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BMJ Case Reports Mar 2022Invasive aspergillosis (IA) is a serious fungal infection that primarily affects patients with prolonged and profound neutropenia, and compromised cell-mediated...
Invasive aspergillosis (IA) is a serious fungal infection that primarily affects patients with prolonged and profound neutropenia, and compromised cell-mediated immunity. Aspergillosis of the oesophagus and gastrointestinal tract is uncommon but seen in advanced cases of disseminated IA. However, it is difficult to diagnose antemortem due to the poor specificity of the symptoms and the absence of characteristic imaging findings. Therefore, the reported cases of gastrointestinal aspergillosis have been associated with high morbidity and mortality, and frequently diagnosed postmortem. Here we present a successful outcome in a patient with relapsed and refractory multiple myeloma who had presented with febrile neutropenia, cough and dysphagia, and was diagnosed with disseminated IA comprising of pulmonary and oesophageal involvement. This case highlights the need for a high index of suspicion and the importance of invasive procedures for histopathology and molecular diagnostics to ensure an early diagnosis and therapeutic intervention.
Topics: Aspergillosis; Esophagus; Humans; Invasive Fungal Infections; Invasive Pulmonary Aspergillosis; Multiple Myeloma
PubMed: 35318199
DOI: 10.1136/bcr-2021-246403 -
Microbial Biotechnology Mar 2017Fungi of the genus Aspergillus are widespread in the environment. Some Aspergillus species, most commonly Aspergillus fumigatus, may lead to a variety of allergic... (Review)
Review
Fungi of the genus Aspergillus are widespread in the environment. Some Aspergillus species, most commonly Aspergillus fumigatus, may lead to a variety of allergic reactions and life-threatening systemic infections in humans. Invasive aspergillosis occurs primarily in patients with severe immunodeficiency, and has dramatically increased in recent years. There are several factors at play that contribute to aspergillosis, including both fungus and host-related factors such as strain virulence and host pulmonary structure/immune status, respectively. The environmental tenacity of Aspergilllus, its dominance in diverse microbial communities/habitats, and its ability to navigate the ecophysiological and biophysical challenges of host infection are attributable, in large part, to a robust stress-tolerance biology and exceptional capacity to generate cell-available energy. Aspects of its stress metabolism, ecology, interactions with diverse animal hosts, clinical presentations and treatment regimens have been well-studied over the past years. Here, we synthesize these findings in relation to the way in which some Aspergillus species have become successful opportunistic pathogens of human- and other animal hosts. We focus on the biophysical capabilities of Aspergillus pathogens, key aspects of their ecophysiology and the flexibility to undergo a sexual cycle or form cryptic species. Additionally, recent advances in diagnosis of the disease are discussed as well as implications in relation to questions that have yet to be resolved.
Topics: Animals; Aspergillosis; Aspergillus; Biophysical Phenomena; Diagnostic Tests, Routine; Ecosystem; Host-Pathogen Interactions; Humans
PubMed: 27273822
DOI: 10.1111/1751-7915.12367 -
Current Opinion in Infectious Diseases Apr 2022Invasive pulmonary aspergillosis (IPA) can affect patients with severe coronavirus disease 2019 (COVID-19), but many questions remain open about its very variable... (Review)
Review
PURPOSE OF REVIEW
Invasive pulmonary aspergillosis (IPA) can affect patients with severe coronavirus disease 2019 (COVID-19), but many questions remain open about its very variable incidence across the world, the actual link between the viral infection and the fungal superinfection, the significance of Aspergillus recovery in a respiratory sample, and the management of such cases. This review addresses these questions and aims at providing some clues for the practical diagnostic and therapeutic approaches of COVID-19-associated pulmonary aspergillosis (CAPA) in a clinical perspective.
RECENT FINDINGS
Definitions have been proposed for possible/probable/proven CAPA, but distinction between colonization and invasive fungal infection is difficult and not possible in most cases in the absence of histopathological proof or positive galactomannan in serum. Most importantly, the recovery of an Aspergillus by a direct (culture, PCR) or indirect (galactomannan) test in a respiratory sample is an indicator of worse outcome, which justifies a screening for early detection and initiation of preemptive antifungal therapy in such cases.
SUMMARY
The COVID-19 pandemic has increased our awareness of IPA among ICU patients. Although current recommendations are mainly based on experts' opinions, prospective studies are needed to get more evidence-based support for the diagnostic approach and management of CAPA.
Topics: COVID-19; Humans; Invasive Pulmonary Aspergillosis; Pandemics; Pulmonary Aspergillosis; SARS-CoV-2
PubMed: 34980831
DOI: 10.1097/QCO.0000000000000812 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Jul 2023Leukemia complicated with and coinfection is very rare, which is difficult to diagnose, and life-threatening. The clinical characteristics, diagnosis and treatment in... (Review)
Review
Leukemia complicated with and coinfection is very rare, which is difficult to diagnose, and life-threatening. The clinical characteristics, diagnosis and treatment in a child with acute myeloid leukemia (AML), who developed mucormycosis and aspergillus coinfection after chemotherapy, was reported. This case was a 12-year-old boy who presented with fever and cough during chemotherapy. and were detected in his blood, cerebrospinal fluid and alveolar lavage fluid by metagenomic next-generation sequencing (mNGS). Amphotericin B, posaconazole, and voriconazole were successively used for antifungal therapy. Skin debridement, bronchoalveolar lavage and local perfusion under bronchoscopy were performed. The infection of children was well controlled. The clinical manifestations of leukemia with mixed fungal infection are non-specific. The disease progresses rapidly and is prone to spread. Early diagnosis and treatment should be carried out. Combined antifungal therapy is recommended, and surgery is helpful to improve the patient's condition.
Topics: Male; Child; Humans; Mucormycosis; Coinfection; Antifungal Agents; Aspergillosis; Leukemia
PubMed: 37724414
DOI: 10.11817/j.issn.1672-7347.2023.230039 -
Critical Care (London, England) Jul 2014Invasive aspergillosis has been mainly reported among immunocompromised patients during prolonged periods of neutropenia. Recently, however, non-neutropenic patients in... (Review)
Review
Invasive aspergillosis has been mainly reported among immunocompromised patients during prolonged periods of neutropenia. Recently, however, non-neutropenic patients in the ICU population have shown an increasing risk profile for aspergillosis. Associations with chronic obstructive pulmonary disease and corticosteroid therapy have been frequently documented in this cohort. Difficulties in achieving a timely diagnosis of aspergillosis in non-neutropenic patients is related to the non-specificity of symptoms and to lower yields with microbiological tests compared to neutropenic patients. Since high mortality rates are typical of invasive aspergillosis in critically ill patients, a high level of suspicion and prompt initiation of adequate antifungal treatment are mandatory. Epidemiology, risk factors, diagnostic algorithms, and different approaches in antifungal therapy for invasive aspergillosis in non-neutropenic patients are reviewed.
Topics: Adrenal Cortex Hormones; Antifungal Agents; Aspergillosis; Communicable Diseases, Emerging; Critical Illness; Humans; Immunocompromised Host; Incidence; Intensive Care Units; Opportunistic Infections; Prevalence; Prognosis; Pulmonary Disease, Chronic Obstructive; Risk Factors
PubMed: 25167934
DOI: 10.1186/s13054-014-0458-4 -
Journal of the American Veterinary... Mar 2017
Topics: Animals; Aspergillosis; Aspergillus fumigatus; Female; Kidney; Lung; Sheep; Sheep Diseases; Vasculitis
PubMed: 28207323
DOI: 10.2460/javma.250.5.509 -
BMC Ophthalmology Jan 2021Orbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to... (Review)
Review
BACKGROUND
Orbital aspergillosis is a rare sight- and life-threatening fungal infection affecting immunocompromised or otherwise healthy patients. It is often misdiagnosed due to its unspecific clinical and radiologic appearance. Therapeutic delay can have dramatic consequences. However, progress in microbiological diagnostic techniques and therapeutic experience from case series help improve the management of this disease.
CASE PRESENTATION
A 78-year-old immunocompetent woman presented at an eye clinic for subacute swelling, reddening, and ptosis of her left upper eyelid. Based on radiologic and histologic considerations, she was treated for idiopathic orbital inflammation, but her condition worsened. After a second biopsy of the orbital mass, aspergillosis was diagnosed. Her condition improved promptly after initiation of an oral voriconazole treatment. Additionally, using a polymerase chain reaction (PCR) assay, A. fumigatus was identified on tissue of both biopsies and its azole susceptibility was examined simultaneously.
CONCLUSIONS
In the case described here, oral antifungal treatment was sufficient for the therapy of invasive orbital aspergillosis. Performing fungal PCR on orbital tissue can accelerate the diagnostic process and should be performed in ambiguous cases of slowly growing orbital mass. Finally, interdisciplinary management is the key to optimal treatment of orbital tumours and infections.
Topics: Aged; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Female; Humans; Voriconazole
PubMed: 33419395
DOI: 10.1186/s12886-020-01773-7 -
Clinical Infectious Diseases : An... Jul 2023Invasive aspergillosis (IA) by a triazole-resistant Aspergillus fumigatus is associated with high mortality. Real-time resistance detection will result in earlier...
BACKGROUND
Invasive aspergillosis (IA) by a triazole-resistant Aspergillus fumigatus is associated with high mortality. Real-time resistance detection will result in earlier initiation of appropriate therapy.
METHODS
In a prospective study, we evaluated the clinical value of the AsperGenius polymerase chain reaction (PCR) assay in hematology patients from 12 centers. This PCR assay detects the most frequent cyp51A mutations in A. fumigatus conferring azole resistance. Patients were included when a computed tomography scan showed a pulmonary infiltrate and bronchoalveolar fluid (BALf) sampling was performed. The primary end point was antifungal treatment failure in patients with azole-resistant IA.
RESULTS
Of 323 patients enrolled, complete mycological and radiological information was available for 276 (94%), and probable IA was diagnosed in 99/276 (36%). Sufficient BALf for PCR testing was available for 293/323 (91%). Aspergillus DNA was detected in 116/293 (40%) and A. fumigatus DNA in 89/293 (30%). The resistance PCR was conclusive in 58/89 (65%) and resistance detected in 8/58 (14%). Two had a mixed azole-susceptible/azole-resistant infection. In the 6 remaining patients, treatment failure was observed in 1. Galactomannan positivity was associated with mortality (P = .004) while an isolated positive Aspergillus PCR was not (P = .83).
CONCLUSIONS
Real-time PCR-based resistance testing may help to limit the clinical impact of triazole resistance. In contrast, the clinical impact of an isolated positive Aspergillus PCR on BALf seems limited. The interpretation of the EORTC/MSGERC PCR criterion for BALf may need further specification (eg, minimum cycle threshold value and/or PCR positive on >1 BALf sample).
Topics: Humans; Prospective Studies; Invasive Pulmonary Aspergillosis; Azoles; Aspergillosis; Aspergillus; Aspergillus fumigatus; Invasive Fungal Infections; Real-Time Polymerase Chain Reaction; Triazoles; Antifungal Agents; Drug Resistance, Fungal
PubMed: 36905147
DOI: 10.1093/cid/ciad141 -
The Journal of Infection Apr 2023
Topics: Humans; COVID-19; Aspergillosis; Adrenal Cortex Hormones
PubMed: 36716978
DOI: 10.1016/j.jinf.2023.01.034 -
Clinical Microbiology and Infection :... Jan 2004Invasive aspergillosis is an increasingly common disease. While there have been significant advances in the past decade, significant challenges remain in terms of...
Invasive aspergillosis is an increasingly common disease. While there have been significant advances in the past decade, significant challenges remain in terms of diagnosis and therapy. Some of the recent advances are outlined and future opportunities to improve the unacceptable mortality that is currently associated with this infection are considered.
Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Clinical Trials as Topic; Humans; Pyrimidines; Treatment Outcome; Triazoles; Voriconazole
PubMed: 14706080
DOI: 10.1111/j.1469-0691.2004.00809.x