Invasive fungal infections in neutropenic enterocolitis: A systematic analysis of pathogens, incidence, treatment and mortality in adult patients

BACKGROUND: Neutropenic enterocolitis is a life-threatening complication most frequently occurring after intensive chemotherapy in acute leukaemias. Gramnegative bacteria constitute the most important group of causative pathogens. Fungi have also been reported, but their practical relevance remains unclear. The guidelines do not address concrete treatment recommendations for fungal neutropenic enterocolitis. METHODS: Here, we conducted a metaanalysis to answer the questions: What are frequency and mortality of fungal neutropenic enterocolitis? Do frequencies and microbiological distribution of causative fungi support empirical antimycotic therapy? Do reported results of antimycotic therapy in documented fungal neutropenic enterocolitis help with the selection of appropriate drugs? Following a systematic search, we extracted and summarised all detail data from the complete literature. RESULTS: Among 186 articles describing patients with neutropenic enterocolitis, we found 29 reports describing 53 patients with causative fungal pathogens. We found no randomised controlled trial, no good quality cohort study and no good quality case control study on the role of antifungal treatment. The pooled frequency of fungal neutropenic enterocolitis was 6.2% calculated from all 860 reported patients and 3.4% calculated from selected representative studies only. In 94% of the patients, Candida spp. were involved. The pooled mortality rate was 81.8%. Most authors did not report or perform antifungal therapy. CONCLUSION: In patients with neutropenic enterocolitis, fungal pathogens play a relevant, but secondary role compared to bacteria. Evidence concerning therapy is very poor, but epidemiological data from this study may provide helpful clues to select empiric antifungal therapy in neutropenic enterocolitis

Current distribution of sarcoptic mange in wombats

Objective To determine the distribution and prevalence of sarcoptic mange in wombats, particularly the common wombat (Vombatus ursinus).\ud \ud Design Questionnaire survey in two parts.\ud \ud Procedure Questionnaires were distributed to biologists, rangers, animal carers and naturalists. Part 1 of the questionnaire aimed to determine the present distribution of sarcoptic mange in wombats (103 responses). Part 2 invited respondents to assess the prevalence of sarcoptic mange in wombats over a 3 month period (four responses). Information on wombats from 66 localities was received. Each locality represented an area of about 2500 km².\ud \ud Results Mange was observed at 93% of localities surveyed and Sarcoptes scabiei was present in common wombats at 52% of localities. Sarcoptic mange was highly prevalent (22%) in two common wombat populations in Victoria. Anecdotal evidence suggested that mange epizootics are sporadic, cause significant morbidity and mortality and have a substantial effect on local abundance. The respondents did not report sarcoptic mange in either northern hairy-nosed wombats (Lasiorhinus krefftii) or southern hairy-nosed wombats (Lasiorhinus latifrons).\ud \ud Conclusions Sarcoptic mange occurs in common wombat populations throughout the range of the common wombat including Tasmania and Flinders Island. While mange epizootics are sporadic, they have the potential to threaten the long-term survival of small, remnant populations

Communicating Sequential Processes

Indeks Bibliografi hlm. 251-252viii, 256 hlm. :il. ;23 cm

Sarcoptic mange in wombats

Sarcoptic mange, commonly referred to as scabies, is a cosmopolitan disease affecting seven different orders within the class Mammalia. It is caused by the mite Sarcoptes scabiei (Linnaeus, 1758) Latreille, 1802 which is an obligate parasite of the skin. The mite is typically oval shaped, dorsally rounded and ventrally flattened. Its length varies between 200 and 500 μm depending on its life-cycle stage. Of the Australian marsupials, only wombats and the koala (Phascolarctos cinereus) (Vombatiformes) and the common ringtail possum (Pseudocheirus peregrinus) (Pseudocheiridae) have been reported with sarcoptic mange. In wombats, sarcoptic mange has been reported as the major infectious disease affecting the group, although it mainly occurs in only one of the three species, the common wombat (Vombatus ursinus). In this species sarcoptic mange can be debilitating. Several reports of severe sarcoptic mange in common wombats describe animals as emaciated and lacking hair with a thick dry crust, composed of keratin, many mites and their debris, bacteria and neutrophilic debris adherent to the skin (Figure 1). This crust is similar to that found in domestic animals with hyperkeratotic sarcoptic mange and humans with Norwegian scabies. The thick crust may be fissured by the movement of the wombat (Figure 2). The underlying skin may also crack resulting in haemorrhage, pyoderma and sometimes cutaneous myiasis. This may encompass the entire body with the head, neck, shoulders and limbs more commonly affected. Typically, the epidermis is thickened and there is a mild predominantly mononuclear inflammatory infiltrate in the dermis. In some animals hypersensitivity reactions occur towards Sarcoptes, with few mites present in the skin. Intense pruritus, a characteristic sign of hypersensitivity reactions to Sarcoptes in humans and animals has been reported in wombats with sarcoptic mange. Only occasional outbreaks of sarcoptic mange have been recorded in the southern hairy-nosed wombat (Lasiorhinus latifrons) and the disease has not been reported in the northern hairy-nosed wombat (Lasiorhinus krefftii)