Deep Fungal Infection- An Emerging Problem in Bangladesh

Abstract

Objective: Invasive deep fungal infections have become a major cause of morbidity and mortality over the pastthree decades. Organ transplantation, the use of aggressive chemotherapy and the availability and widespreaduse of immunosuppressive treatments for many medical ailments have resulted in large populations ofpatients who are at risk of fungal infections. We report our experience to increase awareness of the clinicalspectrum of disseminated fungal infection and its similarity to other infections and malignancy.Materials and Methods: Case reports from different medical institution for last 6 months were searched throughcase registry and recent scientific presentation and publications.Results: Recently a case of Histoplasmosis was reported in Dhaka Medical College Hospital (DMCH) wherea 57 years old male presented with low grade fever for 3 months, backache followed by progressiveweakness of both lower limbs , there was spastic paraplegia with sensory loss upto the level of D10. An openbiopsy from paravertebral soft tissue showed histopathological features consistent with histoplasmosis. Otherdeep fungal infections e.g. pulmonary blastomycoses, mucormycoses and pulmonary aspergilloma were alsoreported in DMCH and Bangabandhu Shiekh Mujib Medical University (BSMMU) and RMCH.Conclusion: As these fungal infections are not commonly encountered in our country and most of the disseminationhas similar clinical features of chronic inflammatory process and malignancy, we need a high index of suspicion todiagnose with different diagnostic approach. Bangladesh may be experiencing increase load of disseminated fungalinfections and awareness is now very important to explore its underlying aetiology.Keywords: Endemic mycoses; histoplasmosis; blastomycosis; mucormycosis; aspergilloma; BangladeshDOI: 10.3329/jom.v11i2.5466J MEDICINE 2010; 11 : 170-175

Concomitant fungal and <i>Mycobacterium bovis</i> infections in beef cattle in Kenya

“…In the present report, the fungi occurred concurrently with tuberculosis in 16.4% of the cases and separately in 17% of the cases. Clinically, dimorphic fungi mimic tuberculosis (Borges-Walmsley et al 2002;Parvin et al 2010) and chronic systemic mycoses caused by dimorphic fungi may therefore be confused with tuberculosis during ante-mortem examination of animals. Examination of acidfast stained smears of post-mortem specimens can, however, provide a preliminary diagnosis of mycobacterial disease (OIE 2009).…”

“…It is noteworthy that climatic conditions similar to those in the presumed endemic regions of South and Central America occur in northern Kenya. Although B. dermatitidis infections are most common in dogs and humans in North America, some isolated cases have been reported in Africa, Israel, India and Bangladesh (Carman et al 1989;Parvin et al 2010;Rouhou et al 2008).…”

Fungal Infection: A Recent Concern for Physician

“…Most of the disseminated infections have similar clinical features of chronic inflammatory process and malignancy, so a high index of suspicion is required to diagnose the cases. 6 . A recently published article "Burden of serious fungal infections in Bangladesh" showed prevalence of 30,178 people with chronic pulmonary aspergillosis, 80% attributable to TB and an anticipated 90,262 and 119,146 patients have allergic bronchopulmonary aspergillosis or severe asthma with fungal sensitization.…”

Hepatic Histoplasmosis: An Update

“…11 Deep mycoses are also an important evolving problem, as evidenced by reports of 16 cases of histoplasmosis with varying clinical manifestations. 12,13 Isolated hepatic histoplasmosis is an uncommon condition; liver involvement is commonly associated with disseminated histoplasmosis. H. capsulatum has been recovered from soil of the Gangetic plains.…”