Posts filed under ‘Infecciones micoticas’

Candida auris Isolates Resistant to Three Classes of Antifungal Medications – New York, 2019.

MMWR Morb Mortal Wkly Rep. January 10, 2020 V.69 N.1 P.6-9.  

Ostrowsky B, Greenko J, Adams E, Quinn M, O’Brien B, Chaturvedi V, Berkow E, Vallabhaneni S, Forsberg K, Chaturvedi S, Lutterloh E, Blog D; C. auris Investigation Work Group.

Abstract

Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1).

Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1).

C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2).

As of June 28, 2019, a total of 801 patients with C. auris were identified in New York, based on clinical cultures or swabs of skin or nares obtained to detect asymptomatic colonization (3).

Among these patients, three were found to have pan-resistant C. auris that developed after receipt of antifungal medications, including echinocandins, a class of drugs that targets the fungal cell wall.

All three patients had multiple comorbidities and no known recent domestic or foreign travel.

Although extensive investigations failed to document transmission of pan-resistant isolates from the three patients to other patients or the environment, the emergence of pan-resistance is concerning.

The occurrence of these cases underscores the public health importance of surveillance for C. auris, the need for prudent antifungal prescribing, and the importance of conducting susceptibility testing on all clinical isolates, including serial isolates from individual patients, especially those treated with echinocandin medications.

This report summarizes investigations related to the three New York patients with pan-resistant infections and the subsequent actions conducted by the New York State Department of Health and hospital and long-term care facility partners.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973342/pdf/mm6901a2.pdf

January 30, 2020 at 3:42 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

MMWR. January 10, 2020 V.69 N.1 P.6-9.

Summary

What is already known about this topic?

Candida auris is an emerging yeast that is often drug-resistant.

What is added by this report?

Three chronically ill patients in New York were identified as having pan-resistant C. auris after receipt of antifungal medications. No transmission of the pan-resistant isolates was found in patient contacts or the facility environments.

What are the implications for public health practice?

Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare. Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901a2-H.pdf

January 18, 2020 at 6:13 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

Morbidity and Mortality Weekly Report (MMWR) (CDC) January 10, 2020 V.69 N.1 P-6-9

What is already known about this topic?

Candida auris is an emerging yeast that is often drug-resistant.

What is added by this report?

Three chronically ill patients in New York were identified as having pan-resistant C. auris after receipt of antifungal medications. No transmission of the pan-resistant isolates was found in patient contacts or the facility environments.

What are the implications for public health practice?

Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare. Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.

Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1). Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1). C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2). As of June 28, 2019, a total of 801 patients with…..

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm?s_cid=mm6901a2_w&deliveryName=USCDC_921-DM16734

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901a2-H.pdf

January 9, 2020 at 3:22 pm

Histoplasmosis-related healthcare use, diagnosis, and treatment in a commercially insured population, United States.

Clinical Infectious Diseases April 30, 2019  

Benedict K1, Beer KD1, Jackson BR1.

Abstract

BACKGROUND:

Infections with Histoplasma can range from asymptomatic to life-threatening acute pulmonary or disseminated disease. Histoplasmosis can be challenging to diagnose and is widely under-recognized. We analyzed insurance claims data to better characterize histoplasmosis testing and treatment practices and its burden on patients.

METHODS:

We used the IBM® MarketScan® Research Databases to identify patients with histoplasmosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 115.00-115.99) during 2012-2014. We analyzed claims in the 3 months before to the 1 year after diagnosis and examined differences between probable (hospitalized or >1 outpatient visit) and suspect (1 outpatient visit) patients.

RESULTS:

Among 1,935 patients (943 probable, 922 suspect), 54% had codes for symptoms or findings consistent with histoplasmosis and 35% had ≥2 healthcare visits in the 3 months before diagnosis. Overall, 646 (33%) had any fungal-specific laboratory test: histoplasmosis antibody test (n= 349, 18%), Histoplasma antigen test (n=349, 18%), fungal smear (n=294, 15%), or fungal culture (n=223, 12%); 464 (24%) had a biopsy. Forty-nine percent of probable patients and 10% of suspect patients were prescribed antifungal medication in the outpatient setting. Total, 19% were hospitalized. Patients’ last histoplasmosis-associated healthcare visits occurred a median of 6 months after diagnosis.

CONCLUSIONS:

Some histoplasmosis patients experienced severe disease, apparent diagnostic delays, and prolonged illness, whereas other patients lacked symptoms and were likely diagnosed incidentally (e.g., via biopsy). Low rates of histoplasmosis-specific testing also suggest incidental diagnoses and low provider suspicion, highlighting the need for improved awareness about this disease.

abstract

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz324/5481778

PDF (CLIC en PDF)

May 23, 2019 at 8:16 am

Mortality due to Cryptococcus neoformans and Cryptococcus gattiiin low-income settings: an autopsy study

Scientific Reports May 2019       

Cryptococcosis is a major opportunistic infection and is one of the leading causes of death in adults living with HIV in sub-Saharan Africa. Recent estimates indicate that more than 130,000 people may die annually of cryptococcal meningitis in this region.

Although complete diagnostic autopsy (CDA) is considered the gold standard for determining the cause of death, it is seldom performed in low income settings.

In this study, a CDA was performed in 284 deceased patients from Mozambique (n = 223) and Brazil (n = 61). In depth histopathological and microbiological analyses were carried out in all cases dying of cryptococcosis. We determined the cryptococcal species, the molecular and sero-mating types and antifungal susceptibility.

We also described the organs affected and reviewed the clinical presentation and patient management. Among the 284 cases included, 17 fatal cryptococcal infections were diagnosed. Cryptococcus was responsible for 16 deaths among the 163 HIV-positive patients (10%; 95%CI: 6–15%), including four maternal deaths.

One third of the cases corresponded to C. gattii (VGI and VGIV molecular types, Bα and Cα strains) and the remaining infections typed were caused by C. neoformans var. Grubii (all VNI and Aα strains). The level of pre-mortem clinical suspicion was low (7/17, 41%), and 7/17 patients (41%) died within the first 72 hours of admission.

Cryptococcosis was responsible for a significant proportion of AIDS-related mortality. The clinical diagnosis and patient management were inadequate, supporting the need for cryptococcal screening for early detection of the disease.

This is the first report of the presence of C. gattii infection in Mozambique…

FULL TEXT

https://www.nature.com/articles/s41598-019-43941-w.epdf

May 22, 2019 at 7:53 am

Liposomal Amphotericin B: Two Decades of Preclinical and Clinical Advances for Treatment of Invasive Fungal Infections

Clinical Infectious Diseases May 15, 2019 V.68 SUPPL. 4

Pharmacology of Liposomal Amphotericin B: An Introduction to Preclinical and Clinical Advances for

Treatment of Life-threatening Invasive Fungal Infections

Preclinical Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Antifungal Activity of Liposomal Amphotericin B

Clinical Pharmacokinetics, Pharmacodynamics, Safety and Efficacy of Liposomal Amphotericin B

https://academic.oup.com/cid/issue/68/Supplement_4

 

May 5, 2019 at 12:31 pm

Candida auris Clinical Isolates from South Korea: Identification, Antifungal Susceptibility, and Genotyping

Journal of Clinical Microbioliology March 2019 57:e01624-18

Yong Jun Kwon, Jong Hee Shin, Seung A Byun, Min Ji Choi, Eun Jeong Won, Dain Lee, Seung Yeob Lee, Sejong Chun, Jun Hyung Lee, Hyun Jung Choi, Seung Jung Kee, Soo Hyun Kim and Myung Geun Shin

Candida auris is an emerging worldwide fungal pathogen. Over the past 20 years, 61 patient isolates of C. auris (4 blood and 57 ear) have been obtained from 13 hospitals in Korea.

abstract

https://jcm.asm.org/content/57/4/e01624-18.abstract?etoc

PDF

https://jcm.asm.org/content/jcm/57/4/e01624-18.full.pdf

 

March 31, 2019 at 6:54 pm

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