- Klíčová slova
- abdominální katastrofa,
- MeSH
- antibakteriální látky * farmakokinetika klasifikace terapeutické užití MeSH
- antifungální látky klasifikace terapeutické užití MeSH
- břišní dutina patologie MeSH
- lidé MeSH
- nitrobřišní infekce * etiologie farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.
- MeSH
- antifungální látky * terapeutické užití MeSH
- COVID-19 * imunologie komplikace MeSH
- dospělí MeSH
- fatální výsledek MeSH
- koinfekce mikrobiologie farmakoterapie imunologie MeSH
- lidé MeSH
- mykózy farmakoterapie mikrobiologie imunologie diagnóza MeSH
- nitrily terapeutické užití MeSH
- popálení komplikace mikrobiologie MeSH
- pyridiny terapeutické užití MeSH
- Saccharomycetales genetika účinky léků imunologie MeSH
- SARS-CoV-2 imunologie MeSH
- sepse farmakoterapie mikrobiologie imunologie MeSH
- triazoly terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Kontext: Kvasinka rodu Candida je vzácnou, ale významnou příčinou infekční endokarditidy. Cílem studie bylo zjistit klinické údaje pacientů s kandidovou endokarditidou léčených na kardiologickém a kardiochirurgickém oddělení jedné nemocnice v letech 2012 až 2023. Metody: Dokumentace pacientů s diagnózou infekční endokarditidy byla prohlédnuta retrospektivně. Sledovaly se demografické údaje, anamnéza, klinické údaje a informace o výsledném stavu a léčbě. Výsledky: Čtyři (29 %) ze 14 pacientů byly ženy, v 10 (71 %) případech se jednalo o muže. Průměrný věk byl 49,7 (± 8,82) roku. Průměrná délka hospitalizace byla 39 dní (33–130 dní). Postiženo bylo 5 (38 %) aortálních chlopní, 2 (15 %) aortální + mitrální chlopně, 3 (23 %) mitrální chlopně, ve 2 (16 %) případech byla příčinou vegetace na elektrodě a v 1 (7 %) případě vegetace na plicní chlopni. Ze základních onemocnění trpělo 5 (35 %) pacientů diabetes mellitus, 5 (35 %) bylo na hemodialýze a 4 (30 %) měli kardiostimulátor. Jeden (7 %) pacient prodělal transplantaci srdce, další transplantaci jater. Sedmi (50 %) pacientům byla implantována umělá chlopeň a 7 (50 %) biologická chlopeň. Mikrobiologické vyšetření prokázalo v 8 (57 %) přípa- dech přítomnost C. parapsilosis, v 5 (35 %) C. albicans a v 1 (7 %) případě C. tropicalis. V 7 (50 %) případech byla provedena výměna chlopně. Ve vzorku odebraném z chlopně jednoho pacienta prokázala kultivace přítomnost C. albicans. Fluconazol byl podáván 6 (43 %) pacientům a echinokandiny v 8 (57 %) případech. V průběhu jednoletého sledování zemřelo 6 (43 %) pacientů. Vyšetření magnetickou rezonancí prokázalo embolii v centrálním nervovém systému u 6 (43 %) pacientů. Závěry: Kandidová endokarditida je spojena s vysokou mortalitou, přitom nejvhodnější způsob léčby lze vzhledem k jejímu vzácnému výskytu velmi obtížně formulovat.
Background: Candida is a rare but important cause of infective endocarditis. The study aimed to describe clinical data on patients with Candida endocarditis treated in cardiology and cardiovascular surgery hospital between 2012-2023. Methods: Patients diagnosed with infective endocarditis were reviewed retrospectively. Demographic information, medical histories, clinical data, and information on outcome and treatment were presented. Results: Four (29%) of 14 patients were female, and 10 (71%) were male. The mean age was 49.7 (±8.82) years. The mean hospital stay was 39 days (33-130 days). The valves involved were 5 (38%) aortic valves, 2 (15%) aortic + mitral valves, 3 (23%) mitral valves, 2 (16%) vegetation on the lead, and 1 (7%) in the pulmonary valve. In the underlying diseases, 5 (35%) had diabetes mellitus, 5 (35%) had hemodialysis, and 4 (30%) had pacemakers. One (7%) of the patients had a heart transplant, and 1 had a liver transplant. Seven (50%) had a prosthetic valve, and 7 (50%) had a natural valve. The detected microbiological factors are: 8 (57%) had Candida parapsilosis (C. parapsilosis), 5 (35%) Candida albicans (C. albicans ) and 1 (7%) Candida tropicalis (C. tropicalis). There was a valve change in 7 (50%) of them. C. albicans grew in the valve culture of one patient. Fluconazole was used in 6 patients (43%), and echinocandins were used in 8 (57%) patients. Six patients (43%) died during 1-year follow-up. Embolism in the central nervous system was detected in 6 patients (43%) on magnetic resonance imaging (MRI). Conclusions: Candida endocarditis has a high mortality, and it is not easy to define the most appropriate treatment because of its rarity.
In children with acute lymphoblastic leukemia (ALL), risk groups for invasive fungal disease (IFD) with need for antifungal prophylaxis are not well characterized, and with the advent of new antifungal compounds, current data on outcome are scarce. Prospectively captured serious adverse event reports of children enrolled in the international, multi-center clinical trial AIEOP-BFM ALL2009 were screened for proven/probable IFD, defined according to the updated EORTC/MSG consensus definitions. In a total of 6136 children (median age 5.2 years), 224 proven/probable IFDs (65 yeast and 159 mold) were reported. By logistic regression, the risk for proven/probable IFDs was significantly increased in children ≥12 years and those with a blast count ≥10% in the bone marrow on day 15 (P < 0.0001 each). Proven/probable IFDs had a 6-week and 12-week mortality of 10.7% and 11.2%, respectively. In the multivariate analysis, the hazard ratio for event-free and overall survival was significantly increased for proven/probable IFD, age ≥12 years, and insufficient response to therapy (P < 0.001, each). Our data define older children with ALL and those with insufficient treatment-response at high risk for IFD. As we show that IFD is an independent risk factor for event-free and overall survival, these patients may benefit from targeted antifungal prophylaxis.
- MeSH
- akutní lymfatická leukemie * komplikace farmakoterapie MeSH
- antifungální látky terapeutické užití MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mykózy * farmakoterapie etiologie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
Cryptococcus neoformans is an encapsulated yeast that can cause cryptococcosis and cryptococcal meningitis, which conventional treatment involves antifungal drugs such as polyenes, flucytosine, azoles, and their combinations. However, the high cost, toxicity, and increase in fungi resistance to antifungal agents stimulate the search for therapeutic strategies such as drug repurposing and combination therapy. This study evaluated the activity of the antihypertensive verapamil (VEH) alone and combined with amphotericin B (AmB) against C. neoformans. VEH exhibited antifungal activity against C. neoformans with minimum inhibitory concentration and minimum fungicidal concentration of 118 μg per mL. The combination of VEH and AmB exhibited synergism, reducing at least eightfold both drugs' concentrations. Moreover, the combination decreased the size and glucuronoxylomannnan content of C. neoformans capsule. However, no difference was observed in ergosterol levels of C. neoformans after treatment with VEH and AmB in combination. Altogether, VEH in combination with AmB exhibits potential as a candidate as for the development of anti-cryptococcal drug.
- MeSH
- amfotericin B farmakologie terapeutické užití MeSH
- antifungální látky farmakologie terapeutické užití MeSH
- Cryptococcus neoformans * MeSH
- flucytosin farmakologie terapeutické užití MeSH
- kryptokokóza * farmakoterapie mikrobiologie MeSH
- mikrobiální testy citlivosti MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- vulvovaginální diskomfort,
- MeSH
- antibakteriální látky farmakologie terapeutické užití MeSH
- antifungální látky farmakologie terapeutické užití MeSH
- antivirové látky farmakologie terapeutické užití MeSH
- bakteriální vaginóza farmakoterapie MeSH
- benzydamin farmakologie terapeutické užití MeSH
- Candida albicans patogenita účinky léků MeSH
- herpes genitalis farmakoterapie patologie MeSH
- lidé MeSH
- probiotika terapeutické užití MeSH
- trichomoniáza farmakoterapie patologie MeSH
- vulvovaginitida * etiologie farmakoterapie MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Our multicentre study aims to identify baseline factors and provide guidance for therapeutic decisions regarding Magnusiomyces-associated infections, an emerging threat in patients with haematological malignancies. METHODS: HM patients with proven (Magnusiomyces capitatus) M. capitatus or (Magnusiomyces clavatus) M. clavatus (formerly Saprochaete capitata and Saprochaete clavata) infection diagnosed between January 2010 and December 2020 were recorded from the SEIFEM (Sorveglianza Epidemiologica Infezioni nelle Emopatie) group and FungiScope (Global Emerging Fungal Infection Registry). Cases of Magnusiomyces fungemia were compared with candidemia. RESULTS: Among 90 Magnusiomyces cases (60 [66%] M. capitatus and 30 (34%) M. clavatus), median age was 50 years (range 2-78), 46 patients (51%) were female and 67 (74%) had acute leukaemia. Thirty-six (40%) of Magnusiomyces-associated infections occurred during antifungal prophylaxis, mainly with posaconazole (n = 13, 36%) and echinocandins (n = 12, 34%). Instead, the candidemia rarely occurred during prophylaxis (p < .0001). First-line antifungal therapy with azoles, alone or in combination, was associated with improved response compared to other antifungals (p = .001). Overall day-30 mortality rate was 43%. Factors associated with higher mortality rates were septic shock (HR 2.696, 95% CI 1.396-5.204, p = .003), corticosteroid treatment longer than 14 days (HR 2.245, 95% CI 1.151-4.376, p = .018) and lack of neutrophil recovery (HR 3.997, 95% CI 2.102-7.601, p < .001). The latter was independently associated with poor outcome (HR 2.495, 95% CI 1.192-5.222, p = .015). CONCLUSIONS: Magnusiomyces-associated infections are often breakthrough infections. Effective treatment regimens of these infections remain to be determined, but neutrophil recovery appears to play an important role in the favourable outcome.
- MeSH
- antifungální látky terapeutické užití MeSH
- dítě MeSH
- dospělí MeSH
- echinokandiny terapeutické užití MeSH
- hematologie * MeSH
- kandidemie * farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- předškolní dítě MeSH
- prognóza MeSH
- senioři 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
- multicentrická studie MeSH
- Klíčová slova
- isavuconazol,
- MeSH
- akutní myeloidní leukemie komplikace mikrobiologie MeSH
- antifungální látky * klasifikace terapeutické užití MeSH
- invazivní mykotické infekce farmakoterapie mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mykózy etiologie farmakoterapie klasifikace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Among the co-infectious agents in COVID-19 patients, Aspergillus species cause invasive pulmonary aspergillosis (IPA). IPA is difficult to diagnose and is associated with high morbidity and mortality. This study is aimed at identifying Aspergillus spp. from sputum and tracheal aspirate (TA) samples of COVID-19 patients and at determining their antifungal susceptibility profiles. A total of 50 patients with COVID-19 hospitalized in their intensive care units (ICU) were included in the study. Identification of Aspergillus isolates was performed by phenotypic and molecular methods. ECMM/ISHAM consensus criteria were used for IPA case definitions. The antifungal susceptibility profiles of isolates were determined by the microdilution method. Aspergillus spp. was detected in 35 (70%) of the clinical samples. Among the Aspergillus spp., 20 (57.1%) A. fumigatus, six (17.1%) A. flavus, four (11.4%) A. niger, three (8.6%) A. terreus, and two (5.7%) A. welwitschiae were identified. In general, Aspergillus isolates were susceptible to the tested antifungal agents. In the study, nine patients were diagnosed with possible IPA, 11 patients were diagnosed with probable IPA, and 15 patients were diagnosed with Aspergillus colonization according to the used algorithms. Serum galactomannan antigen positivity was found in 11 of the patients diagnosed with IPA. Our results provide data on the incidence of IPA, identification of Aspergillus spp., and its susceptibility profiles in critically ill COVID-19 patients. Prospective studies are needed for a faster diagnosis or antifungal prophylaxis to manage the poor prognosis of IPA and reduce the risk of mortality.
- MeSH
- antifungální látky farmakologie terapeutické užití MeSH
- Aspergillus MeSH
- COVID-19 * komplikace MeSH
- invazivní plicní aspergilóza * diagnóza farmakoterapie komplikace MeSH
- lidé MeSH
- plicní aspergilóza * diagnóza farmakoterapie komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
