Atypical Infections in Tsunami Survivors

Garzoni, Christian; Emonet, Stéphane; Legout, L.; Rilliet, Bénédict; Hoffmeyer, Pierre; Bernard, Louis; Garbino, Jorge

doi:10.3201/eid1110.050715

Cited by 81 publications

(72 citation statements)

References 7 publications

(8 reference statements)

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“…Infectious lesions in organs other than the CNS have been reported in 13 of the 21 cases, including in the lung (7 of 21, usually manifested as bronchopneumonia) (78,109,110,179,216,283,448), kidney (3 of 21) (108,110,283), eye (3 of 21, manifested as endophthalmitis or chorioretinitis) (110,283,473), musculoskeletal system (2 of 21, manifested as knee joint synovitis, femoral and tibial osteomyelitis, or spondylodiscitis) (110,144), heart (2 of 21) (108, 110), liver (283), skin (erythematous lesions with purplish-black necrotic centers in arms and abdomen) (110), and thyroid gland (110).…”

Section: Epidemiology Of Human Infectionsmentioning

confidence: 99%

“…The delay in diagnosis together with the previous lack of antifungal drugs with potent activity against P. boydii and good penetration into the CNS may explain the poor outcome of these infections, with a survival rate of 33% (seven cases) among those reviewed. Among the patients who survived, two were treated with high doses of the older azole miconazole (110) and five with voriconazole, alone or in combination with other agents, together with surgical intervention (abscess drainage) when needed (77,78,144,306). The role of voriconazole and newer antifungal agents in the treatment of pseudallescheriasis is discussed more exten-sively in Treatment and Outcomes of Scedosporiosis below.…”

Section: Epidemiology Of Human Infectionsmentioning

confidence: 99%

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Infections Caused byScedosporiumspp

et al. 2008

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SUMMARY Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.

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Section: Epidemiology Of Human Infectionsmentioning

confidence: 99%

Section: Epidemiology Of Human Infectionsmentioning

confidence: 99%

Infections Caused byScedosporiumspp

et al. 2008

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“…The respiratory tract, particularly in ventilated patients (6.9% of hospital-acquired pneumonias in 2003 based on NNIS data), the urinary tract, intravascular devices, surgical sites (including in postneurosurgical meningitis patients), and decubitus or diabetic ulcers are favored sites of infection (4,25,44). A. baumannii has also been described to cause infections outside the health care setting, namely, severe community-acquired pneumonia (usually in alcoholics) (2,3,8) and infections in U.S. service members with war-related injuries (most recently, those injured in the Iraq/Kuwait/Afghanistan regions) (7,12,13,24,39) and in survivors of the Asian tsunami in 2004 (19,28). Mortality rates associated with A. baumannii infection range from 19 to 54% (20).…”

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confidence: 99%

The K1 Capsular Polysaccharide of Acinetobacter baumannii Strain 307-0294 Is a Major Virulence Factor

et al. 2010

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Acinetobacter baumannii is a pathogen of increasing medical importance with a propensity to be multidrug resistant, thereby making treatment challenging. Little is known of virulence traits in A. baumannii. To identify virulence factors and potential drug targets, random transposon (Tn) mutants derived from the A. baumannii strain AB307-0294 were screened to identify genes essential for growth in human ascites fluid in vitro, an inflammatory exudative fluid. These studies led to the identification of two genes that were predicted to be required for capsule polymerization and assembly. The first, ptk, encodes a putative protein tyrosine kinase (PTK), and the second, epsA, encodes a putative polysaccharide export outer membrane protein (EpsA). Monoclonal antibodies used in flow cytometric and Western analyses confirmed that these genes are required for a capsule-positive phenotype. A capsule-positive phenotype significantly optimized growth in human ascites fluid, survival in human serum, and survival in a rat soft tissue infection model. Importantly, the clearance of the capsule-minus mutants AB307.30 (ptk mutant, capsule minus) and AB307.45 (epsA mutant, capsule minus) was complete and durable. These data demonstrated that the K1 capsule from AB307-0294 was an important protectin. Further, these data suggested that conserved proteins, which contribute to the capsule-positive phenotype, are potential antivirulence drug targets. Therefore, the results from this study have important biologic and translational implications and, to the best of our knowledge, are the first to address the role of capsule in the pathogenesis of A. baumannii infection.

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“…4 Infections that develop 24 to 48 h aft er natural disasters are usually opportunistic, acquired as a direct result of trauma. 5 Infections that arise 1 to 4 weeks aft er the event are mostly due to food-, water-, and airborne transmissions. Acute respiratory infections are also frequent, especially in conditions where overcrowding develops.…”

mentioning

confidence: 99%