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Cureus May 2024We describe a recent case of bioprosthetic aortic valve infective endocarditis successfully managed at our institution. This led us to perform a literature review of...
We describe a recent case of bioprosthetic aortic valve infective endocarditis successfully managed at our institution. This led us to perform a literature review of endemic fungal infective endocarditis in the United States caused by , , and . Symptoms preceded infective endocarditis diagnosis by several months. Patients with and infective endocarditis were younger with fewer comorbid conditions. Valvular involvement was relatively uncommon in infective endocarditis (27%). Fungemia was noted in patients with infective endocarditis due to (30%) and (18%). Mortality rates for infective endocarditis were high (, 46%; , 58%; , 80%); infective endocarditis was commonly diagnosed post-mortem ( 58%; 89%). Most surviving patients with infective endocarditis ( 79%; 80%) underwent valve surgery along with prolonged antifungal therapy. The two surviving patients with infective endocarditis received antifungal therapy without surgery.
PubMed: 38746483
DOI: 10.7759/cureus.60285 -
WMJ : Official Publication of the State... May 2024In presenting this case of tick-borne illness in a patient with known disseminated blastomycosis, we aim to discuss the clinical reasoning and decision-making process...
INTRODUCTION
In presenting this case of tick-borne illness in a patient with known disseminated blastomycosis, we aim to discuss the clinical reasoning and decision-making process when treating a septic presentation in a complex patient with multiple exposures and risk factors, from identifying and addressing the most devastating differentials to selecting appropriate empiric anti-infective regimens.
CASE PRESENTATION
We present the case of a 60-year-old male with a medical history of diastolic heart failure, cirrhosis, sarcoidosis, hypertension, splenectomy, and recently diagnosed disseminated blastomycosis, who developed sepsis following a recent tick exposure.
DISCUSSION
While a review of the literature revealed a paucity of cases of coexisting fungal and tick-borne illness, each is independently well-studied. Several reported commonalities exist between and , including endemic regions and at-risk populations.
Topics: Humans; Male; Blastomycosis; Middle Aged; Anaplasmosis; Diagnosis, Differential; Animals
PubMed: 38718246
DOI: No ID Found -
WMJ : Official Publication of the State... May 2024Blastomycosis is a fungal infection caused by Blastomyces dermatitidis that is hyperendemic in Wisconsin. It commonly presents as a pulmonary infection and frequently...
INTRODUCTION
Blastomycosis is a fungal infection caused by Blastomyces dermatitidis that is hyperendemic in Wisconsin. It commonly presents as a pulmonary infection and frequently disseminates to the skin. Studies evaluating the presentation and diagnosis of blastomycosis with skin as a presenting sign have not been thoroughly evaluated, and understanding the most accurate way to diagnose this infection is important for earlier therapeutic intervention.
METHODS
This is a retrospective chart review study of a single institution. Subjects were identified through a search of ICD-9 () and ICD-10 () codes for blastomycosis in the clinical record and pathology database. Patients were included if diagnosed with cutaneous blastomycosis infection or involvement of the skin from systemic infection from January 1, 2009, to June 1, 2021.
RESULTS
Twenty patients with a diagnosis of cutaneous involvement of blastomycosis were identified; 65% (n = 13) were male. Median age of diagnosis was 55.5 years. Fifty-five percent of patients were White, 35% were Black or African American. In addition to residence in an endemic area, 50% (n = 10) had exposure risk factors. Fifty percent of patients (n = 10) initially presented with a skin concerns; 65% (n = 13) had extracutaneous involvement. Diagnosis was made by histopathology alone in 55% (n = 11), culture plus histopathology in 35% (n = 7), and culture alone in 5% (n = 1) of cases.
CONCLUSIONS
Our study highlighted similarities to those previously performed. Half of the patients (n = 10) who had cutaneous involvement of blastomycosis did not demonstrate clinically significant pulmonary involvement. Histopathology and culture remain critical in diagnosing cutaneous blastomycosis.
Topics: Humans; Wisconsin; Blastomycosis; Male; Female; Retrospective Studies; Middle Aged; Adult; Aged; Risk Factors; Blastomyces
PubMed: 38718236
DOI: No ID Found -
Biomolecules & Biomedicine Apr 2024Diagnostic delay leads to poor outcomes in infections, and it occurs more often when the causative agent is unusual. Delays are attributable to failing to consider such...
Diagnostic delay leads to poor outcomes in infections, and it occurs more often when the causative agent is unusual. Delays are attributable to failing to consider such diagnoses in a timely fashion. Using routinely collected electronic health record (EHR) data, we built a preliminary multivariable diagnostic model for early identification of unusual fungal infections and tuberculosis in hospitalized patients. We conducted a two-gate case-control study. Cases encompassed adult patients admitted to 19 Mayo Clinic enterprise hospitals between January 2010 and March 2023 diagnosed with blastomycosis, cryptococcosis, histoplasmosis, mucormycosis, pneumocystosis, or tuberculosis. Control groups were drawn from all admitted patients (random controls) and those with community-acquired infections (ID-controls). Development and validation datasets were created using randomization for dividing cases and controls (7:3), with a secondary validation using ID-controls. A logistic regression model was constructed using baseline and laboratory variables, with the unusual infections of interest outcome. The derivation dataset comprised 1043 cases and 7000 random controls, while the 451 cases were compared to 3000 random controls and 1990 ID-controls for validation. Within the derivation dataset, the model achieved an area under the curve (AUC) of 0.88 (95% confidence interval [CI]: 0.87-0.89) with a good calibration accuracy (Hosmer-Lemeshow P = 0.623). Comparable performance was observed in the primary (AUC = 0.88; 95% CI: 0.86-0.9) and secondary validation datasets (AUC = 0.84; 95% CI: 0.82-0.86). In this multicenter study, an EHR-based preliminary diagnostic model accurately identified five unusual fungal infections and tuberculosis in hospitalized patients. With further validation, this model could help decrease time to diagnosis.
PubMed: 38643478
DOI: 10.17305/bb.2024.10447 -
Clinical Medicine & Research Mar 2024To determine if host genetics may be a risk factor for severe blastomycosis. A cohort of patients who had contracted blastomycosis underwent targeted SNP (single...
To determine if host genetics may be a risk factor for severe blastomycosis. A cohort of patients who had contracted blastomycosis underwent targeted SNP (single nucleotide polymorphism) genotyping. The genetics of these patients were compared to a set of age and gender-matched controls and between patients with severe versus mild to moderate blastomycosis. The Marshfield Clinic Health System in central and northern Wisconsin Patients with a diagnosis of blastomycosis prior to 2017 were contacted for enrollment in this study. A phone hotline was also set up to allow interested participants from outside the Marshfield Clinic Health System to request enrollment. SNP frequency was assessed for significant differences between the patient cohort and controls and between patients with severe versus mild to moderate blastomycosis. We also tested the effect of species identified in clinical isolates on disease symptoms and severity. No significant differences were found in SNP frequency between cases and controls or between those with severe or mild to moderate blastomycosis. We did detect significant differences in symptom frequency and disease severity by species. Our study did not identify any genetic risk factors for blastomycosis. Instead, the species of causing the infection had a significant effect on disease severity.
Topics: Humans; Blastomycosis; Blastomyces; Genotype; Ambulatory Care Facilities; Hotlines
PubMed: 38609141
DOI: 10.3121/cmr.2024.1880 -
MMWR. Morbidity and Mortality Weekly... Mar 2024Coccidioidomycosis, histoplasmosis, and blastomycosis are lower respiratory tract fungal infections whose signs and symptoms can resemble those of other respiratory...
Coccidioidomycosis, histoplasmosis, and blastomycosis are lower respiratory tract fungal infections whose signs and symptoms can resemble those of other respiratory illnesses, including pneumonia caused by bacterial or viral etiologies; this overlap in clinical presentation might lead to missed or delayed diagnoses. The causative fungi live in the environment, often in soil or plant matter. To describe the epidemiologic characteristics of cases of coccidioidomycosis, histoplasmosis, and blastomycosis during the COVID-19 pandemic, CDC analyzed case surveillance data for 2019-2021. During this period, a total of 59,655 coccidioidomycosis cases, 3,595 histoplasmosis cases, and 719 blastomycosis cases were reported to CDC. In 2020, fewer cases of each disease occurred in spring compared with other seasons, and most cases occurred in fall; national seasonality is not typically observed, and cases were seasonally distributed more evenly in 2019 and 2021. Fewer cases coinciding with the start of the COVID-19 pandemic, along with an unusually high blastomycosis case fatality rate in 2021 (17% compared with more typical rates of 8%-10%), suggest that the pandemic might have affected patients' health care-seeking behavior, public health reporting practices, or clinical management of these diseases. Increased awareness and education are needed to encourage health care providers to consider fungal diseases and to identify pneumonia of fungal etiology. Standardized diagnostic guidance and informational resources for fungal testing could be incorporated into broader respiratory disease awareness and preparedness efforts to improve early diagnosis of coccidioidomycosis, histoplasmosis, and blastomycosis.
Topics: Humans; United States; Blastomycosis; Histoplasmosis; Coccidioidomycosis; Pandemics; COVID-19; Respiratory Tract Infections
PubMed: 38512795
DOI: 10.15585/mmwr.mm7311a2 -
Open Forum Infectious Diseases Mar 2024Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical... (Review)
Review
BACKGROUND
Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical presentation, and outcomes of 5 endemic mycoses in SOT recipients.
METHODS
Multiple databases were reviewed from inception through May 2023 using key words for endemic fungi (eg, coccidioidomycosis or histoplasmosis or etc). We included adult SOT recipients and publications in English or with English translation.
RESULTS
Among 16 cohort studies that reported on blastomycosis (n = 3), coccidioidomycosis (n = 5), histoplasmosis (n = 4), and various endemic mycoses (n = 4), the incidence rates varied, as follows: coccidioidomycosis, 1.2%-5.8%; blastomycosis, 0.14%-0.99%; and histoplasmosis, 0.4%-1.1%. There were 204 reports describing 268 unique cases of endemic mycoses, including 172 histoplasmosis, 31 blastomycosis, 34 coccidioidomycosis, 6 paracoccidioidomycosis, and 25 talaromycosis cases. The majority of patients were male (176 of 261 [67.4%]). Transplanted allografts were mostly kidney (192 of 268 [71.6%]), followed by liver (n = 39 [14.6%]), heart (n = 18 [6.7%]), lung (n = 13 [4.9%]), and combined kidney-liver and kidney-pancreas (n = 6 [2.7%]). In all 5 endemic mycoses, most patients presented with fever (162 of 232 [69.8%]) and disseminated disease (179 of 268 [66.8%]). Cytopenias were frequently reported for histoplasmosis (71 of 91 [78.0%]), coccidioidomycosis (8 of 11 [72.7%]) and talaromycosis (7 of 8 [87.5%]). Graft loss was reported in 12 of 136 patients (8.8%). Death from all-causes was reported in 71 of 267 (26.6%); half of the deaths (n = 34 [50%]) were related to the underlying mycoses.
CONCLUSIONS
Endemic mycoses commonly present with fever, cytopenias and disseminated disease in SOT recipients. There is a relatively high all-cause mortality rate, including many deaths that were attributed to endemic mycoses.
PubMed: 38444820
DOI: 10.1093/ofid/ofae036 -
Open Forum Infectious Diseases Mar 2024Invasive fungal disease caused by dimorphic fungi is associated with significant morbidity and mortality. Super-bioavailability itraconazole (SUBA-itra) is a novel...
BACKGROUND
Invasive fungal disease caused by dimorphic fungi is associated with significant morbidity and mortality. Super-bioavailability itraconazole (SUBA-itra) is a novel antifungal agent with pharmacokinetic advantages over currently available formulations. In this prospective comparative study, we report the outcomes of patients with endemic fungal infections (histoplasmosis, blastomycosis, coccidioidomycosis, and sporotrichosis).
METHODS
This open-label randomized trial evaluated the efficacy, safety, and pharmacokinetics SUBA-itra compared with conventional itraconazole (c-itra) treatment for endemic fungal infections. An independent data review committee determined responses on treatment days 42 and 180.
RESULTS
Eighty-eight patients were enrolled for IFD (SUBA-itra, n = 42; c-itra, n = 46) caused by (n = 51), (n = 18), (n = 13), or (n = 6). On day 42, clinical success was observed with SUBA-itra and c-itra on day 42 (in 69% and 67%, respectively, and on day 180 (in 60% and 65%). Patients treated with SUBA-itra exhibited less drug-level variability at days 7 ( = .03) and 14 ( = .06) of randomized treatment. The concentrations of itraconazole and hydroxyitraconazole were comparable between the 2 medications ( = .77 and = .80, respectively). There was a trend for fewer adverse events (AEs; 74% vs 87%, respectively; = .18) and serious AEs (10% vs 26%; = .06) in the SUBA-itra-treated patients than in those receiving c-itra. Serious treatment-emergent AEs were less common in SUBA-itra-treated patients (12% vs 50%, respectively; < .001).
CONCLUSIONS
SUBA-itra was bioequivalent, well tolerated, and efficacious in treating endemic fungi, with a more favorable safety profile than c-itra.
CLINICAL TRIALS REGISTRATION
NCT03572049.
PubMed: 38440302
DOI: 10.1093/ofid/ofae010 -
Journal of Investigative Medicine High... 2024is a dimorphic fungus that can range from mild to severe disease presentation, including the acute respiratory distress syndrome (ARDS) based on the individual's...
is a dimorphic fungus that can range from mild to severe disease presentation, including the acute respiratory distress syndrome (ARDS) based on the individual's immunity. Acute respiratory distress syndrome is an uncommon presentation having an incidence of about 10% to 15% but has a high mortality exceeding 90%. This is a case of a 50-year-old female with past medical history of asthma and type 2 diabetes mellitus who presented to the pulmonology clinic with worsening dyspnea for the last 2 months. She also had a lesion in the left lower back, which was draining purulent fluid. Chest radiographs showed bilateral infiltrates and was started empirically on vancomycin and piperacillin-tazobactam. Bronchoalveolar lavage was done and the cultures grew The patient was moved to a higher level of care and given amphotericin B. Unfortunately, the patient experienced septic shock, which later deteriorated into cardiac arrest, ultimately leading to their passing. The importance of early diagnosis of blastomycosis and timely treatment has been emphasized in this case report.
Topics: Female; Humans; Middle Aged; Blastomycosis; Diabetes Mellitus, Type 2; Amphotericin B; Blastomyces; Respiratory Distress Syndrome
PubMed: 38375745
DOI: 10.1177/23247096241233042