DOCSLIB.ORG

Current Epidemiology,Diagnostic and Treatment Approaches of Invasive Zygomycosis (Mucormycosis)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Current Epidemiology,Diagnostic and Treatment Approaches of Invasive Zygomycosis (Mucormycosis) Current Epidemiology,Diagnostic and Treatment Approaches of Invasive Zygomycosis (Mucormycosis) George Petrikkos, MD, Professor of Internal Medicine and Infectious Diseases [email protected]© by author National and Kapodistrian University of Athens State-of-the-art in Emerging Fungal Infections, ESCMIDESCMID Online Postgraduate Lecture Education LibraryCourse 8 - 9 September 2011, Cluj-Napoca, Romania Zygomycosis Zygomycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis, but its frequency is rising and its fatality remains high. © by author ESCMID Online Lecture Library Zygomycetes • Everywhere in nature – Decaying vegetation and in soil • Common genera: Rhizopus, Absidia, Cunninghamella, Rhizomucor, Syncephalastrum, Saksenaea, Apophysomyces and Mucor • Hyphae are broad, irregularly branched and have rare septations© by author – Opposite of Aspergillus difficult to culture ESCMID Online Lecture Library Zygomycosis: Epidemiology • The incidence of Zygomycosis is approximately 1.7 cases per 1 000 000 inhabitants per year,which means 500 patients per year in the USA.1 • Post-mortem evaluation shows that zygomycosis is ten- to 50-fold less frequent than candidiasis or aspergillosis, and it appears one to five cases per 10 000 autopsies.2-4 • In patients undergoing allogenic bone marrow transplantation the© incidence by author may be 2-3%.5,6 1. Ree JR et al. Clin Infect Dis ; 27:1138-1147;1998. 2. Hotchi M et al. Am J Clin Pathol ;74:410-416;1980. 3. Tietz HJ et al. Mycosis (suppl 2); 81-85;1998. 4.Yamazaki T et al. J Clin Microbiol ; 37: 1732-1738;1999. 5. Maertens J et al. Bone Marrow Transplant ; 24:307- ESCMID312;1999. Online Lecture Library 6. Marty FM et al . N Eng J Med ; 350:950-952 Percentages of Zygomycosis Cases 100% 80% 60% culture 40% 20% © by author Percentage of zygomycosis cases documentedbycases zygomycosis of Percentage 0% 1940s 1950s 1960s 1970s 1980s 1990s 2000s ESCMID Online Lecture Library Roden M, et al. Clinical Infectious Diseases 2005; 41:634–53 Changing Spectrum of Invasive Molds Incidence per 1000 Patient Days 0,7 0,21 Fusariosis Aspergillus 16% 0,6 Zygomycetes 0,18 0,5 0,15 0,4 0,12 0,3 0,09 0,2 0,06 Rate of aspergillosis of Rate Rate of Zygomycosis of Rate Zygomycosis 0,1 0,03 Invasive 20%© by author 0 0 Aspergillosis 2000 2001 2002 2003 200 64% Year ESCMID Online Lecture Library Kontoyiannis DP, et al. J Infect Dis. 2005;191:1350-1360. TRANSNET IFI Incidence July 2001-Dec 2005 45 40 Apergillosis Fusariosis 35 Zygomycosis 30 25 20 15 10 © by author 5 0 Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec ESCMID2001 2002 Online2002 2003 Lecture2003 2004 Library2004 2005 2005 •Cases/1000 transplants Incidence of invasive fungal infections after stem cell transplant, in USA, 2001-2006 (TransNet) 1,8 1,6 1,6 1,4 1,2 1,1 © by1 author 0,8 0,6 incidence incidence (%) 0,3 -month cumulative -month 0,4 0,2 12 0 ESCMID Online LectureAspergillosis Library Candidiasis Zygomycosis Kontoyiannis et al. 2009 Zygomycosis • Increasing incidence • Vulnerable populations: – Diabetes mellitus (association with ketoacidosis) – Malignancy (mostly haematological) – Bone marrow transplantation – Solid organ transplantation – Intra-venous drug use – Deferroxamine therapy – Trauma/Critical illness© by author • Voriconazole? Roden, et al. Clin Inf Dis 2005;41:634-53. ESCMID OnlineKauffman, Lecture CID editorial 2004.Library Zygomycosis Underlying Diseases Other 6% Diabetes 13% Burn Hema 3% malignancy 46% Trauma 17% SO © by author transplantation Immunocompetent: 2 4% Other malignancies BMT 4% 7% G.Petrikkos, A.Skiada, L.Pagano, A.H.Groll, A.Mitroussia-Ziouva, B.Dupont, C.Lass- Floerl, E.BouzaESCMID ,E Roilides, J Meis, Online and the Lecture Library ECMM Zygomycosis Working Group, ICAAC, 2008. Risk factors and most common clinical presentation of zygomycosis Predisposing conditions Clinical presentation Immunosuppression (malignancy) Respiratory tract infection, disseminated infection Metabolic (diabetes) Respiratory tract infection, rhinocerebral infection Deferoxamine therapy Disseminated infection Skin and soft tissue breakdown Primary cutaneous and soft tissue infection Intravenous illicit drug use Endocarditis, cerebral infection Neonatal prematurity © byGastrointestinal author infection, disseminated infection Malnourishment Gastrointestinal infection ESCMID Online Lecture Library Mortality Due to Mold Infections 80 100% 70 60 80% 50 64,0% 40 60% 52,0% 30 42,0% 40% Underlying 20 patientsof % 10 20% Mortality 0 © by author 0% Aspergillus spp Zygomycetes Fusarium spp 11,802 patients (18 centers) ESCMID OnlinePagano Lecture L et al. Haematologica Library 2006;91:1068- 1075. CLINICAL MANIFESTATIONS © by author ESCMID Online Lecture Library Zygomycosis The most frequenly observed clinical manifestations Rhinocerebral and pulmonary zygomycosis While cases have been described gastrointestinal cutaneous disseminated © by author and miscellaneous ESCMID Online Lecture Library Zygomycosis Site of infection Heart 1% Disseminated Lung 15% 24% Sinusitis 11% Bone 1% © by author Soft tissue Rhinocerebral 26% 22% G.Petrikkos, A.Skiada, L.Pagano, A.H.Groll, A.Mitroussia-Ziouva1, B.Dupont,ESCMID C.Lass-Floerl, Online E.Bouza ,E Lecture Roilides, J Meis, Library and the ECMM Zygomycosis Working Group, ICAAC, 2008. Rhino-cerebral zygomycosis © by author ESCMID Online Lecture Library Rhino-cerebral Zygomycosis It is the most frequent presentation overall and classically affects diabetics with ketoacidosis. Usually presents with facial and/or eye pain, proptosis and progressive signs of involvement of orbital structures (muscles, nerves and vessels). Common complications© byinclude author cavernous sinus and internal carotid artery thrombosis. ESCMID FatalityOnline 40%-50% Lecture Library Rhino-cerebral Zygomycosis Pathogenesis • Acquired by the inhalation of spores • Infection starts in the nasal turbinates then spreads to involve the orbits and the brain • Mucor is angioinvasive and can lead to infarction of infected tissues © by author ESCMID Online Lecture Library Rhinocerebral Zygomycosis Presentation • Acute – Fever – Facial pain – Nasal congestion – Epistaxis – Changes in vision – Changes in mentation • Spreads to palate, orbits and brain • Can lead to tissue © by author necrosis and eschar formation ESCMID Online Lecture Library Rhinocerebral Zygomycosis Presentation • Exam findings – Tissue necrosis – Changes in sensation – Vision loss – Proptosis and globe© byfixation author – Bony erosions on CT – Maxillary and ethmoid sinuses most common ESCMID Online Lecture Library Rhinocerebral Zygomycosis Presentation • Chronic – Visual changes – Neurological complaints – Proptosis and globe fixation – Mass lesions and bony erosions on CT © by author ESCMID Online Lecture Library Rhinocerebral Zygomycosis Definitive diagnosis • CT is suggestive but not sensitive of specific • Histopathology • Cultures confirmation • Direct PCR is being investigated © by author ESCMID Online Lecture Library Fungal invasive sinusitis DD • Multiple species in invasive sinusitis for DD – Aspergillus (acute / chronic) – Fusarium – Dematiaceous molds (chronic) – Candida in AIDS and marrow transplant patients © by author ESCMID Online Lecture Library Pulmonary Zygomycosis © by author Anteroposterior chest radiograph showing bilateral ESCMIDnodules and Online a worsening Lecture lingular infiltrateLibrary Juliette L. Wohlrab,et all CHEST / 120 / 3 / SEPTEMBER, 2001 Pulmonary Zygomycosis . It occurs most frequently among neutropenic patients. It presents with nonspecific symptoms such as fever, cough and dyspnea; hemoptysis may occur with vascular invasion. Radiological presentation includes segmental consolidation© that by author progresses to contiguous areas of the lung, with occasional cavitation. ESCMID Fatality Online 80% Lecture Library Pulmonary Zygomycosis Clinical manifestations *Very similar to invasive bronchopulmonary aspergillosis - results in pulmonary infarction & necrosis • Patients with hematological malignancies (lymphoma, leukemia) are particularly at high risk © by author ESCMID Online Lecture Library Pulmonary Zygomycosis in a Diabetic Patient © by author Chest roentgenogram showing CECT chest showing cavitary consolidation consolidation in left lingular lobe in left lung and fresh infiltrates in right lung AnuradhaESCMID et al Indian Online Journal of Medical Lecture Microbiology, Library (2006) 24 (3):222-4 Pulmonary Zygomycosis © by author CT scan of the chest with a cavitary infiltrate in the left upper lobe with interstitial changes and effusions bilaterally ESCMID(nodules Onlinenot demonstrated Lecture in thisLibrary image Juliette L. Wohlrab,et all CHEST / 120 / 3 / SEPTEMBER, 2001 Diagnosis: Pulmonary mucormycosis, BOOP © by author Vascular invasion and hemorrhagic Nonseptated hyphae with wide-angle infarct with fungal overgrowth within branching consistent with Mucor vessels. Areas of BOOP are also seen (Gomori’s methenamine- silver, original (hematoxylin-eosin,ESCMID original 20). Online 40).Lecture Library Juliette L. Wohlrab,et all CHEST / 120 / 3 / SEPTEMBER, 2001 Cutaneous Zygomycosis © by author ESCMID Online Lecture Library Cutaneous Zygomycosis It has been reported with minor trauma, insect bites, contaminated dressings and patches, wounds, and burns. The necrotic lesions progressively evolve from the© by epidermis author into dermis and even muscle and bone. ESCMID Online Lecture Library Cutaneous and subcutaneous Zygomycosis * Clinical manifestations Local
Load more

Recommended publications
  • Oral Candidiasis: a Review
    International Journal of Pharmacy and Pharmaceutical Sciences ISSN- 0975-1491 Vol 2, Issue 4, 2010 Review Article ORAL CANDIDIASIS: A REVIEW YUVRAJ SINGH DANGI1, MURARI LAL SONI1, KAMTA PRASAD NAMDEO1 Institute of Pharmaceutical Sciences, Guru Ghasidas Central University, Bilaspur (C.G.) – 49500 Email: [email protected] Received: 13 Jun 2010, Revised and Accepted: 16 July 2010 ABSTRACT Candidiasis, a common opportunistic fungal infection of the oral cavity, may be a cause of discomfort in dental patients. The article reviews common clinical types of candidiasis, its diagnosis current treatment modalities with emphasis on the role of prevention of recurrence in the susceptible dental patient. The dental hygienist can play an important role in education of patients to prevent recurrence. The frequency of invasive fungal infections (IFIs) has increased over the last decade with the rise in at‐risk populations of patients. The morbidity and mortality of IFIs are high and management of these conditions is a great challenge. With the widespread adoption of antifungal prophylaxis, the epidemiology of invasive fungal pathogens has changed. Non‐albicans Candida, non‐fumigatus Aspergillus and moulds other than Aspergillus have become increasingly recognised causes of invasive diseases. These emerging fungi are characterised by resistance or lower susceptibility to standard antifungal agents. Oral candidiasis is a common fungal infection in patients with an impaired immune system, such as those undergoing chemotherapy for cancer and patients with AIDS. It has a high morbidity amongst the latter group with approximately 85% of patients being infected at some point during the course of their illness. A major predisposing factor in HIV‐infected patients is a decreased CD4 T‐cell count.
    [Show full text]
  • Review Article Sporotrichosis: an Overview and Therapeutic Options
    Hindawi Publishing Corporation Dermatology Research and Practice Volume 2014, Article ID 272376, 13 pages http://dx.doi.org/10.1155/2014/272376 Review Article Sporotrichosis: An Overview and Therapeutic Options Vikram K. Mahajan Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra, Tanda, Himachal Pradesh 176001, India Correspondence should be addressed to Vikram K. Mahajan; [email protected] Received 30 July 2014; Accepted 12 December 2014; Published 29 December 2014 Academic Editor: Craig G. Burkhart Copyright © 2014 Vikram K. Mahajan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Sporotrichosis is a chronic granulomatous mycotic infection caused by Sporothrix schenckii, a common saprophyte of soil, decaying wood, hay, and sphagnum moss, that is endemic in tropical/subtropical areas. The recent phylogenetic studies have delineated the geographic distribution of multiple distinct Sporothrix species causing sporotrichosis. It characteristically involves the skin and subcutaneous tissue following traumatic inoculation of the pathogen. After a variable incubation period, progressively enlarging papulo-nodule at the inoculation site develops that may ulcerate (fixed cutaneous sporotrichosis) or multiple nodules appear proximally along lymphatics (lymphocutaneous sporotrichosis). Osteoarticular sporotrichosis or primary pulmonary sporotrichosis are rare and occur from direct inoculation or inhalation of conidia, respectively. Disseminated cutaneous sporotrichosis or involvement of multiple visceral organs, particularly the central nervous system, occurs most commonly in persons with immunosuppression. Saturated solution of potassium iodide remains a first line treatment choice for uncomplicated cutaneous sporotrichosis in resource poor countries but itraconazole is currently used/recommended for the treatment of all forms of sporotrichosis.
    [Show full text]
  • Mucormycosis of the Central Nervous System
    Journal of Fungi Review Mucormycosis of the Central Nervous System 1 1,2, , 3, , Amanda Chikley , Ronen Ben-Ami * y and Dimitrios P Kontoyiannis * y 1 Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel 3 Department of Infectious Diseases, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA * Correspondence: [email protected] (R.B.-A.); [email protected] (D.P.K.) These authors contribute equally to this paper. y Received: 6 June 2019; Accepted: 7 July 2019; Published: 8 July 2019 Abstract: Mucormycosis involves the central nervous system by direct extension from infected paranasal sinuses or hematogenous dissemination from the lungs. Incidence rates of this rare disease seem to be rising, with a shift from the rhino-orbital-cerebral syndrome typical of patients with diabetes mellitus and ketoacidosis, to disseminated disease in patients with hematological malignancies. We present our current understanding of the pathobiology, clinical features, and diagnostic and treatment strategies of cerebral mucormycosis. Despite advances in imaging and the availability of novel drugs, cerebral mucormycosis continues to be associated with high rates of death and disability. Emerging molecular diagnostics, advances in experimental systems and the establishment of large patient registries are key components of ongoing efforts to provide a timely diagnosis and effective treatment to patients with cerebral mucormycosis. Keywords: central nervous system; mucormycosis; Mucorales; zygomycosis 1. Introduction Mucormycosis is the second most frequent invasive mold disease after aspergillosis [1–3], with rising incidence reported in some countries [4–7].
    [Show full text]
  • Fungal Diseases
    Abigail Zuger Fungal Diseases For creatures your size I offer a free choice of habitat, so settle yourselves in the zone that suits you best, in the pools of my pores or the tropical forests of arm-pit and crotch, in the deserts of my fore-arms, or the cool woods of my scalp Build colonies: I will supply adequate warmth and moisture, the sebum and lipids you need, on condition you never do me annoy with your presence, but behave as good guests should not rioting into acne or athlete's-foot or a boil. from "A New Year Greeting" by W.H. Auden. Introduction Most of the important contacts between human beings and the fungi occur outside medicine. Fungi give us beer, bread, antibiotics, mushroom omelets, mildew, and some devastating crop diseases; their ability to cause human disease is relatively small. Of approximately 100,000 known species of fungi, only a few hundred are human pathogens. Of these, only a handful are significant enough to be included in medical texts and introductory courses like this one. On the other hand, while fungal virulence for human beings is uncommon, the fungi are not casual pathogens. In the spectrum of infectious diseases, they can cause some of the most devastating and stubborn infections we see. Most human beings have a strong natural immunity to the fungi, but when this immunity is breached the consequences can be dramatic and severe. As modern medicine becomes increasingly adept in prolonging the survival of some patients with naturally-occurring immunocompromise (diabetes, cancer, AIDS), and causing iatrogenic immunocompromise in others (antibiotics, cytotoxic and MID 25 & 26 immunomodulating drugs), fungal infections are becoming increasingly important.
    [Show full text]
  • Fungal Infections
    FUNGAL INFECTIONS SUPERFICIAL MYCOSES DEEP MYCOSES MIXED MYCOSES • Subcutaneous mycoses : important infections • Mycologists and clinicians • Common tropical subcutaneous mycoses • Signs, symptoms, diagnostic methods, therapy • Identify the causative agent • Adequate treatment Clinical classification of Mycoses CUTANEOUS SUBCUTANEOUS OPPORTUNISTIC SYSTEMIC Superficial Chromoblastomycosis Aspergillosis Aspergillosis mycoses Sporotrichosis Candidosis Blastomycosis Tinea Mycetoma Cryptococcosis Candidosis Piedra (eumycotic) Geotrichosis Coccidioidomycosis Candidosis Phaeohyphomycosis Dermatophytosis Zygomycosis Histoplasmosis Fusariosis Cryptococcosis Trichosporonosis Geotrichosis Paracoccidioidomyc osis Zygomycosis Fusariosis Trichosporonosis Sporotrichosis • Deep / subcutaneous mycosis • Sporothrix schenckii • Saprophytic , I.P. : 8-30 days • Geographical distribution Clinical varieties (Sporotrichosis) Cutaneous • Lymphangitic or Pulmonary lymphocutaneous Renal Systemic • Fixed or endemic Bone • Mycetoma like Joint • Cellulitic Meninges Lymphangitic form (Sporotrichosis) • Commonest • Exposed sites • Dermal nodule pustule ulcer sporotrichotic chancre) (Sporotrichosis) (Sporotrichosis) • Draining lymphatic inflamed & swollen • Multiple nodules along lymphatics • New nodules - every few (Sporotrichosis) days • Thin purulent discharge • Chronic - regional lymph nodes swollen - break down • Primary lesion may heal spontaneously • General health - may not be affected (Sporotrichosis) (Sporotrichosis) Fixed/Endemic variety (Sporotrichosis) •
    [Show full text]
  • Global Epidemiology of Cutaneous Zygomycosis
    Clinics in Dermatology (2012) 30, 628–632 Global epidemiology of cutaneous zygomycosis Anna Skiada, MD, PhDa,⁎, Dimitris Rigopoulos, MD, PhDb, George Larios, MD, MScc, George Petrikkos, MD, PhDd, Andreas Katsambas, MD, PhDc aFirst Department of Propaedeutic Medicine, University of Athens, School of Medicine, Laikon General Hospital, M. Asias 75, Goudi 11527, Athens, Greece bSecond Department of Dermatology and Venereology, University of Athens, School of Medicine, Attikon General Hospital, Rimini 1, Haidari 12464, Athens, Greece cFirst Department of Dermatology and Venereology, University of Athens, School of Medicine, Andreas Syggros Hospital, I. Dragoumi 5, 16121 Athens, Greece dFourth Department of Internal Medicine, University of Athens, School of Medicine, Attikon General Hospital, Rimini 1, Haidari 12464, Athens, Greece Abstract The large majority of cases reported worldwide as zygomycosis are infections caused by fungi belonging to the order Mucorales. These infections are invasive, often lethal, and they primarily affect immunocompromised patients. Cutaneous zygomycosis is the third most common clinical presentation, after sinusitis and pulmonary disease. Most patients with cutaneous zygomycosis have underlying diseases, such as hematological malignancies and diabetes mellitus, or have received solid organ transplantation, but a large proportion of these patients are immunocompetent. Trauma is an important mode of acquiring the disease. The disease can be very invasive locally and penetrate from the cutaneous and subcutaneous tissues into the adjacent fat, muscle, fascia, and bone. The diagnosis of cutaneous zygomycosis is often difficult because of the nonspecific findings of the infection. The clinician must have a high degree of suspicion and use all available diagnostic tools, because early diagnosis leads to an improved outcome.
    [Show full text]
  • Estimation of Direct Healthcare Costs of Fungal Diseases in the United States
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Clin Infect Manuscript Author Dis. Author manuscript; Manuscript Author available in PMC 2020 May 17. Published in final edited form as: Clin Infect Dis. 2019 May 17; 68(11): 1791–1797. doi:10.1093/cid/ciy776. Estimation of direct healthcare costs of fungal diseases in the United States Kaitlin Benedict, Brendan R. Jackson, Tom Chiller, and Karlyn D. Beer Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Abstract Background: Fungal diseases range from relatively minor superficial and mucosal infections to severe, life-threatening systemic infections. Delayed diagnosis and treatment can lead to poor patient outcomes and high medical costs. The overall burden of fungal diseases in the United States is challenging to quantify because they are likely substantially underdiagnosed. Methods: To estimate total national direct medical costs associated with fungal diseases from a healthcare payer perspective, we used insurance claims data from the Truven Health MarketScan® 2014 Research Databases, combined with hospital discharge data from the 2014 Healthcare Cost and Utilization Project National Inpatient Sample and outpatient visit data from the 2005–2014 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. All costs were adjusted to 2017 dollars. Results: We estimate that fungal diseases cost more than $7.2 billion in 2017, including $4.5 billion from 75,055 hospitalizations and $2.6 billion from 8,993,230 outpatient visits. Hospitalizations for Candida infections (n=26,735, total cost $1.4 billion) and Aspergillus infections (n=14,820, total cost $1.2 billion) accounted for the highest total hospitalization costs of any disease.
    [Show full text]
  • Mycologic Disorders of the Skin Catherine A
    Mycologic Disorders of the Skin Catherine A. Outerbridge, DVM, MVSc, DACVIM, DACVD Cutaneous tissue can become infected when fungal organisms contaminate or colonize the epidermal surface or hair follicles. The skin can be a portal of entry for fungal infection when the epithelial barrier is breached or it can be a site for disseminated, systemic fungal disease. The two most common cutaneous fungal infections in small animals are dermato- phytosis and Malassezia dermatitis. Dermatophytosis is a superficial cutaneous infection with one or more of the fungal species in the keratinophilic genera Microsporum, Tricho- phyton,orEpidermophyton. Malassezia pachydermatis is a nonlipid dependent fungal species that is a normal commensal inhabitant of the skin and external ear canal in dogs and cats. Malassezia pachydermatis is the most common cause of Malassezia dermatitis. The diagnosis and treatment of these cutaneous fungal infections will be discussed. Clin Tech Small Anim Pract 21:128-134 © 2006 Elsevier Inc. All rights reserved. KEYWORDS dermatophytosis, Malassezia dermatitis, dogs, cats, Microsporum, Trichophyton, Malassezia pachydermatis ver 300 species of fungi have been reported toDermatophytosis be animal O pathogens.1 Cutaneous tissue can become infected when fungal organisms contaminate or colonize the epider- Etiology mal surface or hair follicles. The skin can be a portal of entry Dermatophytosis is a superficial cutaneous infection with for fungal infection when the epithelial barrier is breached or one or more of the fungal species in the keratinophilic genera it can be a site for disseminated, systemic fungal disease. Microsporum, Trichophyton,orEpidermophyton. Dermato- Canine and feline skin and hair coats can be transiently con- phyte genera that infect animals are divided into 3 or 4 taminated with a large variety of saprophytic fungi from the groups based on their natural habitat.
    [Show full text]
  • Biology, Systematics and Clinical Manifestations of Zygomycota Infections
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by IBB PAS Repository Biology, systematics and clinical manifestations of Zygomycota infections Anna Muszewska*1, Julia Pawlowska2 and Paweł Krzyściak3 1 Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Pawiskiego 5a, 02-106 Warsaw, Poland; [email protected], [email protected], tel.: +48 22 659 70 72, +48 22 592 57 61, fax: +48 22 592 21 90 2 Department of Plant Systematics and Geography, University of Warsaw, Al. Ujazdowskie 4, 00-478 Warsaw, Poland 3 Department of Mycology Chair of Microbiology Jagiellonian University Medical College 18 Czysta Str, PL 31-121 Krakow, Poland * to whom correspondence should be addressed Abstract Fungi cause opportunistic, nosocomial, and community-acquired infections. Among fungal infections (mycoses) zygomycoses are exceptionally severe with mortality rate exceeding 50%. Immunocompromised hosts, transplant recipients, diabetic patients with uncontrolled keto-acidosis, high iron serum levels are at risk. Zygomycota are capable of infecting hosts immune to other filamentous fungi. The infection follows often a progressive pattern, with angioinvasion and metastases. Moreover, current antifungal therapy has often an unfavorable outcome. Zygomycota are resistant to some of the routinely used antifungals among them azoles (except posaconazole) and echinocandins. The typical treatment consists of surgical debridement of the infected tissues accompanied with amphotericin B administration. The latter has strong nephrotoxic side effects which make it not suitable for prophylaxis. Delayed administration of amphotericin and excision of mycelium containing tissues worsens survival prognoses. More than 30 species of Zygomycota are involved in human infections, among them Mucorales are the most abundant.
    [Show full text]
  • Therapy and Management of Pneumocystis Jirovecii Infection
    Journal of Fungi Review Therapy and Management of Pneumocystis jirovecii Infection P. Lewis White *, Jessica S. Price and Matthijs Backx Public Health Wales Microbiology Cardiff, UHW, Heath Park, Cardiff CF14 4XW, UK; [email protected] (J.S.P.); [email protected] (M.B.) * Correspondence: [email protected]; Tel.: +44-(0)29-2074-6581; Fax: +44-(0)29-2074-2161 Received: 10 October 2018; Accepted: 11 November 2018; Published: 22 November 2018 Abstract: The rates of Pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the prophylaxis and treatment of PcP in HIV, haematology, and solid-organ transplant (SOT) recipients is available, although for many other populations (e.g., auto-immune disorders) there remains an urgent need for recommendations. The main drug for both prophylaxis and treatment of PcP is trimethoprim/sulfamethoxazole, but resistance to this therapy is emerging, placing further emphasis on the need to make a mycological diagnosis using molecular based methods. Outbreaks in SOT recipients, particularly renal transplants, are increasingly described, and likely caused by human-to-human spread, highlighting the need for efficient infection control policies and sensitive diagnostic assays. Widespread prophylaxis is the best measure to gain control of outbreak situations. This review will summarize diagnostic options, cover prophylactic and therapeutic management in the main at risk populations, while also covering aspects of managing resistant disease, outbreak situations, and paediatric PcP. Keywords: Pneumocystis pneumonia; PcP therapy; PcP diagnosis 1. Introduction The incidence of Pneumocystis pneumonia (PcP) is rising as a result of an increase in the susceptible patient population.
    [Show full text]
  • Continuing Education Course – Mycoses
    Curso de Atualização - Micoses Capítulo 7 - Zigomicose* Chapter 7 - Zygomycosis Cecília Bittencourt Severo, Luciana Silva Guazzelli, Luiz Carlos Severo Resumo A zigomicose (mucormicose) é uma infecção rara, mas altamente invasiva, causada por fungos da ordem Mucorales (gêneros Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces e Syncephalastrum). Esse tipo de infecção é usualmente associado a doenças hematológicas, cetoacidose diabética e transplante de órgãos. A apresentação clínica mais frequente é a mucormicose rinocerebral, com ou sem envolvi- mento pulmonar. A zigomicose pulmonar ocorre mais frequentemente em pacientes com neutropenia profunda e prolongada e pode se apresentar como infiltrado lobar ou segmentar, nódulos isolados, lesões cavitárias, hemorragia ou infarto. As manifestações clínicas e radiológicas são na maioria dos casos indistinguíveis daquelas associadas com aspergilose invasiva. Este artigo descreve as características gerais da zigomicose pulmonar, com ênfase no diagnóstico laboratorial, e ilustra a morfologia de algumas lesões. Descritores: Zigomicose; Técnicas de diagnóstico e procedimentos; Mucormicose. Abstract Zygomycosis (mucormycosis) is a rare but highly invasive infection caused by fungi belonging to the order Mucorales, which includes the genera Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Saksenaea, Cunninghamella, Cokeromyces and Syncephalastrum. This type of infection is usually associated with hematologic diseases, diabetic ketoacidosis and organ transplantation.
    [Show full text]
  • Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients
    American Thoracic Society Documents An Official American Thoracic Society Statement: Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients Andrew H. Limper, Kenneth S. Knox, George A. Sarosi, Neil M. Ampel, John E. Bennett, Antonino Catanzaro, Scott F. Davies, William E. Dismukes, Chadi A. Hage, Kieren A. Marr, Christopher H. Mody, John R. Perfect, and David A. Stevens, on behalf of the American Thoracic Society Fungal Working Group THIS OFFICIAL STATEMENT OF THE AMERICAN THORACIC SOCIETY (ATS) WAS APPROVED BY THE ATS BOARD OF DIRECTORS, MAY 2010 CONTENTS immune-compromised and critically ill patients, including crypto- coccosis, aspergillosis, candidiasis, and Pneumocystis pneumonia; Introduction and rare and emerging fungal infections. Methods Antifungal Agents: General Considerations Keywords: fungal pneumonia; amphotericin; triazole antifungal; Polyenes echinocandin Triazoles Echinocandins The incidence, diagnosis, and clinical severity of pulmonary Treatment of Fungal Infections fungal infections have dramatically increased in recent years in Histoplasmosis response to a number of factors. Growing numbers of immune- Sporotrichosis compromised patients with malignancy, hematologic disease, Blastomycosis and HIV, as well as those receiving immunosupressive drug Coccidioidomycosis regimens for the management of organ transplantation or Paracoccidioidomycosis autoimmune inflammatory conditions, have significantly con- Cryptococcosis tributed to an increase in the incidence of these infections. Aspergillosis Definitive
    [Show full text]