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1.
Med Mycol ; 62(4)2024 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-38533663

RESUMEN

Our objective was to determine whether the twice-weekly screening of high-risk hematology patients by Mucorales qPCR on serum affects the prognosis of mucormycosis. Results from all serum Mucorales qPCR tests performed on patients from the hematology unit from January 2017 to December 2022 were analyzed. Patients with positive results were classified as having proven, probable or 'PCR-only' mucormycosis. One-month mortality for the local cohort was compared with that of a national cohort of cases of mucormycosis collected by the French surveillance network for invasive fungal disease ('Réseau de surveillances des infections fongiques invasives en France' (RESSIF)) from 2012 to 2018. From 2017 to 2022, 7825 serum Mucorales qPCR tests were performed for patients from the hematology unit; 107 patients with at least one positive Mucorales qPCR (164 positive samples) were identified. Sixty patients (70 positive samples, median Cq = 40) had no radiological criteria for mucormycosis and were considered not to have invasive fungal disease (70/7825, 0.9% false positives). It was not possible to classify disease status for six patients (12 positive samples, median Cq = 38). Forty-one patients (82 positive samples, median Cq = 35) had a final diagnosis of mucormycosis. In comparison with the RESSIF cohort, the local cohort was independently associated with a 48% lower one-month all-cause mortality rate (age-, sex-, and primary disease-adjusted hazard ratio = 0.52; 95% confidence interval: 0.29-0.94; P 0.03). Proactive screening for invasive mold diseases in high-risk hematology patients, including twice-weekly Mucorales qPCR on serum, was associated with mucormycosis higher survival.


Asunto(s)
Hematología , Infecciones Fúngicas Invasoras , Mucorales , Mucormicosis , Humanos , Mucorales/genética , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Mucormicosis/veterinaria , Infecciones Fúngicas Invasoras/diagnóstico , Infecciones Fúngicas Invasoras/veterinaria , ADN de Hongos
2.
Med Mycol ; 62(2)2024 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-38327232

RESUMEN

Mucormycosis is a rare disease with scarce diagnostic methods for early intervention. Available strategies employing direct microscopy using calcofluor white-KOH, culture, radiologic, and histopathologic testing often are time-intensive and demand intricate protocols. Nucleic Acid Amplification Test holds promise due to its high sensitivity combined with rapid detection. Loop-mediated isothermal amplification (LAMP) based detection offers an ultrasensitive technique that does not require complicated thermocyclers like in polymerase chain reaction, offering a straightforward means for improving diagnoses as a near-point-of-care test. The study introduces a novel magnetic nanoparticle-based LAMP assay for carryover contaminant capture to reduce false positives. Solving the main drawback of LAMP-based diagnosis techniques. The assay targets the cotH gene, which is invariably specific to Mucorales. The assay was tested with various species of Mucorales, and the limit of detections for Rhizopus microsporus, Lichtheimia corymbifera, Rhizopus arrhizus, Rhizopus homothallicus, and Cunninghamella bertholletiae were 1 fg, 1 fg, 0.1 pg, 0.1 pg, and 0.01 ng, respectively. This was followed by a clinical blindfolded study using whole blood and urine samples from 30 patients diagnosed with Mucormycosis. The assay has a high degree of repeatability and had an overall sensitivity of > 83%. Early Mucormycosis detection is crucial, as current lab tests from blood and urine lack sensitivity and take days for confirmation despite rapid progression and severe complications. Our developed technique enables the confirmation of Mucormycosis infection in < 45 min, focusing specifically on the RT-LAMP process. Consequently, this research offers a viable technique for quickly identifying Mucormycosis from isolated DNA of blood and urine samples instead of invasive tissue samples.


Mucormycosis is a challenging disease to diagnose early. This study introduces a sensitive and rapid diagnostic approach using Loop-mediated isothermal amplification technology. Testing blood and urine samples from 30 patients revealed promising sensitivity and repeatability, indicating its potential for non-invasive diagnosis.


Asunto(s)
Nanopartículas de Magnetita , Mucorales , Mucormicosis , Humanos , Mucormicosis/diagnóstico , Mucormicosis/veterinaria , Sensibilidad y Especificidad , Técnicas de Amplificación de Ácido Nucleico/métodos , Técnicas de Amplificación de Ácido Nucleico/veterinaria , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/veterinaria , Mucorales/genética
3.
Med Mycol ; 62(2)2024 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-38289831

RESUMEN

To estimate the diagnostic performance of Mucorales polymerase chain reaction (PCR) in Bronchoalveolar lavage fluid (BALF) in routine practice. This was a single-center retrospective study including all consecutive patients >18 years who underwent Mucorales PCR assay in BALF between January 2021 and May 2022. Index testing was prospectively performed using the MycoGENIE Aspergillus spp.-Mucorales spp. PCR. The reference was the diagnosis of pulmonary mucormycosis by the Adjudication Committee. Mucorales PCR in BALF was performed for 938 patients and was positive for 21 of 938 (2.2%). Eleven pulmonary mucormycosis (including one disseminated) were diagnosed. Among them, one (9.1%) was classified as proven mucormycosis, three (27.3%) as probable, and seven (63.6%) as possible according to the EORTC/MSGERC 2019 criteria. The main host factor was hematological malignancy (10 of 11, 90.9%). Mucorales PCR was positive in serum for eight patients (72.7%). Three patients had positive PCR in BALF, but negative in serum. The mean cycle threshold value was significantly lower in mucormycosis than false-positive cases. Sensitivity was 72.7% (95% confidence interval [CI], 43.4-90.3%), and specificity was 98.6% (95% CI, 97.6-99.2%). The positive and negative predictive values were 38.1% (95% CI, 20.8-59.1%) and 99.7% (95% CI, 99.1-99.9%), respectively. Mucorales PCR in BALF showed good diagnostic performance for mucormycosis, particularly in combination with serum PCR. A positive result should be interpreted with caution, given the possibility of carriage in the airway. However, its high negative predictive value and specificity suggest the utility of Mucorales PCR in BALF in the diagnosis of pulmonary mucormycosis.


Asunto(s)
Mucorales , Mucormicosis , Humanos , Mucorales/genética , Mucormicosis/diagnóstico , Mucormicosis/veterinaria , Líquido del Lavado Bronquioalveolar , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa/veterinaria , ADN de Hongos , Sensibilidad y Especificidad
4.
Med Mycol ; 62(1)2024 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-38130212

RESUMEN

This study aimed to investigate the risk factors associated with intracranial involvement in COVID-19-associated mucormycosis (CAM) and to develop a nomogram model for predicting the risk of intracranial involvement, with a specific focus on perineural spread. An ambispective analysis was conducted on 275 CAM patients who received comprehensive treatment. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors, and a nomogram was created based on the results of the multivariable analysis. The performance of the nomogram was evaluated using a receiver operating characteristic (ROC) curve, and the discriminatory capacity was assessed using the area under the curve (AUC). The model's calibration was assessed through a calibration curve and the Hosmer Lemeshow test. In the results, the multivariable logistic regression analysis revealed that age (OR: 1.23, 95% CI 1.06-3.79), HbA1c (OR: 7.168, 95% CI 1.724-25.788), perineural spread (OR: 6.3, 95% CI 1.281-19.874), and the disease stage were independent risk factors for intracranial involvement in CAM. The developed nomogram demonstrated good discriminative capacity with an AUC of 0.821 (95% CI 0.713-0.909) as indicated by the ROC curve. The calibration curve showed that the nomogram was well-calibrated, and the Hosmer Lemeshow test yielded a P-value of 0.992, indicating a good fit for the model. In conclusion, this study found that CAM particularly exhibits perineural spread, which is a predictive factor for intracranial involvement. A nomogram model incorporating age, HbA1c, disease stage, and perineural spread was successfully developed for predicting intracranial involvement in CAM patients in both in-patient and out-patient settings.


Discovery of perineural spread in COVID-19-associated mucormycosis reveals a new predictive model for intracranial complications which is crucial for early intervention.


Asunto(s)
COVID-19 , Mucormicosis , Humanos , Mucormicosis/epidemiología , Mucormicosis/veterinaria , Hemoglobina Glucada , COVID-19/veterinaria , Curva ROC , Factores de Riesgo , Estudios Retrospectivos
5.
Med Mycol ; 62(1)2024 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-38154488

RESUMEN

On May 30th and 31st, 2023, delegates representing various African subregions, together with global representatives from the International Society of Human and Animal Mycology (ISHAM), the European Confederation of Medical Mycology (ECMM), the United States Centre for Disease Control and Prevention (CDC), and Global Action for Fungal Infections (GAFFI), convened in Nairobi, Kenya under the aegis of the Pan African Mycology Working Group, a working group of ISHAM. The meeting objectives were, amongst others, to deliberate on a continental response to the World Health Organisation Fungal Priority Pathogen List and facilitate interaction between global and regional leaders. Country delegates and international speakers addressed Africa's fungal disease burden; capacity for diagnosis and management; ongoing surveillance; knowledge gaps and trends in invasive fungal diseases such as Candida auris, mucormycosis, aspergillosis, and Acquired Immune Deficiency Syndrome (AIDS)-related mycoses; and current laboratory practice. During the technical sessions, expert panels deliberated on establishing and financing of national/regional surveillance networks for mycoses; establishing and sustaining African-led collaborations; expanding on existing laboratory and point-of-care diagnostic capacity as well as planning a mycology reference laboratory service and network in Africa. The meeting also highlighted successful African-led collaborations, capacity building, and clinical trial initiatives. The meeting conclusions informed the resolutions of the Nairobi Declaration calling for improved awareness; strong collaborations between clinical and laboratory teams across Africa; improved fungal disease surveillance within the continent; access to antifungals and diagnostics; and leveraging qualified human resources for mycology present within and outside Africa to facilitate trainings, collaborations, and exchanges.


This review presents the current state of the art in medical mycology in Africa discussed at the first scientific meeting of the Pan African Mycology Working Group, an affiliate of the International Society for Human and Animal Mycology (ISHAM) held in Nairobi, Kenya on May 30th and 31st, 2023.


Asunto(s)
Infecciones Fúngicas Invasoras , Mucormicosis , Micosis , Humanos , Kenia/epidemiología , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Micosis/epidemiología , Micosis/veterinaria , Mucormicosis/tratamiento farmacológico , Mucormicosis/veterinaria , Infecciones Fúngicas Invasoras/diagnóstico , Infecciones Fúngicas Invasoras/veterinaria , Antifúngicos/uso terapéutico
6.
Med Mycol ; 61(9)2023 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-37715309

RESUMEN

Early diagnosis of mucormycosis, a severe and potentially fatal complication in immunocompromised and COVID-19 patients, is crucial for initiating timely antifungal therapy and reducing infection mortality. In this study, the diagnostic performance of a duplex polymerase chain reaction (PCR) assay was evaluated to detect Mucorales-specific and Rhizopus oryzae-specific targets in 160 clinical samples collected from 112 COVID-19 patients suspected of invasive fungal rhinosinusitis (IFRS). During potassium hydroxide (KOH) direct microscopy, non-septate hyphae were observed in 73 out of 160 samples (45.63%); however, using duplex PCR, 82 out of 160 specimens (51.25%) tested positive. Among the positive PCR samples, 67 (81.71%) exhibited a double band (both 175 and 450 base pairs [bp]) indicating the presence of R. oryzae, and 15 (18.29%) showed only a single band (175 bp), suggesting the presence of non-R. oryzae Mucorales. DNAs from 10 microscopically negative samples and 4 samples with septate hyphae in microscopy were successfully amplified in PCR. Considering Calcofluor white fluorescence microscopy as the gold standard for laboratory diagnosis of mucormycosis, the duplex PCR assay utilized in this study exhibited a sensitivity of 93.88%, a specificity of 100%, a negative predictive value of 91.18%, and a positive predictive value of 100% for detecting mucormycosis in IFRS specimens. The duplex PCR assay demonstrated higher sensitivity compared to direct examination with KOH (82 vs. 73) and culture (82 vs. 41), enabling rapid detection/identification of Mucorales even in samples with negative culture or in biopsies with only a few hyphal elements.


Early diagnosis of mucormycosis, a severe complication in COVID-19 patients, is critical for reducing the mortality of the infection. In this study, a sensitive and rapid PCR assay to detect all Mucorales and delineate Rhizopus oryzae was developed and assessed to improve the diagnosis of mucormycosis.


Asunto(s)
COVID-19 , Mucorales , Mucormicosis , Humanos , Mucormicosis/diagnóstico , Mucormicosis/veterinaria , COVID-19/diagnóstico , COVID-19/veterinaria , Mucorales/genética , Reacción en Cadena de la Polimerasa/veterinaria , Prueba de COVID-19/veterinaria
7.
Med Mycol ; 61(7)2023 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-37442616

RESUMEN

The second wave of coronavirus disease 2019 (COVID-19), during the early 2021, lead to a devastating outbreak of mucormycosis in India. This study aimed to determine the aetiology, clinical features, comorbidities, and risk factors of rhino-orbito-cerebral mucormycosis (ROCM) and antifungal susceptibility pattern for the isolates. The study included all suspected cases of ROCM in post-COVID-19 patients attending the hospital from May to December 2021. A total of 70 patients were diagnosed with mucormycosis during the study period. The commonest presentations were rhino-orbital and rhino-orbito-cerebral in 35.7% of cases each. Diabetes mellitus was the commonest associated risk factor in 95.7% of all patients, while 78.5% of the patients were treated with corticosteroids in the recent past, and 25.7% presented with active COVID-19 pneumonia. The commonest isolate was Rhizopus arrhizus n = 14, followed by Aspergillus flavus n = 16, A. fumigatus n = 4, A. niger n = 3, Fusarium oxysporumn = 1, and Apophysomyces variabilisn = 1. Fungal species identification was done by phenotypic methods for all the isolates and DNA sequence analysis of 18 isolates, and antifungal susceptibility testing of 30 isolates was performed by commercially prepared HiMIC plate (HiMedia, Mumbai, India) using broth microdilution for amphotericin B, isavuconazole, itraconazole, voriconazole, and posaconazole. The MIC50 and MIC90 of amphotericin B for R. arrhizus strains were 0.25 and 4 µg/ml, respectively; and the MIC50 and MIC90 results for itraconazole, posaconazole, and isavuconazole were 8 and 8, 2 and 2, and 2 and 8 µg/ml, respectively. In vitro data showed that amphotericin B was the most effective antifungal against most species. The commercially available ready-to-use minimum inhibitory concentration plates are user-friendly for performing antifungal susceptibility, which may be useful in choosing appropriate regimens and monitoring emerging resistance.


Asunto(s)
COVID-19 , Mucormicosis , Animales , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Mucormicosis/tratamiento farmacológico , Mucormicosis/epidemiología , Mucormicosis/microbiología , Mucormicosis/veterinaria , Itraconazol/farmacología , Anfotericina B/farmacología , Anfotericina B/uso terapéutico , COVID-19/veterinaria , India/epidemiología
8.
Med Mycol ; 61(4)2023 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-36963767

RESUMEN

To describe reasons for initiation and evolution under isavuconazole (ISZ), a 2-year prospective and observational study was performed. Anonymized data collected during the first 3 months of treatment were indications of treatment, efficacy, overall survival (OS), evolution of toxicity markers, and ISZ trough levels. Fifty-one (26 invasive aspergillosis, 16 prophylaxis, and 9 mucormycosis) patients started on isavuconazole. Isavuconazole was initiated upfront in 12/51 cases, especially to avoid toxicities from other antifungals. As second-line therapy (39/51 patients), isavuconazole was mostly initiated after toxicities of the previous treatments (66.7%; 26/39 cases). An improvement in toxicity markers was reported in most patients. However, five patients experienced adverse events. The mean ISZ trough levels measured from 179 samples collected in 37 patients was 3.33 ± 1.64 mg/l. The mean ISZ through levels was significantly lower (P = .003) in alloHSCT recipients (3.10 ± 1.45 mg/l) than in other patients (3.76 ± 1.88 mg/l) but still within the expected range of efficacy. After 12 weeks, the OS was 69.2% (n = 18/26) in the invasive aspergillosis intention-to-treat (ITT) group and 44.4% (n = 4/9) in the mucormycosis ITT group. After 2 years, the OS was respectively 46.2% (n = 12/26) and 33.3% (n = 3/9) in these two groups.


Isavuconazole is commonly prescribed as second-line therapy after the toxicity of a previous treatment. In most cases, an improvement is reported. The well tolerability of isavuconazole was associated with correct blood levels, even in alloHSCT recipients.


Asunto(s)
Aspergilosis , Infecciones Fúngicas Invasoras , Mucormicosis , Animales , Mucormicosis/tratamiento farmacológico , Mucormicosis/veterinaria , Estudios Prospectivos , Triazoles/efectos adversos , Antifúngicos/efectos adversos , Aspergilosis/tratamiento farmacológico , Aspergilosis/veterinaria , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/veterinaria
10.
Med Mycol ; 61(1)2022 Dec 29.
Artículo en Inglés | MEDLINE | ID: mdl-36565722

RESUMEN

The molecular composition and structural organization of the cell wall of filamentous fungi underlie the ability of the host to identify them as pathogens. Although the organization of the fungal cell wall, composed of 90% polysaccharides, is similar from one fungus to another, small variations condition their ability to trigger pattern recognition receptors. Because the incidence of mucormycosis, an emerging life-threatening infection caused by the species of the order Mucorales is increasing worldwide, the precise composition of the cell wall of two strains of Lichtheimia corymbifera was investigated in the early growth stages of germination (spores and germ-tubes) using trimethylsilylation and confocal microscopy. This study also characterizes the response of THP-1 cells to Mucorales. The study identified the presence of uncommon monosaccharides (fucose, galactose, and glucuronic acid) whose respective proportions vary according to the germination stage, revealing early parietal reorganization. Immunofluorescence studies confirmed the exposure of ß-glucan on the surface of swollen spores and germ-tubes. Both spores and germ-tubes of L. corymbifera promoted an early and strong pro-inflammatory response, through TLR-2. Our results show the singularity of the cell wall of the order Mucorales, opening perspectives for the development of specific diagnostic biomarkers.


Lichtheimia corymbifera is a causative agent of mucormycosis, an emerging invasive fungal infection. Deciphering cell wall composition can lead to the identification of a polysaccharide epitope, which could be used as a biomarker, useful for the diagnosis of mucormycosis.


Asunto(s)
Mucorales , Mucormicosis , Animales , Mucorales/fisiología , Mucormicosis/diagnóstico , Mucormicosis/veterinaria , Esporas , Interacciones Huésped-Patógeno
11.
Med Mycol ; 60(9)2022 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-36029277

RESUMEN

We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the presence of orbital pain and superior orbital fissure infiltration on imaging. The ipsilateral geniculate ganglion was found to enhance more profoundly in 7/11 subjects with facial palsy and available magnetic resonance (MR) imaging, and the ipsilateral pterygopalatine fossa was found infiltrated in 14. Among 23 subjects with complete loss of vision, 9 (39%) demonstrated long-segment bright signal in the posterior optic nerve on diffusion MR images. We conclude that orbital pain might be absent in SARS-CoV-2-associated ROCM. Facial nerve palsy is more common than previously appreciated and ischemic lesions of the posterior portion of the optic nerve underlie complete vision loss.


Unique clinical and radiological manifestations identified in the outbreak of Rhino-oculo-cerebral mucormycosis (ROCM) during the second epidemic wave of coronavirus disease 2019 (COVID-19) infection included the common occurrence of facial paralysis, frequent absence of ocular pain, and long segments of optic nerve damage.


Asunto(s)
COVID-19 , Mucormicosis , Animales , COVID-19/complicaciones , COVID-19/veterinaria , Humanos , Mucormicosis/diagnóstico por imagen , Mucormicosis/veterinaria , Dolor/veterinaria , Parálisis/veterinaria , SARS-CoV-2
12.
Med Mycol ; 60(7)2022 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-35709394

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic had led to an increase in a surge of mucormycosis in COVID-19 patients, especially in India. Diabetes and irrational usage of corticosteroids to treat COVID-19 were some of the factors implicated for COVID-19-associated mucormycosis (CAM). We designed this case-control study to identify risk factors for mucormycosis in COVID-19 patients. The study was conducted at a private tertiary care center in western India. Data were extracted from records of COVID 19 patients (January-May 2021) and divided into two groups: Those with proven or probable mucormycosis, and those without mucormycosis with a ratio of 1:3. A binary logistic regression analysis was done to assess potential risk factors for CAM. A total of 64 CAM and 205 controls were included in the analysis. Age and sex distribution were similar in cases and controls with the majority of males in both the groups (69.9%) and the mean age was 56.4 (±13.5) years. We compared the comorbidities and treatment received during acute COVID-19, specifically the place of admission, pharmacotherapy (steroids, tocilizumab, remdesivir), and the requirement of oxygen as a risk factor for CAM. In a multivariate analysis, risk factors associated with increased odds of CAM were new-onset diabetes (vs. non-diabetics, adjusted odds ratio [OR] 48.66, 95% confidence interval [CI] 14.3-166), pre-existing diabetes (vs. non-diabetics, aOR 2.93, 95%CI 1.4-6.1), corticosteroid therapy (aOR 3.64, 95%CI 1.2-10.9) and home isolation (vs. ward admission, aOR 4.8, 95%CI 2-11.3). Diabetes, especially new-onset, along with corticosteroid usage and home isolation were the predominant risk factors for CAM. LAY SUMMARY: This study revealed new-onset diabetes, pre-existing diabetes, corticosteroid therapy, and home isolation as risk factors for COVID-19-associated mucormycosis. Avoiding the use of corticosteroids in non-severe COVID-19 disease coupled with proper blood sugar monitoring and control will help to reduce the CAM burden.


Asunto(s)
COVID-19 , Diabetes Mellitus , Mucormicosis , Corticoesteroides/uso terapéutico , Animales , COVID-19/epidemiología , COVID-19/veterinaria , Estudios de Casos y Controles , Diabetes Mellitus/epidemiología , Diabetes Mellitus/veterinaria , India/epidemiología , Masculino , Mucormicosis/tratamiento farmacológico , Mucormicosis/epidemiología , Mucormicosis/veterinaria , Factores de Riesgo
13.
Med Mycol ; 60(4)2022 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-35134980

RESUMEN

Invasive fungal sinusitis (IFS) is a rare disease that requires careful attention and prompts management due to its high mortality among pediatric patients with hematological malignancies. This is a retrospective analysis of pediatric patients with hematological malignancies treated at Children's Cancer Hospital Egypt 57 357 (CCHE) through the period from 2008 till 2016 with proven IFS. Thirty-four patients were diagnosed with IFS. Five (15%) patients had an invasive rhino-cerebral fungal disease. Mucorales were isolated in 50% (n = 17) patients, Aspergillus in 38% (n = 13) patients, and mixed fungal in 12% (n = 4) patients. Sinuses were the only localized site in (45%). Extra-nasal spread was reported in 20 patients; Sino-pulmonary in 35% (n = 12), sino-cerebral in 15% (n = 5), and sino-orbital in 5% (n = 2) patients. Combined antifungal therapy with surgical debridement was done in 59% of patients with a better outcome when compared to those who received only medical antifungal treatment (P = .01). The overall mortality rate at week 12 was 35% (n = 12), and IFS attributable mortality was 20% (n = 7). IFS with cerebral extension carried the highest mortality rate for both 12-week all-cause (P = .04) and fungal-attributable (P = .01) mortality. Pediatric patients with hematologic malignancies are susceptible to invasive fungal sinusitis (IFS). Surgical debridement, combined with antifungal therapy, improves outcomes among those patients. IFS patients with cerebral extension had a higher risk of mortality. LAY SUMMARY: We studied the characteristics of invasive fungal sinusitis in children with hematological malignancies. Mucormycosis was the most common cause. Surgical debridement, combined with anti-fungal therapy, improves outcomes. Patients with rhino-cerebral fungal disease had a higher risk of mortality.


Asunto(s)
Neoplasias Hematológicas , Infecciones Fúngicas Invasoras , Mucormicosis , Sinusitis , Animales , Antifúngicos/uso terapéutico , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/veterinaria , Humanos , Infecciones Fúngicas Invasoras/diagnóstico , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/veterinaria , Mucormicosis/microbiología , Mucormicosis/veterinaria , Estudios Retrospectivos , Sinusitis/complicaciones , Sinusitis/diagnóstico , Sinusitis/terapia , Sinusitis/veterinaria
14.
Med Mycol ; 60(4)2022 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-35188208

RESUMEN

PCR-based methods applied to various body fluids emerged in recent years as a promising approach for the diagnosis of mucormycosis. In this study, we set up and assess the value of a qPCR to detect a wide variety of Mucorales species in a single tube. A pair of degenerated primers targeting the rDNA operon was used in a qPCR utilizing an intercalating fluorescent dye. Analytical assessment, using a wide variety of both Mucorales strains (8 genera, 11 species) and non-Mucorales strains (9 genera, 14 species), showed 100% sensitivity and specificity rates with a limit of detection at 3 rDNA copy/qPCR reaction. Subsequently, 364 clinical specimens from 166 at-risk patients were prospectively tested with the assay. All the seven patients classified as proven/probable mucormycosis using the EORTC-MSG criteria had a positive qPCR as well as a patient with a proven uncharacterized invasive mold infection. In addition, three out of seven patients with possible mold invasive infections had at least one positive qPCR test. Sensitivity was calculated between 73.33 and 100% and specificity between 98.10 and 100%. The qPCR method proposed showed excellent performances and would be an important adjunctive tool for the difficult diagnosis of mucormycosis diagnosis. LAY ABSTRACT: qPCR-based diagnosis is the most reliable approach for mucormycosis. We set up a pan-Mucorales qPCR able to detect in a single reaction not less than 11 different species. Both analytical and clinical performances support its use in the clinical setting.


Asunto(s)
Mucorales , Mucormicosis , Animales , Cartilla de ADN , ADN de Hongos/genética , Mucorales/genética , Mucormicosis/diagnóstico , Mucormicosis/veterinaria , Reacción en Cadena en Tiempo Real de la Polimerasa/veterinaria
15.
Vet Med Sci ; 7(6): 2404-2409, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34547177

RESUMEN

A 6-year-old female bottlenose dolphin (Tursiops truncatus) kept in dolphinarium died after a 3.5-month period of lethargy and inappetence despite antibiotics and supportive care. At necropsy, gross findings included diffuse varying-sized nodules in the lungs and scattered nodules throughout the heart, spleen, mesenteric and hilar lymph node and kidney. Microscopically, the lesions were characterised by disseminated fungal pyogranulomas with numerous intralesional Mucor-like fungi. The fungi structures were demonstrated by Periodic acid-Schiff and Gomori methenamine silver stain. Molecular analyses of the fungi were Rhizopus microsporus by PCR sequencing 18S ribosomal RNA gene. Ziehl-Neelsen stain failed to show acid-fast bacterial infection. Based on pathological and molecular examination, systemic granulomatous mucormycosis was diagnosed. To our knowledge, this is the first reported case of systemic mucormycosis caused by Rhizopus microsporus in bottlenose dolphin.


Asunto(s)
Delfín Mular , Mucormicosis , Animales , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Mucormicosis/veterinaria , Rhizopus/genética
16.
J Avian Med Surg ; 35(1): 86-89, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33892594

RESUMEN

A 7-month-old, male Magellanic penguin (Spheniscus magellanicus), housed in an outdoor exhibit, developed acute neurologic signs that progressed to death over 2 days. On gross examination, the bird had congested, edematous lungs, and cerebellar hemorrhage. Histologic examination identified granulomatous pneumonia and encephalitis, with thrombosis and eosinophilic, branching fungal hyphae that had invaded the meningeal vessel walls. Polymerase chain reaction identified the fungus in the brain as Rhizomucor pusillus, an uncommon cause of mucormycosis. This organism has previously been reported in respiratory, skeletal, and sino-orbital lesions of avian species. This clinical report describes meningoencephalitis associated with Rhizomucor pusillus in a penguin.


Asunto(s)
Meningoencefalitis , Mucormicosis , Spheniscidae , Animales , Granuloma/veterinaria , Masculino , Meningoencefalitis/veterinaria , Mucormicosis/diagnóstico , Mucormicosis/veterinaria , Rhizomucor
17.
Comp Med ; 70(4): 390-395, 2020 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-32736665

RESUMEN

Immunodeficient rats are valuable in transplantation studies, but are vulnerable to infection from opportunistic organisms such as fungi. Immunodeficient Rag1- and Il2rg-deficient (RRG) rats housed at our institution presented with dark, proliferative, keratinized dermal growths. Histologic and PCR results indicated that the predominant organism associated with these lesions was fungus from the family Mucoraceae, mostly of the genus Rhizopus. The Mucoraceae family of fungi are environmental saprophytes and are often found in rodent bedding. These fungi can cause invasive opportunistic infections in immunosuppressed humans and animals. We discuss husbandry practices for immunosuppressed rodents with a focus on controlling fungal contaminants.


Asunto(s)
Mucormicosis/veterinaria , Infecciones Oportunistas/veterinaria , Animales , Femenino , Vivienda para Animales/normas , Inmunocompetencia , Masculino , Mucormicosis/diagnóstico , Ratas , Enfermedades de los Roedores/diagnóstico
18.
J Comp Pathol ; 175: 90-94, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32138849

RESUMEN

We describe two cases of mucormycosis with systemic and gastrohepatic involvement in two male poodles. Respiratory, neurological and gastrointestinal signs progressed to death within 3 and 19 days of the onset of clinical signs, respectively. In case 1, there was systemic disease affecting the lungs, heart and brain. The lesions were characterized by yellow or red, raised, irregular areas that extended into deeper tissue from the surface. In case 2, there was gastric rupture; the margins of the rupture and the gastric mucosa were covered by a thick, white, friable material. In the liver, there were multiple yellow-white cavitated nodules. Histologically, pyogranulomas occurred in the affected organs and were associated with vasculitis, thrombosis and fungal hyphae. The diagnosis of mucormycosis was based on the characteristic microscopical lesions together with the morphology and staining features of the fungus. The hyphae were strongly labelled by monoclonal antibody specific for Rhizopus arrhizus on immunohistochemistry. Underlying immunosuppression was suspected in both cases.


Asunto(s)
Enfermedades de los Perros/microbiología , Enfermedades de los Perros/patología , Mucormicosis/veterinaria , Animales , Perros , Masculino
19.
J Mycol Med ; 30(1): 100923, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31964598

RESUMEN

Abortion in dairy cattle may be caused by infectious (viruses, fungi and protozoa) and non-infectious causes mostly related to bad management practices and genetic factors. Recently, the significant contribution of mycotic infection to bovine abortion has been recognized. This report describes an abortion case in a Chianina cow due to Aspergillus nidulans, Aspergillus luchuensis and Lichtheimia sp. diagnosed by histology, cytology, culture and molecular assays. A mixed infection due to more than one fungus in abortion is rarely demonstrated. To our knowledge, this is the first case of bovine abortion caused by co-infection with three different moulds.


Asunto(s)
Aborto Veterinario/microbiología , Aspergilosis/complicaciones , Coinfección/complicaciones , Mucormicosis/complicaciones , Aborto Espontáneo/microbiología , Aborto Veterinario/diagnóstico , Animales , Aspergilosis/diagnóstico , Aspergilosis/veterinaria , Aspergillus/clasificación , Aspergillus/aislamiento & purificación , Aspergillus/patogenicidad , Aspergillus nidulans/aislamiento & purificación , Aspergillus nidulans/patogenicidad , Bovinos , Enfermedades de los Bovinos/diagnóstico , Enfermedades de los Bovinos/microbiología , Coinfección/diagnóstico , Coinfección/microbiología , Coinfección/veterinaria , Femenino , Mucorales/aislamiento & purificación , Mucorales/patogenicidad , Mucormicosis/diagnóstico , Mucormicosis/veterinaria , Embarazo
20.
J Comp Pathol ; 165: 67-71, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30502800

RESUMEN

In spring 2014, several wild passeriform garden birds were found severely ill or dead, all with severe periocular swellings. A blue tit (Cyanistes caeruleus) showing severe depression was humanely destroyed and sent for necropsy examination. In this bird, the lower eyelids were sagging, red and oedematous. Microscopical examination revealed marked infiltration of the eyelid tissue with fungal hyphae (stained by periodic acid-Schiff) without any inflammatory reaction. Polymerase chain reaction followed by sequencing identified Mucor racemosus and a so far unknown circovirus. The circovirus infection in this bird might have induced immunosuppression and thus facilitated the fungal infection. To our knowledge this is the first report of ocular M. racemosus infection associated with circovirus infection in a bird.


Asunto(s)
Enfermedades de las Aves/microbiología , Enfermedades de las Aves/patología , Infecciones por Circoviridae/veterinaria , Coinfección/veterinaria , Mucormicosis/veterinaria , Passeriformes/microbiología , Animales , Mucor
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