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Clinical Microbiology Reviews Dec 2022Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has... (Review)
Review
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. osteomyelitis and arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of and Aspergillus arthritis. Relapsed infection, particularly in arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
Topics: Mycoses; Fungi; Aspergillus; Arthritis; Osteomyelitis; Antifungal Agents
PubMed: 36448782
DOI: 10.1128/cmr.00086-19 -
Expert Review of Respiratory Medicine Jul 2020Fungal infections are increasingly encountered in clinical practice due to more favorable environmental conditions and increasing prevalence of immunocompromised... (Review)
Review
INTRODUCTION
Fungal infections are increasingly encountered in clinical practice due to more favorable environmental conditions and increasing prevalence of immunocompromised individuals. The diagnostic approach for many fungal pathogens continues to evolve. Herein, we outline available diagnostic tests for the most common fungal infections with a focus on recent advances and future directions.
AREAS COVERED
We discuss the diagnostic testing methods for angioinvasive molds ( spp. and spp.), invasive yeast ( spp. and ssp.), Pneumocystis, and endemic fungi ( sp., Coccidioides sp., and Hitoplasma sp.). The PubMed-NCBI database was searched within the past 5 years to identify the most recent available literature with dates extended in cases where literature was sparse. Diagnostic guidelines were utilized when available with references reviewed.
EXPERT OPINION
Historically, culture and/or direct visualization of fungal organisms were required for diagnosis of infection. Significant limitations included ability to collect specimens and delayed diagnosis associated with waiting for culture results. Antigen and antibody testing have made great strides in allowing quicker diagnosis of fungal infections but can be limited by low sensitivity/specificity, cross-reactivity with other fungi, and test availability. Molecular methods have a rich history in some fungal diseases, while others continue to be developed.
Topics: Aspergillus; Blastomyces; Candida; Coccidioides; Cryptococcus; Histoplasma; Humans; Lung Diseases, Fungal; Mucor; Pneumocystis; Pneumonia
PubMed: 32290725
DOI: 10.1080/17476348.2020.1753506 -
Seminars in Immunology Mar 2023The respiratory tree maintains sterilizing immunity against human fungal pathogens. Humans inhale ubiquitous filamentous molds and geographically restricted dimorphic... (Review)
Review
The respiratory tree maintains sterilizing immunity against human fungal pathogens. Humans inhale ubiquitous filamentous molds and geographically restricted dimorphic fungal pathogens that form small airborne conidia. In addition, pathogenic yeasts, exemplified by encapsulated Cryptococcus species, and Pneumocystis pose significant fungal threats to the lung. Classically, fungal pneumonia occurs in immune compromised individuals, specifically in patients with HIV/AIDS, in patients with hematologic malignancies, in organ transplant recipients, and in patients treated with corticosteroids and targeted biologics that impair fungal immune surveillance in the lung. The emergence of fungal co-infections during severe influenza and COVID-19 underscores the impairment of fungus-specific host defense pathways in the lung by respiratory viruses and by medical therapies to treat viral infections. Beyond life-threatening invasive syndromes, fungal antigen exposure can exacerbate allergenic disease in the lung. In this review, we discuss emerging principles of lung-specific antifungal immunity, integrate the contributions and cooperation of lung epithelial, innate immune, and adaptive immune cells to mucosal barrier immunity, and highlight the pathogenesis of fungal-associated allergenic disease. Improved understanding of fungus-specific immunity in the respiratory tree has paved the way to develop improved diagnostic, pre-emptive, therapeutic, and vaccine approaches for fungal diseases of the lung.
Topics: Humans; COVID-19; Mycoses; Lung; Fungi; Immunity, Innate
PubMed: 36841146
DOI: 10.1016/j.smim.2023.101728 -
Cell Sep 2022Fungal microorganisms (mycobiota) comprise a small but immunoreactive component of the human microbiome, yet little is known about their role in human cancers....
Fungal microorganisms (mycobiota) comprise a small but immunoreactive component of the human microbiome, yet little is known about their role in human cancers. Pan-cancer analysis of multiple body sites revealed tumor-associated mycobiomes at up to 1 fungal cell per 10 tumor cells. In lung cancer, Blastomyces was associated with tumor tissues. In stomach cancers, high rates of Candida were linked to the expression of pro-inflammatory immune pathways, while in colon cancers Candida was predictive of metastatic disease and attenuated cellular adhesions. Across multiple GI sites, several Candida species were enriched in tumor samples and tumor-associated Candida DNA was predictive of decreased survival. The presence of Candida in human GI tumors was confirmed by external ITS sequencing of tumor samples and by culture-dependent analysis in an independent cohort. These data implicate the mycobiota in the pathogenesis of GI cancers and suggest that tumor-associated fungal DNA may serve as diagnostic or prognostic biomarkers.
Topics: Biomarkers; Candida; DNA, Fungal; Fungi; Humans; Lung Neoplasms; Mycobiome
PubMed: 36179671
DOI: 10.1016/j.cell.2022.09.015 -
Clinical Chemistry Dec 2021Infections caused by fungi can be important causes of morbidity and mortality in certain patient populations, including those who are highly immunocompromised or... (Review)
Review
BACKGROUND
Infections caused by fungi can be important causes of morbidity and mortality in certain patient populations, including those who are highly immunocompromised or critically ill. Invasive mycoses can be caused by well-known species, as well as emerging pathogens, including those that are resistant to clinically available antifungals.
CONTENT
This review highlights emerging fungal infections, including newly described species, such as Candida auris, and those that having undergone taxonomic classification and were previously known by other names, including Blastomyces and Emergomyces species, members of the Rasamsonia argillacea species complex, Sporothrix brasiliensis, and Trichophyton indotinae. Antifungal resistance also is highlighted in several of these emerging species, as well as in the well-known opportunistic pathogen Aspergillus fumigatus. Finally, the increased recognition and importance of fungal co-infections with respiratory pathogens, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is discussed.
SUMMARY
Both clinicians and clinical microbiology laboratories should remain vigilant regarding emerging fungal infections. These may be difficult both to diagnose and treat due to the lack of experience of clinicians and laboratory personnel with these organisms and the infections they may cause. Many of these fungal infections have been associated with poor clinical outcomes, either due to inappropriate therapy or the development of antifungal resistance.
Topics: Antifungal Agents; COVID-19; Communicable Diseases, Emerging; Drug Resistance, Fungal; Fungi; Humans; Mycoses
PubMed: 34969112
DOI: 10.1093/clinchem/hvab217 -
Journal of Fungi (Basel, Switzerland) Jul 2019The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses.... (Review)
Review
The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses. Invasive candidiasis is increasingly caused by non-albicans spp., including , a multidrug-resistant yeast with the potential for nosocomial transmission that has rapidly spread globally. The use of mould-active antifungal prophylaxis in patients with cancer or transplantation has decreased the incidence of invasive fungal disease, but shifted the balance of mould disease in these patients to those from non-fumigatus species, Mucorales, and spp The agricultural application of triazole pesticides has driven an emergence of azole-resistant in environmental and clinical isolates. The widespread use of topical antifungals with corticosteroids in India has resulted in causing recalcitrant dermatophytosis. New dimorphic fungal pathogens have emerged, including , which cause disseminated mycoses globally, primarily in HIV infected patients, and and , causes of atypical blastomycosis in western parts of North America and in Africa, respectively. In North America, regions of geographic risk for coccidioidomycosis, histoplasmosis, and blastomycosis have expanded, possibly related to climate change. In Brazil, zoonotic sporotrichosis caused by has emerged as an important disease of felines and people.
PubMed: 31330862
DOI: 10.3390/jof5030067 -
IDCases 2020Blastomycosis is a fungal infection caused by Blastomyces dermatitidis, a dimorphic fungus endemic in the soils of the Ohio and Mississippi River Vallys, Great Lakes...
Blastomycosis is a fungal infection caused by Blastomyces dermatitidis, a dimorphic fungus endemic in the soils of the Ohio and Mississippi River Vallys, Great Lakes region, and southeastern United States. It most commonly manifests as a pulmonary infection following inhalation of spores, which causes a broad array of clinical manifestations ranging from asymptomatic infection to fulminant sepsis with acute respiratory distress syndrome and death. Extrapulmonary disease occurs in approximately 25-30% of patients following hematogenous spread from the lungs, with skin being the most common site of exytrapulmonary disease. Here we present a case of disseminated blastomycosis in a healthy 48 year old female.
PubMed: 32489864
DOI: 10.1016/j.idcr.2020.e00786 -
Clinical Infectious Diseases : An... Apr 2023The dimorphic mycoses (DMs) of the United States-Histoplasma, Coccidioides, and Blastomyces-commonly known as endemic mycoses of North America (in addition to...
BACKGROUND
The dimorphic mycoses (DMs) of the United States-Histoplasma, Coccidioides, and Blastomyces-commonly known as endemic mycoses of North America (in addition to Paracoccidioides) are increasingly being diagnosed outside their historical areas of endemicity. Despite this trend, the maps outlining their geographic distributions have not been updated in more than half a century using a large, nationwide database containing individual-patient-level data.
METHODS
This was a retrospective analysis of >45 million Medicare fee-for-service beneficiaries from 1 January 2007 through 31 December 2016. Diagnoses of histoplasmosis, coccidioidomycosis, and blastomycosis were defined by International Classification of Diseases, Ninth/10th Revision, codes. The primary outcome was the incidence of histoplasmosis, coccidioidomycosis, and blastomycosis for each US county. Clinically meaningful thresholds for incidence were defined as 100 cases/100 000 person-years for histoplasmosis and coccidioidomycosis and 50 cases/100 000 person-years for blastomycosis.
RESULTS
There were 79 749 histoplasmosis, 37 726 coccidioidomycosis, and 6109 blastomycosis diagnoses in unique persons from 2007-2016 across 3143 US counties. Considering all US states plus Washington, DC, 94% (48/51) had ≥1 county above the clinically relevant threshold for histoplasmosis, 69% (35/51) for coccidioidomycosis, and 78% (40/51) for blastomycosis.
CONCLUSIONS
Persons with histoplasmosis, coccidioidomycosis, and blastomycosis are diagnosed in significant numbers outside their historical geographic distributions established >50 years ago. Clinicians should consider DM diagnoses based on compatible clinical syndromes with less emphasis placed on patients' geographic exposure. Increased clinical suspicion leading to a subsequent increase in DM diagnostic testing would likely result in fewer missed diagnoses, fewer diagnostic delays, and improved patient outcomes.
Topics: Aged; Humans; United States; Blastomycosis; Coccidioidomycosis; Histoplasmosis; Retrospective Studies; Medicare; Mycoses
PubMed: 36366776
DOI: 10.1093/cid/ciac882 -
The Pan African Medical Journal 2020Blastomycosis is a rare fungal disease in Africa which is often due to inhalation of "Blastomyces dermatitidis". Pulmonary blastomycosis is the most common clinical...
Blastomycosis is a rare fungal disease in Africa which is often due to inhalation of "Blastomyces dermatitidis". Pulmonary blastomycosis is the most common clinical manifestation which presents with a variety of clinical features, ranging from asymptomatic to rapidly fatal. We report the case of a Tunisian patient aged 35 years with no previous medical history, hospitalized with chronic cough, bilateral basithoracic pain, fever and weight loss. Clincal examination showed fever and left paravertebral subcutaneous swelling next to the tenth thoracic vertebra (T10). Chest imaging objectified bilateral alveolar and nodular opacities with excavations in some places. Sputum stain for Koch bacillus (BK) was negative (direct examination and culture). Bronchial fibroscopy was normal. Anatomopathological examination of dorsal mass biopsy revealed blastomycosis. The diagnosis was confirmed by cultures of the biopsic fragments of the mass. Antifungal therapy with itraconazole was started with clinical and radiological improvement. This case study highlights challenges in the diagnosis of blastomycosis in our country, in particular when lesions mimick tuberculosis; hence delayed therapy.
Topics: Adult; Antifungal Agents; Biopsy; Blastomycosis; Humans; Itraconazole; Lung Diseases, Fungal; Male; Tunisia
PubMed: 32963686
DOI: 10.11604/pamj.2020.36.220.21829