OBJECTIVES: To evaluate risk factors, diagnostic procedures, and treatment outcomes of invasive aspergillosis (IA) in patients with hematological malignancies. METHODS: A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was performed. RESULTS: We identified 176 IA cases that mainly occurred in patients with acute leukemias (58.5%), mostly those on induction/re-induction treatments (39.8%). Prolonged neutropenia was the most frequent risk factor for IA (61.4%). The lungs were the most frequently affected site (93.8%) and computed tomography detected abnormalities in all episodes; however, only 53.7% of patients had findings suggestive of IA. Galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (positive in 79.1% and 78.8% of episodes, respectively) played a crucial role in IA diagnosis. Neutrophil count and antifungal prophylaxis did not influence the GM positivity rate, but empirical therapy decreased this rate (in serum). Of the IA cases, 53.2% responded to initial antifungal therapy. The combination of voriconazole and echinocandin, even as initial or salvage therapy, did not perform better than voriconazole monotherapy (p=0.924 for initial therapy and p=0.205 for salvage therapy). Neutrophil recovery had a significant role in the response to initial (but not salvage) antifungal therapy. CONCLUSIONS: Our retrospective analysis identified key diagnostic and treatment characteristics, and this understanding could improve the management of hematological malignancy patients with IA.
- MeSH
- akutní nemoc MeSH
- antifungální látky imunologie terapeutické užití MeSH
- aspergilóza diagnóza farmakoterapie epidemiologie MeSH
- bronchoalveolární lavážní tekutina MeSH
- databáze faktografické MeSH
- dítě MeSH
- dospělí MeSH
- echinokandiny terapeutické užití MeSH
- leukemie diagnóza farmakoterapie epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mannany krev MeSH
- mladiství MeSH
- mladý dospělý MeSH
- neutrofily cytologie MeSH
- plicní mykózy diagnóza farmakoterapie epidemiologie MeSH
- předškolní dítě MeSH
- pyrimidiny terapeutické užití MeSH
- retrospektivní studie MeSH
- senioři MeSH
- triazoly terapeutické užití MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
Auxarthron is a genus within the Onygenales encompassing keratinophilic species with typical ascomata (gymnothecia) consisting of anastomosing network of thick-walled hyphae and small globose or oblate ascospores. No association of this genus with clinically relevant cases of human or animal infection has been reported. This paper describes the isolation of an undescribed Auxarthron species as an agent of proven onychomycosis affecting almost all fingernails in a man with psoriasis. The causality of the isolated fungus was verified by repeated sampling and direct microscopy revealing irregular septate hyphae. Based on micro- and macromorphological features and unique sequence data (ITS region, benA and RPB2 gene), the isolated fungus is proposed as the new species A. ostraviense. The sibling species of A. ostraviense, A. umbrinum, was isolated from three patients with suspected onychomycosis and a detailed clinical history is provided for one of these patients. All four isolates were tested for susceptibility to selected antifungal agents. Terbinafine and clotrimazole appear to be effective in vitro. The morphological identification of Auxarthron spp. is non-trivial, time-consuming and requires cultivation media other than Sabouraud glucose agar which is routinely used in dermatomycology.
- MeSH
- antifungální látky farmakologie MeSH
- DNA fungální chemie genetika MeSH
- dospělí MeSH
- fungální proteiny genetika MeSH
- klotrimazol farmakologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mezerníky ribozomální DNA chemie genetika MeSH
- mikrobiální testy citlivosti MeSH
- molekulární sekvence - údaje MeSH
- naftaleny farmakologie MeSH
- onychomykóza mikrobiologie MeSH
- Onygenales klasifikace genetika izolace a purifikace MeSH
- psoriáza komplikace MeSH
- sekvenční analýza DNA MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
A collection of 178 Aspergillus isolates, recovered from Czech patients, mostly from 2007-2011, was subjected to multilocus DNA sequence typing using the ITS region, β-tubulin, and calmodulin genes. An unusually wide spectrum of etiologic agents that included 36 species of Aspergillus is discussed in the context of recent taxonomic and clinical reports. Invasive aspergillosis (IA), onychomycosis, and otitis externa were the predominant clinical entities. Five cases due to species newly proven as etiologic agents of human mycoses, as well as cases with unique clinical manifestations caused by unusual agents are discussed in more detail. Three species (i.e., A. insulicola, A. westerdijkiae and A. tritici) were identified as the confirmed etiologic agents of non-dermatophytic onychomycosis. Emericella rugulosa was recovered from a premature newborn with a fatal necrotising disseminated infection and is reported for only the second time as the cause of IA. Furthermore, we document the first infection due to A. calidoustus in a patient with chronic granulomatous disease. The infection manifested as a latent brain aspergilloma with an unusual clinical-laboratory finding. In addition to the well-known agents of human mycosis, several rarely isolated or poorly documented species were identified. An undescribed cryptic species related to A. versicolor was found to be common among isolates linked to proven and probable onychomycosis. An isolate representing A. fresenii, or an unnamed sister species, were causal agents of otomycosis. Three well defined, and tentative new species belonging to section Cervini, Candidi and Aspergillus (Eurotium spp.), were associated with cases of probable onychomycosis.
- MeSH
- Aspergillus klasifikace genetika izolace a purifikace patogenita MeSH
- aspergilóza farmakoterapie epidemiologie mikrobiologie MeSH
- DNA fungální analýza genetika MeSH
- Emericella genetika izolace a purifikace patogenita MeSH
- geny hub MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrobiologické techniky metody MeSH
- mladiství MeSH
- novorozenec nedonošený MeSH
- novorozenec MeSH
- onychomykóza farmakoterapie epidemiologie mikrobiologie MeSH
- otitis externa mikrobiologie MeSH
- sekvenční analýza DNA metody MeSH
- tubulin genetika MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
Stanovení in vitro citlivosti mikromycet k antifungálním látkám nabývá na významu se vzrůstajícím výskytem mykotických infekcí a rozšiřující se paletou antifungálních preparátů. V posledních letech byly standardizovány metody vhodné k testování citlivosti kvasinek a vláknitých mikromycet k antimykotikům a došlo i k rozšíření nabídky komerčně dodávaných souprav pro stanovení citlivosti odvozených od těchto standardů. V článku je uváděn přehled standardizovaných mikrodilučních kvantitativních metod, metodika diskových difúzních testů a hodnocení komerčně dostupných testů vhodných pro rutinní použití v mykologických laboratořích. Pro vysokou korelaci se standardy CLSI je doporučován Etest, jehož propracovaná metodika včetně interpretace zaručují kvalitní a vzájemně reprodukovatelné výsledky. Pro posouzení farmakokinetiky je doporučováno stanovení hladin antimykotik v séru pacienta.
With the rising incidence of fungal infections and a widening range of antifungal agents, determining the in vitro susceptibility of microfungi to antifungals is increasingly important. Recent years have seen standardization of methods suitable for testing the susceptibility of yeasts and filamentous fungi to antifungals and a wider choice of commercially supplied kits for determining susceptibility derived from those standards. The texts surveys standard microdilution quantitative methods, disk diffusion tests and assessment of commercially available tests suitable for routine use in mycology laboratories. The Etest is recommended for its high correlation with the CLSl standards and sophisticated methodology including interpretation, which guarantees high quality and reproducible results. To assess pharmacokinetics, determination of antifungal levels in the patient's serum is recommended.
