High Prevalence of Fungal Infections in Mechanically Ventilated COVID-19 Patients in the ICU: The French Multicenter MYCOVID Study

2021 ◽  
Author(s):  
Jean Pierre Gangneux ◽  
Eric Dannaoui ◽  
Arnaud Fekkar ◽  
Charles Edouard Luyt ◽  
Francoise Botterel ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Mechanically Ventilated ◽  
High Prevalence

scholarly journals 897. Prevalence of Candida auris at Body Sites, Characterization of Skin Microbiota, and Relation of Chlorhexidine Gluconate (CHG) Skin Concentration to C. auris Detection Among Patients at a High-Prevalence Ventilator-Capable Skilled Nursing Facility (vSNF) with Established CHG Bathing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S25-S26 ◽  
Author(s):  
Mary K Hayden ◽  
Thelma E Dangana ◽  
Rachel D Yelin ◽  
Michael Schoeny ◽  
Pamela B Bell ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Skin Microbiome ◽  
Body Site ◽  
Candida Auris ◽  
Candida Spp ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Mechanically Ventilated ◽  
High Prevalence ◽  
High Concentrations

Abstract Background vSNF patients are at high risk of colonization and infection with C. auris. CHG bathing has been used as an intervention to reduce nosocomial transmission of multi-drug-resistant organisms, but its effect on C. auris is unclear. Methods We studied a 70-bed ventilator ward in a 300-bed vSNF in Chicago, IL with a high prevalence of C. auris and established CHG bathing. Swab samples were collected from patients for culture, microbiome analysis, and CHG skin concentration testing (Table 1). Results We collected 2,467 samples (950 culture, 950 microbiome, 567 CHG) from 57 patients during 2 surveys conducted January–March 2019. Forty-six (81%) patients had C. auris cultured from ≥1 body site. Mean (±SD) age was 59 (±14) years, 40% were women, 70% were African American, mean (±SD) Charlson score was 3 (±2). Patients colonized with C. auris were more likely to be mechanically ventilated (50% vs. 0%, P < 0.001), have a gastrostomy tube (78% vs. 27%, P < 0.001) or have urinary catheter (72% vs. 23%, P = 0.01) than noncolonized patients. Frequency of C. auris isolation varied among 10 body sites tested (P < 0.001); colonization of anterior nares (41%) and hands (40%) was detected most often (Figure 1). By ITS1 analysis, all isolates were members of the C. auris South American clade. Skin microbiome sequencing confirmed culture Results. While Malassezia is the dominant genera observed in healthy volunteers and patients in this vSNF, C. auris was observed to dominate the fungal community of multiple skin sites, including nares, hands, inguinal, toe web (Figure 2). Other Candida spp. were also identified on the skin of patients in the current study, but at lower relative abundance. CHG was detected on skin of 52 (91%) patients (median CHG concentration 19.5 µg/mL; IQR 4.9–78.1 µg/mL). In a mixed-effects model controlling for body site and multiple measurements per patient, odds of C. auris detection by culture were less at CHG concentrations ≥625 µg/mL than at lower concentrations (Figure 3; OR 0.25, 95% CI: 0.10–0.66; P = 0.005). Conclusion Frequent C. auris colonization of vSNF patients’ anterior nares and hands suggests that nasal decolonization and patient hand hygiene are potential options to reduce C. auris transmission. High concentrations of CHG may be needed to suppress C. auris on skin. Disclosures All Authors: No reported Disclosures.

scholarly journals Pathophysiological Processes Underlying the High Prevalence of Deep Vein Thrombosis in Critically Ill COVID-19 Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Sebastian Voicu ◽  
Chahinez Ketfi ◽  
Alain Stépanian ◽  
Benjamin G. Chousterman ◽  
Nassim Mohamedi ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Critically Ill ◽  
Venous Blood ◽  
Lower Limbs ◽  
Venous Stasis ◽  
Venous Blood Flow ◽  
Mechanically Ventilated ◽  
Vein Thrombosis ◽  
High Prevalence ◽  
Deep Vein

Coronavirus disease 2019 (COVID-19) predisposes to deep vein thrombosis (DVT) and pulmonary embolism (PE) particularly in mechanically ventilated adults with severe pneumonia. The extremely high prevalence of DVT in the COVID-19 patients hospitalized in the intensive care unit (ICU) has been established between 25 and 84% based on studies including systematic duplex ultrasound of the lower limbs when prophylactic anticoagulation was systematically administrated. DVT prevalence has been shown to be markedly higher than in mechanically ventilated influenza patients (6–8%). Unusually high inflammatory and prothrombotic phenotype represents a striking feature of COVID-19 patients, as reflected by markedly elevated reactive protein C, fibrinogen, interleukin 6, von Willebrand factor, and factor VIII. Moreover, in critically ill patients, venous stasis has been associated with the prothrombotic phenotype attributed to COVID-19, which increases the risk of thrombosis. Venous stasis results among others from immobilization under muscular paralysis, mechanical ventilation with high positive end-expiratory pressure, and pulmonary microvascular network injuries or occlusions. Venous return to the heart is subsequently decreased with increase in central and peripheral venous pressures, marked proximal and distal veins dilation, and drops in venous blood flow velocities, leading to a spontaneous contrast “sludge pattern” in veins considered as prothrombotic. Together with endothelial lesions and hypercoagulability status, venous stasis completes the Virchow triad and considerably increases the prevalence of DVT and PE in critically ill COVID-19 patients, therefore raising questions regarding the optimal doses for thromboprophylaxis during ICU stay.

scholarly journals High Prevalence of Deep Vein Thrombosis in Mechanically Ventilated COVID-19 Patients

2020 ◽  
Vol 76 (4) ◽  
pp. 480-482 ◽  
Author(s):  
Sebastian Voicu ◽  
Philippe Bonnin ◽  
Alain Stépanian ◽  
Benjamin G. Chousterman ◽  
Arthur Le Gall ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Mechanically Ventilated ◽  
Vein Thrombosis ◽  
High Prevalence ◽  
Deep Vein

scholarly journals Pervasive but Neglected: A Perspective on COVID-19-Associated Pulmonary Mold Infections Among Mechanically Ventilated COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Mona Ghazanfari ◽  
Amir Arastehfar ◽  
Lotfollah Davoodi ◽  
Jamshid Yazdani Charati ◽  
Maryam Moazeni ◽  
...  
Keyword(s):  
Large Scale ◽  
Epidemiological Studies ◽  
Antifungal Drugs ◽  
Valuable Insight ◽  
Radiological Findings ◽  
Serum Samples ◽  
Pulmonary Aspergillosis ◽  
Mechanically Ventilated ◽  
High Prevalence ◽  
Insight Into

Background: Recent studies from multiple countries have shown a high prevalence of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here, we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19-associated pulmonary mold infections (CAPMIs) among mechanically ventilated patients.Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan (GM), and β-D-glucan (BDG) testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings, and mycological criteria.Results: During the study period, 302 COVID-19 patients were admitted to intensive care units (ICUs), among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥1) and serum (GM index &gt;0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients who presented with CAPMI were treated with antifungal drugs.Conclusion: Despite being prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to ICUs. CAPMI can be caused by species other than Aspergillus.

scholarly journals Dynamics of SARS-CoV2 Infection and Multi-Drug Resistant Bacteria Superinfection in Patients With Assisted Mechanical Ventilation

2021 ◽  
Vol 11 ◽  
Author(s):  
Annarita Mazzariol ◽  
Anna Benini ◽  
Ilaria Unali ◽  
Riccardo Nocini ◽  
Marcello Smania ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Fungal Growth ◽  
Carbapenem Resistance ◽  
Resistant Bacteria ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Assisted Mechanical Ventilation ◽  
Bacteria And Fungi ◽  
A Prospective Study ◽  
Ventilated Patients

ObjectiveTo investigate the presence of bacteria and fungi in bronchial aspirate (BA) samples from 43 mechanically ventilated patients with severe COVID-19 disease.MethodsDetection of SARS-CoV-2 was performed using Allplex 2019-nCoV assay kits. Isolation and characterisation of bacteria and fungi were carried out in BA specimens treated with 1X dithiothreitol 1% for 30 min at room temperature, using standard culture procedures.ResultsBacterial and/or fungal superinfection was detected in 25 out of 43 mechanically ventilated patients, generally after 7 days of hospitalisation in an intensive care unit (ICU). Microbial colonisation (colony forming units (CFU) &lt;1000 colonies/ml) in BA samples was observed in 11 out of 43 patients, whereas only 7 patients did not show any signs of bacterial or fungal growth. Pseudomonas aeruginosa was identified in 17 patients. Interestingly, 11 out of these 17 isolates also showed carbapenem resistance. The molecular analysis demonstrated that resistance to carbapenems was primarily related to OprD mutation or deletion. Klebsiella pneumoniae was the second most isolated pathogen found in 13 samples, of which 8 were carbapenemase-producer strains.ConclusionThese data demonstrate the detection of bacterial superinfection and antimicrobial resistance in severe SARS-CoV-2-infected patients and suggest that bacteria may play an important role in COVID-19 evolution. A prospective study is needed to verify the incidence of bacterial and fungal infections and their influence on the health outcomes of COVID-19 patients.

scholarly journals Emergence of azole resistant-Aspergillus fumigatus infections during STAT3-deficiency

2020 ◽  
Vol 69 (6) ◽  
pp. 844-849 ◽  
Author(s):  
François Danion ◽  
Amélie Duréault ◽  
Cécile Gautier ◽  
Agathe Senechal ◽  
Florence Persat ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Fungal Infections ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Point Mutations ◽  
Pulmonary Aspergillosis ◽  
First Case ◽  
High Prevalence ◽  
Immune Deficiencies ◽  
Transcription 3

Introduction. Signal transducer and activator of transcription 3 (STAT3) deficiency is a rare primary immunodeficiency associated with increased susceptibility to bacterial and fungal infections, notably pulmonary aspergillosis. Aim. We describe the emergence of azole-resistant Aspergillus fumigatus infections in STAT3-deficient patients. Methodology. During a retrospective study of 13 pulmonary aspergillosis cases in STAT3-deficient patients conducted in France, we identified patients infected with azole-resistant A. fumigatus isolates. Results. Two out of the 13 STAT3-deficient patients with aspergillosis had azole-resistant A. fumigatus infection, indicating an unexpectedly high prevalence of resistance. The first patient with STAT3 deficiency presented several flares of allergic bronchopulmonary aspergillosis-like episodes. He was chronically infected with two azole-resistant A. fumigatus isolates (TR34/L98). Despite prolonged antifungal treatment, including caspofungin and amphotericin B, the patient was not able to clear the azole-resistant A. fumigatus. The second patient had chronic cavitary pulmonary aspergillosis (CCPA). The A. fumigatus isolate was initially azole susceptible but harboured three F46Y, M172V and E427K point mutations. Despite prolonged antifungal therapies, lesions worsened and the isolate became resistant to all azoles. Surgery and caspofungin treatments were then required to cure CCPA. Resistance was probably acquired from the environment (TR34/L98) in the first case whereas resistance developed under antifungal treatments in the second case. These infections required long-term antifungal treatments and surgery. Conclusions. The emergence of azole-resistant A. fumigatus infections in STAT3-deficiency dramatically impacts both curative and prophylactic antifungal strategies. Physicians following patients with primary immune-deficiencies should be aware of this emerging problem as it complicates management of the patient.

Antifungal susceptibility of non-albicans Candida spp. isolated from raw milk and human blood in Alborz and Tehran provinces

2020 ◽  
Author(s):  
Zahra Namvar ◽  
Abbas Akhavan Sepahy ◽  
Robab Rafiei Tabatabaei ◽  
Sassan Rezaie
Keyword(s):  
Human Blood ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Raw Milk ◽  
Term Treatment ◽  
Clinical Samples ◽  
Candida Spp ◽  
Long Term Treatment ◽  
High Prevalence ◽  
Quality Of Milk

Background and Objectives: Recent reports indicate high prevalence of fungal infections due to non-albicans Candida spp. which are present in various environments such as raw milk. The quality of milk for fungal normal flora was investigated in this study. Materials and Methods: A total of 262 milk samples were collected directly from milk collection tanks indesignated dairy farms and cultured in SDA media. By further analysis of grown yeasts, 69 non-albicans Candida strains were identified. Antifungal susceptibility of the isolated species, were evaluated against amphotericin B, itraconazole, fluconazole and flucytosine. Fifty two non-albicans clinical samples isolated from human blood have been evaluated along. Results: Antifungal susceptibility evaluation in non-albicans strains isolated from milk revealed Candida glabrata and Candida tropicalis to be 100% sensitive to flucytosine and fluconazole. Candida krusei showed 94% and 80% sensitivity to flucytosine and fluconazole respectively. Candida parapsilosis indicated 72.72% sensitivity to fluconazole. Conclusion: Evaluation of non-albicans Candida species in raw milk and antifungal susceptibility patterns of these isolatescompare with non-albicansisolates from human blood, may help physicians to choose an appropriate medication for diseases needing long-term treatment, especially for diseases caused by local strains.

scholarly journals Leukemia and Periodontal Health

2021 ◽  
Vol 30 (1) ◽  
pp. 61-65
Author(s):  
Bann AlHazmi ◽  
Keyword(s):  
Early Diagnosis ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Malignant Neoplasm ◽  
Gingival Hyperplasia ◽  
Oral Manifestations ◽  
Periodontal Health ◽  
Spontaneous Bleeding ◽  
High Prevalence ◽  
Dent Assoc

Leukemia is a malignant neoplasm that arises from hematopoietic cells. leukemia has high prevalence among Saudi and Pakistani populations (6.2% and 4.1% respectively). Dentists should perceive the serious complications of leukemia and its therapies and to manage leukemic patients in dental practice safely and effectively. Oral manifestations of hematological malignancies may represent the initial sign of the underlying hematopoietic disease. 65% of leukemia lesions have some form of oral manifestations. Accordingly, the purpose of this review is to summaries all the general manifestations of Leukemia as well as the oral manifestations to facilitate early diagnosis and referral. Leukemia oral manifestations could be pale mucosa or spontaneous bleeding gingiva or bruising and petechiae in the hard and soft palate. Gingival hyperplasia, ulcerations, and opportunistic infections with Candida albicans and Herpes Viruses can occur in oral mucosa. Dental care for leukemic patients should focus on trauma prevention and meticulous oral hygiene. Antibiotics should be used to prevent and to treat infections (bacterial, virus and fungal infections). Periodontal surgeries like gingivoplasty procedures are considered elective treatments before the diagnosis and or treatment of leukemia and it should not be performed until the patient completes and maintains their antineoplastic treatment. Dentists plays an essential role in the early diagnosis of the leukemia; therefore, they should lead a proper investigation and referral to reach proper diagnosis. KEYWORDS: Gingival Bleeding, Leukemia, Oral Manifestations, Periodontal Surgeries. HOW TO CITE: AlHazmi BA. Leukemia and periodontal health. J Pak Dent Assoc 2021;30(1):61-65

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