12 research outputs found
Prognostic factors in 264 adults with invasive Scedosporium spp. and Lomentospora prolificans infection reported in the literature and FungiScope
Invasive Scedosporium spp. and Lomentospora prolificans infections are an emerging threat in
immunocompromised and occasionally in healthy hosts. Scedosporium spp. is intrinsically resistant
to most, L. prolificans to all the antifungal drugs currently approved, raising concerns about
appropriate treatment decisions. High mortality rates of up to 90% underline the need for comprehensive
diagnostic workup and even more for new, effective antifungal drugs to improve
patient outcome. For a comprehensive analysis, we identified cases of severe Scedosporium spp.
and L. prolificans infections from the literature diagnosed in 2000 or later and the FungiScopeVR
registry. For 208 Scedosporium spp. infections solid organ transplantation (n¼58, 27.9%) and for
56 L. prolificans infection underlying malignancy (n¼28, 50.0%) were the most prevalent risk factors.
L. prolificans infections frequently presented as fungemia (n¼26, 46.4% versus n¼12, 5.8%
for Scedosporium spp.). Malignancy, fungemia, CNS and lung involvement predicted worse outcome
for scedosporiosis and lomentosporiosis. Patients treated with voriconazole had a better
overall outcome in both groups compared to treatment with amphotericin B formulations. This
review discusses the epidemiology, prognostic factors, pathogen susceptibility to approved
and investigational antifungals, and treatment strategies of severe infections caused by Scedosporium spp. and L. prolificansWe thank Sabine Wrackmeyer for her private donation to
support the projec
Contractile reserve and contrast uptake pattern by magnetic resonance imaging and functional recovery after reperfused myocardial infarction
AbstractOBJECTIVESWe hypothesized that contrast-enhanced and dobutamine tagged magnetic resonance imaging (MRI) could investigate microvascular integrity and contractile reserve of reperfused myocardial infarction (MI) in one examination.BACKGROUNDIn reperfused MI, microvascular integrity and contractile reserve are important determinants of functional recovery.METHODSTwenty-three patients with a reperfused first MI were studied. On day 3 ± 1 after MI, patients underwent tagged MRI at baseline and during infusion of 5 and 10 μg/kg/min of dobutamine followed by contrast-enhanced MRI (first pass and delayed imaging) after a bolus infusion of gadolinium-diethylenetriaminepenta-acetic acid. Tagged MRI was performed 9 ± 1 weeks later (follow-up). Eighty-four transmural regions with hyperenhancement on delayed contrast-enhanced images were defined as COMB (first pass hypoenhancement) or HYPER (normal first pass signal enhancement). Percent circumferential segment shortening was measured within the subendocardium and subepicardum of each region of HYPER or COMB at baseline, peak dobutamine and follow-up.RESULTSShortening improved in COMB regions from 4 ± 1% at baseline to 10 ± 1% at peak dobutamine and 10 ± 1% at follow-up, respectively (p < 0.0003 vs. baseline for both). The HYPER regions likewise improved from 10 ± 1% at baseline to 16 ± 1% and 17 ± 1%, respectively (p < 0.0004 vs. baseline for both). Function within COMB regions was less than that of HYPER at baseline, peak dobutamine and follow-up (p < 0.0003 for all).CONCLUSIONSDobutamine magnetic resonance tagging and contrast enhanced MRI are complementary in assessing functional recovery after reperfused MI. Regions of delayed contrast hyperenhancement demonstrate both contractile reserve and late functional recovery. However, if these regions demonstrate first pass contrast hypoenhancement, they are associated with greater myocardial damage
Inferring biogeographic ancestry with compound markers of slow and fast evolving polymorphisms
Needles in a haystack: Extremely rare invasive fungal infections reported in FungiScope (R)-Global Registry for Emerging Fungal Infections
Objectives: Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI. Methods: Extremely rare IFI collected in the FungiScope (R) registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales. Results: Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScope (R). Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales. Conclusions: Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens. (C) 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved
Needles in a haystack: Extremely rare invasive fungal infections reported in FungiScopeⓇ—Global Registry for Emerging Fungal Infections
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Immune plasma for the treatment of severe influenza: an open-label, multicentre, phase 2 randomised study
BackgroundInfluenza causes substantial morbidity and mortality despite available treatments. Anecdotal reports suggest that plasma with high antibody titres to influenza might be of benefit in the treatment of severe influenza.MethodsIn this randomised, open-label, multicentre, phase 2 trial, 29 academic medical centres in the USA assessed the safety and efficacy of anti-influenza plasma with haemagglutination inhibition antibody titres of 1:80 or more to the infecting strain. Hospitalised children and adults (including pregnant women) with severe influenza A or B (defined as the presence of hypoxia or tachypnoea) were randomly assigned to receive either two units (or paediatric equivalent) of anti-influenza plasma plus standard care, versus standard care alone, and were followed up for 28 days. The primary endpoint was time to normalisation of patients' respiratory status (respiratory rate of ≤20 breaths per min for adults or age-defined thresholds of 20-38 breaths per min for children) and a room air oxygen saturation of 93% or more. This study is registered with ClinicalTrials.gov, number NCT01052480.FindingsBetween Jan 13, 2011, and March 2, 2015, 113 participants were screened for eligibility and 98 were randomly assigned from 20 out of 29 participating sites. Of the participants with confirmed influenza (by PCR), 28 (67%) of 42 in the plasma plus standard care group normalised their respiratory status by day 28 compared with 24 (53%) of 45 participants on standard care alone (p=0·069). The hazard ratio (HR) comparing plasma plus standard care with standard care alone was 1·71 (95% CI 0·96-3·06). Six participants died, one (2%) from the plasma plus standard care group and five (10%) from the standard care group (HR 0·19 [95% CI 0·02-1·65], p=0·093). Participants in the plasma plus standard care group had non-significant reductions in days in hospital (median 6 days [IQR 4-16] vs 11 days [5-25], p=0·13) and days on mechanical ventilation (median 0 days [IQR 0-6] vs 3 days [0-14], p=0·14). Fewer plasma plus standard care participants had serious adverse events compared with standard care alone recipients (nine [20%] of 46 vs 20 [38%] of 52, p=0·041), the most frequent of which were acute respiratory distress syndrome (one [2%] vs two [4%] patients) and stroke (one [2%] vs two [4%] patients).InterpretationAlthough there was no significant effect of plasma treatment on the primary endpoint, the treatment seemed safe and well tolerated. A phase 3 randomised trial is now underway to further assess this intervention.FundingNational Institute of Allergy and Infectious Diseases, US National Institutes of Health