DOCSLIB.ORG

Catheter-Related Cutaneous Aspergillosis Complicated By

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Catheter-Related Cutaneous Aspergillosis Complicated By 524 Notes Eur. J. Clin. Microbiol. Infect. Dis. Case Report. In October 1992, a 26-year-old Catheter-Related Cutaneous female intravenous drug addict diagnosed as HIV positive in 1986 was admitted to our institute. She Aspergillosis Complicated by presented with fever, weight loss, oropharyngeal Fungemia and Fatal Pulmonary candidiasis, anemia, marked thrombocytopenia, high serum lactate dehydrogenase levels and a Infection in an HIV-Positive pelvic mass with a diameter of 13 x 10 cm. The di- Patient with Acute agnosis of ALL was made on the basis of morpho- logical and immunophenotypic features of bone Lymphocytic Leukemia marrow needle aspirate and bilateral lilac poste- rior crest biopsy. At the time of diagnosis, micro- biological, virological and clinical findings were C. Girmenia, R. Gastaldi, P. Martino* negative for the presence of C1-CDC opportunis- tic infections (8), and the absolute CD4+ lympho- cyte count was 145/mm 3. There was no detectable HIV p24 serum antigenemia. A central venous A case of intravenous catheter-related cutaneous catheter (Groshong catheter placed through a aspergillosis and Aspergitlus fumigatus fungemia subcutaneous tunnel) was inserted before initia- in an HIV-positive patient with Burkitt-cell acute tion of an aggressive chemotherapy (from 27 Oc- lymphocytic leukemia is reported. The patient tober to I February) according to the BFM-NHL developed pulmonary aspergillosis with a rapidly 83 protocol (9). During chemotherapy, steroids, fatal outcome despite recovery from neutropenia parenteral nutrition, oral methadone and an- and improvement of the underlying malignancy. timicrobiat prophylaxis with fluconazole, The unusual severity and rapid spread of the infec- trimethoprim-sulfamethoxazole and acyclovir tion, despite normal neutrophil count and prompt were also administered. The patient experienced antifungal therapy, suggest that HIV-related three febrile episodes of unidentified origin immunocompromise might play a role in the impair- during the post-chemotherapy neutropenic peri- ment of host defenees against Aspergillus infec- ods, all of which responded to empiric broad- tion. Thus catheter-related cutaneous aspergillosis spectrum antibacterial treatment. could lead to a severe deep-seated infection in HIV- positive patients. On 22 February, the patient developed fever with an indurated erythema (without skin necrosis) at the catheter exit site. A chest radiograph per- formed two days later showed a nodular pulmo- Invasive aspergiltosis, once rather infrequent in nary lesion at the upper right lung field. Multiple AIDS patients, has recently emerged as a consid- blood cultures taken from the catheter grew erable clinical problem. Use of corticosteroids, Aspergillus furnigatus, whereas four peripheral neutropenia, hematological malignancy, pneu- blood cultures were negative. Leukocyte count monia due to other pathogens, marijuana smok- was 3,660/mm 3 with 3,140 neutrophils and 180 ing or the use of broad-spectrum antibiotics are lymphocytes. The absolute CD4+ cell count was predisposing factors (1-6). The role of cytome- 24/mm 3, with no HIV p24 antigenemia. Treat- galovirus infection as cofactor in invasive asper- ment with itraconazole (200 mg/day) was started gillosis is the subject of debate (1-3). but, due to persistence of fever and positive blood On the other hand, data from clinical and in vitro cultures, the catheter was removed. Aspergillus studies suggest that HIVorelated immunosup- fumigatus was isolated from the catheter tip as pression may by itself predispose to invasive well as from a purulent secretion from the cathe" aspergillosis (6-7). We report a case of primary ter exit site. Following removal of the catheter, cutaneous infection caused by Aspergitlus fumi- fever disappeared, blood cultures became negative gatus and fungemia associated with a central and cutaneous infection progressively improved. venous catheter followed by a fatal pulmonary in- A bone marrow needle aspirate and bilateral iliaC fection in an HIV-positive patient with Burkitt- posterior crest biopsy showed complete remis- celt acute lymphocytic leukemia (ALL). sion of the underlying malignancy and echo- graphic examination showed a greater than 80 % reduction in the size of the pelvic mass. Section of Haematology, Department of Human Bio- pathology, University La Sapienza, Via Benevento 6, 00161 On 19 March, two small cavitary lesions (pseudo- Rome, Italy. mycetomas) were seen in the upper right lung Vol. 14, 1995 Notes 525 field on chest radiograph and CT scan. Thus, itra- In immunosuppressed patients with aspergillosis, Conazole administration was replaced by in- the respiratory tract is the almost exclusive site of travenous amphotericin B (1 mg/kg/day). On the entry. Skin and subcutaneous tissue are only same day, cytomegalovirus viremia was detected rarely involved as either the primary or secondary by shell vial culture. Despite antifungal treat- focus of invasive aspergillosis. However, primary ment, the cavitary lesions increased in size and cutaneous aspergillosis may occur at the site of Small new lesions appeared on a chest radiograph the intravenous catheter, which could be the por- of both lung fields. Sputum culture yielded Asper- tal of entry of a deep-seated infection with a poor gillus fumigatus. On 1 April, the patient reported outcome in severely immunocompromised bilateral chest pain. Subcutaneous emphysema of patients, particularly those with neutropenia (16). the neck with crepitus was observed. A CT scan In the present case, the exit site of the central showed bilateral pneumothorax and a small venous catheter was presumably the primary pneumomediastinum with emphysema of the soft source of the infection. Despite the patient's re- tissues of the neck. Pneumothorax and pneumo- covery from neutropenia, the cutaneous infection mediastinum spontaneously resolved, while sub- was complicated by fungemia and fatal pulmo- Cutaneous emphysema resolved on insertion of nary infection with pneumomediastinum and skin needles. However, the patient's general con- pneumothorax, a well-known late complication dition progressively deteriorated, with respira- of pulmonary aspergillosis (17). tory failure and development of new pulmonary Our patient developed an unusually severe and lesions, The patient was then discharged to un- rapidly spreading pulmonary aspergillosis, dergo a treatment regimen at home, where she despite normal neutrophil count and prompt anti- died a few days later. fungal therapy. It seems reasonable to assume that HIV-related immunocompromise with a low Discussion. Despite the severe CD4+ cell deple- CD4+ lymphocyte count played an important tion seen in patients with AIDS, invasive aspergil- role in the impairment of the host defences losis is very uncommon unless other well-known against the Aspergillus infection, adding to the risk factors for the development of this disease immunocompromise due to the underlying malig- are also present. In particular, neutropenia, nancy, previous neutropenia and steroid therapy. corticosteroids and broad-spectrum antibiotic We conclude that primary cutaneous aspergillosis therapy have traditionally been recognized as risk occurring at the exit site of intravenous catheters factors for the development of invasive aspergil- could be a serious complication in HIV-positive Iosis (1-6). Denning et al. (1) cited infection with patients with hematological malignancies, as it cytomegalovirus as a risk factor for aspergillosis, can lead to a fatal, deep-seated infection. The in- but this association was not considered relevant fection requires early diagnosis, early catheter re- by other authors, as the effects of cytome- moval and prompt treatment with amphotericin galovirus in promoting fungal infection have been B, even in non-neutropenic patients. documented only in animal models (2, 3). Inter- estingly, cytomegalovirus viremia was docu- mented at the time of the' fungal infection in our Acknowledgement patient, however, no definite conclusion can be drawn from this finding. Data from clinical and The study was supported by the Progetto Finalizzato ACRO CNR Italy. Applicazioni Cliniche nella Ricerca laboratory investigations suggest that the immu- Oncologica (Unit P. Martino) No. 92.02219.39. nosuppression caused by HIV infection itself Could have a role in the increased predisposition to the fungal disease and/or the severity of the in- References fection. Lortholary et al. (6) reported that ap- proximately 50 % of the patients in their study 1. Denning DW, Follansbee SE, Scolaro M, Norris S, did not exhibit any classic risk factors and that al- Edelstein H, Stevens DA: Pulmonary aspergillosis in the acquired immunodeficiency syndrome. New England most all patients had a CD4+ cell count of less Journal of Medicine 1991, 324: 654-662. !han 50/ram 3. Lymphopenia related to other viral 2. Schaffner A: Pulmonary aspergillosis in AIDS. New Eng- !nfections has been reported to predispose to land Journal of Medicine 1991, 325: 355-356. mvasive infection with Aspergillus (10, 11). De- 3. Stevens DA, Denning DW: Pulmonary aspergillosis in fective in vitro functions of the monocyte/macro- AIDS. New England Journal of Medicine 1991,325: 356- 357. Phage system and neutrophils of HIV-positive 4. Minamoto GY, Barlam TF, Vender Els NJ: tnvasive asper- Patients would predispose to invasive aspergillo- gillosis in patients with AIDS. Clinical Infectious Diseases sis (7, 12-15). 1992, 14: 66-74. 526 Notes Eur. J. Clin. Microbiol. Infect. Dis. 5. Pursell
Load more

Recommended publications
  • Fungal Infections from Human and Animal Contact
    Journal of Patient-Centered Research and Reviews Volume 4 Issue 2 Article 4 4-25-2017 Fungal Infections From Human and Animal Contact Dennis J. Baumgardner Follow this and additional works at: https://aurora.org/jpcrr Part of the Bacterial Infections and Mycoses Commons, Infectious Disease Commons, and the Skin and Connective Tissue Diseases Commons Recommended Citation Baumgardner DJ. Fungal infections from human and animal contact. J Patient Cent Res Rev. 2017;4:78-89. doi: 10.17294/2330-0698.1418 Published quarterly by Midwest-based health system Advocate Aurora Health and indexed in PubMed Central, the Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. REVIEW Fungal Infections From Human and Animal Contact Dennis J. Baumgardner, MD Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI; Center for Urban Population Health, Milwaukee, WI Abstract Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America.
    [Show full text]
  • Candida Auris
    microorganisms Review Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities Suhail Ahmad * and Wadha Alfouzan Department of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait; [email protected] * Correspondence: [email protected]; Tel.: +965-2463-6503 Abstract: Candida auris, a recently recognized, often multidrug-resistant yeast, has become a sig- nificant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently re- sulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of ‘dry’ biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris Citation: Ahmad, S.; Alfouzan, W. Candida auris: Epidemiology, infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new Diagnosis, Pathogenesis, Antifungal infections in healthcare facilities, including the screening of susceptible patients for colonization; the Susceptibility, and Infection Control cleaning and decontamination of the environment, equipment, and colonized patients; and successful Measures to Combat the Spread of approaches to identify and treat infected patients, particularly during outbreaks.
    [Show full text]
  • Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting
    Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting a b,c, Alexander Lepak, MD , David Andes, MD * KEYWORDS Invasive candidiasis Pharmacokinetics-pharmacodynamics Therapy Source control Invasive fungal infections (IFI) and fungal sepsis in the intensive care unit (ICU) are increasing and are associated with considerable morbidity and mortality. In this setting, IFI are predominantly caused by Candida species. Currently, candidemia represents the fourth most common health care–associated blood stream infection.1–3 With increasingly immunocompromised patient populations, other fungal species such as Aspergillus species, Pneumocystis jiroveci, Cryptococcus, Zygomycetes, Fusarium species, and Scedosporium species have emerged.4–9 However, this review focuses on invasive candidiasis (IC). Multiple retrospective studies have examined the crude mortality in patients with candidemia and identified rates ranging from 46% to 75%.3 In many instances, this is partly caused by severe underlying comorbidities. Carefully matched, retrospective cohort studies have been undertaken to estimate mortality attributable to candidemia and report rates ranging from 10% to 49%.10–15 Resource use associated with this infection is also significant. Estimates from numerous studies suggest the added hospital cost is as much as $40,000 per case.10–12,16–20 Overall attributable costs are difficult to calculate with precision, but have been estimated to be close to 1 billion dollars in the United States annually.21 a University of Wisconsin, MFCB, Room 5218, 1685 Highland Avenue, Madison, WI 53705-2281, USA b Department of Medicine, University of Wisconsin, MFCB, Room 5211, 1685 Highland Avenue, Madison, WI 53705-2281, USA c Department of Microbiology and Immunology, University of Wisconsin, MFCB, Room 5211, 1685 Highland Avenue, Madison, WI 53705-2281, USA * Corresponding author.
    [Show full text]
  • Candida Auris Fungemia at Tified
    RESEARCH LETTERS This case illustrates the need to better define the geo- Management of Patients with graphic extent and modes of transmission of this debilitat- ing disease so that primary control measures can be iden- Candida auris Fungemia at tified. In addition, health workers must be provided with Community Hospital, the training and tools to diagnose and treat M. ulcerans. Brooklyn, New York, Research into a point-of-care diagnostic test is needed so 1 that timely treatment can minimize disability and costs to USA, 2016–2018 the family. Jenny YeiSol Park,2 Nicole Bradley,3 Acknowledgments Steven Brooks, Sibte Burney, Chanie Wassner Thanks to Emily Duecke, Sidy Ba, Carlos Bleck, and Teunella Wolters for their sharp clinical skills and therapeutic efforts on DOI: https://doi.org/10.3201/eid2503.180927 behalf of this patient. Candida auris is an emerging fungus that can cause inva- sive infections. It is associated with high mortality rates and About the Author resistance to multiple classes of antifungal drugs and is dif- Ms. Turner is a family nurse practitioner living and working in ficult to identify with standard laboratory methods. We de- Dakar, Senegal. Her background includes trauma and pediatric scribe the management and outcomes of 9 patients with C. primary care in high-income and low-income countries. auris fungemia in Brooklyn, New York, USA. References andida auris is an emerging fungus that can cause inva- 1. Sakyi SA, Aboagye SY, Otchere ID, Yeboah-Manu D. Clinical and Csive infections associated with high mortality rates and laboratory diagnosis of Buruli ulcer disease: a systematic review.
    [Show full text]
  • Fever, Rash and Fungemia in a Traveler from South China Osamuyimen Igbinosa*, Krishna Dass and Glenn Wortmann
    ical C lin as C e f R o Igbinosa et al., J Clin Case Rep 2015, 5:11 l e a p n o r r DOI: 10.4172/2165-7920.1000639 t u s o J Journal of Clinical Case Reports ISSN: 2165-7920 Case Report Open Access Fever, Rash and Fungemia in a Traveler from South China Osamuyimen Igbinosa*, Krishna Dass and Glenn Wortmann Section of Infectious Diseases, Medstar Washington Hospital Center, Washington DC, USA Abstract Introduction: Penicillium (Talaromyces) marneffei is a dimorphic fungus that is endemic in Southeast Asia and South China, but rarely seen the United States except in immunosuppressed patients who have had travel-related exposure. Case Presentation: A 28 year-old man with advanced HIV/AIDS presented with dyspnea, cough and fever two weeks after returning from Shenzhen, South China. He was treated for presumptive Pneumocystis jiroveci pneumonia with improvement in his symptoms and was then started on antiretroviral therapy. Three weeks later he developed rash and fever, and blood culture grew Penicillium (Talaromyces) marneffei. Conclusion: This case highlights the importance of obtaining a detailed travel history in order to incorporate travel-related diseases in a differential diagnosis. Keywords: HIV/AIDS; Anti-retroviral therapy; Pneumocystis jiroveci A chest x-ray demonstrated bilateral pulmonary infiltrates compatible pneumonia with Pneumocystis jiroveci pneumonia (PJP). Sputum stained for acid-fast bacilli was negative three times, and the patient refused Abbreviations: ART: Antiretroviral Therapy; PJP: Pneumocystis bronchoscopy. He was treated for presumptive PJP with trimethoprim/ jiroveci pneumonia; MALDI- TOF: Matrix-Assisted Laser Desorption/ sulfamethoxazole, with improvement in his dyspnea.
    [Show full text]
  • Fungal-Bacterial Interactions in Health and Disease
    pathogens Review Fungal-Bacterial Interactions in Health and Disease 1, 1, 1,2 1,2,3 Wibke Krüger y, Sarah Vielreicher y, Mario Kapitan , Ilse D. Jacobsen and Maria Joanna Niemiec 1,2,* 1 Leibniz Institute for Natural Product Research and Infection Biology—Hans Knöll Institute, Jena 07745, Germany; [email protected] (W.K.); [email protected] (S.V.); [email protected] (M.K.); [email protected] (I.D.J.) 2 Center for Sepsis Control and Care, Jena 07747, Germany 3 Institute of Microbiology, Friedrich Schiller University, Jena 07743, Germany * Correspondence: [email protected]; Tel.: +49-3641-532-1454 These authors contributed equally to this work. y Received: 22 February 2019; Accepted: 16 May 2019; Published: 21 May 2019 Abstract: Fungi and bacteria encounter each other in various niches of the human body. There, they interact directly with one another or indirectly via the host response. In both cases, interactions can affect host health and disease. In the present review, we summarized current knowledge on fungal-bacterial interactions during their commensal and pathogenic lifestyle. We focus on distinct mucosal niches: the oral cavity, lung, gut, and vagina. In addition, we describe interactions during bloodstream and wound infections and the possible consequences for the human host. Keywords: mycobiome; microbiome; cross-kingdom interactions; polymicrobial; commensals; synergism; antagonism; mixed infections 1. Introduction 1.1. Origins of Microbiota Research Fungi and bacteria are found on all mucosal epithelial surfaces of the human body. After their discovery in the 19th century, for a long time the presence of microbes was thought to be associated mostly with disease.
    [Show full text]
  • WOS000311017000004.Pdf
    Microbes and Infection 14 (2012) 1144e1151 www.elsevier.com/locate/micinf Original article Dermatophyteehost relationship of a murine model of experimental invasive dermatophytosis James Venturini a,b, Anuska Marcelino A´ lvares c, Marcela Rodrigues de Camargo a,b, Camila Martins Marchetti a, Thais Fernanda de Campos Fraga-Silva a, Ana Carolina Luchini d, Maria Sueli Parreira de Arruda a,* a Faculdade de Cieˆncias, UNESP e Univ Estadual Paulista, Departamento de Cieˆncias Biolo´gicas, Laborato´rio de Imunopatologia Experimental, Av. Eng. Luiz Edmundo C. Coube 14-01, 17033-360 Bauru, SP, Brazil b Faculdade de Medicina de Botucatu, UNESP e Univ Estadual Paulista, Distrito de Rubia˜o Junior s/n, 18618-970 Botucatu, SP, Brazil c Departamento de Microbiologia, Imunologia e Parasitologia, UNIFESP e Universidade Federal de Sa˜o Paulo, R. Botucatu 862, 04023-900 Sa˜o Paulo, SP, Brazil d Instituto de Cieˆncias Biolo´gicas e Naturais, UFTM, Av. Frei Paulino 30, 38025-180 Uberaba, MG, Brazil Received 15 March 2012; accepted 16 July 2012 Available online 27 July 2012 Abstract Recognizing the invasive potential of the dermatophytes and understanding the mechanisms involved in this process will help with disease diagnosis and with developing an appropriate treatment plan. In this report, we present the histopathological, microbiological and immunological features of a model of invasive dermatophytosis that is induced by subcutaneous infection of Trichophyton mentagrophytes in healthy adult Swiss mice. Using this model, we observed that the fungus rapidly spreads to the popliteal lymph nodes, spleen, liver and kidneys. Similar to the human disease, the lymph nodes were the most severely affected sites.
    [Show full text]
  • Case Report: Nosocomial Fungemia Caused by Candida Diddensiae Seong Eun Kim1, Sook in Jung1* , Kyung-Hwa Park1, Yong Jun Choi2, Eun Jeong Won2 and Jong Hee Shin2
    Kim et al. BMC Infectious Diseases (2020) 20:377 https://doi.org/10.1186/s12879-020-05095-3 CASE REPORT Open Access Case report: nosocomial fungemia caused by Candida diddensiae Seong Eun Kim1, Sook In Jung1* , Kyung-Hwa Park1, Yong Jun Choi2, Eun Jeong Won2 and Jong Hee Shin2 Abstract Background: Candida diddensiae, a yeast found in olive oil, is considered non-pathogenic to humans. Here, we describe the first case of fungemia caused by C. diddensiae in a hospitalized patient with underlying diseases. Case presentation: A 62-year-old woman was admitted because of multiple contusions due to repeated falls and generalized weakness. She presented with chronic leukopenia due to systemic lupus erythematosus, and multiple cranial nerve neuropathies due to a recurring chordoma. She was given a lipid emulsion containing total parenteral nutrition (TPN) starting on the day of admission. Broad-spectrum antibiotics had been administered during her last hospital stay and from day 8 of this hospitalization. However, no central venous catheter was used during this hospital stay. Blood cultures obtained on hospital days 17, 23, and 24 yielded the same yeast, which was identified as C. diddensiae via sequence analyses of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. In vitro susceptibility testing showed that the minimum inhibitory concentration of fluconazole for all isolates was 8 μg/mL. On day 23, TPN was discontinued and fluconazole therapy was started. Blood cultures obtained on day 26 were negative. The fluconazole therapy was replaced with micafungin on day 26 and the patient exhibited improvements.
    [Show full text]
  • Infection What Is the Clinical Significance of Positive Blood
    Bone Marrow Transplantation (2005) 35, 303–306 & 2005 Nature Publishing Group All rights reserved 0268-3369/05 $30.00 www.nature.com/bmt Infection What is the clinical significance of positive blood cultures with Aspergillus sp in hematopoietic stem cell transplant recipients? A 23 year experience E Simoneau1, M Kelly1, AC Labbe1, J Roy2 and M Laverdie` re1 1Department of Microbiology-Infectious Diseases, Hoˆpital Maisonneuve-Rosemont, Quebec, Canada; and 2Department of Hematology, Hoˆpital Maisonneuve-Rosemont, Quebec, Canada Summary: underlying predisposing condition to invasive aspergil- losis.3 To our knowledge, no study has yet examined the Hematopoietic stem cell (HSC) transplantation is the significance of positive blood cultures with Aspergillus sp most frequent underlying predisposing condition to in this very high-risk population of patients. We report a invasive aspergillosis. However, the significance of posi- 23-year single-center retrospective study of positive blood tive blood culture with Aspergillus sp in this particular cultures for Aspergillus sp documented in HSC transplant population remains uncertain. We retrospectively re- recipients. viewed all blood cultures performed in 1453 patients who received HSC transplant at our institution between 1980 and 2002. We identified 19 patients with positive blood Patients and methods cultures with Aspergillus sp. Only one of these patients had clinical, histologic or microbiologic evidence of Blood culture records of all patients who underwent an invasive aspergillosis. Thus, even in a population at HSC transplantation at Hoˆ pital Maisonneuve-Rosemont highest risk for invasive aspergillosis, positive blood (HMR) between April 1980 and December 2002 were cultures with Aspergillus sp remain unusual, and cannot reviewed.
    [Show full text]
  • Glucocorticoids and Invasive Fungal Infections
    REVIEW Review Glucocorticoids and invasive fungal infections Michail S Lionakis and Dimitrios P Kontoyiannis Since the 1990s, opportunistic fungal infections have emerged as a substantial cause of morbidity and mortality in profoundly immunocompromised patients. Hypercortisolaemic patients, both those with endogenous Cushing’s syndrome and, much more frequently, those receiving exogenous glucocorticoid therapy, are especially at risk of such infections. This vulnerability is attributed to the complex dysregulation of immunity caused by glucocorticoids. We critically review the spectrum and presentation of invasive fungal infections that arise in the setting of hypercortisolism, and the ways in which glucocorticoids contribute to their pathogenesis. A better knowledge of the interplay between glucocorticoid-induced immunosuppression and invasive fungal infections should assist in earlier recognition and treatment of such infections. Efforts to decrease the intensity of glucocorticoid therapy should help to improve outcomes of opportunistic fungal infections. Introduction efficient phagocytic capacity, phagocytosing more than Cushing’s syndrome is a metabolic condition featuring 108 conidia daily.5 Still, some conidia escape phagocytosis, persistently excessive plasma cortisol levels (normal germinate to hyphae, and establish an invasive infection. morning values: 138–607 nmol/L). Its origins fall into two Then, neutrophils are chemotactically attracted and categories. First, endogenous Cushing’s syndrome is attach to the hyphae, which
    [Show full text]
  • Clinical and Etiological Study of Onychomycosis in Institutionalized
    ISSN: 2469-5858 Oliveira et al. J Geriatr Med Gerontol 2019, 5:062 DOI: 10.23937/2469-5858/1510062 Volume 5 | Issue 1 Journal of Open Access Geriatric Medicine and Gerontology ReSeARCH ARTiCLe Clinical and Etiological Study of Onychomycosis in Institutionalized Elderly in Goiânia City, Goiás State, Brazil Jefferson Teixeira Oliveira1, Mateus Silva Santos2, Wesley Vieira Naves3, Hygor Lima Costa1, Andressa Santana Santos4, Vivianny Aparecida Queiroz Freitas4, Maria do Rosário Rodrigues Silva4, Milton Camplesi Junior1, Antonio Márcio Teodoro Cordeiro Silva1 and Fábio Silvestre Ataides1* 1Institute of Health Sciences, University Paulista Campus Flamboyant, Brazil 2Postgraduate Program in Genetic, MGene, Pontifical Catholic University of Goiás, Brazil Check for 3Postgraduate Program in Environmental Sciences and Health, Pontifical Catholic University of Goiás, Brazil updates 4Postgraduate Program in Tropical Medicine and Public Health, Federal University of Goiás, Brazil *Corresponding author: Prof Dr. Fábio Silvestre Ataides, Institute of Health Sciences, University Paulista Campus Flam- boyant, Rua Beijuaçu Q.168, Lt.14, Setor Parque Amazonas, Goiânia, Goiás, Brazil, CEP: 74835-340, Tel: 55-62-99631- 8545 Abstract Conclusions: This study found a higher frequency of onychomycosis in women, and the main etiological agents Background: Onychomycosis is fungal nail infection, which were Candida spp. and Fusarium spp. The onychomycosis can be associated with some factors, such as decreased significantly changes the routine of its patients, with most nail growth and immunodeficiency, makes the elderly participants reporting that people find it unpleasant to look at predisposed to onychomycosis. The objective of this study their nails and note the problem and they are uncomfortable was to investigate the frequency of onychomycosis in elderly with the appearance of the lesion.
    [Show full text]
  • Pathology of Fungal Infection
    14/10/56 Pathology of Fungal Infection Julintorn Somran, MD. Growth form of fungi Filamentous or hyphae Yeasts 1 14/10/56 Dimorphic fungi • Presence of both filamentous forms and yeasts in their cycle – Histoplasma spp. • Hyphae at environmental temperatures and yeast form in the body – Candida spp. • Hyphae, pseudohyphae, and yeast form in the body Three types of fungal infection (Mycoses) 1. Superficial mycoses: – Skin, hair, and nails 2. Cutaneous and Subcutaneous mycoses: – deeper layer of skin 3. Systemic or deep mycoses: – internal organ involvement – Including opportunistic infection 2 14/10/56 Superficial mycoses Tinea (Ringworm) Ptyriasis versicolor Cutaneous and Subcutaneous mycoses Eumycotic mycetoma 3 14/10/56 Systemic or deep mycoses Mucormycosis or Zygomycosis Systemic or deep mycoses Pulmonary aspergilllosis 4 14/10/56 Host – Agent relationship Immunocompetent Nosocomial host infection Pathogenic agents Environment Organisms Host Infectious disease Impaired Defense mechanism Immunocompromise Opportunistic host infection Superficial mycoses Representative Causative Growth form disease organisms in Tissue Dermatophytosis Microsporum, Filamentous form Trichophyton, and Epidermophyton Pityriasis versicolor or Malassezia Yeast and filamentous skin infection via form malassezia Tinea nigra or Exophialia Filamentous form keratomycosis nigrican (Phaeoanellomyces) (pigmented) palmaris wernekii Onychomycosis Microsporum, Filamentous form Trichophyton, Epidermophyton etc. 5 14/10/56 DERMATOPHYTOSIS • Definition and Epidemiology: – Common superficial infection caused by fungi that able to invade keratinized tissue – stratum corneum, hair, and nails. – World wide in distribution – The source of infection – another person, animal or soil • Etiologic agents: – Microsporum, Trichophyton, and Epidermophyton – T rubrum – most common for tinea pedis and onychomycosis in temperate climate, and tinea cruris and tinea corporis in the tropics.
    [Show full text]