Fusariosis in Mexico: A 10-year retrospective series.

Fusarium species represent an opportunistic fungal pathogen. The data in Mexico about Fusarium infections in humans are scarce. Here, we present a retrospective series of patients with a confirmed diagnosis of fusariosis in eight different hospitals in Mexico from January 2010 to December 2019. The diagnosis of proven fusariosis was made according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORT/MSG) criteria. A total of 49 cases were identified in our series. Most patients had burn injuries (49%), and 37% had hematological malignancies. Most patients had fire injuries (40%), followed by electric injuries (8%), febrile neutropenia (10%), and pancytopenia (6%). Patients had skin and soft tissue involvement in 49%, followed by blood culture isolation and biopsies from different sites of the body (lung, sinuses, bone tissue, and eyes). Febrile neutropenia (10%) and fungemia (8%) were the most common clinical syndromes in immunosuppressed patients. Most patients received monotherapy (67%), where voriconazole was used in 30% of the cases, followed by conventional amphotericin B (16%), and lipidic formulations of amphotericin B in 10% (either liposomal amphotericin B or amphotericin B lipid complex). Combination therapy was used in 20% of the cases, and the most common combination therapy was triazole plus any lipidic formulation of amphotericin B (10%). Mortality related to Fusarium infection occurred in 22% of patients. Fusariosis is a serious threat. Burn injuries and hematologic malignancies represent the most common causes of infection in this small series from Mexico.

This study describes the epidemiological characteristics of patients with fusariosis from a multicenter cohort in Mexico. These findings provide information from this invasive fungal disease that threatens different countries in Latin America.

Correlating indoor and outdoor temperature and humidity in a sample of buildings in tropical climates.

The incidence of several respiratory viral infections has been shown to be related to climate. Because humans spend most of their time indoors, measures of indoor climate, rather than outdoor climate, may be better predictors of disease incidence and transmission. Therefore, understanding the relationship between indoor and outdoor climate will help illuminate their influence on the seasonality of diseases caused by respiratory viruses. Indoor-outdoor relationships between temperature and humidity have been documented in temperate regions, but little information is available for tropical regions, where seasonal patterns of respiratory viral diseases differ. We have examined indoor-outdoor correlations of temperature, relative humidity (RH), and absolute humidity (AH) over a 1-year period in each of seven tropical cities. Across all cities, the average monthly indoor temperature was 25 ± 3°C (mean ± standard deviation) with a range of 20-30°C. The average monthly indoor RH was 66 ± 9% with a range of 50-78%, and the average monthly indoor AH was 15 ± 3 g/m3 with a range of 10-23 g/m3 . Indoor AH and RH were linearly correlated with outdoor AH when the air conditioning (AC) was off, suggesting that outdoor AH may be a good proxy of indoor humidity in the absence of AC. All indoor measurements were more strongly correlated with outdoor measurements as distance from the equator increased. Such correlations were weaker during the wet season, especially when AC was in operation. These correlations will provide insight for assessing the seasonality of respiratory viral infections using outdoor climate data, which is more widely available than indoor data, even though transmission of these diseases mainly occurs indoors.

The epidemiology and clinical characteristics of respiratory syncytial virus infection in children at a public pediatric referral hospital in Mexico.

OBJECTIVES: The aim of this study was to determine the epidemiological and clinical characteristics of children with respiratory syncytial virus (RSV) treated at a public referral children's hospital in Mexico. METHODS: We reviewed RSV infection in patients aged 0-18 years who were treated at Hospital Infantil from January 2004 to December 2008. RESULTS: During the 5 years, 2797 samples were tested for respiratory viruses; 356 samples were positive for any virus, including 266 (74.7%) positive for RSV. Complete clinical information was available for 205 RSV patients. The mean age was 22 months, and 33.7% of the infections were nosocomially acquired. Hospitalization occurred in 187 children. Of 14 deaths, nine were directly attributed to RSV infection. During the study, RSV infections were seen throughout the year, predominating in the colder months. Of the 205 patients, 79.0% (162/205) had an underlying disease. Congenital heart disease was found in 30.2% (49/162), including three children (33.3%) who died of RSV. Thirty-three patients (16.1%) with RSV required mechanical ventilation. None of the children with RSV received palivizumab or ribavirin. CONCLUSIONS: RSV caused high hospitalization rates and admission to intensive care units, especially among those with underlying illnesses and young infants. The data presented here will be useful for strategies to improve outcomes in children at risk of complications.

Infusión de desoxicolato de anfotericina B en 6 horas versus 24 horas en niños con leucemia aguda / Amphotericin B deoxychocolate: conventional continuous infusion vs 24 infusion in children with acute lymphocytic leukemia

Introducción. El desoxicolato de anfotericina B sigue constituyendo el tratamiento de elección de infecciones fúngicas sistémicas graves en el huésped inmunocomprometido, principalmente en países en vías de desarrollo. Sin embargo, su administración se asocia frecuentemente a efectos adversos. En adultos se ha observado una disminución en la frecuencia de toxicidad asociada a la anfotericina B con la infusión más lenta del antifúngico. Objetivo: evaluar en un estudio comparativo la toxicidad asociada a la anfotericina B administrada en infusión continua de 24 horas versus el régimen estándar de infusión en 6 horas. Material y métodos. Estudio prospectivo, controlado, abierto, en el cual se incluyeron niños de 1 a 18 años con leucemia aguda en quienes se inició anfotericina B como terapia empírica por fiebre persistente en el curso de episodios de neutropenia febril sin foco. Los pacientes fueron distribuidos aleatoriamente para recibir anfotericina B a 1 mg/kg en infusión continua en 24 horas (n =22) o la misma dosis en infusión de 6 horas (n =22), con monitorización de los eventuales efectos adversos relacionados a la infusión del antifúngico, incluyendo escrutinio seriado de nefrotoxicidad. Resultados. Entre enero de 2004 y enero de 2005 se incluyeron 44 pacientes con una edad media de 10 ± 2 años. Las características clínicas y de laboratorio al ingreso fueron similares en ambos grupos. En las primeras 24 horas del inicio del tratamiento, la anfotericina B en infusión estándar se asoció más frecuentemente a fiebre, escalofríos y exantema que en el grupo de infusión continua (55 vs 66%, 59 vs 36%, y 36 vs 14%, respectivamente, P < 0.05). En 77% (17/22) de los pacientes del grupo estándar se observó un incremento > 20% de la creatinina sérica vs 27% (6/22) de los pacientes del grupo de infusión lenta (P < 0.01); 50% de los pacientes del grupo estándar presentaron hipopotasemia < 3 mmol/ L vs 13% de los del grupo de infusión en 24 horas (P < 0.01). Similarmente, la depuración de creatinina en el grupo estándar disminuyó entre los 7 y 14 días post-inicio del tratamiento 21 vs 14 mL/m²/min en el grupo de infusión continua (P < 0.05). Conclusiones. El presente estudio sugiere que la administración de anfotericina B en infusión continua de 24 horas se acompaña de menor número de efectos adversos y disminución significativa de nefrotoxicidad asociada comparada con la infusión estándar en 6 horas.

Introduction. Amphotericin B deoxycholate (Amp-d) remains the standard therapy for treatment of life-threatening fungal infections in the immunocompromised host. However, Amp-d infusion is associated with significant toxicity. In adult population, a reduction in toxicity has been shown by a slower Amp-d infusion rate. Objective: to evaluate in an open comparative study the toxicity of Amp-d in children given as a continuous infusion versus conventional regimen over 6 hours. Material and methods. Prospective, controlled, unblinded trial, which enrolled children with acute leukemia with suspected fungal infections and ranging from 1 to 18 years who were hospitalized in Hospital Infantil de Mexico. Amp-d was started as empiric therapy for persistent fever in the setting of neutropenia. Patients (Pts) were randomized to receive 1 mg/kg Amp-d by continuous infusion over 24 hours or 1 mg/kg over 6 hours. Pts were evaluated for side effects related to infusion and nefrotoxicity. Results. Forty four Pts, mean age 10 ± 2 years, were included; 22 Pts were randomized to 24 hours infusion and 22 to 6 hours infusion (standard group). Baseline characteristics were not different for both groups. Fever, chills and rash related to Amp-d infusion were significantly more frequent on day 1 in standard group (77 vs 59%, 59 vs 36% and 36 vs 14%, respectively, P < 0.05). An increase in serum creatinine (> 20%) in the course of treatment was observed in 17/22 of the Pts in the standard therapy group vs 6/22 of the Pts in the slow infusion group (P < 0.01). Fifty percent of the Pts of standard group showed hypokalemia vs only 13% of the slow infusion group (P < 0.01). At day 7 to 14, the mean creatinine clearance decreased in the therapy standard group 21 mL/m²/min vs 14 mL/m²/min in the continuous infusion group (P < 0.05). Conclusions. This study suggests that patients on continuous Amp-d 24 hours infusion regimen have fewer infusion related reactions and significantly reduced nefrotoxicity compared with those in the standard 6 hours infusion.