1/11. Breakthrough candidaemias during empirical therapy with fluconazole in non-cancer and non-hiv adults caused by in vitro-susceptible Candida spp.: report of 33 cases.The objective of this study was to assess risk factors and the outcome of breakthrough fungaemias (BFs) occurring during fluconazole (FLU) therapy in non-cancer and non-hiv individuals. Thirty-three fungaemias occurring during therapy with FLU among a total of 310 fungaemias observed within a 10-y national survey were analysed. The agar disk diffusion method was used for antifungal susceptibility testing and the Vitek system for species identification. Univariate and multivariate analysis was performed to determine risk factors for BF. All BFs were due to species known to be susceptible to FLU: candida albicans (25/33), C. parapsilosis (6/33) and C. guillermondii (2/33). The mean number of positive blood cultures per episode was 2.4. The MIC of Candida spp. to FLU was 0.5-8 mg/ml (all strains were susceptible in vitro). Neonatal age (< 4 weeks), very low birth weight, prior surgery, central venous catheter placement, artificial ventilation, total parenteral nutrition and C. parapsilosis were significantly related to BF in univariate analysis, but only central venous catheter placement was significantly related in multivariate analysis. However, the outcome of BFs and non-BFs was similar. All BFs occurred in non-hiv patients who were not previously treated with azoles, and were caused by in vitro FLU-susceptible species (C. albicans and C. tropicalis). Thus factors other than in vitro susceptibility play a role in BFs.- - - - - - - - - - ranking = 1keywords = candida (Clic here for more details about this article) |
2/11. pseudallescheria boydii (Anamorph scedosporium apiospermum). Infection in solid organ transplant recipients in a tertiary medical center and review of the literature.(Sca) is a ubiquitous filamentous fungus capable of causing invasive disease. We reviewed our electronic microbiology records and the English-language literature. Between 1976 and December 1999 we identified 23 solid organ transplant recipients with Sca infection, 7 of which occurred between December 1987 and December 1999 at our institution. overall incidence was 1 per 1,000 patients, with a trend of higher incidence in patients receiving lung transplants compared with other transplant organs (p = 0.06). The 23 patients included liver (4), kidney (8), heart (8), lung (2), and heart/lung (1) recipients. Male to female ratio was 19:4, and the mean age was 46 /- 12 (SD) years. Fungal infection was diagnosed at a median of 4 months (range, 0.4-156 mo) after transplant. The clinical presentation included disseminated disease ( 8), skin lesions (3), lung disease (5), endophthalmitis (1), meningitis (1), brain abscess with or without extension to eye (3), fungal mycotic aneurysm (1), and sinusitis (1). Seven (30%) patients had intravascular infection, and 11 (48%) patients had central nervous system involvement. Antifungal therapy was accompanied by surgical debridement in 9 cases. Three additional patients were found to have airway colonization only and received itraconazole prophylaxis, without evidence of disease. Of 22 patients with known outcome, 16 (72.7%) died. Five of 6 patients who survived had localized infections: skin lesions (n = 3), sinus fungus ball (n = 1), and solitary lung nodule (n = 1). All patients with disseminated disease and 10 of 11 patients with central nervous system disease died. An exception was 1 patient with a brain abscess, successfully treated with voriconazole and surgical drainage. Sca infection is rare but is associated with high mortality. early diagnosis by culture is important because Sca is resistant to amphotericin b, routinely used in the empiric therapy of invasive fungal infections. Treatment with the combination of an antifungal and surgery may have a better outcome. Voriconazole promises to be an effective antifungal agent. Cultures positive for Sca should not be ignored, and long-term antifungal prophylaxis in candidates and transplant recipients should be considered.- - - - - - - - - - ranking = 0.25keywords = candida (Clic here for more details about this article) |
3/11. Treatment of peritonitis due to Curvularia and trichosporon with amphotericin b.Fungal infection is a rare cause of peritonitis among patients receiving continuous ambulatory peritoneal dialysis. Most cases of fungal peritonitis are secondary to candida infection. Two uncommon agents of fungal peritonitis are Curvularia species and trichosporon beigelii. We report on two patients receiving peritoneal dialysis who presented for medical evaluation within a 1-week period. Fungal culture of the dialysis catheter was positive for Curvularia species in one case and for T. beigelii in the other. Both patients probably had acquired their infections through environmental contamination. Successful treatment of these infections includes removal of the peritoneal dialysis catheter and administration of intravenous amphotericin b.- - - - - - - - - - ranking = 0.25keywords = candida (Clic here for more details about this article) |
4/11. Hansenula anomala: a new fungal pathogen. Two case reports and a review of the literature.Fungal infections are characteristic of severely immunocompromised patients. Noncandidal yeasts represent a growing proportion of such infections. risk factors for developing fungal infections include the use and abuse of central venous catheters. Two patients with gynecologic malignant neoplasms became fungemic with Hansenula anomala, a yeast of the Ascomycetes class, after insertion of central venous catheters. Frequent catheter manipulation and prolonged use favored the development of fungemia in both patients. A review of the literature revealed 19 additional cases over the course of four decades, all in hosts with underlying diseases. Thirteen of these cases have been described in the last 18 months, suggesting either increased recognition or increased frequency of infection with this organism. All tested isolates have been susceptible to amphotericin b. patients have generally responded to catheter withdrawal and amphotericin b administration. Hansenula anomala is an opportunistic pathogen, whose clinical behavior resembles that of Candida species.- - - - - - - - - - ranking = 0.25keywords = candida (Clic here for more details about this article) |
5/11. acquired immunodeficiency syndrome (AIDS). Clinical, immunological, pathological, and microbiological studies of the first case diagnosed in norway.The first case of acquired immunodeficiency syndrome (AIDS) in norway, diagnosed in January 1983, is presented, with results of clinical, immunological, and microbiological studies and the results of autopsy. Immunological studies showed several immunological abnormalities, including a profound deficiency of the T-cell system of the type usually associated with AIDS. During the 11 months of symptomatic disease the patient had a series of opportunistic infections, including recurrent candida esophagitis, probable pneumocystis carinii pneumonia, and severe and recurrent perioral herpes simplex virus infection. During the last months he had increasing signs and symptoms of disseminated cytomegalovirus infection, which was probably the major cause of death, as revealed by autopsy. autopsy also showed the presence of disseminated infection with a slowly growing, so far unclassified mycobacterium species, and signs of a focal aspergillus pneumonia.- - - - - - - - - - ranking = 0.25keywords = candida (Clic here for more details about this article) |
6/11. Non-candidal infections in children with chronic mucocutaneous candidiasis.Chronic mucocutaneous candidiasis (CMCC) is a clinical syndrome characterized by persistent and recurrent candida albicans infections of the mucous membranes and skin often associated with immunodeficiency. In order to gain insight into the frequency and severity of non-candidal infections in children with CMCC, four patients with CMCC are described in detail and 60 previously reported cases are reviewed. Fifty percent of children with CMCC had significant infections with other fungi, bacteria and viruses. Recurrent bacterial pneumonias and bronchiectasis were a major cause of morbidity and mortality. In addition, there were a large number of infections, in both the lung and other sites, due to opportunistic organisms. Thus the clincial syndrome of CMCC includes not only mucocutaneous candidiasis, endocrine failure and autoimmune phenomena, but patients with CMCC also show a remarkable susceptibility to non-candidal infections. These non-candidal infections represent a serious cause of morbidity for patients with CMCC.- - - - - - - - - - ranking = 1.75keywords = candida (Clic here for more details about this article) |
7/11. trichosporon capitatum: thrush-like oral infection, local invasion, fungaemia and metastatic abscess formation in a leukaemic patient.A thrush-like oral infection with subsequent alveolar abscess formation and a positive blood culture due to trichosporon capitatum developed in a patient with acute myelogenous leukaemia. Later T. capitatum was identified by indirect immunofluorescence in multiple splenic abscesses. The infection was controlled by immediate aggressive treatment with amphotericin b, flucytosine and rifampicin and by splenectomy. This case of systemic T. capitatum infection resembles somewhat the invasive mycosis due to candida.- - - - - - - - - - ranking = 0.25keywords = candida (Clic here for more details about this article) |
8/11. Invasive sinonasal disease due to scopulariopsis candida: case report and review of scopulariopsosis.Sinonasal infection with fungi of the order mucorales--termed mucormycosis or zygomycosis--is sometimes seen in immunosuppressed patients, including those with diabetic ketoacidosis and malignancy. We describe a case of invasive sinonasal infection with scopulariopsis candida (not among the mucorales organisms) in a 12-year-old girl who was being treated for non-Hodgkin's lymphoma. Only a few cases of invasive infection with scopulariopsis species have been reported previously; five of six of these cases were associated with persistent or fatal disease. Our patient survived without undergoing radical surgical debridement and was treated with granulocyte colony-stimulating factor, amphotericin b, and itraconazole; chemotherapy was stopped. in vitro susceptibility testing of our patient's scopulariopsis isolate showed that it was resistant to amphotericin b and that it was relatively susceptible to itraconazole and miconazole. The case described herein demonstrates the expanding spectrum of fungal organisms that may cause invasive sinonasal infection in immunocompromised hosts and the need for reliable antifungal susceptibility testing.- - - - - - - - - - ranking = 1.25keywords = candida (Clic here for more details about this article) |
9/11. Idiopathic hypoparathyroidism with fungal seminal vesiculitis.A 23-year-old man was suffering from high fever and general fatigue 6 months before admission. The levels of serum Ca and intact-parathyroid hormone (PTH) were low. His brain computed tomography (CT) revealed marked calcifications of the basal ganglia, and pelvis magnetic resonance imaging (MRI) showed inflammation of his seminal vesicle. His candida antigen titer was high and antibiotic therapy was unsuccessful. High fever persisted despite fluconazole treatment, however he recovered after treatment with fluconazole and vitamin d (alfacalcitol). Idiopathic hypoparathyroidism hinders the activation of vitamin d via insufficient PTH secretion, and vitamin d has some immunological effects. His decreased natural killer (NK) cell activity improved after alfacalcitol treatment. We suggest the possible immunological effects of vitamin d in this fungal infection.- - - - - - - - - - ranking = 0.25keywords = candida (Clic here for more details about this article) |
10/11. Fine needle aspiration cytology diagnosis of a fungal lesion of the verticillium species. A case report.BACKGROUND: Fine needle aspiration (FNA) cytology has great potential for the diagnosis of fungal lesions and other opportunistic infections, the frequency of which is rising due to immunosuppression, travel and environmental exposure. However, reports on FNA diagnosis of fungal lesions are rare. CASE: A 40-year-old male juvenile diabetic presented with a 5 x 4-cm swelling over the upper part of the left arm. He had a recent history of a left nephrectomy for renal cell carcinoma followed by radiotherapy. At the time of presentation, he was also receiving chemotherapy and interferon alpha-2a for a suspected pulmonary metastasis. FNA smears from the swelling showed an inflammatory exudate rich in neutrophils and a few septate fungal hyphae that branched at acute angle. Gomori's silver methenamine stain and periodic acid-Schiff stain revealed numerous fungal hyphae. The provisional diagnosis based on the cytomorphologic features was aspergillosis. However, culture of the aspirate confirmed the fungus to be of the verticillium species. The lesion on the left arm responded to antifungal therapy, and the swelling disappeared gradually. CONCLUSION: FNA cytology was very useful in the diagnosis of a rare fungal lesion that was not clinically suspected in spite of the fact that the patient was a highly susceptible candidate for it.- - - - - - - - - - ranking = 0.25keywords = candida (Clic here for more details about this article) |
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