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1.
Pan Afr Med J ; 33: 198, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692732

RESUMO

Introduction: Epidemiology of these disorders, mainly caused by mycosis, is little known in the Ivory Coast. The aim of this study was to determine the different clinical aspects of intertrigos caused by fungal infections. Methods: We conducted a cross-sectional study in the Department of Clinical Dermatology at the University Hospital in Yopougon (Abidjan, Ivory Coast) from April to October 2012. The study involved the patients come to consultation with lesions in the folds suggesting a mycosis. Samples of serous fluid by swabbing or of scales by scrape cutting with the scalpel blade were performed at the level of the lesions. The fungal agents responsible for these lesions were identified after biological culture. Results: A total of 200 patients had lesions suggesting intertrigo caused by fungal infection. The average age of patients was 29.8 years (with a standard deviation of 11.1 years). Mycosis-related intertrigos accounted for 6.7% of reasons for consultation. A female predominance was observed (76.7%). Lesions mainly occurred in the groin area (40.8%) and in the intergluteal clefts (36.9%). The most observed symptoms were maceration (52.4%) followed by burning (18.4%). In 89.3% of cases, intertrigos were caused by yeasts, including Candida albicans (33%), and Candida parapsilosis(19.4%) which were predominant. Conclusion: Mycosis-related intertrigos mainly affect the young adults of female sex. Lesions mainly occur at the level of the inguinal folds and intergluteal clefts. The main etiological agents are yeasts (Candida).


Assuntos
Candidíase/epidemiologia , Intertrigo/epidemiologia , Micoses/epidemiologia , Adolescente , Adulto , Candida/isolamento & purificação , Candidíase/microbiologia , Criança , Pré-Escolar , Costa do Marfim , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Lactente , Intertrigo/microbiologia , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Fatores Sexuais , Adulto Jovem
2.
Medicine (Baltimore) ; 98(41): e17535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593129

RESUMO

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07-3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09-15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.


Assuntos
Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/cirurgia , Scedosporium/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica/fisiologia , Feminino , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Pneumopatias Fúngicas/microbiologia , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Estudos Observacionais como Assunto , Cuidados Pós-Operatórios , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Scedosporium/isolamento & purificação , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
3.
Internist (Berl) ; 60(10): 1111-1117, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31444523

RESUMO

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.


Assuntos
Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Micoses/tratamento farmacológico , Adulto , Comorbidade , Endocardite/diagnóstico , Endocardite/epidemiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Incidência , Micoses/diagnóstico , Micoses/epidemiologia
4.
MMWR Morb Mortal Wkly Rep ; 68(26): 583-586, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31269011

RESUMO

During 2014-2017, CDC Emerging Infections Program surveillance data reported that the occurrence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections associated with injection drug use doubled among persons aged 18-49 years residing in Monroe County in western New York.* Unpublished surveillance data also indicate that an increasing proportion of all Candida spp. bloodstream infections in Monroe County and invasive group A Streptococcus (GAS) infections in 15 New York counties are also occurring among persons who inject drugs. In addition, across six surveillance sites nationwide, the proportion of invasive MRSA infections that occurred in persons who inject drugs increased from 4.1% of invasive MRSA cases in 2011 to 9.2% in 2016 (1). To better understand the types and frequency of these infections and identify prevention opportunities, CDC and public health partners conducted a rapid assessment of bacterial and fungal infections among persons who inject drugs in western New York. The goals were to assess which bacterial and fungal pathogens most often cause infections in persons who inject drugs, what proportion of persons who inject use opioids, and of these, how many were offered medication-assisted treatment for opioid use disorder. Medication-assisted treatment, which includes use of medications such as buprenorphine, methadone, and naltrexone, reduces cravings and has been reported to lower the risk for overdose death and all-cause mortality in persons who use opioids (2,3). In this assessment, nearly all persons with infections who injected drugs used opioids (97%), but half of inpatients (22 of 44) and 12 of 13 patients seen only in the emergency department (ED) were not offered medication-assisted treatment. The most commonly identified pathogen was S. aureus (80%), which is frequently found on skin. Health care visits for bacterial and fungal infections associated with injection opioid use are an opportunity to treat the underlying opioid use disorder with medication-assisted treatment. Routine care for patients who continue to inject should include advice on hand hygiene and not injecting into skin that has not been cleaned or to use any equipment contaminated by reuse, saliva, soil, or water (4,5).


Assuntos
Infecções Bacterianas/epidemiologia , Micoses/epidemiologia , Vigilância da População , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Adulto Jovem
5.
J Zoo Wildl Med ; 50(2): 492-497, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31260222

RESUMO

Chytridiomycosis, an infectious disease caused by the fungus Batrachochytrium dendrobatidis (chytrid or Bd), has not been well studied in Oklahoma. This is of particular concern regarding the connection between seasonality and chytrid infection. To further investigate this connection, chytrid prevalence and infection load were quantified within amphibians in central Oklahoma from March to October, across two sites in Oklahoma Co. and two sites in Cleveland Co. The results show a trend between seasonality and chytrid, with spring and fall showing higher prevalence and summer showing lower prevalence, which coincides closely with the preferred chytrid growth temperatures. Additionally, periods of high rainfall in May 2015 are linked to increased chytrid prevalence, as has been suggested by other research. Additionally, species exhibiting high chytrid prevalence follow the results of previous studies: Blanchard's cricket frog (Acris blanchardi), American bullfrog (Rana catesbeiana), and southern leopard frog (Rana sphenocephala).


Assuntos
Anuros/microbiologia , Quitridiomicetos/isolamento & purificação , Animais , Micoses/epidemiologia , Micoses/microbiologia , Oklahoma/epidemiologia , Prevalência , Estações do Ano , Tempo (Meteorologia)
6.
BMC Vet Res ; 15(1): 257, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340816

RESUMO

BACKGROUND: Infectious abortion in ruminants is a problem in animal husbandry worldwide. It is important to obtain a diagnosis, to make sure that proper control measures can be instituted, but most abortion cases remain without an etiologic diagnosis. This report describes the presence of Arcobacter species and several neglected opportunistic abortifacient agents in ruminant abortion cases showing or not co-infections among at least one of the major recognized protozoal, fungal, bacterial and viral abortifacient agents. RESULTS: A total of 67 fetuses (55 cattle and 12 goats) and just one placenta (cattle) were considered. Among the most common abortive agents, Neospora caninum (19,4%), followed by Chlamydophila abortus (4,5%), Listeria monocytogenes 1/2a (2,98%), Bovine Viral Diarrhea Virus type 1b (2,98%), Bovine herpesvirus 4 (2,98%), and Aspergillus spp. (2,98%) were detected. The isolated neglected opportunistic bacteria include Escherichia coli, Acinetobacter lwoffii, Staphylococcus spp., Streptococcus spp., Streptococcus uberis, Streptococcus suis, Trueperella pyogenes, Mannheimia haemolytica, Bacillus cereus and Nocardia spp. Other bacterial species, not associated with abortion by literature, but described as causes of diseases occurring sporadically both in humans and animals, were also detected. Three Arcobacter strains, namely two A. skirrowii and one A. cryaerophilus, were isolated from 3 bovine aborted fetuses, and A. butzleri was isolated from the placenta. CONCLUSIONS: A not negligible isolation of Arcobacter species and other neglected abortifacient agents has to be mentioned, with prevalences that seem to be emerging and replacing or co-placing the major infectious players in bovine and caprine reproductive failure due to abortion disease, even if further studies investigating the aetiological power and transmission routes are needed in order to define the role of these microrganisms in ruminant abortion.


Assuntos
Feto Abortado/microbiologia , Feto Abortado/parasitologia , Feto Abortado/virologia , Arcobacter/isolamento & purificação , Doenças dos Bovinos/epidemiologia , Doenças das Cabras/epidemiologia , Infecções Oportunistas/veterinária , Aborto Animal/epidemiologia , Aborto Animal/microbiologia , Aborto Animal/parasitologia , Aborto Animal/virologia , Animais , Arcobacter/classificação , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/veterinária , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/parasitologia , Doenças dos Bovinos/virologia , Feminino , Doenças das Cabras/microbiologia , Doenças das Cabras/parasitologia , Doenças das Cabras/virologia , Cabras , Itália/epidemiologia , Micoses/epidemiologia , Micoses/veterinária , Doenças Parasitárias em Animais/epidemiologia , Placenta/microbiologia , Gravidez , Viroses/epidemiologia , Viroses/veterinária
7.
Comp Immunol Microbiol Infect Dis ; 64: 153-158, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174691

RESUMO

PURPOSE: The etiology of community-acquired pneumonia (CAP) in hospital patients is often ambiguous due to the limited pathogen detection. Lack of a microbiological diagnosis impairs precision treatment in CAP. METHODS: Specimens collected from the lower respiratory tract of 195 CAP patients, viruses were measured by the Single-plex real-time PCR assay and the conventional culture method was exploited for bacteria. RESULTS: Among the 195 patients, there were 46 (23.59%) pure bacterial infections, 20 (10.26%) yeast infections, 32 (16.41%) pure viral infections, 8 (4.10%) viral-yeast co-infections, and 17 (8.72%) viral-bacterial co-infections. The two most abundant bacteria were Acinetobacter baumannii and klebsiella pneumoniae, whereas the most common virus was influenza A. CONCLUSIONS: Non-influenza respiratory microorganisms frequently co-circulated during the epidemic peaks of influenza, which easily being ignored in CAP therapy. In patients with bacterial and viral co-infections, identifying the etiologic agent is crucial for patient's therapy.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Influenza Humana/epidemiologia , Pneumonia/epidemiologia , Pneumonia/microbiologia , Infecções por Acinetobacter/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/virologia , Feminino , Humanos , Lactente , Recém-Nascido , Influenza Humana/microbiologia , Infecções por Klebsiella/epidemiologia , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Adulto Jovem
8.
Indian J Ophthalmol ; 67(7): 1048-1053, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238406

RESUMO

Purpose: The aim of the study is to identify risk factors, clinical characteristics, causative fungi, and treatment outcome of dematiaceous fungal keratitis in North India. Methods: Consecutive cases of culture-proven dematiaceous fungal keratitis between January 2012 and June 2017 were retrieved from the medical record department. Risk factors, clinical signs, and outcome were registered. Results: Eighty-three patients were included. Identified dematiaceous fungal organism were Curvularia sp. (n = 55/83; 66.3%), Alternaria sp. (n = 12/83; 14.5%), Ulocladium sp. (n = 5/83; 6%), Bipolaris sp. (n = 5/83; 6.1%), Scedosporium sp. (n = 3/83; 3.6%), Acremonium sp. (n = 2/83; 2.4%), and Epicoccum sp. (n = 1/83; 1.2%). Male preponderance was reported. The most common predisposing factor was corneal trauma (67.4%). In cases associated with corneal trauma due to vegetative matter, sugarcane was the most common cause. In all, 89% of the patients were more than 30 years of age. The median infiltrate size was 8 mm2. The median time of antifungal therapy was 4.2 weeks (interquartile range [IQR]: 1-25 weeks). Complications were seen in 14 (n = 14/65; 21.5%) patients. Complete resolution of dematiaceous fungal keratitis was present in 27 (n = 27/65; 41.5%) eyes. Conclusion: Curvularia sp. and Alternaria sp. were the predominant pathogenic genera causing dematiaceous fungal keratitis. Among the causative fungi, infections due to Scedosporium sp. were associated with the worst outcomes. Ulocladium sp. and Epicoccum sp. were also identified. Both the species are not reported previously as a causal organism of dematiaceous fungal keratitis from North India.


Assuntos
Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia , Fungos Mitospóricos/isolamento & purificação , Micoses/microbiologia , Adulto , Córnea/microbiologia , Córnea/patologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Ceratite/diagnóstico , Ceratite/epidemiologia , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Lâmpada de Fenda
9.
Eur Arch Otorhinolaryngol ; 276(7): 1975-1980, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30929057

RESUMO

OBJECTIVE: Fungal rhinosinusitis occurs in different forms depending on race and region. While allergic fungal rhinosinusitis is common in Caucasians, fungal ball (FB) is more common in Asians. However, most cases are reported as unilateral, and clinical data on bilateral FB (BFB) are rare. Therefore, the purpose of this study was to analyze and to compare the clinical characteristics of BFB and unilateral FB (UFB) in Koreans. METHODS: We retrospectively analyzed medical records and computed tomography (CT) images of 434 patients diagnosed with FB. The patients were divided into two groups: BFB and UFB. Demographic data, multiple allergen simultaneous test including total or specific immunoglobulin E (IgE) levels, symptoms, CT findings, treatment, and outcomes were analyzed. RESULTS: Among the patients, 26 had BFB and 408 had UFB. Hypertension was noted in 61.5% of the BFB and 39% of the UBF individuals (p = 0.023). While total IgE levels were similar between the two groups, Dermatophagoides pteronyssinus (p = 0.004), Cladosporium (p = 0.017), and Aspergillus-specific IgE positivity (p = 0.025) were significantly higher in the BFB than in the UFB group. Not only symptoms such as postnasal drip (p = 0.013), mucopurulent rhinorrhea (p = 0.009), and foul odor (p = 0.037), but also sphenoid sinus involvement on CT images were more common in the BFB than in the UFB group (p = 0.011). CONCLUSION: Patients with BFB in Korea showed more common hypertension and symptoms of foul odor, mucopurulent rhinorrhea, and postnasal drip with allergy positivity compared to those with UFB. Therefore, understanding clinical characteristics of BFB will allow clinicians to approach BFB more appropriately.


Assuntos
Fungos , Hipertensão/epidemiologia , Micoses , Rinite , Sinusite , Adulto , Comorbidade , Gerenciamento Clínico , Feminino , Fungos/classificação , Fungos/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/microbiologia , Micoses/terapia , República da Coreia/epidemiologia , Estudos Retrospectivos , Rinite/epidemiologia , Rinite/microbiologia , Rinite/terapia , Fatores de Risco , Sinusite/epidemiologia , Sinusite/microbiologia , Sinusite/cirurgia , Sinusite/terapia , Tomografia Computadorizada por Raios X/métodos
10.
Artigo em Alemão | MEDLINE | ID: mdl-30923845

RESUMO

BACKGROUND: Climate change may cause profound and complex changes in the prevalence of infectious diseases. Obligate pathogenic fungi causing endemic mycoses and the agents of cryptococcosis are environmental pathogens adapted to environmental niches. They may be exposed to changing climatic conditions, which may change the epidemiology of human infections. OBJECTIVES: To review documented changes in the epidemiology of endemic fungal infections and cryptococcosis. To review evidence that changing climate is a potential mechanism for changes in the epidemiology of these infections. METHODS: A selective literature review focusing on endemic mycoses and cryptococcosis. RESULTS: Changes in endemic regions of infections caused by C. gattii and selected endemic mycoses have been well documented. Significant increases in the incidence of infections have been demonstrated for some areas. Climatic factors (temperature, precipitation, and extreme weather events), changes in land use, distribution of potential host animals, and global trade routes are discussed as contributory factors. CONCLUSIONS: Improved surveillance of fungal infections of humans and animals including molecular typing of clinical and environmental isolates is necessary to understand the epidemiology of these infections. The characterization of environmental niches, mechanisms of distribution of fungi, and fungal adaptation mechanisms are needed to guide prevention strategies.


Assuntos
Mudança Climática , Micoses/epidemiologia , Animais , Criptococose , Cryptococcus gattii , Alemanha , Humanos
11.
Science ; 363(6434): 1459-1463, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30923224

RESUMO

Anthropogenic trade and development have broken down dispersal barriers, facilitating the spread of diseases that threaten Earth's biodiversity. We present a global, quantitative assessment of the amphibian chytridiomycosis panzootic, one of the most impactful examples of disease spread, and demonstrate its role in the decline of at least 501 amphibian species over the past half-century, including 90 presumed extinctions. The effects of chytridiomycosis have been greatest in large-bodied, range-restricted anurans in wet climates in the Americas and Australia. Declines peaked in the 1980s, and only 12% of declined species show signs of recovery, whereas 39% are experiencing ongoing decline. There is risk of further chytridiomycosis outbreaks in new areas. The chytridiomycosis panzootic represents the greatest recorded loss of biodiversity attributable to a disease.


Assuntos
Anuros/microbiologia , Anuros/fisiologia , Biodiversidade , Quitridiomicetos , Extinção Biológica , Micoses/veterinária , Américas/epidemiologia , Animais , Anuros/classificação , Austrália/epidemiologia , Micoses/epidemiologia
12.
Diagn Microbiol Infect Dis ; 94(2): 173-179, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30691724

RESUMO

We present extremity wound microbiology data from 250 combat casualties (2009-2012). Confirmed extremity wound infections (EWIs) were based on clinical and laboratory findings. Suspected EWIs had isolation of organisms from wound cultures with associated signs/symptoms not meeting clinical diagnostic criteria. Colonized wounds had organisms isolated without any infection suspicion. A total of 335 confirmed EWIs (131 monomicrobial and 204 polymicrobial) were assessed. Gram-negative bacteria were predominant (57% and 86% of monomicrobial and polymicrobial infections, respectively). In polymicrobial infections, 61% grew only bacteria, while 30% isolated bacteria and mold. Multidrug resistance was observed in 32% of isolates from first monomicrobial EWIs ±3 days of diagnosis, while it was 44% of isolates from polymicrobial EWIs. Approximately 96% and 52% of the suspected and colonized wounds, respectively, shared ≥1 organism in common with the confirmed EWI on the same patient. Understanding of combat-related EWIs can lead to improvements in combat casualty care.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Fungos/isolamento & purificação , Militares , Micoses/microbiologia , Infecção dos Ferimentos/microbiologia , Anti-Infecciosos/uso terapêutico , Bactérias/classificação , Infecções Bacterianas/epidemiologia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Resistência Microbiana a Medicamentos , Fungos/classificação , Humanos , Micoses/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Infecção dos Ferimentos/epidemiologia
13.
Mycoses ; 62(5): 450-457, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30597630

RESUMO

Although case series of talaromycosis have been reported in China, their detailed clinical and microbiological characteristics have never been systematically profiled. In this study, we report the clinical characteristics, molecular epidemiology, rapid identification and antifungal susceptibilities of talaromycosis in The University of Hong Kong-Shenzhen Hospital in Shenzhen. Seven cases of talaromycosis were observed since commencement of hospital service in 2012. Three patients were local Shenzhen residents, whereas the other four were immigrants from other parts of China. Two patients were HIV-negative, but with underlying diseases requiring immunosuppressive therapy. Two of the seven patients succumbed. All the seven isolates were successfully identified as T. marneffei by MALDI-TOF MS using Bruker database expanded with in-house generated T. marneffei mass spectra. MLST showed that the seven strains belonged to six different, novel sequences types. Phylogenetic analyses of the concatenated five-locus sequence revealed that the seven strains were scattered amongst other T. marneffei strains. The MICs of itraconazole, isavuconazole, posaconazole and voriconazole against the seven clinical isolates were low but MICs of anidulafungin were high. Underlying diseases other than HIV infection are increasingly important risk factors of talaromycosis. MALDI-TOF MS is useful for rapid identification. Highly diverse T. marneffei sequence types were observed.


Assuntos
Antifúngicos/farmacologia , Técnicas Microbiológicas/métodos , Micoses/epidemiologia , Micoses/patologia , Talaromyces/isolamento & purificação , Adulto , Idoso , Feminino , Genótipo , Hong Kong , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Técnicas de Tipagem Micológica , Micoses/diagnóstico , Micoses/microbiologia , Estudos Retrospectivos , Fatores de Risco , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Análise de Sobrevida , Talaromyces/classificação , Talaromyces/efeitos dos fármacos , Talaromyces/genética
14.
Eur Arch Otorhinolaryngol ; 276(4): 1081-1087, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30671603

RESUMO

PURPOSE: The incidence of Acute invasive fungal rhinosinusitis (AIFRS) is on the rise considering the multitude of comorbidities present in a single patient.The delay in suspecting the fungal etiology, presentation of the patient for an Otorhinolaryngology consult and lack of defined protocols affects outcome.This study looks in to the various aspects of treatment of AIFRS including sample collection, diagnosis and medicosurgical treatment. We propose a protocol for the management of these patients crafted from our outcome. METHODS: Between September 2015-September 2017, 14 patients presented with AIFRS. Targeted samples were taken for Potassium hydroxide mount, histopathological studies and fungal culture. Management was initiated with antifungals and multi-approach surgical debridement. RESULTS: Six of these patients had multiple comorbidities and most were uncontrolled diabetics. The average delay in presentation was 9 days. Potassium hydroxide mount was the screening test of choice. A minimum of two sittings of debridement was essential. In an average follow-up period of 15.12 months, all the patients are alive and disease free. CONCLUSION: A high index of suspicion, awareness among medical fraternity and precise sample collection aids a firm diagnosis. Simultaneous initiation of surgical debridement and anti-fungals is fundamental.


Assuntos
Antifúngicos/uso terapêutico , Rinite , Sinusite , Doença Aguda , Adulto , Desbridamento/métodos , Diabetes Mellitus/epidemiologia , Feminino , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/epidemiologia , Micoses/terapia , Estudos Retrospectivos , Rinite/diagnóstico , Rinite/epidemiologia , Rinite/microbiologia , Rinite/terapia , Fatores de Risco , Sinusite/diagnóstico , Sinusite/epidemiologia , Sinusite/microbiologia , Sinusite/terapia
15.
Mycoses ; 62(3): 247-251, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30561858

RESUMO

OBJECTIVES: We investigated the colonisation by Candida spp in patients using orthodontic fixed appliances by characterising the isolated Candida strains and by evaluating the host oral mucosa response through the measure of human ß-defensins 3 (HBD-3) expression and Interleukin-1ß/IL-10. METHODS: Ninety patients were enrolled after signing an informed consent. Prevalence, susceptibility to fluconazole, genotyping and oral fungal burden of Candida sp. isolated were determined. Host responses were evaluated by measuring HBD-3 expression as well as IL-1ß and IL-10 in saliva. RESULTS: The colonisation rate reached 6.7% (6/90), and 5 patients were colonised with C. albicans strains and one with one with C. tropicalis. The fluconazole MIC90/susceptibility of C. albicans strains ranged 1/0.25-1 µg/mL. However, isolated strains did not present different genotype (SAB>0.9), C. albicans colonisation seems to be influenced by the duration of treatment and by level expression of HBD3 that were higher in colonised patients (not statistically different). A negative correlation between the fungal burden and IL-1ß levels was found in colonised patients but not for IL-10. CONCLUSIONS: Our study revealed that patients with orthodontic fixed appliances were mainly colonised by C. albicans, which was related to a decrease in HBD-3 expression and IL-1ß levels.


Assuntos
Candida/isolamento & purificação , Portador Sadio/epidemiologia , Fatores Imunológicos/análise , Mucosa Bucal/imunologia , Micoses/epidemiologia , Aparelhos Ortodônticos Fixos/efeitos adversos , Saliva/microbiologia , Adolescente , Adulto , Candida/classificação , Candida/efeitos dos fármacos , Candida/imunologia , Candida albicans , Portador Sadio/microbiologia , Contagem de Colônia Microbiana , Feminino , Genótipo , Humanos , Interleucina-10/análise , Interleucina-1beta/análise , Masculino , Testes de Sensibilidade Microbiana , Micoses/microbiologia , Prevalência , Adulto Jovem , beta-Defensinas/análise
16.
Sci Total Environ ; 646: 727-734, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30059932

RESUMO

INTRODUCTION: Playing a wind instrument is an increasingly reported cause of hypersensitivity pneumonitis. However, current knowledge about contamination of wind instruments by fungi and specific fungal sensitization is scarce. Therefore, we aimed: (i) to assess the current prevalence and type of fungal contamination of wind instruments, (ii) to identify potential risk factors associated with instrument contamination, and (iii) to evaluate the prevalence of sensitization to these fungi among musicians. MATERIAL AND METHODS: Musicians from music schools in eastern France and who played a wind instrument were prospectively recruited (NCT01487850). The mouthpiece and the reed of their instrument were sampled to quantify the magnitude and type of fungi. Each subject had a physical examination, a mycological analysis of saliva and a blood sample in search of serum precipitins against the most frequent fungi isolated from instruments. The results were compared with those of 40 healthy non-exposed controls. RESULTS: Forty musicians playing a wind instrument (bassoon, clarinet, oboe, saxophone) were included. (i) 95% of wind instruments were colonized by fungi, mainly with Phoma spp., Penicillium spp. and Rhodotorula mucilaginosa; (ii) absence of systematic drying of the instrument was a main contributing factor; (iii) serum precipitins were significantly more present in the musicians' sera than in control sera and were consistent with the fungi present in their instrument. CONCLUSION: This study reveals a constant and specific fungal contamination among wind reed instruments with a significant sensitization among musicians, pleading in favour of regular instrument cleaning. Physicians should be aware of this possible source of antigenic exposure.


Assuntos
Música , Micoses/epidemiologia , Doenças Profissionais/epidemiologia , França , Humanos , Prevalência , Fatores de Risco
17.
Lupus ; 28(1): 77-85, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30526329

RESUMO

OBJECTIVE: To investigate the characteristics and associated factors of invasive fungal disease in patients with systemic lupus erythematosus from Southern China. METHODS: A retrospective study was performed. Demographic and clinical characteristics, laboratory data, and radiographic manifestations were recorded. RESULTS: A total of 45 lupus patients with invasive fungal disease (incidence 1.1%) were included. Twenty-three cases (51.1%) were infected with mold and 22 cases (48.9%) with yeast. Aspergillus spp. (44.4%) and Cryptococcus spp. (33.3%) were common. Aspergillosis mainly occurred in the lung. Cryptococcosis developed in the lung (40.0%), meninges (46.7%) and bloodstream (13.3%). Compared with yeast infection, mold infection tended to develop in patients with active lupus nephritis (65.2% vs. 31.8%, P = 0.03) and the mortality rate was higher (20.0% vs. 0%, P = 0.001). Co-infection with bacteria, virus or superficial fungi occurred in 12 patients (26.7%). Multivariate logistic regression analysis indicated that lymphopenia (odds ratio 2.65, 95% confidential interval 1.14-6.20, P = 0.02) and an accumulated dose of glucocorticoid (odds ratio 1.58, 95% confidence interval 1.10-2.25, P = 0.01) was associated with invasive fungal disease in lupus patients. CONCLUSION: Mold infection tended to develop in patients with active lupus disease with high mortality. Co-infection is not rare. Lymphopenia and an accumulated dose of glucocorticoid are associated with invasive fungal disease in lupus patients.


Assuntos
Glucocorticoides/efeitos adversos , Lúpus Eritematoso Sistêmico/complicações , Linfopenia/complicações , Micoses/complicações , Micoses/epidemiologia , Adulto , China/epidemiologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Incidência , Modelos Logísticos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
18.
Gastroenterology ; 156(5): 1368-1380.e10, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30552895

RESUMO

BACKGROUND & AIMS: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. METHODS: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. RESULTS: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. CONCLUSIONS: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.


Assuntos
Infecções Bacterianas/epidemiologia , Saúde Global , Cirrose Hepática/epidemiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Infecções Bacterianas/terapia , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Feminino , Mortalidade Hospitalar , Humanos , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Cirrose Hepática/terapia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Micoses/terapia , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
19.
Rev. iberoam. micol ; 35(4): 171-178, oct.-dic. 2018. ilus, tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-179635

RESUMO

El paisaje epidemiológico de las micosis invasoras está en continua evolución, hecho que tiene implicaciones importantes en el diagnóstico y el tratamiento. El número de estas infecciones sigue siendo alto, particularmente en recién nacidos, ancianos y pacientes ingresados en UCI, o que usan prótesis, catéteres u otros dispositivos intravenosos, o reciben diferentes tratamientos inmunosupresores o quimioterapia antineoplásica, o en los receptores de trasplantes. Además, pueden estar asociadas a la infección por el VIH. Muchas micosis se adquieren por inhalación, contacto o ingestión, pero los hongos también pueden acceder al torrente sanguíneo a través de agujas y catéteres. La candidiasis invasora continúa siendo la micosis más frecuente, pero se observa un cambio etiológico progresivo de Candida albicans a otras especies de Candida, como Candida parapsilosis, Candida glabrata o la especie multirresistente Candida auris. Sin embargo, la aspergilosis invasiva puede ser predominante en entornos muy específicos, como el de los receptores de trasplante de médula ósea. Además, Pneumocystis, Cryptococcus, Fusarium y Rhizopus pueden causar enfermedades devastadoras. Existen importantes variaciones etiológicas, entre hospitales y países, relacionadas con múltiples factores, como sus características locales y las enfermedades subyacentes de los pacientes, o las diferentes praxis en los servicios médicos y quirúrgicos. La mortalidad atribuida sigue siendo alta, aunque varía del 30% en la candidiasis invasora al 90-100% en determinadas presentaciones clínicas de escedosporiasis y mucormicosis. La gran complejidad de los pacientes y la creciente diversidad de hongos patógenos son desafíos importantes para mejorar el diagnóstico, crear redes de vigilancia e implementar medidas de control de estas micosis


The landscape of invasive mycoses is in a continuous evolution with important implications for their diagnosis and treatment. The overall burden remains high, particularly in neonates and the elderly, patients admitted to intensive care units, using prostheses, catheters or other intravenous devices, those receiving different immunosuppressant treatments or antineoplastic chemotherapy, or transplant recipients. In addition, opportunistic mycoses can be associated with HIV infection. Many fungal infections are acquired by inhalation, direct contact or ingestion, but fungi can also enter into the bloodstream through needles or catheters. Invasive candidiasis remains the most frequent mycosis, but its aetiology progressively shifts from Candida albicans to other species of Candida, such as Candida parapsilosis, Candida glabrata, or the multiresistant Candida auris. However, aspergillosis can be predominant in specific conditions, such as bone marrow transplant recipients. Moreover, Pneumocystis, Cryptococcus, Fusarium and Rhizopus can cause devastating illnesses. There are significant variations among hospitals and countries that are related to many factors, such as local characteristics of mycoses and patients, or different practices between medical and surgical wards. The attributed mortality remains high, ranging from 30% in invasive candidiasis to 90-100% in some clinical presentations of scedosporiosis and mucormycosis. The extremely complexity of patients and the growing diversity of pathogenic fungi are major challenges for improving diagnosis, creating surveillance networks, and implementing control measures for these invasive infections


Assuntos
Humanos , Infecções Fúngicas Invasivas/epidemiologia , Micoses/epidemiologia , Candidíase Invasiva/epidemiologia , Candida/classificação , Aspergilose/epidemiologia , Farmacorresistência Fúngica , Fatores de Risco
20.
Rev Fac Cien Med Univ Nac Cordoba ; 75(2): 128-133, 2018 06 22.
Artigo em Espanhol | MEDLINE | ID: mdl-30273536

RESUMO

Introduction: Infections are the most frequent complications in burn patients. Filamentous fungi have an uncertain place within the statistics, since in our media data regarding their prevalence, causal agents and outcome of those who suffer them remain scarce. The aim of this study was to evaluate the prevalence of fungal infection by filamentous fungi (IHF) in patients hospitalized in burn intensive care unit (BICU), and to review clinical, epidemiological, microbiological and evolutionary characteristics of these patients and to know the frequency and distribution of the isolated fungi. Materials and methods: Retrospective and descriptive study. It includes all individuals admitted in burns intensive care unit (2012-2015), with positive culture for filamentous fungi in skin biopsies and bedsores. Results: A total of 168 patients were admitted in the BICU in a period of 3 years. 90% were major burned and 17% of them developed IHF (29/168). Aspergillus spp (24%), Fusarium sp (14%), Mucor spp (3%) and various black fungus genera (58%) were the main genera found in cultives. About 24% of the patients with IHF died and Fusarium spp was found in 50% of the cases. The cause of death was irreversible cardiogenic shock with multiorgan failure. Conclusions: Filamentous fungal infection was present in 17% of burned patients. The main isolatte fungi in samples were dematiaceous mould. Mortality among patients was 24%, with Fusarium being the fungus found in the highest number of deaths (50%).


Assuntos
Unidades de Queimados/estatística & dados numéricos , Queimaduras/microbiologia , Fungos/isolamento & purificação , Micoses/epidemiologia , Adulto , Aspergilose/epidemiologia , Aspergilose/microbiologia , Aspergillus/isolamento & purificação , Feminino , Fusariose/microbiologia , Fusariose/mortalidade , Fusarium/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
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