Revista Iberoamericana De Micologia最新文献

Isavuconazole has emerged as a significant antifungal agent in the treatment and prophylaxis of invasive fungal infections (IFIs) among immunocompromised patients, particularly those undergoing hematopoietic stem cell transplantation (HSCT) or receiving treatment for hematological malignancies. Real-world experience with the use of isavuconazole in oncohematological patients has increasingly been reported. Isavuconazole has demonstrated efficacy against a broad spectrum of fungal pathogens, with a favorable safety profile and lower rates of hepatotoxicity compared to other azoles. Isavuconazole is generally well-tolerated, making it suitable for long-term use in high-risk patients for both treatment and prophylaxis of IFIs. Isavuconazole can be considered a valuable treatment option for IFIs in patients with hematological malignancies and HSCT recipients. It may be a suitable alternative to other azoles, especially in patients with underlying liver dysfunction or those experiencing the effects of multiple drug interactions. Nevertheless, further research is needed to evaluate the long-term safety and efficacy of isavuconazole, particularly in specific patient populations and in combination with other antifungal agents. Overall, isavuconazole represents a promising addition to the antifungal armamentarium, offering a safer and more effective treatment option for patients at high risk of IFIs.

Background: Invasive aspergillosis poses a significant threat to immunocompromised individuals. Diagnostic criteria incorporating biomarkers and imaging have improved diagnosis, and treatment options have expanded. However, in Argentina, diverse patient demographics and environmental factors add complexity to managing this infection.

Aims: This study aims to explore the epidemiology, diagnostic methods, and treatment of invasive aspergillosis in an Argentine hospital setting.

Methods: We collected data from patients with suspected invasive aspergillosis at a tertiary care hospital in Central-Northern Argentina. Variables included demographics, underlying conditions, diagnostic criteria, treatment, and outcomes.

Results: With a median age of 44.5 years and a 51% of male patients, our institution conducted invasive aspergillosis screenings on 192 patients, many of whom were battling malignancies (90%). One third of them had the infection set as probable or possible. Imaging (31%) and positive microbiological results (16%) were examples of diagnostic evidence. With an overall mortality rate of 15%, half of the patients got antifungal treatment for a median of seven days. Mortality among the diagnosed patients was 22%. Patients without stem-cell transplantation had a high death rate (31%), although this difference was not statistically significant; in patients having pulmonary nodules (15%) the death rate was not statistically significant either. There were no discernible variations in mortality according to the type of treatment received.

Conclusions: Our study reveals that invasive aspergillosis remains a significant issue in high-risk patients, and has a notable mortality rate, particularly among those patients with pulmonary nodules. Computed tomography provides a high diagnostic yield.

Background: Trichosporon genus encompasses emergent fungal pathogens with an increased incidence that concerns potential multi-drug resistance and mortality, especially in immunocompromised patients. COVID-19 is a disease of pandemic proportions with complications related to cytokine storm and lymphopenia.

Aims: To study the isolation of fungi within the Trichosporanaceae family in patients infected with SARS-CoV-2.

Methods: In this work we recovered 35 fungal isolates belonging to the Trichosporonaceae family from urine samples of 32 patients hospitalized due to COVID-19 complications. We evaluated their mycological characteristics, as well as the patient's clinical aspects.

Results: Trichosporon asahii was the main species identified, followed by Cutaneotrichosporon jirovecii and Trichosporon inkin, respectively. The blood cultures of 20 of these patients were all negative for fungi. Isolation of Trichosporonaceae fungi in urine was associated with high COVID-19 severity. The antifungal susceptibility test showed low MIC values for voriconazole, an antifungal in the first-line treatment of trichosporonosis. In contrast, high MIC values were found in the case of amphotericin B and 5-fluorocytosine in all the species, except for C. jirovecii. Since invasive trichosporonosis was not confirmed, none of the patients were given an antifungal treatment, without affecting the outcome of the patients.

Conclusions: Our results suggest that the isolation in urine of fungi from the Trichosporonaceae family may be associated to more severe forms of the disease COVID-19, but not with an increase in death rate. However, these isolates do not seem to be linked to urinary infections, therefore no antifungal therapy is mandatory in these cases.

A 48-year-old man with no relevant medical history went to a general acute hospital seeking medical attention. He had fever, cough, and chest pain. A chest X-ray revealed pleural effusion, which prompted a puncture and a subsequent culture of the sample; antibiotic treatment was prescribed. Despite the treatment, the man remained febrile, and a new clinical examination suggested a probable onychomycosis of all 20 nails. A rapid HIV test was carried out. The culture from the pleural puncture showed yeast growth identified as Cryptococcus sp., revealing a disseminated disease with central nervous involvement, thus leading to an early diagnosis with a better prognosis.

Fungal infections are becoming an escalating public health challenge, particularly among immunocompromised individuals. The partially limited efficacy of current antifungal treatments, their potential adverse effects, and the increasing problem of resistance emphasize the need for new treatment options. Existing antifungal classes-allylamines, azoles, echinocandins, polyenes, and pyrimidine analogs-face challenges due to their similarity with human cells and rising resistance. New antifungal agents, such as ibrexafungerp, rezafungin, oteseconazole, and miltefosine, offer novel mechanisms of action along with reduced toxicity. While antifungal resistance is a growing global concern, fungal infections in low- and middle-income countries (LMICs) present specific challenges with high rates of opportunistic infections like cryptococcosis and endemic mycoses such as histoplasmosis. The World Health Organization's fungal priority pathogens list highlights the prevalence of these infections in LMICs, where limited access to antifungal drugs and misuse are common. This review provides a comprehensive overview of these new agents and their mechanisms, and explores the challenges and roles of antifungal drugs in LMICs, where the burden of fungal infections is high. Continued research and development are essential to address the rising incidence and resistance of fungal infections globally.

Background: Disseminated histoplasmosis is a common infection in people living with human immunodeficiency virus (HIV) in Latin America and the Caribbean.

Aims: To examine the clinical characteristics and outcomes of disseminated histoplasmosis in people living with HIV focusing on delayed diagnoses.

Methods: A descriptive study in a public hospital in Santa Fe (Argentina) was conducted between 2017 and 2023. Disseminated histoplasmosis was diagnosed through direct examination and/or culture of blood, respiratory secretions, bone marrow, or skin samples.

Results: Twenty-one patients were included (median age: 34 years; 61.9% male). Ten (47.6%) patients were under antiretroviral therapy, but were non-adherent. The median CD4+ count was 10cells/mm³. Fever was the prevailing symptom (19, 90.5%), with a median duration of 30 days. Visceromegalies were observed in 11 patients (52.4%), lymphadenopathy in 10 (47.6%), and skin lesions in 11 (52.4%). All patients had anemia, and 13 (61.9%) had liver function abnormalities. Diagnosis was made through the scraping of mucocutaneous lesions in 11 patients (52.4%). Eight patients (38.1%) were admitted to the Intensive Care Unit, and six (28.6%) died. Five patients (23.8%) had delayed diagnoses.

Conclusions: Disseminated histoplasmosis may be underdiagnosed due to its subacute course and nonspecific clinical presentation. A high index of suspicion is essential, particularly in people living with the HIV.

Background: Pneumocystis jirovecii colonization rates in healthy patients are unclear. Previously published studies suggest that the fungus could play a role in the physiopathology and progression of chronic respiratory diseases.

Aims: The goal of this study was to determine the prevalence of colonization by this fungus in the lower respiratory tract of immunocompetent patients who are not at risk of dysbiosis.

Methods: The presence of P. jirovecii was confirmed in the bronchoalveolar lavage (BAL) samples from adults who underwent bronchoscopy for non-infectious reasons, had no immunosuppressive factors, and had not been on antibiotic treatment for at least one month. The results were compared with those obtained in the study on the presence of Pneumocystis in environmental dust samples obtained by swabbing surfaces in the participating subjects' domestic settings. Real-time PCR was the technique used for detecting the fungus in both types of samples.

Results: A total of 97 BAL samples and 49 domestic environment samples were studied. The medical reasons for needing a bronchoscopy were, mainly, the examination of both pulmonary neoplasm in 55 patients (57%) and diffuse interstitial lung disease in 21 patients (22%). The overall prevalence of P. jirovecii in our population was 7.22% in BAL samples and 0% in domestic samples.

Conclusions: The presence of P. jirovecii in the lower respiratory tract is relevantly linked with the patient's immune status, not with an underlying pathology. Prevalence is low in immunocompetent individuals who do not have any infectious pathology and are not having antimicrobial treatments. Our results do not enable us to figure out which the environmental niche of P. jirovecii is.