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Global Emergence of Multidrug-Resistant Yeast Candida auris causing Invasive Infections

June 28 2016

The CDC is alerting U.S. healthcare facilities to be on the lookout for Candida auris in their patients having received reports from international healthcare facilities, that this emerging multidrug resistant yeast is causing invasive infections with high mortality. There is particular concern because it is often multidrug resistant, it is difficult to identify with standard laboratory methods and it has already caused outbreaks in hospital settings. C. auris can enter the bloodstream and spread throughout the body, causing serious invasive infections & often does not respond to commonly used antifungal drugs, making infections difficult to treat. Some strains of C. auris have elevated minimum inhibitory concentrations (MICs) to the three major classes of antifungals, severely limiting treatment options. No MIC breakpoints exist for C. auris – but testing of an international collection of isolates demonstrated that they were nearly all highly resiistant to fluconazole, more than half of isolates were voriconazole resistant , one third were amphotericin B resistant and a few to echinocandins. Alarmingly some isolates showed elevated MICs to all three major classes of antifungals. Since 2009, C. auris has been found in patients in nine countries, including the United States, and it has been reported to cause bloodstream infections, wound infections, and otitis, it has also been cultured from respiratory samples and urine, but it is not known if these are infection sites or due to colonization. A very recent report of C. auris from a hospital in Venezuela isolated from 18 critically ill patients, 11 of which were neonates has been highlighted (view).
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Comparison of Talaromyces marneffei infection in HIV positive and HIV negative patients in China

June 16 2016

Talaromyces marneffei (formerly called Penicillium marneffei) is a dimorphic fungus which causes systemic fungal infections formerly referred to as penicilliosis. T. marneffei was commonly diagnosed in HIV-infected individuals from endemic areas (Southeast Asia and Southern China and nearby countries including Thailand, Laos and Malaysia), prior to the era of highly-active antiretroviral therapy (HAART), and was an important cause of morbidity and mortality. The widespread use of HAART has led to a significant decline in T.marneffei infections among HIV-infected patients in these areas. T.marneffei is believed to be acquired by inhalation of microconidia from the micelial phase of the organism. T .Marneffei infections typically develop in immunocompromised individuals, especially those with HIV infection at the advance stage of disease (CD4 cell count, 100 cells/L). However, it has also been described in patients from endemic areas in Asia who were HIV-negative and had CD4 cell counts within normal limits (1). Some of these patients had other underlying diseases (eg, autoimmune disorders, cancer or diabetes) and those without underlying diseases were found to have auto-antibodies to interferon gamma as a reason for their increased susceptibility to disseminated infection (2).
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First cases of fungal infections in man from Fereydounia khargensis

June 13 2016

The number of new fungal pathogens is increasing due to a growing population of immunocompromised patients and advanced identification techniques. Fereydounia khargensis is a newly discovered yeast, first isolated in 2014 from plant remnants in Iran. Tap et al. (2015) report the first two cases of fungal infections associated with Fereydounia khargensis in humans. Patient 1, a 33 year old HIV positive male was admitted to hospital due to episodes of fever associated with chills and rigours lasting 2 weeks. There were no other associated symptoms except weight loss. Chest X-ray did not reveal the cause of the fever. On admission, blood culture was negative; however, after several repeats, it was positive on the 6th day of hospitalisation.
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5 diagnostic approaches for cryptococcal meningitis in non-HIV-infected patients

June 09 2016

Cryptococcal meningitis (CM) is a fungal illness often associated with HIV positive patients; however, an increasing percentage of CM cases in non-HIV-infected individuals, particularly in China, Japan and Taiwan have been identified (article). Diagnosis of CM is perceived to be more difficult in HIV negative patients; this could be both due to physicians overlooking the possibility of CM, and the potentially lower fungal burden in non-HIV-infected patients, leading to low sensitivity in common diagnostic tests. It is therefore very important to evaluate a variety of diagnostic approaches in this patient population.
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Essential medicines in the USA – acquisition of marketing licenses causing exponential price rise

June 06 2016

In the USA an alarming trend for pharmaceutical companies to purchase marketing rights for aged off-patent drugs and then immediately raising the cost of the generic medication extortionately by as much as 5433% has been highlighted in an editorial in the New England Journal of Medicine (Alpern, Son & Stauffer, 2016). A much publicised case is pyrimethamine (bought by Turing Pharma in 2015), a first line treatment for toxoplasmosis, and its huge price rise on acquisition. The consequence of this very high price means that it is prohibitively expensive for most people (many of whom are in low socio-economic disadvantaged groups) and many are forced to receive only second-line treatment instead.
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