Cross-Linking Treatment and Corneal Transplant in Refractory Acremonium Keratitis: Case Report

WOS: 000392952700018PubMed ID: 27452505Objectives: To report a case of Acremonium keratitis treated with voriconazole, corneal collagen cross-linking, and corneal transplant. Materials and Methods: Case report. Results: A 42-year-old woman who wore contact lenses daily was referred for refractory keratitis. Her main complaints were gritty sensation and pain. At slit lamp biomicroscopy, an infiltrate on the inferior paracentral cornea and an arcuate conjunctival ulceration were evident. The rest of the cornea was clear with no anterior chamber reaction. Scrapings from the corneal ulcer showed Candida parapsilosis and Acremonium species, which were sensitive to voriconazole. Despite the administration of topical, systemic, and intrastromal voriconazole for 1 month, repeat corneal scraping was positive for Acremonium, and clinical appearance and pain did not resolve. Therefore, corneal collagen cross-linking was applied. Although the pain resolved immediately after the procedure, the lesion showed no improvement. After a month of cross-linking, corneal transplant was performed for visual rehabilitation and treatment of the refractory lesion. The excised corneal button was negative for any microorganisms. Conclusions: Although corneal collagen cross-linking may be an effective treatment for Acremonium keratitis refractory to medical therapy, corneal transplant was required for visual gain and recovery

First isolation of Alternaria alternata from a dog in Turkey

WOS: 000398845100011Alternaria alternata is a fungus species which can infect animals and people as well as being commonly found in nature. On the other hand, animals with Alternaria infection can infect other animals and people by spreading a high amount of fungal spores. In this work, Alternaria alternata was detected for the first time in Turkey from the skin lesions of a dog, an antifungal susceptiblity testing was carried out and treatment with itracanozole to which the agent showed susceptibility was accomplished. The aim of this work was to report the Alternaria infection in dogs in Turkey for the first time, to draw attention to the zoonotic dimension of this disease and to emphasize the importance of antifungal susceptibility tests

Trichosporon Asahii, Sepsis, and Secondary Hemophagocytic Lymphohistiocytosis in Children with Hematologic Malignancy

WOS: 000335379000011PubMed ID: 24383917Trichosporon asahii (T. asahii) is an uncommon fungal pathogen rarely seen in patients with hematologicmalignancies. Although appropriate therapy is started, infection with T. asahii usually leads to mortality. Here, we describe two patients developed severe T. asahii infection and secondary HLH. Despite rapid identification of T. asahii and negative blood cultures achieved by prompt initiation of treatment with voriconazole, fever and pancytopenia, persisted and both developed hepatosplenomegaly, and their clinical state worsened. Bone marrow aspiraton revealed hemophagocytosis. Elevated ferritin, triglyceride levels were seen. The first patient did not receive HLH directed therapy and died with multiple organ dysfunctions. Prompt diagnosis and treatment of secondary HLH led to rapid improvement in clinical and laboratory abnormalities in the second patient and kept her alive. We suggest that HLH may present as a secondary condition, accompanying a severe infection with T. asahii may, at least in part, contribute to high mortality rates in these cases

Short communication: Comparison of minimum inhibitory and minimum effective concentration values for the detection of in vitro susceptibilities of Aspergillus species against caspofungin

WOS: 000246913000015PubMed ID: 17682716Caspofungin is a promising echinocandin-group antifungal agent used especially in the treatment of resistant invasive aspergillosis. The guidelines for in vitro susceptibility testing of Aspergillus species against caspofungin are not described by the Clinical and Laboratory Standards Institute (CLSI). The minimum inhibitory concentration that showed a prominent reduction of growth (MIC-2) and minimum effective concentration (MEC) endpoints are frequently used for the susceptibility testing of caspofungin as MIC determination criteria. The aim of this study was to evaluate the in vitro activity of caspofungin against Aspergillus species and to compare MIC-2 and MEC endpoints in the determination of MICs. A total of 32 Aspergillus species (18 A.fumigatus, seven A.flavus, five A.niger, and two A.versicolor) isolated from different clinical samples were included to the study. In vitro susceptibilities of the strains against 0.03-16 mu g/ml caspofungin concentrations were searched by broth microdilution method as recommended by CLSI M-38A document, with the use of glucose supplemented 2% RPIVII 1640 media. The MIC-2 and MEC endpoints were determined both at 24 and 48 hours. The concordance between MIC-2 and MEC endpoints of the strains at 24 and 48 hours incubations was found as 53% and 100%, respectively, with the difference of 1 dilution. MIC-2 and MEC measurements showed the same values at the end of 48 hours, whereas 7% showed differences in 1 dilution. MEC endpoints were also found to be more stable than MIC-2 in both of the incubation periods. In conclusion, MEC value is a more objective and stable endpoint and easier to use than MIC-2 for testing in vitro caspofungin activity against Aspergillus species

Recent Increase in the Prevalence of Fluconazole-Non-susceptible Candida tropicalis Blood Isolates in Turkey: Clinical Implication of Azole-Non-susceptible and Fluconazole Tolerant Phenotypes and Genotyping

WOS: 000581278900001PubMed: 33123116Candida tropicalis is the fourth leading cause of candidemia in Turkey. Although C. tropicalis isolates from 1997 to 2017 were characterized as fully susceptible to antifungals, the increasing global prevalence of azole-non-susceptible (ANS) C. tropicalis and the association between high fluconazole tolerance (HFT) and fluconazole therapeutic failure (FTF) prompted us to re-evaluate azole susceptibility of C. tropicalis in Turkey. in this study, 161 C. tropicalis blood isolates from seven clinical centers were identified by ITS rDNA sequencing, genotyped by multilocus microsatellite typing, and tested for susceptibility to five azoles, two echinocandins, and amphotericin B (AMB); antifungal resistance mechanisms were assessed by sequencing of ERG11 and FKS1 genes. the results indicated that C. tropicalis isolates, which belonged to 125 genotypes grouped into 11 clusters, were fully susceptible to echinocandins and AMB; however, 18.6% of them had the ANS phenotype but only two carried the ANS-conferring mutation (Y132F). HFT was recorded in 52 isolates, 10 of which were also ANS. Large proportions of patients infected with ANS and HFT isolates (89 and 40.7%, respectively) showed FTF. Patients infected with azole-susceptible or ANS isolates did not differ in mortality, which, however, was significantly lower for those infected with HFT isolates (P = 0.007). There were significant differences in mortality (P = 0.02), ANS (P = 0.012), and HFT (P = 0.007) among genotype clusters. the alarming increase in the prevalence of C. tropicalis blood isolates with ANS and HFT in Turkey and the notable FTF rate should be a matter of public health concern.Major National R&D Projects of the National Health Department [2018ZX10101003]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [31770161]; Shanghai Science and Technology CommitteeShanghai Science & Technology Committee [17DZ2272900, 14495800500]; Shanghai Municipal Commission of Health and Family Planning [2017ZZ01024-001]; Shanghai Sailing Program [19YF1448000]; Chinese Academy of Engineering [2019-XY-33]This work was supported by the Major National R&D Projects of the National Health Department (2018ZX10101003), National Natural Science Foundation of China (31770161), Shanghai Science and Technology Committee (17DZ2272900 and 14495800500), Shanghai Municipal Commission of Health and Family Planning (2017ZZ01024-001), Shanghai Sailing Program (19YF1448000), and the Chinese Academy of Engineering (2019-XY-33)

Does topical voriconazole trigger dysplastic changes on the ocular surface?

WOS: 000351060700009PubMed ID: 24621171Purpose: Systemic voriconazole treatment was reported to cause photosensitivity and related cutaneous malignancies. The aim of this report is to demonstrate a graft-related Candida endophthalmitis case that developed ocular surface dysplastic changes after receiving topical 1% voriconazole treatment. Methods: Full ocular examination, photography, and in vivo confocal microscopy examination (Rostock Cornea Module/HRT II, Heidelberg, Germany) were performed. Results: A 73-year-old male with graft-related Candida endophthalmitis that was on topical 1% voriconazole for 4 months developed a whitish gelatinous lesion on the cornea originating from the nasal limbus. In vivo confocal microscopy examination revealed mild dysplastic changes in the cornea epithelium. Conclusion: Topical voriconazole might trigger neoplastic changes on the ocular surface as reported with systemic use in other sun-exposed parts of the body. Further studies are needed to relate topical use of voriconazole with ocular surface dysplasia

Do incubation temperature, incubation time, and carbon dioxide affect the chromogenic properties of CHROMagar?

WOS: 000309796300005Aim: On CHROMagar medium Candida species form different colors; thus, the medium enables the differentiation of these species from each other as well as from other Candida species. The aim of this study is to investigate the effect of incubation temperatures, incubation times, and CO2 on the chromogenic properties of CHROMagar. Materials and methods: A total of 112 strains of Candida spp. were used. A 0.5 McFarland suspension of each strain was inoculated onto CHROMagar with a calibrated loop and incubated at 26 degrees C and 35 degrees C for 24-48 h in normal atmosphere and in an atmosphere of 5% CO2. The results were evaluated at the end of 24 and 48 h by 2 of the authors working in strict separation. Results: The chromogenic property of the medium was best observed at an incubation temperature of 35 degrees C. Incubation in an atmosphere of 5% CO2 yielded more prominent colonies at the end of 48 h. The chromogenic differentiation of C. dubliniensis from C. albicans was not easy, for C. albicans yielded a green color and C. dubliniensis a somewhat darker green color. Conclusion: To obtain the best results with CHROMagar, the medium should be incubated at 35 degrees C for 48 h in an atmosphere of 5% CO2. A control C. albicans strain should be inoculated on each medium plate to differentiate the color tones of C. albicans and C. dubliniensis

Clonal Candidemia Outbreak by Candida parapsilosis Carrying Y132F in Turkey: Evolution of a Persisting Challenge

As the second leading etiological agent of candidemia in Turkey and the cause of severe fluconazole-non-susceptible (FNS) clonal outbreaks, Candida parapsilosis emerged as a major health threat at Ege University Hospital (EUH). Evaluation of microbiological and pertinent clinical profiles of candidemia patients due to C. parapsilosis in EUH in 2019-2020. Candida parapsilosis isolates were collected from blood samples and identified by sequencing internal transcribed spacer ribosomal DNA. Antifungal susceptibility testing was performed in accordance with CLSI M60 protocol and ERG11 and HS1/HS2-FKS1 were sequenced to explore the fluconazole and echinocandin resistance, respectively. Isolates were typed using a multilocus microsatellite typing assay. Relevant clinical data were obtained for patients recruited in the current study. FNS C. parapsilosis isolates were recovered from 53% of the patients admitted to EUH in 2019-2020. Y132F was the most frequent mutation in Erg11. All patients infected with C. parapsilosis isolates carrying Y132F, who received fluconazole showed therapeutic failure and significantly had a higher mortality than those infected with other FNS and susceptible isolates (50% vs. 16.1%). All isolates carrying Y132F grouped into one major cluster and mainly recovered from patients admitted to chest diseases and pediatric surgery wards. The unprecedented increase in the number of Y132F C. parapsilosis, which corresponded with increased rates of fluconazole therapeutic failure and mortality, is worrisome and highlights the urgency for strict infection control strategies, antifungal stewardship, and environmental screening in EUH.This work was supported by the Major National R;D Projects of the National Health Department [2018ZX10101003], National Natural Science Foundation of China [31770161], Shanghai Science and Technology Committee [17DZ2272900 and 14495800500], Shanghai Municipal Commission of Health and Family Planning [2017ZZ01024-001], Shanghai Sailing Program [19YF1448000], and the Chinese Academy of Engineering [2019-XY-33].Major National R;D Projects of the National Health Department [2018ZX10101003]; National Natural Science Foundation of China [31770161]; Shanghai Science and Technology Committee [17DZ2272900, 14495800500]; Shanghai Municipal Commission of Health and Family Planning [2017ZZ01024-001]; Shanghai Sailing Program [19YF1448000]; Chinese Academy of Engineering [2019-XY-33