- Role of Bi-Weekly Serum Galactomannan Screening for the Diagnosis of Invasive Aspergillosis in Hematologic Cancer Patients. [Journal Article]
- MMycoses 2018 Feb 17
- Invasive aspergillosis (IA) is a life-threatening infection affecting hematologic cancer patients with chemotherapy-induced neutropenia. The diagnosis of IA often relies on the detection of galactoma...
Invasive aspergillosis (IA) is a life-threatening infection affecting hematologic cancer patients with chemotherapy-induced neutropenia. The diagnosis of IA often relies on the detection of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BAL). Bi-weekly serum GM screening has been proposed for a preemptive therapeutic approach of IA in patients not receiving mold-active prophylaxis. We have analyzed all IA cases among patients with hematologic malignancies and prolonged chemotherapy-induced neutropenia (>14 days) in our institution over a 10-year period (2007-2017). Serum GM was measured twice weekly and mold-active prophylaxis was not routinely administered. Thirty IA cases were observed and a positive serum GM was the first indicator of IA in 10 (33%) of them, which represents a need of approximately 500 GM tests for the detection of a single IA case. In the other 20 (67%) cases, suggestive chest CT lesion was the first sign of IA and bronchoscopy was required in 15 (50%) cases with negative serum GM for establishing the diagnosis of probable/proven IA. A positive serum GM was associated with a worse prognosis (57% 12-week survival versus 100% among serum GM-negative patients, p=0.006), irrespective of the timing of GM positivity compared to CT. We concluded that bi-weekly serum GM screening demonstrated limited benefit in this population. This article is protected by copyright. All rights reserved.
- Elastin increases biofilm and extracellular matrix production of Aspergillus fumigatus. [Journal Article]
- BJBraz J Microbiol 2018 Feb 13
- Aspergillus fumigatus is an opportunistic saprobe fungus that accounts for 90% of cases of pulmonary aspergillosis in immunosuppressed patients and is known for its angiotropism. When it reaches the ...
Aspergillus fumigatus is an opportunistic saprobe fungus that accounts for 90% of cases of pulmonary aspergillosis in immunosuppressed patients and is known for its angiotropism. When it reaches the respiratory tract, A. fumigatus interacts with structural components and blood vessels of the lungs, such as elastin. To understand the effect of this structural component, we examined the effect of elastin on the production and development of the biofilm of A. fumigatus. In RPMI containing 10mg/mL of elastin, a significant increase (absorbance p<0.0001; dry weight p<0.0001) in the production of biofilm was observed in comparison to when RPMI was used alone, reaching a maximum growth of 18.8mg (dry weight) of biofilm in 72h. In addition, elastin stimulates the production (p=0.0042) of extracellular matrix (ECM) and decreases (p=0.005) the hydrophobicity during the development of the biofilm. These results suggest that elastin plays an important role in the growth of A. fumigatus and that it participates in the formation of thick biofilm.
- Differential role of gpaB and sidA gene expressions in relation to virulence in Aspergillus species from patients with invasive aspergillosis. [Journal Article]
- BJBraz J Microbiol 2018 Feb 03
- The virulence genes in invasive aspergillosis (IA) have not been analyzed adequately. The present study was designed to evaluate the expression of gpaB and sidA genes, which are important virulence g...
The virulence genes in invasive aspergillosis (IA) have not been analyzed adequately. The present study was designed to evaluate the expression of gpaB and sidA genes, which are important virulence genes in Aspergillus spp. from bronchoalveolar lavage (BAL) samples. Direct examination and culture on Czapek Agar and Sabouraud Dextrose Agar media were performed for 600 BAL specimens isolated from patients with possible aspergillosis. A Galactomannan ELISA assay was also carried out. The expression levels of the gpaB and sidA genes in isolates were analyzed using quantitative real-time PCR (qRT-PCR). We identified 2 species, including Aspergillus flavus (A. flavus) and Aspergillus fumigatus (A. fumigatus) in 25 positive samples for invasive aspergillosis as validated using GM-ELISA. A. flavus is the main pathogen threatening transplant recipients and cancer patients worldwide. In this study, A. flavus had low levels of the gpaB gene expression compared to A. fumigatus (p=0.006). The highest sidA expression was detected in transplant recipients (p=0.05). There was no significant correlation between sidA expression and underlying disease (p=0.15). The sidA and gpaB gene expression patterns may provide evidence that these virulence genes play important roles in the pathogenicity of Aspergillus isolates; however, there are several regulatory genes responsible for the unexpressed sidA and gpaB genes in the isolates.
- Pulmonary Cavity FromMycobacterium malmoensein an HIV-Infected Patient: Complicated by Bronchopleural Fistula. [Journal Article]
- OFOpen Forum Infect Dis 2018; 5(2):ofy023
- We present a case ofM. malmoenseand HIV co-infection complicated by aspergilloma leading to bronchopleural fistula with intractable pneumothorax and pleural aspergillosis, ultimately requiring surgic...
We present a case ofM. malmoenseand HIV co-infection complicated by aspergilloma leading to bronchopleural fistula with intractable pneumothorax and pleural aspergillosis, ultimately requiring surgical intervention. Treatment guidelines forM. malmoenseare reviewed, literature regardingM. malmoenseand HIV co-infection is reviewed, and the epidemiology ofM. malmoensein North America is discussed.
- Clinical characteristics and treatment outcomes of pulmonary invasive fungal infection among adult patients with hematological malignancy in a medical centre in Taiwan, 2008-2013. [Journal Article]
- JMJ Microbiol Immunol Infect 2018 Jan 31
- CONCLUSIONS: Patients with acute leukaemia and myelodysplastic syndrome/severe aplastic anaemia were at high risk of pulmonary IFI.
- Low sensitivity of Lateral Flow Device-Aspergillusin patients with probable and proven aspergillosis: results from a multicentre evaluation. [Journal Article]
- JCJ Clin Microbiol 2018 Feb 14
- Invasive aspergillosis (IA) is one of the most important causes of morbidity and mortality in immunocompromised patients.….
Invasive aspergillosis (IA) is one of the most important causes of morbidity and mortality in immunocompromised patients.….
- Antifungal susceptibility of theAspergillus viridinutanscomplex: comparison of twoin vitromethods. [Journal Article]
- AAAntimicrob Agents Chemother 2018 Feb 05
- Cryptic species ofAspergillus fumigatus,including theAspergillus viridinutansspecies complex, are increasingly reported as a cause of invasive aspergillosis. Their identification is clinically releva...
Cryptic species ofAspergillus fumigatus,including theAspergillus viridinutansspecies complex, are increasingly reported as a cause of invasive aspergillosis. Their identification is clinically relevant as these species frequently have intrinsic resistance to common antifungals. We evaluated susceptibilities of 90 environmental and clinical isolates from theA. viridinutansspecies complex, identified by DNA sequencing of the calmodulin gene, to seven antifungals (voriconazole, posaconazole, itraconazole, amphotericin B, anidulafungin, micafungin and caspofungin) using the reference European Committee on Antimicrobial Susceptibility testing (EUCAST) method. The majority of species demonstrated elevated MICs of voriconazole (geometric mean, GM: 4.46 mg/l) and itraconazole (GM: 9.85 mg/l), and had variable susceptibility to amphotericin B (GM: 2.5 mg/l). Overall, the MICs of posaconazole and MECs of echinocandins were low. The EUCAST results were compared with the Sensititre YeastOne (YO) panels. Overall, there was 67% agreement (95% confidence interval, CI: 62-72%) between EUCAST and YO panels when read at 48 hours and 82% (95% CI: 78-86%) at 72 hours. There was a significant difference in agreement between antifungals; agreement was high for amphotericin B, voriconazole and posaconazole (70-86% at 48 hours and 88-93% at 72 hours), but was very low for itraconazole (37% at 48 hours and 57% at 72 hours). The agreement was also variable between species with the maximum agreement observed forA. felisisolates (85 and 93% at 48 and 72 hours, respectively). Elevated MICs of voriconazole and itraconazole were cross-correlated but there was no correlation between other azoles tested.
- Early-onset invasive aspergillosis and other fungal infections in patients treated with ibrutinib. [Journal Article]
- BloodBlood 2018 Feb 01
- Ibrutinib has revolutionized the management of chronic lymphocytic leukemia and is now being increasingly used. Although considered to be less immunosuppressive than conventional immunochemotherapy, ...
Ibrutinib has revolutionized the management of chronic lymphocytic leukemia and is now being increasingly used. Although considered to be less immunosuppressive than conventional immunochemotherapy, the observation a few cases of invasive fungal infections in patients treated with ibrutinib prompted us to conduct a retrospective survey. We identified 33 cases of invasive fungal infections in patients receiving ibrutinib alone or in combination. Invasive aspergillosis was overrepresented (27/33) and was associated with cerebral localizations in 40% of the cases. Remarkably, most cases of invasive fungal infections occurred with a median of 3 months after starting ibrutinib. In 18/33 cases, other conditions that could have contributed to decreased antifungal responses, such as corticosteroids, neutropenia or combined immunochemotherapy, were present. These observations indicate that ibrutinib may be associated with early-onset invasive fungal infections, in particular invasive aspergillosis with frequent cerebral involvement, and that patients on ibrutinib should be closely monitored in particular when other risk factors of fungal infections are present.
- [A clinican linical analysis of 29 cases of chronic pulmonary aspergillosis]. [Journal Article]
- ZJZhonghua Jie He He Hu Xi Za Zhi 2018 Feb 12; 41(2):100-104
- Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment ...
Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment and prognosis of this disease.Methods:Cases of CPA, proven by microbiological evidence based on pathological study in Fuzhou General Hospital of the People's Liberation Army and Affiliated Fuzhou City First Hospital of Fijian Medical University from January 2006 to October 2016 were retrospectively analyzed.Results:The patients consisted of 17 males and 12 females, aged 24 to 75 years, mean (42±16) years. The underlying disorders included post-tuberculosis infection (n=11), bronchiectasis (n=8), chronic obstructive pulmonary disease (n=3) and diabetes mellitus (n=2). The main clinical symptoms included productive cough (n=25), chronic sputum production (n=18) and hemoptysis (n=15). Serum GM antigen tests were performed in 19 cases, and the result was positive in 12 patients. BALF GM antigen tests were performed in 2 cases, both of which were positive. Chest CT showed that the lesions were located predominantly in the upper lobes (n=24). Single cavity with interior irregular intraluminal material (n=16) and multiple cavities with interior irregular intraluminal material (n=10) were the most frequent CT findings, while the "air crescent sign" was found in 13 cases. In the 22 patients who underwent surgical treatment, Aspergillus filaments were found in the cavity (n=20) or the bronchi (n=2) of lung samples, and histological examination didn't show tissue invasion by fungi. Surgical therapy was performed in 22 patients, with complete remission in 19 cases, and death in 3 cases. Anti-fungal therapy was administered in 6 patients, with partial remission in 4, and stable disease in 2 cases. One patient was not treated.Conclusions:CPA is more frequently seen in patients with underlying chronic pulmonary diseases. The common CT findings are single or multiple cavities with interior irregular intraluminal materials. Aspergillus filament in the cavity or bronchi of lung samples, without parenchymal invasion, is the proof of CPA. The surgical cure rate for simple aspergilloma and aspergillus nodule is high, while the risk of operation for chronic cavitary disease is high. GM antigen test may be an evidence for diagnosing CPA.
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- Clinical features of fatal severe fever with thrombocytopenia syndrome that is complicated by invasive pulmonary aspergillosis. [Journal Article]
- JIJ Infect Chemother 2018 Feb 07
- CONCLUSIONS: Given the high mortality rate in this series, there is a need for increased awareness of SFTS-associated IPA. Additional examinations should be performed in these cases, and early-stage antifungal treatment with organ support may be helpful.