Current Fungal Infection Reports[JOURNAL]
Sun
82 papers
Updates on Chromoblastomycosis: Evolving Insights in Clinical Management and Therapeutic Strategies.
Popovic K, Henao-Martínez AF, Teixeira MM … +3 more , de Souza EBA, Rakotoarisaona M, Agudelo Higuita NI
Curr Fungal Infect Rep · 2026 · PMID 42099658 · Full text
PURPOSE OF REVIEW: The aim of this review is to provide an in-depth overview of chromoblastomycosis, with emphasis on emerging management strategies and therapeutic options, and to underscore potential gaps in the litera...
PURPOSE OF REVIEW: The aim of this review is to provide an in-depth overview of chromoblastomycosis, with emphasis on emerging management strategies and therapeutic options, and to underscore potential gaps in the literature and priorities for future research. RECENT FINDINGS: Among the newer triazoles, posaconazole has demonstrated greatest therapeutic potential in the treatment of chromoblastomycosis, including for severe and refractory disease. Adjunctive immunomodulatory therapies such as glucan, imiquimod, and acitretin have shown potential as well. Several novel and repurposed agents also have potential activity against dematiaceous fungi, including tricyclazole, HIV peptidase inhibitors, 1,10-phenanthroline-5,6-dione, and benzimidazoles. A recently proposed combination protocol with debulking, intralesional amphotericin B, and oral terbinafine (DAT protocol) achieved cure in all 16 included patients in a 2025 case series. While excisional surgery remains the preferred physical therapeutic modality, several reports have shown favorable results with both photodynamic and heat therapy. SUMMARY: Chromoblastomycosis continues to pose a therapeutic challenge, requiring prolonged antifungal therapy often combined with physical therapeutic modalities. Improved access to diagnostics and early intervention remain essential to reducing global disease burden.
Quality of Life, Disability, and Fungal Neglected Tropical Diseases.
Cavanaugh AM, Ribeiro Dos Santos A, Freitas DFS … +4 more , Venturini J, Fahal A, Azevedo C, Gold JAW
Curr Fungal Infect Rep · 2025 Apr · PMID 40927623 · Full text
PURPOSE OF REVIEW: This review summarizes current literature about the disability burden of the fungal neglected tropical diseases (NTDs) sporotrichosis, chromoblastomycosis, eumycetoma, and paracoccidioidomycosis. The r...
PURPOSE OF REVIEW: This review summarizes current literature about the disability burden of the fungal neglected tropical diseases (NTDs) sporotrichosis, chromoblastomycosis, eumycetoma, and paracoccidioidomycosis. The review highlights current knowledge gaps in global settings and describes available tools that could be adopted to fill these gaps. RECENT FINDINGS: Sporotrichosis, chromoblastomycosis, and eumycetoma often present initially as skin lesions that can become progressively disfiguring, lead to stigmatization, and cause various sequalae affecting health and function. Chronic paracoccidioidomycosis can have systemic involvement and commonly results in impaired pulmonary function, which can limit activities of daily living and employment capacity. Use of standardized tools to quantify disability with fungal NTDs has been limited to date. Standardized tools to measure the impacts on quality of life and mental health are available and have been used for similar patient populations, including persons with other fungal diseases and persons with non-fungal skin NTDs. SUMMARY: Fungal NTDs can be disabling. Improved understanding of the quality of life and mental health consequences might lead to greater awareness of the burden of fungal NTDs and enhance health planning to address the health and rehabilitation needs of persons affected by these diseases.
The Current Landscape of Repurposed Drugs for Fungal Neglected Tropical Diseases.
Farid T, Tumas KC, Stone HA … +1 more , Duggal M
Curr Fungal Infect Rep · 2025 Dec · PMID 40837073 · Full text
PURPOSE OF REVIEW: Eumycetoma, chromoblastomycosis, and sporotrichosis are three of only four fungal infections recognized as Neglected Tropical Diseases (NTDs) by the World Health Organization. They are a significant so...
PURPOSE OF REVIEW: Eumycetoma, chromoblastomycosis, and sporotrichosis are three of only four fungal infections recognized as Neglected Tropical Diseases (NTDs) by the World Health Organization. They are a significant source of morbidity in subtropical and tropical regions of the Americas, Africa, and Asia. There are very few treatments approved for these diseases. Clinicians often use drug repurposing, off-label use of existing drugs, for their treatment. This article is a systematic review of the published literature on the treatment of fungal NTDs from the last five years (2019-2024). It will provide an overview for each fungal NTD, their current treatment landscape, and the challenges associated with their treatment. RECENT FINDINGS: Itraconazole remains the most widely used antifungal for the treatment of these fungal NTDs. Newer antifungals such as fosravuconazole have matched the efficacy of currently available drugs while reducing adverse events and pill burden. Other promising treatment strategies involve the use of immunomodulators (e.g., imiquimod), steroids (e.g., prednisolone), or non-steroidal anti-inflammatory agents in combination with traditional antifungal agents. SUMMARY: Frequently repurposed drugs include itraconazole, posaconazole, voriconazole, amphotericin B, terbinafine, potassium iodide, and 5-flucytosine. Most of these drugs have significant side effects, unsatisfactory cure rates, and significant cost that restricts their use. Systematic collection of this drug repurposing data and analyzing it in aggregate using platforms such as CURE ID has the potential to generate efficacy signals for drugs. These promising candidates can then be studied comprehensively in clinical trials for drug approval.
Fungal Infections and Social Determinants of Health: Using Data to Identify Disparities.
Williams SL, Benedict K, Toda M
Curr Fungal Infect Rep · 2024 Mar · PMID 39380623 · Full text
PURPOSE OF REVIEW: Fungal diseases disproportionately affect certain demographic populations, but few studies have thoroughly investigated the drivers of those disparities. We summarize data sources that can be considere...
PURPOSE OF REVIEW: Fungal diseases disproportionately affect certain demographic populations, but few studies have thoroughly investigated the drivers of those disparities. We summarize data sources that can be considered to explore potential associations between fungal diseases and social determinants of health in the United States. RECENT FINDINGS: Sociodemographic disparities are apparent in fungal diseases, and social determinants of health (e.g., income, living conditions, and healthcare access) may be associated with increased risk of infection, severe disease, and poor health outcomes. SUMMARY: Numerous data sources are available in the United States to analyze the potential association between fungal diseases and underlying social determinants of health. Each source has benefits and limitations that should be considered in the development of analysis plans. Inherent challenges to all fungal disease data (e.g., underdiagnosis, underreporting, and inability to detect people who do not seek medical care) should be noted and accounted for in interpretation of results.
Pneumonia in HIV-Negative, Non-transplant Patients: Epidemiology, Clinical Manifestations, Diagnosis, Treatment, and Prevention.
Rhoads S, Maloney J, Mantha A … +2 more , Van Hook R, Henao-Martínez AF
Curr Fungal Infect Rep · 2024 Jun · PMID 38948111 · Full text
PURPOSE OF REVIEW: pneumonia (PJP) is an opportunistic fungal infection that is increasingly seen in HIV-negative patients with immune compromise due to other etiologies. We lack comprehensive clinical recommendations f...
PURPOSE OF REVIEW: pneumonia (PJP) is an opportunistic fungal infection that is increasingly seen in HIV-negative patients with immune compromise due to other etiologies. We lack comprehensive clinical recommendations for this population. RECENT FINDINGS: In non-HIV cases, PJP has a mortality rate of up to 50%, which is unacceptable despite the presence of safe and effective prophylaxis and therapy. Steroid use is one of the most common risk factors for disease development. New data suggests that lower doses of the preferred treatment regimen, TMP-SMX, may be equally effective for treatment while limiting side effects. While commonly used, the benefit of corticosteroids for the treatment of PJP has recently been called into question, with a recent multicenter cohort demonstrating no benefit among solid organ transplant recipients. SUMMARY: A high suspicion of PJP in individuals with pneumonia during immunosuppressant use is crucial. Therapeutic options are evolving to decrease potential side effects while maintaining efficacy in this highly morbid disease.
Epidemiology of COVID-19-Associated Mucormycosis.
Tayabali K, Pothiwalla H, Narayanan S
Curr Fungal Infect Rep · 2023 May · PMID 37360859 · Full text
PURPOSE OF THE REVIEW: To describe the epidemiology and risk factors for Coronavirus disease-19 (COVID-19)-associated mucormycosis (CAM) based on current published literature. RECENT FINDINGS: COVID-19 is associated with...
PURPOSE OF THE REVIEW: To describe the epidemiology and risk factors for Coronavirus disease-19 (COVID-19)-associated mucormycosis (CAM) based on current published literature. RECENT FINDINGS: COVID-19 is associated with an increased risk of secondary infections. Mucormycosis is an uncommon invasive fungal infection that typically affects people with immunocompromising conditions and uncontrolled diabetes. Treatment of mucormycosis is challenging and is associated with high mortality even with standard care. During the second wave of the COVID 19 pandemic, an abnormally high number of CAM cases were seen particularly in India. Several case series have attempted to describe the risk factors for CAM. SUMMARY: A common risk profile identified for CAM includes uncontrolled diabetes and treatment with steroids. COVID-19-induced immune dysregulation as well as some unique pandemic specific risk factors may have played a role.
Aspergillosis: an Update on Clinical Spectrum, Diagnostic Schemes, and Management.
Kanaujia R, Singh S, Rudramurthy SM
Curr Fungal Infect Rep · 2023 May · PMID 37360858 · Full text
PURPOSE OF REVIEW: This review gives an overview of the diseases caused by , including a description of the species involved and the infected clinical systems. We provide insight into the various diagnostic methods avail...
PURPOSE OF REVIEW: This review gives an overview of the diseases caused by , including a description of the species involved and the infected clinical systems. We provide insight into the various diagnostic methods available for diagnosing aspergillosis, particularly invasive aspergillosis (IA), including the role of radiology, bronchoscopy, culture, and non-culture-based microbiological methods. We also discuss the available diagnostic algorithms for the different disease conditions. This review also summarizes the main aspects of managing infections due to spp., such as antifungal resistance, choice of antifungals, therapeutic drug monitoring, and new antifungal alternatives. RECENT FINDINGS: The risk factors for this infection continue to evolve with the development of many biological agents that target the immune system and the increase of viral illnesses such as coronavirus disease. Due to the limitations of present mycological test methods, establishing a fast diagnosis is frequently difficult, and reports of developing antifungal resistance further complicate the management of aspergillosis. Many commercial assays, like AsperGenius®, MycAssay Aspergillus®, and MycoGENIE®, have the advantage of better species-level identification and concomitant resistance-associated mutations. Fosmanogepix, ibrexafungerp, rezafungin, and olorofim are newer antifungal agents in the pipeline exhibiting remarkable activity against spp. SUMMARY: The fungus is found ubiquitously around the world and can cause various infections, from harmless saprophytic colonization to severe IA. Understanding the diagnostic criteria to be used in different patient groups and the local epidemiological data and antifungal susceptibility profile is critical for optimal patient management.
Invasive Aspergillosis and the Impact of Azole-resistance.
Bosetti D, Neofytos D
Curr Fungal Infect Rep · 2023 Mar · PMID 37360857 · Full text
PURPOSE OF REVIEW: IA (invasive aspergillosis) caused by azole-resistant strains has been associated with higher clinical burden and mortality rates. We review the current epidemiology, diagnostic, and therapeutic strate...
PURPOSE OF REVIEW: IA (invasive aspergillosis) caused by azole-resistant strains has been associated with higher clinical burden and mortality rates. We review the current epidemiology, diagnostic, and therapeutic strategies of this clinical entity, with a special focus on patients with hematologic malignancies. RECENT FINDINGS: There is an increase of azole resistance in spp. worldwide, probably due to environmental pressure and the increase of long-term azole prophylaxis and treatment in immunocompromised patients (e.g., in hematopoietic stem cell transplant recipients). The therapeutic approaches are challenging, due to multidrug-resistant strains, drug interactions, side effects, and patient-related conditions. SUMMARY: Rapid recognition of resistant spp. strains is fundamental to initiate an appropriate antifungal regimen, above all for allogeneic hematopoietic cell transplantation recipients. Clearly, more studies are needed in order to better understand the resistance mechanisms and optimize the diagnostic methods to identify spp. resistance to the existing antifungal agents/classes. More data on the susceptibility profile of spp. against the new classes of antifungal agents may allow for better treatment options and improved clinical outcomes in the coming years. In the meantime, continuous surveillance studies to monitor the prevalence of environmental and patient prevalence of azole resistance among spp. is absolutely crucial.
Developments in Fungal Serology.
White PL
Curr Fungal Infect Rep · 2023 Apr · PMID 37360856 · Full text
PURPOSE OF REVIEW: The true incidence of fungal disease is hampered by conventionally poor diagnostic tests, limited access to advanced diagnostics, and limited surveillance. The availability of serological testing has b...
PURPOSE OF REVIEW: The true incidence of fungal disease is hampered by conventionally poor diagnostic tests, limited access to advanced diagnostics, and limited surveillance. The availability of serological testing has been available for over two decades and generally underpins the modern diagnosis of the most common forms of fungal disease. This review will focus on technical developments of serological tests for the diagnosis of fungal disease, describing advances in clinical performance when available. RECENT FINDINGS: Despite their longevity, technical, clinical, and performance limitations remain, and tests specific for fungal pathogens outside the main pathogens are lacking. The availability of LFA and automated systems, capable of running multiple different tests, represents significant developments, but clinical performance data is variable and limited. SUMMARY: Fungal serology has significantly advanced the diagnosis of the main fungal infections, with LFA availability increasing accessibility to testing. Combination testing has the potential to overcome performance limitations.
Diagnostic Efficacy of LAMP Assay for Human Fungal Pathogens: a Systematic Review and Meta-analysis.
Bumbrah GS, Jain S, Singh S … +2 more , Fatima Z, Hameed S
Curr Fungal Infect Rep · 2023 May · PMID 37360855 · Full text
PURPOSE: Human fungal infections particularly caused by and have emerged as major public health burden. Long turnaround time and poor sensitivity of the conventional diagnostics are the major impediments for faster dia...
PURPOSE: Human fungal infections particularly caused by and have emerged as major public health burden. Long turnaround time and poor sensitivity of the conventional diagnostics are the major impediments for faster diagnosis of human fungal pathogens. RECENT FINDINGS: To overcome these issues, molecular-based diagnostics have been developed. They offer enhanced sensitivity but require sophisticated infrastructure, skilled manpower, and remained expensive. In that context, loop-mediated isothermal amplification (LAMP) assay represents a promising alternative that facilitates visual read outs. However, to eradicate fungal infections, all forms of fungi must be accurately detected. Thus, a need for alternative testing methodologies is imperative that should be rapid, accurate and facilitate widespread adoption. Therefore, the aim of the present study is to conduct a meta-analysis to assess the diagnostic efficiency of LAMP in the detection of a panel of human fungal pathogens following PRISMA guidelines using scientific databases viz. PubMed, Google Scholar, Science Direct, Scopus, BioRxiv, and MedRxiv. SUMMARY: From various studies reported on the diagnosis of fungi, only 9 articles were identified as eligible to meet the criteria of LAMP based diagnosis. Through this meta-analysis, it was found that most of the studies were conducted in China and Japan with sputum and blood as the most common specimens to be used for LAMP assay. The collected data underlined that ITS gene and fluorescence-based detections ranked as the most used target and method. The pooled sensitivity values of meta-analysis ranged between 0.71 and 1.0 and forest plot and SROC (summary receiver operating characteristic) curve revealed a pooled specificity values between 0.13 and 1.0 with the confidence interval of 95%, respectively. The accuracy and precision rates of eligible studies mostly varied between 70 to 100% and 68 to 100%, respectively. A quality assessment based on QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) of bias and applicability was conducted which depicted low risk of bias and applicability concerns. Together, LAMP technology could be considered as a feasible alternative to current diagnostics considering high fungal burden for rapid testing in low resource regions.
Novel Approaches in the Management of Mucormycosis.
Lamoth F
Curr Fungal Infect Rep · 2023 May · PMID 37360854 · Full text
PURPOSE OF REVIEW: Invasive mucormycosis (IM), caused by fungi of the order Mucorales, is one of the deadliest fungal infection among hematologic cancer patients. Its incidence is also increasingly reported in immunocomp...
PURPOSE OF REVIEW: Invasive mucormycosis (IM), caused by fungi of the order Mucorales, is one of the deadliest fungal infection among hematologic cancer patients. Its incidence is also increasingly reported in immunocompetent individuals, notably with the COVID-19 pandemic. Therefore, there is an urgent need for novel diagnostic and therapeutic approaches of IM. This review discusses the current advances in this field. RECENT FINDINGS: Early diagnosis of IM is crucial and can be improved by Mucorales-specific PCR and development of lateral-flow immunoassays for specific antigen detection. The spore coat proteins (CotH) are essential for virulence of the Mucorales and may represent a target for novel antifungal therapies. Adjuvant therapies boosting the immune response, such as interferon-γ, anti-PDR1 or fungal-specific chimeric antigen receptor (CAR) T-cells, are also considered. SUMMARY: The most promising perspectives for improved management of IM consist of a multilayered approach targeting both the pathogen and the host immune system.
The Impact of Corticosteroids on the Outcome of Fungal Disease: a Systematic Review and Meta-analysis.
Li Z, Denning DW
Curr Fungal Infect Rep · 2023 · PMID 36852004 · Full text
PURPOSE OF REVIEW: Corticosteroids have a complex relationship with fungal disease - risk for many, benefit for others. This systematic review aims to address the effect of corticosteroids on mortality and visual outcome...
PURPOSE OF REVIEW: Corticosteroids have a complex relationship with fungal disease - risk for many, benefit for others. This systematic review aims to address the effect of corticosteroids on mortality and visual outcome in different fungal diseases. RECENT FINDINGS: Corticosteroids are a risk factor of aspergillosis for patients who have COVID-19, and they also led to a worse outcome. Similarity, corticosteroids are a risk factor for candidemia and mucormycosis. Some researchers reported that using topical corticosteroid in keratitis was associated with worse visual outcome if fungal keratitis. Some studies showed that corticosteroids are linked to a negative outcome for non-HIV patients with pneumonia (PCP), in contrast to those with HIV and PCP. SUMMARY: In 59 references, we found that corticosteroid therapy showed a worse clinical outcome in invasive aspergillosis (IA) (HR: 2.50, 95%CI: 1.89-3.31, < 0.001) and chronic pulmonary aspergillosis (CPA) (HR: 2.74, 95%CI: 1.48-5.06, = 0.001), PCP without HIV infection (OR: 1.29, 95%CI: 1.09-1.53, = 0.003), invasive candidiasis and candidaemia (OR: 2.13, 95%CI: 1.85-2.46, < 0.001), mucormycosis (OR: 4.19, 95%CI: 1.74-10.05, = 0.001) and early in the course of fungal keratitis (OR: 2.99, 95%CI: 1.14-7.84, = 0.026). There was equivocal outcome in cryptococcal meningoencephalitis in AIDS and primary coccidioidomycosis, while corticosteroid therapy showed a better outcome in PCP in HIV-infected patients (RR: 0.62, 95%CI: 0.46-0.83, =0.001) and fungal keratitis patients after keratoplasty surgery (OR: 0.01, 95%CI: 0.00-0.41, = 0.041) and probably in cryptococcal meningoencephalitis in non-immunocompromised patients. A sub-analysis in invasive aspergillosis and CPA showed that use of more than 2 mg/kg/day of prednisolone equivalents per day is a significant factor in increasing mortality (HR: 2.94, 95%CI: 2.13-4.05, < 0.001). Corticosteroid therapy during invasive fungal disease was usually associated with a slightly or greatly increased mortality or worse visual outcome (in fungal keratitis), with two disease exceptions. Avoiding the addition of corticosteroids, or minimising dose and duration in those who require them, is likely to improve the outcome of most life- and vision-threatening fungal diseases. This review provides a cornerstone for further research in exploring the accuracy of suitable dose and duration of corticosteroids treatment in fungal diseases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12281-023-00456-2.
Candidiasis and Other Emerging Yeasts.
Sharma M, Chakrabarti A
Curr Fungal Infect Rep · 2023 · PMID 36741271 · Full text
PURPOSE OF REVIEW: The review presents a comprehensive and updated information on the contemporary status of invasive candidiasis (IC), other emerging yeast infections, and the challenges they present in terms of at-risk...
PURPOSE OF REVIEW: The review presents a comprehensive and updated information on the contemporary status of invasive candidiasis (IC), other emerging yeast infections, and the challenges they present in terms of at-risk population, specific virulence attributes, and antifungal susceptibility profile. RECENT FINDINGS: With the advancement in medical field, there has been parallel expansion of vulnerable populations over the past two decades. This had led to the emergence of a variety of rare yeasts in healthcare settings, both and non-Candida yeast causing sporadic cases and outbreaks. The advancements in diagnostic modalities have enabled accurate identification of rare species and non-Candida yeast (NCY) of clinical importance. Their distribution and susceptibility profile vary across different geographical regions, thus necessitating surveillance of local epidemiology of these infections to improve patient outcomes. SUMMARY: The challenges in management of IC have been complicated with emergence of newer species and resistance traits. has already overtaken in many Asian ICUs, while is rising rapidly worldwide. Recent genomic research has reclassified several yeasts into newer genera, and an updated version of MALDI-TOF MS or ITS sequencing is necessary for accurate identification. Having a knowledge of the differences in predisposing factors, epidemiology and susceptibility profile of already established pathogenic yeasts, as well as new emerging yeasts, are imperative for better patient management.
Folliculitis in the Setting of COVID-19.
Barrera-Godínez A, Figueroa-Ramos G
Curr Fungal Infect Rep · 2023 · PMID 36741270 · Full text
PURPOSE OF REVIEW: To review recent literature on folliculitis and explore its association with COVID-19. RECENT FINDINGS: Reports of folliculitis in the setting of COVID-19 are scarce. Shared characteristics between a...
PURPOSE OF REVIEW: To review recent literature on folliculitis and explore its association with COVID-19. RECENT FINDINGS: Reports of folliculitis in the setting of COVID-19 are scarce. Shared characteristics between affected individuals include male sex, obesity, intensive care, and administration of systemic antibiotics and systemic steroids. Dexamethasone can potentially stimulate sebum production and therefore lead to proliferation. The clinical picture of folliculitis accompanying COVID-19 is similar to classic descriptions but tends to spare the face and predominates in occlusion sites. SUMMARY: folliculitis is under-recognized. Fever, sweating, occlusion, immobility, antibiotics, and dexamethasone contribute to COVID-19 patients developing folliculitis. Antifungal therapy, together with correcting predisposing factors, is the mainstay of management. Future research should explore the relationship between systemic steroids and other acneiform reactions.
Strategies to Prevent Transmission of in Healthcare Settings.
Ahmad S, Asadzadeh M
Curr Fungal Infect Rep · 2023 · PMID 36718372 · Full text
PURPOSE OF REVIEW: , a recently recognized yeast pathogen, has become a major public health threat due to the problems associated with its accurate identification, intrinsic and acquired resistance to antifungal drugs, a...
PURPOSE OF REVIEW: , a recently recognized yeast pathogen, has become a major public health threat due to the problems associated with its accurate identification, intrinsic and acquired resistance to antifungal drugs, and its potential to easily contaminate the environment causing clonal outbreaks in healthcare facilities. These outbreaks are associated with high mortality rates particularly among older patients with multiple comorbidities under intensive care settings. The purpose of this review is to highlight strategies that are being adapted to prevent transmission of in healthcare settings. RECENT FINDINGS: Colonized patients shed into their environment which contaminates surrounding equipment. It resists elimination even by robust decontamination procedures and is easily transmitted to new patients during close contact resulting in outbreaks. Efforts are being made to rapidly identify -infected/-colonized patients, to determine its susceptibility to antifungals, and to perform effective cleaning and decontamination of the environment and isolation of colonized patients to prevent further transmission. SUMMARY: Rapid and accurate identification of hospitalized patients infected/colonized with , rapid detection of its susceptibility patterns, and appropriate use of infection control measures can help to contain the spread of this highly pathogenic yeast in healthcare settings and prevent/control outbreaks.
Epidemiology of Invasive Fungal Infections in Solid Organ Transplant Recipients: an Indian Perspective.
Sharma M, Rudramurthy SM, Chakrabarti A
Curr Fungal Infect Rep · 2022 · PMID 36281339 · Full text
PURPOSE OF REVIEW: This review summarizes the available Indian data on epidemiology of invasive fungal infections (IFI) in recipients of solid organ transplants (SOT). The epidemiology is further compared with studies fr...
PURPOSE OF REVIEW: This review summarizes the available Indian data on epidemiology of invasive fungal infections (IFI) in recipients of solid organ transplants (SOT). The epidemiology is further compared with studies from other parts of the world for each SOT type. RECENT FINDINGS: The available studies on Indian epidemiology of IFI in SOT are scarce, though the number of SOTs performed in India have increased tremendously in recent years. The limited data from India present a distinct spectrum of infection in transplant recipients with high incidence of mucormycosis. During COVID-19 outbreak, IFI rate increased and renal transplant recipients acquired mucormycosis earlier than previous studies. SUMMARY: Maximum data on IFI was available from renal transplant recipients, wherein mucormycosis was the predominant IFI in Indian patients in contrast to invasive candidiasis in majority countries. The other IFIs had varied spectrum. With the increasing number of SOTs being performed and the already persisting high burden of IFI in India, there is an urgent need of larger prospective studies on epidemiology of IFI in transplant recipients.
Pathogenesis and Pathology of COVID-Associated Mucormycosis: What Is New and Why.
Radotra B, Challa S
Curr Fungal Infect Rep · 2022 · PMID 36193101 · Full text
PURPOSE OF REVIEW: There is global increase in the incidence of mucormycosis. However, a sudden increase in the COVID-associated mucormycosis (CAM) was noted, particularly in India, during the second wave of the COVID-19...
PURPOSE OF REVIEW: There is global increase in the incidence of mucormycosis. However, a sudden increase in the COVID-associated mucormycosis (CAM) was noted, particularly in India, during the second wave of the COVID-19 pandemic. The interplay of factors involved in the pathogenesis is complex. In this review, the influence of pre-existing disease, exaggerated risk factors, altered milieu due to COVID-19 itself and the consequences of its treatment on the host pathogen interactions leading to the disease and morphology of the fungus will be highlighted. RECENT FINDINGS: Hyperglycemia, acidosis, available free iron, lowered host defenses, and the fungal virulence factors promote the growth of Mucorales. There is a high background prevalence of diabetes mellitus (DM) in India. Uncontrolled or undiagnosed DM, COVID-19 itself, and inappropriate administration of corticosteroids in high doses and for prolonged periods result in hyperglycemia. Diabetic ketoacidosis (DKA) and metabolic acidosis due to hypoxia or renal failure contribute to acidic pH and dissociate bound iron from serum proteins. The host defenses are lowered due to COVID-19-induced immune dysregulation, hyperglycemia itself, and administration of corticosteroids and immune suppressants for the treatment of COVID-19. The altered metabolic milieu in the local microenvironment of nose and paranasal sinuses (PNS) promotes specific interaction of glucose-regulated protein-78 (GRP-78) on host cells with spore coat protein homologue (CotH 3) on Mucorales resulting in rhino-orbito-cerebral mucormycosis (ROCM) as the predominant clinical form in CAM. The pathology is extensive soft tissue involvement with angioinvasion and perineural invasion. Melanized hyphae and sporangia were seen on histopathology, which is unique to CAM. While many factors favor the growth of Mucorales in CAM, hyperglycemia, hyperferritinemia, and administration of hyperbaric oxygen result in reactive oxygen species (ROS) and inadequate humidification results in dehydration. Melanization is possibly the adaptive and protective mechanism of Mucorales to escape the unfavorable conditions due to the treatment of COVID-19. SUMMARY: High background prevalence of DM, inappropriate administration of corticosteroids and immune dysregulation due to COVID-19 favor the growth of Mucorales in CAM. Melanization of Mucorales hyphae and sporangia on histopathology probably represent adaptive and protective mechanism due to the treatment with hyperbaric oxygen with inadequate humidification as well as the metabolic alterations.
Updates on Histoplasmosis in Solid Organ Transplantation.
Saullo JL, Miller RA
Curr Fungal Infect Rep · 2022 · PMID 36097519 · Full text
PURPOSE OF REVIEW: Histoplasmosis remains a challenging infection in solid organ transplantation. This review provides a topic update with emphasis on the changing epidemiology, along with new diagnostic and treatment i...
PURPOSE OF REVIEW: Histoplasmosis remains a challenging infection in solid organ transplantation. This review provides a topic update with emphasis on the changing epidemiology, along with new diagnostic and treatment innovations. RECENT FINDINGS: Recent years have observed expanding geographic distribution due to climate change, environmental disruption, and host factors. Early clinical experience also suggests a relationship between COVID-19 infection and histoplasmosis, particularly among immunocompromised individuals. Advances in diagnostic methods, such as newer enzyme immunoassays and molecular techniques, have broadened the capability for expedient and highly specific pathogen identification. Novel drug innovations, including the development of new formulations of existing antifungal agents, extended-spectrum azoles and new antifungal drug classes have expanded therapeutic options. SUMMARY: Advances in organ transplantation have largely outpaced those for histoplasmosis. However, these emerging insights enhance our understanding of this pathogen and management of clinical infection, particularly for transplant recipients with a higher incidence and severity of disease.
Prevalence of Fungal Drug Resistance in COVID-19 Infection: a Global Meta-analysis.
Habibzadeh A, Lankarani KB, Farjam M … +7 more , Akbari M, Kashani SMA, Karimimoghadam Z, Wang K, Imanieh MH, Tabrizi R, Ahmadizar F
Curr Fungal Infect Rep · 2022 · PMID 35990407 · Full text
PURPOSE: Secondary bacterial or fungal infections are one of the most important medical complications among patients with Coronavirus Disease 2019 (COVID-19). The emergence of multidrug-resistant (MDR) candida can cause...
PURPOSE: Secondary bacterial or fungal infections are one of the most important medical complications among patients with Coronavirus Disease 2019 (COVID-19). The emergence of multidrug-resistant (MDR) candida can cause many problems such as treatment failure, adverse clinical outcomes, and even disease outbreaks. This systematic review and meta-analysis aims to investigate the prevalence and outcomes of fungal drug-resistant in COVID-19 patients. METHODS: PubMed, Embase, Scopus, Cochrane Library, and Web of Science databases were searched for peer reviewed-articles published in English up to May 20, 2021. Heterogeneity across studies was evaluated using Cochrane's Q test and the I index. The pooled point prevalence and their corresponding 95% confidence intervals (CIs) were considered to estimate the prevalence of fungal drug resistance infection in COVID-19 patients. RESULTS: Eight eligible articles were included in our meta-analysis. The number of COVID-19 patients with fungal co-infection varied from 5 to 35 among selected studies. The overall pooled prevalence of fungal drug resistance among patients with co-infections of fungal and COVID-19 was 69% (95% CI: 37%, 94%) by using a random-effects model. In terms of specific species, the pooled meta-analysis for Candida Auris was estimated to be 100% (95%CI: 98%, 100%; I = 0%), for Multi-Candida 59% (95%CI: 38%, 79%; I = 12.5%), and for Aspergillus 15% (95%CI: 0%, 42%; I = 0%). CONCLUSION: Our study shows the high prevalence of fungal drug resistance in COVID-19 patients and emphasizes the need to strengthen antimicrobial stewardship programs, close monitoring for treatment failure, and the emergence of resistance upon treatment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12281-022-00439-9.
Mortality-Related Risk Factors for Coronavirus Disease (COVID-19)-Associated Mucormycosis: a systematic review and meta-analysis.
Ostovan VR, Tabrizi R, Bazrafshan H … +6 more , Bahrami Z, Khazraei H, Khazraei S, Borhani-Haghighi A, Moghadami M, Grant M
Curr Fungal Infect Rep · 2022 · PMID 35971380 · Full text
PURPOSE OF REVIEW: Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can increase the susceptibility of individuals to contracting mucormycosis through several mechanisms. Nowadays, coronavirus disease (COVID-...
PURPOSE OF REVIEW: Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) can increase the susceptibility of individuals to contracting mucormycosis through several mechanisms. Nowadays, coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a serious public health concern, particularly in developing countries. This meta-analysis aims to identify the risk factors that affect the mortality rate of patients with CAM. RECENT FINDINGS: We systematically searched PubMed, Google Scholar, Scopus, Cochrane library, and preprint databases using pertinent keywords and the reference lists of the included relevant articles from inception till October 27, 2021. In order to reduce the effects of small-scale studies, we only selected cross-sectional, case-control, and cohort studies and case series with at least four patients. We identified 26 articles that included 821 patients with CAM. The effect size (ES) of mortality rate was 28% (95% confidence interval (CI) 20%-38%; I =82.28%; p for Cochran Q<0.001). The CAM patients with a history of comorbidities other than diabetes (malignancies, transplant, or renal failure), mechanical ventilation due to COVID-19, pulmonary and cerebral mucormycosis, and those who only received medical treatment for mucormycosis had the highest mortality rate. SUMMARY: Coronavirus disease (COVID-19)-associated mucormycosis (CAM) is a major public health problem, particularly in developing countries. Severe COVID-19 infection, history of mechanical ventilation, early CAM, comorbidities other than diabetes (malignancies, transplant, or renal failure), pulmonary and rhino-orbito-cerebral mucormycosis, and delivering only medical treatment for mucormycosis were the worst prognostic factors in CAM patients. Identifying the mortality-related risk factors in CAM patients may help reduce the mortality rate by implementing optimized treatment approaches. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12281-022-00440-2.
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