Postmortem analysis of invasive aspergillosis in a tertiary care hospital

Vogeser, Michael; Haas, Antje; Aust, Daniela E.; Ruckdeschel, G.

doi:10.1007/bf01575110

Cited by 48 publications

(38 citation statements)

References 19 publications

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“…The incidence of life-threatening invasive aspergillosis in immunocompromised hosts has increased dramatically over the last two decades (Groll et al, 1996;Vogeser et al, 1997;Latgé, 1999;Denning et al, 2002). Aspergillus fumigatus is the most common aetiological agent of invasive aspergillosis, being responsible for approximately 90 % of human infections (Derouin, 1994).…”

Section: Introductionmentioning

confidence: 99%

Oxidative and amphotericin B-mediated cell death in the opportunistic pathogen Aspergillus fumigatus is associated with an apoptotic-like phenotype

Mousavi

Robson

2004

Microbiology

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When protoplasts of the opportunistic fungal pathogen Aspergillus fumigatus were treated with low but toxic levels of hydrogen peroxide (0?1 mM) or amphotericin B (0?5 mg ml "1 ), loss of cell viability and death were associated with a number of phenotypic changes characteristic of apoptosis. The percentage of protoplasts staining positive with annexin V-FITC, an indicator of the externalization of phosphatidylserine and an early marker of apoptosis, rose to~55 % within 1 h. This was followed by a similar increase in apoptotic DNA fragmentation detected by the TUNEL assay, and led to a loss of cell permeability and death in~90 % of protoplasts, as indicated by the uptake of propidium iodide. The development of an apoptotic phenotype was blocked when protoplasts were pre-treated with the protein synthesis inhibitor cycloheximide, indicating active participation of the cell in the process. However, no significant activity against synthetic caspase substrates was detected, and the inclusion of the cell-permeant broad-spectrum caspase inhibitor Z-VAD-fmk did not block the development of the apoptotic-like phenotype. Higher concentrations of H 2 O 2 (1?8 mM) and amphotericin B (1 mg ml "1 ) caused protoplasts to die without inducing an apoptotic phenotype. As predicted, the fungistatic antifungal agent itraconazole, which inhibits growth without causing immediate cell death, did not induce an apoptotic-like phenotype. INTRODUCTIONThe incidence of life-threatening invasive aspergillosis in immunocompromised hosts has increased dramatically over the last two decades (Groll et al., 1996;Vogeser et al., 1997;Latgé, 1999;Denning et al., 2002). Aspergillus fumigatus is the most common aetiological agent of invasive aspergillosis, being responsible for approximately 90 % of human infections (Derouin, 1994). The incidence of invasive aspergillosis varies between 1 and 19 % for patients who have undergone solid organ transplantation (Patel & Paya, 1997;Verweij & Denning, 1997), and patients with leukaemia, AIDS and granulomatous disease are also at risk (Brown et al., 1998;Denning, 1998;Kaizer et al., 1998). In contrast, the disease is rarely found in immunocompetent hosts (Karim et al., 1997). A. fumigatus is a common, widespread saprophytic fungus, and environmental surveys indicate that humans inhale several hundred A. fumigatus conidia per day (Hospenthal et al., 1998). Ingestion and killing of spores by alveolar macrophages represent the first line of defence against infection, mainly by non-oxidative mechanisms, whilst neutrophils employ an oxidative respiratory burst to kill germinating conidia that have escaped macrophage engulfment (Schaffner et al., 1986;Levitz et al., 1986; Morgenstern et al., 1997;Roilides et al., 1998; Latgé, 2001). Invasive aspergillosis has a high mortality and morbidity rate, with only 34 % of patients showing a favourable response to antifungal therapy (Denning, 1996). The fungicidal agent amphotericin B is widely used to treat invasive aspergillosis, although it can have serious side-effect...

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Section: Introductionmentioning

confidence: 99%

Oxidative and amphotericin B-mediated cell death in the opportunistic pathogen Aspergillus fumigatus is associated with an apoptotic-like phenotype

Mousavi

Robson

2004

Microbiology

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“…16 Up to 7% patients dying in teaching hospitals have invasive aspergillosis. 17,18 Candida spp. accounts for 8%-15% of nosocomial blood stream infections and as per the study, was the fourth most common isolate among patients in the intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

Common fungal isolates from routine clinical specimens: a two years’ studyfrom a tertiary care hospital in South India

et al. 2017

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Background: Fungal infections are gaining prominence in recent years and are becoming a cause of significant morbidity as well as mortality. Reliable data from India about the spectrum of pathogens causing fungal infection in various body systems, and particularly about the antifungal susceptibility pattern of Candida spp., which is the most common isolate worldwide is not available. Methods:We prospectively studied 48,155 clinical samples submitted for fungal work-up to the microbiology laboratory at our tertiary care teaching hospital. Standard procedures were followed for fungal identification. Candida isolates were differentiated into Candida albicans and non-albicans candida (NAC) by germ tube test. Antifungal susceptibility of Candida isolates was determined by disc diffusion technique using amphotericin B (10 µg), fluconazole (25 µg), and voriconazole (1 µg) discs.Results: A total of 555 fungal isolates were obtained of which 541 were Candida spp, while the others were filamentous fungi. Male gender and age over 50 years were found to be independent risk factors. Proportion of NAC isolates (n = 384, 69.2%) were greater compared to C. albicans (n = 157, 28.3%). Aspergillus spp. was the second most frequent isolate. Azole resistance was significantly more in NAC group as compared to C. albicans. For fluconazole, 57.5% of the NAC showed resistance compared to 24.8% seen in strains of C. albicans while the corresponding figure for voriconazole was 56.8% Vs 22.9%. Overall resistance for amphotericin B was low (8.9%). Conclusions:Our observations bring to light the spectrum of common fungal isolates and their susceptibility patterns. This information will be useful for health planners and policy makers, as early institution of appropriate antifungal treatment can be life saving. Key words: Mycoses, Antifungal susceptibility testing, CandidaJayaprada R, Nagaraja M, Sumanth Kumar GLS, Venkataramana B, Kalawat U. Common fungal isolates from routine clinical specimens -A two-year study from a tertiary care hospital in South India. J Clin Sci Res 2017;6:2-9. DOI: http:// dx

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“…The number of fungi causing systemic disease is growing and the number of systemic diseases caused by fungi is increasing. Up to 7% patients dying in teaching hospitals have invasive aspergillosis 3,4,5 . Candida spp.…”

Section: Introductionmentioning

confidence: 99%

Cytodiagnosis of Dimorphic Fungi with Disseminated Infection in a HIV Positive Patient – A Diagnostic Dilemma

Yadav¹,

Nandini²,

Shruti³

et al. 2015

SJCM

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Systemic mycosis caused by fungi (or dimorphic fungi) such as Histoplasma, emmonsia, candida & penicillium has emerged as an important opportunistic fungal infection in immunocompromised patient in South-East Asia. Several cases of opportunistic fungal infection has been reported but cytological diagnosis of disseminated (dimorphic) fungal infection has been reported in very few cases. Cytological diagnosis of these infections depending on the morphological characteristics has always been a challenge to practising cytologists. A case of rare disseminated fungal infection reported in a 45 year old seropositive male who is noncompliant on ART presented with ulcer over palate, fever, weight loss, occasional per rectal bleeding. On examination having bilateral cervical lymphadenopathy and hepatomegaly. On investigation-anaemia, high ESR, deranged liver function test, CD4 count 16/cumm, USG showed hepatomegaly, underwent FNAC cervical lymphnodes and guided FNAC of liver, which showed these organisms, but no pathogens were found with classical microbiological procedure. Patient was treated with itraconazole and amphotericine and showed improvement. This case illustrate the utility of FNAC in early diagnosis & management of rare infection & it also highlight the combined role of molecular technique and FNAC as an interdisciplinary approach for management of patient.

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Postmortem analysis of invasive aspergillosis in a tertiary care hospital

Cited by 48 publications

References 19 publications

Oxidative and amphotericin B-mediated cell death in the opportunistic pathogen Aspergillus fumigatus is associated with an apoptotic-like phenotype

Oxidative and amphotericin B-mediated cell death in the opportunistic pathogen Aspergillus fumigatus is associated with an apoptotic-like phenotype

Common fungal isolates from routine clinical specimens: a two years’ studyfrom a tertiary care hospital in South India

Cytodiagnosis of Dimorphic Fungi with Disseminated Infection in a HIV Positive Patient – A Diagnostic Dilemma

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