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Paracoccidioidomycosis (PCM) is an endemic fungal disease that occurs in Latin America and primarily affects humans. The disease has been rarely documented in non-human primates. This report details a disseminated and fatal case of PCM caused by Paracoccidioides brasiliensis in a western black-handed tamarin (Saguinus niger) under human care. Histopathological examination revealed extensive pyogranulomatous inflammation in the lungs, spleen, liver, lymph nodes, kidneys, epididymis, right testicle, heart, adrenal gland and intestines, associated with characteristic yeast forms consistent with Paracoccidioides spp and confirmed by immunohistochemistry. Molecular analysis indicated a high nucleotide similarity with P. brasiliensis sequences for both the 18S rRNA and gp43 genes. This naturally occurring infection highlights the susceptibility of these animals to PCM and their role in ecoepidemiology warrants further investigation.
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Doenças dos Macacos , Paracoccidioidomicose , Saguinus , Animais , Paracoccidioidomicose/veterinária , Doenças dos Macacos/microbiologia , Doenças dos Macacos/patologia , Masculino , ParacoccidioidesRESUMO
BACKGROUND: Lobomycosis is a rare cutaneous tropical neglected disease caused by the fungal agent Lacazia loboi, recently renamed Paracoccidioides lobogeorgii. Our objectives were to present all cases of lobomycosis diagnosed in French Guiana, to offer a precise description of their histopathological features and to propose a new clinico-histological prognostic classification. METHODS: All cases of lobomycosis diagnosed in French Guiana between 1959 and 2022 were included. We looked for associations between the occurrence of relapses and the clinic-histological form. RESULTS: 31 patients diagnosed with lobomycosis were included. An epidemiological shift was observed in the 2000s as Brazilian patients became the most important ethnic group. Gold mining, forestry and fishing/sailing were reported as professional exposures. New histological features, such as inflammatory "rosettes" formations were described. We describe two clinic-histological patterns: a major form (high fungal density and/or multifocal lesions) and a minor form (low fungal density, unifocal lesions, association with fewer relapses). CONCLUSIONS: The changing epidemiology of lobomycosis in French Guiana is characterized by a shift towards Brazilian patients, mostly gold miners. Minor forms should be treated with surgery, major forms with a combination of surgery followed by nultiple drug therapy (MDT) or posaconazole.
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We present a patient referred for investigation of adrenal insufficiency, confirmed due to disseminated paracoccidioidomycosis (PCM), with abdominal and central nervous system (CNS) involvement. Establishing the pathogenesis and immunological processes involved in chronic or latent infections by PCM has been challenging. Medical doctors caring for patients with immunodeficiencies should learn about these fungal infections to properly guide travel planning and have this possibility in the diagnostic arsenal when the patient returns from endemic areas. After 13 months of treatment, the patient showed good clinical evolution, and we repeated imaging exams, showing partial improvement of the preview lesions. Diagnosis and treatment can prevent catastrophic events.
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La enfermedad fúngica invasora (EFI) es una de las principales causas de morbimortalidad en los pacientes pediátricos inmunocom- prometidos. Los hongos que con mayor frecuencia causan EFI en este grupo de pacientes corresponden a especies de Candida y Aspergillus. Sin embargo, en los últimos años se ha descrito un aumento de patógenos no clásicos, tales como Fusarium, Scedosporium, Mucorales, Cryptococcus, Trichosporon, entre otros. Se presenta un caso de EFI por Trichosporon asahii en un preescolar con una leucemia linfo- blástica aguda en quimioterapia de inducción. Además, se presenta una revisión actualizada de la literatura especializada, con énfasis en la importancia del diagnóstico precoz y el tratamiento antifúngico específico.
Invasive fungal disease (IFD) is one of the leading causes of morbidity and death among immunosuppressed pediatric patients. The fungi that most frequently cause IFD in this group of patients correspond to Candida and Aspergillus species, however, in recent years an increase in non-classical pathogens, such as Fusarium, Scedosporium, Mucorales, Cryptococcus, Trichosporon, among others. A case of invasive fungal disease caused by Trichosporon asahii is presented in a preschool patient with acute lymphoblastic leukemia in induction stage. This review highlights the importance of active search for pathogens in immunosuppressed patients, and proposes a specific treatment.
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Humanos , Masculino , Pré-Escolar , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Tricosporonose/complicações , Infecções Fúngicas Invasivas , Trichosporon/isolamento & purificação , Tricosporonose/diagnóstico , Tricosporonose/microbiologia , Tricosporonose/tratamento farmacológico , Antifúngicos/uso terapêuticoRESUMO
Pediatric invasive fungal rhinosinusitis (PIFR) is a rapidly progressive, potentially fatal disease. Previous medical literature demonstrates that its early diagnosis significantly reduces the risk of mortality in these patients. This study aims to present an updated clinical algorithm for optimized diagnosis and management of PIFR. A comprehensive review was conducted with only original, full-text articles published in English and Spanish from Cochrane Library, Pub-Med/MEDLINE, Embase, Scopus, and Google Scholar between January 2010 and June 2022. Relevant information was extracted and then integrated to develop a clinical algorithm for a proper diagnosis and management of PIFR.
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Feline sporotrichosis is a zoonotic mycosis caused by fungi belonging to the Sporothrix schenckii complex. In the state of Ceará, there are no reports of isolation of this fungus in cats. This study presents the first report of feline sporotrichosis caused by the species Sporothrix brasiliensis in the state of Ceará - Brazil. The diagnosis was made through cytopathological examination, mycological culture and PCR. The findings were compatible with feline sporotrichosis caused by Sporothrix brasiliensis.
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Aspergillosis is a mycosis, most commonly affecting the airways. This mycosis can worsen the clinical condition of patients with concurrent lung diseases. We assayed for the presence of serum anti-A. fumigatus IgG in bronchiectasis patients from a tertiary hospital in south Brazil and evaluated the relationship with clinical outcome. Thirty-one patients with bronchiectasis, without cystic fibrosis, were included. Clinical and epidemiological data were collected from all participants. Positive serological tests were detected in 13% (4/31) of the patients. The mortality rate for the year following the assay was, in the seropositive group, 75% (3/4), whereas in the seronegative group, 15% (4/27). An illustrative case is also shown and discussed. Our study highlights the diagnostic challenge and the possible impact of Aspergillus infection on these patients, indicating the necessity of more and larger investigations in the field.
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Aspergilose , Bronquiectasia , Fibrose Cística , Humanos , Bronquiectasia/complicações , Imunoglobulina G , Aspergilose/diagnóstico , Brasil/epidemiologiaRESUMO
Crop fungal diseases constitute a major cause of yield loss. The development of crop disease monitoring and forecasting tools is an important effort to aid farmers in adapting to climate variability and change. Recognizing weather as a main driver of fungal disease outbreaks, this work assesses the climate suitability for wheat blast (Magnaporthe oryzae pathotype Triticum, MoT) development in Asian wheat-producing countries. MOT was reported for the first time in Bangladesh in 2016 and could spread to other countries, provided that environmental conditions are suitable to spore development, distribution, and infection. With results from a generic infection model driven by air temperature and humidity, and motivated by the necessity to assess the potential distribution of MoT based on the response to weather drivers only, we quantify potential MOT infection events across Asia for the period 1980-2019. The results show a potential higher incidence of MOT in Bangladesh, Myanmar, and some areas of India, where the number of potential infection (NPI) events averaged up to 15 during wheat heading. Interannual trends show an increase in NPI over those three countries, which in turns show their higher interannual variability. Cold/dry conditions in countries such as Afghanistan and Pakistan appear to render them unlikely candidates for MOT establishment. The relationship between seasonal climate anomalies and NPI suggests a greater association with relative humidity than with temperature. These results could help to focus future efforts to develop management strategies where weather conditions are conducive for the establishment of MOT.
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Magnaporthe , Triticum , Triticum/microbiologia , Doenças das Plantas/microbiologia , Paquistão/epidemiologia , Mudança ClimáticaRESUMO
INTRODUCTION: Stewardship programs have been developed to optimize the use of antibiotics, but programs focusing on antifungal agents are less frequent. OBJECTIVE: To evaluate the quality of antifungal prescriptions in a tertiary care hospital, and to test if a simple educational activity could improve the quality of prescriptions. METHODS: The study comprised three phases: 1) Retrospective audit of all antifungal prescriptions in a 6-month period, applying a score based on six parameters: indication, drug, dosage, route of administration, microbiologic adequacy after results of cultures, switching to an oral agent, and duration of treatment; 2) Creation of text boxes in the electronic medical records with information about antifungal agents, shown during prescription; 3) Retrospective audit of all antifungal prescriptions in a 6-month period, applying the same 6-parameters score, and comparison between the two periods. RESULTS: Among 333 prescriptions, fluconazole was the most frequently (80.5%) prescribed agent. Hematology (26.7%), Infectious Diseases Department (22.8%), Internal Medicine (15.9%) and Intensive Care Unit (14.4%) were the units with most antifungal prescriptions. The median score for the 333 prescriptions was 8.0 (range 0 - 10), and 72.7% of prescriptions were considered inappropriate. The median and mean scores in the first and second audit were 8.0 and 6.9, and 8.0 and 7.9, respectively (p<0.001). All items that comprised the score improved from the first to the second audit. Likewise, there was a reduction of inappropriate prescriptions (80.2% in the first audit vs. 64.6% in the second audit, p=0.001). CONCLUSIONS: A large proportion of inappropriate prescriptions was observed, which improved with the implementation of simple educational activities.
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Antifúngicos , Prescrição Inadequada , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Prescrições de Medicamentos , Humanos , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
Abstract Introduction Stewardship programs have been developed to optimize the use of antibiotics, but programs focusing on antifungal agents are less frequent. Objective To evaluate the quality of antifungal prescriptions in a tertiary care hospital, and to test if a simple educational activity could improve the quality of prescriptions. Methods The study comprised three phases: 1) Retrospective audit of all antifungal prescriptions in a 6-month period, applying a score based on six parameters: indication, drug, dosage, route of administration, microbiologic adequacy after results of cultures, switching to an oral agent, and duration of treatment; 2) Creation of text boxes in the electronic medical records with information about antifungal agents, shown during prescription; 3) Retrospective audit of all antifungal prescriptions in a 6-month period, applying the same 6-parameters score, and comparison between the two periods. Results Among 333 prescriptions, fluconazole was the most frequently (80.5%) prescribed agent. Hematology (26.7%), Infectious Diseases Department (22.8%), Internal Medicine (15.9%) and Intensive Care Unit (14.4%) were the units with most antifungal prescriptions. The median score for the 333 prescriptions was 8.0 (range 0 - 10), and 72.7% of prescriptions were considered inappropriate. The median and mean scores in the first and second audit were 8.0 and 6.9, and 8.0 and 7.9, respectively (p<0.001). All items that comprised the score improved from the first to the second audit. Likewise, there was a reduction of inappropriate prescriptions (80.2% in the first audit vs. 64.6% in the second audit, p=0.001). Conclusions A large proportion of inappropriate prescriptions was observed, which improved with the implementation of simple educational activities.
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Since the nineteenth century, a ring-forming disease attacking Antarctic mosses has been reported. However, to date, only the effects on the mosses themselves are known. In this study, we used DNA metabarcoding to investigate the effects on the moss epiphytic algal community at different stages of disease progression. As the disease progressed, algal species richness decreased, although overall abundance was not significantly affected. Prasiolales appeared unaffected, whereas Ulotrichales were more sensitive. Trebouxiales dominated the advanced disease stage, suggesting a possible benefit from the disease, either through the elimination of competition or creation of new niches. Infection is responsible for moss death, leading to habitat loss for other organisms, but pathogenic effects on algae cannot be ruled out. Our data indicate that the disease not only impacts mosses but also other groups, potentially resulting in loss of Antarctic biodiversity. This study provides the first report of the disease effects on epiphytic algal communities of Antarctic bryophytes.
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Briófitas , Clorófitas , Regiões Antárticas , Biodiversidade , EcossistemaRESUMO
Patients with hematologic malignancies and hematopoietic cell transplant recipients (HCT) are at high risk for invasive fungal disease (IFD). The practice of antifungal prophylaxis with mold-active azoles has been challenged recently because of drug-drug interactions with novel targeted therapies. This is a retrospective, single-center cohort study of consecutive cases of proven or probable IFD, diagnosed between 2009 and 2019, in adult hematologic patients and HCT recipients managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. During the study period, 94 cases of IFD occurred among 664 hematologic patients and 316 HCT recipients. The frequency among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%). The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology of IFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFD occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.
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Fungal infections have increased in recent years due to host factors, such as oncohaematological and transplant-related disorders, immunosuppressive therapy, and AIDS. Additionally, molecular and proteomic facilities have become available to identify previously unrecognizable opportunists. For these reasons, reports on less-known and recalcitrant mycoses, such as those caused by black fungi, hyaline filamentous fungi, coelomycetes, Mucorales, and non-Candida yeasts have emerged. In this review, novel taxonomy in these groups, which often are multi-resistant to one or several classes of antifungals, is discussed. Clinical presentations, diagnosis and current treatment of some major groups are summarised.
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Mucorales , Micoses , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Humanos , Micoses/diagnóstico , Micoses/tratamento farmacológico , ProteômicaRESUMO
Introduced in the late 1950s, polyenes represent the oldest family of antifungal drugs. The discovery of amphotericin B and its therapeutic uses is considered one of the most important scientific milestones of the twentieth century . Despite its toxic potential, it remains useful in the treatment of invasive fungal diseases owing to its broad spectrum of activity, low resistance rate, and excellent clinical and pharmacological action. The well-reported and defined toxicity of the conventional drug has meant that much attention has been paid to the development of new products that could minimize this effect. As a result, lipid-based formulations of amphotericin B have emerged and, even keeping the active principle in common, present distinct characteristics that may influence therapeutic results. This study presents an overview of the pharmacological properties of the different formulations for systemic use of amphotericin B available for the treatment of invasive fungal infections, highlighting the characteristics related to their chemical, pharmacokinetic structures, drug-target interactions, stability, and others, and points out the most relevant aspects for clinical practice.
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Invasive fungal disease (IFD) is frequent in patients with haematologic malignancies and in recipients of haematopoietic cell transplantation (HCT). An epidemiologic study conducted in Brazil reported a high incidence of IFD in haematologic patients, and invasive fusariosis was the leading IFD. A limitation of that study was that galactomannan was not available for at least half of the study period. In order to characterise the epidemiology and burden of IFD in three cohorts, HCT, acute myeloid leukaemia (AML) or myelodysplasia (MDS), and acute lymphoid leukaemia (ALL), we conducted a prospective multicentre cohort study in four haematologic Brazilian centres. From August 2015 to July 2016, all patients receiving induction chemotherapy for newly diagnosed or relapsed AML, MDS or ALL, and all HCT recipients receiving conditioning regimen were followed during the period of neutropenia following chemotherapy or the conditioning regimen. During a 1-year period, 192 patients were enrolled: 122 HCT recipients (71 allogeneic, 51 autologous), 46 with AML, and 24 with ALL. The global incidence of IFD was 13.0% (25 cases, 11 proven and 14 probable). Invasive aspergillosis (14 cases) was the leading IFD, followed by candidemia (6 cases) and fusariosis (3 cases). The incidence of IFD was 26.1% in AML/MDS, 16.7% in ALL, 11.3% in allogeneic HCT, and 2.0% in autologous HCT. The burden of IFD in haematologic patients in Brazil is high, with a higher frequency in AML and ALL. Invasive aspergillosis is the leading IFD, followed by invasive candidiasis and fusariosis.
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Doenças Hematológicas/complicações , Infecções Fúngicas Invasivas/epidemiologia , Adolescente , Adulto , Idoso , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Doenças Hematológicas/epidemiologia , Doenças Hematológicas/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Incidência , Lactente , Infecções Fúngicas Invasivas/classificação , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplantados/estatística & dados numéricos , Transplante Autólogo/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. CASE PRESENTATION: We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. CONCLUSION: To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.
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Complicações do Diabetes/microbiologia , Mucorales/genética , Mucormicose/complicações , Doenças Orbitárias/complicações , Rinite/complicações , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/cirurgia , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Masculino , Maxila/microbiologia , Maxila/patologia , Maxila/cirurgia , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Mucormicose/cirurgia , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/microbiologia , Doenças Orbitárias/cirurgia , RNA Ribossômico 28S/genética , Rinite/tratamento farmacológico , Rinite/microbiologia , Rinite/cirurgiaRESUMO
MAIN CONCLUSION: The infection of wheat leaves by Pyricularia oryzae induced remarkable reprogramming of the primary metabolism (amino acids, sugars, and organic acids) in favor of a successful fungal infection and certain changes were conserved among cultivars regardless of their level of resistance to blast. Wheat blast, caused by Pyricularia oryzae, has become one of the major threats for food security worldwide. Here, we investigated the behavior of three wheat cultivars (BR-18, Embrapa-16, and BRS-Guamirim), differing in their level of resistance to blast, by analyzing changes in cellular damage, antioxidative metabolism, and defense compounds as well as their photosynthetic performance and metabolite profile. Blast severity was lower by 45 and 33% in Embrapa-16 and BR-18 cultivars (moderately resistant), respectively, at 120 h after inoculation in comparison to BRS-Guamirim cultivar (susceptible). Cellular damage caused by P. oryzae infection was great in BRS-Guamirim compared to BR-18. The photosynthetic performance of infected plants was altered due to diffusional and biochemical limitations for CO2 fixation. At the beginning of the infection process, dramatic changes in both carbohydrate metabolism and on the levels of amino acids, intermediate compounds of the tricarboxylic acid cycle, and polyamines were noticed regardless of cultivar suggesting an extensive metabolic reprogramming of the plants following fungal infection. Nevertheless, Embrapa-16 plants displayed a more robust and efficient antioxidant metabolism, higher phenylalanine ammonia-lyase and polyphenoloxidase activities and higher concentrations of phenolics and lignin, which, altogether, helped them to counteract more efficiently the infection by P. oryzae. Our results demonstrated that P. oryzae infection significantly modified the metabolism of wheat plants and different types of metabolic defence may act both additively and synergistically to provide additional plant protection to blast.
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Antioxidantes/metabolismo , Ascomicetos/fisiologia , Dióxido de Carbono/metabolismo , Fotossíntese , Doenças das Plantas/imunologia , Triticum/metabolismo , Metaboloma , Doenças das Plantas/microbiologia , Folhas de Planta/imunologia , Folhas de Planta/metabolismo , Folhas de Planta/microbiologia , Espécies Reativas de Oxigênio/metabolismo , Triticum/imunologia , Triticum/microbiologiaRESUMO
BACKGROUND: Invasive fungal disease is a significant cause of morbidity and mortality in immunosuppressed children. The recognition of patients at risk for candidaemia is paramount to a better prognosis. OBJECTIVES: To characterize Candida spp bloodstream infections (BSI) in a reference centre for paediatric oncology and to describe the most prevalent risk factors associated with candida infections. PATIENTS/METHODS: This is a retrospective cohort study carried out with paediatric patients followed up with at the Institute of Pediatric Oncology, Brazil, who presented positive blood culture for Candida spp from January 2004 to December 2016. RESULTS: Ninety episodes of candidaemia were analysed; patients had a median age of 4.5 years, and 57.8% were males, with a diagnosis of solid tumours in 54.5% of cases. The most common Candida species were C albicans (35.6%), C parapsilosis (30.0%) and C tropicalis (16.7%). C tropicalis BSI was associated with neutropenia and skin lesions. Therapy was successful in 67.1% of the episodes. Older age and thrombocytopenia were associated with therapeutic failure. Death within 30 days occurred in 24.4% of patients; predictive factors were older age and admission to an ICU C parapsilosis candidaemia was a protective factor for death when compared to C albicans. CONCLUSION: The main species isolated were C albicans, C parapsilosis and C tropicalis. C tropicalis BSI was associated with neutropenia and skin lesions. The death rate was significant, and a worse prognosis was associated with older age, thrombocytopenia and admission to an ICU C parapsilosis infection proved to be a protective factor against mortality.