Mucormycosis experience through the eyes of the laboratory.

Background: Mucormycosis is a rare, worldwide fungal infection with high mortality, which mostly affects immunocompromised patients. Compared to large parts of Asia, Europe, and the USA, information on clinical expression and fungal species distribution in mucormycosis in Turkey is limited. Objectives and methods: The main aim of this study was to evaluate the demographic features of mucormycosis cases, identify the isolates at the species level by using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF), compare culture results with histopathological examination and determine the antifungal susceptibility patterns of the pathogens. Results: Between 2016 and 2018, 10 mucormycosis cases (six female, four male; age range: 35-74 years) were evaluated retrospectively. The predominance of the cases were in late autumn and winter. Diabetes mellitus was the most common underlying condition. Seven patients had rhinoorbitocerebral, two had pulmonary and one had cutaneous mucormycosis. By mycological culture and direct microscopic examination nine strains were identified as Rhizopus spp. and one as Mucor spp. Seven of these strains were identified at the species level by MALDI-TOF. Histopathological examination of eight tissues were reported as compatible with mucormycosis. All isolates were resistant to azoles and echinocandins. Two isolates were resistant to Amphotericin B and one was resistant to posaconazole. Surgical debridement combined with antifungal therapy was the main treatment option. The mortality rate was 40% (n = 4) and the mean number of days between the onset of complaints and the initiation of treatment was 9.25. Conclusions: Early, rapid and accurate diagnosis of mucormycosis is of critical importance in the treatment of immunosuppressed patients.

Early diagnosis of cerebral aspergillosis with various methods: a case report.

The clinical and laboratory diagnosis of cerebral aspergillosis (CA) is problematic and mortality is quite high, even in cases receiving appropriate treatment. Therefore, an early and accurate diagnosis may prove to be life saving in patients with the diagnosis of CA. In this report, a case of CA which developed in a pediatric patient with acute lymphoblastic leukemia (ALL) is presented. Upon development of neutropenia and focal seizures in the left arm during implementation of the ALL treatment protocol, brain MRI was performed in the patient and nodular lesions compliant with brain abscess were detected in the frontal lobe, left cerebellum and the cingulate gyrus on the superior aspect of the left corpus callosum. Direct assessment of brain tissue revealed fungal elements, while consecutive serum galactomannan (GM) values were determined as 3.39 ng/ml and 0.72 ng/ml, and the consecutive serum (1x3)-beta-D-glucan (BG) values were 93 pg/ml and 356 pg/ml. Negative serum real-time polymerase chain reaction (RtPCR) and positive tissue RtPCR were determined, with growth of Aspergillus fumigatus in the culture. Treatment was initiated with amphotericin B and voriconazole; upon disappearance of symptoms and negative control serum BG and GM values, the patient was discharged with recommendations. In conclusion, this case is presented with the objective of indicating the significance of serological and molecular methods used in the early diagnosis of patients with CA.

La bacteriemia, ¿puede inducir resultados falsos positivos en la determinación de 1,3-beta- d -glucano? Análisis de 83 episodios de bacteriemia en pacientes en alto riesgo de infecciones micóticas invasivas / Can bacteraemia lead to false positive results in 1, 3-beta- d -glucan test? Analysis of 83 bacteraemia episodes in high-risk patients for invasive fungal infections

Antecedentes. Aunque se ha descrito que la bacteriemia se relaciona con resultados falsos positivos en la determinación de 1,3-beta- d -glucano (BDG), las pruebas de esta interacción son limitadas. Objetivo. El objetivo de este estudio fue investigar la asociación entre la bacteriemia y la determinación de BDG. Métodos. Para identificar a los pacientes con bacteriemia hospitalizados en la sala de hematología y la unidad de trasplante de células progenitoras, se revisaron los archivos de historias clínicas del comité de control de infecciones. En el estudio se incluyeron a los pacientes sometidos como mínimo a una determinación de BDG al cabo de 5 días de un resultado positivo del hemocultivo. La determinación de los valores séricos de BDG se analizó con el test Fungitell (Associates of Cape Cod, East Falmouth, MA, EE. UU.), de acuerdo con las especificaciones del fabricante. El punto de corte para la determinación de un resultado positivo se estableció en 80pg/mL. Resultados. Se identificó un total de 83 episodios de bacteriemia en 71 pacientes. En 14 de ellos, la determinación de BDG fue positiva, pero sólo se identificaron valores elevados en un paciente con bacteriemia por Escherichia coli (>80pg/mL), a pesar de que no se detectaron pruebas de infección fúngica invasora (IFI). Conclusiones. Los resultados del presente estudio sugieren que la reactividad cruzada entre la determinación de BDG y con una bacteriemia concomitante o reciente es excepcional. Cuando se documenten resultados positivos de la determinación de BDG, es preciso valorar con precaución a los pacientes con factores de riesgo de IFI(AU)

Background. Although bacteraemia has been reported to be related to false positive results in the 1,3-beta- d -glucan (BDG) test, the evidence for this interaction is limited. Aims. To investigate the association between bacteraemia and the BDG test. Methods. Records of the Infection Control Committee were reviewed to identify bacteraemia in patients who were hospitalized in the haematology ward and stem cell transplantation unit. Patients who had undergone the BDG test at least once within 5 days of a positive blood culture were included in the study. BDG levels in the sera were assayed using the Fungitell kit (Associates of Cape Cod, East Falmouth, MA) according to the manufacturer's specifications. The cutoff for BDG positivity was 80pg/mL. Results. Eighty-three bacteraemic episodes were identified in 71 patients. BDG positivity was detected in 14 patients with bacteraemia, and only 1 patient with Escherichia coli bacteraemia had high BDG levels (over 80pg/mL) despite having no evidence of invasive fungal infection (IFI). Conclusions. Our study suggests that the cross-reactivity of the BDG test with a concomitant or recent bacteraemia is a very rare condition. Patients with risk factors for IFI should be evaluated cautiously when a positive BDG test is reported(AU)

Isolation of Acremonium strictum from pleural fluid of a patient with colon adenocarcinoma.

Although Acremonium strictum is environmentally widespread as opportunistic fungus, it may cause infection in patients who have immunodeficiency. In this study, A. strictum were isolated from the pleural fluid of a patient with colon adenocarcinoma. The patient did not receive antifungal therapy because the patient died on the same day after the isolation of the mould from the pleural fluid. Major risk factors for the fungal infection are surgery because of cancer, administration of parenteral hyperalimentation and broad-spectrum antibiotics, attaching chest tube and ventilation tube and hospitalization in intensive care unit. The minimal inhibitory concentrations (MICs) of amphotericin B, fluconazole, ketoconazole, itraconazole, voriconazole for the A. strictum strain isolated from pleural fluid were 0.125, 256, 2, 1.5 and 0.25 microg ml(-1), respectively. In conclusion, bacteria and fungi, especially opportunistic fungi should be taken into consideration in the developing pleuritis in the patients with predisposing risks for the fungal infection.