DOCSLIB.ORG

Diagnosis of Pulmonary Infections Due to Endemic Fungi

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnosis of Pulmonary Infections Due to Endemic Fungi diagnostics Review Diagnosis of Pulmonary Infections Due to Endemic Fungi Victoria Poplin 1, Clarissa Smith 2 , Dominique Milsap 3, Lauren Zabel 3 and Nathan C. Bahr 1,* 1 Department of Internal Medicine, Division of Infectious Diseases, University of Kansas, Kansas City, KS 66160, USA; [email protected] 2 Department of Internal Medicine, University of Kansas, Kansas City, KS 66160, USA; [email protected] 3 School of Medicine, University of Kansas, Kansas City, KS 66160, USA; [email protected] (D.M.); [email protected] (L.Z.) * Correspondence: [email protected]; Tel.: +1-(913)-588-6035; Fax: +1-(913)-945-6916 Abstract: Endemic mycoses including Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, and Ta- laromyces are dimorphic fungi that can cause a variety of clinical manifestations, including respiratory infections. Their pulmonary presentations are variable, and diagnosis is often delayed as they can mimic other infectious and non-infectious causes of pulmonary disease. Delay in diagnosis can lead to unnecessary antibiotic use, repeat hospitalizations, and increased morbidity and mortality. The diagnosis of endemic fungal pulmonary infections often relies on multiple diagnostic tests including culture, tissue histopathology, antigen assays, and antibody assays. Due to the increased use of immunosuppressive agents and the widening geographic ranges where these infections are being found, the prevalence of endemic fungal infections is increasing. Physicians need to be aware of the clinical manifestations of pulmonary infections due to endemic fungal in order to ensure that the proper diagnostic work up is obtained promptly. A high index of suspicion is particularly important in patients with suspected pulmonary infections who have failed to improve despite antibiotics in the appropriate setting. We present a review diagnostic testing for pulmonary infections due to endemic mycoses. Citation: Poplin, V.; Smith, C.; Milsap, D.; Zabel, L.; Bahr, N.C. Keywords: endemic fungi; diagnostic tests; histoplasmosis; blastomycosis; coccidioidomycosis; Diagnosis of Pulmonary Infections paracoccidioidomycosis; talaromycosis; pulmonary infection Due to Endemic Fungi. Diagnostics 2021, 11, 856. https://doi.org/ 10.3390/diagnostics11050856 1. Introduction Academic Editor: Byeong-Ho Jeong Fungal pneumonia caused by endemic fungi including Histoplasma, Blastomyces, Coc- cidioides, Paracoccidioides, and Talaromyces can be challenging to diagnose. These mycoses Received: 5 March 2021 are termed endemic as they classically occur in particular geographic regions [1]. Endemic Accepted: 30 April 2021 Published: 10 May 2021 fungi are dimorphic, existing as molds at cooler environmental temperatures and yeast within the warmer temperatures of the human body. The endemic fungi can cause a variety Publisher’s Note: MDPI stays neutral of syndromes, but all carry the potential to cause respiratory infections since inhalation with regard to jurisdictional claims in is a major mode of disease acquisition in humans. Furthermore, rates of pneumonia due published maps and institutional affil- to endemic fungi are increasing due to increased use of immunosuppressive therapies [2]. iations. Diagnosis of pneumonia due to endemic fungi can be challenging as the clinical presen- tations are varied and non-specific, meaning this type of pneumonia may be mistaken for a variety of infectious or non-infectious causes of lung disease [1,3]. The diagnosis is frequently delayed, particularly when occurring outside of traditional endemic areas as physicians may not be familiar with the disease manifestations [1]. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Multiple diagnostic tests may be required for diagnosis including tissue histopathol- This article is an open access article ogy, culture, or specific fungal antigen or antibody detection assays in the appropriate distributed under the terms and clinical scenario. One non-specific fungal diagnostic test may be useful in the diagnosis of conditions of the Creative Commons Coccidioides, Histoplasma, Talaromyces, and Paracoccidioides is detection of 1,3-β-D-glucan, a Attribution (CC BY) license (https:// component of the cell wall of many fungi [4–6]. The 1,3-β-D-glucan assay is less useful to creativecommons.org/licenses/by/ detect Blastomyces given its yeast phase produces low levels of 1,3-β-D-glucan [4]. 1,3-β- 4.0/). D-glucan assay is a nonspecific test, therefore additional testing is needed to differentiate Diagnostics 2021, 11, 856. https://doi.org/10.3390/diagnostics11050856 https://www.mdpi.com/journal/diagnostics Diagnostics 2021, 11, 856 2 of 18 between fungi when the test is positive. Accordingly, the main role for 1,3-β-D-glucan testing in the diagnosis of endemic fungal pneumonia is as a screening test, or a non-specific test to help one further narrow the planned workup. We present a review of diagnostic testing for pneumonia due to endemic fungi. Given that geographic location and clinical presentations are crucial to proper diagnosis, these factors are described as well. 2. Histoplasmosis Histoplasmosis is caused by Histoplasma capsulatum var capsulatum and Histoplasma capsulatum var. duboisii [7]. Classically, H capsulatum is thought of as endemic to the Ohio and Mississippi River Valleys in the United States, as well as parts of Central and South America [2,7–10]. More recently it has become clear that Histoplasma occurs frequently in many parts of the world including: Central and Eastern North America, the majority of Central and South America, much of sub-Saharan Africa, large portions of southeast Asia and small areas within Australia and Europe [7]. H duboisii has primarily been described in West Africa. Infection is acquired through inhalation of spores from soil that is contaminated with bird or bat droppings [9,10]. Histoplasma can cause a wide variety of clinical man- ifestations including a spectrum of pulmonary diseases ranging from acute to chronic presentations [9,11]. Table1 describes signs, symptoms, imaging and lab findings, and epidemiology of histoplasmosis and other endemic fungi. Table 1. Signs, symptoms, imaging and lab findings, and epidemiology of pulmonary infections due to endemic mycoses *. Clinical Presentation Imaging Laboratory Epidemiology Histoplasmosis Fevers, chills, malaise, Diffuse patchy dyspnea ranging from Pancytopenia in opacities self-limited illness to disseminated disease Hilar/mediastinal Acute Pulmonary ARDS Narrow based budding adenopathy. Histoplasmosis Painful compressive ovoid Histoplasma yeast, Miliary pattern in adenopathy. 2–4 µM in diameter on severe and Rheumatologic pathology disseminated disease manifestations Central and Eastern North America, much Pancytopenia in of Central and South Hilar and mediastinal disseminated disease Mild respiratory and America, Sub-Saharan Subacute pulmonary Adenopathy Narrow based budding constitutional Africa, large portions of Histoplasmosis Focal/patchy airspace ovoid Histoplasma yeast, symptoms, >1 month Southeast Asia, small disease 2–4 µM in diameter on areas of Australia and pathology Europe Patchy infiltrates, cavities that may Fever, night sweats, Narrow based budding enlarge over time Chronic Pulmonary weight loss, cough, ovoid Histoplasma yeast, Calcified lymph nodes. Histoplasmosis shortness, chest pain of 2–4 µM in diameter on Typically no breath, >3 months pathology mediastinal lymphadenopathy Acute: fevers, chills, Consolidation productive cough with Mass like infiltrates or without sputum Miliary pattern production severe cases Nodules Midwestern United can develop ARDS. Reticular infiltrates Broad-based budding States and Eastern Blastomycosis Subacute/chronic: Often no mediastinal yeast North America, much 2–6 months: lymphadenopathy on pathology of Africa and India fever, night sweats, Chronic disease cough, typically hemoptysis, weight upper lobe loss predominant Diagnostics 2021, 11, 856 3 of 18 Table 1. Cont. Clinical Presentation Imaging Laboratory Epidemiology Histoplasmosis Lobar consolidation (more common), Peripheral eosinophilia Nodular opacities Spherules range in Fatigue, cough, fever, Mediastinal, hilar, diameter from 10 to dyspnea, night sweats, and/or C immitis: Central 200 µm, are filled with myalgias, paratracheal California, Washington 2–5 µm diameter symptoms onset adenopathy C posadasii: South and Coccidiomycosis endospores 1–3 weeks after Pleural effusion Central America, Endospores may be exposure (typically unilateral) Mexico, Arizona, Texas, outside Rheumatologic Cavities Utah of spherules and phenomena Miliary pattern in misidentified as other immunosuppressed fungi Migratory (phantom) infiltrates Acute/subacute: fever, Reticular, nodular, weight loss, interstitial or mixed Characteristic yeast lymphadenopathy, opacities. Referred to resembling “pilot Parts of Central and signs of disseminated as ‘bat’ or ‘butterfy’ Paracoccidiomycosis wheel” or “Mickey South America, most disease wing in median zone mouse” head on commonly in Brazil Chronic/adult: cough, Nodules pathology dyspnea, weight loss, Cavities. Interlobular anorexia septal thickening Fever, weight loss, cutaneous lesions, hepatosplenomegaly, lymphadenopathy, Patchy exudates respiratory signs (both Anemia, Nodular infiltrates in thrombocytopenia, South and Southeast Talaromycosis Pleural effusions HIV positive and HIV elevated liver function Asia Cavitary lesions negative individuals) tests Miliary pattern Arthritis, spondylodiskitis, osteomyelitis (more common in HIV negative individuals) ARDS: Acute
Load more

Recommended publications
  • Estimated Burden of Serious Fungal Infections in Ghana
    Journal of Fungi Article Estimated Burden of Serious Fungal Infections in Ghana Bright K. Ocansey 1, George A. Pesewu 2,*, Francis S. Codjoe 2, Samuel Osei-Djarbeng 3, Patrick K. Feglo 4 and David W. Denning 5 1 Laboratory Unit, New Hope Specialist Hospital, Aflao 00233, Ghana; [email protected] 2 Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box KB-143, Korle-Bu, Accra 00233, Ghana; [email protected] 3 Department of Pharmaceutical Sciences, Faculty of Health Sciences, Kumasi Technical University, P.O. Box 854, Kumasi 00233, Ghana; [email protected] 4 Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana; [email protected] 5 National Aspergillosis Centre, Wythenshawe Hospital and the University of Manchester, Manchester M23 9LT, UK; [email protected] * Correspondence: [email protected] or [email protected] or [email protected]; Tel.: +233-277-301-300; Fax: +233-240-190-737 Received: 5 March 2019; Accepted: 14 April 2019; Published: 11 May 2019 Abstract: Fungal infections are increasingly becoming common and yet often neglected in developing countries. Information on the burden of these infections is important for improved patient outcomes. The burden of serious fungal infections in Ghana is unknown. We aimed to estimate this burden. Using local, regional, or global data and estimates of population and at-risk groups, deterministic modelling was employed to estimate national incidence or prevalence. Our study revealed that about 4% of Ghanaians suffer from serious fungal infections yearly, with over 35,000 affected by life-threatening invasive fungal infections.
    [Show full text]
  • Coccidioides Immitis
    24/08/2017 FUNGAL AGENTS CAUSING INFECTION OF THE LUNG Microbiology Lectures of the Respiratory Diseases Prepared by: Rizalinda Sjahril Microbiology Department Faculty of Medicine Hasanuddin University 2016 OVERVIEW OF CLINICAL MYCOLOGY . Among 150.000 fungi species only 100-150 are human pathogens 25 spp most common pathogens . Majority are saprophyticLiving on dead or decayed organic matter . Transmission Person to person (rare) SPORE INHALATION OR ENTERS THE TISSUE FROM TRAUMA Animal to person (rare) – usually in dermatophytosis 1 24/08/2017 OVERVIEW OF CLINICAL MYCOLOGY . Human is usually resistant to infection, unless: Immunoscompromised (HIV, DM) Serious underlying disease Corticosteroid/antimetabolite treatment . Predisposing factors: Long term intravenous cannulation Complex surgical procedures Prolonged/excessive antibacterial therapy OVERVIEW OF CLINICAL MYCOLOGY . Several fungi can cause a variety of infections: clinical manifestation and severity varies. True pathogens -- have the ability to cause infection in otherwise healthy individuals 2 24/08/2017 Opportunistic/deep mycoses which affect the respiratory system are: Cryptococcosis Aspergillosis Zygomycosis True pathogens are: Blastomycosis Seldom severe Treatment not required unless extensive tissue Coccidioidomycosis destruction compromising respiratory status Histoplasmosis Or extrapulmonary fungal dissemination Paracoccidioidomycosis COMMON PATHOGENS OBTAINED FROM SPECIMENS OF PATIENTS WITH RESPIRATORY DISEASE Fungi Common site of Mode of Infectious Clinical
    [Show full text]
  • Estimated Burden of Fungal Infections in Oman
    Journal of Fungi Article Estimated Burden of Fungal Infections in Oman Abdullah M. S. Al-Hatmi 1,2,3,* , Mohammed A. Al-Shuhoumi 4 and David W. Denning 5 1 Department of microbiology, Natural & Medical Sciences Research Center, University of Nizwa, Nizwa 616, Oman 2 Department of microbiology, Centre of Expertise in Mycology Radboudumc/CWZ, 6500 Nijmegen, The Netherlands 3 Foundation of Atlas of Clinical Fungi, 1214GP Hilversum, The Netherlands 4 Ibri Hospital, Ministry of Health, Ibri 115, Oman; [email protected] 5 Manchester Fungal Infection Group, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, UK; [email protected] * Correspondence: [email protected]; Tel.: +968-25446328; Fax: +968-25446612 Abstract: For many years, fungi have emerged as significant and frequent opportunistic pathogens and nosocomial infections in many different populations at risk. Fungal infections include disease that varies from superficial to disseminated infections which are often fatal. No fungal disease is reportable in Oman. Many cases are admitted with underlying pathology, and fungal infection is often not documented. The burden of fungal infections in Oman is still unknown. Using disease frequencies from heterogeneous and robust data sources, we provide an estimation of the incidence and prevalence of Oman’s fungal diseases. An estimated 79,520 people in Oman are affected by a serious fungal infection each year, 1.7% of the population, not including fungal skin infections, chronic fungal rhinosinusitis or otitis externa. These figures are dominated by vaginal candidiasis, followed by allergic respiratory disease (fungal asthma). An estimated 244 patients develop invasive aspergillosis and at least 230 candidemia annually (5.4 and 5.0 per 100,000).
    [Show full text]
  • Turning on Virulence: Mechanisms That Underpin the Morphologic Transition and Pathogenicity of Blastomyces
    Virulence ISSN: 2150-5594 (Print) 2150-5608 (Online) Journal homepage: http://www.tandfonline.com/loi/kvir20 Turning on Virulence: Mechanisms that underpin the Morphologic Transition and Pathogenicity of Blastomyces Joseph A. McBride, Gregory M. Gauthier & Bruce S. Klein To cite this article: Joseph A. McBride, Gregory M. Gauthier & Bruce S. Klein (2018): Turning on Virulence: Mechanisms that underpin the Morphologic Transition and Pathogenicity of Blastomyces, Virulence, DOI: 10.1080/21505594.2018.1449506 To link to this article: https://doi.org/10.1080/21505594.2018.1449506 © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group© Joseph A. McBride, Gregory M. Gauthier and Bruce S. Klein Accepted author version posted online: 13 Mar 2018. Submit your article to this journal Article views: 15 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=kvir20 Publisher: Taylor & Francis Journal: Virulence DOI: https://doi.org/10.1080/21505594.2018.1449506 Turning on Virulence: Mechanisms that underpin the Morphologic Transition and Pathogenicity of Blastomyces Joseph A. McBride, MDa,b,d, Gregory M. Gauthier, MDa,d, and Bruce S. Klein, MDa,b,c a Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA; b Division of Infectious Disease, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 1675 Highland Avenue, Madison, WI 53792, USA; c Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, 1550 Linden Drive, Madison, WI 53706, USA.
    [Show full text]
  • Blastomycosis Surveillance in 5 States, United States, 1987–2018
    Article DOI: https://doi.org/10.3201/eid2704.204078 Blastomycosis Surveillance in 5 States, United States, 1987–2018 Appendix State-Specific Blastomycosis Case Definitions Arkansas No formal case definition. Louisiana Blastomycosis is a fungal infection caused by Blastomyces dermatitidis. The organism is inhaled and typically causes an acute pulmonary infection. However, cutaneous and disseminated forms can occur, as well as asymptomatic self-limited infections. Clinical description Blastomyces dermatitidis causes a systemic pyogranulomatous disease called blastomycosis. Initial infection is through the lungs and is often subclinical. Hematogenous dissemination may occur, culminating in a disease with diverse manifestations. Infection may be asymptomatic or associated with acute, chronic, or fulminant disease. • Skin lesions can be nodular, verrucous (often mistaken for squamous cell carcinoma), or ulcerative, with minimal inflammation. • Abscesses generally are subcutaneous cold abscesses but may occur in any organ. • Pulmonary disease consists of a chronic pneumonia, including productive cough, hemoptysis, weight loss, and pleuritic chest pain. • Disseminated blastomycosis usually begins with pulmonary infection and can involve the skin, bones, central nervous system, abdominal viscera, and kidneys. Intrauterine or congenital infections occur rarely. Page 1 of 6 Laboratory Criteria for Diagnosis A confirmed case must meet at least one of the following laboratory criteria for diagnosis: • Identification of the organism from a culture
    [Show full text]
  • COVID-19 Pneumonia: the Great Radiological Mimicker
    Duzgun et al. Insights Imaging (2020) 11:118 https://doi.org/10.1186/s13244-020-00933-z Insights into Imaging EDUCATIONAL REVIEW Open Access COVID-19 pneumonia: the great radiological mimicker Selin Ardali Duzgun* , Gamze Durhan, Figen Basaran Demirkazik, Meltem Gulsun Akpinar and Orhan Macit Ariyurek Abstract Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since December 2019. Although the reference diagnostic test is a real-time reverse transcription-polymerase chain reaction (RT-PCR), chest-computed tomography (CT) has been frequently used in diagnosis because of the low sensitivity rates of RT-PCR. CT fndings of COVID-19 are well described in the literature and include predominantly peripheral, bilateral ground-glass opacities (GGOs), combination of GGOs with consolida- tions, and/or septal thickening creating a “crazy-paving” pattern. Longitudinal changes of typical CT fndings and less reported fndings (air bronchograms, CT halo sign, and reverse halo sign) may mimic a wide range of lung patholo- gies radiologically. Moreover, accompanying and underlying lung abnormalities may interfere with the CT fndings of COVID-19 pneumonia. The diseases that COVID-19 pneumonia may mimic can be broadly classifed as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). We summarize the imaging fndings of COVID-19 and the aforementioned lung pathologies that COVID-19 pneumonia may mimic. We also discuss the features that may aid in the diferential diagnosis, as the disease continues to spread and will be one of our main diferential diagnoses some time more.
    [Show full text]
  • Antifungals for Onychomycosis & Systemic Infections
    Clinical Policy: Infectious Disease Agents: Antifungals for Onychomycosis & Systemic Infections Reference Number: OH.PHAR.PPA.70 Effective Date: 01/01/2020 Last Review Date: N/A Coding Implications Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description: INFECTIOUS DISEASE AGENTS: AGENTS FOR ONYCHOMYCOSIS NO PA REQUIRED “PREFERRED” PA REQUIRED “NON-PREFERRED” GRIFULVIN®V tablets (griseofulvin, microsize) ITRACONAZOLE (generic of Sporanox®) GRISEOFULVIN suspension (generic of LAMISIL Granules (terbinafine) Grifulvin®V) ONMEL® (itraconazole) GRIS-PEG® (griseofulvin, ultramicrosize) SPORANOX® 100mg/10ml oral solution TERBINAFINE (generic of Lamisil®) (itraconazole) INFECTIOUS DISEASE AGENTS: AGENTS FOR SYSTEMIC INFECTIONS NO PA REQUIRED “PREFERRED” PA REQUIRED “NON-PREFERRED” FLUCONAZOLE (generic of Diflucan®) CRESEMBA® (isavuconazonium) FLUCONAZOLE suspension (generic of ITRACONAZOLE capsules (generic of Diflucan®) Sporanox®) FLUCYTOSINE (generic of Ancobon®) NOXAFIL® (posaconazole) KETOCONAZOLE (generic of Nizoral®) ORAVIG® (miconazole) SPORANOX® 100mg/10ml oral solution (itraconazole) VORICONAZOLE (generic of Vfend®) TOLSURA (itraconazole) FDA Approved Indication(s): Antifungals are indicated for the treatment of: • aspergillosis • blastomycosis • bone and joint infections • candidemia • candidiasis • candidiasis prophylaxis • candiduria • cryptococcal meningitis • cryptococcosis • cystitis Page 1 of 9 CLINICAL POLICY Infectious Disease Agents:
    [Show full text]
  • Epidemiology and Geographic Distribution of Blastomycosis, Histoplasmosis, and Coccidioidomycosis, Ontario, Canada, 1990–2015 Elizabeth M
    Epidemiology and Geographic Distribution of Blastomycosis, Histoplasmosis, and Coccidioidomycosis, Ontario, Canada, 1990–2015 Elizabeth M. Brown,1 Lisa R. McTaggart,1 Deirdre Dunn, Elizabeth Pszczolko, Kar George Tsui, Shaun K. Morris, Derek Stephens, Julianne V. Kus,2 Susan E. Richardson2 In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/eid; and (4) view/print certificate. For CME questions, see page 1400. Release date: June 15, 2018; Expiration date: June 15, 2019 Learning Objectives Upon completion of this activity, participants will be able to: • Describe the epidemiology and geographic distribution of microbiology laboratory-confirmed
    [Show full text]
  • Fungal Infection in the Lung
    CHAPTER Fungal Infection in the Lung 52 Udas Chandra Ghosh, Kaushik Hazra INTRODUCTION The following risk factors may predispose to develop Pneumonia is the leading infectious cause of death in fungal infections in the lungs 6 1, 2 developed countries . Though the fungal cause of 1. Acute leukemia or lymphoma during myeloablative pneumonia occupies a minor portion in the immune- chemotherapy competent patients, but it causes a major role in immune- deficient populations. 2. Bone marrow or peripheral blood stem cell transplantation Fungi may colonize body sites without producing disease or they may be a true pathogen, generating a broad variety 3. Solid organ transplantation on immunosuppressive of clinical syndromes. treatment Fungal infections of the lung are less common than 4. Prolonged corticosteroid therapy bacterial and viral infections and very difficult for 5. Acquired immunodeficiency syndrome diagnosis and treatment purposes. Their virulence varies from causing no symptoms to death. Out of more than 1 6. Prolonged neutropenia from various causes lakh species only few fungi cause human infection and 7. Congenital immune deficiency syndromes the most vulnerable organs are skin and lungs3, 4. 8. Postsplenectomy state RISK FACTORS 9. Genetic predisposition Workers or farmers with heavy exposure to bird, bat, or rodent droppings or other animal excreta in endemic EPIDEMIOLOGY OF FUNGAL PNEUMONIA areas are predisposed to any of the endemic fungal The incidences of invasive fungal infections have pneumonias, such as histoplasmosis, in which the increased during recent decades, largely because of the environmental exposure to avian or bat feces encourages increasing size of the population at risk. This population the growth of the organism.
    [Show full text]
  • Oral Antifungals Month/Year of Review: July 2015 Date of Last
    © Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 | Fax 503-947-1119 Class Update with New Drug Evaluation: Oral Antifungals Month/Year of Review: July 2015 Date of Last Review: March 2013 New Drug: isavuconazole (a.k.a. isavunconazonium sulfate) Brand Name (Manufacturer): Cresemba™ (Astellas Pharma US, Inc.) Current Status of PDL Class: See Appendix 1. Dossier Received: Yes1 Research Questions: Is there any new evidence of effectiveness or safety for oral antifungals since the last review that would change current PDL or prior authorization recommendations? Is there evidence of superior clinical cure rates or morbidity rates for invasive aspergillosis and invasive mucormycosis for isavuconazole over currently available oral antifungals? Is there evidence of superior safety or tolerability of isavuconazole over currently available oral antifungals? • Is there evidence of superior effectiveness or safety of isavuconazole for invasive aspergillosis and invasive mucormycosis in specific subpopulations? Conclusions: There is low level evidence that griseofulvin has lower mycological cure rates and higher relapse rates than terbinafine and itraconazole for adult 1 onychomycosis.2 There is high level evidence that terbinafine has more complete cure rates than itraconazole (55% vs. 26%) for adult onychomycosis caused by dermatophyte with similar discontinuation rates for both drugs.2 There is low
    [Show full text]
  • Blastomycosis — Wisconsin, 1986–1995
    July 19, 1996 / Vol. 45 / No. 28 601 Blastomycosis — Wisconsin 603 Measles Pneumonitis Following Measles-Mumps-Rubella Vaccination of a Patient with HIV Infection, 1993 606 Biopsy-Confirmed Hypersensitivity Pneumonitis in Automobile Production Workers Exposed to Metalworking Fluids — Michigan 611 Update: Outbreaks of Cyclospora cayetanensis Infection — United States and Canada, 1996 Blastomycosis — Wisconsin, 1986–1995 Blastomycosis is— a Conti diseasenued of humans and animals caused by inhalation of airborne spores from Blastomyces dermatitidis, a dimorphic fungus found in soil. The spec- trum of clinical manifestations of blastomycosis includes acute pulmonary disease, subacute and chronic pulmonary disease (most common presentations), and dissemi- nated extrapulmonary disease (cutaneous manifestations are most common, fol- lowed by involvement of the bone, the genitourinary tract, and central nervous system) (1 ). Although the disease is not nationally notifiable, it was designated a re- portable condition in Wisconsin in 1984 following two large outbreaks. This report summarizes information about cases of blastomycosis reported in Wisconsin during 1986–1995 and highlights the importance of surveillance for blastomycosis in areas with endemic disease. In Wisconsin, cases of blastomycosis are reported to the Division of Health (DOH), Wisconsin Department of Health and Social Services. A confirmed case is defined as isolation of B. dermatitidis or visualization of characteristic broad-based budding yeast from a clinical specimen obtained from a person with clinically compatible ill- ness (e.g., subacute pneumonia or characteristic skin lesions). During 1986–1995, a total of 670 cases of blastomycosis were reported to DOH, representing a statewide mean annual incidence rate of 1.4 cases per 100,000 persons.
    [Show full text]
  • Therapeutic Class Overview Onychomycosis Agents
    Therapeutic Class Overview Onychomycosis Agents Therapeutic Class • Overview/Summary: This review will focus on the antifungal agents Food and Drug Administration (FDA)-approved for the treatment of onychomycosis.1-9 Onychomycosis is a progressive infection of the nail bed which may extend into the matrix or plate, leading to destruction, deformity, thickening and discoloration. Of note, these agents are only indicated when specific types of fungus have caused the infection, and are listed in Table 1. Additionally, ciclopirox is only FDA-approved for mild to moderate onychomycosis without lunula involvement.1 The mechanisms by which these agents exhibit their antifungal effects are varied. For ciclopirox (Penlac®) the exact mechanism is unknown. It is believed to block fungal transmembrane transport, causing intracellular depletion of essential substrates and/or ions and to interfere with ribonucleic acid (RNA) and deoxyribonucleic acid (DNA).1 The azole antifungals, efinaconazole (Jublia®) and itraconazole tablets (Onmel®) and capsules (Sporanox®) works via inhibition of fungal lanosterol 14-alpha-demethylase, an enzyme necessary for the biosynthesis of ergosterol. By decreasing ergosterol concentrations, the fungal cell membrane permeability is increased, which results in leakage of cellular contents.2,5,6 Griseofulvin microsize (Grifulvin V®) and ultramicrosize (GRIS-PEG®) disrupts the mitotic spindle, arresting metaphase of cell division. Griseofulvin may also produce defective DNA that is unable to replicate. The ultramicrosize tablets are absorbed from the gastrointestinal tract at approximately one and one-half times that of microsize griseofulvin, which allows for a lower dose of griseofulvin to be administered.3,4 Tavaborole (Kerydin®), is an oxaborole antifungal that interferes with protein biosynthesis by inhibiting leucyl-transfer ribonucleic acid (tRNA) synthase (LeuRS), which prevents translation of tRNA by LeuRS.7 The final agent used for the treatment of onychomycosis, terbinafine hydrochloride (Lamisil®), is an allylamine antifungal.
    [Show full text]