Exploring European Consensus About the Remaining Treatment Challenges and Subsequent Opportunities to Improve the Management of Invasive Fungal Infection (IFI) in the Intensive Care Unit

Mycopathologia, Journal Year: 2024, Volume and Issue: 189(3)

Published: May 5, 2024

Abstract Background The global prevalence of invasive fungal infections (IFI) is increasing, particularly within Intensive Care Units (ICU), where Candida spp. and Aspergillus represent the most important pathogens. Diagnosis management IFIs becomes progressively challenging, with increasing antifungal resistance emergence rare species. Through a consensus survey focused on assessing current views how IFI should be managed, aim this project was to identify challenges around diagnosing managing in ICU. status different countries perceived date amongst multidisciplinary cohort healthcare professionals involved care ICU assessed. Methods Using modified Delphi approach, an expert panel developed 44 Likert-scale statements across 6 key domains concerning patient screening minimal standards for diagnosis ICU; initiation termination treatments minimise their side effects insights future research topic. These were used develop online which distributed convenience sampling basis utilising subscriber list held by independent provider (M3 Global). This intensivists, infectious disease specialists, microbiologists antimicrobial/ICU pharmacists UK, Germany, Spain, France Italy. threshold set at 75%. Results A total 335 responses received during five-month collection period. From these, 29/44 (66%) attained very high agreement (90%), 11/44 (25%) (< 90% ≥ 75%), 4/44 (9%) did not meet 75%). Conclusion results outline need physicians aware local incidence associated rate azole ICUs. Where clinical suspicion exists, treatment start immediately prior receiving from any diagnostic test. Beta-D-glucan testing available all centres, 48 h inform cessation empirical therapy. proposed measures may guide areas further optimise

Language: Английский

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Pulmonary Aspergillosis in Critically Ill COVID-19 Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Journal of Fungi, Journal Year: 2023, Volume and Issue: 9(3), P. 315 - 315

Published: March 3, 2023

COVID-19-associated pulmonary aspergillosis (CAPA) is a life-threatening fungal infection that mainly affects critically ill patients. The aim of this study was to assess the incidence and clinical outcomes putative CAPA in COVID-19 This retrospective observational cohort included 181 cases from 5 ICUs at Vienna General Hospital between January 2020 April 2022. Patients were diagnosed with according AspICU classification, which positive Aspergillus culture bronchoalveolar lavage sample, compatible signs symptoms, abnormal medical imaging. primary outcome adjusted 60-day all-cause mortality ICU admission patients vs. without CAPA. Secondary time diagnosis pathogen prevalence distribution. Putative identified 35 (19.3%) mean 9 days. Death 60 days occurred 18 (51.4%) 43 146 (29.5%) (adjusted HR (95%CI) = 2.15 (1.20-3.86, p 0.002). most frequently isolated species fumigatus. high associated significantly higher mortality.

Language: Английский

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Concurrent COVID-19 and pneumocystis carinii pneumonia in a patient subsequently found to have underlying hairy cell leukemia

Radiology Case Reports, Journal Year: 2022, Volume and Issue: 17(9), P. 3238 - 3242

Published: July 2, 2022

SARS-CoV-2 infection manifestation has great diversity and it becomes even greater while co-infection occurs or there is a serious underlying disease in an affected patient. In this case report, we present of 71-year-old man who underwent chest CT scan following the development fever, weakness, pulmonary symptoms. Chest showed segmental consolidation with centrilobular nodular infiltration, ground glass opacifications inferior segment left upper lower lobes, lung pleural thickening which was atypical for either COVID-19 pneumocystis carinii pneumonia but his PCR result positive he received treatment. His symptoms recurred after few months same findings subsequent bronchoalveolar lavage revealed presence infection. Consequently, cotrimoxazole caused improvement symptoms, nonetheless splenomegaly anemia remained clinical laboratory investigation. Accordingly, bone marrow study flow cytometry done confirmed previously undiagnosed hairy cell leukemia. This accentuates fact that when face paraclinical features patient, should explore coinfection unknown diseases.

Language: Английский

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Antifungal Activity of Isavuconazole and Comparator Agents against Contemporaneous Mucorales Isolates from USA, Europe, and Asia-Pacific

Journal of Fungi, Journal Year: 2023, Volume and Issue: 9(2), P. 241 - 241

Published: Feb. 11, 2023

Isavuconazole is the only US FDA-approved antifungal for treating invasive mucormycosis. We evaluated isavuconazole activity against a global collection of Mucorales isolates. Fifty-two isolates were collected during 2017-2020 from hospitals located in USA, Europe, and Asia-Pacific. Isolates identified by MALDI-TOF MS and/or DNA sequencing susceptibility tested broth microdilution method following CLSI guidelines. (MIC50/90, 2/>8 mg/L) inhibited 59.6% 71.2% all at ≤2 mg/L ≤4 mg/L, respectively. Among comparators, amphotericin B 0.5/1 displayed highest activity, followed posaconazole 0.5/8 mg/L). Voriconazole >8/>8 echinocandins >4/>4 had limited varied species this agent 85.2%, 72.7%, 25% Rhizopus spp. (n = 27; MIC50/90, 1/>8 mg/L), Lichtheimia 11; 4/8 Mucor 8; MIC50, >8 isolates, Posaconazole MIC50/90 values Rhizopus, Lichtheimia, 2/- respectively; 1/1 0.5/- As profiles among genera, identification testing are advised whenever possible to manage monitor

Language: Английский

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Perturbations of immune landscape in COVID‐19 associated mucormycosis

Mycoses, Journal Year: 2022, Volume and Issue: 66(3), P. 226 - 236

Published: Nov. 16, 2022

A rise in secondary fungal infections during the COVID-19 pandemic necessitates a deeper understanding of associated immunological perturbations.To evaluate clinical and characteristics observed patients with mucormycosis (CAM) infection.Cases or post-COVID-19 infection were compared cases acute convalescent COVID-19. Lymphocyte subsets, cytokines other laboratory markers between groups.The frequency proposed risk factors for CAM was diabetes mellitus (77%), recent history steroid use (69%) hypoxia (52%). Iron metabolism dysregulated low TIBC total iron. Further, accompanied lymphopenia drastic reduction B cell counts; however, plasmablasts not altered. had immunoglobulin levels antibodies specific to mucor peptide did increase suggesting dysfunction B-cell response. There activated effector cytotoxic CD8 T cells NK healthy controls. Among helper cells, Tregs reduced Th-1 increased infection. distinct cytokine signature evident IL-1β, IFN-γ, IL-6, IL-22, IL-17A, IL-10, IL-2, IL-8, IL-7, IL-21 GM-CSF.This is first study on immunophenotyping need long-term monitoring function after SARS-CoV-2 glycaemic control possible benefit therapeutic supplementation intravenous immunoglobulins CAM.

Language: Английский

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Use of Venovenous Extracorporeal Membrane Oxygenation in Patients With Acute Respiratory Distress Syndrome Caused by Fungal Pneumonia

Surgical Infections, Journal Year: 2023, Volume and Issue: 24(7), P. 632 - 636

Published: Aug. 18, 2023

Background: Patients with fungal pneumonias sometimes progress to acute respiratory distress syndrome (ARDS). Mortality has been reported as high 60% 90% in this group. Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used support such patients, however, outcomes are not well understood. and Methods: This was a retrospective study across the four adult ECMO centers Minnesota for one decade (2012-2022). The of interest were duration ECMO, survival rate, complications. Data extracted from electronic medical record analyzed using descriptive statistics. Results: Fungal pneumonia etiology ARDS 22 422 (5%) adults supported VV-ECMO during 10-year period. Median patient age 43 years (interquartile range [IQR], 35-56) 68% male. By type infection, 16 (72%) had blastomycosis, five (22%) pneumocystis, cryptococcus. Of patients blastomycosis two immunosuppressed whereas all pneumocystis immunosuppressed. overall rate 73%; most (67%) (80%) survived hospital discharge. greater group (median, 30 days; IQR, 21-43) compared 10 8-18). Conclusions: Our findings use caused by select immunocompetent immunocompromised patients. Although high, required longer runs.

Language: Английский

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The effect of COVID-19 on the frequency of Pneumocystis jirovecii pneumonia: a monocentric, retrospective, and observational study

BMC Infectious Diseases, Journal Year: 2023, Volume and Issue: 23(1)

Published: Oct. 17, 2023

Pneumocystis jirovecii pneumonia (PCP) and SARS-CoV2 share some similarities in their effects on the respiratory system, clinical presentation, management. The COVID-19 pandemic required rapid action to curb transmission mitigate its lethiferous impact. Non-pharmaceutical interventions (NPIs) were globally adopted. We hypothesized that these measures reduced acquisition of P. both hospital community settings.We conducted a retrospective observational study 2950 specimens from patients with suspected pulmonary infection, analyzed at Laboratory Parasitology Unit Policlinico Tor Vergata Rome, Italy, January 2014 December 2022.We show significant reduction frequency PCP era compared previous period. Among four sequence types identified, genotype 1 was most prevalent (37%). observed non-significant trend decreasing cases increasing 3 over period.The nationwide implementation NPIs against may have changed microbiological landscape exposure, thereby exposure consequently reducing incidence PCP.

Language: Английский

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Post-COVID pulmonary fungal infections: An unanticipated predicament or a ticking time bomb? Clinico-microbiological profile of cases encountered during the second wave of COVID-19 pandemic at a teaching hospital in the Himalayas with a brief literature review

Journal of Family Medicine and Primary Care, Journal Year: 2023, Volume and Issue: 12(12), P. 3228 - 3235

Published: Dec. 1, 2023

Introduction: This study attempts to generate preliminary data regarding post-COVID pulmonary fungal infections, namely, COVID-19-associated aspergillosis (CAPA), mucormycosis (CAPM), and mixed infections from the Himalayas compares micro-radio-clinical profile outcomes of affected patients. Materials Methods: A retrospective analysis was conducted, where clinical profiles, microbiological radiological reports, n = 16 patients were compared. Results: Of patients, 7 had CAPA ( 5 Aspergillus fumigatu s, 1 flavus, niger ), CAPM (Rhizopus arrhizus) , 4 with 3 infected fumigatus Rhizopus spp. flavus arrhizus ). Thick-walled cavitary lesions, air–fluid levels, multiple centrilobular nodules some common findings reported among these Conclusion: The immuno-compromised state following COVID-19 infection treatment might be responsible for progression regular exposure dense Himalayan vegetation into an invasive infection. Suspecting is necessary primary care physicians ensure timely referral higher centers. Mixed (coinfection spp.) are also emerging as important sequelae COVID-19.

Language: Английский

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The effect of COVID-19 on the frequency of Pneumocystis jirovecii pneumonia: a monocentric, retrospective, and observational study

Research Square (Research Square), Journal Year: 2023, Volume and Issue: unknown

Published: June 6, 2023

Abstract Background Pneumocystis jirovecii pneumonia (PCP) and SARS-CoV2 share some similarities in their effects on the respiratory system, clinical presentation, management. The COVID-19 pandemic required rapid action to curb transmission mitigate its lethiferous impact. Non-pharmaceutical interventions (NPIs) were globally adopted. We hypothesized that these measures reduced acquisition of P. both hospital community settings. Methods conducted a retrospective observational study 2950 specimens from patients with suspected pulmonary infection, analyzed at Laboratory Parasitology Unit Policlinico Tor Vergata Rome, Italy, January 2014 December 2022. Results show significant reduction frequency PCP era, compared previous period. Among four sequence types identified, genotype 1 was most prevalent (37%). observed non-significant trend decreasing cases increasing 3 over Conclusions nationwide implementation NPIs against may have changed microbiological landscape exposure, thereby exposure consequently reducing incidence PCP.

Language: Английский

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CRISPR systems tackling fungal infections

Elsevier eBooks, Journal Year: 2024, Volume and Issue: unknown, P. 191 - 205

Published: Jan. 1, 2024

Language: Английский

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