Abstract:Comprehensive data on emerging invasive fungal infections (EIFIs) in the critically ill are scarce. We conducted a case-control study to characterize EIFIs in patients admitted to a French medical ICU teaching hospital from 2006 to 2019. Among 6900 patients, 26 (4 per 1000) had an EIFI: Mucorales accounted for half, and other isolates were mainly Saprochaete, Fusarium and Scedosporium. EIFIs occurred mostly in patients with immunosuppression and severe critical illness. Antifungal treatments (mainly amphoteric… Show more
“…The patient’s immunological status (i.e., low mHLA-DR and high PD-1 lymphocyte expression) allowed us to target the innate and adaptive component of immunity dysfunction using both IFN-γ and nivolumab as previously reported in a young patient who died from refractory mucormycosis after sustaining bomb blast injuries [ 5 ]. Data on the control of such invasive infections and outcomes in ICU patients are scarce [ 7 , 8 ], although we can hypothesise that such immunotherapy has improved the anti-fungi response as described in the case of Turnbull et al [ 1 ].…”
“…The patient’s immunological status (i.e., low mHLA-DR and high PD-1 lymphocyte expression) allowed us to target the innate and adaptive component of immunity dysfunction using both IFN-γ and nivolumab as previously reported in a young patient who died from refractory mucormycosis after sustaining bomb blast injuries [ 5 ]. Data on the control of such invasive infections and outcomes in ICU patients are scarce [ 7 , 8 ], although we can hypothesise that such immunotherapy has improved the anti-fungi response as described in the case of Turnbull et al [ 1 ].…”
“…(6) Invasive fungal infections (IFIs) by molds in general are an emerging condition in critically ill patients, with associated mortality rates that can be up to 70%. (7)The most common etiologic agents are Aspergillus or Mucorales spp. ; however, infections by less common molds such as Fusarium and Scedosporium spp., have been reported.…”
Background: Disseminated disease by species in the Scedosporium genus are rare in immunocompetent patients, and have not been reported in the context of severe SARS Cov-2 infection.
Case presentation: A retired, 41-year-old police officer with a history of obesity and arterial hypertension presented to emergency department with acute respiratory hypoxemic failure due to severe SARS-Cov2 pneumonia. He used to practice home aquarium care, biking, river swimming, and fishing. He reported no recent travel to the sea, lakes, or caves. He required prolonged mechanical ventilation, and had several documented episodes of ventilator-associated pneumonia due to Pseudomonas aeruginosa and Klebsiella pneumoniae, which later evolved to necrotizing pneumonia, multiple lung abscesses, bronchopleural fistula, empyema and subpleural abscess. Despite sedation withdrawal he remained unconscious; a brain MRI revealed multiple brain abscesses. Scedosporium boydii was isolated from both lung and brain abscess cultures. In addition to percutaneous drainage of lung abscesses, he was treated with combined therapy with voriconazole and liposomal amphotericin B, considering a possible synergic effect. Drainage of the multiple brain abscesses was not feasible; thus, radiological progression was documented, leading to the patient´s demise despite five weeks of treatment.
Conclusion: Invasive fungal infections (IFIs) by molds are an emerging condition in patients with COVID-19. Cases of aspergillosis, candidiasis and mucormycosis were increasingly reported during the COVID-19 pandemic. This is the first report of a fatal disseminated infection due to Scedosporium boydii preceded by a severe SARS Cov-2 infection.
“…The common pathogens of deep fungal infections are Aspergillus and Cryptococcus rank after Candida ( 3 ). In recent years, some rare filamentous fungi such as Mucor and Fusarium have been reported from time to time in patients with hematological malignancies and bone marrow transplantation ( 11 ). In this study, we conducted a retrospective analysis of the status of deep fungal infections in the First Affiliated Hospital of Kunming Medical University from January 2015 to December 2019.…”
BackgroundDeep fungal infection is a type of life-threatening opportunistic infection. Its incidence has been increasing in recent years. This infection can affect the prognosis of patients, prolong hospital stays and raise costs for patients and their families.ObjectiveWe aimed to understand the current situation of deep fungal infections in the First Affiliated Hospital of Kunming Medical University and to provide a basis for the clinical diagnosis and treatment of deep fungal infections.MethodsThis was a retrospective analysis of 528,743 cases in the hospital from 2015 to 2019, including the epidemiological characteristics, treatment and prognosis of deep fungal infections.ResultsA total of 274 cases (0.05%) with deep fungal infections were identified, accounting for 0.05% of the total number of hospitalizations. The incidence of deep fungal infections in the hospital showed an increasing trend from 2015 to 2019. The most commonly infected site was the respiratory tract (93.07%). Among patients with deep fungal infections, 266 specimens were positive for fungal culture, by which 161 cultured Candida albicans (C. albicans), accounting for 60.53%, the main pathogen causing deep fungal infection. From 2015 to 2019, the percentage of C. albicans cases showed a downward trend, while that of non-C. albicans showed an opposite trend. Antibiotics were the most common predisposing factor for deep fungal infections (97.45%). Among the underlying diseases of patients with deep fungal infections, infectious diseases (59.49%) were the most common. Those with underlying diseases such as renal insufficiency and neurological diseases had a worse prognosis. Indwelling catheters, nervous system disease and tumors were risk factors for a poor prognosis.ConclusionsWe report for the first time the epidemiological data of deep fungal infections in a general hospital in southwestern China from 2015 to 2019. In the past 5 years, the number of patients with deep fungal infections in the First Affiliated Hospital of Kunming Medical University has been increasing. Although the clinical data are limited, these results can provide references for the diagnosis and treatment of deep fungal infections.
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