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Published in Gail Miriam Moraru, Jerome Goddard, The Goddard Guide to Arthropods of Medical Importance, Seventh Edition, 2019
Gail Miriam Moraru, Jerome Goddard
Clinical and laboratory manifestations of infection with HGA include fever, headache, myalgia, progressive leukopenia (often with a left shift), thrombocytopenia, and anemia. In addition, there may be moderate elevations in levels of hepatic transaminases. Sometimes there is a cough, gastroenteritis, or meningitis. Illness due to HGA is somewhat milder than with HME; reported fatality rates are about 1 and 2% for HGA and HME, respectively. Some research has indicated that both agents alter the patient’s immune system, allowing opportunistic infections such as fungal pneumonia to occur. Diagnosis depends mainly on clinical findings, although IFA tests may be used to detect antibodies against the anaplasmal agent. The gold standard serologic test is IFA performed on paired acute and convalescent sera demonstrating a fourfold rise in antibody titers. Antibodies may not be detectable in the first week of illness, so a negative test during that time does not rule out infection. Due to confusion over HGE/HGA terminology, physicians should carefully check what tests they are ordering. If HGA is suspected, physicians should make sure the test detects antibodies to Anaplasma phagocytophilum.
Bottom-Up Cell Culture Models to Elucidate Human In Vitro Biomarkers of Infection
Published in Raquel Cumeras, Xavier Correig, Volatile organic compound analysis in biomedical diagnosis applications, 2018
Michael Schivo, Mitchell M. McCartney, Mei S. Yamaguchi, Eva Borras, Cristina E. Davis
Fungal respiratory disorders often occur from inhaling airborne spores, especially during building demolitions or handling moist soil or decomposing matter. Aspergillosis, histoplasmosis, fungal pneumonia, and blastomycosis are examples of pulmonary infections by fungi. Some have symptoms that mimic non-fungal infections. For diagnostics, focus has been spent on identifying unique volatile biomarkers specific to fungal infections. Chambers et al. measured breath from healthy controls and patients infected with Aspergillus fumigatus using GC-MS. They detected 2-pentylfuran in breath from subjects with Aspergillus infections and could not associate 2-pentylfuran with healthy subjects (Chambers et al., 2009). Furthermore, breath tests for fungal infections could utilize volatile compounds only emitted by a certain type or species of fungus. This was proven plausible, as a study by Matysik et al. found that some cultured fungal species produce unique VOC signals. For example, Aspergillus fumigatus emitted butoxyethoxyethanol and 2-nonen-1-ol, which were not observed in five other types of fungi (Matysik et al., 2008). These unique VOC signatures could help establish breath-based volatile tests for specific fungal pulmonary diseases, but this area requires more effort in understanding fungal-pulmonary interactions and their effects on breath emissions.
Case 3
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
Infection is clearly the likeliest cause in this setting. The marked facial cellulitis would be compatible with a Gram-positive skin infection but an x-ray of her sinuses should also be carried out. The chest x-ray shows widespread consolidation with ring shadows. Cavitation should be carefully looked for, and, if present, would support a diagnosis of staphylococcal pneumonia. The CT scan confirms cavitation, but the nature of these peripheral, triangular and enhancing lesions is highly suggestive of a fungal pneumonia.
Updates on the profile of GenMark’s ePlex blood culture identification fungal pathogen panel
Published in Expert Review of Molecular Diagnostics, 2023
Masako Mizusawa, Karen C Carroll
Broad-range PCR and sequence-based assays use whole blood specimens and can identify a very wide range of fungal pathogens without waiting for culture growth. However, those tests are labor-intensive, often use expensive reagents and/or instrumentation and require technical expertise which is not yet suitable for routine clinical use. The direct detection of cell-free DNA in plasma by metagenomic next generation sequencing (mNGS) can also identify a very wide range of fungal pathogens and the test indications are not limited to blood stream infections. Current literature cites its use in the diagnosis of fungal pneumonia in adult and pediatric patients [58,59]. However, test interpretations are complex and require clinical context. The Karius cell-free DNA assay is also costly ($2500 per sample) and is only available through the manufacturer. Other mNGS methods currently require time-consuming and labor-intensive workflows. Other sequence-based assays including mNGS are making their way into academic institutions and reference labs that care for growing numbers of severely immunocompromised hosts such as patients with hematological malignancies and transplant recipients. The current major challenge with these approaches is in results interpretation, as the fungi detected may be saprophytes or could in fact be opportunistic pathogens causing disease. The other problem relates to not having an isolate for antifungal susceptibility testing.
Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC)
Published in Expert Review of Clinical Pharmacology, 2021
Bernardo L. Rapoport, Tim Cooksley, Douglas B. Johnson, Ronald Anderson, Vickie R. Shannon
Common clinical features of CAP include fever, productive cough, dyspnea, tachypnea, and pleuritic chest pain. Leukocytosis, bronchial breath sounds, tactile fremitus, dullness to percussion, and egophony on lung examination are supportive findings; however, they are only present in approximately one-third of patients. Leukocytosis (typically between 15,000 and 30,000 per mm3) with a leftward shift is a common finding, particularly in pneumonia of bacterial origin. Leukopenia may also be seen and portends a poor prognosis. Mucopurulent sputum is a prominent feature of bacterial pneumonia, while symptoms of coryza, symptoms and myalgias more often signal pneumonia of viral origin [139]. Lung nodules or mass-like lesions with associated adenopathy, and abnormalities of the skin, central nervous system, or bone are important clues to fungal pneumonia. However, no clear constellation of signs and symptoms is reliably predictive of any specific type of pneumonia [39]. Furthermore, impaired immune responses in the cancer setting may diminish the clinical and radiographic hallmarks of pneumonia. Thus, fever, leukocytosis, and productive cough and the characteristic radiographic findings of lobar infiltrates may be minimal or absent. Competing diagnoses that mimic pneumonia, including diffuse alveolar hemorrhage, radiation pneumonitis, drug toxicity, hydrostatic pulmonary edema, and cancer progression, are frequent challenges for the neutropenic cancer patient and should be excluded with appropriate testing.
A retrospective analysis of infections and antibiotic treatment in patients with Stevens–Johnson syndrome and toxic epidermal necrolysis
Published in Journal of Dermatological Treatment, 2020
Min Diao, Christina Thapa, Xin Ran, Yuping Ran, Xiaoyan Lv
Older patients with comorbidities, due to the combined use of powerful broad-spectrum antibiotics, are predisposed to secondary fungal infections, such as oral candidiasis, flora disorders of gastrointestinal tract, and fungal infections of respiratory and urinary tracts. These patients are prescribed local or intravenous antifungal drugs, such as oral diluent nystatin, or oral or intravenous fluconazole and itraconazole, based on the severity of infection. For patients with fungal pneumonia, it is reasonable to treat with voriconazole or echinocandin (15).