Central Nervous System Infections by Members of the Pseudallescheria
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Rapid and Precise Diagnosis of Pneumonia Coinfected By
Rapid and precise diagnosis of pneumonia coinfected by Pneumocystis jirovecii and Aspergillus fumigatus assisted by next-generation sequencing in a patient with systemic lupus erythematosus: a case report Yili Chen Sun Yat-Sen University Lu Ai Sun Yat-Sen University Yingqun Zhou First Peoples Hospital of Nanning Yating Zhao Sun Yat-Sen University Jianyu Huang Sun Yat-Sen University Wen Tang Sun Yat-Sen University Yujian Liang ( [email protected] ) Sun Yat-Sen University Case report Keywords: Pneumocystis jirovecii, Aspergillus fumigatus, Next generation sequencing, Case report Posted Date: March 19th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-154016/v2 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/12 Abstract Background: Pneumocystis jirovecii and Aspergillus fumigatus, are opportunistic pathogenic fungus that has a major impact on mortality in patients with systemic lupus erythematosus. With the potential to invade multiple organs, early and accurate diagnosis is essential to the survival of SLE patients, establishing an early diagnosis of the infection, especially coinfection by Pneumocystis jirovecii and Aspergillus fumigatus, still remains a great challenge. Case presentation: In this case, we reported that the application of next -generation sequencing in diagnosing Pneumocystis jirovecii and Aspergillus fumigatus coinfection in a Chinese girl with systemic lupus erythematosus (SLE). Voriconazole was used to treat pulmonary aspergillosis, besides sulfamethoxazole and trimethoprim (SMZ-TMP), and caspofungin acetate to treat Pneumocystis jirovecii infection for 6 days. On Day 10 of admission, her chest radiograph displayed obvious absorption of bilateral lung inammation though the circumstance of repeated fever had not improved. -
Allergic Bronchopulmonary Aspergillosis and Severe Asthma with Fungal Sensitisation
Allergic Bronchopulmonary Aspergillosis and Severe Asthma with Fungal Sensitisation Dr Rohit Bazaz National Aspergillosis Centre, UK Manchester University NHS Foundation Trust/University of Manchester ~ ABPA -a41'1 Severe asthma wl'th funga I Siens itisat i on Subacute IA Chronic pulmonary aspergillosjs Simp 1Ie a:spe rgmoma As r§i · bronchitis I ram une dysfu net Ion Lun· damage Immu11e hypce ractivitv Figure 1 In t@rarctfo n of Aspergillus Vliith host. ABP A, aHerg tc broncho pu~ mo na my as µe rgi ~fos lis; IA, i nvas we as ?@rgiH os 5. MANCHl·.'>I ER J:-\2 I Kosmidis, Denning . Thorax 2015;70:270–277. doi:10.1136/thoraxjnl-2014-206291 Allergic Fungal Airway Disease Phenotypes I[ Asthma AAFS SAFS ABPA-S AAFS-asthma associated with fu ngaIsensitization SAFS-severe asthma with funga l sensitization ABPA-S-seropositive a llergic bronchopulmonary aspergi ll osis AB PA-CB-all ergic bronchopulmonary aspergi ll osis with central bronchiectasis Agarwal R, CurrAlfergy Asthma Rep 2011;11:403 Woolnough K et a l, Curr Opin Pulm Med 2015;21:39 9 Stanford Lucile Packard ~ Children's. Health Children's. Hospital CJ Scanford l MEDICINE Stanford MANCHl·.'>I ER J:-\2 I Aspergi 11 us Sensitisation • Skin testing/specific lgE • Surface hydroph,obins - RodA • 30% of patients with asthma • 13% p.atients with COPD • 65% patients with CF MANCHl·.'>I ER J:-\2 I Alternar1a• ABPA •· .ABPA is an exagg·erated response ofthe imm1une system1 to AspergUlus • Com1pUcatio n of asthm1a and cystic f ibrosis (rarell·y TH2 driven COPD o r no identif ied p1 rior resp1 iratory d isease) • ABPA as a comp1 Ucation of asth ma affects around 2.5% of adullts. -
GAFFI Fact Sheet Pneumocystis Pneumonia
OLD VERSION GLOBAL ACTION FUNDGAL FOR INFECTIONS FUN GAFFI Fact Sheet Pneumocystis pneumonia GLOBAL ACTION FUNDGAL FOR INFECTIONS Pneumocystis pneumonia (PCP) is a life-threatening illness of largely FUN immunosuppressed patients such as those with HIV/AIDS. However, when diagnosed rapidly and treated, survival rates are high. The etiologic agent of PCP is DARKER AREAS AND SMALLER VERSION TEXT FIT WITHIN CIRCLE (ALSO TO BE USED AS MAIN Pneumocystis jirovecii, a human only fungus that has co-evolved with humans. Other LOGO IN THE FUTURE) mammals have their own Pneumocystis species. Person to person transmission occurs early in life as demonstrated by antibody formation in infancy and early childhood. Some individuals likely clear the fungus completely, while others become carriers of variable intensity. About 20% of adults are colonized but higher colonization rates occur in children and immunosuppressed adults; ethnicity and genetic associations with colonization are poorly understood. Co-occurrence of other respiratory infections may provide the means of transmission in most instances. Patients with Pneumocystis pneumonia (PCP) are highly infectious. Prophylaxis with oral cotrimoxazole is highly effective in preventing infection. Pneumocystis pneumonia The occurrence of fatal Pneumocystis pneumonia in homosexual men in the U.S. provided one of earliest signals of the impending AIDS epidemic in the 1980s. Profound immunosuppression, especially T cell depletion and dysfunction, is the primary risk group for PCP. Early in the AIDS epidemic, PCP was the AIDS-defining diagnosis in ~60% of individuals. This frequency has fallen in the western world, but infection is poorly documented in most low-income countries because of the lack of diagnostic capability. -
Allergic Bronchopulmonary Aspergillosis: a Perplexing Clinical Entity Ashok Shah,1* Chandramani Panjabi2
Review Allergy Asthma Immunol Res. 2016 July;8(4):282-297. http://dx.doi.org/10.4168/aair.2016.8.4.282 pISSN 2092-7355 • eISSN 2092-7363 Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity Ashok Shah,1* Chandramani Panjabi2 1Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India 2Department of Respiratory Medicine, Mata Chanan Devi Hospital, New Delhi, India This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid spu- tum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmo- nary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagno- sis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in pa- tients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hall- mark of AAS. -
Valley Fever a K a Coccidioidomycosis Coccidioidosis Coccidiodal Granuloma San Joaquin Valley Fever Desert Rheumatism Valley Bumps Cocci Cox C
2019 Lung Infection Symposium - Libke 10/26/2019 58 YO ♂ • 1974 PRESENTED WITH HEADACHE – DX = COCCI MENINGITIS WITH HYDROCEPHALUS – Rx = IV AMPHOTERICIN X 6 WKS – VP SHUNT – INTRACISTERNAL AMPHO B X 2.5 YRS (>200 PUNCTURES) • 1978 – 2011 VP SHUNT REVISIONS X 5 • 1974 – 2019 GAINFULLY EMPLOYED, RAISED FAMILY, RETIRED AND CALLS OCCASIONALLY TO SEE HOW I’M DOING. VALLEY FEVER A K A COCCIDIOIDOMYCOSIS COCCIDIOIDOSIS COCCIDIODAL GRANULOMA SAN JOAQUIN VALLEY FEVER DESERT RHEUMATISM VALLEY BUMPS COCCI COX C 1 2019 Lung Infection Symposium - Libke 10/26/2019 COCCIDIOIDOMYCOSIS • DISEASE FIRST DESCRIBED IN 1892 – POSADAS –ARGENTINA – RIXFORD & GILCHRIST - CALIFORNIA – INITIALLY THOUGHT PARASITE – RESEMBLED COCCIDIA “COCCIDIOIDES” – “IMMITIS” = NOT MINOR COCCIDIOIDOMYCOSIS • 1900 ORGANISM IDENTIFIED AS FUNGUS – OPHULS AND MOFFITT – ORGANISM CULTURED FROM TISSUES OF PATIENT – LIFE CYCLE DEFINED – FULFULLED KOCH’S POSTULATES 2 2019 Lung Infection Symposium - Libke 10/26/2019 COCCIDIOIDOMYCOSIS • 1932 ORGANISM IN SOIL SAMPLE FROM DELANO – UNDER BUNKHOUSE OF 4 PATIENTS – DISEASE FATAL • 1937 DICKSON & GIFFORD CONNECTED “VALLEY FEVER” TO C. IMMITIS – USUALLY SELF LIMITED – FREQUENTLY SEEN IN SAN JOAQUIN VALLEY – RESPIRATORY TRACT THE PORTAL OF ENTRY The usual cause for coccidioidomycosis in Arizona is C. immitis A. True B. False 3 2019 Lung Infection Symposium - Libke 10/26/2019 COCCIDIOIDAL SPECIES • COCCIDIOIDES IMMITIS – CALIFORNIA • COCCIDIOIDES POSADASII – NON-CALIFORNIA • ARIZONA, MEXICO • OVERLAP IN SAN DIEGO AREA THE MICROBIAL WORLD • PRIONS -
Concomitant Mucormycosis with Aspergillosis in Patients with Uncontrolled Diabetes
DOI: 10.7860/JCDR/2021/47912.14507 Case Series Concomitant Mucormycosis with Aspergillosis in Patients with Uncontrolled Diabetes Microbiology Section Microbiology Mellitus: A Case Series ARPANA SINGH1, AROOP MOHANTY2, SHWETA JHA3, PRATIMA GUPTA4, NEELAM KAISTHA5 ABSTRACT Fungal infections are life threatening especially in presence of immunosuppression or uncontrolled diabetes mellitus mainly due to their invasive potential. Mucormycosis of the oculo-rhino-cerebral region is an opportunistic, aggressive, fatal and rapidly spreading infection caused by organisms belonging to Mucorales order and class Zygomycetes. The organisms associated are ubiquitous. Aspergillosis is a common clinical condition caused by the Aspergillus species, most often by Aspergillus fumigatus (A. fumigatus). Both fungi have a predilection for the immunosuppressive conditions, with uncontrolled diabetes and malignancy being the most common among them. Mucormycosis is caused by environmental spores which get access into the body through the lungs and cause various systemic manifestations like rhino-cerebral mucormycosis. Here, a case series of such concomitant infections of Aspergillus and Mucor spp from Rishikesh, Uttarakhand, India is reported. Keywords: Diabetes, Fungal infection, Invasive mycoses, Rhinosinusitis INTRODUCTION Case 2 Mucorales are the universally distributed saprophytes causing A 60-year-old female patient presented with complaints of aggressive and opportunistic infection. They are angio-invasive fever for three days and ptosis for one day. She was a known in nature. Aspergillosis is the clinical condition caused by the case of Type 2 Diabetes Mellitus (T2DM) and hypertension for Aspergillus species most often A. fumigatus [1]. It proves to be the past seven years but was on irregular drug metformin and fatal, if it infects secondarily to the brain. -
New Species and Changes in Fungal Taxonomy and Nomenclature
Journal of Fungi Review From the Clinical Mycology Laboratory: New Species and Changes in Fungal Taxonomy and Nomenclature Nathan P. Wiederhold * and Connie F. C. Gibas Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; [email protected] * Correspondence: [email protected] Received: 29 October 2018; Accepted: 13 December 2018; Published: 16 December 2018 Abstract: Fungal taxonomy is the branch of mycology by which we classify and group fungi based on similarities or differences. Historically, this was done by morphologic characteristics and other phenotypic traits. However, with the advent of the molecular age in mycology, phylogenetic analysis based on DNA sequences has replaced these classic means for grouping related species. This, along with the abandonment of the dual nomenclature system, has led to a marked increase in the number of new species and reclassification of known species. Although these evaluations and changes are necessary to move the field forward, there is concern among medical mycologists that the rapidity by which fungal nomenclature is changing could cause confusion in the clinical literature. Thus, there is a proposal to allow medical mycologists to adopt changes in taxonomy and nomenclature at a slower pace. In this review, changes in the taxonomy and nomenclature of medically relevant fungi will be discussed along with the impact this may have on clinicians and patient care. Specific examples of changes and current controversies will also be given. Keywords: taxonomy; fungal nomenclature; phylogenetics; species complex 1. Introduction Kingdom Fungi is a large and diverse group of organisms for which our knowledge is rapidly expanding. -
Successful Treatment of Aspergillus Flavus Onychomycosis with Oral
Brtef communications Successful treatment of Aspergillusfiavus brown-black colonies identified as Aspergillusfiavus, sensitive onychomycosis with oral itraconazole to itraconazole. Whitfield's ointment (benzoic and salicylic acids), I twice daily for several months , was ineffective, and Richard K. Scher, MD, and Jay M. Barnett, MD therefore oral itraconazole, 100 rug/day, was begun. During the 5 months of oral intraconazole treatment, no ad New York. New York verse effects were recognized. Improvement in nail dystrophy Systemic therapy with griseofulvin and ketoconazole was noted within I month, with the regrowth of approx.imately has been used in onychomycosis resistant to topical 1.5 rnm of nail plate. At 4 months almost all the nail plate was agents, but because of a cure rate that remains subopti normal (Fig. 2), and repeated KOH preparations and cultures, mal, especially in nondermatophyte and toenail infec which had been positive during most of the treatment, were tions, the search for more effective therapy has continued. negative. Casereport. A 47-year-old woman had had a dystrophy ofthe Discusslen, Recently a class of agents called azoles, left fourth fingernail for at least 1 year. Ex.amination revealed administered systemically and topically, have been used distal onycholysis,and marked subungual hyperkeratosis of the in the treatment of a variety of deep and superficial fun distal third of the digit (Fig. I). Radiographs were unremark gal infections. Use of the azoles should be considered in able . Initial cultures grew only Candida organisms. Topical and patients with fungal organisms sensitive to the particular oral ketoconazole treatment (200 mg once daily for 5 months) azole, who meet any of the following criteria: (1) griseo and laser destruction of the nail plate were unsuccessful. -
Antifungal Drugs for Coccidioidomycosis
Antifungal Drugs for Coccidioidomycosis John H. Rex, MD Chief Medical Officer, F2G Limited 5 Aug 2020 FDA Workshop 2020-08-05 F2G comments at FDA Valley Fever workshop 1 Background on Olorofim • Olorofim • Is a novel mechanism candidate antifungal drug1 • It inhibits DHODH (pyrimidine biosynthesis pathway) • It shows broad microbiologic activity vs. mould fungi • Low MICs vs. Aspergillus spp., Lomentospora prolificans, Scedosporium spp., Fusarium spp., Coccidioides spp., and others • Fungicidal effects in vitro (Aspergillus) and in vivo (Coccidioides)2,3 • Dosed by mouth (30-mg tablet), it has FDA Breakthrough Therapy Designation based on • “preliminary clinical evidence indicating that it may … • demonstrate substantial improvement over existing therapies … • on one or more clinically significant endpoints.” • Now in an open-label Phase 2 study (NCT03583164) of mould IFD4 in patients with limited treatment options 1. Oliver JD et al. (2016). "F901318 represents a novel class of antifungal drug that inhibits dihydroorotate dehydrogenase." PNAS USA 113: 12809-14. 2. du Pre, S., et al. (2018). "Effect of the Novel Antifungal Drug F901318 (Olorofim) on Growth and Viability of Aspergillus fumigatus." AAC 62(8): e00231-18. 3. Wiederhold, N. P., et al. (2018). "The Orotomide Olorofim Is Efficacious in an Experimental Model of Central Nervous System Coccidioidomycosis." AAC 62(9): e00999-18. 4. IFD = Invasive Fungal Disease 2020-08-05 F2G comments at FDA Valley Fever workshop 2 How to design a Cocci RCT? • Day 42 All-Cause Mortality is OK for -
Allergic Bronchopulmonary Aspergillosis in a Patient with Chronic Obstructive Pulmonary Disease
Prim Care Respir J 2012; 21(1): 111-114 CASE-BASED LEARNING Allergic bronchopulmonary aspergillosis in a patient with chronic obstructive pulmonary disease Elias Mira,*Ashok Shaha a Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India Originally received 13th April 2011; resubmitted 27th July 2011; revised 16th September 2011; accepted 17th September 2011; online 5th January 2012 Summary Allergic bronchopulmonary aspergillosis (ABPA) is a debilitating lung disease which occurs as a result of interplay between a variety of host and environmental factors. It occurs in certain susceptible individuals who develop hypersensensitivity to the colonised Aspergillus species. ABPA is a complicating factor in 2% of patients with asthma and is also seen in patients with cystic fibrosis. Asthma and chronic obstructive pulmonary disease (COPD) are known to share key elements of pathogenesis. It is well known that ABPA can occur in patients with asthma, but it has recently been reported in patients with COPD as well. We report a 55-year-old male ex-smoker who presented with complaints of exertional breathlessness and productive cough for five years and an episode of haemoptysis four days prior to presentation. Spirometery showed airflow obstruction which was not reversible with bronchodilators. Chest CT scan revealed paraseptal emphysema along with central bronchiectasis (CB) in the right upper lobe and bilateral lower lobes. A type I skin hypersensitivity reaction to Aspergillus species was elicited. He fulfilled the serological criteria for ABPA and was diagnosed as having concomitant COPD and ABPA-CB. The patient was initiated on therapy for COPD along with oral corticosteroids, on which he had remarkable symptomatic improvement. -
Scedosporium, Chrysosporium, Sepedonium Ve Beauveria)
Simpozyum: Hyalen küfler ve hyalohifomikozlar (Aspergillus dışı) TEK KONİDİYUM OLUŞTURAN HYALEN KÜFLER VE İNFEKSİYONLARI (SCEDOSPORIUM, CHRYSOSPORIUM, SEPEDONIUM VE BEAUVERIA) Şaban GÜRCAN Trakya Üniversitesi Tıp Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Edirne, ([email protected]) Scedosporium Scedosporium cinsinin tıpta önemli olan ve isimleri birkaç kez değiştirilmiş olan iki türü vardır: Scedosporium apiospermum ve Scedosporium prolificans (1-3). Bunlar esasen immünkompro- mize hastalarda öldürücü pulmoner veya yaygın infeksiyonlara, immünkompetan hastalarda travma, cerrahi uygulama, boğulma veya intravenöz ilaç kullanımını takiben lokalize infeksi- yonlara neden olabilen hifomiçetlerdir (4-6). İnvazif ve yaygın infeksiyonlar organ nakli, lösemi, lenfoma, sistemik lupus eritamatozus veya Crohn Hastalığı için immünsüpresif tedavi veya kortikosteroit alan hastalarda görülür (7-9). Pseudallescheria boydii’nin aseksüel formu olan S. apiospermum tüm dünyada yaygın olarak bulunur ancak olgular daha çok İspanya, Avustralya ve takiben Amerika Birleşik Devletleri’nden bildirilmiştir (6, 7, 10). Genel virulans özellikleri düşük olmasına rağmen diğer saprofitlerle kıyaslandığında Pseudallescheria/ Scedosporium göreceli yüksek virulansa sahiptir (2, 7). Pseudallescheria/Scedosporium türleri toprak, çürüyen bitki, lağım pisliği, kirli su ve çiftlik hayvanlarının gübrelerinden izole edilebilirler (2, 7). İnsanlarda ise kütanöz (miçetom, madura ayağı), solunum sistemi ve santral sinir sistemi infeksiyonları sırasıyla en -
Allergic Bronchopulmonary Aspergillosis
Allergic Bronchopulmonary Aspergillosis Karen Patterson1 and Mary E. Strek1 1Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois Allergic bronchopulmonary aspergillosis (ABPA) is a complex clinical type of pulmonary disease that may develop in response to entity that results from an allergic immune response to Aspergillus aspergillus exposure (6) (Table 1). ABPA, one of the many fumigatus, most often occurring in a patient with asthma or cystic forms of aspergillus disease, results from a hyperreactive im- fibrosis. Sensitization to aspergillus in the allergic host leads to mune response to A. fumigatus without tissue invasion. activation of T helper 2 lymphocytes, which play a key role in ABPA occurs almost exclusively in patients with asthma or recruiting eosinophils and other inflammatory mediators. ABPA is CF who have concomitant atopy. The precise incidence of defined by a constellation of clinical, laboratory, and radiographic ABPA in patients with asthma and CF is not known but it is criteria that include active asthma, serum eosinophilia, an elevated not high. Approximately 2% of patients with asthma and 1 to total IgE level, fleeting pulmonary parenchymal opacities, bronchi- 15% of patients with CF develop ABPA (2, 4). Although the ectasis, and evidence for sensitization to Aspergillus fumigatus by incidence of ABPA has been shown to increase in some areas of skin testing. Specific diagnostic criteria exist and have evolved over the world during months when total mold counts are high, the past several decades. Staging can be helpful to distinguish active disease from remission or end-stage bronchiectasis with ABPA occurs year round, and the incidence has not been progressive destruction of lung parenchyma and loss of lung definitively shown to correlate with total ambient aspergillus function.