Invasive fungal infections are infections of importance and are increasing in incidence in immunocompromised hosts such as patients who have had hematopoietic stem cell and solid organ transplants. Despite our expanded antifungal armamentarium, these infections cause considerable morbidity and mortality. Indeed, certain trends have emerged in these invasive fungal infections: a rise in the incidence of invasive mold infections, an increase in the non-albicans strains of Candida spp. causing invasive disease and, finally, the emergence of less susceptible fungal strains that are resistant to the broader-spectrum antifungal agents due to overutilization of these agents. Clinicians must recognize the patient groups that are potentially at risk for these invasive fungal infections, as well as the risk factors for such infections. By using more sensitive nonculture-based diagnostic techniques, appropriate therapy may be initiated earlier to enhance survival in these immunocompromised patient populations.
Neurologic complications have long been associated with influenza. A novel strain of influenza A (H1N1) first described in humans to have outbreak potential in 2009 in Mexico went on to become the first influenza pandemic of this century. We evaluated the neurologic complications of the novel influenza A (H1N1) 2009 in children and adults admitted to all public hospitals in Singapore during the influenza A (H1N1) 2009 pandemic between May 2009 and March 2010. All patients were positive for novel H1N1 infection and presented with neurologic symptoms prior to oseltamivir treatment. Ninety-eight patients (median age 6.6 years, range 0.4-62.6) were identified; 90 % were younger than 18 years; 32 % suffered from preexisting neurological, respiratory, or cardiac disease; and 66 % presented with seizures. Of those presenting with seizures, new onset seizures were the most common manifestation (n = 40, 61.5 %), followed by breakthrough seizures (n = 18, 27.7 %) and status epilepticus (n = 7, 10.8 %). Influenza-associated encephalopathy occurred in 20 %. The majority of children (n = 88) presented with seizures (n = 63, 71.6 %), encephalopathy (n = 19, 21.6 %), and syncope (n = 4, 4.5 %). Among adults, a wider range of neurological conditions were seen, with half of them presenting with an exacerbation of their underlying neurological disease. The neurological symptoms developed at a median of 2 days after the onset of systemic symptoms. The median length of hospital stay was 3 days, and 79 % were monitored in general wards. Neurologic complications associated with the novel influenza A (H1N1) 2009 strain were generally mild and had a good outcome. They occurred more frequently in patients with underlying neurological disorders. Seizures and encephalopathy were the most common manifestations, similar to other influenza virus strains.
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