Mycotic Infections in the Compromised Host

2013 ◽  
Author(s):  
Jo-Anne H. Young
Keyword(s):  
Fungal Infections ◽  
Fusarium Species ◽  
Diagnostic Testing ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Bimodal Distribution ◽  
Dematiaceous Fungi ◽  
Pneumocystis Jiroveci ◽  
Compromised Host ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Mycotic Infections

Opportunistic fungal infections have become increasingly important over the past several decades, paradoxically because advances in medical practice have improved the survival of debilitated and immunosuppressed patients. The mycotic infections that appear in the compromised host are candidiasis, cryptococcosis, pneumocystosis, aspergillosis, zygomycosis, and fusariosis. The aspergillosis section addresses allergic bronchopulmonary aspergillosis and invasive aspergillosis separately. Timely diagnosis of opportunistic fungal infection depends on understanding host characteristics, environmental risk factors, clinical presentation, and diagnostic testing, which each section covers. There is also a section on infection by dematiaceous fungi. Figures illustrate the cysts of Pneumocystis and the bimodal distribution of Aspergillus infection after bone marrow transplantation. Tables describe the desensitization of adult patients with sulfa allergy; the stages of allergic bronchopulmonary aspergillosis; the treatment of infections caused by Candida, Cryptococcus, Aspergillus, and Fusarium species; and the treatment and prophylaxis of Pneumocystis jiroveci pneumonia.  This review contains 2 highly rendered figures, 7 tables, and 108 references.

Important Infections Due To Molds

2018 ◽  
Author(s):  
Timothy Ando
Keyword(s):  
Invasive Aspergillosis ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Antibody Therapy ◽  
Therapeutic Drug ◽  
Blood Levels ◽  
Intravenous Route ◽  
Dematiaceous Fungi ◽  
Liver Function Testing

Mold-based fungal infections have become increasingly important over several decades, paradoxically because advances in medical practice have allowed patients with chronic medical conditions to live longer and have lives that are more productive. Allergic bronchopulmonary aspergillosis can affect those individuals with an atopic predisposition. Use of direct antimold antifungal agents can decrease the number of steroid treatment courses and monoclonal antibody therapy used in these patients. Pulmonary invasive aspergillosis remains the most important opportunistic mold infection among immunocompromised patients. Surrogate markers of diagnosis can include β-d-glucan or Aspergillus galactomannan antigen testing, although the specificity of both tests is not robust. There are three general classes of antifungal agents in use, with less nephrotoxic options. With safer therapeutic options, empirical treatment occurs with tremendous frequency among otherwise immunosuppressed individuals. Thus, clinicians will need to maintain a high suspicion for mold infections that can be resistant to a previously used antifungal therapy. Attention to liver function testing during long-term use of these advanced-generation azole antifungal agents, and at times therapeutic drug monitoring with blood levels, will be needed. The echinocandin class of antifungal agents does not have hepatic or renal toxicity in general, but these agents need to be administered via an intravenous route. With routine use of agents that have activity against aspergillosis, fusariosis, mucormycosis, or other mold infections become evident for a minority of at-risk patients. This review contains 5 figures, 3 tables and 90 references Key words: allergic bronchopulmonary aspergillosis, dematiaceous fungi, Exserohilum, fusariosis, invasive aspergillosis, mucormycosis, Scedosporium

scholarly journals 1130. Low Risk of Pneumocystis jiroveci Pneumonia in Patients With Waldenstrom’s Macroglobulinemia on Ibrutinib

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S338-S339
Author(s):  
Amanda E Kusztos ◽  
Matthew P Cheng ◽  
Joshua N Gustine ◽  
Toni E Dubeau ◽  
Ann E Woolley ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Lymphocytic Leukemia ◽  
Waldenström’S Macroglobulinemia ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Increased Risk ◽  
Waldenstrom's Macroglobulinemia ◽  
Waldenstrom’S Macroglobulinemia ◽  
Waldenström's Macroglobulinemia ◽  
Research Grant

Abstract Background Ibrutinib is a Bruton’s tyrosine kinase inhibitor that is FDA approved for the treatment of chronic lymphocytic leukemia (CLL), mantle cell lymphoma, marginal zone lymphoma, and Waldenstrom’s macroglobulinemia (WM). Fungal infections including Pneumocystis jiroveci pneumonia (PCP) are increasingly reported in patients with CLL and lymphoma on ibrutinib possibly due to the off-target effect of ibrutinib on the adaptive immune system. Whether this increased risk is due to the effect of ibrutinib alone or in combination with immune dysregulation due to underlying malignancy is unknown. The purpose of this study was to assess the incidence of PCP in patients with WM on ibrutinib therapy. Methods A retrospective cohort study was performed of all patients with WM who initiated ibrutinib monotherapy at Dana-Farber Cancer Institute between July 1, 2015 and January 30, 2018. Baseline characteristics, laboratory parameters, previous and concomitant malignancy treatment regimens, and antimicrobial medications were collected by chart review. Patients were followed until April 1, 2018 for the development of PCP. Results There were a total of 106 patients with WM on ibrutinib during the study period. Sixty-one (58%) were male, and the median age at initiation of ibrutinib was 69 years (range 43 – 89). Forty-six patients (43%) received prior therapy for WM, with a median of two previous treatment courses (range 1–6). Fourteen patients (13%) were on PCP prophylaxis for a combined duration of 8 person-years. No cohort patient developed PCP during the study period, which included 146 person-years of ibrutinib exposure. Three patients (3%) died due to disease progression (n = 2) and E. coli sepsis (n = 1). Conclusion Patients with WM on ibrutinib monotherapy appear to have a different infectious risk profile than patients with CLL or lymphoma and do not have a high risk of developing PCP. These data suggest that PCP prophylaxis is likely not beneficial for patients with WM on ibrutinib. Disclosures M. P. Cheng, Royal College of Physicians and Surgeons of Canada: Member, Salary. S. P. Hammond, Merck: Investigator, Research support. J. J. Castillo, Pharmacyclics: Consultant and Grant Investigator, Consulting fee and Research grant. N. C. Issa, GSK: Investigator, Research grant. Merck: Investigator, Research grant. Akros Pharma: Consultant, Consulting fee.

scholarly journals Allergic Diseases Caused by Aspergillus Species in Patients with Cystic Fibrosis

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 357
Author(s):  
Aidan K. Curran ◽  
David L. Hava
Keyword(s):  
Cystic Fibrosis ◽  
Fungal Infections ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Hyphal Growth ◽  
Allergic Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Th2 Immune Response ◽  
Difficulty Breathing ◽  
Oral Corticosteroids

Aspergillus spp. are spore forming molds; a subset of which are clinically relevant to humans and can cause significant morbidity and mortality. A. fumigatus causes chronic infection in patients with chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). In patients with CF, A. fumigatus infection can lead to allergic disease, such as allergic bronchopulmonary aspergillosis (ABPA) which is associated with high rates of hospitalizations for acute exacerbations and lower lung function. ABPA results from TH2 immune response to Aspergillus antigens produced during hyphal growth, marked by high levels of IgE and eosinophil activation. Clinically, patients with ABPA experience difficulty breathing; exacerbations of disease and are at high risk for bronchiectasis and lung fibrosis. Oral corticosteroids are used to manage aspects of the inflammatory response and antifungal agents are used to reduce fungal burden and lower the exposure to fungal antigens. As the appreciation for the severity of fungal infections has grown, new therapies have emerged that aim to improve treatment and outcomes for patients with CF.

scholarly journals Evaluation of pathogenic fungi occurrence in traumatogenic structures of freshwater fish

2011 ◽  
Vol 44 (2) ◽  
pp. 182-185 ◽  
Author(s):  
Fabio Caetano Oliveira Leme ◽  
Marcos Mendes de Barros Negreiros ◽  
Fernando Akira Koga ◽  
Sandra de Moraes Gimenes Bosco ◽  
Eduardo Bagagli ◽  
...  
Keyword(s):  
Freshwater Fish ◽  
Fungal Infections ◽  
Pathogenic Fungi ◽  
Dematiaceous Fungi ◽  
Candida Spp ◽  
Pathogenic Potential ◽  
Infection Route ◽  
5.8S Rdna ◽  
Dorsal Fin ◽  
Pimelodus Maculatus

INTRODUCTION: Fungal infections in human skin, such as sporotrichosis, can occur after fish induced trauma. This work aimed to identify fungi in freshwater fish that are pathogenic to humans. METHODS: Extraction of dental arches from Serrassalmus maculatus (piranha) and Hoplias malabaricus (wolf fish), stings from Pimelodus maculatus (mandis catfish), dorsal fin rays from Plagioscion spp. (corvina) and Tilapia spp., for culture in Mycosel agar. Some cultures were submitted to DNA extraction for molecular identification by sequencing ITS-5.8S rDNA. RESULTS: Cultures identified most yeast as Candida spp., while sequencing also permitted the identification of Phoma spp. and Yarrowia lipolytica. CONCLUSIONS: While the search for S. schenckii was negative, the presence of fungus of the genera Phoma and Candida revealed the pathogenic potential of this infection route. The genus Phoma is involved in certain forms of phaeohyphomycosis, a subcutaneous mycosis caused by dematiaceous fungi, with reports of infections in human organs and systems. Traumatizing structures of some freshwater fish present pathogenic fungi and this may be an important infection route that must be considered in some regions of Brazil, since there are a large number of a fisherman in constant contact with traumatogenic fish.

scholarly journals Lethal Pneumocystis jiroveci pneumonia 24 Years After Kidney Transplantation

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
Babak Rezavand ◽  
Mohammad Javad Hosseini ◽  
Morteza Izadi ◽  
Abbas Mahmoodzadeh Poornaki ◽  
Javid Sadraei ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia
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