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Management of Invasive Pulmonary Aspergillosis in Intensive Care Units: Guidelines From the Fungal Infection Network of Switzerland (FUNGINOS).

Invasive pulmonary aspergillosis (IPA) is increasingly recognised in intensive care units (ICU) affecting not only patients with classical immunosuppressive conditions but also other severely ill patients, including those with respiratory viral infections (influenza, COVID-19), advanced chronic obstructive pulmonary disease or acute and chronic liver diseases. Several expert panels have proposed definitions of IPA in different ICU settings. However, practical recommendations for its diagnostic and therapeutic approaches are scarce. Moreover, these approaches can be influenced by different para

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… L., “Invasive Fungal Infections in Acute and Chronic Liver Impairment: A Systematic Review,” Mycoses 65 (2022): 140–151. 21. … E., Abril E., Padilla R., et al., “Invasive Aspergillosis in Critically Ill Patients: An Autopsy Study,” Mycoses 62 (2019): 673–679. 53. …

CT Findings for Differentiating Pulmonary Mucormycosis From Invasive Pulmonary Aspergillosis, Prior to Invasive Procedure Such as a Biopsy or Surgery: A 22-Year Single-Center Experience.

OBJECTIVES: Computed tomography (CT) plays a critical role in the early detection and diagnosis of pulmonary invasive mould infection. This study aimed to compare the CT findings of proven invasive pulmonary aspergillosis (IPA) and proven pulmonary mucormycosis (PM) and develop a clinical scoring system based on CT features to differentiate PM from IPA. METHODS: The medical records of the pathology database among adult patients (aged ≥ 18 years) diagnosed with proven IPA or PM between January 2003 and June 2024 were retrospectively reviewed, according to the 2020 European Organisation for Res

Clinical Characteristics, Radiological, and Outcomes of Mucormycosis: A 14-Year Retrospective Study From Southern China.

BACKGROUND: Mucormycosis is a rare, rapidly progressive fungal infection with a high mortality rate. However, clinical data of mucormycosis patients, especially those related to adverse outcomes in China, remain limited. OBJECTIVE: To enhance understanding of the clinical characteristics of different infection site mucormycosis and identify the factors associated with adverse outcomes. METHODS: A 14-year retrospective study was conducted at a tertiary care hospital in China. Patients were categorised based on the site of infection and clinical outcomes. RESULTS: From 2010 to 2024, 32 cases

Mucormycosis in Paediatric Patients After Haematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.

BACKGROUND: Data on the epidemiology, diagnostic methods and evidence-based recommended treatment methods for children with mucormycosis who have undergone Haematopoietic stem cell transplantation (HSCT) are limited. OBJECTIVE: Summarise past recommendations and the latest literature on the treatment of HSCT in children with mucorin infection and clarify the epidemiology, diagnosis, treatment and outcomes of this invasive fungal disease. METHODS: A comprehensive search for full-text studies involving humans that were published in English between January 2000 and December 2022 was conducted i

Serological Response and Associated Prognostic Factors in Paracoccidioidomycosis: A 15-Year Retrospective Study.

BACKGROUND: Small studies have used various serological methods to evaluate the response to paracoccidioidomycosis (PCM) treatment, with limited use of counterimmunoelectrophoresis (CIE). This study assessed CIE titres during and after PCM therapy and their prognostic value for serological negativity. METHODS: In this retrospective study, we reviewed medical records of patients with positive serology in proven or probable PCM from 2006 to 2021 at University of São Paulo. We performed multivariate logistic regression to identify independent variables associated with CIE titre negativity. RESU

Utility and Pitfalls of β-D-Glucan for Diagnosis and Response Monitoring of Chronic Disseminated Candidiasis in Paediatric Cancer Patients.

BACKGROUND: β-D-Glucan (BDG) is a useful but nonspecific biomarker in patients with suspected invasive fungal diseases including Pneumocystis pneumonia. Little is known, however, about its utility for response monitoring in chronic disseminated candidiasis (CDC). PATIENTS AND METHODS: We describe the utility and pitfalls of serum BDG in paediatric cancer patients with suspected CDC. BDG in serum was measured serially (i.e., 5 to 10 times of a time period of 200 to 400 days) by a commercially available assay (Fungitell; Associates of Cape Cod, MA, USA) and values were correlated to patient- an

Ex Vivo Fungal Nail Penetration Study: Effects of Causative Organisms, Nail Polish and Age.

BACKGROUND: Few ex vivo studies have investigated the virulence factors of fungi causing onychomycosis. The effect of nail polish in predisposing or protecting against onychomycosis remains debatable. OBJECTIVES: This ex vivo study aimed to identify the nail invasion ability of dermatophytes, non-dermatophytes and yeast, with and without nail polishing, in the nails of young and elderly individuals. METHODS: Six fungal species were tested: dermatophytes (Trichophyton rubrum, T. mentagrophytes, Microsporum canis), non-dermatophytes (Neoscytalidium dimidiatum, Fusarium spp.) and Candida albica

Modified Tinea Corporis Score (mTCS) Versus Tinea Corporis Score (TCS): A Comparative, Noninterventional Validation Study.

BACKGROUND: Tinea corporis (TC) is a common fungal infection affecting 20%-25% of the global population. Though diagnosing TC is straightforward, treatment has become challenging due to the use of certain medications and lack of follow-up, leading to resistance. Andrea et al. proposed Tinea Corporis Score (TCS) to assess and provide follow-up care for TC. However, double tracing was its limitation. We proposed modified Tinea Corporis Score (mTCS) to overcome this limitation. AIMS AND OBJECTIVES: To compare mTCS with TCS and validate it. METHODOLOGY: A comparative, noninterventional validatio

The First Isolation of Multiple Antifungal-Drug-Resistant Trichophyton Rubrum in China and the Novel Resistance Mechanism.

OBJECTIVES: This study reports the first isolation of a multidrug-resistant Trichophyton rubrum strain in China, characterizing its drug resistance profile and mechanisms. METHODS: The isolate was identified by internal transcribed spacer (ITS) sequencing and phylogenetic analysis. In vitro antifungal susceptibility testing (AFST) was performed according to the M38-A3 CLSI guideline to determine minimum inhibitory concentrations (MICs) against eight antifungals (terbinafine, itraconazole, fluconazole, amorolfine, griseofulvin, voriconazole, luliconazole and amphotericin B). Whole genome seque

Central Nervous System Histoplasmosis: A Retrospective Review of Clinical Characteristics, Treatments and Outcomes With Comparison to Disseminated Histoplasmosis Without Central Nervous System Involvement.

BACKGROUND: Central nervous system (CNS) histoplasmosis occurs in 5%-10% of patients with disseminated histoplasmosis, is sparsely described in the literature and is highly morbid. OBJECTIVES: To evaluate clinical characteristics and outcomes of patients with CNS and non-CNS disseminated histoplasmosis. METHODS: In this retrospective case-control study, we matched 45 cases of CNS histoplasmosis with 45 controls with disseminated histoplasmosis without CNS involvement by hospital and date of encounter. Data were collected from three hospitals from January 2000 to December 2022 using histoplas

Deep Learning Models for CT Segmentation of Invasive Pulmonary Aspergillosis, Mucormycosis, Bacterial Pneumonia and Tuberculosis: A Multicentre Study.

BACKGROUND: The differential diagnosis of invasive pulmonary aspergillosis (IPA), pulmonary mucormycosis (PM), bacterial pneumonia (BP) and pulmonary tuberculosis (PTB) are challenging due to overlapping clinical and imaging features. Manual CT lesion segmentation is time-consuming, deep-learning (DL)-based segmentation models offer a promising solution, yet disease-specific models for these infections remain underexplored. OBJECTIVES: We aimed to develop and validate dedicated CT segmentation models for IPA, PM, BP and PTB to enhance diagnostic accuracy. Methods：Retrospective multi-centre da

High-Resolution Melting Assay to Detect the Mutations That Cause the Y132F and G458S Substitutions at the ERG11 Gene Involved in Azole Resistance in Candida parapsilosis.

BACKGROUND: Candida parapsilosis is a pathogenic yeast that has reduced susceptibility to echinocandins and ranks as the second or third leading cause of candidaemia, depending on the geographical region. This yeast often causes nosocomial infections, which are frequently detected as outbreaks. In recent years, resistance to azoles in C. parapsilosis has increased globally, primarily due to the accumulation of mutations in the ERG11 gene. OBJECTIVES: In this study, we have developed an assay based on real-time PCR and high-resolution melting (HRM) curve analysis to detect two of the most prev

Risk factors associated with fluconazole resistance in Candida parapsilosis candidemia: A case-case study.

BACKGROUND: Candida species are among the most important invasive pathogens in intensive care units (ICUs). Non-albicans species including Candida parapsilosis (C. parapsilosis) has increased in recent years. Fluconazole is the leading antifungal agent but resistance is a concern among C. parapsilosis species. OBJECTIVES: The aim of this study was to determine the factors associated with fluconazole resistance in patients with candidemia due to C. parapsilosis in ICUs. METHODS: This case-case study was conducted in a 750-bed, tertiary hospital between 2015 and 2021. Patients with fluconazole

Epidemiological patterns of candidaemia: A comprehensive analysis over a decade.

BACKGROUND: The prevalence of fungal bloodstream infections (BSI), especially candidaemia, has been increasing globally during the last decades. Fungal diagnosis is still challenging due to the slow growth of fungal microorganisms and need for special expertise. Fungal polymicrobial infections further complicate the diagnosis and extend the time required. Epidemiological data are vital to generate effective empirical treatment strategies. OBJECTIVES: The overall aim of this project is to describe the epidemiology of monomicrobial candidaemia and polymicrobial BSI, both with mixed fungaemia an

The In Vitro Activity of Rezafungin Against Uncommon Species of Candida.

BACKGROUND: Invasive candidiasis (IC) is increasing due to the rising numbers of immunocompromised patients. Increasing azole resistance rates and daily dosing required for most echinocandins have complicated its treatment. The approval of rezafungin has provided an option for weekly echinocandin treatment. The susceptibility of less common Candida spp. to rezafungin is unclear. We looked at the minimum inhibitory concentrations (MICs) of rezafungin and comparator agents against Candida spp. collected as part of a global surveillance program. METHOD: The CLSI reference broth microdilution met

Distribution of Aspergillus species and prevalence of azole resistance in clinical and environmental samples from a Spanish hospital during a three-year study period.

BACKGROUND: Surveillance studies are crucial for updating trends in Aspergillus species and antifungal susceptibility information. OBJECTIVES: Determine the Aspergillus species distribution and azole resistance prevalence during this 3-year prospective surveillance study in a Spanish hospital. MATERIALS AND METHODS: Three hundred thirty-five Aspergillus spp. clinical and environmental isolates were collected during a 3-year study. All isolates were screened for azole resistance using an agar-based screening method and resistance was confirmed by EUCAST antifungal susceptibility testing. The

First detection of triazole-resistant aspergillus fumigatus harbouring the TR34/L98H Cyp51A mutation in Burkina Faso.

BACKGROUND: Triazole-resistant Aspergillus fumigatus (TRAF) isolates are a growing public health problem with worldwide distribution. Epidemiological data on TRAF is limited in Africa, particularly in West Africa. OBJECTIVES: This study aimed to screen for the environmental presence of TRAF isolates in the indoor air of two hospitals in Burkina Faso. MATERIALS AND METHODS: Air samples were collected in wards housing patients at risk for invasive aspergillosis, namely infectious diseases ward, internal medicine ward, nephrology ward, pulmonology ward, medical emergency ward and paediatric war

Azole resistance in Aspergillus flavus and associated fitness cost.

BACKGROUND: The resistance of Aspergillus flavus to the azole antifungal drugs is an emerging problem. Mutations in the molecular targets of the azole antifungals - CYP 51 A, B and C - are possible mechanisms of resistance, but data to confirm this hypothesis are scarce. In addition, the behaviour of resistant strains in vitro and in vivo is not yet understood. OBJECTIVES: This study had 3 objectives. The first was to compare the sequences of CYP51 A, B and C in resistant and susceptible strains of A. flavus. The second was to look for the existence of a fitness cost associated with resistanc

Systematic review on efficacy and safety of empirical versus pre-emptive antifungal therapy among children with febrile neutropenia reveals paucity of data.

BACKGROUND: Two approaches are used to manage invasive fungal disease (IFD) in febrile neutropenic patients viz. empirical therapy (without attempting to confirm the diagnosis), or pre-emptive therapy (after screening tests for IFD). OBJECTIVE: This systematic review was undertaken to compare these approaches in children. METHODS: We searched PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, CINAHL, Clinical Trial Registries and grey literature, for randomized controlled trials (RCT) comparing empirical versus pre-emptive antifungal therapy in children with FN suspected to have IFD.

Sensitivity and specificity of LDBio Aspergillus ICT lateral flow assay for diagnosing allergic bronchopulmonary aspergillosis in adult asthmatics.

BACKGROUND: Aspergillus fumigatus-specific IgG estimation is crucial for diagnosing allergic bronchopulmonary aspergillosis (ABPA). A point-of-care LDBio immunochromatographic lateral flow assay (LFA) had 0%-90% sensitivity to detect IgG/IgM antibodies against A. fumigatus. OBJECTIVE: To assess the accuracy of LDBio-LFA in diagnosing ABPA, using the modified ISHAM-ABPA working group criteria as the reference standard. The secondary objective was to compare the diagnostic performance between LDBio-LFA and A. fumigatus-specific IgG (cut-offs, 27 and 40 mgA/L), using a multidisciplinary team (bl