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Lymphadenitis and streaking not always Streptococci

February 23 2017

A useful summary paper recently published by Brandon Cohen and colleagues from New York reminds us that not all lymphadenitis is streptococcal and may be fungal. Streptococcal lymphadenitis with streaking presents as linear erythema extending proximally towards the regional lymph nodes. It may progress rapidly leading to serious complications including streptococcal toxic shock syndrome and therefore warrants systemic antibiotics. While Streptococcus pyogenes is the commonest bacterial cause of superficial lymphatic vessel inflammation in immunocompetent people, other bacterial and non-bacterial aetiologies can have similar presentations (ie Staphylococcus aureus and Pasteurella multocida). Recognition of these other aetiologies- though challenging- is important to avoid misdiagnosis, delay in administration of appropriate treatments and unnecessary systemic antibiotics.
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Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Diagnostic Capabilities

January 31 2017

Ignorance of fungal disease and lack of diagnostics across the world is causing doctors to unknowingly overprescribe antibiotics a new report warns. Experts from GAFFI (the Global Action Fund for Fungal Infections) caution that we will lose the battle against antibiotic resistance unless doctors better understand how to suspect fungal disease and have proper access to the appropriate testing for it. In a paper published today in the cutting edge US journal Emerging Infectious Diseases (click here for paper), several leading authors from GAFFI warn of the gross misuse of antibacterial antibiotics, because doctors treat without knowing what is wrong with their patients. The authors focus on scenarios, all common, where the lack of the best diagnostic tests prevent the correct antimicrobial being given.
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Prevalence, clinical and economic burden of mucormycosis-related hospital admissions in the US

January 23 2017

There were 555 cases of mucormycosis in hospital among 47 million inpatient episodes, a prevalence of 0.16 per 10,000 discharges. The median length of stay was ~17 days and mean cost was $112,419. Mucormycosis is an uncommon, opportunistic fungal infection primarily caused by Mucorales, a filamentous fungus of the Mucormycetes class. This fungal infection particularly affects patients with diabetes mellitus (especially following ketoacidosis), or those with hematologic malignancies on chemotherapy (especially with neutropenia), stem cell and solid organ transplants. The study used the Premier’s Perspective™ Comparative Database, a large, U.S hospital based database covering more than 560 participating hospitals across the U.S and 104 million patients. Data was collected from January 2005 to June 2014. Mucormycosis related-hospitalisations were identified with an ICD-9 code of 17.7 or a positive laboratory microbiology result for Mucorales. Laboratory results were only available from 2009 and for about 37% of the hospitals. All eligible encounters needed at least one prescription of amphotericin B or posaconazole to qualify for a mucormycosis-related hospitalisation. The clinical and economic outcomes assessed included death at discharge, length of stay, and re-admission rates at 1 and 3 months. The cost for hospitalisation included all supplies, labour, depreciation of equipment, etc. All costs were inflated to 2014 USD.
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University Hospital of South Manchester awarded Centre of Excellence status

January 11 2017

The University Hospital of South Manchester is to become the first hospital in the UK and Europe to be recognised as a centre of excellence for the diagnosis and treatment of aspergillosis and other fungal infections. The European Confederation of Medical Mycology (ECMM) Centre of Excellence scheme (see here for more details) will provide a network of centres able to direct physicians, patients and relatives to an appropriate and capable centre. The Mycology Reference Centre Manchester (MRCM) based at the University of Manchester, in partnership with the National Aspergillosis Centre (NAC) at UHSM’s Wythenshawe Hospital is therefore the first of many across Europe to receive this award. It recognises their collaboration in better understanding medical issues related to mycology.
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December 19 2016

In the first study of its kind, Gail Sondermeyer et al from Stanford Medical Centre. provide an overview of coccidioidomycosis burden of disease and epidemiology specifically in Californian children (age ≤ 17 years) from 2000 to 2012, Coccidioidomycosis (Valley fever) is an infection caused by the inhalation of Coccidioides fungi endemic in dirt and soil in the southwestern United States and Central and South America. Primary inoculation is rare. Human disease can be asymptomatic or can range from a mild febrile illness to severe pulmonary manifestations to disseminated disease in approximately 40% of those who develop symptoms.
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