Candida albicans: mechanistic insight

In the recent past, the occurrence of fungal infections has increased drastically and candidiasis, caused prominently by Candida albicans, is foremost among them which has caused significant mortality and morbidity majorly in immune-compromised patients. Shikonin is a well-known natural naphthazarin derivative with promising antifungal efficacy, but it's mechanism of action is still unclear. Keeping this in view, present workwas designed to get a mechanistic insight of anti-candida efficacy of shikonin via in vitro experiments and in situ molecular modelling studies. The current exploratory study is based on research that uses both qualitative and quantitative techniques, including minimum inhibitory concentration, minimum biofilm inhibitory concentration, time kill assay, cell cycle analysis and apoptotic assays, static biofilm formation assays, microscopic biofilm assessment assays, ergosterol content estimation and molecular docking/simulation studies. The study revealed a notable effect of shikonin against Candida albicans, including retardation of biofilms. Shikonin, with its increasing concentration leads to candidal cell apoptosis and necrosis establishing its dose-dependent effect. Additionally, it exhibited fungicidal activity via a mechanism of action likely related to ergosterol complexation which was further corroborated by molecular docking and simulation studies.

In silico prediction of Antifungal compounds from Natural sources towards Lanosterol 14-alpha demethylase (CYP51) using Molecular docking and Molecular dynamic simulation

An increase in the occurrence of fungal infections throughout the world, as well as the rise of novel fungal strains and antifungal resistance to commercially available drugs, suggests that new therapeutic choices for fungal infections are needed. The purpose of this research was to find new antifungal candidates or leads of secondary metabolites derived from natural sources that could effectively inhibit the enzymatic activity of Candida albicans lanosterol 14-alpha demethylase (CYP51) while also having good pharmacokinetics. In silico prediction of the drug-likeness, chemo-informatics and enzyme inhibition indicate that the 46 compounds derived from fungi, sponges, plants, bacteria and algae sources have a high novelty to meet all five requirements of Lipinski's rules and impede enzymatic function. Among the 15 candidate molecules with strong binding affinity to CYP51 investigated by molecular docking simulation, didymellamide A-E compounds demonstrated the strongest binding energy against the target protein at −11.14, −11.46, −11.98, −11.98, and −11.50 kcal/mol, respectively. Didymellamide molecules bind to comparable active pocket sites of antifungal ketoconazole and itraconazole medicines by hydrogen bonds forming to Tyr132, Ser378, Met508, His377 and Ser507, and hydrophobic interactions with HEM601 molecule. The stability of the CYP51-ligand complexes was further investigated using molecular dynamics simulations that took into account different geometric features and computed binding free energy. Using the pkCSM ADMET descriptors tool, several pharmacokinetic characteristics and the toxicity of candidate compounds were assessed. The findings of this study revealed that didymellamides could be a promising inhibitor against these CYP51 protein. However, there is still a need for further in vivo and in vitro studies to support these findings.

Confronting trends of antibiotic resistance beyond the COVID-19 pandemic: insight from five worst hit countries

Antibiotic resistance is and has been a prominent obstacle prior to the occurrence of the COVID-19 pandemic. Due to the inability to efficiently treat the newly discovered coronavirus disease and the rise of bacterial co-infections in COVID-19 patients, the consumption of antibiotics increased drastically. Although the COVID-19 situation has somewhat contributed to reducing the spread of infections, the increment in antibiotic resistance is still a significant consequence. This emergence of increased rates is a global issue. The purpose of this review is to study the trend of antibiotic resistance before and since the COVID-19 pandemic in Brazil, China, India, Russia, and The United States of America. It was found that the most troublesome pathogens with the highest resistance rates in Brazil were Acinetobacter spp. The said bacterium species had developed peak resistance against meropenem, ciprofloxacin, gentamicin, and amikacin. Also, China had incredibly susceptible pathogens resistant towards macrolides, penicillins, and aminoglycosides; however, not much change was witnessed in the resistance rates of several pathogens. In India, increased usage of azithromycin led to the emergence of macrolide resistance among various bacterial pathogens, whereas the perpetual usage of doxycycline had not yet resulted in any tetracycline resistance. Although, the occurrence of fungal infections had enlarged, causing COVID-19-associated mucormycosis more frequent among the Indian population. While commonly present pathogens in Russia were extremely resistant to most antibiotic classes, Acinetobacter baumannii was the chief resistant bacterium reported. The United States of America was recognized with concentrated resistance against vancomycin, fluoroquinolones, and extended-spectrum β-lactamase producing antibiotics. This alarming rate of growing antibiotic resistance in world’s battle with COVID-19 is indeed a matter of concern.

Vaccines against candidiasis: Status, challenges and emerging opportunity.

Candidiasis is a mycosis caused by opportunistic Candida species. The occurrence of fungal infections has considerably increased in the last few years primarily due to an increase in the number of immune-suppressed individuals. Alarming bloodstream infections due to Candida sp. are associated with a higher rate of morbidity and mortality, and are emerged as major healthcare concerns worldwide. Currently, chemotherapy is the sole available option for combating fungal diseases. Moreover, the emergence of resistance to these limited available anti-fungal drugs has further accentuated the concern and highlighted the need for early detection of fungal infections, identification of novel antifungal drug targets, and development of effective therapeutics and prophylactics. Thus, there is an increasing interest in developing safe and potent immune-based therapeutics to tackle fungal diseases. In this context, vaccine design and its development have a priority. Nonetheless, despite significant advances in immune and vaccine biology over time, a viable commercialized vaccine remains awaited against fungal infections. In this minireview, we enumerate various concerted efforts made till date towards the development of anti-Candida vaccines, an option with pan-fugal vaccine, vaccines in the clinical trial, challenges, and future opportunities.

Novasomes as Nano-Vesicular Carriers to Enhance Topical Delivery of Fluconazole: A New Approach to Treat Fungal Infections.

The occurrence of fungal infections has increased over the past two decades. It is observed that superficial fungal infections are treated by conventional dosage forms, which are incapable of treating deep infections due to the barrier activity possessed by the stratum corneum of the skin. This is why the need for a topical preparation with advanced penetration techniques has arisen. This research aimed to encapsulate fluconazole (FLZ) in a novasome in order to improve the topical delivery. The novasomes were prepared using the ethanol injection technique and characterized for percent entrapment efficiency (EE), particle size (PS), zeta potential (ZP), drug release, Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), scanning electron microscopy (SEM) and antifungal activity. The FN7 formulation with 94.45% EE, 110 nm PS and −24 ZP proved to be the best formulation. The FN7 formulation showed a 96% release of FLZ in 8 h. FTIR showed the compatibility of FLZ with excipients and DSC studies confirmed the thermal stability of FLZ in the developed formulation. The FN7 formulation showed superior inhibition of the growth of Candida albicans compared to the FLZ suspension using a resazurin reduction assay, suggesting high efficacy in inhibiting fungal growth.

Comprehensive analysis of peripheral blood non-coding RNAs identifies a diagnostic panel for fungal infection after transplantation

The occurrence of fungal infection seriously affects the survival and life quality of transplanted patients. The accurate diagnosis is of particular importance in the early stage of infection. To develop a novel diagnostic method for this kind of patient, we established a post-transplant immunosuppressed mice model with fungus inoculation and collected their peripheral blood at specific time points after infection. After screening by microarray, differentially expressed miRNAs and lncRNAs were selected and homologously analyzed with those of human beings from the gene database. These miRNAs and lncRNAs candidates were validated by qRT-PCR in peripheral blood samples from transplanted patients. We found that, compared with normal transplanted patients, the levels of miR-215 and miR-let-7 c were up-regulated in the plasma of patients with fungal infection (P < 0.01), while levels of miR-154, miR-193a, NR_027669.1, and NR_036506.1 were down-regulated in their peripheral blood mononuclear cells (P < 0.01). Principal component analysis shows that the expression pattern of the above RNAs was different between the two groups. A 6-noncoding-RNA detection panel was established by the support vector machine analysis, whose area under the ROC curve was 0.927. The accuracy, precision, sensitivity, and specificity of this model were 0.928, 0.919, 0.944, and 0.910, respectively. Though our detection panel has excellent diagnostic efficacy, its clinical application value still needs to be further confirmed by multi-center prospective clinical trials.

A Brief Review of Fungal Infection- Pityriasis Versicolor

The occurrence of fungal infections is increasing at a distressing rate, presenting an vast pressure and challenge to healthcare professionals for their diagnosis and treatment. Rising fungal infections is also cause of significant morbidity and mortality. This emergence is directly related to the increasing population of immune-compromised individuals. Patient with circumstance such as Granulocytopenia, advanced HIV infection, bone marrow and solid organ transplantation, cancer, diabetes mellitus, severe burn and trauma and severe malnutrition are amongst many others predisposing factor for low immunity. Pityriasis versicolor most normally affects young adults and is slightly more widespread in men than in women. It can also influence children, adolescents, and older adults. Pityriasis versicolor is more common in hot, humid climates than in cool, dry climates. It often affects people who perspire heavily. It may clear in the winter months and persist each summer.

Mycafungin Prophylaxis for Adult Acute Leukemia Patients Undergoing Induction Chemotherapy

BackgroundMicafungin is a tolerable and effective prophylactic antifungal agent used during allogeneic stem cell transplantation. In this prospective single arm trial, we aimed to evaluate the potential efficacy and safety of micafungin as a prophylactic agent during first induction chemotherapy in acute leukemia patients.Materials and MethodsPatients received 50mg of micafungin intravenously once daily from initiation of induction chemotherapy to recovery of neutrophil count (absolute neutrophil count > 500/μg for consecutive days) or suspected fungal infection or occurrence of drug-related toxicity. Primary end point was the incidence of invasive fungal infection and secondary end point was overall survival and non-relapse mortality (ClinicalTrials. Gov number, NCT02440178).ResultA total of 65 patients (median age 51.0 years, male:female = 34:31) were enrolled in this study; 33 (50.8%) acute myeloid leukemia (AML), 31 (47.7%) acute lymphoblastic leukemia, and 1 acute biphenotypic leukemia, respectively. The median treatment duration of micafungin was 24 days (range 1.0-68 days). Proven invasive fungal disease occurred in 1/65 patients (1.5%) and possible fungal infection occurred in 2/65 patients (4.6%). Overall, 19/65 patients (29.2%) discontinued prophylactic micafungin and 18/65 patients (27.7%) changed micafungin to other antifungal agents; 2 patients (3.1%) for fungal infection and 15 patients (23.1%) for prolonged neutropenic fever of unknown cause. For safety, 3/65 patients (4.6%) experienced adverse events: 2 liver function abnormality (Grade 2 and 3 respectively) and 1 grade 2 allergic reaction. Induction-related mortality occurred in 3 patients, where 1 event was caused by invasive aspergillosis pneumonia. The period of from initiation of micafungin to change to other antifungal agents was 46 days (95% CI 27-64 days). There were no significant differences in adverse events and fungal infections between AML and ALL (2/33 for AML vs. 1/31 for ALL patients, p=1.000). In addition, the occurrence of fungal infection during induction therapy was associated with poor overall survival (hazard ratio 8.470, 95% confidence interval 1.048-68.465, p=0.045) in multivariable analysis. Additionally, there was no fungal infection caused by resistant organism after induction chemotherapy. Micafungin also prevented invasive fungal infection more effectively and adverse events were tolerable when compared to the results of previous prophylactic posaconazole trial (proven or probable invasive fungal infection: 2% (7/304); adverse events 19/304 (6%) in patients treated with prophylactic posaconazole) [1].ConclusionLikewise posaconazole, micafungin could be used effectively and safely as prophylactic regimen in both AML and ALL patients undergoing induction chemotherapy.Reference1. Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, Helfgott D, Holowiecki J, Stockelberg D, Goh YT, Petrini M, Hardalo C, Suresh R, Angulo-Gonzalez D. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. The New England journal of medicine. 2007;356:348-59.Figure captionFigure 1. The period of from initiation of micafungin to change to other antifungal agents [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Mucormycosis – The Black Fungus

Human history has witnessed a number of natural pandemics of diseases in the past such as smallpox, tuberculosis, cholera, measles, and the deadliest of all, the Black Death – Plague. The current pandemic of Covid-19 in the 21st century, however, seems to be different because of the supposed non-natural origin of the virus and an ability to change its virulence and strain so quickly. As our understanding of this virus is increasing, unusual associations and occurrences are coming to our forefront. One such lethal association that has recently been of concern and taken lots of lives especially during the recovery phase is the occurrence of fungal infection in the form of Mucormycosis or Black fungus. In this review, we highlight the significance, pathogenesis, diagnosis, and treatment of this very association.

Identification of Candida Species Circulating in Dakar using Multiplex Nested PCR

Background: In most developing countries, laboratory identification of Fungi belonging to the genus Candida is often problematic. The germ test tube known as Blastese test, which is the most used has the limitation that it only differentiates the C. albicans complex from other Candida complexes. Not only it is important to know the involvement of other species in the occurrence of fungal infections, but also the difference in sensitivity to the azoles used in the treatment of these fungal infections makes it necessary to identify the Fungi at the species level. The objective of this study was to identify by multiplex nested PCR the Candida species isolated in the laboratory of Parasitology and Mycology of Aristide Le Dantec Hospital, Senegal. Methodology: Candida isolates were obtained from patients who were admitted to the laboratory of Parasitology and Mycology with suspected fungal infections. After identification by conventional methods, isolates were preserved in a storage medium and kept at -20°C. Species identification was performed by nested PCR. Results: A total of 42 yeast isolates were collected after culture on Sabouraud medium, among which 10 (24%) from vaginal swabs and 32 (76%) from patients suffering from superficial mycoses (skin and nails). C. albicans represented 68% and nonCandida albicans (NAC) species 32%. The distribution of the NAC species was as follows: C. parapsilosis (group I and II) 17% (8), C. tropicalis 8.5% (4), C. kefyr 4.25% (2) and C. lusitaniae 2.15% (1). Mixed infection with two species represented 17.39% of the isolates. Conclusion: This study shows that other Candida species are common in Dakar, although their identification is not routinely performed in most laboratories. Thus, it is necessary to improve the technical facilities in these diagnostic laboratories.

Google search trends in onychomycosis: Influences of flip flops and advertising.

Onychomycosis is a fungal infection of the nail, affecting 5.5% of the population. Individuals affected by this disease experience increased anxiety about this disorder and a decreased quality of life. There are multiple available treatments across the globe, leading people to search online for information on the various therapies. To analyze Google search trends of fungal infection and treatment keywords and the influence of different geographical locations, season, regulatory decisions, and advertisements on these trends. In May, 2020 we used Google Trends to determine the relative interest of various fungal infection and treatment keywords worldwide and in the US, the UK, Canada, and Australia. Notable peaks were investigated for contemporaneous news events. In general, searches for toenail fungus and associated treatment terms peak during the summer months. Interest in individual treatments peaks when a product is launched, is the subject of an advertising campaign, or becomes more available to the public through approval or reclassification. Yeast infection, thrush, and ringworm terms are consistently searched more often than toenail fungus, jock itch, or foot fungus; all terms are most popular in the summer months, with toenail fungus reaching annual popularity one month prior to jock itch. In general, interest in toenail fungus and treatments is the highest when social anxiety about toenail appearance and the occurrence of fungal infection is the greatest. Curiosity about treatment products increases with their availability and visibility to the public. Combining the power of seasonal interest and advertising generates the greatest search profile for onychomycosis treatments.

Optimal control for the use of botanical fungicides in the spread of plant diseases

One of the main obstacles in crop cultivation is the occurrence of fungal infections. Fungal spores can spread due to direct contact between susceptible hosts and infected hosts, which can be controlled using botanical fungicides. We constructed a mathematical model of the growth of logistics on the spread of plant diseases. From this model, we show the value of the Basic Reproduction Number (ℜ0) of plant diseases transmission. The value of ℜ0 is obtained by finding the largest eigenvalue of the next generation matrix. The results obtained show that when ℜ0 is greater than one (ℜ0 > 1), the endemic equilibrium point will be stable. However, if ℜ0 is less than one (ℜ0 < 1), the endemic equilibrium point is unstable. In addition, the results of this discussion indicate that using botanical fungicides can reduce the infected host population. We provide numerical simulations to describe the results of the analysis obtained.

Risk Factors for Fungal Infections After Liver Transplantation

Introduction Fungal infections after transplantation are associated with high morbidity and mortality. Awareness of the treating physicians and thereby early detection is key to successful treatment. Aim of the present study was to identify risk factors for fungal infections in a cohort of liver transplant recipients in the MELD era. Patients and Methods Out of 579 adult patients transplanted from 01/2012-12/2016, 33 (5.6%) patients developed fungal infections after liver transplantation. These 33 patients (mean age 48 years; LabMELD 22) were matched with 99 patients (mean age 50 years; LabMELD 22) without fungal infections after transplantation by MELD score and age. Standard donor and recipient and procedural factors were analyzed and correlated with occurrence of fungal infections and outcomes by univariable/multivariable statistics. Fungal prophylaxis is not administered at our center. Results After adjustment by multivariable analysis the Donor Risk Index (p=0.02) and dialysis after transplantation (p=0.01) were independently associated with occurrence of fungal infections. 30-day and 12-month survival in patients with fungal infections were 63.6% and 48.5%, respectively, while patients without fungal infections demonstrated 30-day and 12 month survival rates of 85.9% and 76.7%, respectively (p<0.01). Conclusions Rates of fungal infections are low after liver transplantation in the modern MELD era. Indeed, outcome is significantly diminished if fungal infections occur. Patients requiring hemodialysis after liver transplantation are under high risk of this dangerous complication and should therefore be monitored carefully.

Population Development of the Invasive Species Thaumastocoris peregrinus (Hemiptera: Thaumastocoridae) on four Eucalyptus Species of the Subgenus Symphyomyrtus.

Thaumastocoris peregrinus Carpintero & Dellapé (Hemiptera: Thaumastocoridae) is a small sap-sucking insect that feeds on Eucalyptus L'Hér. leaves. Although it is native to Australia, it currently has a global distribution and it is considered as one of the big five pests of eucalypts around the world. We described the development of T. peregrinus population on four Eucalyptus species under the environmental conditions in Argentina. We also analyzed the use of yellow sticky traps as a monitoring method for this pest. The four Eucalyptus species were suitable for T. peregrinus. A cyclic pattern was observed in the development of the bronze bug population with an annual seasonal peak followed by a decrease in the abundance, reaching a minimum value during the unfavorable seasons. During the fall and winter seasons, epizootic events were registered in all the Eucalyptus species, caused by an entomopathogenic fungus. None of the meteorological variables had a clear influence neither on the bronze bug population nor with the occurrence of fungal infection. We found a significant relationship between the number of nymphs and adults of T. peregrinus in branches and the number of individuals caught in traps, suggesting that traps give actual information about the bronze bug abundance in the tree canopy.

Natural occurrence of the entomopathogenic genus Pandora on spittlebug pests of crops and pastures in Argentina

AbstractThe natural occurrence of entomophathogenic fungi infecting spittlebugs (Hemiptera: Cercopidae) considered serious pests to pasture grasses and crops in Argentina was investigated during summer˗autumn (December to May) from 2013 to 2016. Adults and nymphs of spittlebugs were collected from Sorghum halepense and Setaria parviflora var. parviflora in San Miguel de Tucumán, Tucumán province. The entomopathogenic fungal species were characterized on the basis of morphological keys and molecular techniques. Microscopic characters were described from material mounted in lactophenol/aceto‐orcein (1% w/v), and the amplification of the fungal SSU rDNA was carried out using the universal primers nu‐SSU‐0021‐5′ and nu‐SSU‐1780‐3′. Summarized information about occurrence of fungal infections on spittlebugs populations is provided. This study reports for the first time the occurrence of the genus Pandora infecting adults of the economically important spittlebugs Deois (Deois) mourei, D. (D.) knoblauchii, Isozulia christenseni christenseni and Notozulia entreriana from Argentina expanding the host range and geographical distribution of entomophthoralean fungi.

The relevance of collaborative work: the Latin American Society for Immunodeficiencies (LASID) registry model.

The Latin American Society for Immunodeficiencies (LASID) registry was established in April 2009 with the support of the European Society for Immunodeficiencies (ESID), the Jeffrey Modell Foundation, Baxter Bioscience and Conselho Nacional de Pesquisa e Desenvolvimento Científico (CNPq, Brazil). The mission of LASID is to educate and increase awareness of primary immunodeficiencies (PIDs), and educate doctors in Latin America to recognize PIDs according to the different phenotypes. The LASID registry has evolved from 25 centres in seven countries in April 2009, to now include 93 centres in 14 countries in July 2014. In total, 5203 PID cases have been reported. To date, the rate of response has been highest in Argentina, with 1942 (37%) reported cases, followed by Brazil with 1175 (23%) cases, Mexico with 854 (16%) cases and Columbia with 817 (16%) cases. Of the 5203 cases, antibody defects were recorded in 56% of patients, followed by well-established syndromes with immunodeficiency in 18% of patients, combined immunodeficiency in 10% of patients and phagocytic disorders in 9% of patients. Based on an estimated frequency of one PID case for every 10 000 people in Latin America, and the patients currently recorded in the registry, we can estimate the number of patients still to be identified in each country. For example, Argentina has identified the greatest proportion of PID cases, with 1942 cases of an expected total of 3900 cases identified. In comparison, 1175 of 18 600 have been identified in Brazil, 854 of 10 600 have been identified in Mexico and 817 of 4200 have been identified in Columbia. Evaluation of hyper-immunoglobulin (Ig)M syndrome is one of three clinical epidemiological projects developed within the LASID registry programme 1. Hyper-IgM syndrome is a group of disorders characterized by normal to elevated levels of IgM, and absent or decreased levels of IgA, IgE and IgG. CD40 ligand (CD40L) deficiency is the most common form of hyper-IgM syndrome, which is estimated to represent 75% of cases 1. Another form of hyper-IgM is a deficiency of activation-induced cytidine deaminase (AID). Patients with AID-deficiency are susceptible to extracellular bacterial infections, while patients with CD40L-deficiency are additionally susceptible to viral, fungal and intracellular bacterial infections 1, 2. A recent publication from the LASID registry summarizes the clinical and molecular characteristics of a cohort of 58 hyper-IgM patients 1. In this cohort, genetic defects were found in 37 patients, 35 of whom were CD40L-deficient (causing an X-linked form of hyper-IgM syndrome) and two were AID-deficient. Following genetic analysis, five novel mutations which abolished CD40L protein production on activated CD4+ T cells were identified 1. The most frequently observed clinical manifestation of hyper-IgM syndrome was pneumonia, which affected 80% of CD40L-deficient patients. Pneumocystis jirovecii was the most frequent cause of pneumonia, followed by cytomegalovirus, Pseudomonas aeruginosa, Streptococcus pneumoniae, parainfluenza virus type II and other unknown pathogens. Other common clinical manifestations of hyper-IgM syndrome included upper respiratory tract infections (63%), neutropenia (48%) and chronic diarrhoea (46%) 1. Our study identified several microorganisms that were not previously associated with hyper-IgM syndrome, including Aspergillus spp., Microsporidium spp. and Isospora belli, which caused infections such as severe pneumonia and chronic diarrhoea in CD40L-deficient patients. In addition, CD40L-deficient patients frequently developed other fungal infections such as paracoccidioidomycosis. Recent studies have found that paracoccidioidomycosis, an infection endemic to South America which has been previously associated with a mutation in the beta 1 subunit of the interleukin-12 receptor, can also occur in CD40-deficient patients 1-3. It should be noted that the different clinical phenotypes observed may be attributed to different environmental pressures. For instance, the occurrence of fungal infections may be higher in Latin America due to the prevailing warm and humid conditions. In conclusion, the LASID registry programme has evolved significantly to become a centralized resource for clinical immunologists throughout Latin America and beyond. The clinical epidemiological data are beginning to indicate that PIDs may present with distinct clinical features, which must be communicated to Latin American physicians in order to achieve early diagnosis and treatment. LASID thank Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ, http://www.cnpq.br), Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP, http://www.fapesp.br) and Baxter Bioscience, CSL Behring, Octapharma, and Grifols for unrestricted educational grants supporting the LASID registry initiative. The author would also like to thank Meridian HealthComms Ltd for providing medical writing services. A. C. N. has no conflicts of interest to disclose.

Superficial Fungal Infections in Renal Transplant Recipients

BackgroundRenal transplant recipients (RTRs) are predisposed to fungal infections because of long-term graft-preserving immunosuppressive therapy. MethodsWe prospectively enrolled 223 consecutive adult RTRs. Patients were transplanted at 1 of 2 transplant centers in Poland. The group consisted of 97 women (43%) and 126 men (57%). The control group consisted of 100 patients (39 women and 61 men) randomly selected from the outpatient dermatology clinic and from hospital personnel. All RTRs and the control group were screened for the presence of superficial fungal infections. All patients were examined by the same dermatologist. The oral mucosa and the entire body surface were fully examined. Mucosal swabs were obtained from all patients in both the examined and control groups. Skin scrapings and swabs were obtained from any clinically suspicious lesions. Nail clippings were collected in the case of any nail changes. ResultsSuperficial fungal infections have been detected in 133 RTRs (60%)and 27 controls (27%; P = .00001). One hundred eight RTRs (62%) developed superficial fungal infections in the first year after transplantation (P < .008). The most common site for superficial fungal infections in the RTRs group was the oral cavity. Candida albicans was the most frequently isolated species in the oral cavity. ConclusionsSuperficial fungal infections in RTRs are statistically more common among RTRs than in the general population. Whether the drug was used separately or administrated under immunosuppressive combinations had no influence on the occurrence of fungal infections. The final results showed no correlation between patient age and the occurrence of fungal infections. Dermatologists who care for transplant patients should be aware of the clinical course of fungal species in RTRs compared with the general population.

Assessment of microbiological air quality in hemato-oncology units and its relationship with the occurrence of invasive fungal infections: an integrative review

Worldwide aging of the human population has promoted an increase in the incidence of neoplasia, including hematological cancers, which render patients particularly vulnerable to invasive fungal infections. For this reason, air filtration in hematooncology units has been recommended. However, scarce literature has assessed the impact of microbiological air quality on the occurrence of fungal infections in this population. We performed an integrative review of studies in the MEDLINE database that were published between January 1980 and October 2012, using the following combinations of keywords: air × quality × HEPA, air × quality × hematology, and airborne fungal infections. The search yielded only 13 articles, suggesting that high-efficiency filtering of the ambient air in hemato-oncology units can prevent the incidence of invasive fungal infections. However, no randomized clinical trial was found to confirm this suggestion. Currently, there is no consensus about the maximum allowable count of fungi in the air, which complicates filtration monitoring, including filter maintenance and replacement, and needs to be addressed in future studies.

Soaking effects on seed germination and fungal infection in Picea abies

The effect of soaking on germination and occurrence of fungal infections on Norway spruce (Picea abies (L.) Karst.) seeds and germinants was studied in three commercial seed lots. Treatments in which seeds were soaked in water for 24 h or in which the water was changed during the soak did not have an effect on the species diversity or on the abundance of the fungi isolated from the seeds. Different fungi were found in different seed lots. Most of those isolated are saprophytic or weakly pathogenic, but pathogens such as Sirococcus conigenus (D.C.) P.F. Cannon & Minter and Trichothecium roseum (Pers.) Link were also isolated. Soaking increased germination energy but had no effect on final germination percentage. The number of mouldy seeds and germinants with disease symptoms was different among seed lots when seeds were germinated on water agar. When germinated in low humified Sphagnum peat, no differences in the emergence of disease symptoms were observed among seed lots. The frequency of disease was lower in peat than in water agar. Soaking had no effect on disease emergence in germination trials on either water agar or in Sphagnum peat.