Outcomes of patients with invasive fusariosis who undergo further immunosuppressive treatments, is there a role for secondary prophylaxis?

BACKGROUND: Patients treated for invasive aspergillosis may relapse during subsequent periods of immunosuppression and should receive secondary prophylaxis. Little is known about the frequency of relapse and practices of secondary prophylaxis for invasive fusariosis (IF). OBJECTIVES: Evaluate practices of secondary prophylaxis and the frequency of relapse in patients who survived IF and were exposed to subsequent periods of immunosuppression. METHODS: Multicentre retrospective study of patients with haematological malignancies who developed IF, survived the initial fungal disease period, and were exposed to subsequent periods of immunosuppression. RESULTS: Among 40 patients, 35 received additional chemotherapy and developed neutropenia (median, 24 days; range, 4-104), and five received glucocorticoids for the treatment of graft-vs-host disease. Overall, 32 patients received secondary prophylaxis (voriconazole in 24) for a median of 112 days (range, 12-468). IF relapsed in five patients (12.5%): 2/8 (25%) not on prophylaxis and 3/32 (9.4%) receiving prophylaxis. Among 28 patients with disseminated IF, relapse occurred in 2/2 (100%) not on prophylaxis and in 3/26 (11.5%) on prophylaxis (P = 0.03). All patients who relapsed IF died. CONCLUSIONS: Patients with IF who survive the initial disease may relapse if exposed to subsequent episodes of immunosuppressive therapies. Secondary prophylaxis should be considered, especially if IF was disseminated.

Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM.

Cryptococcosis is a major worldwide disseminated invasive fungal infection. Cryptococcosis, particularly in its most lethal manifestation of cryptococcal meningitis, accounts for substantial mortality and morbidity. The breadth of the clinical cryptococcosis syndromes, the different patient types at-risk and affected, and the vastly disparate resource settings where clinicians practice pose a complex array of challenges. Expert contributors from diverse regions of the world have collated data, reviewed the evidence, and provided insightful guideline recommendations for health practitioners across the globe. This guideline offers updated practical guidance and implementable recommendations on the clinical approaches, screening, diagnosis, management, and follow-up care of a patient with cryptococcosis and serves as a comprehensive synthesis of current evidence on cryptococcosis. This Review seeks to facilitate optimal clinical decision making on cryptococcosis and addresses the myriad of clinical complications by incorporating data from historical and contemporary clinical trials. This guideline is grounded on a set of core management principles, while acknowledging the practical challenges of antifungal access and resource limitations faced by many clinicians and patients. More than 70 societies internationally have endorsed the content, structure, evidence, recommendation, and pragmatic wisdom of this global cryptococcosis guideline to inform clinicians about the past, present, and future of care for a patient with cryptococcosis.

Aspectos epidemiológicos das micoses dos pés em um time chinês de futebol / Epidemiological aspects of the feet mycosis in a Chinese soccer team

As infecções fúngicas podais podem interferir no desempenho esportivo ao provocar desconforto e dor nos atletas. O objetivo deste estudo foi avaliar a prevalência das infecções fúngicas podais em um time profissional de futebol, verificando os agentes mais freqüentes e os fatores predisponentes. O delineamento da pesquisa foi transversal e descritivo. A amostra foi composta de 22 homens, com idades entre 23 e 36 anos, integrantes do time de futebol profissional chinês, quando de sua participação de jogos em Curitiba (PR). Todos foram avaliados clinicamente e submetidos a exames micológicos (direto e cultura) de escamas de pele e unha dos pés e estudo histopatológico de fragmento ungueal. Os resultados encontrados foram: 12 casos (54,5 por cento) não apresentavam micose; cinco casos (22,72 por cento) apresentavam onicomicose isolada e cinco casos (22,72 por cento) apresentavam onicomicose associada a tinea pedis, tendo como principal agente isolado o Trichophyton rubrum. Os fatores predisponentes apontados pelos atletas incluíram: banho em local público (85 por cento), prática de esporte (76 por cento), uso de calçados fechados (70 por cento), contato com animal doméstico (63 por cento) e irregularidade na higiene dos pés (50 por cento). CONCLUSÃO: A freqüência da onicomicose em atletas chineses foi maior do que na população em geral. O agente mais freqüente foi o Trichophyton rubrum. Os hábitos individuais podem contribuir para a aquisição dessas infecções fúngicas, além do trauma direto pelo calçado e bola, bem como pelo contato físico durante treinos e jogos que podem favorecer lesões cutâneas e ungueais.

Podal fungal infections can interfere in the sportive performance, since they provoke discomfort and pain in the athletes. The purpose of this study was to assess the prevalence of podal fungal infections in a professional soccer team, verifying the more frequent agents and the predisposing factors to that condition. The research had a transversal and descriptive outlining. The sampling was composed by twenty-two 23 to 36 years old male athletes from the professional Chinese soccer team on the occasion they participated in a game series in Curitiba (PR). All athletes were clinically assessed, and they were submitted to mycological examinations (direct and culture) of the skin and nail's squamas from their feet, as well as to a histopathologic study of the ungual fragment. The results found were: twelve cases (54.5 percent) did not present mycosis; 5 cases (22.72 percent) presented isolated onychomycosis, and 5 cases (22.72 percent) presented onychomycosis associated to tinea pedis, having as major isolated agent the Trichophyton rubrum. The predisposing agents pointed by athletes included: bath in a public place (85 percent), sports practice (76 percent), use of closed shoes (70 percent), contact with pets (63 percent), and irregular feet hygiene (50 percent). CONCLUSION: The frequency of the onychomycosis in Chinese athletes was higher than in the general population. The most frequent agent found it was the Trichophyton rubrum. The individual habits may contribute to the acquisition of these fungal infections added to the direct trauma provoked by the shoe and the ball, as well as to the physical contact during the trainings and games that may favor the cutaneous and ungual injuries.

Las infecciones fúngicas pueden interferir en la acción deportiva por provocar incomodidad y dolor en los atletas. El objetivo de este estudio fue evaluar el predominio de infecciones fúngicas en los pies que afectan a un equipo profesional de fútbol, mientras se verifican los agentes más frecuentes y los factores predisponentes. El delineamento de la investigación fue cruzado y descriptivo. La muestra estaba compuesta de 22 hombres, con las edades entre 23 y 36 años, íntegrantes del equipo de fútbol profesional chino, cuando participaron en juegos en Curitiba (PR). Todos fueron evaluados clínicamente y sometidos a los exámenes micológicos respectivos (directo y cultivo) de escamas de piel y uña de los pies y estudio histopatológico de fragmento ungueal. Los resultados que se encontraron fueron: 12 casos (54,5 por ciento) que no presentaron micosis; 5 casos (22,72 por ciento) que presentaron onicomicosis aislada y 5 casos (22,72 por ciento) que presentaron onicomicosis asociada a tinea pedis, que tiene como agente aislado principal el Trichophyton rubrum. Los factores predisponentes para los atletas incluidos consignados fueron: bañarse en lugares públicos (85 por ciento), la práctica deportiva (76 por ciento), el uso de zapatos cerrados (70 por ciento), tener un animal doméstico (63 por ciento) y la irregularidad en la higiene de los pies (50 por ciento). CONCLUSIONES: La frecuencia de la onicomicosis en los atletas chinos es más grande que en la población en general. El agente más frecuente fué el Trichophyton rubrum. Los hábitos individuales pueden contribuir a la adquisición de esas infecciones fúngicas, además del trauma directo por el zapato, así como el contacto físico durante los entrenamientos y juegos que pueden favorecer lesiones cutáneas y ungueales.

Isolation of herpotrichiellacious fung from the environment

Herpotrichiellaceous fungi, common agents of chromoblastomycosis and phaeohyphomycosis, were searched in samples of rotten wood, leaf littler, bark and soil of the rhizosphere, collected in the Centro Nacional de Pesquisas de Florestas/EMBRAPA, Colombo, PR, Brazil. Morphological analyses of macro, optic and scanning electron microscopy, as well as the determination of the nutritional pattern of the isolated strains were carried out for a taxonomical study. In a total of 17 colonies, 3 isolates (17.6 per cente) were identified as species of medical relevance: Cladophialophora bantiana (Sacc.) de Hoog et al., Fonsecaea pedrosoi (Brumpt) Negroni and Phialophora verrucosa Medlar. The identifications were based on the results of the analyses and on the comparison with CBS (Centraal Bureau voor Schimmelcultures) reference strains. This investigation revealed the saprophytic existence of species known as agents of chromoblastomycosis and phaeohyphomycosis. These diseases are considered autochthonous in the studied area.(au)