Fungal infection

真菌感染
  • 文章类型: Systematic Review
    近拉皮念珠菌在全球范围内分布,并被认为引起越来越多的侵袭性念珠菌感染。它与所有年龄组的高粗死亡率有关。它特别与医院爆发有关,特别是与使用侵入性医疗设备,如中央静脉导管。近带念珠菌是WHO优先考虑的病原体之一,进行此审查是为了告知病原体在列表中的排名。在这次系统审查中,我们搜索了PubMed和WebofScience,找到了2011年至2021年之间的研究,报告了以下标准的近融合梭菌感染:死亡率,发病率(住院和残疾),耐药性,可预防性,年发病率,和分布/出现。我们确定了336篇潜在相关论文,其中51项被包括在分析中。纳入的研究证实了高死亡率,从17.5%到46.8%不等。关于残疾和后遗症的数据很少。许多报告强调了对唑类耐药性的担忧,在一些地区描述的耐药率>10%。年发病率描述相对较差,尽管有明确的证据表明,随着时间的推移,由近融合梭菌引起的念珠菌血症病例的比例增加。虽然这篇综述总结了当前关于近拉索氏杆菌的数据,仍然迫切需要正在进行的研究和监测,以充分了解和管理这种日益重要的病原体。
    Candida parapsilosis is globally distributed and recognised for causing an increasing proportion of invasive Candida infections. It is associated with high crude mortality in all age groups. It has been particularly associated with nosocomial outbreaks, particularly in association with the use of invasive medical devices such as central venous catheters. Candida parapsilosis is one of the pathogens considered in the WHO priority pathogens list, and this review was conducted to inform the ranking of the pathogen in the list. In this systematic review, we searched PubMed and Web of Science to find studies between 2011 and 2021 reporting on the following criteria for C. parapsilosis infections: mortality, morbidity (hospitalisation and disability), drug resistance, preventability, yearly incidence, and distribution/emergence. We identified 336 potentially relevant papers, of which 51 were included in the analyses. The included studies confirmed high mortality rates, ranging from 17.5% to 46.8%. Data on disability and sequelae were sparse. Many reports highlighted concerns with azole resistance, with resistance rates of >10% described in some regions. Annual incidence rates were relatively poorly described, although there was clear evidence that the proportion of candidaemia cases caused by C. parapsilosis increased over time. While this review summarises current data on C.parapsilosis, there remains an urgent need for ongoing research and surveillance to fully understand and manage this increasingly important pathogen.
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  • 文章类型: Case Reports
    山谷热是一种真菌感染,通常是肺部,由球虫或球虫引起。这种疾病是美国西南部特有的,中美洲,和南美洲。受感染的个体通常无症状,但可能发展为社区获得性肺炎。在极少数情况下,球孢子菌病除肺部表现外,还可出现严重的并发症。在这项研究中,一名58岁有免疫能力的男性因咳嗽出现在急诊科,盗汗,胸膜炎性胸痛.尽管广谱抗微生物剂的管理,他出现了大量的右胸腔积液,在胸腔穿刺术后没有消退。球虫血清学呈阳性,由于持续的积液,患者被转诊给胸外科医生。球菌病患者很少出现需要手术干预的大量胸腔积液,尤其是在有免疫能力的个体中。此病例强调了在流行地区监测未解决的急性肺炎患者并将球虫作为可能的病因的重要性。
    Valley fever is a fungal infection, commonly of the lungs, caused by Coccidioides immitis or Coccidioides posadasii. This disease is endemic to the southwestern United States, Central America, and South America. Infected individuals are typically asymptomatic but may develop community-acquired pneumonia. On rare occasions, coccidioidomycosis can present with severe complications in addition to the pulmonary manifestation. In this study, a 58-year-old immunocompetent male presented to the Emergency Department with a cough, night sweats, and pleuritic chest pain. Despite the administration of broad-spectrum antimicrobials, he developed a large right pleural effusion that did not resolve following thoracentesis. Serology was positive for Coccidioides, and the patient was referred to a thoracic surgeon due to persistent effusion. It is rare for patients with coccidiomycosis to develop a large pleural effusion requiring surgical intervention, especially in immunocompetent individuals. This case highlights the importance of monitoring patients with unresolved acute pneumonia in endemic areas and considering Coccidioides as a possible etiology.
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  • 文章类型: Journal Article
    有有限的文献综合了髋关节置换术后真菌性假体周围关节感染(PJI)的外科手术治疗效果。作者目前的研究旨在全面回顾和分析这些相关文献,并仔细为今后的临床实践提出建议。
    我们目前的研究是根据PRISMA2020声明进行的。通过彻底搜索PubMed收集了有关髋关节置换术后真菌性PJI手术治疗的研究,Embase和谷歌学者数据库。最后一次搜索是在2023年3月进行的。非英语语言,reviews,具有重复数据的文章,和文章没有明确信息的真菌病原体的类型和治疗方案被排除。作者使用AMSTAR2标准评估了他们的系统评价依从性,质量中等。评估不同手术方式的临床结果,并使用二元逻辑回归模型来识别与治疗失败相关的风险。使用SPSS版本19.0进行数据分析。
    共发现33篇文章,其中包括80例髋关节置换术后的真菌性PJI患者。白色念珠菌是最常见的真菌(56.3%,45/80)。71.1%(54/76)的报告病例获得了总体治疗成功。单因素分析显示,各发表期成功率差异不显著,性别,年龄,标本采集方法,和真菌病原体。真菌PJI合并细菌感染的治疗成功率为47.4%(9/19),明显低于没有[vs.79.0%(45/57),P=0.017]。合并手术清创成功率,垫片植入,关节切除术,一阶段修订,两阶段修订为50.0%(4/8),42.9%(3/7),55.0%(11/20),86.7%(13/15),和88.5%(23/26),分别,差异有统计学意义(P=0.009)。二元logistic回归模型显示,细菌合并感染和手术选择是髋关节置换术后真菌PJI治疗失败的两个重要危险因素。
    关于髋关节置换术后真菌性PJI的手术治疗,合并细菌感染的患者,以及那些接受手术如清创术治疗的患者,垫片植入,和关节切除术应该意识到更高的失败风险。尽管如此,未来的多中心队列研究需要确定最佳治疗方案.
    UNASSIGNED: There has been limited literature synthesizing the therapeutic effects of surgical procedures for fungal periprosthetic joint infection (PJI) following hip arthroplasty. The authors\' current study aims to comprehensively review and analyze those relevant literature, and carefully make recommendations for future clinical practices.
    UNASSIGNED: Our current study was carried out in accordance with the PRISMA 2020 statement. Studies regarding the surgical management of fungal PJI following hip arthroplasty were collected via a thorough search of PubMed, Embase and Google scholar databases. The search was lastly performed in March 2023. Non-English language, reviews, articles with duplicated data, and articles without clear information about the type of fungal pathogens and treatment options were excluded. The authors evaluated their systematic review compliance by using AMSTAR 2 criteria and fell in moderate quality. Clinical outcomes of different surgical procedures were evaluated, and a binary logistic regression model was used to identify the risks associated with treatment failure. Data analyses were performed using the SPSS version 19.0.
    UNASSIGNED: A total of 33 articles encompassing 80 patients with fungal PJI following hip arthroplasty were identified. Candida albicans was the most frequently isolated fungus (56.3%, 45/80). The overall treatment success was achieved in 71.1% (54/76) of the reported cases. Univariate analysis showed that the differences of success rate were not significant between publication periods, genders, ages, specimen collection methods, and fungal pathogens. Treatment success rate was 47.4% (9/19) in fungal PJI cases with bacterial co-infection, significantly lower than those without [vs. 79.0% (45/57), P=0.017]. The pooled success rate for surgical debridement, spacer implantation, resection arthroplasty, one-stage revision, and two-stage revision was 50.0% (4/8), 42.9% (3/7), 55.0% (11/20), 86.7% (13/15), and 88.5% (23/26), respectively, with significant differences between them (P=0.009). A binary logistic regression model showed that bacterial co-infection and surgical option were the two significant risk factors associated with treatment failure for fungal PJI following hip arthroplasty.
    UNASSIGNED: Regarding the surgical treatment of fungal PJI following hip arthroplasty, patients with bacterial co-infection, and those treated with surgical procedures such as debridement, spacer implantation, and resection arthroplasty should be aware of the higher risks of failure. Nonetheless, future multiple-centre cohort studies are required to establish the optimal treatment.
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  • 文章类型: Journal Article
    真菌感染对人类健康的负担在全球范围内日益增加。曲霉菌,念珠菌,隐球菌是人类三大病原真菌,占感染相关死亡的90%以上。此外,缺乏有效的抗真菌疗法,主要是由于宿主毒性,病原体抗性,和免疫缺陷。近年来,纳米材料不仅被证明是更有效的抗真菌治疗药物,而且还可以克服对真菌药物的耐药性。这篇综述将探讨标准抗真菌治疗的局限性以及纳米材料的发展。
    The burden of fungal infections on human health is increasing worldwide. Aspergillus, Candida, and Cryptococcus are the top three human pathogenic fungi that are responsible for over 90% of infection-related deaths. Moreover, effective antifungal therapeutics are lacking, primarily due to host toxicity, pathogen resistance, and immunodeficiency. In recent years, nanomaterials have proved not only to be more efficient antifungal therapeutic agents but also to overcome resistance against fungal medication. This review will examine the limitations of standard antifungal therapy as well as focus on the development of nanomaterials.
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  • 文章类型: Journal Article
    深部真菌感染在上肢很少见。血管和神经感染,滑膜炎,腱鞘炎,肌筋膜炎,关节炎和骨髓炎已在文献中发现。在大多数情况下,治疗包括外科手术和抗真菌剂的使用。截肢是最后的,对患者的功能最具破坏性,解决方案。静脉内抗真菌药物,经常口服给药,是初始治疗和预防复发的重要辅助药物。因此,我们对当前的文献进行了回顾,为了收集不同研究的分散结果并阐明上肢真菌感染的各个方面。
    Deep fungal infections are rare in the upper extremity. Vessel and nerve infection, synovitis, tenosynovitis, myofasciitis, arthritis and osteomyelitis have been discovered in literature. Treatment in most cases includes surgical procedure and antifungal agent use. Amputation is the final, most devastating for patient\'s functionality, solution. Intravenous antifungal drugs, frequently followed by oral administration, are important ancillary agents both for the initial treatment and the prevention of recurrence. We therefore performed a review of the current literature, in order to assemble the dispersed results of different studies and clarify the various aspects of upper extremity fungal infections.
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  • 文章类型: Journal Article
    随着COVID-19的出现,诊断为毛霉菌病的患者数量有所增加,尤其是在发展中国家。这种增加背后的原因是COVID-19导致缺氧,促进真菌的生长。在危重或免疫功能低下的COVID-19患者中,确定毛霉菌病与COVID-19的相关性。评论中包含的文献是通过使用GoogleScholar数据库作为搜索引擎从2021年10月1日至2022年11月1日进行的。在包括的20篇文章中,有4个病例报告,2个案例系列,10条叙述性评论,和4项定量研究。粘菌的生长是由几个因素引起的,包括以前存在的糖尿病或过度使用类固醇引起的高血糖,由于COVID-19引发的炎症级联反应以及使用类固醇或其他免疫抑制疗法引起的免疫抑制,铁蛋白水平升高。COVID-19中白细胞数量和活性的减少导致真菌孢子萌发增加,从而形成了鼻脑毛霉菌病的灾难性景象。考虑到血液学患者经常使用可的松治疗,由于潜在的疾病而受到免疫抑制,而且通过给药的治疗,与可能的糖尿病相关,使得该患者在COVID-19感染期间容易发生鼻脑毛霉菌病.尽管很严重,毛霉菌病和COVID-19之间的关联是特异性的和可治疗的。患有严重COVID-19疾病的血液学患者的毛霉菌病的发展是危险的,但不是强制性的,可以预防。使用常见的类固醇剂量方案与高压氧和必要的预防措施揭示了这种疾病是一种额外的感染。缺氧,血糖控制不佳和过度使用类固醇或免疫抑制药物会导致这种情况。
    With the advent of COVID-19, the number of patients diagnosed with mucormycosis has increased, especially in developing countries. The reason behind this increase is that COVID-19 causes hypoxia that promotes the growth of fungus. To identify the association between mucormycosis and COVID-19, in critically ill or immunocompromised COVID-19 patients. The literature included in the review was researched from October 1, 2021, to November 1, 2022, by using the Google Scholar database as the search engine. Of the 20 articles included, there were 4 case reports, 2 case series, 10 narrative reviews, and 4 quantitative studies. Mucormycetes growth is caused by several factors, including hyperglycemia owing to previously existing diabetes or excessive use of steroids, increased ferritin levels owing to the inflammatory cascade initiated by COVID-19, and immunosuppression caused by the use of steroids or other immunosuppressive therapy. Reduced white-cell count and activity in COVID-19 leads to increased germination of fungal spores hence developing a catastrophic picture of rhinocerebral mucormycosis. Considering that the hematological patient is frequently treated with cortisone, immunosuppressed due to the underlying condition, but also through the administered therapy, the association with a possible diabetes makes this patient susceptible to developing rhinocerebral mucormycosis during COVID-19 infection. Despite being severe, the association between mucormycosis and COVID-19 is specific and treatable. Development of mucormycosis in hematological patients suffering from severe COVID-19 disease is dangerous, yet not compulsory and can be prevented. Using a common steroid-dose protocol with hyperbaric oxygen and necessary preventive measure reveals the disease as a superadded infection. Hypoxia, poor glycemic control and overuse of steroids or immunosuppressive drugs cause it.
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  • 文章类型: Journal Article
    最近真菌感染的增加是健康危机。这种激增与医疗实践变化引起的免疫功能低下人群的增加直接相关,例如使用苛刻的化疗和免疫抑制药物。诸如HIV之类的免疫抑制疾病使情况急剧恶化。皮下或浅表真菌感染会伤害皮肤,角质组织,和粘膜。此类别包括影响全球数百万人的一些最常见的皮肤病。尽管它们很少致命,它们会对一个人的生活质量产生灾难性的影响,在罕见的情况下,传播给其他人或变得突兀。皮肤下和表面的大多数真菌感染都可以简单而迅速地治愈。捕食弱宿主或自然入侵者的机会生物都可能导致全身性真菌感染。此外,这对一个人的生命可能非常致命和危险。异形真菌可能对未暴露于地方性真菌的健康人群构成危害。加强监控,快速的可用性,非侵入性诊断测试,监测抗真菌药物耐药性的出现,和病理生理学的研究,预防,和真菌感染的管理只是这些新的健康问题的一些潜在的解决方案。这篇综述的目的是总结真菌感染的可用数据以及涉及其治疗的不同疗法。此外,它还总结了具有抗真菌活性的植物的分子和科学数据。数据是通过谷歌获得的,PubMed,学者,和其他在线来源。
    The recent increase in fungal infections is a health crisis. This surge is directly tied to the increase in immunocompromised people caused by changes in medical practice, such as the use of harsh chemotherapy and immunosuppressive medicines. Immunosuppressive disorders such as HIV have exacerbated the situation dramatically. Subcutaneous or superficial fungal infections can harm the skin, keratinous tissues, and mucous membranes. This category includes some of the most common skin disorders that impact millions of people worldwide. Despite the fact that they are seldom fatal, they can have a catastrophic impact on a person\'s quality of life and, in rare situations, spread to other people or become obtrusive. The majority of fungal infections under the skin and on the surface are simply and quickly cured. An opportunistic organism that preys on a weak host or a natural intruder can both result in systemic fungal infections. Furthermore, it might be exceedingly lethal and dangerous to one\'s life. Dimorphic fungi may pose a hazard to healthy populations that are not exposed to endemic fungi. Increased surveillance, the availability of quick, noninvasive diagnostic tests, monitoring the emergence of antifungal medication resistance, and research on the pathophysiology, prevention, and management of fungal infections are just a few potential solutions to these new health problems. The goal of this review is to summarize the data available for fungal infections and the different therapies which are involved in their treatment. Additionally, it also summarizes the molecular and scientific data of the plants which contain anti-fungal activity. Data are acquired using Google, PubMed, Scholar, and other online sources.
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  • 文章类型: Review
    背景:曲霉属。在有COVID-19病史的患者中,是可能导致危及生命的感染的真菌病原体之一。
    方法:我们介绍了一名58岁的伊朗妇女患有COVID-19感染后烟曲霉心内膜炎并伴有多种血栓栓塞的病例。她接受了二尖瓣置换手术和多次下肢栓塞切除术,并接受了伏立康唑治疗,最终导致了她的康复.
    结论:任何有COVID-19感染史且对常规抗生素和抗真菌治疗无反应的疑似心内膜炎患者,应考虑曲霉菌性心内膜炎,因为COVID-19干扰适当的免疫功能,缺乏潜在的心脏疾病和免疫缺陷并不排除诊断。植被和栓子的培养和组织病理学评估,以及PCR,可以确认诊断。早期开始抗真菌治疗和手术切除感染的瓣膜和栓子可以改善曲霉菌性心内膜炎患者的预后。
    BACKGROUND: Aspergillus spp. are among the fungal pathogens that can cause life-threatening infections in patients with a history of COVID-19.
    METHODS: We present the case of a 58-year-old Iranian woman with post-COVID-19 Aspergillus fumigatus endocarditis complicated by numerous thromboembolisms. She underwent mitral valve replacement surgery and multiple lower extremity embolectomies and was treated with voriconazole, which led to her final recovery.
    CONCLUSIONS: Aspergillus endocarditis should be considered in any patient with suspected endocarditis who has a history of COVID-19 infection and does not respond to routine antibiotic and antifungal therapy, as COVID-19 interferes with proper immune function, and lack of underlying cardiac conditions and immunodeficiencies does not preclude the diagnosis. Culture and histopathological evaluation of vegetations and emboli, as well as PCR, can confirm the diagnosis. Early initiation of antifungal therapy and surgical removal of infected valves and emboli can improve prognosis in patients with Aspergillus endocarditis.
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  • 文章类型: Review
    我们报告了法国一名57岁的免疫功能正常的患者中罕见的主动脉双i假体同种异体毛霉菌病病例。手术和脂质体两性霉素B和伊沙武康唑双重抗真菌治疗后,结果良好。在文献综述中,我们确定了另外12例人工血管或心脏瓣膜毛霉菌病;死亡率为38%.
    We report a rare case of aorto-bi-iliac prosthetic allograft mucormycosis in a 57-year-old immunocompetent patient in France. Outcome was favorable after surgery and dual antifungal therapy with liposomal amphotericin B and isavuconazole. In a literature review, we identified 12 other cases of prosthetic vascular or heart valve mucormycosis; mortality rate was 38%.
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  • 文章类型: Case Reports
    心室辅助装置(VAD)的使用正在增加;然而,设备并发症的诊断和管理,例如动力传动系统出口(DES)是真菌感染的入口,不是众所周知的。
    进行了涉及搜索PubMed(2005年至2020年7月)的系统评价。一名43岁的女性患者患有左VAD(LVAD)(HeartMate3,Abbott,美国)也有报道。
    患者成功使用酮康唑乳膏和口服氟康唑治疗可能的浅表DES真菌感染。我们纳入了符合我们纳入标准的36项研究;然而,我们的审查中只包括了一个。在文学中,报告5例DES真菌感染,念珠菌是唯一的真菌病原体。
    LVAD真菌感染并不常见,但可能导致高死亡率,需要长时间的治疗,当没有手术替代方案时,可能会带来巨大的问题。然而,念珠菌属最常见。真菌感染只能产生清晰的分泌物,因此,基于脓性分泌物的传动系统感染的经典定义可能会有所不同。阴性皮肤培养并不排除DES感染的诊断,因此,经验诊断可能仅基于临床。
    UNASSIGNED: The use of ventricular assist devices (VAD) is increasing; however, diagnosis and management of device complications, such as the driveline exit site (DES) being the portal of entry for fungal infection, is not well known.
    UNASSIGNED: A systematic review involving searching PubMed (2005 to July 2020) was conducted. The case of a 43-year-old female patient who had a left VAD (LVAD) (HeartMate 3, Abbott, US) is also reported.
    UNASSIGNED: The patient was successfully treated with ketoconazole cream and oral fluconazole for likely superficial DES fungal infections. We included 36 studies that met our inclusion criteria; however, only one was included in our review. In the literature, five cases of DES fungal infection were reported, with Candida being the only fungal pathogen.
    UNASSIGNED: LVAD fungal infections are uncommon but can be responsible for high mortality rates, require a prolonged period of treatment, and can present a huge problem when surgical alternatives are not available. However, Candida species are most common. Fungal infections can only produce clear discharge, and so the classic definition of driveline infection based on purulent secretion can vary. Negative skin culture does not exclude the diagnosis of infection of the DES, and so empirical diagnosis may only be clinically based.
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