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Nihon Ishinkin Gakkai Zasshi = Japanese... 2008Fungal keratitis is one of the most challenging types of microbial keratitis for the ophthalmologist to diagnose and treat. Fungi causing human keratitis take the form...
Fungal keratitis is one of the most challenging types of microbial keratitis for the ophthalmologist to diagnose and treat. Fungi causing human keratitis take the form of either yeasts or mold. Candida, the major pathogenic yeasts, can be detected in the normal ocular surface flora. Preceding ocular surface disorder, the wearing of contact lenses and the use of antibiotic/steroid eye drops may lead to candida keratitis. Infectious focus caused by Candida tends to melt the corneal stroma. Keratitis caused by mold often develops after an injury caused by soil and/or a plant. Mold can reach the anterior chamber without destroying the stromal layer of the cornea, which results in distinctive clinical features such as endothelial plaque and hyphate ulcer. Fungal keratitis needs to be managed by antifungal agents, most of which must be prepared by ourselves to apply to the ocular surface. Candida keratitis should be managed with azoles. If the infection seems to be caused by mold, several antifungal drugs including pimaricin, which is the only agent officially applicable to the eye, should be used. Some cases of mold keratitis need to have therapeutic penetrating keratoplasty because of their lack of response to intensive medication. Mold causing keratitis is variegated. Fusarium and Aspergillus can reach the intraocular space rapidly. Alternaria and some other unclassified molds remain in the superficial layer of the cornea for a long time. Our experiments indicate that the progress of focus in the cornea is regulated by the receptiveness of mold against temperature.
Topics: Endophthalmitis; Female; Humans; Keratitis; Middle Aged; Mycoses
PubMed: 18689966
DOI: 10.3314/jjmm.49.175 -
Clinical Microbiology and Infection :... Sep 2010Both acquired and congenital immunodeficiencies may be associated with increased susceptibility to invasive fungal infections (IFIs), depending on the type of immune... (Review)
Review
Both acquired and congenital immunodeficiencies may be associated with increased susceptibility to invasive fungal infections (IFIs), depending on the type of immune deficit. IFIs frequently occur in patients with phagocytic and cellular immune defects, but are rarely observed in those with humoral or complement deficits. Among congenital immune disorders, chronic granulomatous disease and hyper-IgE syndrome are most frequently associated with IFIs; variable susceptibility to fungal pathogens is also seen in patients with severe combined immunodeficiency, X-linked hyper-IgM syndrome, Wiskott-Aldrich syndrome, DiGeorge syndrome, common variable immunodeficiency, defects in the interferon-γ-interleukin-12 axis, and myeloperoxidase deficiency. Aspergillus, Candida, Cryptococcus, Histoplasma and other fungal genera are variably implicated in causing invasive infections in these patients. Prompt diagnosis of IFIs in this patient population requires a high degree of suspicion, together with a knowledge of their clinical presentation and the limitations of diagnostic modalities. Apart from administration of appropriate antifungal agents, successful management often requires the addition of surgical intervention. Adjunctive immunotherapy may be considered, although this has not been systematically studied. Prophylactic interferon-γ and itraconazole administration have been shown to reduce the risk of IFIs in patients with chronic granulomatous disease; however, the possibility of infections with azole-resistant organisms following long-term itraconazole prophylaxis should not be overlooked.
Topics: Antifungal Agents; Chemoprevention; Fungi; Humans; Immunologic Deficiency Syndromes; Mycoses; Surgical Procedures, Operative
PubMed: 20840542
DOI: 10.1111/j.1469-0691.2010.03289.x -
Pneumologie (Stuttgart, Germany) May 2010Recognition of and therapy for fungal infections of the lungs still presents problems even for the experienced clinician. The distinction between invasive mycoses of the... (Review)
Review
Recognition of and therapy for fungal infections of the lungs still presents problems even for the experienced clinician. The distinction between invasive mycoses of the lungs and fungal colonisations that do not require therapy is cinically difficult and can often not be made satisfactorily even with advanced microbiological diagnostics. One must differentiate between a primary, often locally limited, endemic pulmonary mycosis and a pulmonary mycosis against the background of a locally or systemically compromised immune system. Patients at risk include those with advanced HIV infections, patients under long-term antibiotic therapy as well as oncological and multimorbid patients. The pulmonary manifestation of a mycosis may not only be the starting point for a systemic dissemination but can also arise in the course of hematogenous spread of the infection. The latter can appear, for example, as an invasive pulmonary aspergillosis in immunesuppressed patients. Thus, early clinical, radiological and biological confirmation of the diagnosis is essential in order to avoid the possible complications of pulmonary mycosis.
Topics: Blastomycosis; Coccidioidomycosis; Endemic Diseases; Geography; Histoplasmosis; Humans; Immunosuppression Therapy; Lung Diseases, Fungal; Mycoses; Opportunistic Infections; Radiography; Risk Factors
PubMed: 20455177
DOI: 10.1055/s-0029-1244004 -
Diseases of Aquatic Organisms Nov 2010Effective and safe treatments of amphibian chytridiomycosis, caused by Batrachochytrium dendrobatidis (Bd), are needed to prevent mortality in captive programs, reduce... (Review)
Review
Effective and safe treatments of amphibian chytridiomycosis, caused by Batrachochytrium dendrobatidis (Bd), are needed to prevent mortality in captive programs, reduce the risk of disease spread, and better manage the disease in threatened wild populations. Bd is susceptible to a range of antifungal agents and low levels of heat (>30 degrees C) when tested in vitro, but there are few proven methods for clearing adult amphibians of Bd, and acute drug toxicity is a problem for tadpoles and juveniles. In postmetamorphic animals, heat (32 and 37 degrees C) is the only well-supported treatment. Antifungal drugs have not undergone rigorous testing--for example, trials were small or lacked controls and thorough post-treatment testing. In addition, pharmacokinetic studies have not been performed so there are no data on blood or tissue levels of antifungal agents. However, itraconazole baths have been widely used in amphibian rescue and conservation programs and anecdotal evidence suggests that they are effective for adults and subadults. In an experimental trial with tadpoles, a low dose of itraconazole cleared Bd but may have been associated with cutaneous depigmentation. Fluconazole appeared safe for tadpoles as it did not cause mortality, and future attempts to find an effective dose may be worthwhile. Palliative restoration of blood sodium and potassium levels by administration of electrolyte solutions appears useful in frogs with clinical chytridiomycosis. Randomised and blinded clinical trials, which include basic pharmacological studies, are urgently needed to provide comparable evidence for the safety and efficacy of treatment options which are likely to vary with amphibian species. Priorities are to validate and optimize the use of heat and itraconazole regimes.
Topics: Amphibians; Animals; Antifungal Agents; Chytridiomycota; Clinical Trials as Topic; Hot Temperature; Mycoses
PubMed: 21268978
DOI: 10.3354/dao02238 -
Revue Scientifique Et Technique... Dec 2013Chytridiomycosis, which is caused by Batrachochytrium dendrobatidis, is an emerging infectious disease of amphibians. The disease is one of the main causes of the global... (Review)
Review
Chytridiomycosis, which is caused by Batrachochytrium dendrobatidis, is an emerging infectious disease of amphibians. The disease is one of the main causes of the global decline in amphibians. The aetiological agent is ubiquitous, with worldwide distribution, and affects a large number of amphibian species in several biomes. In the last decade, scientific research has substantially increased knowledge of the aetiological agent and the associated infection. However, important epidemiological aspects of the environment-mediated interactions between the aetiological agent and the host are not yet clear. The objective of the present review is to describe chytridiomycosis with regard to the major features of the aetiological agent, the host and the environment.
Topics: Amphibians; Animals; Chytridiomycota; Disease Susceptibility; Global Health; Mycoses
PubMed: 24761737
DOI: 10.20506/rst.32.2.2210 -
Actas Dermo-sifiliograficas Dec 2016The deep mycoses are uncommon in our setting. These fungal infections occur mainly in immunosuppressed patients or in tropical climates, and include subcutaneous... (Review)
Review
The deep mycoses are uncommon in our setting. These fungal infections occur mainly in immunosuppressed patients or in tropical climates, and include subcutaneous infections and systemic infections. The skin is always involved in the former. In the first part of this review, we describe the main subcutaneous mycoses: sporotrichosis, chromoblastomycosis, mycetoma, phaeohyphomycosis, hyalohyphomycosis, and lacaziosis. Early recognition and treatment is important, as these infections are frequently associated with high morbidity.
Topics: Dermatomycoses; Humans; Subcutaneous Tissue
PubMed: 27374381
DOI: 10.1016/j.ad.2016.05.017 -
Clinical Microbiology and Infection :... Jun 2014Although considered to be a rare infection, mucormycosis (zygomycosis) has emerged as the second most common invasive mould infection. Despite the advent of newer... (Review)
Review
Although considered to be a rare infection, mucormycosis (zygomycosis) has emerged as the second most common invasive mould infection. Despite the advent of newer antifungal agents, mortality rate of mucormycosis remains exceedingly high. Successful management of mucormycosis requires early diagnosis, reversal of underlying predisposing risk factors, surgical debridement and prompt administration of active antifungal agents. However, mucormycosis is not always amenable to cure. There are challenging obstacles that lead to difficulties in management of amphotericin B. These include unique host-based risk factors for mucormycosis, the fungus' resistance to innate host defences and distinctive features of its immunopathogenesis, such as extensive angioinvasion, increased virulence and use of chelators by the fungus as siderophores. In addition to these obstacles, the difficulties in early diagnosis, including nonspecific clinical manifestations, lack of serological methods, as well limitations of culture and molecular methods, lead to delay in initiation of antifungal therapy. Finally, the variability of susceptibility to amphotericin B and resistance to most other conventional antifungal agents leads to major limitations in successful treatment of this devastating infection.
Topics: Antifungal Agents; Humans; Mucormycosis; Mycoses; Risk
PubMed: 24279587
DOI: 10.1111/1469-0691.12466 -
Mycopathologia Apr 2020Fungal disease is an increasingly recognised global clinical challenge associated with high mortality. Early diagnosis of fungal infection remains problematic due to the... (Review)
Review
Fungal disease is an increasingly recognised global clinical challenge associated with high mortality. Early diagnosis of fungal infection remains problematic due to the poor sensitivity and specificity of current diagnostic modalities. Advances in sequencing technologies hold promise in addressing these shortcomings and for improved fungal detection and identification. To translate such emerging approaches into mainstream clinical care will require refinement of current sequencing and analytical platforms, ensuring standardisation and consistency through robust clinical benchmarking and its validation across a range of patient populations. In this state-of-the-art review, we discuss current diagnostic and therapeutic challenges associated with fungal disease and provide key examples where the application of sequencing technologies has potential diagnostic application in assessing the human 'mycobiome'. We assess how ready access to fungal sequencing may be exploited in broadening our insight into host-fungal interaction, providing scope for clinical diagnostics and the translation of emerging mycobiome research into clinical practice.
Topics: Computational Biology; Fungi; High-Throughput Nucleotide Sequencing; Host Microbial Interactions; Humans; Metagenomics; Mycobiome; Mycoses; Pathology, Molecular
PubMed: 31894501
DOI: 10.1007/s11046-019-00413-z -
Therapeutische Umschau. Revue... 2016
Review
Topics: Diagnosis, Differential; Female; Humans; Male; Mycological Typing Techniques; Mycoses; Pathology, Molecular; Pelvic Infection
PubMed: 27731790
DOI: 10.1024/0040-5930/a000817 -
European Journal of Clinical... Jan 2015The aim of this study was to compare the utility of BACTEC™ Mycosis-IC/F (Mycosis), BACTEC™ Plus Aerobic/F (Aerobic), and BACTEC™ Plus Anaerobic/F (Anaerobic)... (Comparative Study)
Comparative Study
The aim of this study was to compare the utility of BACTEC™ Mycosis-IC/F (Mycosis), BACTEC™ Plus Aerobic/F (Aerobic), and BACTEC™ Plus Anaerobic/F (Anaerobic) media in the detection of fungi from simulated (obtained by the inoculation of tested media first with sterile sheep's blood and subsequently with one of 60 clinical yeast isolates) and clinical blood samples, taken during routine diagnostic examination in two hospitals. All tested strains grew on Mycosis as well as Aerobic bottles, and the time to detection obtained for Mycosis was significantly shorter (p < 0.05). The largest differences in the time to positivity was found for Candida glabrata and Cryptococcus neoformans, when Mycosis preceded Aerobic in 20-48 h (mean 35.5 h) and 0.7-64 h (mean 24 h), respectively. On the contrary, C. krusei were detected earlier in Aerobic media. In clinical samples, the detection of C. glabrata was also significantly faster in Mycosis than in Aerobic (29.22 ± 11.48 h compared to 86 ± 40 h). The media complement each other and, in 45% of clinical examination sets, a single positive medium was noted (25% in Mycosis and 19% in Aerobic). The study proved that both Aerobic and Mycosis media serve as the correct condition for the culture of fungi and that they varied significantly in the detection time of clinically important species. This result could suggest that the simultaneous use of Aerobic as well as Mycosis media may improve the time of diagnosis in many patients, especially those infected with C. glabrata or C. neoformans.
Topics: Culture Media; Fungi; Humans; Microbiological Techniques; Mycoses; Time Factors
PubMed: 25098681
DOI: 10.1007/s10096-014-2218-4