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1.
Top Antivir Med ; 28(2): 455-458, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32886465

RESUMO

Due to COVID-19, this year marked the first virtual Conference on Retroviruses and Opportunistic Infections (CROI) in the conference's 27-year history. There were important studies presented that provided new insights into the prevention, diagnosis, and treatment of tuberculosis (TB) and other HIV coinfections. Highlights related to TB and HIV coinfections from this year's meeting are reviewed below.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas/epidemiologia , Saúde Pública , Tuberculose/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Controle de Doenças Transmissíveis/organização & administração , Congressos como Assunto , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/epidemiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Gravidez , Prevalência , Prevenção Primária/métodos , Medição de Risco , Análise de Sobrevida , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Interface Usuário-Computador , Adulto Jovem
2.
Yonsei Med J ; 61(8): 670-678, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32734730

RESUMO

PURPOSE: The diagnosis of pulmonary fungal infections is challenging due to the difficulty of obtaining sufficient specimens. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needle rinse fluid has become an emerging diagnostic material. This study evaluated the role of routine fungal culture from EBUS-TBNA needle rinse fluid, in addition to histopathologic examination and fungal culture of EBUS-TBNA core tissue, in the diagnosis of pulmonary fungal infections. MATERIALS AND METHODS: Among patients who underwent EBUS-TBNA, those with results for at least one of three tests (histopathologic examination, fungal culture of EBUS-TBNA core tissue or needle rinse fluid) were included. Patients with a positive test were divided into two groups (clinical fungal infection and suspected fungal contamination) according to their clinical assessment and therapeutic response to antifungal. RESULTS: Of 6072 patients, 41 (0.7%) had positive fungal tests and 9 (22%) were diagnosed as clinical fungal infection. Of the 5222 patients who were evaluated using a fungal culture from EBUS-TBNA needle rinse fluid, 35 (0.7%) had positive results. However, only 4 out of 35 (11.4%) were classified as clinical fungal infection. Positive results were determined in 4 of the 68 (5.9%) evaluated by a fungal culture of EBUS-TBNA core tissue, and all were diagnosed as clinical fungal infection. CONCLUSION: Routine fungal culture of EBUS-TBNA needle rinse fluid is not useful due to the low incidence of fungal infection and high rate of contamination. However, fungal culture of EBUS-TBNA core tissue and needle rinse fluid should be considered in patients with clinically suspected fungal infection.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Fungos/crescimento & desenvolvimento , Agulhas , Idoso , Feminino , Humanos , Biópsia Guiada por Imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico
3.
Mycopathologia ; 185(4): 607-611, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32737746

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China, in late 2109, and has rapidly spread around the world. Until May 25, 2020, there were 133,521 confirmed COVID-19 cases and 7359 deaths in Iran. The role of opportunistic fungal infections in the morbidity and mortality of COVID-19 patients remains less defined. Based on our multicenter experiences, we categorized the risks of opportunistic fungal infections in COVID-19 patients in Iran. The COVID-19 patients at high risk included those with acute respiratory distress syndrome, in intensive care units, receiving broad-spectrum antibiotics, immunosuppressants or corticosteroid, and supported by invasive or noninvasive ventilation. The patients were most likely to develop pulmonary aspergillosis, oral candidiasis, or pneumocystis pneumonia. Most diagnoses were probable as the accurate diagnosis of opportunistic fungal infections remains challenging in resource-poor settings. We summarize the clinical signs and laboratory tests needed to confirm candidiasis, aspergillosis, or pneumocystosis in our COVID-19 patients.


Assuntos
Infecções por Coronavirus/complicações , Micoses/complicações , Infecções Oportunistas/complicações , Pneumonia Viral/complicações , Candidíase Bucal/complicações , Candidíase Bucal/diagnóstico , Candidíase Bucal/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Micoses/diagnóstico , Micoses/epidemiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Pandemias , Doenças Faríngeas/complicações , Doenças Faríngeas/diagnóstico , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/microbiologia , Pneumocystis carinii , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/microbiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/epidemiologia
4.
Mycopathologia ; 185(4): 599-606, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32737747

RESUMO

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been sweeping across the globe. Based on a retrospective analysis of SARS and influenza data from China and worldwide, we surmise that the fungal co-infections associated with global COVID-19 might be missed or misdiagnosed. Although there are few publications, COVID-19 patients, especially severely ill or immunocompromised, have a higher probability of suffering from invasive mycoses. Aspergillus and Candida infections in COVID-19 patients will require early detection by a comprehensive diagnostic intervention (histopathology, direct microscopic examination, culture, (1,3)-ß-D-glucan, galactomannan, and PCR-based assays) to ensure effective treatments. We suggest it is prudent to assess the risk factors, the types of invasive mycosis, the strengths and limitations of diagnostic methods, clinical settings, and the need for standard or individualized treatment in COVID-19 patients. We provide a clinical flow diagram to assist the clinicians and laboratory experts in the management of aspergillosis, candidiasis, mucormycosis, or cryptococcosis as co-morbidities in COVID-19 patients.


Assuntos
Infecções por Coronavirus/complicações , Micoses/complicações , Pneumonia Viral/complicações , Candidíase Invasiva/complicações , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/terapia , China , Infecções por Coronavirus/diagnóstico , Criptococose/complicações , Criptococose/diagnóstico , Criptococose/terapia , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/terapia , Mucormicose/complicações , Mucormicose/diagnóstico , Mucormicose/terapia , Micoses/diagnóstico , Micoses/terapia , Pandemias , Pneumonia Viral/diagnóstico
5.
Clin Microbiol Infect ; 26(10): 1395-1399, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32603803

RESUMO

OBJECTIVES: To investigate the incidence of bacterial and fungal coinfection of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study across two London hospitals during the first UK wave of coronavirus disease 2019 (COVID-19). METHODS: A retrospective case series of hospitalized patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (20 February-20 April 2020; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza-positive patients admitted during the 2019-2020 flu season. Patient demographics, microbiology and clinical outcomes were analysed. RESULTS: A total of 836 patients with confirmed SARS-CoV-2 were included; 27 (3.2%) of 836 had early confirmed bacterial isolates identified (0-5 days after admission), rising to 51 (6.1%) of 836 throughout admission. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens and respiratory viral PCR panels were obtained from 643 (77%), 110 (13%), 249 (30%), 246 (29%) and 250 (30%) COVID-19 patients, respectively. A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteraemia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteraemia was identified in six patients (three Candida, two Enterococcus spp. and one Pseudomonas aeruginosa). All other community-acquired bacteraemias (n = 16) were attributed to nonrespiratory infection. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24; 16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Comparable rates of positive coinfection were identified in the control group of confirmed influenza infection; clinically relevant bacteraemias (2/141; 1.4%), respiratory cultures (10/38; 26.3%) and pneumococcal-positive antigens (1/19; 5.3%) were low. CONCLUSIONS: We found a low frequency of bacterial coinfection in early COVID-19 hospital presentation, and no evidence of concomitant fungal infection, at least in the early phase of COVID-19.


Assuntos
Infecções Bacterianas/epidemiologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Influenza Humana/epidemiologia , Micoses/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Infecções Respiratórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/virologia , Coinfecção , Infecções Comunitárias Adquiridas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/microbiologia , Infecções por Coronavirus/virologia , Feminino , Hospitalização , Humanos , Influenza Humana/diagnóstico , Influenza Humana/microbiologia , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/microbiologia , Micoses/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/microbiologia , Pneumonia Viral/virologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Reino Unido/epidemiologia
7.
BMC Infect Dis ; 20(1): 394, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493232

RESUMO

BACKGROUND: Talaromyces marneffei is a highly pathogenic fungus that can cause life-threatening fatal systemic mycosis. Disseminated Talaromycosis marneffei affects multiple organs, including the lungs, skin, and reticuloendothelial system. However, T. marneffei infection has rarely been reported in human immunodeficiency virus (HIV)-negative infants with multiple intestinal perforations and diffuse hepatic granulomatous inflammation. CASE PRESENTATION: We present the case of an HIV-negative 37-month-old boy who has had recurrent pneumonia since infancy and was infected with disseminated Talaromycosis. Contrast-enhanced computed tomography of the whole abdomen showed hepatomegaly and intestinal wall thickening in the ascending colon and cecum with mesenteric lymphadenopathy. Colonoscopy showed a cobblestone pattern with erosion, ulcer, polypoid lesions, and lumen deformation ranging from the colon to the cecum. T. marneffei was isolated from the mucous membrane of the colon, liver, and bone marrow. After antifungal treatment and surgery, his clinical symptoms significantly improved. Whole-exome sequencing using the peripheral blood of the patient and his parents' revealed a heterozygous missense mutation in exon 17 of the STAT3 gene (c.1673G>A, p.G558D). CONCLUSIONS: In T. marneffei infection-endemic areas, endoscopic examination, culture, or histopathology from the intestine tissue should be performed in disseminated Talaromycosis patients with gastrointestinal symptoms. Timely and systemic antifungal therapy could improve the prognosis. Immunodeficiency typically should be considered in HIV-negative infants with opportunistic infections.


Assuntos
Hepatopatias/diagnóstico , Micoses/diagnóstico , Fator de Transcrição STAT3/genética , Talaromyces/isolamento & purificação , Antifúngicos/uso terapêutico , Pré-Escolar , Colonoscopia , Diagnóstico Diferencial , Humanos , Mucosa Intestinal/microbiologia , Perfuração Intestinal , Hepatopatias/tratamento farmacológico , Hepatopatias/microbiologia , Masculino , Mutação de Sentido Incorreto , Micoses/tratamento farmacológico , Micoses/microbiologia , Tomografia Computadorizada por Raios X
8.
J Med Microbiol ; 69(7): 944-948, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32490795

RESUMO

Introduction. Polymicrobial infections including yeasts and bacteria are not rare and patients with polymicrobial bloodstream infection have higher early and overall case fatality rates. The diagnosis of invasive fungal and bacterial infections is mainly based on blood culture.Aim. The aim was to reveal the effect of concomitant bacteraemia on the detection of fungi from blood cultures in the presence of polymicrobial bloodstream infections involving Candida and non-Candida fungi and to show the superiority of blood culture bottles including selective fungal media in such situations.Methodology. Twenty-four polymicrobial bloodstream infection models - involving one fungus and one bacterium - were constituted by using clinical blood culture isolates (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Candida glabrata, Fusarium solani and Trichosporon asahii). The Plus Aerobic/F (PAF) and Mycosis IC/F (MICF) culture bottles were used with the BACTEC 9240 device. After a bottle signalled positive, direct microscopic examination and subcultures on agar plates were performed.Results. All of fungi that were inoculated alone and in combination were detected by both direct microscopic examination and subcultures on agar plates from MICF bottles, whereas direct microscopic examination only revealed the bacterial agents from PAF bottles including combinations. Furthermore, fungal growth was hidden by bacterial growth on blood agar subcultures from PAF bottles including combinations of F. solani, C. glabrata or T. asahii with bacteria.Conclusion. Blood culture bottles including selective fungal media that can allow selective growth of fungi and earlier detection of some species should be preferred in addition to non-selective blood culture bottles, especially in specific patient populations. Further, the use of selective agar plates such as inhibitory mould agar may contribute to the solution of this problem in clinical laboratories.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Bacteriemia/sangue , Bacteriemia/microbiologia , Bactérias/crescimento & desenvolvimento , Bactérias/isolamento & purificação , Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Candida/isolamento & purificação , Candidemia/sangue , Candidemia/diagnóstico , Candidemia/microbiologia , Meios de Cultura , Fungos/crescimento & desenvolvimento , Fungos/isolamento & purificação , Humanos , Técnicas Microbiológicas/métodos , Micoses/sangue , Micoses/diagnóstico
9.
Ann Biol Clin (Paris) ; 78(3): 299-313, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32540816

RESUMO

The diagnosis of parasitic and fungal infections, historically based on the detection of these pathogens using direct diagnosis (macro/microscopic examination, culture) or serological methods, has considerably evolved in the last decades, especially with the development of molecular approaches and mass spectrometry. These techniques, as well as most analyses of parasitic and fungal serology, are mostly the preserve of Hospital University Centers Parasitology-Mycology laboratories. In 2016, the French association of medical parasitology and mycology teachers and hospital practitioners (Anofel) has provided a Catalogue of rare analyses, regularly updated and freely accessible on the Anofel website (https://anofel.net/). This tool, which hinges on 4 parts (parasitology, parasitic serology, mycology, and fungal serology), aims to provide information on all available analyses, and a list of hospital laboratories able to undertake them. It is complementary to the other reference works that were developed by our association, including the Guide of analyses and methods in parasitology and mycology, published in 2018, and the eANOFEL pictures and videos database, freely accessible online (http://www.eanofel.fr). In this article, we draw-up a state-of-the-art of the most specialized techniques available in the parasitology-mycology laboratories and presented in the Catalogue of rare analyses of the Anofel collegium, and their interest for the diagnosis of these infections.


Assuntos
Técnicas e Procedimentos Diagnósticos , Micologia/métodos , Micoses/diagnóstico , Doenças Parasitárias/diagnóstico , Parasitologia/métodos , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , Técnicas e Procedimentos Diagnósticos/tendências , Humanos , Laboratórios Hospitalares/normas , Laboratórios Hospitalares/estatística & dados numéricos , Micologia/tendências , Micoses/microbiologia , Doenças Parasitárias/parasitologia , Parasitologia/tendências
10.
J Laryngol Otol ; 134(5): 404-408, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32498734

RESUMO

OBJECTIVE: To predict skull base osteomyelitis in patients with necrotising otitis externa using diffusion-weighted imaging. METHODS: A retrospective analysis was conducted of 25 necrotising otitis externa patients with skull base osteomyelitis (n = 10) or without skull base involvement (n = 14) who underwent a single-shot diffusion-weighted imaging of the skull base. RESULTS: The respective mean apparent diffusion coefficient values of the skull base, as determined by two reviewers, were 0.851 ± 0.15 and 0.841 ± 0.14 ×10-3mm2/s for the skull base osteomyelitis patients, and 1.065 ± 0.19 and 1.045 ± 0.20 ×10-3mm2/s for the necrotising otitis externa patients without skull base involvement. The difference in apparent diffusion coefficients between the groups was significant, for both reviewers (p = 0.008 and 0.012). The optimal threshold apparent diffusion coefficient for predicting skull base osteomyelitis in necrotising otitis externa patients was 0.945 ×10-3mm2/s and 0.915 ×10-3mm2/s, with an area under the curve of 0.825 and 0.800, accuracy of 87.5 and 83.3 per cent, sensitivity of 85.7 and 90.0 per cent, and specificity of 90.0 and 78.6 per cent, for each reviewer respectively. CONCLUSION: Apparent diffusion coefficient is a non-invasive imaging parameter useful for predicting skull base osteomyelitis in necrotising otitis externa patients.


Assuntos
Osteomielite/patologia , Otite Externa/complicações , Base do Crânio , Adulto , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Necrose/patologia , Osteomielite/complicações , Osso Petroso , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus
11.
J Mycol Med ; 30(2): 100967, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32321676

RESUMO

A 44-year-old woman, victim of a road accident in Mali was diagnosed with left knee arthritis. Joint effusion aspiration and subcutaneous surgical biopsies were positive for a melanized asexual ascomycete. Using microscopy and molecular biology, the fungus was identified as Curvularia sp. In vitro antifungal susceptibility was determined by the EUCAST broth microdilution reference technique and by E-test. The patient was treated with liposomal amphotericin B before posaconazole relay. Mycological samples obtained 10 days after starting the antifungal therapy by liposomal amphotericin B were negative in culture. Curvularia spp. are environmental fungi which can under certain conditions be pathogenic for humans.


Assuntos
Acidentes de Trânsito , Artrite Infecciosa/microbiologia , Ascomicetos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/microbiologia , Adulto , Antifúngicos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/imunologia , Ascomicetos/isolamento & purificação , Ascomicetos/fisiologia , Evolução Fatal , Feminino , França , Humanos , Imunocompetência , Traumatismos do Joelho/tratamento farmacológico , Traumatismos do Joelho/imunologia , Articulação do Joelho/microbiologia , Mali , Micoses/complicações , Micoses/diagnóstico , Micoses/tratamento farmacológico , Micoses/microbiologia , Quadriplegia/etiologia , Quadriplegia/microbiologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/microbiologia , Doença Relacionada a Viagens
16.
BMC Infect Dis ; 20(1): 115, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041547

RESUMO

BACKGROUND: Normothermic and hypothermic oxygenated perfusion for donation after circulatory death in kidney transplantation are becoming popular in Italy, with the purpose of reducing the risk of primary non function and delayed graft function due to the prolonged warm ischemia time. Potential complications related to these procedures are currently under investigation and are continuously emerging with the increasing experience. Post-operative infections - in particular graft arteritis - are a rare complication but determine high risk of mortality and of graft loss. The acute onset of the arterial complications makes it very difficult to find an effective treatment, and early diagnosis is crucial for saving both patient and graft. Prevention of such infections in this particular setting are advisable. CASE PRESENTATION: We present a patient with an acute arterial rupture after transplantation of a DCD graft treated in-vivo hypothermic oxygenated perfusion. The cause was a severe arteritis of the renal artery caused by Candida krusei and Pseudomonas aeruginosa. We discussed our treatment and we compared it to the other reported series. CONCLUSION: Fungal infections in DCD transplant may be treacherous and strategies to prevent them should be advocated.


Assuntos
Isquemia Fria/métodos , Oxigenação por Membrana Extracorpórea , Transplante de Rim/métodos , Micoses/diagnóstico , Preservação de Órgãos/métodos , Perfusão/métodos , Arterite/microbiologia , Função Retardada do Enxerto/etiologia , Seguimentos , Sobrevivência de Enxerto , Humanos , Itália , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Artéria Renal/microbiologia , Artéria Renal/patologia , Doadores de Tecidos , Resultado do Tratamento , Isquemia Quente/efeitos adversos
17.
Int J Infect Dis ; 93: 208-210, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32105768

RESUMO

Talaromyces (formerly Penicillium) marneffei, a dimorphic fungus, is the most common opportunistic pathogen in human immunodeficiency viruses (HIV)-positive patients, but it rarely appears in HIV-negative individuals. Previously, in 2014, we reported the case of an HIV-negative Chinese woman with disseminated T. marneffei infection within an osteolytic lesion. Subsequently, she was followed up for 6 years, and we present an updated report of her clinical condition during the follow-up period. She presented with T. marneffei infection relapse and nontuberculous mycobacterium (NTM) infection. Laboratory tests showed anti-interferon-gamma (anti-IFN-γ) autoantibody-positive. Antifungals and anti-NTM treatment successfully improved her symptoms and laboratory results. This case highlights the type of infectious diseases that occurs as a result of immunodeficiency syndrome associated with anti-IFN-γ autoantibody.


Assuntos
Coinfecção/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micoses/diagnóstico , Talaromyces , Antifúngicos/uso terapêutico , Autoanticorpos , Feminino , Seguimentos , Humanos , Interferon gama/imunologia , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/imunologia , Micoses/complicações , Micoses/tratamento farmacológico , Micoses/imunologia , Osteólise , Recidiva
18.
J Korean Med Sci ; 35(3): e22, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31950777

RESUMO

BACKGROUND: Central dark-signal intensity with high-signal, hypertrophic mucosal wall of paranasal sinuses on T2-weighted images (T2WI) is a characteristic magnetic resonance imaging (MRI) feature of sinonasal fungus ball. However, this finding is usually interpreted as non-fungal chronic sinusitis with central normal sinus air. In addition, T1-weighted images (T1WI) and T2WI are basic sequences of all magnetic resonance (MR) examinations. Therefore, we evaluated the usefulness of T1WI for detecting fungus balls comparing with computed tomography (CT) findings and T2-weighted MRI findings. METHODS: This retrospective study was approved by the Institutional Review Board of Korea University Guro Hospital. Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship between calcifications and MRI signals was also evaluated. RESULTS: Of the patients, 89.1% had calcifications on CT. All had dark signal portions with high signal, hypertrophic mucosal walls on T2WI. Most (92.7%) patients showed iso- to hyper-intense overall signals on T1WI and 89.1% had T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no significant correlation with T1-weighted high-signal intensity portion. CONCLUSION: Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass on T1WI in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic mucosal walls in paranasal sinuses on T2WI.


Assuntos
Imagem por Ressonância Magnética , Micoses/diagnóstico , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Aspergillus/isolamento & purificação , Calcificação Fisiológica , Candida/isolamento & purificação , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Estudos Retrospectivos , Sinusite/microbiologia
19.
Int J Infect Dis ; 92: 114-122, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863876

RESUMO

OBJECTIVES: Current knowledge on infections caused by Scedosporium spp. and Lomentospora prolificans in children is scarce. We therefore aim to provide an overview of risk groups, clinical manifestation and treatment strategies of these infections. METHODS: Pediatric patients (age ≤18 years) with proven/probable Scedosporium spp. or L. prolificans infection were identified in PubMed and the FungiScope® registry. Data on diagnosis, treatment and outcome were collected. RESULTS: Fifty-five children (median age 9 years [IQR: 5-14]) with invasive Scedosporium spp. (n = 33) or L. prolificans (n = 22) infection were identified between 1990 and 2019. Malignancy, trauma and near drowning were the most common risk factors. Infections were frequently disseminated. Most patients received systemic antifungal therapy, mainly voriconazole and amphotericin B, plus surgical treatment. Overall, day 42 mortality was 31%, higher for L. prolificans (50%) compared to Scedosporium spp. (18%). L. prolificans infection was associated with a shorter median survival time compared to Scedosporium spp. (6 days [IQR: 3-28] versus 61 days [IQR: 16-148]). Treatment for malignancy and severe disseminated infection were associated with particularly poor outcome (HR 8.33 [95% CI 1.35-51.40] and HR 6.12 [95% CI 1.52-24.66], respectively). Voriconazole use at any time and surgery for antifungal treatment were associated with improved clinical outcome (HR 0.33 [95% CI 0.11-0.99] and HR 0.09 [95% CI 0.02-0.40], respectively). CONCLUSIONS: Scedosporium spp. and L. prolificans infections in children are associated with high mortality despite comprehensive antifungal therapy. Voriconazole usage and surgical intervention are associated with successful outcome.


Assuntos
Micoses/diagnóstico , Micoses/terapia , Scedosporium , Adolescente , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Micoses/tratamento farmacológico , Micoses/microbiologia , Fatores de Risco , Voriconazol/uso terapêutico
20.
Mycopathologia ; 184(6): 709-720, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31811603

RESUMO

Talaromycosis (penicilliosis) is a major fungal disease endemic across a narrow band of tropical countries of South and Southeast Asia. The etiologic agent is a thermally dimorphic fungus Talaromyces (Penicillium) marneffei, which was first isolated from a bamboo rat in Vietnam in 1956, but no formal description was published. In 1959, Professor Gabriel Segretain formally described it as a novel species Talaromyces (Penicillium) marneffei, and the human pathogenic potential of the fungus in Mycopathologia. The first natural human case of talaromycosis (penicillosis) was reported in 1973 and involved an American minister with Hodgkin's disease who lived in Southeast Asia. Sixty years after the discovery of the pathogen, talaromycosis caused by T. marneffei is recognized as an important human disease with the potential to cause high mortality in the absence of proper diagnosis and prompt treatment. Talaromycosis remains a significant infectious complication in HIV/AIDS patients and in patients with other immune defects. The disease is being recognized with an increasing frequency well beyond the traditional endemic areas. The natural reservoirs of T. marneffei in wild rodents are well-defined, which links the ecology with the epidemiology of talaromycosis in endemic areas. There is an urgent unmet need for rapid and affordable point-of-care diagnostic tests. We also need more clinical studies to define the best therapeutic options for the management of talaromycosis patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Micoses , Talaromyces , Animais , Antifúngicos/uso terapêutico , Reservatórios de Doenças/microbiologia , Humanos , Mortalidade , Micoses/diagnóstico , Micoses/imunologia , Micoses/microbiologia , Micoses/terapia , Micoses/transmissão , Prevalência , Fatores de Risco , Talaromyces/classificação , Talaromyces/isolamento & purificação , Talaromyces/patogenicidade
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