Invasive Aspergillosis in the Intensive Care Unit

Journal of Fungi, Journal Year: 2025, Volume and Issue: 11(1), P. 70 - 70

Published: Jan. 17, 2025

Invasive aspergillosis (IA) is a fungal infection, which has traditionally been associated with neutropenia and immunosuppressive therapies. Our understanding of invasive evolving and, in the past few decades, IA among ICU patients recognized as common infection become more widely recognized. The diagnosis management particularly challenging, due to unstable clinical condition patients, lack diagnostic markers, increased risk further deterioration, multiple comorbidities, need for early assessment treatment. In this article, we will discuss challenges pitfalls an setting, along review current literature that pertinent specific population.

Language: Английский

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Real-world clinical impact of plasma cell-free DNA metagenomic next-generation sequencing assay

Infection Control and Hospital Epidemiology, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 8

Published: Jan. 30, 2025

Abstract Objective: To describe the real-world clinical impact of a commercially available plasma cell-free DNA metagenomic next-generation sequencing assay, Karius test (KT). Methods: We retrospectively evaluated KT by panel adjudication. Descriptive statistics were used to study associations diagnostic indications, host characteristics, and KT-generated microbiologic patterns with KT. Multivariable logistic regression modeling was further characterize predictors higher positive impact. Results: 1000 unique cases from 941 patients between January 1, 2017–August 31, 2023. The cohort included adult (70%) pediatric (30%) patients. overall in 16%, negative 2%, no 82% cases. Among patients, multivariable showed that culture-negative endocarditis (OR 2.3; 95% CI, 1.11–4.53; P .022) concern for fastidious/zoonotic/vector-borne pathogens 2.1; 1.11–3.76; .019) associated Host immunocompromised status not reliably 1.03; 0.83–1.29; .7806). No significant found Microbiologic result pattern also predictor Conclusions: Our highlights despite select situations, most testing results had confirm indications where may have highest yield, thereby generating tools stewardship.

Language: Английский

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From chart biopsy to liquid biopsy: evaluating the diagnostic yield and clinical impact of plasma microbial cell-free DNA next-generation sequencing in the management of FUO

Open Forum Infectious Diseases, Journal Year: 2025, Volume and Issue: 12(2)

Published: Jan. 31, 2025

Abstract Background The underlying cause of fever unknown origin (FUO) remains unidentified in up to 51% cases despite systematic evaluation. Microbial cell-free DNA next-generation sequencing (mcfDNA-NGS) offers an agnostic, noninvasive approach pathogen identification, but the utility and clinical impact this assay FUO remain unknown. Methods This retrospective cohort study evaluated adult patients referred for evaluation at a tertiary medical center between November 2019 2023. Patients underwent both standard microbiologic testing (ST) mcfDNA-NGS. Diagnostic was assessed 4 domains: new diagnoses, earlier time diagnosis, avoidance invasive procedures, non-hypothesis-driven diagnoses. Logistic regression used identify predictors positive mcfDNA-NGS testing. Results Among 176 patients, 44.3%, with 49% these considered clinically significant. Infectious identified 39% noninfectious 35%, 26%. contributed diagnostic 30% cases, mainly by diagnosis (16%) potential procedures (10%). Positive significantly associated higher Charlson comorbidity index score (odds ratio [OR], 1.22; P < .001) white blood cell (WBC) count ≤4.5 × 109 cells/L (OR, 8.61; .001). Conversely, without localization decreased likelihood mcfNDA 0.18; Conclusions effectively complements ST diagnosing FUO, providing detection minimizing Clinical such as high low WBC may guide optimal use FUO. Prospective timing cost-benefit analysis is needed.

Language: Английский

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Invasive Aspergillosis in the Current Era

Infectious Disease Clinics of North America, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Language: Английский

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NGS-based Aspergillus detection in plasma and lung lavage of children with invasive pulmonary aspergillosis

npj Genomic Medicine, Journal Year: 2025, Volume and Issue: 10(1)

Published: March 17, 2025

Abstract In immunocompromised pediatric patients, diagnosing invasive pulmonary aspergillosis (IPA) poses a significant challenge. Next-Generation Sequencing (NGS) shows promise for detecting fungal DNA but lacks standardization. This study aims to advance towards clinical evaluation of liquid biopsy NGS Aspergillus detection, through an wet-lab procedures and computational analysis. Our findings support using both CHM13v2.0 GRCh38.p14 in host-read mapping reduce false-positives. We demonstrate the sensitivity our custom kraken2 database, cRE.21, species. Additionally, cell-free sequencing superior performance whole-cell by recovering higher fractions lung fluid (bronchoalveolar lavage [BAL] fluid) plasma samples from patients with probable IPA. proof-of-principle, A. fumigatus was identified 5 out 7 BAL 3 samples. optimized workflow can fungal-NGS research represents step enhancing diagnostic certainty enabling more sensitive accurate species-level diagnosis IPA patients.

Language: Английский

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Incorporating microbial cell-free DNA testing into healthcare-associated invasive fungal infection surveillance: benefits and challenges

Infection Control and Hospital Epidemiology, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 4

Published: April 4, 2025

Abstract Surveillance by clinical epidemiology teams for invasive fungal infections (IFIs) in healthcare settings can be challenging due to several factors including low sensitivity of noninvasive conventional microbiologic diagnostics, nonspecific presentation, and complex patient populations. Recently, availability microbial cell-free DNA testing (cfDNA) via the Karius Test has shown promise increased diagnostic IFIs. However, how best incorporate cfDNA results into IFI surveillance remains a vexing challenge. Herein, we provide perspectives on benefits challenges use surveillance.

Language: Английский

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A fatal case of disseminated Cladophialophora bantiana infection in a renal transplant recipient

IDCases, Journal Year: 2024, Volume and Issue: 39, P. e02128 - e02128

Published: Dec. 12, 2024

Dematiaceous molds often cause noninvasive disease but have the potential to disseminated infection, particularly in immunosuppressed hosts. Cladophialophora bantiana is most neurotropic of dematiaceous and associated with brain abscesses, infection quite rare. Here we present a case C. 67-year-old renal transplant recipient multifocal soft tissue, bone presumed central nervous system involvement. infections been significant mortality our patient had progression his despite intensive dual antifungal therapy close therapeutic drug monitoring. There was delay diagnosis initiation as represent malignant process. This review highlights importance having high index suspicion for fungal immunocompromised patients need tissue biopsy aid prompt timely empiric therapy, concomitant surgical management whenever possible improve outcomes.

Language: Английский

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Recent Developments in Culture-Independent Fungal Diagnostics

Infectious Disease Clinics of North America, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 1, 2024

Language: Английский

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