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Advances in Fungal Infections: Special Issue in Diagnostics Journal
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Advances in Fungal Infections: Special Issue in Diagnostics Journal

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Diagnostic Microbiology and Infectious Disease".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 25349

Special Issue Editors

Dr. Alfred O. Ankrah

E-Mail Website
Guest Editor
1. National Centre for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB369, Korle Bu, GA-222 7974 Accra, Ghana
2. Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
3. Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa
Interests: PET/CT imaging; fungal infections; tuberculosis; human immunodeficiency virus
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Andor W.J.M. Glaudemans

E-Mail Website
Guest Editor
Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
Interests: infections; inflammatory diseases; PET/CT; imaging; (tumor)immunology; multimodality imaging
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Mike M. Sathekge

E-Mail Website
Guest Editor
1. Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
2. Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
Interests: radionuclide therapy; radiobiology; theranostics; targeted alpha therapy; radionuclide imaging; inflammation and infection imaging; tuberculosis; HIV; fungal infections; prostate cancer; neuroendocrine tumors; novel radiopharmaceutical design; machine learning
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Fungi are ubiquitous in the environment and occur as commensals in the flora of mucosal surfaces of mammalian tissues. Fungal infections, however, cause severe morbidity and mortality, particularly in immunocompromised patients and seriously ill patients. In fact, some epidemiologists have even projected that a fungus may be the next cause of a pandemic after COVID-19.

In order to be prepared to stop or contain the potential havoc that fungi may cause, it is important to understand the emerging epidemiological patterns, the mechanisms underlying their microbiology, the drug-resistance mechanisms, to discuss all available techniques for diagnosis and treatment, and to explore new diagnostic and therapeutic interventions. It is also important that the different disciplines that work on different aspects of fungi pull their resources and expertise together to overcome the current and potential threat posed by the infection.

In this Special Issue on fungi, we invite review and original articles that include, but are not limited to, the following:

  1. Advances in our knowledge of the genetics and the microbiologic mechanisms by which the fungi resist destruction
  2. New insights in human immune response, and the mechanisms by which fungi are able to evade this
  3. New diagnostic and therapeutic platforms in managing these fungal infections
  4. New paradigms of multidisciplinary management of fungal infections
  5. Potential therapeutic strategies that may augment the current strategies

Dr. Alfred O. Ankrah
Prof. Dr. Andor W.J.M. Glaudemans
Prof. Dr. Mike M. Sathekge
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • mycosis
  • invasive fungal infections
  • antifungal agents
  • galactomannan
  • β-D-glycan
  • antifungal stewardship
  • computed tomography
  • monitoring antifungal treatment
  • blood stream infections
  • molecular testing

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Published Papers (11 papers)

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17 pages, 301 KiB  
Review
Skeletal Infections Caused by Coccidioides Species
by Christos Koutserimpas, Symeon Naoum, Konstantinos Raptis, Georgia Vrioni, George Samonis and Kalliopi Alpantaki
Diagnostics 2022, 12(3), 714; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030714 - 15 Mar 2022
Cited by 5 | Viewed by 1721
Abstract
Background: Coccidioidomycosis represents an endemic and challenging disease, with rare extrapulmonary manifestations. The present review of all published cases of core and extremities osseous coccidioidomycosis aims to describe epidemiology, patients’ characteristics, symptoms as well as medical and surgical treatment options and their effectiveness. [...] Read more.
Background: Coccidioidomycosis represents an endemic and challenging disease, with rare extrapulmonary manifestations. The present review of all published cases of core and extremities osseous coccidioidomycosis aims to describe epidemiology, patients’ characteristics, symptoms as well as medical and surgical treatment options and their effectiveness. Methods: A thorough review of all published skeletal core and extremity infections due to Coccidioides species was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 92 cases of Coccidioides spp. skeletal infections were recorded in 87 patients. The patients’ mean age was 35.3 years. The most common site of infection was the spine (82.6%), followed by the foot (6.5%), while the predominant symptom upon presentation was pain (29.9%). Immunosuppressive conditions and/or medications were observed in 21 patients (24.1%). Regarding imaging methods, indicating diagnosis, plain X-rays or CT scans were performed in most patients (50.6%), followed by magnetic resonance imaging (MRI) (47.1%). Most cases were diagnosed through histopathology (62; 71.3%), followed by serology testing (36; 42.4%) and by cultures (35; 40.2%). In 32 cases (36.8%), Coccidioides immitis was cultured, while in the remaining 55 cases (63.2%) the fungus was not further characterized. Regarding AFT, amphotericin B was the preferred agent (52.9%), followed by fluconazole (43.3%). In most cases (78.2%) surgical treatment was also performed. Treatment was successful in 80.5% of cases. Conclusions: Skeletal core and extremity infections due to Coccidioides spp. represent a severe disease. With the available data, the combination of prolonged proper AFT with surgical intervention seems to be the optimal current therapeutic approach. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
15 pages, 319 KiB  
Review
The Diagnosis and Treatment of Fungal Endophthalmitis: An Update
by Ciprian Danielescu, Horia Tudor Stanca, Raluca-Eugenia Iorga, Diana-Maria Darabus and Vasile Potop
Diagnostics 2022, 12(3), 679; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030679 - 10 Mar 2022
Cited by 15 | Viewed by 2956
Abstract
In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism [...] Read more.
In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism found in most cases of endogenous FE. However, we must keep in mind that prevalence of fungal species varies with the geographical area. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. The most important shortcoming of PCR—the limited number of pathogens that can be simultaneously searched for—may be overcome by newer techniques, such as next-generation sequencing. There are even hopes of searching for genetic sequences that codify resistance to antifungals. We must not forget the potential of simpler tests (such as galactomannan and β-d-glucan) in orienting towards a diagnosis of FE. There are few reports about the use of newer antifungals in FE. Echinocandins have low penetration in the vitreous cavity, and may be of use in cases of fungal chorioretinitis (without vitritis), or injected intravitreally as an off-label, salvage therapy. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
15 pages, 315 KiB  
Review
Osseous Infections Caused by Aspergillus Species
by Christos Koutserimpas, Ifigeneia Chamakioti, Konstantinos Raptis, Kalliopi Alpantaki, Georgia Vrioni and George Samonis
Diagnostics 2022, 12(1), 201; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12010201 - 14 Jan 2022
Cited by 9 | Viewed by 1932
Abstract
Background: Osteomyelitis caused by Aspergillus spp. is a severe, but rare, clinical entity. However, clear guidelines regarding the most effective medical management have not yet been established. The present study is a literature review of all such cases, in an effort to elucidate [...] Read more.
Background: Osteomyelitis caused by Aspergillus spp. is a severe, but rare, clinical entity. However, clear guidelines regarding the most effective medical management have not yet been established. The present study is a literature review of all such cases, in an effort to elucidate epidemiology, as well as the therapeutic management and the infection’s outcome. Methods: A thorough review of all reports of osteomyelitis of the appendicular and the axial skeleton, without the skull and the spine, caused by Aspergillus spp. was undertaken. Data about demographics, imaging techniques facilitating diagnosis, causative Aspergillus, method of mold isolation, antifungal treatment (AFT), surgical treatment, as well as the infection’s outcome were recorded and evaluated. Results: A total of 63 cases of osseous infection due to Aspergillus spp. were identified. The studied population’s mean age was 37.9 years. The most commonly affected site was the rib cage (36.8%). Most hosts suffered immunosuppressive conditions (76.2%). Regarding imaging methods indicating diagnosis, computer tomography (CT) was performed in most cases (42.9%), followed by plain X-ray (41.3%) and magnetic resonance imaging (MRI) (34.9%). The most frequent isolated mold was Aspergillus fumigatus (49.2%). Cultures and/or histopathology were used for definite diagnosis in all cases, while galactomannan antigen test was additionally used in seven cases (11.1%), polymerase chain reaction (PCR) in four cases (6.3%), and beta-d-glucan testing in three cases (4.8%). Regarding AFT, the preferred antifungal was voriconazole (61.9%). Most patients underwent surgical debridement (63.5%). The outcome was successful in 77.5%. Discussion: Osteomyelitis due to Aspergillus spp. represents a severe infection. The available data suggest that prolonged AFT in combination with surgical debridement is the preferred management of this infection, while identification of the responsible mold is of paramount importance. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
12 pages, 252 KiB  
Review
Native Joint Infections by Aspergillus Species
by Christos Koutserimpas, Ifigeneia Chamakioti, Symeon Naoum, Konstantinos Raptis, Kalliopi Alpantaki and George Samonis
Diagnostics 2021, 11(12), 2335; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122335 - 11 Dec 2021
Cited by 7 | Viewed by 1992
Abstract
Background: Septic arthritis due to Aspergillus spp. represents a rare, but severe disease. Nevertheless, clear guidelines regarding most effective medical treatment have not yet been established. The present study is a literature review of all reported cases of fungal septic arthritis due to [...] Read more.
Background: Septic arthritis due to Aspergillus spp. represents a rare, but severe disease. Nevertheless, clear guidelines regarding most effective medical treatment have not yet been established. The present study is a literature review of all reported cases of fungal septic arthritis due to Aspergillus spp, in order to clarify epidemiology, as well as the medical and operative management and their outcome. Methods: A meticulous review of all published septic arthritis infections due to Aspergillus has been conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical intervention, as well as the infection’s outcome were recorded and evaluated. Results: A total of 30 Aspergillus spp. strains from 29 hosts have been studied. The patients’ mean age was 45.8 years. The most commonly affected joint was the knee (45.7%), while the predominant symptom was joint pain (62%). Most patients were immunocompromised (72.4%). Diagnosis was established through cultures and/or histopathology. Aspergillus fumigatus was the most common responsible fungi (63.3%), followed by A. flavus (16.6%) and A. terreus (10%). Regarding AFT, the preferred agent proved to be Amphotericin B (14 cases; 48.3%), followed by voriconazole (11; 37.9%), while the mean AFT duration was 5.6 months. In most cases surgical treatment was also performed (in 4 cases no surgery was reported). Treatment was effective in 20 cases (69%). Conclusions: Septic arthritis caused by Aspergillus spp. represents a severe clinical entity. It seems that, with the available data, prolonged AFT along with surgical intervention is the preferred management of this infection, while identification of the responsible fungus is of utmost importance. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
24 pages, 1755 KiB  
Review
Radionuclide Imaging of Invasive Fungal Disease in Immunocompromised Hosts
by Ismaheel O. Lawal, Kgomotso M. G. Mokoala, Mankgopo M. Kgatle, Rudi A. J. O. Dierckx, Andor W. J. M. Glaudemans, Mike M. Sathekge and Alfred O. Ankrah
Diagnostics 2021, 11(11), 2057; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112057 - 06 Nov 2021
Cited by 6 | Viewed by 2571
Abstract
Invasive fungal disease (IFD) leads to increased mortality, morbidity, and costs of treatment in patients with immunosuppressive conditions. The definitive diagnosis of IFD relies on the isolation of the causative fungal agents through microscopy, culture, or nucleic acid testing in tissue samples obtained [...] Read more.
Invasive fungal disease (IFD) leads to increased mortality, morbidity, and costs of treatment in patients with immunosuppressive conditions. The definitive diagnosis of IFD relies on the isolation of the causative fungal agents through microscopy, culture, or nucleic acid testing in tissue samples obtained from the sites of the disease. Biopsy is not always feasible or safe to be undertaken in immunocompromised hosts at risk of IFD. Noninvasive diagnostic techniques are, therefore, needed for the diagnosis and treatment response assessment of IFD. The available techniques that identify fungal-specific antigens in biological samples for diagnosing IFD have variable sensitivity and specificity. They also have limited utility in response assessment. Imaging has, therefore, been applied for the noninvasive detection of IFD. Morphologic imaging with computed tomography (CT) and magnetic resonance imaging (MRI) is the most applied technique. These techniques are neither sufficiently sensitive nor specific for the early diagnosis of IFD. Morphologic changes evaluated by CT and MRI occur later in the disease course and during recovery after successful treatment. These modalities may, therefore, not be ideal for early diagnosis and early response to therapy determination. Radionuclide imaging allows for targeting the host response to pathogenic fungi or specific structures of the pathogen itself. This makes radionuclide imaging techniques suitable for the early diagnosis and treatment response assessment of IFD. In this review, we aimed to discuss the interplay of host immunity, immunosuppression, and the occurrence of IFD. We also discuss the currently available radionuclide probes that have been evaluated in preclinical and clinical studies for their ability to detect IFD. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
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13 pages, 263 KiB  
Review
Spondylodiscitis Caused by Aspergillus Species
by Christos Koutserimpas, Ifigeneia Chamakioti, Symeon Naoum, Konstantinos Raptis, Kalliopi Alpantaki, Diamantis P. Kofteridis and George Samonis
Diagnostics 2021, 11(10), 1899; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11101899 - 14 Oct 2021
Cited by 7 | Viewed by 1700
Abstract
Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., [...] Read more.
Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., in an effort to elucidate epidemiology, patients’ characteristics, andand the medical and surgical treatment options and their effectiveness. Methods: A thorough review of all existing spondylodiscitis cases caused by Aspergillus was performed. Data regarding demographics, responsible fungus, time between symptoms’ onset and firm diagnosis, antifungal treatment (AFT), surgical intervention, andand the infection’s outcome were investigated. Results: A total of 118 Aspergillus spondylodiscitis cases, yielding 119 Aspergillus spp. isolates, were identified in the literature. The patients’ mean age was 40.6 years. Magnetic resonance imaging (MRI) (after its introduction) indicated the diagnosis in most cases (66.7%), while definite diagnosis was established through cultures in the majority of cases (73.7%). Aspergillus fumigatus was isolated in most cases (73; 61.3%), followed by Aspergillus flavus (15; 12.6%) andand Aspergillus nidulans and terreus (7; 5.9%, each). The mean time between symptoms’ onset and diagnosis was 5.7 months. Amphotericin B was the preferred antifungal regiment (84 cases; 71.2%), followed by voriconazole (31; 26.3%), and the mean AFT duration was 6.1 months. The final outcome was successful in 93 cases (78.8%). Furthermore, 77 patients (65.3%) underwent surgery. Conclusions: Spondylodiscitis caused by Aspergillus spp. represents a clinical challenge, requiring a multidisciplinary approach. The present review has shown that prolonged AFT has been the standard of care of the studied cases, while surgical treatment seems to play an important role in selected patents. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
13 pages, 270 KiB  
Review
Non-Candida Fungal Prosthetic Joint Infections
by Christos Koutserimpas, Ifigeneia Chamakioti, Stylianos Zervakis, Konstantinos Raptis, Kalliopi Alpantaki, Diamantis P. Kofteridis, Georgia Vrioni and George Samonis
Diagnostics 2021, 11(8), 1410; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11081410 - 04 Aug 2021
Cited by 14 | Viewed by 1541
Abstract
Background: Fungal prosthetic joint infections (PJIs) are rare, especially those caused by non-Candida species. Treatment has not been fully elucidated, since a plethora of antifungal and surgical interventions have been proposed. Τhis study represents an effort to clarify the optimal management of [...] Read more.
Background: Fungal prosthetic joint infections (PJIs) are rare, especially those caused by non-Candida species. Treatment has not been fully elucidated, since a plethora of antifungal and surgical interventions have been proposed. Τhis study represents an effort to clarify the optimal management of non-Candida fungal PJIs, by reviewing all relevant published cases. Methods: A thorough review of all existing non-Candida fungal PJIs in the literature was conducted. Data regarding demographics, responsible organisms, antifungal treatment (AFT), surgical intervention, time between initial arthroplasty and onset of symptoms, and time between onset of symptoms and firm diagnosis, as well as the infection’s outcome, were evaluated. Results: Forty-two PJIs, in patients with mean age of 66.2 years, were found and reviewed. Aspergillus spp. were isolated in most cases (10; 23.8%), followed by Coccidioides spp. (7; 16.7%) and Pichiaanomala (5; 11.9%). Fluconazole was the preferred antifungal regimen (20 cases; 47.6%), followed by amphotericin B (18 cases; 42.9%), while the mean AFT duration was 9.4 months (SD = 7.06). Two-stage revision arthroplasty (TSRA) was performed in 22 cases (52.4%), with the mean time between stages being 5.2 months (SD = 2.9). The mean time between initial joint implantation and onset of symptoms was 42.1 months (SD = 50.7), while the mean time between onset of symptoms and diagnosis was 5.8 months (SD = 14.3). Conclusions: Non-Candida fungal PJIs pose a clinical challenge, demanding a multidisciplinary approach. The present review has shown that combination of TSRA separated by a 3–6-month interval and prolonged AFT has been the standard of care in the studied cases. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)

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9 pages, 2830 KiB  
Case Report
Necrotizing Skin and Soft Tissue Infection Due to Syncephalastrum Species and Fusarium solani Species Complex Following Open Tibia Fracture
by Vasiliki Mamali, Christos Koutserimpas, Kassiani Manoloudaki, Olympia Zarkotou, George Samonis and Georgia Vrioni
Diagnostics 2022, 12(5), 1163; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051163 - 07 May 2022
Cited by 4 | Viewed by 2127
Abstract
Fungal necrotizing skin and soft tissue infection (NSSTI) represents a rare clinical entity. An extremely rare case of NSSTI, following an open tibia fracture in a 36-year-old male caused by both Syncephalastrum spp. and Fusarium solani species complex (SC) is presented. The infection [...] Read more.
Fungal necrotizing skin and soft tissue infection (NSSTI) represents a rare clinical entity. An extremely rare case of NSSTI, following an open tibia fracture in a 36-year-old male caused by both Syncephalastrum spp. and Fusarium solani species complex (SC) is presented. The infection was diagnosed through direct microscopy, cultures and histology. The disease had a long course. The patient underwent a total of seven consecutive surgical debridements, while proper and timely antifungal treatment was initiated and included liposomal amphotericin B and voriconazole. He gradually recovered and 4 years later he is completely functioning and healthy. Invasive fungal infections are well-documented causes of high morbidity and mortality in immunocompromised individuals, whereas in immunocompetent hosts, trauma-related fungal infections have also been reported. It is of note that Syncephalastrum spp. has very rarely been identified to cause infection in immunocompromised or immunocompetent hosts, whereas Fusarium spp. has rarely been involved in skin necrotic lesions in non-immunocompromised individuals. A high suspicion index, especially in necrotic lesions in trauma patients, is pivotal for early diagnosis, which may lead to lower mortality as well as lower amputation rates. Definite diagnosis through microscopy, histology and/or cultures are of paramount importance, whereas PCR testing may also be extremely useful. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
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12 pages, 5252 KiB  
Case Report
Disseminated Cunninghamella spp. Endocarditis in a Beta-Thalassemia Patient after Asymptomatic COVID-19 Infection
by Eliza Cinteza, Alin Nicolescu, Tatiana Ciomartan, Liana-Cătălina Gavriliu, Cristiana Voicu, Adelina Carabas, Monica Popescu and Irina Margarint
Diagnostics 2022, 12(3), 657; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030657 - 08 Mar 2022
Cited by 8 | Viewed by 2563
Abstract
Cunninghamella spp. is a group of fungi belonging to the Mucorales order. Cases of fungal endocarditis are sporadic, but more frequent in immunocompromised patients. COVID-19 (SARS-CoV-2 Infection Disease 2019) infections, prematurity, deferoxamine treatment, iron overload, neutropenia, diabetes, and malignant hemopathies proved to be [...] Read more.
Cunninghamella spp. is a group of fungi belonging to the Mucorales order. Cases of fungal endocarditis are sporadic, but more frequent in immunocompromised patients. COVID-19 (SARS-CoV-2 Infection Disease 2019) infections, prematurity, deferoxamine treatment, iron overload, neutropenia, diabetes, and malignant hemopathies proved to be risk factors for mucormycosis. We present the case of a 7-year-old boy who was treated every three weeks with blood transfusion for major beta-thalassemia, receiving deferoxamine for secondary hemochromatosis. After two weeks with nonspecific respiratory and digestive symptoms, he was admitted for fever, followed by lower limb ischemia and neurological signs. Echocardiography revealed massive endocarditis affecting the mitral and tricuspid valves with embolization phenomena in the brain, lungs, kidney, spleen, and lower limbs. As a particular finding, IgG antibodies for COVID-19 were positive. Emergency cardiac surgery was performed. The mitral valve necessitated replacement with CarboMedics prosthesis. Unfortunately, the patient did not survive. Cunninghamella spp. was confirmed via the PCR analysis of vegetations. Cunninghamella endocarditis in the context of a systemic infection presented as an opportunistic infection affecting a child who had several risk factors. Mucormycosis is challenging to treat, with high mortality. Prophylactic treatment in beta-thalassemia patients with iron-chelator deprivation drugs, such as deferiprone, may help in preventing these particular fungal infections. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
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7 pages, 1646 KiB  
Case Report
Isolated Cerebral Mucormycosis Caused by Lichtheimia Species in a Polytrauma Patient
by Vasiliki Mamali, Christos Koutserimpas, Olympia Zarkotou, Georgia Vrioni and George Samonis
Diagnostics 2022, 12(2), 358; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020358 - 31 Jan 2022
Cited by 4 | Viewed by 2008
Abstract
Isolated post-traumatic cerebral mucormycosis represents an extremely rare and severe disease. A case of isolated cerebral mucormycosis infection caused by Lichtheimia spp. in a 21-year-old multi-trauma patient is presented. The patient was hospitalized in the intensive care unit and underwent craniotomy due to [...] Read more.
Isolated post-traumatic cerebral mucormycosis represents an extremely rare and severe disease. A case of isolated cerebral mucormycosis infection caused by Lichtheimia spp. in a 21-year-old multi-trauma patient is presented. The patient was hospitalized in the intensive care unit and underwent craniotomy due to brain injuries. Two weeks following the initial procedure, pus drained from the surgical wound was microscopically examined and cultured, yielding Lichtheimia spp. Imaging showed parietal, temporal and frontal abscesses at the right side. The patient was commenced on amphotericin B and underwent surgical debridement, while histopathological examination of the affected tissue demonstrated broad, aseptate hyphae, findings typical for mucormycetes. The patient passed away due to heavy traumatic injuries after 2 months. It is speculated that direct inoculation was the portal of entry for infection, and that high steroid use for 2 weeks following inoculation contributed to the severity of infection that developed. Isolated cerebral mucormycosis in immunocompetent hosts is an extremely rare, but severe disease. Diagnosis is established through direct microscopy, histopathology and/or cultures. PCR-based techniques are useful either to detect mucormycetes in tissues, especially when cultures are negative, or to accurately identify the fungi grown in cultures at the species level. A high suspicion index, especially in the necrotic lesions of traumas, is of the utmost importance for early diagnosis. Appropriate surgical debridement, as well as antifungal therapy, including amphotericin B, represents the treatment of choice. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
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7 pages, 2986 KiB  
Case Report
Fungal Septic Knee Arthritis Caused by Aspergillus fumigatus following Anterior Cruciate Ligament Reconstruction
by George Samonis, Christos Koutserimpas, Georgia Vrioni, Elsa Kampos Martinez, Panagiotis Kouloumentas, Kalliopi Alpantaki and George Saroglou
Diagnostics 2021, 11(11), 1975; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11111975 - 24 Oct 2021
Cited by 8 | Viewed by 2675
Abstract
Postoperative infections after arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) represent a rare but severe complication. An extremely rare case of Aspergillus septic arthritis in a 27-year-old patient following arthroscopic ACLR is reported. The patient presented with signs of knee infection 14 days [...] Read more.
Postoperative infections after arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) represent a rare but severe complication. An extremely rare case of Aspergillus septic arthritis in a 27-year-old patient following arthroscopic ACLR is reported. The patient presented with signs of knee infection 14 days after ACLR. Two consecutive arthroscopic debridements were performed, while eventually histopathology, cultures and multiplex PCR test revealed Aspergillus identified as A. fumigatus by mass spectrometry. The patient commenced long-term treatment with voriconazole. Fungal arthritis or osteomyelitis following ACLR has a mild local and general inflammatory reaction when compared to the bacterial ones. Nevertheless, such infections may lead to aggressive osseous destruction and necrosis. A high index of suspicion is of utmost importance for early detection, while microscopic, histological examination and multiplex PCR may be more helpful for the diagnosis than cultures since cultures are more time-consuming and may vary depending on different factors. Full article
(This article belongs to the Special Issue Advances in Fungal Infections: Special Issue in Diagnostics Journal)
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