amphotericin-b and Communicable-Diseases--Emerging

Mucormycosis is a rare fungal infection caused by Mucor indicus. Phylogenetic analysis of many M. indicus isolates, mainly sampled from different clinical and environmental specimens collected worldwide, revealed two genotypes, I and II, based on ITS and D1/D2 LSU rDNA sequences. A retrospective review of the literature revealed 13 cases. Eight (76.9%) patients had disseminated infections, and the overall mortality rate was 30.7%. A pulmonary infection caused by M. indicus genotype I in a liver transplant recipient was disseminated to include the skin and was successfully treated with liposomal amphotericin B and aggressive surgery. M. indicus can infect a wide variety of patients with no real preference for the site of infection. We concluded that M. indicus has emerged as a significant cause of invasive mycosis in severely immunocompromised patients worldwide. Early diagnosis and initiation of appropriate therapy could enhance survival in these immunocompromised patient populations.

Topics: Aged; Amphotericin B; Antifungal Agents; Communicable Diseases, Emerging; DNA, Ribosomal Spacer; Genotype; Humans; Immunocompromised Host; Invasive Fungal Infections; Liver Transplantation; Lung; Male; Middle Aged; Mucor; Mucormycosis; Opportunistic Infections; Phylogeny; Retrospective Studies; Skin

Kodamaea (Pichia) ohmeri is a yeast-like fungus that has recently emerged as an important etiologic agent of fungemia in immunocompromised patients. We report such a case in a premature neonate born at 29 weeks of gestation. Prior to developing fungemia, she had two episodes of bacterial sepsis on day 13 and day 32 due to Enterobacter cloacae and Staphylococcus epidermidis, respectively. Kodamaea ohmeri was repeatedly isolated from blood cultures and its identity was determined by phenotypic characteristics and sequencing of the ITS and D1/D2 regions of rDNA. The neonate was successfully treated with amphotericin B. The published cases of K. ohmeri fungemia reported in pediatric patients are reviewed highlighting its increasing importance as a bloodstream pathogen.

Topics: Amphotericin B; Antifungal Agents; Bacteremia; Communicable Diseases, Emerging; DNA, Fungal; DNA, Ribosomal; DNA, Ribosomal Spacer; Enterobacter cloacae; Female; Fungemia; Humans; Infant, Newborn; Microbial Sensitivity Tests; Molecular Sequence Data; Mycological Typing Techniques; Phylogeny; Saccharomycetales; Sequence Analysis, DNA; Staphylococcus epidermidis; Treatment Outcome

Scedosporium prolificans is an emerging agent for severe infections. Although among the dematiaceous fungi Scedosporium is the most frequently isolated in blood cultures, Scedosporium endocarditis is rarely reported. We show herein a patient with acute leukaemia who developed S. prolificans endocarditis. Twelve cases were found in an extensive review of the English literature. In six cases (46%), there was predisposing heart conditions such as a prosthetic valve or an intracavitary device. Only 4 patients (31%) were immunocompromised hosts with haematologic neoplasia, solid-organ transplantation or acquired immunodeficiency syndrome (AIDS). Exposure to Scedosporium was observed in immunocompetent patients who developed infection while in the community. Scedosporium endocarditis occurred on both sides of the heart. Systemic and pulmonary emboli and other metastatic complications were seen in all of these patients. The overall mortality was 77% and, specifically, all of the immunocompromised hosts and 6 out of 7 patients with mitral or aortic valve endocarditis died. Patients with right-sided endocarditis associated with a removable intracardiac device exhibited a better prognosis. Scedosporium endocarditis, although still rare, is an emerging infection with an ominous prognosis. At the present time, valve replacement or the removal of cardiac devices plus combined antifungal treatment may offer the best possibility of cure.

Topics: Adult; Amphotericin B; Antifungal Agents; Communicable Diseases, Emerging; Embolectomy; Endocarditis; Fatal Outcome; Female; Femoral Artery; Humans; Immunocompromised Host; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Pyrimidines; Scedosporium; Thrombosis; Tomography, X-Ray Computed; Triazoles; Voriconazole

Invasive fungal infections are major medical complications in immunocompromised patients. The recent rise in the incidence of cancer and the increased use of newer medical treatment modalities, including organ transplantations, have resulted in growing numbers of highly immunosuppressed individuals. Although aspergillosis and candidiasis are among the most common invasive mycoses in such patients, there is evidence that the incidence of infectious diseases caused by Zygomycetes has risen significantly over the past decade. Patients with diabetes, malignancies, solid organ or bone marrow transplants, or iron overload and those receiving immunosuppressive agents, deferoxamine therapy, or broad-spectrum antimicrobial drugs are at highest risk for zygomycosis. This review details the emergence and importance of zygomycosis in current clinical practice and its manifestations and management. The etiologic species, pathogenesis and risk factors for zygomycosis are reviewed and updated. The clinical spectrum of zygomycosis is now broader, and it can be difficult to distinguish between mucormycosis and enthomophthoramycosis, both of which can manifest as disease ranging from a superficial infection to an angioinvasive infection with high mortality. Finally, the three-part treatment strategy (antifungal drugs, surgery, control of underlying diseases) is reviewed. Lipid formulations of amphotericin B are the antifungal agents of choice for treatment of zygomycosis. A novel antifungal triazole, posaconazole, has been developed and may become approved for treatment of zygomycosis. The clinical experience with adjunctive treatments like colony-stimulating factors, interferon-gamma, and hyperbaric oxygen therapy is still limited.

Topics: Amphotericin B; Antifungal Agents; Communicable Diseases, Emerging; Comorbidity; Drug Resistance, Fungal; Fungi; Humans; Mucormycosis; Risk Factors; Zygomycosis

Sri Lanka is a new focus of human cutaneous leishmaniasis caused by a genetic variant of usually visceralizing parasite Leishmania donovani. Over 3000 cases have been reported to our institution alone, during the past two decades. Recent emergence of visceral leishmaniasis is of concern.. Patients suspected of having visceral leishmaniasis (n = 120) fulfilling at least two of six criteria (fever > 2 weeks, weight loss, tiredness affecting daily functions, splenomegaly, hepatomegaly and anemia) were studied using clinic-epidemiological, immunological and haematological parameters. Seven cases (four progressive, treated (group A) and 3 non- progressive, potentially asymptomatic and observed (group B) were identified. Clinical cases were treated with systemic sodium stibogluconate or amphotericin B and all were followed up at the leishmaniasis clinic of University of Colombo for 3 years with one case followed up for 9 years.. All treated cases responded well to anti leishmanial treatment. Relapses were not noticed. Clinical features subsided in all non-progressive cases and did not develop suggestive clinical features or change of laboratory parameters. Visceral leishmaniasis cases have been originated from different districts within the country. Majority had a travel history to identified local foci of cutaneous leishmaniasis.. Visceral leishmaniasis is recognized as an emerging health threat in Sri Lanka. At least a proportion of locally identified strains of L. donovani possess the ability to visceralize. Apparent anti leishmanial sensitivity is encouraging. Timely efforts in disease containment will be important in which accurate understanding of transmission characteristics, increased professional and community awareness, improved diagnostics and availability of appropriate treatment regimens.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antimony Sodium Gluconate; Antiprotozoal Agents; Child; Child, Preschool; Communicable Diseases, Emerging; Female; Humans; Infant; Leishmania donovani; Leishmaniasis, Visceral; Male; Middle Aged; Sri Lanka; Young Adult

Visceral leishmaniasis (VL) is an emerging zoonosis, and Brazil harbors about 90% of those infected in Latin America. Since 1998, the disease has been spreading quickly in São Paulo state, and the western region is considered an emerging focus of VL in Brazil. Our aim was to evaluate the clinical characteristics and spatial distribution of VL in children referred to a public tertiary hospital located in the western region of São Paulo state, Brazil.. Medical records of children up to 18 years of age who were diagnosed with VL between January 2006 and December 2010 were reviewed. Geospatial analysis was performed using the ArcGIS 10.2 platform.. Sixty-three patients were enrolled in the study; the median age was 3.3 ± 3.3 years. The median time interval between the onset of clinical symptoms and diagnosis was 16.1 ± 11.1 days, and the median time in the pediatric ward was 18.0 ± 9.4 days. Liposomal amphotericin B was the first-line treatment in 90.5% of the patients and 9.6% relapsed. One patient died (1.6%), and 19% were submitted to the pediatric intensive care unit.. The short interval between the onset of symptoms, diagnosis, and treatment and the reduced number of days of hospitalization certainly influenced the small number of deaths, relapses, and severity among the children infected with VL. However, the disease is spreading fast in the western region of São Paulo state. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices.

Topics: Adolescent; Amphotericin B; Animals; Antiprotozoal Agents; Brazil; Child; Child, Preschool; Communicable Diseases, Emerging; Dog Diseases; Dogs; Female; Humans; Infant; Infant, Newborn; Leishmaniasis, Visceral; Male; Prevalence; Retrospective Studies; Sensitivity and Specificity; Spatial Analysis

Visceral leishmaniasis (VL) is re-emerging in endemic areas. The epidemiological, clinical, laboratory, and treatment outcome characteristics in a large cohort of VL patients is described herein.. The cases of 67 VL patients (57% male, mean age 56 years) treated in two Greek hospitals over the last 7 years were identified and evaluated retrospectively.. Forty-six percent of patients reported contact with animals. Seventeen patients (25%) were immunocompromised, and 22% were co-infected with another pathogen. Sixty-four percent of patients had fever, 57% had weakness, 37% had sweats, 21% had weight loss, and 13% had a dry cough, while 6% developed haemophagocytic syndrome. The median duration of symptoms was 28 days. Fifty-eight percent of patients had splenomegaly, 49% had hepatomegaly, and 36% had lymphadenopathy. The diagnosis was established by positive PCR in peripheral blood (73%) and/or bone marrow specimens (34%). Sixty-one patients (91%) received liposomal amphotericin (L-AMB). Six patients (10%) did not respond or relapsed but were eventually cured after a second cycle of L-AMB. During a 6-month follow-up, the overall mortality was 9%, although none of these deaths was attributed to VL.. VL is still a common disease in endemic areas, affecting immunocompetent and immunocompromised patients. Its diagnosis is challenging, and molecular techniques are valuable and helpful tools to achieve this. Treatment with L-AMB is safe and very effective.

Topics: Adolescent; Adult; Amphotericin B; Animals; Antiprotozoal Agents; Bone Marrow; Coinfection; Communicable Diseases, Emerging; Female; Fever; Greece; Hepatomegaly; Hospitals; Humans; Immunocompromised Host; Leishmaniasis, Visceral; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Splenomegaly; Treatment Outcome; Young Adult

The emergence of visceral leishmaniasis (VL) in nonendemic areas is a matter of great concern. We conducted a study and present a brief description of six nonmigrant children with VL from the nonendemic area of Uttarakhand, diagnosed in our tertiary teaching hospital from February 2012 to June 2013. We also present here a geographic distribution of these cases to assess the impact of global warming and climate change on the spread of the disease. Patients were diagnosed as VL by clinical findings and confirmed by demonstration of Leishmania donovani bodies in the bone marrow or a positive serum rK39 test. Four cases were treated successfully with amphotericin B. One patient died during treatment and one patient was discharged on persistent request. Clinicians should suspect and investigate for VL in patients with pyrexia of unknown origin, even in nonmigrant patients from nonendemic regions, for an early diagnosis.

Topics: Amphotericin B; Antiprotozoal Agents; Child; Child, Preschool; Communicable Diseases, Emerging; Female; Global Warming; Humans; Infant; Leishmania donovani; Leishmaniasis, Visceral; Male; Parasitology; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Azoles; Communicable Diseases, Emerging; Fatal Outcome; Febrile Neutropenia; Humans; Induction Chemotherapy; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Pyrimidines; Respiratory Distress Syndrome; Tomography, X-Ray Computed; Triazoles; Voriconazole

Invasive fungal infections continue to be a major cause of morbidity and mortality in immunocompromised or severely ill patients. This report highlights new research data presented at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy on invasive fungal disease and its treatment. A number of important clinical trials were reported, and there were also interesting presentations on the use of new diagnostic tools, further studies on therapeutic drug monitoring for azoles and updates on several of the emerging fungal pathogens.

Topics: Amphotericin B; Antibiotic Prophylaxis; Azoles; Biomarkers; Clinical Trials as Topic; Communicable Diseases, Emerging; Congresses as Topic; Diagnostic Techniques and Procedures; Drug Monitoring; Drug Resistance, Fungal; Humans; Immunocompromised Host; Mycoses

The uncommon fungal pathogen Trichoderma shows increasing medical importance particularly in immunocompromised patients. Despite systemic antifungal therapy, prognosis of Trichoderma infection is poor regardless of the type of infection and the therapy used. The aim of the present study was to evaluate the in vitro activity and synergism of double antifungal combinations including amphotericin B, voriconazole, fluconazole, chlorhexidine digluconate and Akacid plus against 15 isolates of Trichoderma longibrachiatum and 1 isolate of Trichoderma harzianum.. Individual MICs were determined by using broth microdilution method following the NCCLS M38-A guidelines with standard RPMI 1640 broth. Synergy tests were performed using the chequerboard method.. All clinical Trichoderma strains showed reduced susceptibility to fluconazole (MICs>or=64 mg/L) and amphotericin B (MICs=2 mg/L), whereas lower MICs of 0.5-1 mg/L were detected for voriconazole. Akacid plus reached the lowest MIC values in a range of 0.06-0.5 mg/L, 4- to 32-fold higher MICs were found for chlorhexidine. No antagonism was observed for any of the antifungal combinations tested. Interaction of amphotericin B and azoles was indifferent (fractional inhibitory concentration index, FICI 2-4). The combination of one azole and one cationic biocide showed different degree of synergism (FICI 0.07-2.03). Interaction of Akacid plus and chlorhexidine resulted in synergism for each Trichoderma isolate (FICI-range 0.05-0.5).. These results demonstrate no interaction between antifungals and some degree of synergism between azoles and cationic antimicrobials against Trichoderma spp.

Topics: Amphotericin B; Antifungal Agents; Antimicrobial Cationic Peptides; Azoles; Chlorhexidine; Communicable Diseases, Emerging; Drug Synergism; Fluconazole; Guanidines; Humans; Microbial Sensitivity Tests; Mycoses; Polymers; Pyrimidines; Triazoles; Trichoderma; Voriconazole

To report an outbreak of Pichia anomala fungemia that occurred in a Brazilian pediatric intensive care unit (ICU) from October 2002 to January 2004.. Unmatched case-control study.. We randomly selected four control-patients for each case-patient from a list of all patients admitted to the ICU for at least 48 hours during the outbreak. A second control group was composed of all consecutive patients with nosocomial candidemia in the ICU during the outbreak. An environmental study was performed, and genetic relatedness among the clinical isolates was characterized by randomly amplified polymorphic DNA assay.. During the study period, 1,046 children were admitted to the pediatric ICU, 17 of whom developed P. anomala fungemia (attack rate, 1.6%). The median age was 1.1 years, and the main underlying conditions were congenital malformations (35.3%) and neoplastic diseases (11.8%). The overall mortality rate was 41.2%. Two patients received no antifungal treatment; all of the others were treated with amphotericin B. On multivariate analysis, only the presence of a central venous catheter was significantly associated with P. anomala fungemia. The yeast was not found on healthcare workers' hands or in the environment. Molecular studies showed that the outbreak was caused by a single strain. The distribution of risk factors was similar between patients with P. anomala fungemia and control-patients with candidemia.. This study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen. Patients with P. anomala fungemia seem to have risk factors in common with those who have candidemia.

Topics: Age Distribution; Amphotericin B; Antifungal Agents; Brazil; Candidiasis; Case-Control Studies; Catheterization, Central Venous; Communicable Diseases, Emerging; Cross Infection; Disease Outbreaks; DNA, Fungal; Female; Fungemia; Hospital Mortality; Humans; Infant; Intensive Care Units, Pediatric; Male; Microbial Sensitivity Tests; Multivariate Analysis; Pichia; Random Amplified Polymorphic DNA Technique; Risk Factors; Seasons

Mucormycoses are seen with an increasing incidence in immunocompromised patients. Most common presentations are rhinocerebral and pulmonary. We here report the experience of a single center with mucormycoses in patients with hematologic malignancies.. Mucormycoses were diagnosed in six patients, (median age of 52 years; range, 26-74) treated between 2001-2004. Diagnoses included acute myeloid leukemia (AML) (n=3), acute lymphoblastic leukemia (n=1), chronic lymphocytic leukemia (n=1) and multiple myeloma (n=1). Mucormycosis was diagnosed in the neutropenic state following allogeneic hematopoietic cell transplantation (n=3) or intense chemotherapy (n=3). Sites of infections were rhinocerebral, facial and pulmonary involvement in one patient each and disseminated mucormycosis in three patients. The diagnosis was established by computed tomography followed by surgical interventions and histological diagnosis in 4 patients and post-mortem in two patients. Species identified were Rhizopus (n=3), Rhizomucor (n=2) and Absidia (n=1). Treatment responses were best if surgical resection was followed by aggressive antifungal chemotherapy. Five of six 6 patients died, all of complications of mucormycosis or their underlying disease. Only one patient with facial mucormycosis is still alive.. This experience demonstrates that patient with mucormycoses have a high mortality rate and early recognition followed by aggressive surgical debridement, high dose antifungal therapy and attempts to correct the underlying immunocompromised state are crucial in the treatment of this fatal infection.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Communicable Diseases, Emerging; Dermatomycoses; Disease Susceptibility; Female; Fluconazole; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Neutropenia; Pyrimidines; Sinusitis; Transplantation Conditioning; Triazoles; Viscera; Voriconazole

The spectrum of candidiasis has changed with the emergence of non-albicans Candida spp. and acquired antifungal resistance, especially in immunocompromised hosts. This changing scenario has necessitated routine antifungal susceptibility testing. In the present work, 102 Candida spp. isolates gathered during 2003 - 2004 were characterized by standard procedures, and antifungal susceptibility testing to amphotericin B, fluconazole and itraconazole was performed by broth macrodilution (BMD)-minimum inhibitory concentration (MIC) and disk diffusion (DD) methods. Among all isolates, 77.4% were from an ICU and 10.8% were obtained from a nursery. The majority of the isolates were C. tropicalis (48%), followed by C. parapsilosis (27.4%) and C. albicans (22.5%). Overall 6.9, 4.9 and 3.9% of all isolates were resistant to amphotericin B, fluconazole and itraconazole, respectively. Out of the 5 (4.9%) isolates resistant to fluconazole, 4 (3.9%) were from patients with AIDS on fluconazole prophylaxis. A discrepancy was observed between the results of susceptibility testing by DD and those by BMD-MIC: 15 (14.7%) isolates were reported to be resistant by DD despite having low MICs. Based on these results, it was concluded that initial antifungal screening of clinical isolates by the DD method followed by confirmation of resistant strains by the broth dilution method is desirable to optimize patient management.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Communicable Diseases, Emerging; Drug Resistance, Fungal; Female; Fluconazole; Hospitals; Humans; Itraconazole; Male

We present two cases of nosocomial urinary tract infection due to Trichosporon asahii in intensive care unit patients with bladder catheter from two hospitals in Santiago, Chile. Both patients had an several catheters and bacterial infections that required the use of antibiotic therapy. One strain showed in vitro resistance to amphotericin B. Both strains were susceptible to fluconazole, but presented MIC with dose-dependent susceptibility to ketoconazole and itraconazole. This is the first report showing T. asahii as urinary tract infection agent in Chile.

Topics: Amphotericin B; Antifungal Agents; Chile; Communicable Diseases, Emerging; Cross Infection; Drug Resistance, Fungal; Fatal Outcome; Fluconazole; Humans; Immunocompromised Host; Intensive Care Units; Itraconazole; Ketoconazole; Male; Microbial Sensitivity Tests; Middle Aged; Multiple Myeloma; Mycoses; Opportunistic Infections; Parkinson Disease; Postoperative Complications; Trichosporon; Urinary Catheterization; Urinary Tract Infections; Ventriculoperitoneal Shunt

Aspergillus terreus is an uncommon but emerging fungal pathogen, which causes lethal infections that are often refractory to amphotericin B (AmB). In comparison to Aspergillus fumigatus, A. terreus was resistant to the in vitro fungicidal effects of safely achievable concentrations of AmB. These in vitro findings correlated directly with resistance of A. terreus to AmB in experimental invasive pulmonary aspergillosis. Residual fungal pulmonary burden and galactomannan antigenemia demonstrated persistent infection, despite therapy with deoxycholate AmB or liposomal AmB. By comparison, posaconazole and itraconazole resolved GM antigenemia, reduced residual fungal burden, and improved survival. There were no differences in phagocytic host response to A. terreus versus A. fumigatus; however, the rate of conidial germination of A. terreus was slower. The strain of A. terreus with the highest minimum inhibitory and minimum lethal concentration of AmB also had the lowest membrane ergosterol content. The hyphae of A. terreus in vivo displayed distinctive aleurioconidia, which may be a practical microscopic feature for rapid preliminary diagnosis.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Communicable Diseases, Emerging; Drug Resistance, Fungal; Female; Lung; Lung Diseases, Fungal; Microbial Sensitivity Tests; Rabbits; Species Specificity

Fungal infections of the skin and deeper tissues of the periorbital region are quite rare. We report a case of a localized, deep periorbital necrotizing Fusarium infection in an otherwise healthy, elderly lady. Since the clinical features and histopathological findings of Fusarium infection are by no means characteristic, the definitive diagnosis was achieved with the help of microbiological examination of cultured organisms. A combined medical and surgical therapy led to adequate control of infection. To conclude, localized, deep periorbital necrotizing soft tissue infection by Fusarium in an immunocompetent lady is not reported in literature. One should have a high index of suspicion for emerging fungal pathogens in the differential diagnosis of necrotizing orbital or adnexal conditions, even in an immunocompetent patient. The histologic findings of septate, branching hyphae and vascular invasion cannot distinguish Fusarium species from various other moulds such as Aspergillus species; microbiologic studies are essential for confirming the diagnosis.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cataract; Clotrimazole; Communicable Diseases, Emerging; Eye Infections, Fungal; Female; Fusarium; Humans; Immunocompetence; Lens Implantation, Intraocular; Middle Aged