Use of mycobacterial and fungal blood culture bottle in diagnosis of bloodstream infections in AIDS patients北大核心CSCD

Objective To understand the use of mycobacterial and fungal blood culture bottle and the prevalence of Mycobacterium and fungus in the bloodstream infections in AIDS patients. Methods Blood samples were collected from hospitalized AIDS patients for culture of Mycobacterium and fungus. Results Of the 3 012 blood samples submitted for culture, 425 (14.1%) were positive, including195 strains of fungal pathogens, mostly Talaromyces marneffei (129) and Cryptococcus (62), 172 strains of Mycobacterium spp, and 58 strains of other pathogens. Conclusions The mycobacterial and fungal blood culture bottle is useful for detection of bloodstream infection in AIDS patients. The prevalence of fungal bloodstream infection is 6.5% (195/3 012) and the prevalence of mycobacterial bloodstream infection is 5.7% (172/3 012). The top three pathogens are Mycobacterium spp, Talaromyces marneffei and Cryptococcus neoformans. Our finding is inconsistent with the reports of other authors. © 2018, Editorial Department of Chinese Journal of Infection. All rights reserved.     

异硫氰酸荧光素染色在真菌性角膜炎中的应用

目的：寻找真菌性角膜炎组织切片快速、准确、方便操作的特殊染色方式。

方法：采用经真菌培养均为阳性的真菌性角膜炎患者的角膜标本38例,常规固定脱水透明浸蜡,进行4μm石蜡切片,脱蜡至水,选用异硫氰酸荧光素(FITC)荧光法和过碘酸雪夫氏染色法(PAS)进行染色对比。

结果：异硫氰酸荧光素法检测阳性率为97.4%(37/38),过碘酸雪夫氏染色法检测阳性率为86.8%(33/38)。结果比较有统计学差异(P<0.001)。

结论：异硫氰酸荧光素法镜检真菌性角膜炎优于过碘酸雪夫氏染色法镜检。     

Cellular immune reactions in the lung

The lung constantly interacts with the environment through thousands of liters of air that are inhaled daily. This continually transports toxic chemicals and particles or pathogenic microorganisms deep into the respiratory system, posing a challenge to physicochemical barriers and the local immune system. Thus, complex structures and mechanisms have evolved to recognize and fend off environmental dangers while at the same time allowing efficient gas exchange. Here we review our current knowledge regarding cellular mechanisms of the immune system in context with the highly specialized anatomical features of the airways and especially the alveolar compartment. The focus is on fungal and viral infections, merging anatomical aspects well known to pulmonologists with fundamental immunological concepts. We discuss the specialized morphological constraints of immune cells compressed under a continuous layer of the surfactant lining within alveoli as well as the importance of functional polarization of respiratory tract epithelia. Furthermore, we summarize the different types of innate and adaptive immune cells and their relative contribution to lung homeostasis with respect to localization. Finally, we provide a list of currently unresolved questions with high relevance for the field that might serve as food for thought regarding future research directions.     

血浆(1-3)-β-D-葡聚糖对侵袭性真菌感染诊断价值的荟萃分析

目的采用荟萃分析评价血浆(1,3)-β-D-葡聚糖检测对侵袭性真菌感染的诊断价值。方法采用STATA11软件分析纳入研究项目血浆(1,3)-β-D-葡聚糖浓度诊断侵袭性真菌感染总的灵敏度、特异度,阳性似然比和阴性似然比。结果纳入的31组研究数据分析显示总的灵敏度,特异度,阳性似然比和阴性似然比分别为0.79(95%CI,0.73～0.85),0.86(95%CI,0.80～0.90),5.64(95%CI,3.818～8.352),和0.242(95%CI,0.179～0.326)。结论荟萃分析显示血浆(1,3)-β-D-葡聚糖检测对于诊断IFI有较高的临床价值。     

A case of allergic fungal rhinosinusitis caused by Schizophyllum commune identified in both patient's nasal sputum and veranda's soil samples

This is a case report of allergic fungal rhinosinusitis caused by Schizophyllum commune (S. commune) identified in a patient's nasal mucus and environmental soil sample using (r)DNA sequencing. Although filamentous basidiomycetes, including S. commune, are known as environmental pathogens causing allergic respiratory diseases worldwide, many patients with infections caused by S. commune have not been correctly diagnosed. Repeated exposures to environmental floating fungi supposedly make an easy sensitization and colonization of fungi in the nasal passages, resulting in the onset of allergic fungal rhinosinusitis due to S. commune in our living environments. This report indicates the importance of reconsidering allergic respiratory diseases associated with our living environments.     

Incidence and associated risk factors for invasive fungal infections and other serious infections in patients on ibrutinib

BackgroundIbrutinib is a small molecule tyrosine kinase inhibitor that blocks the activity of B cells and other immune effectors and is used in a variety of hematologic malignancies. There have been numerous reports of increased frequency of serious infections including invasive fungal infections (IFI) in patients on ibrutinib.MethodsDemographic and clinical features of all patients receiving ibrutinib at a single tertiary care center were collected from electronic medical records. Univariate and multivariate statistical analyses were performed to find out the factors associated with infection.ResultsA total of 244 patients received ibrutinib for hematologic malignancies, of which 44 (18.0%) experienced ≥ 1 serious infection including 5 (2.0%) with IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis), 39 (16.0%) with bacterial infections and 8 (3.3%) with viral infections. Ten patients (4.1%) experienced multiple infections or co-infections while on ibrutinib and 10 (4.1%) expired or were transferred to hospice as a result of infection. In multivariate analysis risk factors that were less common in uninfected versus infected patients included advanced age (73 years vs. 77 years), Eastern Cooperative Oncologic Grade (ECOG) performance score ≥ 2 (6.5% vs. 31.8%) and concurrent use of steroids (4.5% vs. 20.5%) or other cytotoxic agents (0% vs. 4.6%).ConclusionsThere was a high rate of serious infection but relatively few IFI in patients receiving ibrutinib. Most patients who developed serious infections while on ibrutinib had additional predisposing risk factors including concurrent use of steroids or other cytotoxic agents, advanced age and frailty.     

Emerging Issues With Diagnosis and Management of Fungal Infections in Solid Organ Transplant Recipients

Invasive fungal infections (IFIs) are being increasingly recognized in solid organ transplant (SOT) recipients, and delayed diagnosis can lead to graft loss and death. Therefore, there is a low threshold for prophylaxis and early initiation of empiric antifungal treatment, in this patient population. Meanwhile, the increasing consumption of antifungals is associated with high cost, medication toxicities and the emergence of resistance in Candida species, all of which call for rational use of antifungal agents. The implementation of fungal biomarkers, molecular diagnostic methods and direct detection of volatile fungal metabolites in breath samples could lead to faster diagnosis, early appropriate treatment and improved clinical outcomes, but also aid in the de‐escalation of antifungal treatment. Those novel diagnostic modalities need to be validated specifically in SOT recipients. Infectious diseases consultation can contribute to optimization of care through prompt initiation and appropriate modification of antifungal treatment, management of medication toxicities and drug‐drug interactions, as well as source control. In this review, we conceptually summarize recent advances in the diagnosis and management of IFI in SOT recipients, and highlight the importance of early diagnostic tools and good stewardship of antifungal drugs.