Administration of steroids for immune rejection after keratoplasty in patients with fungal keratitis
May 22 2017
Initiating the use of topical corticosteroids in patients with fungal keratitis 1 week after keratoplasty can aid in rapid control of anterior segment inflammation and reduction of immune rejection, with no increase in the rate of fungal recurrence. In a prospective observational study performed at Shandong Eye Hospital between January 2009 – April 2014; Wang et al 2016 evaluated the introduction of the low dose steroid (0.02% fluorometholone eye drops) one week following corneal transplantation for proven fungal keratitis. The rates of anterior chamber inflammation, graft rejection and recurrence of fungal keratitis were observed.
Chronic pulmonary mucormycosis: an emerging fungal infection in diabetes mellitus
May 10 2017
Three cases of chronic pulmonary mucormycosis have been reported from Pakistan in patients (all females in their 60s) with poorly controlled diabetes mellitus and with no other underlying conditions.
In this report by Igbal et al 2017, productive cough, fever, haemoptysis and shortness of breath were the main clinical presentations of pulmonary mucormycosis; all the patients had poorly controlled diabetes with HbA1c ranging from 9.4 to 13.1%. Diagnostic bronchoscopy was performed on all the patients with subsequent histopathology demonstrating numerous aseptate hyphae. Fungal culture of bronchoalveolar lavage sample yielded Rhizopus species in one of the patients. Two patients with unilateral disease improved on intravenous amphotericin B deoxycholate and surgery (lobectomy/pneumonectomy). A patient with bilateral disease in whom surgery was not advisable responded on amphotericin B deoxycholate treatment only.
Fungal meningitis still kills over 180,000 people per year despite the drugs are available
May 09 2017
International HIV experts on fungal meningitis in AIDS report finding nearly 250,000 cases annually, 73% in sub-Saharan Africa. Fungal meningitis due to the Cryptococcus fungus typically affects those in the prime of life, 35 years old, and affects the tissues covering the brain and spinal cord. Of those affected an estimated 181,000 people die, despite the existence of a simple blood test and long developed life saving medicines.
Deaths from Cryptococcal Meningitis in AIDS are 15% of all 1,100,000 AIDS-related deaths. Yet, the vast majority of those who survive do so without complications and with treatment of their HIV infection, go on to make a full recovery.
Published in the prestigious journal Lancet Infectious Diseases, Radha Rajasingham and colleagues from the University of Minnesota, which also runs a major research program on fungal meningitis in Kampala in Uganda, used 46 studies from around world to estimate current case numbers. The resurgence of interest in fungal meningitis arises from excellent diagnostic tests that take 10 minutes to perform and cost only about £5/$8. Patients can be picked up early with a blood test and treated. Without diagnosis and treatment fungal meningitis in AIDS is always fatal.
Dr David Boulware, Associate Professor of Infectious Diseases at the University of Minnesota, and senior author of the study, said: “Still too many HIV-infected people enter care late and Cryptococcal Meningitis is an unfortunate excellent metric of HIV treatment programme failure. In 2017, no person with HIV should develop fungal meningitis, yet in a failed cascade of HIV care, too often Cryptococcus is a final death sentence.”
Basidiobolus infection in children – a mimic of inflammatory bowel disease
May 02 2017
Basidiobolomycosis is a rare chronic inflammatory disease affecting immunocompetent hosts caused by the fungus Basidiobolus ranarum. Dr Khalid Shreef from the Zagazig University Hospital, Egypt and colleagues report the largest series to date - 18 patients (5-10 years old).
The infection results in human disease mimicking soft tissue tumours restricted to subcutaneous tissues in the limbs, trunk and buttocks. Visceral involvement is rare but there are increasing reports of its role in gastrointestinal infections presenting with non-specific signs & symptoms. Prior ranitidine use and prolonged residence in endemic areas seem to contribute to the risk of acquiring gastrointestinal basidiobolomycosis (GIB).
Shreef describes the commonest presenting features of: abdominal pain (94%), right sided abdominal masses (77%) involving the caecum and ascending colon at surgery and constipation (83.3%) which alternated with diarrhoea in a few patients. Other uncommon presentations included hepatomegaly (3 patients) and isolated liver abscess. Fever, vomiting, weight loss, abdominal pain and abdominal masses are some of the presenting symptoms of GIB infection.
Burden of fungal diseases in Belarus, Cameroon, Indonesia and Italy presented at ECCMID Vienna
April 25 2017
For the fourth year running, multiple country burdens of fungal diseases have been presented at ECCMID; 4 countries covering a population of 351 million people. The remarkable findings were:
· The annual incidence of candidaemia in Italy is 24/100,000 and was estimated at 5/100,000 for Belarus, Cameroon and Indonesia, in the absence of data.
· Cryptococcal meningitis was estimated to be common in Cameroon at an incidence of 30/100,000 compared with only 0.81, 0.6 and 0.22/100,000 rates in Indonesia, Belarus and Italy, respectively.
· The prevalence of chronic pulmonary aspergillosis was estimated to be very high in Belarus and Indonesia at 60 and 32/100,000, because of the high burden of TB in both countries, compared to 22 and 4.9 in Cameroon and Italy.
· Tinea capitis was remarkably common in Cameroon (3,240/100,000 population) and Italy (1,003/100,000 children) – there are no data for Belarus and Indonesia.
· Asthma and its complications ABPA and severe are thought to be especially common in Indonesia with an ABPA prevalence of 135/100,000 in Indonesia and also Italy 126/100,000 compared with Belarus and Cameroon (62 and 40/100,000).