Invasive Non- Aspergillus Mold Infections in Transplant Recipients, United States, 2001–2006 (original) (raw)
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Invasive Non-AspergillusMold Infections in Transplant Recipients, United States, 2001–2006
Emerging Infectious Diseases, 2011
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Clinical Infectious Diseases, 2003
To determine the spectrum and impact of mycelial fungal infections, particularly those due to non-Aspergillus molds, 53 liver and heart transplant recipients with invasive mycelial infections were prospectively identified in a multicenter study. Invasive mycelial infections were due to Aspergillus species in 69.8% of patients, to non-Aspergillus hyalohyphomycetes in 9.4%, to phaeohyphomycetes in 9.4%, to zygomycetes in 5.7%, and to other causes in 5.7%. Infections due to mycelial fungi other than Aspergillus species were significantly more likely to be associated with disseminated ( ) and central nervous system ( ) infection than were P p .005 P p .07 those due to Aspergillus species. Overall mortality at 90 days was 54.7%. The associated mortality rate was 100% for zygomycosis, 80% for non-Aspergillus hyalohyphomycosis, 54% for aspergillosis, and 20% for phaeohyphomycosis. Thus, non-Aspergillus molds have emerged as significant pathogens in organ transplant recipients. These molds are more likely to be associated with disseminated infections and to be associated with poorer outcomes than is aspergillosis.
Epidemiology of invasive fungal infections due to Aspergillus spp. and Zygomycetes
Clinical Microbiology and Infection, 2006
An increased incidence of invasive fungal infections, especially those caused by filamentous fungi, has been observed among high-risk patients such as allogeneic stem-cell transplant recipients and those with acute leukaemia receiving high-dose chemotherapy. Despite significant progress in the prevention and treatment of fungal infections, invasive aspergillosis continues to be a major cause of morbidity and mortality. Development of more efficient therapeutic and prophylactic strategies with currently available and new antifungal agents, as well as of sensitive and specific methods for early diagnosis, is needed. In addition, an increasing incidence of invasive infections caused by Zygomycetes is of concern. Several reports of breakthrough zygomycosis in patients receiving voriconazole have raised the possibility of a relationship between voriconazole use and increased risk of Zygomycetes infection, although evidence of a definite causal relationship remains controversial. The potential impact that all therapeutic and prophylactic changes can have on the emergence of 'new' pathogens should be kept in mind.
Diagnostic Microbiology and Infectious Disease, 2011
Mucormycosis has been reported to be occurring more frequently in hematopoietic stem cell transplant (HSCT) recipients in recent years. We investigated a hospital cluster of mucormycosis cases among patients with hematologic disorders. Case-patients were identified through hospital microbiology and pathology database searches and compared to randomly selected controls matched on underlying disease and hospital discharge date using conditional logistic regression. Environmental assessments, including collection of samples for fungal cultures, were performed. Of 11 case-patients, 6 (55%) had acute myelogenous leukemia and 3 (27%) were allogeneic HSCT recipients. Five casepatients (45%) died. In univariate analysis, case-patients were more likely than controls to have refractory hematologic disease (odds ratio [OR], 13.75; 95% confidence interval [CI], 1.31-689); neutropenia N14 days (OR, 11.50; 95% CI, 1.27-558) or to have received voriconazole prophylaxis (OR, 11.26; 95% CI, 1.11-infinity). A point source was not identified. Factors such as underlying disease state and antifungal prophylaxis type may identify hematology patients at highest risk for mucormycosis. Our investigation highlighted critical Abstract P-0023). ★ Financial support. Office of Workforce and Career Development, Centers for Disease Control and Prevention. ★★ Potential conflicts of interest: A.A.L. has served on advisory boards for Schering-Plough and has participated in clinical research trials sponsored by Schering-Plough and Astellas. G.M.L. has received research support from Astellas, Merck, and Pfizer; has received honoraria from Astellas, Schering-Plough, and Wyeth; and has consulted for Astellas and Merck. S.S.M. consulted for and received grant support from Pfizer and received an honorarium from Astellas, before commencing employment at the Centers for Disease Control and Prevention. All other authors: no conflict. ⁎ Corresponding autho.
International Journal of Antimicrobial Agents, 2010
A prospective, observational, multicentre study was performed to assess the incidence, diagnosis, epidemiology and outcome of invasive mould infections (IMIs) reported to the Nationwide Austrian Aspergillus Registry. In total, 186 cases were recorded, corresponding to an annual incidence of 42 cases/1000 patients at risk or 2.36 cases/100 000 inhabitants. Patients with acute myelogenous leukaemia (34%) and lung transplant recipients (17%) are currently at highest risk for IMI, followed by a mixed population with impaired immunity (14%). In total, 34%, 30% and 36% were proven, probable and possible cases of IMI. Predominant pathogens were Aspergillus spp. (67%), followed by the zygomycetes (28%). Voriconazole was the most frequently administered agent (38%), followed by caspofungin (20%) and posaconazole (19%). Eighty patients (43%) received antifungal prophylaxis for ≥7 days, 30% of whom (24 patients) suffered from a breakthrough infection. The overall crude 12-week mortality was 34%. Multivariate analysis showed that outcome and survival did not correlate with the status of fungal disease, breakthrough infection, fungal species or age (P > 0.05). Aspergillosis remains the most commonly identified IMI amongst immunocompromised and/or immunosuppressed patients, but other moulds constitute a significant problem. Survival from IMIs appears to have improved and the main challenge is to overcome breakthrough fungal infections.
Open Forum Infectious Diseases
Background Invasive aspergillosis (IA) and mucormycosis contribute to substantial mortality, especially among immunocompromised persons, including those with hematopoietic stem cell transplant (HSCT), hematologic malignancy (HM), and solid organ transplant (SOT). Methods Using International Classification of Diseases, Ninth Revision codes available in the National Inpatient Sample, a hospital discharge database, we estimated IA-related hospitalizations (IA-RH), mucormycosis-RH (M-RH), HSCT-RH, HM-RH, and SOT-RH during 2000–2013. United States census data were used to calculate overall M-RH and IA-RH rates and present trends; estimated annual numbers of HSCT-RH, HM-RH, and SOT-RH served as denominators to calculate M-RH and IA-RH rates occurring with these conditions. Weighted least-squares technique was used to test for linear trends and calculate average annual percentage change (APC). Results There were an estimated 169 110 IA-RH and 9966 M-RH during 2000–2013. Overall, IA-RH and ...
Epidemiology of invasive fungal infection
International Journal of Antimicrobial Agents, 2008
Invasive fungal infection is a growing cause of morbidity and mortality in immunosuppressed patients. Furthermore, the use of azole prophylaxis against Candida species has coincided with an increase in the incidence of invasive aspergillosis and infections by other filamentous fungi such as Mucorales. New risk factors and different timescales for onset have been identified. Knowledge of changes in the epidemiology of, and risk factors for, invasive fungal infection is particularly important when developing therapeutic strategies and effective prophylaxis to improve the prognosis of immunosuppressed patients.
Invasive mould infections: a multi-disciplinary update
Medical Mycology, 2009
Systemic fungal infections remain a significant cause of mortality in neutropenic and immunocompromised patients, despite advances in their diagnosis and treatment. The incidence of such infections is rising due to the use of intensive chemotherapy regimens in patients with solid tumours or haematological cancers, the increasing numbers of allogeneic haematopoietic stem cell and solid organ transplants, and the use of potent immunosuppressive therapy in patients with autoimmune disorders. In addition, the epidemiology of systemic fungal infections is changing, with atypical species such as Aspergillus terreus and zygomycetes becoming more common. Treatment has traditionally focused on empirical therapy, but targeted pre-emptive therapy in high-risk patients and prophylactic antifungal treatment are increasingly being adopted. New treatments, including lipid formulations of amphotericin B, second-generation broad-spectrum azoles, and echinocandins, offer effective antifungal activity with improved tolerability compared with older agents; the potential impact of these treatments is reflected in their inclusion in current treatment and prophylaxis guidelines. New treatment strategies, such as aerosolized lipid formulations of amphotericin B, may also reduce the burden of mortality associated with systemic fungal infections. The challenge is to identify ways of coupling potentially effective treatments with early and reliable identification of patients at highest risk of infection.