Cryptococcus
Rossana de Aguiar Cordeiro in Pocket Guide to Mycological Diagnosis, 2019
Primary skin lesion by traumatic inoculum is rare and may occur due to laboratory accidents and direct trauma (Neuville et al., 2003). Cryptococcemia or cryptoccocal fungemia may present with fever, tremors, and chills in individuals with high fungal burden that can be revealed by blood culture. Cryptococcal peritonitis occurs in individuals undergoing peritoneal dialysis or with hepatic cirrhosis. Other sites can also be infected, although less frequently, such as the subcutaneous tissue, muscle, heart, adrenal gland, thyroid, gastrointestinal tract, and lymph nodes. Infection in the genitourinary tract is usually asymptomatic, but pyelonephritis may occur, especially in diabetic patients. The elimination of the fungus by the urine is frequently observed in cases of fungemia and can be detected by culture exam (Pinto-Junior et al., 2006).
Molecular Methods for the Diagnosis of Fungal Infections
Attila Lorincz in Nucleic Acid Testing for Human Disease, 2016
Most molecular diagnostic methods described to date employ polymerase chain reaction (PCR) amplification of single or multiple gene targets and most of these methods used target sequences within the ribosomal RNA (rRNA) gene complex. This region of the fungal genome includes both highly conserved and highly variable regions, allowing the selection of either pan-fungal or species-specific amplification targets, respectively. This chapter will review methods for the extraction, purification, amplification, and detection of fungal nucleic acids from clinical materials. Experimental tests developed for the diagnosis of fungal diseases using nucleic acid amplification and detection from body fluids, tissues, and blood culture bottles inoculated with blood from patients with fungemia will be included. Clinical studies of the past 10 to 15 years examining nucleic acid-based diagnosis of invasive aspergillosis (IA) and systemic candidiasis (IC) will be reviewed. These studies are outlined in Tables 12.1 and 12.2. A limited number of clinical studies have also been conducted to evaluate the use of molecular tests for the diagnosis of fungal diseases other than IA or IC, and these are outlined in Table 12.3.
Febrile Neutropenia in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
In a cohort of 3417 patients with candidemia in Paris (3666 isolates), 1164 (34.1%) had a solid tumor (45.7% digestive tract) and 586 (17.1%) had a hematological malignancy (41.8% lymphoma and 33.5% acute leukemia) [42]. The hematology patients were significantly younger, more often pre-exposed to antifungals, more often infected by C. tropicalis, C. krusei, or C. kefyr, and more often treated in the first instance with an echinocandin. Compared with inpatients who were not in CCU at the time of fungemia, those in CCU were less frequently infected by C. parapsilosis, had more recent surgery, and died more frequently before day 8 and day 30. An increase in crude mortality over time in CCU was observed only in oncology patients [42]. In the same cohort, 338 episodes of fungemia due to uncommon yeasts were also analyzed. Thirty-five different species were identified (27 ascomycetes and 8 basidiomycetes), of which 11 had caspofungin MIC 50 >0.25 mg/L and 15 had fluconazole minimal inhibitory concentration (MIC) 50 >4 mg/L. Hematological malignancies and prior exposure to antifungal drugs were independent predisposing factors for uncommon species. Infections due to C. kefyr-related species and Trichosporon spp. remained associated with hematological malignancies, those due to the Geotrichum group were associated with acute leukemia. Infections due to Trichosporon spp. or fungus of the Geotrichum group were associated with prior exposure to caspofungin but not to fluconazole [43].
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
Use of blood samples is ideal for diagnostic assays of IFDs as the risk of venipuncture is minimal and presence of fungi in blood usually suggests true infection. Commercial molecular-based multiplex panels that test positive blood cultures based upon the presence of fungal elements visualized on Gram stain, such as the ePlex BCID-FP Panel are easy-to-use, require minimal hands-on time and can provide definitive diagnosis of fungemia in a short turnaround time. The costs of those assays are higher than conventional methods, but the costs may be off-set by earlier targeted therapy and improved clinical outcomes. As highlighted in this review, several studies have demonstrated earlier treatment modifications in up to 45% of patients using the ePlex BCID-FP assay. However, the sensitivity of blood cultures for diagnosis of IFDs is limited and the time required for fungal growth in blood cultures cannot be shortened. It is also impossible to create an exhaustive fungal pathogen panel as potential pathogens of fungemia include a variety of saprophytic and environmental fungi and new emerging fungal pathogens continue to be discovered.
Fungal Endogenous Endophthalmitis during Pregnancy as a Complication of In-Vitro Fertilization
Published in Ocular Immunology and Inflammation, 2021
Murat Hasanreisoglu, Sarakshi Mahajan, Huseyin Baran Ozdemir, Pinar Cakar Ozdal, M. Sohail Halim, Muhammad Hassan, Quan Dong Nguyen
The treatment of FEE classically includes a combination of systemic and intravitreal antifungal agents and surgery.10 Although there is no prospective study, intravitreal corticosteroids are not recommended for initial treatment. Our patient was misdiagnosed and injected intravitreal triamcinolone acetate. This treatment probably exacerbated FEE. It is very important to rule out endophthalmitis before intravitreal corticosteroid therapy in patients with uveitis. Intravitreal corticosteroids may have beneficial effects after antifungal treatment.11 Systemic therapy should be started if there is an ongoing fungemia and/or foci of fungal infection elsewhere. On the other hand, PPV together with intravitreal administration of antifungal agents are other effective options where the eye is the only infection site.12 In the current case, the possible side-effects of the drugs to the fetus were the issue of concern as safety data of many antifungals in pregnancy is limited.3 Mølgaard-Nielsen et al. reported that fluconazole is not associated with a significantly increased risk of birth defects, but it may lead to increase the risk of tetralogy of Fallot.13 Our patient did not approve the systemic therapy. She was in her first trimester of pregnancy, and in order to be on the safe side, we preferred to use intravitreal treatment for local control of Candida endogenous endophthalmitis.
Bendamustine treatment of haematological malignancies: significant risks of opportunistic viral, fungal and bacterial infections
Published in Hematology, 2022
Tony K.Y. Wu, Karen H.K. Tang, Yu-Yan Hwang, Thomas S.Y. Chan, Eric Tse, Yok-Lam Kwong
IFD was found in five patients. Notably, four patients received bendamustine as first-line treatment. IFD is unusual in patients with lymphoid malignancies undergoing first-line chemotherapy, so that anti-fungal prophylaxis is considered unnecessary [24]. However, bendamustine appears to have increased the risk of IFD. In two patients not receiving anti-fungal prophylaxis, yeast fungemia occurred. One patient had cryptococcemia, a condition typically found only in immunocompromised patients [25]. Arguably, this case might have been prevented with a simple azole such as fluconazole. In the three cases receiving anti-fungal prophylaxis, breakthrough IFDs might be caused by inherently resistant fungi. Two patients receiving echinocandin prophylaxis developed pulmonary mould infection. The rate of breakthrough invasive mould infections including invasive aspergillosis was about 5–7% in patients receiving echinocandins [26]. The third patient receiving itraconazole prophylaxis developed Candida parapsilosis fungemia. In in vitro studies, the sensitivities of Candida parapsiolosis isolates to posaconazole and voriconazole were 100% and 99%, whereas that to itraconazole was only 89% [27]. As this was the patient with CMV duodenitis/colitis where a breach of mucosal defence and multiple risk factors for IFD were found, in retrospect a more potent azole such as posaconazole or isavuconazole ought to have been used in this case.
Related Knowledge Centers
- Candida
- Candidiasis
- Cryptococcus
- Immunosuppression
- Saccharomyces
- Yeast
- Blood
- Neutropenia
- Bloodstream Infections
- Immunodeficiency