King Louis XIV of France

A portrait of a cartoon version of King Louis XIV of France

Baseline predictors influencing the prognosis of invasive aspergillosis in adults

Invasive aspergillosis (IA) is a serious hazard to haematological and critical care patients. Impactful risk factors for developing IA have been characterised; however, systematic analysis of baseline prognostic factors for treatment course of IA is missing. To understand prognostic variables, we analysed original articles identifying baseline factors that predict treatment outcome in patients with IA. PubMed database was searched for publications since database inception until May 2018. Inclusion criteria were published baseline prognostic factors present at the diagnosis of IA. In total, 58 studies from 267 centres reported 7320 patients with IA and 40 different predictors. Unfavourable predictors in medical history were kidney (7.4%, 10/136) and liver failure (3.7%, 5/136), ICU admission (3.7%, 5/136) and uncontrolled underlying disease (3.7%, 5/136). Regarding state of immunosuppression, negative outcome predictors were prolonged neutropenia (12.5%, 17/136), corticosteroid treatment (8.1%, 11/136) and graft-vs-host disease (3.7%, 5/136). On the pathogen side, relevant predictors were galactomannan positivity (8.1%, 11/136), Aspergillus terreus infection (2.2%, 3/136) and lack of amphotericin B susceptibility (1.5%, 2/136). IA-specific predictors were disseminated disease (5.1%, 7/136) and CNS involvement (2.9%, 4/136). Imaging results associated with negative outcome were multiple consolidations (2.9%, 4/136), bipulmonary lesions (2.2%, 3/136) and pleural effusion (2.2%, 3/136). At diagnosis of IA, most frequently identified predictors of outcome were neutropenia, corticosteroid use, elevated galactomannan, renal failure and disseminated disease. The predictors may be used to identify patients at high risk for treatment failure and to stratify neglected patient groups for clinical trials

Mucormycosis in the Middle East and North Africa: Analysis of the FungiScope(R)registry and cases from the literature

Background Regional differences in the underlying causes, manifestations and treatment of mucormycosis have been noted in studies covering Europe, Asia and South America. Objectives To review cases of mucormycosis across the Middle East and North Africa (MENA) region in order to identify epidemiological, treatment and outcome trends in this region. Patients/Methods Cases of proven or probable invasive mucormycosis from the region were identified from the FungiScope(R)database and the medical literature. For each case, information on underlying condition, site of infection, pathogenic species, therapeutic intervention, type of antifungal therapy and outcome were analysed. Results We identified 310 cases of mucormycosis in the MENA region. The number of reported cases increased by decade from 23 before 1990 to 127 in the 2010s. In this region, the most common underlying conditions associated with mucormycosis were diabetes mellitus (49.7%) and conditions associated with immunosuppression (46.5%). The majority of patients received treatment with antifungals (93.5%), with a large proportion treated with both antifungals and surgery (70.6%). Overall mortality rates decreased from 47.8% before 1990 to 32.3% in the 2010s. Conclusions The number of reported cases of mucormycosis in the MENA region has risen over the past few decades, in line with increases in the number of patients with underlying conditions associated with this infection. Although the majority of patients received treatment with antifungal therapies and/or surgery, the associated mortality rate remains high and there is a clear need for more effective prevention and treatment strategies in the MENA region

Re-thinking visitor loyalty at ‘once in a lifetime’ nature-based tourism destinations: Empirical evidence from Purnululu National Park, Australia

Visitor loyalty with respect to national parks has been under-researched, especially for iconic or ‘once in a lifetime’ tourism destinations. This study reports on results from a survey of 529 visitors to the remote and iconic Purnululu National Park, Australia. An investigation of the relationships between loyalty, satisfaction and service quality indicates loyalty has multiple dimensions, including word of mouth recommendations and intention to revisit, with each having a different relationship with satisfaction and service quality. These findings, plus the weak correlation between revisiting and positive word of mouth intentions, suggests a need to reconceptualise loyalty in relation to ‘once in a lifetime’ destinations. For these tourism destinations, there may be other ways for visitors to demonstrate loyalty and the associated means for measuring it, rather than intention to revisit. Loyalty may be a transferred concept, with loyalty to one iconic destination resulting in visitation to other, similar destinations. Management implications Traditional measures of visitor loyalty may not be applicable to iconic or ‘once in a lifetime’ tourism destinations. Managers of these types of tourism destinations may be best served measuring word of mouth recommendations or intentions of visitors to engage in positive communications about the destination as a means of determining visitor loyalty. Although potentially difficult to influence, a focus on visitor satisfaction rather than service quality would be beneficial